ESID Working Paper No. 107 The political economy of maternal healthcare in Ghana Abdul-Gafaru Abdulai 1 October 2018 1 University of Ghana Business School, Legon, Accra Email correspondence:
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[email protected] Effective States and Inclusive Development Research Centre (ESID) Global Development Institute, School of Environment, Education and Development, The University of Manchester, Oxford Road, Manchester M13 9PL, UK www.effective-states.org The political economy of maternal healthcare in Ghana Abstract Despite substantial improvements in access to health services in Ghana during the last two decades, there has been limited progress in improving maternal health, and the country as a whole was unable to meet the Millennium Development Goal (MDG 5) in relation to maternal mortality. However, some administrative regions have made significant progress, with the Upper East, one of Ghana’s most impoverished regions, surprisingly recording the most dramatic progress in the reduction of maternal mortality during the last decade. This paper explains Ghana’s limited progress in reducing maternal mortality as a product of the country’s ‘political settlement’, in which ruling elites are characterised by a perennial threat of losing power to other powerful excluded elites in tightly fought elections, incentivising those in power to direct public investments to policy measures that contribute to their short-term political survival. Competitive clientelist political pressures have contributed to greater elite commitment towards health sector investments with visual impact, while weakening elite incentives for dedicating sufficient public resources and providing consistent oversight over other essential, but less visible, interventions that are necessary for enhancing the quality of maternal health.