Managerial Leadership Performance in the Public Sector. A Ghanaian Case Study of District Health Systems

  • Issifu Amadu

Student thesis: Phd


ABSTRACT Public sector organisations play a very crucial developmental role in both developed and developing nations the world over. The provision of public services, more particularly health services, has proven not only to be a perennial development challenge, but equally a daunting task for governments. Ghana’s health sector, like in most countries all over the world, delivers healthcare to its citizens within the ambit of a national health insurance scheme that covers, to a very large extent, every stratum of society. Therefore, the reform of the health sector has been envisaged as the silver bullet that could leverage healthcare delivery particularly at the subnational level since districts are the very essence of Ghana’s public sector reform through decentralisation. Inherently, the focus of the study was to understand the leverages such reform efforts have had on the management of healthcare facilities and their performance in the country. To unearth the managerial leadership experiences of frontline managers of the district health system, the qualitative research design anchored in the social constructivist philosophy was adopted. Using a multi-case study strategy, data was collected from fifty (50) managerial staff from six district hospitals and eight (8) health clinics in six (6) districts within resource-constrained districts in Northern Ghana. Experiences and opinions of fifty (50) clients on healthcare delivery in the study areas was gathered in a survey. Generally, findings from the study corroborated, albeit, minimally with the extant literature. Managerial leaders at the frontline of service delivery are in a dilemma. In one breath, they enjoy some autonomy in managing health facilities, yet in another breath their exercise of managerial discretion is cumbered by rules and regulations form the centre. Further, the decentralisation of the sector still lingers in an atmosphere of a highly bureaucratic environment reminiscent of centralisation. Also, internal organisational effectiveness of healthcare facilities has been severely constrained by the lack of an efficient, reliable and sustainable NHIS funding regime. The conclusion is that the ethos of the new public management resonates in the public sector; however, ddecentralisation in itself does not solely ensure efficient and effective healthcare delivery in Ghana. There is a yawning gap between rhetoric and implementation. The sustenance of a successful healthcare delivery is contingent on a host of other factors such as district level synergies among social actors with unwavering commitment to ensure effective healthcare services to the citizenry. Thus, the envisaged leverage between health sector reform and healthcare delivery at the subnational level is inconclusive.
Date of Award31 Dec 2019
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorMohammad Farhad Hossain (Supervisor) & Aminu Mamman (Supervisor)


  • Health Systems
  • Ghana
  • District
  • Public Sector
  • Performance
  • Leadership
  • Managerial

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