The research documented many factors which impeded
reform progress, including inadequate capacity to implement
(especially the lack of costing and performance measurementsystems and insufficient numbers of personnel), professional
barriers between clinical and accounts staff who must work
together for effective budgeting and a lack of leadership. Weak
leadership prevented hospital management teams from developing
a shared understanding of the reform and the
motivation to see it succeed, while the health sector’s hierarchical
authority structure inhibited the type of creative
problem solving and adaptation of systems that PBB requires
(Guess 2001; Miller et al. 2001; Melkers and Willoughby 2005).
Professional boundaries and mistrust between clinicians and
accounts staff made it hard for the two groups to share or use
information that might benefit the hospital as a whole. Budget
reform in Ghana was similarly impeded by the failure to
overcome professional ‘silos’ separating staff with different
functions and training (Roberts and Andrews 2005).