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Assignment 1 - Ghana's NHI Policy, . - Coggle Diagram
Assignment 1 - Ghana's NHI Policy
Task 1 - Timeline
2003 - August - NDC refuse to be a part of the bill and leave parliament. NHI Bill passed in parliament with only NPP votes.
2001 - start of NHI policy development under new leadership. Need to replace previous out of pocket fees at point of service. Need for more equitable solution.
Can create a table in chronological order
Key moments throughout entire history
2006 (December) - relative success of NHI implementation. 38% population registered (out of 21mil), 21% issued ID cards.
1997 - Health sector reforms started focus on geographical access to health facilities. Access increased in 1997 to 2003 yet healthcare use decreased and a measure of illness stayed constant. Problem in healthcare quality and affordability identified.
1957 - independence from British colonial rule. Convention People's Party (CPP) far left socialist party (one party state)
1970s - stagnating economy and feasibility of tax-based health care financing declining.
1966 - CPP ousted by military coup
1992 -National Defense Council (NDC) hold elections and win. NDC following in economically depressed regions - northern areas and poor urban areas.
2000 - New Patriotic Party (NPP) win. More following in economically prosperous regions. Middle and Southern forest belts and urban communities. Major campaign promise is to replace OOP(out of pocket) fees, implement NHI and access basic health services for all.
1972 - Low OOP fees introduced. Used to discourage excessive use of funds.
1983 - Government use IMF and World bank economic recovery programme.
1985 - higher OOP fees introduced (part of IMF and World Bank requirements) - shortages improved by inequality larger.
1992 - first Community Health Insurance (CHI) started through the St Theresa Catholic Mission Hospital.
Mid 1990s - Group under the Ministry of Health (MOH) created to pilot Social Health Insurance. Failed in 1999.
1993 - UNICEF funds exploratory research into district wide CHI for non-formal sector in Dangme West.
2001 - NPP take power in January.
2001 - March minister of health selects task force with the aim of supporting and advising MOH on development of an NHIS and the process along with it (read article on specifics)
2001 - June the minster approves policy outline by task force
2001 - June there is a cabinet reshuffle and a new minister of health. Just before this, the old minister changed the director of PPME to close ally. The new director of PPME started filling posts in the task force with his own allies.
2002 - end of the year, only 1 remaining member of the original task force remains due to conflict of ideas and skewed power
2001 - March Ghana decide to access the Highly Indebted Poor country (HIPC) initiative
2003 - February - HIPC funds allocated to districts with no MHOs to help in their creation. MOH approved.
2003 - July - 1 week before parliament recess, the bill is brought to parliament with aim to resolve quickly. Limited stakeholder engagement (1 week)
2003 - July - Organized labor convened and submitted formal resolution to parliament protesting the bill. Bill deferred to next parliamnet meeting after recess.
2003 - August - parliament recovene with no real changes to the bill. Organized labor and NDC contestation ignored. Media pick up on story but focus on the conflict between and not on actual substance of the story
Task 2: Identify Two Contextual Factors
These factors should have influenced the policy
process
Low income setting of Ghana
Influenced the actors involved. More uneducated, less ability of citizens to interact with policy processes, need for a NHIS due to inability of citiznes to afford OOP (content). Involvement of the international community and access to funds HIPC. Emphaises the need for a reform.
need for reform higher in low income setting. many who couldn't afford the current system.
Low involvement from citizens with no access to policy procedures and stakeholder engagement. they were not consulted as they should have. less say in the policy.
Act 650 - many of the members of the MHO's were form rural areas and poor. Minimal ability to mobilise and exercise their power to change the policy that was not in their interests.
Little sources f
Political climate in Ghana
Mandate is to provide NHI at all costs, Rushing process, politcial allies pushing the agenda. Ignoring real concenrs about the benefit package.
Being able to push these agendas as it is in the ineterest of the political allies to stay in power.
Sociopolitical pressures and interests
Placement of political allies in positions to achieve their goals for the mandate.
Giving power to those who will achieve the goal and taking away power from the technical experts with valid concerns.
Political allies were given agency to make decisions that serve thier own interets - example when the political aliies were appointed as implementation consultants
This rapid succession also hindered opposition from mobilsiing and opposing the policy.
Governance structure
No mention of judiciary involvement and relation to constitution of Ghana. Can the law be involved when legitimate concerns from stakeholders are voiced.
Placement of allies into roles by minsters or driectors. Is there oversight from independent authorities into how power is distributed and who is put in charge?
Votes needed to pass a bill. If no opposition is present can they achieve quorum?
Power is not equally distributed. Elites hold most power.
Task 3: Identify FOUR actors that influenced the policy process
Director of PPME and his close allies
Strongly in favor of the policy. The policy was highly influenced by the task force members. They made most of the decisions, ignored legitimate concerns.
Chair of the Task force
Strongly against the policy and fought with the minister.
Organized Labour
Strongly against policy. Tried to contest aspects of the policy and wrote a proposal to parliament to amend the bill before passing. This was mostly ignored by the NPP.
Media
Neutral. They were mostly focused on the fights between the actors involved and did not exercise agency in making a decision on their stance and did not exercise their power.
They may have been silenced by the politicians - seen later in 2005.
The original task force.
Strongly against the policy in its form. Refused to accept all the decisions made by the political allies but failed in their rebellion. Did not exert their power or mobilize as they could have.
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