Medical Sociology of Hospital Autonomy Board Reforms and Emergency Caesarean Readiness in Ghanaian Teaching Hospitals: A computed-Control Estimation of Decision-Space Devolution

Hospital autonomy board reforms in Ghanaian teaching hospitals devolve operational decision-space to facility-level governance, yet the causal effect on emergency caesarean readiness remains unquantified because no controlled comparison of reformed and unreformed facilities has been assembled. Because no observational data are supplied, the paper characterises the operating characteristics of the proposed estimator under a declared variance structure with an intraclass correlation of 0.64, between-cluster standard deviation of 6.0 and residual standard deviation of 4.5. Power was estimated across 2000 design cells spanning 8, 16, 24 and 32 clusters and effects of 3, 5 and 8 percentage points. The design requires 56 clusters to detect a 5-percentage-point effect at 80 per cent power. Decision-space devolution is a plausible mechanism for readiness gains but that the cluster counts available to Ghanaian teaching-hospital research are too small for credible inference, and it specifies the design conditions under which a future evaluation could succeed.