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This paper aims to examine empirically the ways in which workforce knowledge and organisational factors of an implementing agency affected the implementation of health sector administration decentralisation in Ghana with insights from the Nkwanta district health administration.

This is a qualitative study using data from individual and group interviews through purposive selection of health officials, who were directly involved in the work of actual implementation of the programme. Specifically, participants included senior management, middle management and junior workers, who had worked at least for the past three months in the district.

The study found that most of the interviewees involved in the implementation process are knowledgeable of the objectives of the decentralisation process. Also, major factors that are militating against effective decentralisation in the district include inadequate funds, lack of qualified personnel, inadequate logistics and equipment, poor interpersonal relationships, lack of transparency and a good operational system, lack of incentives to motivate the staff, political interference, poor infrastructure and high rate of illiteracy.

The findings of this study will help improve the implementation of decentralisation within the health sector in Ghana. The paper provides recommendations, which, if considered for implementation, will help improve the decentralisation process.

Nearly at the end of its lifespan, the Ghana ICT4AD policy is in a position for a holistic view, especially through the eyes of the intended beneficiaries. This paper aims to fill that gap. The paper measures the gap between what was intended and what has been realised and, based on that, makes recommendations for stakeholders.

The research used the design reality gap analysis approach to numerically examine the deviation or otherwise of the ideals of the Ghana ICT4AD policy from or to the reality on the ground. It required the breaking down of the problem into dimensions and subdimensions and involved interviewing office holders, academics, practitioners and students over a three-year period. The recommendations include a review of the policy before it expires and an explicit designation of an agency responsible for coordination, monitoring and evaluation of the various stages of the policy.

The chief finding is that Ghana’s ICT4AD policy might miss the targets totally, or might well be a partial failure unless action is taken to close the design–reality gaps identified by the research. As the policy is almost at the end of its lifespan, recommendations are even more useful when the recommended revision takes place.

The major limitation of the is that it looks only at the implementation success or failure without a probe into the causal factors and/or the impact on society.

The policy runs full term at end 2022, with large gaps between the plans of the framers and the reality on the ground. An immediate revision of the policy is most recommended.

Besides this study, the authors have not come across any such comprehensive study of the Ghana ICT4AD policy, especially with the amount of data now available after two decades. There is a similarity with a Pakistani study, which has been acknowledged in this study, but the two works differ greatly in methodology, context and style.