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Strengthening District Health Systems in Ghana: The Experience of Ejisu District

INTRODUCTION Most developing countries have endorsed the AlmaAta declaration of Health for All by the Year 2000, and have developed primary health care strategies to achieve this goal. However, after more than a decade, PHC implementation still lags behind policy. Although weak management is often cited as the root cause of this failure, considerable investment in management training has changed the situation very little. Traditional PHC management courses do not adequately prepare people for the situation in which they have to work. Vertical organizational structures and centralized management systems, for example, undermine team work at district level. In the long run, organizational reform is required. In the meanwhile, however, strategies are needed which will help district health management teams (DHMTs) work more effectively together, despite the difficult circumstances found in most developing countries. This paper reports on what has been achieved as the result of one such management development initiative in Ejisu District, Ghana.