The Politics of Healthcare Financing Reforms in Ghana: A Comparative Analysis of The Rawlings And Kufuor Years

Abstract

Presidents Jerry John Rawlings and John Agyekum Kufuor of Ghana carried out health financing reforms in their respective periods and adopted policy choices that were in opposition to their known ideological preferences. Although Rawlings subscribes to the tenets of socialism he introduced a cash-and-carry health financing policy that required citizens to pay for health services at the point of delivery. Kufuor on the other hand opted for socially inclusive health insurance scheme based on risk and resource pooling against his party’s ideological preference for market solutions to service provision. This paper provides a comparative analysis of the choices made during the time of these two leaders in the area of health financing and points to a complex interaction between (a) variants of dominant ideological beliefs at the foreground of global policy discoursesin their respective years–(Rawlings 1981-2000 & Kufuor 2000- 2008); and (b) a configuration of domestic political exigencies. In particular, the analyses show that (a) global neo-liberal policy discourse with its high emphasis on commodification of social services was instrumental in shaping the choice of cash-and-carry under Rawlings, notwithstanding his socialist posturing; while (b) the rise of inclusive growth based on global narratives wrapped in the language of poverty reduction in the early 2000s enhanced the opportunity structures for the adoption of national health insurance policy under Kufuor, much against his preference for free market approach to public policy. The analysis has implications for the extent of commitment to party ideology and autonomy of actors in the decision-making processes in developing countries.