This West African nation, with a population of 23 million, has made great advances in its development since its independence in 1957. The country’s economy, education system, and health system all compare favorably to its regional neighbors. However, despite these advances the country still faces considerable challenges, including decentralizing the health system. In light of the growing degree of managerial responsibility delegated to districts and hospitals, the Ghana Health Service (GHS) agency is to provide and manage comprehensive and accessible health services with special emphasis on primary health care at regional, district and sub-district levels. The interventions undertaken by the GHS have the promise to improve performance of regional and district programs and to markedly reduce maternal and child mortality. GHS regional and district teams have developed plans and now face the difficult challenge of ensuring their full implementation and impact. This requires a level of engagement and leadership and management skills not generally present in the district and regional teams.
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