Kanmiki Edmund Wedam, Bempah Ben Owusu Smith, Awoonor-Williams John Koku, Bawah Ayaga A, d'Almeida Selassi Amah, Kassak Kassem M
Regional Institute for Population Studies, University of Ghana, Accra, Ghana.
Policy, Planning, Monitoring and Evaluation Division, Ghana Health Service, Accra, Ghana.
BMC Health Serv Res. 2018 Dec 27;18(1):995. doi: 10.1186/s12913-018-3810-6.
As part of its efforts to improve efficiency, accountability and overall performance, the Ghana Health Service (GHS) introduced annual Performance-based Management Agreements (PMAs) in the year 2013. However, no assessment of this initiative has since been made in order to inform policy and practice. This paper provides an assessment of this policy initiative from the perspective of managers at various levels of service implementation.
Mixed methods were employed. Questionnaires were administered to managers through an online survey (using Google forms). Descriptive and inferential statistical methods were used to analyze and present quantitative results while qualitative data was analyzed via thematic analysis.
The content and objectives of the PMAs were observed to be comprehensive and directed at ensuring high performance of directorates. Targets of PMAs were found to be aligned with overall health sector objectives and priorities. The directors felt PMAs were useful for delegating task to subordinates. PMAs were also found to increase commitment and contributed to improving teamwork and prudent use of resources. However, PMAs were found to lack clear implementation strategies and were not backed by incentives and sanctions. Also, budgetary allocations did not reflect demands of PMAs. Furthermore, directors at lower levels were not adequately consulted in setting PMAs targets as such district specific challenges and priorities are not usually factored into the process. Insufficient training of staff and lack of requisite staff were key challenges confronting the implementation of PMAs in most directorates. Weak monitoring and evaluation was also observed to significantly affect the success of PMAs.
There is the need to address the weaknesses and improve on the existing strengths identified by this assessment in order to enhance the effectiveness of PMAs utilization in the Ghana health service.
作为提高效率、问责制和整体绩效的努力的一部分，加纳卫生服务局（GHS）于2013年引入了年度基于绩效的管理协议（PMA）。然而，此后尚未对该举措进行评估以指导政策和实践。本文从服务实施各级管理人员的角度对这一政策举措进行评估。
采用混合方法。通过在线调查（使用谷歌表单）向管理人员发放问卷。使用描述性和推断性统计方法分析和呈现定量结果，同时通过主题分析对定性数据进行分析。
观察到PMA的内容和目标全面，旨在确保各部门的高绩效。发现PMA的目标与卫生部门的总体目标和优先事项一致。部门主管认为PMA有助于向下属分配任务。还发现PMA增加了责任感，有助于改善团队合作和资源的合理使用。然而，发现PMA缺乏明确的实施策略，且没有激励措施和制裁措施的支持。此外，预算分配没有反映PMA的需求。此外，在设定PMA目标时，没有充分征求较低级别主管的意见，因此地区特定的挑战和优先事项通常没有纳入该过程。大多数部门在实施PMA时面临的关键挑战是工作人员培训不足和缺乏必要的人员。还观察到监测和评估不力对PMA的成功产生了重大影响。
有必要解决这些弱点，并改进本评估中确定的现有优势，以提高加纳卫生服务中PMA使用的有效性。
