Hostname: page-component-848d4c4894-ndmmz Total loading time: 0 Render date: 2024-05-14T08:07:39.966Z Has data issue: false hasContentIssue false
  • English
  • Français

Democratic demands and social policies: the politics of health reform in Ghana*

Published online by Cambridge University Press:  05 August 2011

Giovanni Carbone
Giovanni Carbone*
Affiliation:
Università degli Studi di Milano, Dipartimento di Studi Sociali e Politici, via Conservatorio 7, Milano, Italy
*
Email: g.carbone@unimi.it
Get access Rights & Permissions [Opens in a new window]

Abstract

It is commonly assumed that the advent of democracy tends to bring about social welfare improvements. Few studies, however, have examined empirically the impact of third-wave democratisation processes on social policies in developing countries, particularly in sub-Saharan Africa. Through a diachronic comparison, this paper examines the effects of Ghana's democratisation process on the evolution of its health policy. It shows that the emergence of democratic competition played an important role in the recent adoption of a crucial health reform. A policy feedback effect on politics and a process of international policy diffusion were additional but secondary factors.

Type
Research Article
Information
The Journal of Modern African Studies , Volume 49 , Issue 3 , September 2011 , pp. 381 - 408
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

This paper is part of a PRIN research project co-funded by the Italian Ministry of Universities and Research and the Università degli Studi di Milano.

