The politics of healthcare reforms in Ghana under the Fourth Republic since 1993: a critical analysis

Abstract

This article analyzes the politics behind the consensus on healthcare by major political parties in Ghana's Fourth Republic since 1993. Using Ghana over the period under review as a case in point, the paper's main argument is that politics matters when it comes to the origination, design and implementation of healthcare programs, including the influence of constitutional design and practice, evidenced in a relative paucity of veto points, in facilitating the enactment of legislation on healthcare reforms; and the extent to which healthcare is defined as a human right. A high point of the paper is a critical assessment of the effectiveness of Ghana's healthcare initiative based on the extent to which it meets the needs of citizens, from a human rights standpoint, in the face of a public health emergency of the type that the world currently faces with the COVID-19 pandemic. RÉSUMÉ Cet article examine la politique sous-jacente au consensus sur les soins de santé des principaux partis politiques de la Quatrième République du Ghana depuis 1993. En prenant le Ghana comme exemple pour la période examinée, le principal argument de l'article est que la politique est importante lorsqu'il s'agit de l'origine, de la conception et de la mise en oeuvre de programmes des soins de santé, y compris l'influence de la conception et de la pratique constitutionnelles, attestée par une relative rareté des points de veto, dans la facilitation de la promulgation de la réglementation relevant des réformes des soins de santé ; et de la mesure dans laquelle les soins de santé sont définis comme un droit humain. L'un des points forts de cet article est une évaluation critique de l'efficacité de l'initiative des soins de santé du Ghana, basée sur la mesure dans laquelle elle répond aux besoins des citoyens, du point de vue des droits humains, face à une urgence de santé publique du type de celle à laquelle le monde est actuellement confronté avec la pandémie de la COVID-19.

Beyond political will: unpacking the drivers of (non) health reforms in sub-Saharan Africa

“…99 The period from the 2000s is dominated by diffusion of policies aimed at achieving UHC through health financing reforms such as SHI, NHI, Community-Based Health Insurance (CBHI), abolishment of user fees and PBF. 22 38 41 55 75 76 78 79 100-103 While the diffusion of SHI, NHI and abolishment of user fees was mainly through the broad ideational movement towards financial protection, we found that emulation and learning fostered the uptake of CBHI and PBF across diverse settings. The acceptability of PBF in Cameron was influenced by encouraging results from Rwanda and the involvement of senior MOH officials in regional meetings where countries that had started PBF reported quicker progress towards Millennium Development Goals.…”

“…Health policy reform efforts face resistance because they commonly place concentrated new costs on well-organised, powerful groups while seeking to make new benefits available to non-organised and powerless groups 30. In Ghana, the transition from the pay for service arrangement or ‘cash and carry system’ to a National Health Insurance (NHI) in the early 2000s received popular support because the working middle class wanted to be relieved of the burden to cater for their own health and that of extended families36 37 and parliamentarians desired to offload the constituents’ incessant demand for money to cater for personal health needs 22. Contrary, the middle class in South Africa showed apathy towards advocating for the NHI policy because they benefited from a labour structure that provided them with private sector health 38.…”

“…30 In Ghana, the transition from the pay for service arrangement or 'cash and carry system' to a National Health Insurance (NHI) in the early 2000s received popular support because the working middle class wanted to be relieved of the burden to cater for their own health and that of extended families 36 37 and parliamentarians desired to offload the constituents' incessant demand for money to cater for personal health needs. 22 Contrary, the middle class in South Africa showed apathy towards advocating for the NHI policy because they benefited from a labour structure that provided them with private sector health. 38 At institutional or bureaucratic level, reforms with fiscal implications were slowed down or derailed due to divergent frames between the Ministry of Health (MOH) and the Ministry of Finance (MOF) as in the case of South Africa.…”

“…[16][17][18][19][20] Political will has been cited as the underlying driver for transformative health sector reforms internationally 15 and among African countries. [21][22][23][24] Political will has been defined as the commitment of actors to undertake actions to achieve a set of objectives and to sustain the costs of those actions over time. 25 Although frequently invoked as a rhetorical tool in political discussions, the concept of political will remains ambiguous and one of the 'slipperiest concept in the policy lexicon'' that is often presented as a 'catch-all culprit' with 'little analytic content'.…”

“…This mismatch is often blamed on the ‘lack of political will’2 15 with persistent demand for it 16–20. Political will has been cited as the underlying driver for transformative health sector reforms internationally15 and among African countries 21–24. Political will has been defined as the commitment of actors to undertake actions to achieve a set of objectives and to sustain the costs of those actions over time 25.…”