The Politics of State Welfare Expansion in Africa: Emergence of National Health Insurance in Ghana, 1993-2004

Abstract

After years of military rule, Ghana returned to democratic governance in January 1993. Since then, it has consolidated its democracy, evidenced by seven successive general elections, three alternations of power, and institutional actors using the rules of the game to pressure elected officials to influence policy development and implementation. This article examines the passage of massive state expansion of welfare legislation in 2003, the National Health Insurance Law (Act 650). I argue that not only was healthcare reform a salient issue in the 2000 general elections, the new law was the result of civil society and citizen pressure on the governing New Patriotic Party to fulfill its campaign promise to overhaul the country's healthcare system. This article contributes to the literature on the welfare state from the developing world, which mostly focuses on Latin America and Asia.