The district health system in Ghana today is characterized by high resource-uncertainty and narrow decision-space. This article builds a theory-driven historical case study to describe the... Show moreThe district health system in Ghana today is characterized by high resource-uncertainty and narrow decision-space. This article builds a theory-driven historical case study to describe the influence of path-dependent administrative, fiscal and political decentralization processes on development of the district health system and district manager decision-space. Methods included a non-exhaustive literature review of democratic governance in Ghana, and key informant interviews with high-level health system officials integral to the development of the district health system. Through our analysis we identified four periods of district health system progression: (1) development of the district health system (1970–85); (2) Strengthening District Health Systems Initiative (1986–93); (3) health sector reform planning and creation of the Ghana Health Service (1994–96) and (4) health sector reform implementation (1997–2007). It was observed that district manager decision-space steadily widened during periods (1) and (2), due to increases in managerial profile, and concerted efforts at managerial capacity strengthening. Periods (3) and (4) saw initial augmentation of district health system financing, further widening managerial decision-space. However, the latter half of period 4 witnessed district manager decision-space contraction. Formalization of Ghana Health Service structures influenced by self-reinforcing tendencies towards centralized decision-making, national and donor shifts in health sector financing, and changes in key policy actors all worked to the detriment of the district health system, reversing early gains from bottom-up development of the district health system. Policy feedback mechanisms have been influenced by historical and contemporary sequencing of local government and health sector decentralization. An initial act of administrative decentralization, followed by incomplete political and fiscal decentralization has ensured that the balance of power has remained at national level, with strong vertical accountabilities and dependence of the district on national level. This study demonstrates that the rhetoric of decentralization does not always mirror actual implementation, nor always result in empowered local actors. Show less
Koduah, A.; Akua Agyepong, I.; Dijk, J.W.M. van 2016
This paper seeks to advance our understanding of health policy agenda setting and formulation processes in a lower middle income country, Ghana, by exploring how and why maternal health policies... Show moreThis paper seeks to advance our understanding of health policy agenda setting and formulation processes in a lower middle income country, Ghana, by exploring how and why maternal health policies and programmes appeared and evolved on the health sector programme of work agenda between 2002 and 2012. We theorized that the appearance of a policy or programme on the agenda and its fate within the programme of work is predominately influenced by how national level decision makers use their sources of power to define maternal health problems and frame their policy narratives. National level decision makers used their power sources as negotiation tools to frame maternal health issues and design maternal health policies and programmes within the framework of the national health sector programme of work. The power sources identified included legal and structural authority; access to authority by way of political influence; control over and access to resources (mainly financial); access to evidence in the form of health sector performance reviews and demographic health surveys; and knowledge of national plans such as Ghana Poverty Reduction Strategy. Understanding of power sources and their use as negotiation tools in policy development should not be ignored in the pursuit of transformative change and sustained improvement in health systems in low- and middle income countries (LMIC). Show less
Background: Why issues get on the policy agenda, move into policy formulation and implementation while others drop off in the process is an important field of enquiry to inform public social policy... Show moreBackground: Why issues get on the policy agenda, move into policy formulation and implementation while others drop off in the process is an important field of enquiry to inform public social policy development and implementation. This paper seeks to advance our understanding of health policy agenda setting, formulation and implementation processes in Ghana, a lower middle income country by exploring how and why less than three months into the implementation of a pilot prior to national scale up; primary care maternal services that were part of the basket of services in a primary care per capita national health insurance scheme provider payment system dropped off the agenda. Methods: We used a case study design to systematically reconstruct the decisions and actions surrounding the rise and fall of primary care maternal health services from the capitation policy. Data was collected from July 2012 and August 2014 through in-depth interviews, observations and document review. The data was analysed drawing on concepts of policy resistance, power and arenas of conflict. Results: During the agenda setting and policy formulation stages; predominantly technical policy actors within the bureaucratic arena used their expertise and authority for consensus building to get antenatal, normal delivery and postnatal services included in the primary care per capita payment system. Once policy implementation started, policy makers were faced