Decentralized environmental health governance in a mining municipality: An interpretive analysis from Obuasi, Ghana

Objectives: Decentralization is widely promoted as a strategy for strengthening local governance and improving environmental health outcomes, particularly in settings exposed to pollution and unsafe living conditions. However, the extent to which decentralization delivers these benefits in mining-dependent municipalities remains unclear. This study examined how decentralized governance shapes environmental health management in the Obuasi Municipality of Ghana, with particular attention to institutional authority, capacity constraints, and community participation. Study design: This study employed a qualitative interpretivist design. Methods: Semi-structured interviews were conducted with thirty stakeholders, including municipal officials, environmental health workers, community leaders, and residents in mining-affected communities. Data were analyzed using reflexive thematic analysis to identify patterns related to governance structures, capacity, participation, and environmental health risks. Results: Four main themes emerged from the analysis. These are authority gaps within decentralized governance structures, institutional capacity constraints affecting preventive health functions, reactive community participation driven by health crises, and governance pressures created by mining-related environmental risks. Participants described how local authorities are expected to manage environmental health outcomes despite lacking regulatory authority, financial resources and technical capacity to address mining-related hazards. Conclusions: Environmental health outcomes in mining municipalities cannot be improved through administrative decentralization alone. Strengthening environmental health governance requires clearer regulatory authority at the local level, targeted investments in technical and financial capacity, and more inclusive, health-focused engagement mechanisms to protect community health in high-risk environments.