Power sources among district health managers in Ghana: a qualitative study
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Date
2022
Journal Title
Journal ISSN
Volume Title
Publisher
BMC
Abstract
Background: In Ghana district directors of health services and district hospital medical superintendents provide
leadership and management within district health systems. A healthy relationship among these managers is dependent
on the clarity of formal and informal rules governing their routine duties. These rules translate into the power
structures within which district health managers operate. However, detailed nuanced studies of power sources
among district health managers are scarce. This paper explores how, why and from where district health directors and
medical superintendents derive power in their routine functions.
Methods: A multiple case study was conducted in three districts; Bongo, Kintampo North and Juaboso. In each case
study site, a cross-sectional design was used to explore the research question. Purposive sampling technique was
used to select study sites and 61 participants for interview and focus group discussion. A total of 11 interviews (3 in
each district and 2 with deputy regional directors), and 9 focus group discussions (3 in each district) were conducted.
Transcriptions of the voice-recordings were done verbatim, cleaned and imported into the Nvivo version 11 software
for analysis using the inductive content analysis approach.
Results: The findings revealed that legitimacy provides formal power source for district health managers since they
are formally appointed by the Director General of the Ghana Health Service after going through the appointment
processes. These appointments serve as the primary power source for district health managers based on the existing
legal and policy framework of the Ghana Health Service. Additionally, resource control especially finances and medical
dominance are major informal sources of power that district health managers often employ for the management and
administration of their functional areas in the health districts.
Conclusions: The study concludes that district health managers derive powers primarily from their positions within
the hierarchical structure (legitimacy) of the district health system. Secondary sources of power stems from resource
control (medical dominance and financial dominance), and these power sources inform the way district health
managers relate to each other. This paper recommends that district health managers are oriented to understand the
power dynamics in the district health system.
Description
Research Article
Keywords
Power, District health system, District health managers