Purpose: The study examined the administrative challenges faced by public hospital managers in Ghana and explored the coping strategies adopted to sustain hospital operations. The study focused on understanding how financial, human resource and institutional constraints shape managerial decisions and service delivery in public hospitals.

Methodology Design: A qualitative research design was adopted. Data were collected through in depth interviews with 20 public hospital administrators selected using purposive sampling. The study relied on a constructivist and pragmatist philosophical orientation. Interview data were analyzed using thematic analysis to identify recurring patterns related to administrative challenges and coping strategies.

Findings: The findings revealed that hospital managers faced persistent challenges related to inadequate funding, staff shortages, bureaucratic procedures, and weak infrastructure. In response, managers adopted coping strategies such as prioritizing critical services, flexible role assignment, collaboration with external stakeholders, and strengthening internal communication. These strategies helped hospitals maintain essential services despite difficult operating conditions.

Implications: The study provides useful insights for health sector policymakers and hospital administrators in Ghana. Strengthening institutional support, improving funding flows and granting managers’ greater administrative flexibility can enhance hospital performance and service sustainability.