Ghana Health Service, Upper West Regional Health Directorate, Wa, Ghana.
Regional Institute for Population Studies, University of Ghana, Legon-Accra, Ghana.
Int J Health Policy Manag. 2019 Jan 1;8(1):28-39. doi: 10.15171/ijhpm.2018.88.
The implications of decentralisation on human resource for health management has not received adequate research attention despite the presupposition that the concept of decentralisation leads to the transfer of management authority and discretion for human resource management from national levels to subnational levels. This study aims at investigating the extent to which decentralisation practice transfers management autonomy and discretion to subnational units, and the effect of the level of decision space on human resource management in the health sector.
A mixed methods study design was adopted employing a cross-sectional survey and a document analysis. The respondents included health managers from the regional, district and hospital administrations as well as facility managers from the community-based health planning and services zones. A decision space framework was employed to measure management autonomy and discretion at various management levels of the study region. For the quantitative data, descriptive statistical analysis was used to analyse and report the data whilst the qualitative data was contentanalysed.
The study reported that in practice, management authority for core human resource functions such as recruitment, remuneration, personnel training and development are centralised rather than transferred to the subnational units. It further reveals that authority diminishes along the management continuum from the national to the community level. Decentralisation was however found to have led to greater autonomy in technical supervision and performance appraisal. The study also reported the existence of discrepancy between the wide decision space for performance assessment through technical supervision and performance appraisal exercised by managers at the subnational level and a rather limited discretion for providing incentives or rewards to staff.
The practice of decentralisation in the Ghanaian health sector is more apparent than real. The limited autonomy and discretion in the management of human resource at the subnational units have potential adverse implications on effective recruitment, retention, development and distribution of health personnel. Therefore, further decision space is required at the subnational level to enhance effective and efficient management of human resource to attain the health sector objectives.
尽管分权的概念导致人力资源管理的管理权限和酌处权从国家层面转移到国家以下各级，但分权对卫生人力资源管理的影响尚未得到充分研究。本研究旨在调查分权实践在多大程度上将管理自主权和酌处权转移给国家以下各级，以及决策空间的程度对卫生部门人力资源管理的影响。
采用混合方法研究设计，采用横断面调查和文献分析。受访者包括来自地区、地区和医院行政部门的卫生管理人员以及来自社区为基础的卫生规划和服务区的设施管理人员。采用决策空间框架衡量研究区域各个管理层面的管理自主权和酌处权。对于定量数据，采用描述性统计分析进行分析和报告数据，而定性数据则进行内容分析。
研究报告称，在实践中，核心人力资源职能的管理权限，如招聘、薪酬、人员培训和发展，是集中的，而不是转移到国家以下各级。它进一步表明，权力沿着从国家到社区的管理连续体递减。然而，分权导致技术监督和绩效评估方面的自主权更大。研究还报告了在国家以下各级管理人员通过技术监督和绩效评估进行的绩效评估的广泛决策空间与为员工提供激励或奖励的相当有限的酌处权之间存在差异。
加纳卫生部门分权的实践更多的是表面的，而不是实际的。国家以下各级人力资源管理自主权和酌处权有限，对有效招聘、留住、发展和分配卫生人员可能产生不利影响。因此，需要在国家以下各级进一步扩大决策空间，以加强人力资源的有效和高效管理，实现卫生部门的目标。
