What Should Macroeconomists Know About Health Care Policy: A Primer

The contribution of community leadership upon the performance of mutual health organisations in Ghana

PURPOSE

The purpose of this paper is to investigate the effect of social dynamics on the performance of mutual health organisations (MHOs) exploring the influence of community wealth and community leadership on policy implementation.

DESIGN/METHODOLOGY/APPROACH

Four operating district mutual health insurance schemes were selected using geographical locations, among other criteria, as case studies. Data were gathered through interviews and documentary review. The findings were analysed using community field and social capital theories.

FINDINGS

Traditional leaders like the Chiefs serve as the pivot around which social and human capital of the communities revolve in the developmental process of the country.

RESEARCH LIMITATIONS/IMPLICATIONS

Lack of exhaustive examination of the financial and institutional viability issues of the MHOs. Future studies could assess the interplay between financial, institutional and social viability models when measuring the financial and overall sustainability of MHOs.

PRACTICAL IMPLICATIONS

Health policy makers need to involve traditional leaders in the formulation and implementation of national policies since their acceptance or rejection of central government policy could have negative consequences.

SOCIAL IMPLICATIONS

Ghana is a dynamic country and there is the need to utilise existing social networks: inter-family and inter-tribal relationships to ensure the viability of MHOs.

ORIGINALITY/VALUE

There is and can be a successful interplay between public sector funding and community sector revenue mobilisation for financing the health sector in Ghana. This justifies the complementarity between government funding and community's resource mobilisation efforts in the health sector.

Health sector policy in the first decade of Nepal’s multiparty democracy

Nepal experienced a significant political regime shift in 1990 from the partyless Panchyat system to the present multiparty form of democracy. While political instability existed in the decade of the 1990s, reflected in the approximately one government per year, there had been continued enunciation of health policy priorities toward the rural sector, as reflected in the Nepal National Health Policy, 1991 (NHP (1991)) and subsequent plans. The objective of the paper is to assess whether clear enunciation of health priorities have translated into beneficial health outcomes, reflected in reduction of the child death rate, child morality rate, infant mortality rate and increase in the life expectancy rate. This question is assessed empirically over the 10-year period of fiscal year 1989/1990 to 1999/2000 using mainly secondary data published by His Majesty's Government of Nepal (HMG/N), through the perspectives of input-output model and extension of health services, along with an indicative regression of a Nepalese health production function. The results (i.e. empirical observations) suggest that while there have been clear enunciation of health priorities, there have not been significant positive effects on health sector outcomes. The paper ends with a number of recommendations and concludes with the necessity for effective and appropriate implementation.