Interest Groups, Issue Definition and the Politics of Healthcare in Ghana

Abstract

The provision of healthcare in Ghana from the pre-colonial period to the 4^th Republic has been characterized by struggles to maintain dominance. While the politics in the pre-independence period focused on the manner of providing healthcare, the post-independence period encapsulates healthcare financing. Using the interest groups theory, the study examines the manner and motive of healthcare management in Ghana. The study finds that a coalition of healthcare interest groups often comprising healthcare providers, government functionaries, bureaucrats, and the World Bank and IMF etc.,  (from the 1970s), uses the definition of healthcare management to maintain leverage in the management of healthcare. Healthcare management in the pre-colonial period was defined as interventionism while the colonial administration focused on scientific therapy. The post-colonial period witnessed a shift of focus to healthcare financing and Nkrumah’ government adopted free healthcare system financed by the state. The Busia’s government focused on sustainability based on payment of small user fee. The Rawling’s regime adopted cost recovery featuring cash and carry, and the Kuffour’s regime focused on a collective responsibility through the adoption of a national health insurance scheme as financing methods. The paper argues that the way healthcare delivery is defined enables governments and political systems to maintain leverage over its management and subsequently reap direct and indirect benefits of the leverage, which among others include the allegiance and legitimacy of the public.  The analysis helps to understand the process of health policymaking in Ghana and perhaps other sub Saharan African countries.

Keywords: Healthcare management, sustainability, healthcare financing, interest groups, issues definition, policy paradigm