The Politics of Healthcare Financing Reforms in Ghana: A Comparative Analysis of the Rawlings and Kufuor Years
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Date
2018
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Publisher
Ghana Social Science Journal,
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.
Description
Research Article
Keywords
health financing, Rawlings, Kufuor