References

REFERENCES

Addai, E. & Gaere, L.. 2001. ‘Capacity-building and systems development for sector-wide approaches (SWAps): the experience of the Ghana health sector’, available at: http://www.swisstph.ch/fileadmin/user_upload/Pdfs/swap/swap154.pdf.Google Scholar
Agyepong, A. & Adjei, S.. 2008. ‘Public social policy development and implementation: a case study of the Ghana National Health Insurance Scheme’, Health Policy and Planning 23, 2: 150–60.CrossRefGoogle ScholarPubMed
Agyepong, I. 1999. ‘Reforming health service delivery at district level in Ghana: the perspective of a district medical officer’, Health Policy and Planning 14, 1: 59–69.CrossRefGoogle ScholarPubMed
Aryeetey, E. & Goldstein, M.. 2000. ‘Ghana: social policy reform in Africa’, in D. Morales-Gomez, N. Tschirgi & Moher, J., eds. Reforming Social Policy: changing perspectives on sustainable human development. Ottawa: International Development Research Centre, 9–43.Google Scholar
Asante, F. & Aikins, M.. 2007. ‘Does the NHIS cover the poor?’, Legon: ISSER & School of Public Health, University of Ghana.Google Scholar
Asenso-Okyere, K. 1995. ‘Financing health care in Ghana’, World Health Forum 16, 1: 86–91.Google ScholarPubMed
Asenso-Okyere, K., Osei-Akoto, I., Anum, A. & Adukonu, A.. 1999. ‘The behaviour of health workers in an era of cost sharing: Ghana's drug cash and carry system’, Tropical Medicine and International Health 4, 8: 586–93.CrossRefGoogle Scholar
Atim, C., Grey, S., Apoya, P., Anie, S. J. & Aikins, M.. 2001. A survey of health financing schemes in Ghana. Bethesda, MD: Abt Associates, USAID/Partners for Health Reformplus.Google Scholar
Ayee, J. R. A. 2001. ‘The 2000 general elections and presidential run-off in Ghana: an overview’, in Ayee, J. R. A., ed. Deepening Democracy in Ghana: politics of the 2000 elections. Vol. 1. Accra: Freedom Publications, 23–55.Google Scholar
Badasu, D. M. 2004. ‘Implementation of Ghana's health user fee policy and the exemption of the poor: problems and prospects’, African Population Studies 19, Supplement A: 285–302.Google Scholar
Baldwin, P. 1990. The Politics of Social Solidarity. Cambridge University Press.CrossRefGoogle Scholar
Bartolini, S. 1993. ‘On time and comparative research’, Journal of Theoretical Politics 5, 2: 131–67.CrossRefGoogle Scholar
Bollen, K. & Jackman, R.. 1985. ‘Political democracy and the size distribution of income’, American Sociological Review 50, 4: 438–57.CrossRefGoogle Scholar
Bratton, M. & Mattes, R.. 2001. ‘Support for democracy in Africa: intrinsic or instrumental?’, British Journal of Political Science 31, 1: 447–74.CrossRefGoogle Scholar
Brown, D. & Mobarak, A. M. 2009. ‘The transforming power of democracy: regime type and the distribution of electricity’, American Political Science Review 103, 2: 193–213.CrossRefGoogle Scholar
Bueno de Mesquita, B., Morrow, J., Silverson, R. & Smith, A.. 2002. ‘Political institutions, policy choice and the survival of leaders’, British Journal of Political Science 32, 4: 559–90.CrossRefGoogle Scholar
Cameron, D. R. 1978. ‘The expansion of the public economy: a comparative analysis’, American Political Science Review 72, 4: 1243–61.CrossRefGoogle Scholar
Carbone, G. 2009. ‘The consequences of democratization’, Journal of Democracy 20, 2: 123–37.CrossRefGoogle Scholar
Carnes, M. & Mares, I.. 2007. ‘The welfare state in global perspective’, in Boix, C. & Stokes, S., eds. The Oxford Handbook of Comparative Politics. Oxford University Press, 868–85.Google Scholar
Carrin, G., Doetinchem, O., Kirigia, J., Mathauer, I. & Musango, L.. 2008. ‘Social health insurance: how feasible is its expansion in the African region?’, DevISSues 10, 2: 1–4.Google Scholar
Cassels, A. & Janovsky, K.. 1992. ‘A time of change: health policy, planinng and organization in Ghana’, Health Policy and Planning 7, 2: 144–54.CrossRefGoogle Scholar
de Waal, A. 2000. ‘Democratic political processes and the fight against famine’, IDS Working Paper 107, Brighton: IDS.Google Scholar
Durairaj, V., D'Almeida, S. & Kirigia, J.. 2010. Obstacles in the process of establishing sustainable National Health Insurance Scheme: insights from Ghana. Geneva: WHO.Google Scholar
Esping-Andersen, G. 1990. The Three Worlds of Welfare Capitalism. Princeton, NJ: Princeton University Press.Google Scholar
Evening News, Accra.Google Scholar
Ferrera, M. 2006. Le Politiche Sociali: l'Italia in prospettiva comparata. Bologna: Il Mulino.Google Scholar
Fiori, A. 2008. ‘Globalizzazione, crisi economica e welfare state in Corea’, unpublished paper presented at the xxii Conference of the Italian Political Science Association (SISP), Pavia.Google Scholar