with unanticipated resistance. Service providers, especially the private self-financing used their professional knowledge and skills, access to political and social power and street level bureaucrat power to contest and resist various aspects of the policy and its implementation arrangements - including the inclusion of primary care maternal health services. The context of intense public arena conflicts and controversy in an election year added to the high level political anxiety generated by the contestation. The President and Minister of Health responded and removed antenatal, normal delivery and postnatal care from the per capita package. Conclusion: The tensions and complicated relationships between technical considerations and politics and bureaucratic versus public arenas of conflict are important influences that can cause items to rise and fall on policy agendas. Show less
This dissertation contributes to the study of Nkrumah’s Pan-African policy by examining the role played by three Ghanaian institutions specifically created to support African liberation and unity:... Show moreThis dissertation contributes to the study of Nkrumah’s Pan-African policy by examining the role played by three Ghanaian institutions specifically created to support African liberation and unity: the Bureau of African Affairs, the African Affairs Centre, and the Kwame Nkrumah Ideological Institute of Winneba.Between 1957 and 1966, these institutions have worked for supporting African liberation movements both in Ghana and on the battlefields. Moreover, they contributed to spread Pan-Africanism and Nkrumahism in the whole continent.After the recovery of important new sources, the author has been able to adopt Accra’s own perspective on the question and to provide an insight into the daily activities of the three institutions examining the impact of their activity on African liberation movements and on the Ghanaian state. Show less
This paper is about Kete Krachi. It discusses the various historical changes that took place after the area had contact with Germans. The paper points out the profound impact that colonialism had... Show moreThis paper is about Kete Krachi. It discusses the various historical changes that took place after the area had contact with Germans. The paper points out the profound impact that colonialism had on KeteKrachi. The author argues that chieftaincy, boundaries, allegiances trade and agricultural systems were reshaped by colonial policies and institutions under German rule in Kete Krachi. Show less
The documented analysis of the forest offences revealed eight forest offence types with prevalent cases being chainsaw milling, illegal logging and illegal farming. Between 2005 and 2010, the... Show moreThe documented analysis of the forest offences revealed eight forest offence types with prevalent cases being chainsaw milling, illegal logging and illegal farming. Between 2005 and 2010, the district recorded 121 offences with more offences occurring in the on-reserve areas than in the off-reserve areas. The timber species, which was most exploited illegally is Triplochiton scleroxylon (wawa), a scarlet star-rated species, which is under imminent economic threat. Analyses of the official records revealed lapses in record keeping since there are no references to the outcomes of most offences, especially those relating to cases under investigation by the Police and Regional Forest Services Division. A call for capacity development of the frontline staff of the Forest Services Division at the District levels is paramount especially in detecting, collecting, entering and analyzing forest offences cases and outcomes as well as training in forest investigation and incident management. Furthermore, equipping the district offices with the requisite technological equipment like computers and accessories, software and real-time Global Positioning System (GPS) trackers will enhance effective monitoring and data management of forest resources especially when Ghana is committed in ensuring timber legality under the Voluntary Partnership Agreement. Show less
Background Many African countries experience a protracted epidemiologic transition, different from the classical transition in western societies. The factors driving this protracted transition are... Show moreBackground Many African countries experience a protracted epidemiologic transition, different from the classical transition in western societies. The factors driving this protracted transition are largely unknown. In northeast Ghana, we studied an ongoing epidemiologic transition and investigated the effects of socioeconomic status and drinking water source on the transition. Methods During a 9-year period, we followed a cohort of almost 30 000 individuals and collected information on mortality and fertility rates. In addition, using the standards set out by the WHO, we obtained the causes of death by verbal autopsy. Individuals were stratified according to their socioeconomic status and the households' use of an improved or unimproved drinking water source. Results Mortality rates decreased by −5.0% annually (p<0.001) and the main cause of death shifted from infectious to non-infectious diseases (p=0.014). General fertility rates and child-women ratios decreased annually by −12.7% (p<0.001) and −11.9% (p<0.001), respectively. There was no difference in the decline of mortality and fertility depending on socioeconomic status or drinking water source. Show less
Dietz, A.J.; Rutten, M.M.E.M.; Bergh, M. van den; Foeken, D.W.J.; Hees, S.; Hemsteede, R.; ... ; Veldkamp, F. 2014
