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Ghana Social Science Journal, Volume 15, Number 1, June, 2018 ISSN 0855-4730 Attributions License 4.0 Ghana Social Science Journal V GHANA SOCIAL SCIENCE olume 15, Number 1, June 2018 JOURNAL Volume 15, Number 1, June 2018 School of Social Sciences, YAMENS PRESS LTD. University of Ghana, Legon 0302 223222 GHANA SOCIAL SCIENCE JOURNAL Volume 15, Number 1, June 2018 School of Social Sciences University of Ghana, Legon Ghana Social Science Journal, Volume 15, Number 1, June, 2018 ISSN 0855-4730 Attributions License 4.0. eISSN (online): 2590-9673 Ghana Social Science Journal Volume 15, Number 1, June 2018 Editor James S. Dzisah Editorial Committee Charity Sylvia Akotia Chairperson Ama de-Graft Aikins Member Maxwell Asumeng Member Mavis Dako-Gyeke Member Akosua K. Darkwah Member Victoria Ellen Smith Member Michael Perry K. Okyerefo Member Alidu Seidu Member Edward Nketiah-Amponsah Member Martin Oteng-Ababio Member Supporting Staff Sandra Alima Fiamavle Editorial Assistant International Editorial Advisory Board Emmanuel Akyeampong, Harvard University, Cambridge, United States. Samuel Agyei-Mensah, College of Humanities, University of Ghana. Eugenia Amporfu, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. Timothy Insoll, University of Manchester, United Kingdom. Michael Lofchie, University of California, Los Angeles, United States. Patience Elabor-Idemudia, University of Saskatchewan, Canada. Mohammed Salih, Erasmus University of Rotterdam, The Netherlands. Wilson Kwame Yayoh, University of Cape Coast, Cape Coast, Ghana. © School of Social Sciences, University of Ghana, Legon, Accra, Ghana, 2018. ii Ghana Social Science Journal, Volume 15, Number 1, June, 2018 ISSN 0855-4730 Attributions License 4.0. eISSN (online): 2590-9673 ISSN: 0855-4730 eISSN (2590-9673- ONLINE) All rights reserved; no part of this journal may be reproduced, stored in a retrieval system, or transmitted in any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the publishers. Any person who does any unauthorized act in relation to this journal will be liable to prosecution and claims for damages. Published by the School of Social Sciences, College of Humanities, University of Ghana, Post Office Box LG72, Legon, Accra, Ghana Telephone Number: +233-302-500179 Electronic mail address: [email protected] Production editing of this issue was undertaken by James Dzisah. Printed by Yamens Press Limited, Post Office Box AN6045, Accra, Ghana Telephone Number: +233-302-223222/235036. Electronic mail address: [email protected] The views expressed in the papers are those of the authors and do not necessarily reflect the views of the Editor or the Publishers or the University of Ghana. Ghana Social Science Journal is indexed and abstracted in the ProQuest Periodicals Acquisition Databases, Ann Arbor, Michigan, United States. The Ghana Social Science Journal is visible on the Web of Science through the Thomson Reuters’ Emerging Sources Citation Index (ESCI). The Ghana Social Science Journal is also indexed in African Journals online (AJOL). iii Ghana Social Science Journal, Volume 15, Number 1, June, 2018 ISSN 0855-4730 Attributions License 4.0. eISSN (online): 2590-9673 CONTENTS A Comparative Analysis of the Politics of Healthcare Financing Reforms in Ghana in the Rawlings and Kufuor Years……………………...…1-29 Civil Society Engagement in Ghana’s Public-Private Partnership Regime: A Study of IMANI and Ghana Integrity Initiative (GII)….30-64 Systematic Preparation Process and Resource Mobilisation Towards Post-retirement Life in Urban Ghana: An Exploration………......…65-98 Rational Voting in National Elections in Ghana: The 2012 and 2016 Elections in Perspective………………………………………...…99-122 Understanding Child Abuse in Care Institutions in Ghana as a Child Protection Concern…………………………………………….…123-147 Child Labour or Child Work? Children and Tobacco Production in Gbefi, Volta Region…………………………………………...…148-177 Re-tooling the Triple Helix: Georg Simmel’s Tertius Gaudens as an Anchor? ……………………………………………………….