title: The role of institutions on the effectiveness of malaria treatment in the Ghanaian health sector.
abstract: BACKGROUND
  The Ghanaian health sector has undertaken several policies to help improve the quality of care received by patients. This includes the construction of several health facilities, the increase in the training of health workers, especially nurses, and the introduction of incentive packages (such as salary increase) to motivate health workers. The important question is to what extent does the institutional arrangement between the health facilities and the government as well as between health workers and public health facility administration affect the quality of care? The objective of this study is to find the effect of institutional factors on the quality of care. The institutional factors examined were mainly the extent of decentralization between government and health facilities, as well as between health workers and facility administration, the hiring procedure, and job satisfaction.
  
  
  METHODS
  The study used primary data on former patients from sixty six health facilities in three administrative regions of Ghana: the Northern, the Ashanti and the Greater Accra regions. The quality indicator used was effectiveness of treatment as determined by the patient. Ordered logit regression was run for the indicator with patient and health facility characteristics as well as institutional factors as independent variables. The sample size was 2248.
  
  
  RESULTS
  The results showed that the patient's level of formal education had a strong influence on the effectiveness of treatment. In addition, effectiveness of treatment differed according to the administrative region in which the facility was located, and according to the extent of decentralization between health facility and government. The quality of instruments used for treatment, the working conditions for health workers, and job satisfaction had no effect on the effectiveness of treatment.
  
  
  CONCLUSIONS
  Decentralization, the flow of information from government to health facilities and from health facility administrators to health workers are important in ensuring effectiveness. The study recommends further decentralization between health facilities as well as between health workers and administrators. In addition, the study recommends the involvement of health facilities in malaria programs to ensure the flow of information needed for effectiveness of treatment.
authors.affiliation: Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. eamporfu@gmail.com.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Amporfu
authors.affiliation: School of Public Health, University of Ghana, Legon, Ghana. justicenon@gmail.com.
authors.forename: Justice
authors.initials: J
authors.lastname: Nonvignon
mesh_terms: D000288:Administrative Personnel; D000328:Adult; D005260:Female; D005869:Ghana; D006268:Health Facilities; D006282:Health Personnel; D006801:Humans; D007588:Job Satisfaction; D008288:Malaria / Q000188:drug therapy*; D008297:Male; D009042:Motivation; D024382:Professional Role; D016896:Treatment Outcome