Promoting a New Health Policy in the Ghanaian Media: Newspaper Framing of the National Health Insurance Scheme from 2005-2007 A dissertation presented to the faculty of the Scripps College of Communication of Ohio University In partial fulfillment of the requirements for the degree Doctor of Philosophy Andrews Ofori-Birikorang August 2009 © 2009 Andrews Ofori-Birikorang. All Rights Reserved. This dissertation titled Promoting a New Health Policy in the Ghanaian Media: Newspaper Framing of the National Health Insurance Scheme from 2005-2007 by ANDREWS OFORI-BIRIKORANG has been approved for the School of Media Arts and Studies and the Scripps College of Communication by Steve Howard Professor of Media Arts and Studies Gregory J. Shepherd Dean, Scripps College of Communication ii ABSTRACT OFORI-BIRIKORANG, ANDREWS, Ph.D., August 2009, Mass Communication Promoting a New Health Policy in the Ghanaian Media: Newspaper Framing of the National Health Insurance Scheme from 2005-2007 (278 pp.) Director of Dissertation: Steve Howard This research examined the National Health Insurance Scheme (NHIS) in Ghana to understand the frames and representations used by the local newspapers to promote the policy. The study also examined the major themes that were embedded in the NHIS news stories and the extent to which they promoted official perspectives. Again, it investigated the culture and ideology that guided media professionals in the representation of the NHIS. Framing analysis was used as a major theoretical tool for the study, particularly news frame. The inquiry also explored the relationship between framing and ideology as connected concepts that are rarely interrogated in media studies, especially, in the construction of new stories. It was also guided by the social constructivism theory that conceptualizes news making as a direct reflection of the social realities of individuals and groups. All these theories became interconnected during the construction news stories on the NHIS. The study used both quantitative and qualitative methods for the data collection and analysis. Four major local newspapers with the highest circulation, including the Daily Graphic, the Ghanaian Times, Chronicle and the Daily Guide, were selected for the study. In, addition, interviews were conducted with media professionals , composed iii of three journalists and three public relations officials, to complement the analyses of the stories from the newspapers. The major findings of this research showed that: 1) news stories were dominantly framed around the core issues of NHIS implying that newspapers showed a more responsible coverage of the health policy; however, most of the news stories were not accorded the front page prominence normally given to many other social issues; 2) while the media embarked on a sustained effort to present the NHIS as a mainstream event, they, nevertheless, relied heavily on government sources for information supporting the assertion that, the media see official rhetoric as the most important input for news making; it also implied that newspapers in Ghana still give government officials and politicians larger voice on public discourse; 3) finally, the research showed that the responsible coverage accorded the NHIS can be attributed to new positive attitudes that are emerging in newsrooms toward health reporting. Approved: _____________________________________________________________ Steve Howard Professor of Media Arts and Studies iv ACKNOWLEDGMENTS Six years ago I embarked on another phase of an academic journey to seek higher education in the hope of improving my personal life, the lives of my family, and many others scattered around the globe, people who I choose to call my ‘neighbors’. I have always shared the strong belief that higher education holds the intellectual key that could open doors of opportunity for many individuals around the world, to enjoy descent lives. She/ he who is fortunate enough to have access to this key, eventually becomes a channel through whom the dreams of many to acquire this form of better life can be realized. I see myself, now, as that channel of empowerment for me and several others. In reaching this point of academic achievement, I must humbly say that I could not have made it without a strong support system which I had the privilege of enjoying throughout the six-year period. As this phase of the journey draws to a close, I must acknowledge those to whom I am greatly indebted: To my mother who, though never had any formal education, yet realized in her early years of motherhood that education, higher education in particular, was the only potent weapon worthy of acquisition by families trying to extricate themselves from the vicious web of poverty and ignorance. Am happy she has lived to see the efforts and admonitions she put in to make sure that I reached this level of education, come to fruition. What I have accomplished is first to you, my wonderful mum. To my father, who taught and blessed me with a personality that has created in me a passion for knowledge, wisdom, patience, selflessness, and service to one’s community in exchange for personal and social harmony. v To my wonderful and loving family, my wife Hannah Serwah Bonsu, who had to endure the frustrations of living away from her husband on another continent for six years, and like a single mum, was entrusted with the difficult job of raising those sweet daughters of ours. Thanks for running around, shuttling between Kumasi and Accra to gather most of the newspapers materials needed for this project. Your labor was never in vain. To my daughters Ama Boatemaa and Ohemaa Dufie, who bore the disappointment of growing up almost into teen years, always looking forward to the coming home of an absentee father, your future is brighter even now than before. I am thankful to you mother, and daughters. Your prayers, love, patience, support, and courage have carried me this far. To my sweet sister Anastasia Williams (nee Abena Asantewaa), thanks for the sisterly love, the wonderful support, thoughtfulness, and being there for me all the time. To my uncle, Nana (Dr.) Kwaku Owusu- Kwarteng thanks for leading the way and asking me to follow. Your important role in my life in Athens, Ohio is highly appreciated. To my most wonderful and supportive friends, especially, Basetsana Maposa, Kwaku Agyemang-Badu, Rosemary Mburu, Ernest Waititu, and Jonathan Twum Twumasi, you individually and collectively provided unyielding support for me at every stage of this journey. All of you were away in the last year of this dissertation, but you remained closer than I could imagine. You stood with me when the going got tough; your prayers strengthened me; your words of encouragement still echo in my ears; and, you redefined friendship by adding meaning and value to it. Basetsana and Ernest, this work is also a product of the rich intellectual dialogue we have always vi had on issues pertaining to the continent. Thanks for believing in me and filling me with so much sense of optimism. To my dissertation advisor, Professor W. Stephen Howard, I owe you tons of gratitude. I have reached this level because you believed in me, you invested your time, energy, and resources in me, and you mentored me in an incredibly brotherly fashion. Your guidance sustained me, your assistantships supported me, and your words pushed me on. Your tireless efforts, despite your busy schedule, in reading, editing and critiquing this work are humbly acknowledged. You inspired me to greater heights where I now direct my next efforts. To one of my academic mentors and friend, Dr. Diane Ciekawy, thanks for pushing me on and on, and telling me early in this phase of my academic life, “you can be way up there if you choose to “. I am so grateful that I took your advice, and hope, I made the choice that can send me “way up there”. To my committee members, Dr. Benjamin Bates, Dr. Francis Godwyll, and Dr. Rafael Obregon whose support, advice, guidance and suggestions in various form, before and during the period of writing this dissertation, were remarkably magnificent. Your collective insight in the area of research, immensely, benefitted me. To my research participants and interviewees, Ms Lucy Adomah-Yeaboah, Mr. Clement Atagra, Mr. Sam Okaitey, Alhaji, Mohammad Muniru, Mr Ibrahim Wiredu, and Mr. Benjamin Kufuor, my warmest appreciations go to you. This work was greatly shaped by the rich and insightful data you provided. I am profoundly grateful to you. vii Finally, to God Almighty through whom all things are possible, your son has come to the end of another academic passage and your grace and blessings were bestowed on him in abundance during the whole period. Glory Be to Your Name! viii TABLE OF CONTENTS Page ABSTRACT ....................................................................................................................... iii ACKNOWLEDGMENTS .................................................................................................. v LIST OF TABLES ........................................................................................................... xiv LIST OF FIGURES .......................................................................................................... xv CHAPTER 1: INTRODUCTION ....................................................................................... 1 Background to the Study ................................................................................................. 4 Health cost recovery discourse in Ghana .......................................................................