The Dilemmas Of Public (Middle) Managers Under NPM: Implementing Public Service Outsourcing In Ghana’s Health Sector

Tengey, Samuel (2010). The Dilemmas Of Public (Middle) Managers Under NPM: Implementing Public Service Outsourcing In Ghana’s Health Sector. PhD thesis The Open University.



Globally, public management underwent substantial reforms over the past three decades. Known as new public management (NPM), reforms have sought to redefine the role of politicians and public managers, redesign public organisations for enhanced autonomy and effectiveness, and restructure service delivery by integrating private organisations to ensure competition believed as necessary for efficiency. Premised on tensional forces of public choice' and `managerialism' the NPM model potentially creates conflicts between managers and professionals. Developed in OECD countries, and applied to less developed countries (LCDs) with generally ineffective public sectors; and admittedly an engrained corruption culture, NPM reforms are typified by increased bureaucratic centralisation, which restricts professionals' discretion. Using semi-structured interviews and a range of qualitative analytic devices, this thesis examines the challenges professional managers encounter under senior managers, when some support functions were privately outsourced, in line with NPM, in two corporatised hospitals in Ghana.

Findings suggest professionals feel by-passed, their discretion restricted, and their expertise ignored by senior managers, generating clashes over mediating the conflicting dualities of cost/quality, results/procedures, and output/outcome. Conceptualised as resistance strategies, professionals' response(s) to the encountered issues portrayed appreciable unconventionality and non-deviance, coming close to individualised version of work to rule, and professionalised version of weapons of the weak. Such professionals' resistance strategies elucidate the complexities of Ghana's embedded political, economic and socio-cultural context. The findings suggest the true outcomes of NPM reforms within this and similar contexts are masked, distorted by the refracting effects of corruption, producing a type of bureaucracy that encourages reduced devolution, tending to inhibit rather than aid effective delivery of public services.

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