title: What Do District Health Managers in Ghana Use Their Working Time for? A Case Study of Three Districts.
abstract: BACKGROUND
  Ineffective district health management potentially impacts on health system performance and service delivery. However, little is known about district health managing practices and time allocation in resource-constrained health systems. Therefore, a time use study was conducted in order to understand current time use practices of district health managers in Ghana.
  
  
  METHODS
  All 21 district health managers working in three districts of the Eastern Region were included in the study and followed for a period of three months. Daily retrospective interviews about their time use were conducted, covering 1182 person-days of observation. Total time use of the sample population was assessed as well as time use stratified by managerial position. Differences of time use over time were also evaluated.
  
  
  RESULTS
  District health managers used most of their working time for data management (16.6%), attending workshops (12.3%), financial management (8.7%), training of staff (7.1%), drug and supply management (5.0%), and travelling (9.6%). The study found significant variations of time use across the managerial cadres as well as high weekly variations of time use impulsed mainly by a national vertical program.
  
  
  CONCLUSIONS
  District health managers in Ghana use substantial amounts of their working time in only few activities and vertical programs greatly influence their time use. Our findings suggest that efficiency gains are possible for district health managers. However, these are unlikely to be achieved without improvements within the general health system, as inefficiencies seem to be largely caused by external factors.
authors.affiliation: Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Bonenberger
authors.affiliation: School of Public Health, University of Ghana, Legon, Ghana.
authors.forename: Moses
authors.initials: M
authors.lastname: Aikins
authors.affiliation: School of Public Health, University of Ghana, Legon, Ghana.
authors.forename: Patricia
authors.initials: P
authors.lastname: Akweongo
authors.affiliation: Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
authors.forename: Xavier
authors.initials: X
authors.lastname: Bosch-Capblanch
authors.affiliation: Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
authors.forename: Kaspar
authors.initials: K
authors.lastname: Wyss
mesh_terms: D000288:Administrative Personnel / Q000592:standards*; D003906:Developing Countries; D005376:Financial Management / Q000592:standards*; D005869:Ghana; D006295:Health Resources / Q000592:standards*; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration*; D013997:Time Factors; D016526:Workload / Q000592:standards*