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.