A qualitative appraisal of stakeholder reactions to a tool for burden of disease–based health system budgeting in Ghana

John Koku Awoonor-Williams,Margaret L Schmitt,Janet Tiah,Joyce Ndago,Rofina Asuru,Ayaga A Bawah,James F Phillips

doi:10.3402/gha.v9.30448

John Koku Awoonor-Williams, Margaret L Schmitt + Show 5 more

Open Access

https://doi.org/10.3402/gha.v9.30448

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Abstract

BackgroundIn 2010, the Ghana Health Service launched a program of cooperation with the Tanzania Ministry of Health and Social Welfare that was designed to adapt Tanzania's PLANREP budgeting and reporting tool to Ghana's primary health care program. The product of this collaboration is a system of budgeting, data visualization, and reporting that is known as the District Health Planning and Reporting Tool (DiHPART).ObjectiveThis study was conducted to evaluate the design and implementation processes (technical, procedures, feedback, maintenance, and monitoring) of the DiHPART tool in northern Ghana.DesignThis paper reports on a qualitative appraisal of user reactions to the DiHPART system and implications of pilot experience for national scale-up. A total of 20 health officials responsible for financial planning operations were drawn from the national, regional, and district levels of the health system and interviewed in open-ended discussions about their reactions to DiHPART and suggestions for systems development.ResultsThe findings show that technical shortcomings merit correction before scale-up can proceed. The review makes note of features of the software system that could be developed, based on experience gained from the pilot. Changes in the national system of financial reporting and budgeting complicate DiHPART utilization. This attests to the importance of pursuing a software application framework that anticipates the need for automated software generation.ConclusionsDespite challenges encountered in the pilot, the results lend support to the notion that evidence-based budgeting merits development and implementation in Ghana.

Highlights

Widespread commitment by governments to decentralize planning has arrived at a time when budgetary pressures on health sectors are mounting
Discussions explored the broader challenges related to the organizational context of the health system, including reasons for staff resistance to change and strategies that could address problems
District Health Planning and Reporting Tool (DiHPART) results visualization As a consequence of the 10 themes noted in the course of the IDIs, it was apparent that DiHPART could not be sustained as a health sector budgeting tool and was not at all compatible with multisectoral planning: At no point in the discussion sessions was there any mention of using DiHPART results to communicate health sector priorities to district chief executives or other local officials

Summary

Introduction

Widespread commitment by governments to decentralize planning has arrived at a time when budgetary pressures on health sectors are mounting This situation has generated international interest in developing tools to support officials in engaging in budgeting and financial planning in ways that shape priorities according to evidence of actual need. Despite increased efforts and commitment for strengthening health systems, many countries lack evidence-based budgeting capacity This problem is especially prominent in resource-constrained programs in subSaharan Africa (SSA) where evidence-based planning is needed most [1, 2]. In 2010, the Ghana Health Service launched a program of cooperation with the Tanzania Ministry of Health and Social Welfare that was designed to adapt Tanzania’s PLANREP budgeting and reporting tool to Ghana’s primary health care program. Conclusions: Despite challenges encountered in the pilot, the results lend support to the notion that evidencebased budgeting merits development and implementation in Ghana

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