The political development of the Ghanaian national health insurance system: lessons in health governance

This paper from Health Systems 20/20 examines Ghana’s national health insurance system (NHIS). It describes the success of the project, for example within two years over a third of the country had enrolled, as well as some of the problems, such as design flaws and questions of sustainability. The study examines the political dynamics behind the development of the NHIS, with a particular focus on the role of health sector governance in policy development.

Thirty five interviews with key stakeholders were conducted and secondary data was also analysed. The authors found that stakeholders with political viewpoints different from the political party in power were marginalised, while party loyalists were empowered, leaving the process vulnerable to exploitation. Thus, this study argues that the political nature of health reform requires strong institutional mechanisms to safeguard transparency and accountability throughout the policy development process. Countries and their development partners must incorporate governance-related activities into their long-term health sector development plans to maximise the impact of public health policy.

[Adapted from author]