Agenda Setting And Health Policy Formulation Process In Ghana

Introduction

Agenda setting and policy formulation process in health policy are complex, intertwined, and do not follow a predetermined path (Koduah, van Dijk & Agyepong, 2015). Understanding the processes of health policy formulation is very key to ascertain why some policy issues remain and are sustained on the agenda-setting, whiles others are drop off. This is because putting and keeping policy issues on the agenda is an important component of policy-making decisions (Awenva et al., 2010).

Agenda setting is the problem-sorting stage in the process of policy (health policy), during which some issues attract policy maker’s attention while others stay ignored (Flisher et al, 2007). In the works of Awenva et al. (2010), they argue out that, how power and authority is practiced by those who hold it; is key in understanding health policy agenda-setting. Furthermore, the prominent agenda-setting process model theorizes that the policymaker’s attention is raised on issues with solutions, political engagement, and avenue for the opportunity.

Literature has revealed that, there is a broad range of explanations as to why some health issues make it on the agenda and others fail. According to Green-Pedersen and Wilkerson (2006), Koduah, van Dijk, and Agyepong (2015), some are systemic, emphasizing how institutions are structured to take benefit over others of some alternatives. Cognitive factors emphases how knowledge is processed at any specified moment by people or even organizations and this may/not restrict what will be resolved. In addition, role of external bodies or government views, and how they combine with political incentives, to move attention rapidly to maiden developments adds to why some policy issues drop off the agenda setting table.

History of HealthCare Financing Policy in Ghana

According to Anyinam (1989) cited in Alatinga and Williams (2014), formulation and development of modern health policy in Ghana took place under the rulership of Sir Gordon Guggisber, the then Governor of Gold Coast. His leadership also developed health policy which instituted free medical care for the European officials. Access to free medical and healthcare was later expanded to include 0.02% of the African population living in Ghana , and these category of people included people working in the civil and public service (Alatinga and Williams (2014).

In 1930 a proportional user-fee system was introduced in the Gold Coast for people seeking health care in public facilities, in line with the concept of financial accessibility. People working within the formal sector were charge lower user fees for assessing healthcare services within the public sector. However, people working in the informal sector where not directly considered in the proportional lower fee policy (Alatinga & Williams, 2014; Konotey-Ahulu et al., 1970)

It is also important to note that medical doctors were permitted to collect personal professional charges under the colonial health policy despite the reality that they worked in public health centers. According to Konotey-Ahulu et al. (1970), as at 1954, the medical policy required that patients assessing public hospitals for their health care needs to pay professional, dispensary, and drug fees. This requirement by the policy created financial burden on the side of the patients and impediment to access health care. Notwithstanding this, the poor in society were not exempted from paying fees to access healthcare in public facilities under the colonial medical policy.

In another development, the policy for free medical care to the very poor in society did not make it clear on the determination of who is poor and who is not. This gave the medical doctors and the Director of Medical Services the privilege to decide at their own discretion; who is poor and who is not poor. A report of a study conducted by Konotey-Ahulu et al. (1970) mentioned that practice continued till independence.

A study by Kooney (2007) noted that the first maiden policy direction by Dr. Kwame Nkrumah was to abolish private medical practice by medical doctors within the public hospitals. As at the end of September 1st, 1958; the government under the leadership of Dr. Kwame Nkrumah brought a complete stoppage to the payment of professional fees by patients in Ghana, irrespective of their nationality, in government hospitals.

This decision by the government brought a remarkable increase to healthcare service utilization; as this reduced financial barrier to healthcare services by patients (Konotey-Ahulu et al., 1970 cited in Alatinga & Williams, 2014). The free medical health care in public institutions as inherited from Colonial masters in piece and extended to all citizens in full was without the exemption of mental health care.

In the works of J.B Asare (2010) he mentioned that, there are several policies that have tried to address mental health care provision in Ghana since the Colonial Era through to independence in 1957 to current time. He affirmed that in 1994, a mental health policy was formulated and revised in 2000, and 2004 with the objective of providing facilities at all levels of health care to treat various forms of mental illness.

It is interesting to note that, none of the policies on mental health which was formulated since 1994, 2000 and 2004 did not mention the treatment of mental health care to be free. One could assume that since general health care was free, mental health care was inclusive. Nevertheless, free health care policy to all citizens introduced by Dr. Kwame Nkrumah was in forced until 1966 when he was overthrown by the military rule led by Lt.General Ankrah (Konotey-Ahulu et al., 1970)

In the era of National Liberation Council, and under the leadership of Lt. General Ankrah, patients were charge lower fees for drugs, and payment of higher fees for those patients admitted into a VIP wards. The general public at that time punched and fired the government with their grievances but that could not cause any change (Alatinga & Williams, 2014).

In another development, there was a shift in the health care financing in Ghana, from lower fees paid by patient to outright free care under the tutelage of Dr. Kofi Busia. In the works of Konotey-Ahulu et al.(1970) as cited in, Alatinga & Williams (2014), the government of the day brought a complete halt to the payment of hospital fees in a press release titled “ until further noticed” in October, 16th 1969 (Konotey-Ahulu et al.,1970:19) following the public outcry on the reintroduction of hospital user fees by Lt. General Ankrah.

As days goes by, with emerging of new governments, both civilian and military rule, health sector financing went through a robust structuring depending on the ideology of the government of the day. It is worth noting, according to Arhin (2003), two years later, there was re-introduction of user fee policy through the Hospital Fee Act of 1971, hence requiring all patients accessing public health facilities to pay for their health care needs.

CHAPTER THREE: RESEARCH METHODOLOGY

3.1 Introduction

This section describes the methodology used in this research. It comprises of study design, research approach, and study population, sampling procedure and sample size, an instrument for data collection, source of data, data processing and analysis, as well as ethical considerations.

Defechereux, T., Paolucci, F., Mirelman, A., Youngkong, S., Botten, G., Hagen, T. P., & Niessen, L. W. (2012). Health care priority setting in Norway a multicriteria decision analysis. BMC health services research, 12(1), 39.

Alatinga, K. A., & Williams, J. J. (2014). Development policy planning in Ghana: The case of health care provision. European Scientific Journal, 10(33).

Awenva, A. D., Read, U. M., Ofori-Attah, A. L., Doku, V. C. K., Akpalu, B., Osei, A. O., & Flisher, A. J. (2010). From mental health policy development in Ghana to implementation: What are the barriers?. African Journal of Psychiatry, 13(3).

Koduah, A., van Dijk, H., & Agyepong, I. A. (2015). The role of policy actors and contextual factors in policy agenda setting and formulation: maternal fee exemption policies in Ghana over four and a half decades. Health research policy and systems, 13(1), 27.

Green-Pedersen, C., & Wilkerson, J. (2006). How agenda-setting attributes shape politics: Basic dilemmas, problem attention and health politics developments in Denmark and the US. Journal of European Public Policy, 13(7), 1039-1052.

Flisher, A. J., Lund, C., Funk, M., Banda, M., Bhana, A., Doku, V., ... & Petersen, I. (2007). Mental health policy development and implementation in four African countries. Journal of health psychology, 12(3), 505-516.

World Health Organization. Department of Mental Health, Substance Abuse, World Health Organization, World health organisation. Department of mental health, substance abuse. Mental health, evidence, ... & Research Team. (2005). Mental health atlas 2005. World Health Organization.

Asare, J. B. (2010). Mental health profile of Ghana. International Psychiatry, 7(3), 67-68.