…178-194 The Transformation of Intimacy: Mate Selection in a Ghanaian Municipality……………………………………………….……..195-222 Feminine Voyeurism in Ghana Films: Unmasking Frank Raja Arase’s Chauvinist Directorial Techniques…………………………....…223-237 Notes to Contributors…………………………………………….238-240 iv Ghana Social Science Journal, Volume 15, Number 1, June, 2018 ISSN 0855-4730 Attributions License 4.0. eISSN (online): 2590-9673 ACKNOWLEDGEMENT This issue of the Ghana Social Science Journal was produced with financial support from the Carnegie Corporation of New York through the University of Ghana Building A New Generation Of Academics in Africa (BANGA-Africa) Project. v Ghana Social Science Journal, Volume 15, Number 1, June, 2018 ISSN 0855-4730 Attributions License 4.0. eISSN (online): 2590-9673 THE POLITICS OF HEALTHCARE FINANCING REFORMS IN GHANA: A COMPARATIVE ANALYSIS OF THE RAWLINGS AND KUFUOR YEARS Michael Kpessa-Whyte1 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 discourses in 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 1 Research fellow, Institute for African Studies, University of Ghana. E-mail: [email protected] 1 Ghana Social Science Journal, Volume 15, Number 1, June, 2018 ISSN 0855-4730 Attributions License 4.0. eISSN (online): 2590-9673 of actors in the decision-making processes in developing countries. Keywords: health financing, Rawlings, Kufuor, global-neoliberal policy, national health insurance, cash-and-carry Introduction Healthcare financing in Ghana witnessed a shift from individualized out- of-pocket payment to a collectivist National Health Insurance Scheme (NHIS) in 2003 (Gobah & Liang, 2011). In the 1980s, the military government under the leadership of Jerry John Rawlings rolled out a cash- and-carry policy that required all patients to pay out-of-pocket for most medical services obtained at health institutions in the country (Nyonator & Kutzin, 1999). This policy was however abolished and replaced with a National Health Insurance Scheme in the early 2000s when John Agyekum Kufuor was elected President (Wahab, 2008). The policy choices of the two leaders is puzzling because while Rawlings is associated with the politics of social democracy or socialism in Ghana, Kufuor came from the political tradition of Ghanaian conservative liberal democrats that believed in limited government and private sector solutions to public services. Ideologically and programmatically social democratic governments prioritize collectivist approaches to public policy, and liberal democrats are associated with individual liberties and have preference for market principles. Against the background of their respective belief systems, Rawlings’ government was expected to choose a social health policy like the National Health Insurance Scheme that pools risks and builds solidarity, while Kufuor's administration was expected to opt for a more private sector driven solution to health financing in line with the liberal principles of choice and responsibility. So why did Rawlings’ administration opt for a cost imposing cash-and-carry, and Kufuor's government for a socially inclusive health policy against their respective belief systems? And how were both leaders able to deal with resistance and opposition from their core ideological constituencies? This paper answers these questions by arguing that the healthcare financing policy choices made during the time of Jerry John Rawlings and 2 Ghana Social Science Journal, Volume 15, Number 1, June, 2018 ISSN 0855-4730 Attributions License 4.0. eISSN (online): 2590-9673 John Agyekum Kufuor were shaped by a complex interaction between (a) variants of dominant ideological beliefs at the foreground of global policy discourses during their respective years–(Rawlings 1981-2000 & Kufuor 2000-2008); and (b) a configuration of domestic political exigencies. In particular, the analyses show that (a) 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
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