Garrett, G. 1998. Partisan Politics in the Global Economy. Cambridge University Press.CrossRefGoogle Scholar
Gerring, J. 2007. Case Study Research: principles and practice. Cambridge University Press.Google Scholar
Gerring, J., Thacker, S. & Alfaro, R.. 2006. ‘Democracy and human development’, unpublished manuscript.Google Scholar
Grindle, M. S. & Thomas, J. W.. 1991. Public Choices and Policy Change: the political economy of reform in developing countries. Baltimore, MD: Johns Hopkins University Press.CrossRefGoogle Scholar
Gyimah-Boadi, E. 1999. ‘Ghana: the challenges of consolidating democracy’, in Joseph, R., ed. State, Conflict and Democracy in Africa. London: Lynne Rienner, 409–27.Google Scholar
Hickey, S. 2005. ‘Thinking about the politics of social protection in Africa: towards a conceptual and theoretical approach’, paper presented at the Social Protection for Chronic Poverty Conference, Manchester: Institute for Development Policy and Management/Chronic Poverty Research Centre, University of Manchester.Google Scholar
Hickey, S. 2007. ‘Conceptualising the politics of social protection in Africa’, Working Paper 4, Manchester: Brooks World Poverty Institute, University of Manchester.CrossRefGoogle Scholar
Hsiao, W. & Shaw, P.. 2007. ‘Introduction, context and theory’, in Hsiao, W. & Shaw, P., eds. Social Health Insurance for Developing Nations. Washington, DC: WBI Development Studies, World Bank, 1–20.CrossRefGoogle Scholar
Jeffries, R. 1998. ‘The Ghanaian elections of 1996: towards the consolidation of democracy?’, African Affairs 97, 387: 189–208.CrossRefGoogle Scholar
Katzenstein, P. 1985. Small States in World Markets: industrial policy in Europe. Ithaca, NY: Cornell University Press.Google Scholar
Khan, M. H. 2005. ‘Markets, states and democracy: patron–client networks and the case for democracy in developing countries’, Democratization 12, 5: 704–24.CrossRefGoogle Scholar
Korpi, W. 1983. The Democratic Class Struggle. London: Routledge.Google Scholar
Kosack, S. 2007. ‘Do democracies serve the poor? The organizational foundations of pro-poor policy, with evidence from education policies in Taiwan, Ghana, and Brazil’, paper presented at the Conference on the Comparative Politics of Inequality and Redistribution Princeton, NJ: Princeton University.Google Scholar
Lake, D. A. & Baum, M. A.. 2001. ‘The invisible hand of democracy: political control and the provision of public services’, Comparative Political Studies 34, 6: 587–621.CrossRefGoogle Scholar
Lindberg, S. 2003. ‘“It's our time to ‘chop'”: do elections in Africa feed neo-patrimonialism rather than counteract it?’, Democratization 10, 2: 121–40.CrossRefGoogle Scholar
MacLean, L. M. 2002. ‘Constructing a social safety net in Africa: an institutionalist analysis of colonial rule and state social policies in Ghana and Côte d'Ivoire’, Studies in Comparative International Development 37, 3: 64–90.CrossRefGoogle Scholar
Mensah, J., Oppong, J. & Schmidt, C.. 2010. ‘Ghana's National Health Insurance Scheme in the context of the health MDGs: an empirical evaluation using propensity score matching’, Health Economics 19, 1: 95–106.CrossRefGoogle ScholarPubMed
Ministry of Health, Ghana. 2009. Pulling Together, Achieving More, Independent Review. Health Sector Programme of Work 2008. Accra: draft.Google Scholar
National Democratic Congress (NDC). 1996. Manifesto 1996: always for people, always for development. Accra: NDC.Google Scholar
NDC. 2000. Manifesto 2000: spreading the benefits of development. Accra: NDC.Google Scholar
NDC. 2004. Manifesto 2004: a better Ghana. Accra: NDC.Google Scholar
NDC. 2008. Manifesto 2008: a better Ghana: investing in people, jobs and the economy. Accra: NDC.Google Scholar
Nattrass, N. & Seekings, J. 2001. ‘Democracy and distribution in highly unequal economies: the case of South Africa’, Journal of Modern African Studies 39, 3: 471–98.CrossRefGoogle Scholar
New Patriotic Party (NPP). 1996. Manifesto 1996: development in freedom, agenda for change. Accra: NPP.Google Scholar
NPP. 2000. Manifesto 2000. Accra: NPP.Google Scholar
NPP. 2004. Manifesto 2004. Accra: NPP.Google Scholar
Norton, A., Bortei-Doku Aryeetey, E., Korboe, D. & Dogbe, D. K. T.. 1995. ‘Poverty assessment in Ghana using qualitative and participatory research methods’, Poverty and Social Policy Discussion Paper 83, Washington, DC: World Bank.Google Scholar
Nugent, P. 1995. Big Men, Small Boys and Politics in Ghana: power, ideology and the burden of history, 1982–1994. London & New York: Pinter.Google Scholar
Nyonator, F. & Kutzin, J.. 1999. ‘Health for some? The effects of user fees in the Volta Region of Ghana’, Health Policy and Planning 14, 4: 329–41.CrossRefGoogle ScholarPubMed
