ABSTRACTThe purpose of the study was to compare various expenditure control systems and practices in various hospitals (government, mission and private) in the Bono region. Specifically, the study ascertained the expenditure control methods adopted by these health institutions, the expenditure control practices, the similarities and differences in these methods and …
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ABSTRACTThe purpose of the study was to compare various expenditure control systems and practices in various hospitals (government, mission and private) in the Bono region. Specifically, the study ascertained the expenditure control methods adopted by these health institutions, the expenditure control practices, the similarities and differences in these methods and practices, and looked their weaknesses and strengths. The study used explanatory case study design and data were collected using questionnaires. The study population was made up of core management staff of these health facilities. The main findings of the study are the publicly owned hospitals and the Mission or Christian Health institutions (CHAG) use appropriation control, commitment control, control of regularity and accounting cash controls, however, the private hospitals use only one of the controls which is the aggregate cash control. Again, while both the public and the mission hospitals practice similar expenditure control practices, the privately owned health facilities, the processes are dependent on contingencies (i.e. when the needs arise). The study revealed that the public and CHAG health facilities prepare comprehensive and approved budget, have institutional internal audit function, prepare Local Purchase Order (LPO), and the preparation of disbursement vouchers and payments. The study further revealed breaches of the expenditure control processes particularly as top management stepping aside the rules due to interferences, and there is a failure to check the availability of funding before authorizing expenditure, circumvention of controls at key stages, including through collusion, delays in processing of payments, failure to record and maintain data on commitments and reporting delays, and accumulation of liabilities/arrearsTABLE OF CONTENTSPageDECLARATIONABSTRACTACKNOWLEDGEMENTSDEDICATIONLIST OF TABLESLIST OF FIGURESLIST OF ACRONYMSCHAPTER ONE: INTRODUCTIONBackground of the StudyStatement of the ProblemPurpose of the StudyObjectives of the StudyResearch QuestionsSignificance of the StudyDelimitationsLimitationsDefinition of TermsOrganization of the StudyCHAPTER TWO: LITERATURE REVIEWIntroductionTheoretical FrameworkAgency TheoryInstitutional TheoryConcept of Expenditure ControlClarifications of ExpenditureTypes of Controls and Institutional ActorsKey Stages of Expenditure Control FrameworkFinancial Control and Healthcare DeliveryLimitations/Challenges of Expenditure ControlsJudgementBreakdownsManagement OverrideCollusionEmpirical ReviewHealth Service Delivery SystemHealth FacilitiesConceptual FrameworkChapter SummaryCHAPTER THREE: RESEARCH METHODSIntroductionResearch DesignStudy SettingsSunyani Regional HospitalMunicipal Hospital SunyaniPresbyterian HospitalWenchi Methodist HospitalGreenhill HospitalOwusu Memorial HospitalPopulationSample and Sampling ProceduresData Collection InstrumentsPilot StudyReliability and ValidityData Collection ProceduresData AnalysisEthical ConsiderationChapter SummaryCHAPTER FOUR: RESULTS AND DISCUSSIONIntroductionPresentation of ResultsDemographic Characteristics of RespondentsExpenditure Control Method Adopted by the Government, Mission and Privately Owned HospitalsExpenditure control Practices of Health Facilities (Government, Mission and Private)Similarities and Differences in Terms of Expenditure Control Practices between these Health Facilities (Government, Mission and Private)Strengths and Weaknesses of the System of Expenditure Control in all the Selected HospitalsDiscussion of ResultsResearch Objective 1: Expenditure Control Method Adopted by the Government and Privately Owned HospitalsResearch Question 2: Expenditure Control Practices of Health Facilities (Government, Mission and Private)Research Question 3: Similarities and Differences in Terms of Expenditure Control Practices between these Health Facilities (Government, Mission and Private)Research question 4: Strengths and Weaknesses of the System of Expenditure Control in all the Selected HospitalsChapter SummaryCHAPTER FIVE: SUMMARY, CONCLUSIONS AND RECOMMENDATIONSIntroductionSummaryConclusionsRecommendationsSuggestions for Further StudyREFERENCESAPPENDIX A
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