Ghana Health Service, Research and Development Division, Ministries, P.O. Box MB190, Accra, Ghana.
Achimota, Accra, Ghana.
Int J Equity Health. 2017 Sep 15;16(1):85. doi: 10.1186/s12939-017-0583-1.
Decision-making on postings and transfers - that is, the geographic deployment of the health workforce - is a key element of health workforce governance. When poorly managed, postings and transfers result in maldistribution, absenteeism, and low morale. At stake is managing the balance between organisational (i.e., health system) and individual (i.e., staff preference) needs. The negotiation of this potential convergence or divergence of interests provides a window on practices of postings and transfers, and on the micro-practices of governance in health systems more generally. This article explores the policies and processes, and the interplay between formal and informal rules and norms which underpin postings and transfers practice in two rural districts in the Greater Accra Region of Ghana.
Semi-structured interviews were conducted with eight district managers and 87 frontline staff from the district health administration, district hospital, polyclinic, health centres and community outreach compounds across two districts. Interviews sought to understand how the postings and transfers process works in practice, factors in frontline staff and district manager decision-making, personal experiences in being posted, and study leave as a common strategy for obtaining transfers.
Differential negotiation-spaces at regional and district level exist and inform postings and transfers in practice. This is in contrast to the formal cascaded rules set to govern decision-making authority for postings and transfers. Many frontline staff lack policy clarity of postings and transfers processes and thus 'test' the system through informal staff lobbying, compounding staff perception of the postings and transfers process as being unfair. District managers are also challenged with limited decision-space embedded in broader policy contexts of systemic hierarchy and resource dependence. This underscores the negotiation process as ongoing, rather than static.
These findings point to tensions between individual and organisational goals. This article contributes to a burgeoning literature on postings and transfers as a distinct dynamic which bridges the interactions between health systems governance and health workforce development. Importantly, this article helps to expand the notion of health systems governance beyond 'good' governance towards understanding governance as a process of negotiation.
职位分配和调动决策——即卫生人力的地域部署——是卫生人力治理的关键要素。如果管理不善，职位分配和调动会导致分配不均、旷工和士气低落。关键在于平衡组织（即卫生系统）和个人（即员工偏好）的需求。这种潜在利益的协调或分歧的谈判提供了一个窗口，可以了解职位分配和调动的实践，以及更广泛的卫生系统治理的微观实践。本文探讨了加纳大阿克拉地区两个农村地区职位分配和调动实践背后的政策和流程，以及正式和非正式规则和规范之间的相互作用。
对来自两个地区的 8 名区经理和 87 名来自区卫生行政部门、区医院、综合诊所、卫生中心和社区外展大院的一线工作人员进行了半结构化访谈。访谈旨在了解职位分配和调动过程在实践中的运作方式、一线工作人员和区经理决策中的因素、个人在被分配职位方面的经验，以及作为获得调动的常见策略的研究假。
区域和区一级存在不同的协商空间，这对实践中的职位分配和调动产生了影响。这与正式的级联规则形成鲜明对比，这些规则旨在管理职位分配和调动的决策权。许多一线工作人员对职位分配和调动过程缺乏政策清晰度，因此通过非正式的员工游说“测试”制度，加剧了员工对职位分配和调动过程不公平的看法。区经理也面临着更广泛的政策背景下系统层次结构和资源依赖所带来的有限决策空间的挑战。这突显了协商过程是持续的，而不是静态的。
这些发现指出了个人和组织目标之间的紧张关系。本文为职位分配和调动作为连接卫生系统治理和卫生人力发展互动的独特动态的不断发展的文献做出了贡献。重要的是，本文有助于将卫生系统治理的概念从“良好”治理扩展到理解治理是一个协商过程。
