Unlike the other items of budget, there are no incentives to BMC Managers to be efficient in utilizing their personnel budgets (item-1 budgets) and to effectively monitor expenses on that item. For example, salaries of persons not working in an institution can be retained on the payroll for periods simply because action to remove such name does not give the manager an opportunity to replace such staff, neither does it stop him/her from receiving additional staff through transfers. Evidence from the recent payroll cleaning exercise carried out within Ghana Health Service has shown that there are some pockets of wastage in the payroll, which contribute to the escalating health sector wage bill.

The issue of shortage of critical health staff particularly Doctors and Nurses in the country has been and continue to be a major concern in the health sector. Indeed the issue has been a pressing subject matter in many for a locally and internationally and it has been widely discussed and well documented.

One of the key components of the poverty reduction strategy adopted by the Government to deal with poverty in Ghana is reducing inequalities in access to health, reproduction and nutrition services, and health outcomes. In line with this policy strategy, the government of Ghana has made an impressive effort to introduce National Health Insurance Scheme (NHIS) to finance affordable and quality healthcare to all residents of Ghana without out-of-pocket payment requirement at the point of service.

The health sector reforms have as their basis the objectives of improving access to services and the equity which these are delivered. It also has the objective of enhancing the quality of health services and greater efficiency in utilizing resources for health and in ensuring that all stakeholders are involved in health care decisions at all levels.

Public sector wages have of late attracted a lot of attention in the media. While Health Workers Group (HWG) (comprising nurses, midwives, allied health professionals, administrators, accountants and other health sector workers) is complaining about unfair treatment within the health sector, other public sector workers are accusing government of discriminating against them. The public sector unions are currently threatening to use any means to ensure that Government implements the universal rule of 'equal pay for work of equal value' in the public service.

The role of Health Service Administrators in the management of Hospitals is receiving increased attention. Health Service Administrators are being looked to for improvement of internal management of hospitals. Some leaders in the health sectors are however alarmed by the position being occupied by Health Service Administrators in the management of Hospitals. They claim Health Services Administrators do not have the complete package - knowledge, clinical experience and better understanding of hospital operating system, the complexity of the modern day medicine and patient care etc to manage hospitals. In effect, they seem to suggest that Health Services Administrators do not have the required training and acumen to enable them manage hospitals. Your view on this issue!