In the landscape of Ghana’s healthcare, the hierarchy of the Ghana Health Service (GHS) is a clear pyramid. At the narrow apex sit the policymakers and senior executives; at the sprawling base are the thousands of nurses, midwives, physician assistants, laboratory staff, and community health workers who form the backbone of national care.
While leadership is concentrated at the top, the true stress test of any policy occurs at the bottom. Yet, a persistent gap remains: health policies are frequently designed in high-level boardrooms and handed down to the frontline with minimal consultation. This top-down approach risks creating “paper reforms”—policies that look flawless in a report but crumble under the weight of clinical reality.
The View from the Frontline
The reality is simple: a frontline worker understands the pulse of the system in a way no data set can fully capture. They are the ones who navigate the bottlenecks, improvise during resource shortages, and witness exactly how a patient experiences the system.
When the GHS listens only “upward,” a dangerous distance grows between policy and practice. Directives are issued, but implementation becomes fragmented. Frustration mounts among staff, compliance drops, and accountability withers. However, when health workers are engaged as partners rather than just implementers, they become co-owners of the reform.
Lessons from the Classroom
Ghana’s health sector could find a blueprint for success in the Ghana Education Service (GES). In recent years, education reforms have shifted toward broader consultation with teachers, headteachers, and unions. By listening to those in the classroom, policies have gained greater relevance and local “buy-in.”
Healthcare—a sector arguably more complex and intensely people-centered—deserves a similar evolution. Stakeholder engagement cannot remain a symbolic gesture or a meeting restricted to regional directors. It must be decentralized.
Building a Stronger Foundation
To bridge this gap, the GHS should consider a structured, bottom-up feedback loop:
Facility-Level Forums: Creating safe spaces for frontline staff to propose practical solutions to local workflow issues.
Regional Validation: Using district platforms to synthesize grassroots input, ensuring national policies are grounded in local reality.
Inclusive Expertise: Acknowledging that while senior leaders have the technical expertise, frontline workers have the “lived experience” necessary to make that expertise functional.
The strength of a pyramid is not found in how much weight the apex can hold, but in the stability of its base. True leadership is not diminished by listening downward; it is fortified by it.
As Ghana faces evolving health challenges and a growing population, the solutions often already exist within the wards and clinics. If our health reforms are to be truly transformative, the voices from the ground must move from the margins to the center. Listening to the base of the pyramid is no longer optional—it is a necessity for survival.
About the Author
Desmond Yaani is an ophthalmic nurse and a nursing and midwifery leader within the GHS, currently serving in district hospital management. He is the Upper East Regional Public Relations Officer of the Ghana Registered Nurses and Midwives Association (GRNMA) and an advocate for health systems quality improvement.
Writer’s name: Desmond Yaani
Writer’s email: desmondyaani@outlook.com
Date: January 30, 2026
Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy, position, or editorial stance of this publication.
