In both districts, the health management teams had strong upward accountability systems through which they accounted to the regional and central level authorities of the Ghana Health Service.
Relevant regional secretariats and CHMTs were informed before the start of the study, and were provided with official letters from the central level authorities approving the study.
How will the roles of the central-level authorities in workforce management be changing in this process?
District level health authorities were found not only to report to their directly corresponding central level VL authority, but also to a multiplicity of different offices.
(a) General Views With regard to the measures suggested for the central and district level authorities to consider if they were to improve and optimise the delivery of quality ANC services and effectiveness of the IPTp intervention, the views were also obtained.
Local variations in compliance with national policies and guidelines may have been related to differences in the perception of risk among health professionals and the public and to ineffective communication and feedback systems between authorities at the central level and health providers at peripheral levels.
In depth discussions in Nepal revealed that two different types of district-level health authorities report to the central level: District Public Health Offices (D(P HOs) and Early Warning and Reporting System (EWARS) sentinel sites (usually located in zonal/district hospitals).
The new system of partial centralisation provides more room for district authorities to plan what they need in terms of numbers and types of health workers, and to submit their requests to the central level.
Decentralization refers to the transfer of fiscal, administrative and political authority for health service delivery from the central levels of the Ministry of Health to alternate institutions, frequently district health systems [ 54].
However, a major stumbling block was that the lack of power of district level authorities restricted them from exercising leadership in their management of HR and in disputes with an over-controlling central authority [ 24] Five articles had decentralisation as a primary focus [ 16, 18, 19, 24, 28].
