The context of health policy formulation and implementation in
Ghana
In the 1980s, Ghana began work on a general health sector reform, key
aspect of this being decentralization of health systems. In Sakyi’s
(2008) opinion, the decentralization process was evident in the
rearrangement of the internal systems of the health sector. The reform
highlighted de-bureaucratization, autonomization, agencification, and
delayering as key components to break the centralized tendencies that
characterized the governmental apparatus (Sakyi, 2008).
Bossert et al . (2000) asserts that decentralization specifically
started in 1988 following the World Health Organization (WHO) supported
”strengthening District Health Systems” Project which kick-started a
comprehensive program of delegation and administrative decentralization
in the Ghana health system. However, it was not until 1997 that the
current policy arrangement underpinned by the decentralization process
gained root. The passage of the Ghana Health Service and Teaching
Hospitals Act, 1996 (Act 525), was integral to this process. This Act
established the Ghana Health Service (GHS) to take over the performance
of certain functions from the Ministry of Health (MOH). Section 3 of the
Act empowers the GHS to implement approved national policies for health
delivery in the country. As part of the decentralization scheme, the
primary responsibilities of the MOH were the formulation of policies and
the determination of priorities for the health sector while the GHS was
to take responsibility for the development of implementation guidelines
for the regions and districts of the country (Bossert et al .,
2000). Thus, the MOH, which prior to the decentralization policy was
responsible for both policy formulation and implementation, delegated
powers and functions to the newly established GHS, which was now in
charge of implementation of policies formulated by the MOH. This
arrangement underpins the formulation and implementation of all health
policies in Ghana including policies for managing diabetes and
hypertension.