Pierson, P. 1994. Dismantling the Welfare State? Reagan, Thatcher and the politics of retrenchment. Cambridge University Press.CrossRefGoogle Scholar
Rajkotia, Y. 2007. ‘The political development of the Ghanaian national health insurance system: lessons in health governance’, Health Systems 20/20 project, Bethesda, MD: Abt Associates Inc.Google Scholar
Ramachandra, S. & Hsiao, W.. 2007. ‘Ghana: initiating social health insurance’, in Hsiao, W. & Shaw, P., eds. Social Health Insurance for Developing Nations. Washington, DC: World Bank, WBI Development Studies, 61–80.Google Scholar
Republic of Ghana. 1992. The Constitution of the Republic of Ghana, Accra:Government of Ghana.Google Scholar
Ross, M. 2006. ‘Is democracy good for the poor?’, American Journal of Political Science 50, 4: 860–74.CrossRefGoogle Scholar
Schiller, C., Hensen, H. & Kuhnle, S.. 2009. ‘Global health policy: what role for international governmental organisations?’, in R. Ervik, N. Kildal & Nilssen, E., eds. The Role of International Organizations in Social Policy: ideas, actors and impact. Cheltenham: Edward Elgar, 212–45.Google Scholar
Sen, A. 1982. ‘Food battles: conflicts in the access to food, the 12th Coromandel Lecture, New Delhi.Google Scholar
Sen, A. 1994. ‘Freedoms and needs’, New Republic 17: 31–8.Google Scholar
Senah, K. 2001. ‘In sickness and in health: globalization and health care delivery in Ghana’, Research Review 17, 1: 83–9.Google Scholar
SEND-Ghana. 2010. Balancing Access with Quality Health Care: an assessment of the NHIS in Ghana (2004–2008). Accra: SEND-Ghana.Google Scholar
Singleton, J. L. 2006. ‘Negotiating change: an analysis of the origins of Ghana's National Health Insurance Act’, Honors Projects, paper 4, Saint Paul, MN: Sociology Department, Macalester College, available at: http://digitalcommons.macalester.edu/soci_honors/4.Google Scholar
Skocpol, T., Evans, P. & Rueschemeyer, D., eds. 1985. Bringing the State Back In. Cambridge University Press.Google Scholar
Stasavage, D. 2005a. ‘Democracy and education spending in Africa’, American Journal of Political Science 49, 2: 343–58.CrossRefGoogle Scholar
Stasavage, D. 2005b. ‘The role of democracy in Uganda's move to universal primary education’, Journal of Modern African Studies 43, 1: 53–73.CrossRefGoogle Scholar
Sulzbach, S., Garshong, B. & Owusu-Banahene, G.. 2005. Evaluating the Effects of the National Health Insurance Act in Ghana: baseline report. Bethesda, MD: Abt Associates, USAID/Partners for Health Reformplus.Google Scholar
Tsikata, Y. 2001. ‘Ghana’, in S. Devarajan, D. Dollar & Holmgren, T., eds. Aid and Reform in Africa. Washington, DC: World Bank, 45–100.Google Scholar
United Nations Development Programme (UNDP). 2007. Ghana Human Development Report: towards a more inclusive society. Washington: UNDP.Google Scholar
van Kersbergen, K. & Manow, P.. 2008. ‘The welfare state’, in Caramani, D., ed. Comparative Politics. Oxford University Press, 520–45.Google Scholar
Varshney, A. 2000. ‘Why have poor democracies not eliminated poverty? A suggestion’, Asian Survey 40, 5: 718–36.CrossRefGoogle Scholar
Waddington, C. & Enyimayew, A. K.. 1989. ‘A price to pay: the impact of user charges in Ashanti-Akim district, Ghana’, International Journal of Health Planning and Management 4, 1: 17–47.Google Scholar
Waddington, C. & Enyimayew, A. K.. 1990. ‘A price to pay, Part 2: the impact of user charges in the Volta Region of Ghana’, International Journal of Health Planning and Management 5, 4: 287–312.Google Scholar
Wahab, H. 2008. ‘Universal healthcare coverage: assessing the implementation of Ghana's NHIS law’, paper presented at the Workshop in Political Theory and Policy Analysis MiniConference, Bloomington, IN: Indiana University.Google Scholar
Weyland, K. 2005. ‘Theories of policy diffusion: lessons from Latin American pension reform’, World Politics 57, 1: 262–95.CrossRefGoogle Scholar
Wilensky, H. 1975. The Welfare State and Equality. Los Angeles, CA: University of California Press.Google Scholar
Witter, S. & Garshong, B.. 2009. ‘Something old or something new? Social health insurance in Ghana’, BMC International Health and Human Rights 9, 20: 1–13.CrossRefGoogle ScholarPubMed
World Bank. 1993. World Development Report: investing in health. Washington, DC: World Bank.Google Scholar
World Bank. 2010. World Development Indicators. Available at: http://databank.worldbank.org, accessed 20.10.2009.Google Scholar
World Health Organisation (WHO). 2008. World Health Report 2008: primary health care now more than ever. Geneva: WHO.Google Scholar