Conflicts undermine forest-based livelihoods for the rural poor. Conflict management is key to preventing such conflicts. This article analyzes actor perceptions of forest- and tree-related... Show moreConflicts undermine forest-based livelihoods for the rural poor. Conflict management is key to preventing such conflicts. This article analyzes actor perceptions of forest- and tree-related conflicts and conflict management in Ghana's high forest zone. It also assesses a phased methodology that promotes shared problem definition and ownership of recommendations on conflict resolution strategies through the presentation and discussion of findings from document analysis, surveys, interviews, and focus-group discussions at a workshop with forest professionals held in Kumasi, Ghana. The study found that conflicts are inherent in forest-based livelihoods due to policy and legislative failures and institutional deficiencies, perceived goal incompatibility, opportunities for interfering with the attainment of one another's goals, and environmental scarcity. Ongoing forest governance reforms in Ghana should consider the stepwise conflict management model developed by the workshop participants involved in this study, but expand it to include the views of other stakeholder groups. Show less
This article is a historical study of a 'motor road' linking the north of the Gold Coast (present day Ghana) to the South. Historians concerned with routes and trade in nineteenth century Gold... Show moreThis article is a historical study of a 'motor road' linking the north of the Gold Coast (present day Ghana) to the South. Historians concerned with routes and trade in nineteenth century Gold Coast usually end their accounts at the onset of colonial rule. While studies that concentrate on transport development in modern periods make little reference to the motor road linking Kumasi to Tamale and beyond. Difficulty in communication between the north and the south of Gold Coast, led to the construction of the Great North Road. Northern labourers, the majority of them Dargarti, Frafra, Vagla, Kanjarga (Builsa) among others played a critical role in the road construction. Women also played an important part in the construction as they ensured that food was prepared for the labourers without which it would have been impossible for work to go on. In 1920, the road was completed and the first motor vehicle driven by the then Governor Guggisberg arrived in Tamale in April of that year. The Great North road aside facilitating the work of administrators, also played a significant role in moving a variety of trade goods such as cattle, goats, fowls, Shea butter, corn, groundnuts and migrants to the south. The north also received southern goods especially salt and beer and other European products such as soap, sugar, cloths, bicycles among others. The opportunities offered by the road in terms of ease of travel and trade encouraged the development of settlements on the road and the urban expansion of Salaga and Tamale. Show less
Mens, S.P. van; Aryeetey, Y.; Yazdanbakhsh, M.; Lieshout, L. van; Boakye, D.; Verweij, J.J. 2013
Stigmatization of people associated with HIV can be devastating, even more so than the virus itself. It destroys the lives of HIV positive people and their loved ones. All too often in Ghana, those... Show moreStigmatization of people associated with HIV can be devastating, even more so than the virus itself. It destroys the lives of HIV positive people and their loved ones. All too often in Ghana, those with no direct HIV experience do not see the depth of the impact of stigma on individuals, households and communities. This monograph, the result of fifteen months of ethnographic fieldwork in two communities in Ghana, brings to the fore the lived experiences of people infected with and affected by HIV from their own perspectives. In particular, their negotiations between resignation to fate and the struggle for survival as they cope with stigma are presented. Significantly, this book shows that being infected with or affected by HIV is as much a social issue as a medical one, and those associated with HIV/AIDS require more than medical care and support. Concerted efforts by all stakeholders - social and political leadership, the untested, the uninfected, the infected, the affected, service providers and policy makers - would go a long way to reduce the main problem that persists with regard to HIV prevention and treatment in Ghana: stigma. Show less
This paper analyzes forest governance and conflict management in the Ghanaian forest sector from the perspective of forest experts. It does so by applying interactive governance theory (Kooiman et... Show moreThis paper analyzes forest governance and conflict management in the Ghanaian forest sector from the perspective of forest experts. It does so by applying interactive governance theory (Kooiman et al. 2005, 2008) to characterize the governing system in terms of governance modes, actors and elements. Show less
This publication provides a set of guiding principles for constitutional reform on the basis of practical experiences of constitutional reform processes in selected countries: Bolivia, Ghana,... Show moreThis publication provides a set of guiding principles for constitutional reform on the basis of practical experiences of constitutional reform processes in selected countries: Bolivia, Ghana, Indonesia, Iraq, Kenya, Malawi, Zimbabwe and South Africa. The focus is on the role of political parties in constitution-building processes. The publication shows that although country-specific reform processes may be unique in terms of objectives, context, popular involvement, and achievements, they go through similar phases: preparatory, consultative, drafting, and implementation. All cases illustrate the political nature of constitutional reform and the central role of political parties in the process. [ASC Leiden abstract] Show less
