Getting to the Roots: Constitutional Rules and the Zero-Sum Politics of Winner-Takes-All in Ghana

Ghana’s democracy is plagued by zero-sum politics usually described as winner-takes-all. Winner-takes-all is political behaviour involving post-election distribution and redistribution of public resources to reward political loyalists, with or without considerations for competence and merit. A key mechanism for this is the appointment of such loyalists to public offices that control key national resources. Although winner-takes-all is seen as a cancer cell in the country’s democracy and politics and has often been condemned by the citizenry and civil society organizations alike, it has become behaviour of choice for all political parties once they win the mandate to govern. This study analyses the institutional basis of contemporary democratic politics in Ghana, focusing on the rules, and argues that winner-takes-all is a rational response by political actors to the incentives and opportunities offered by specific formal and informal rules of the country’s democracy. The argument is shaped by a careful analysis of specific legal provisions that incentivize political actors to act in that manner. The study makes two important contributions to our understanding of contemporary Ghanaians politics. First it provides an alternative perspective that suggests that winner-takes-all is an effect and not a cause of the country’s governance challenges, and second it draws attention to the centrality of rules and their design in shaping political behaviour. Keywords: Rules, Democracy, Winner-takes-all, Zero-sum, institutions, Ghana, Politics, Law DOI: 10.7176/JLPG/99-08 Publication date:July 31st 2020

Citizenship and Health Reform: An Analytical Review of the Politics and Institutional Arrangement of Ghana’s National Health Insurance Scheme

Recent studies on health financing reform in Ghana have focused on the institutional legacies and political forces underpinning the dramatic shift from “cash-and-carry” to policy initiatives that find expression in universalism and social inclusion. Yet little attention has been paid to the complex interactions between institutional and ideational elements that account for the policy failure of Ghana’s National Health Insurance Scheme (NHIS). Drawing primarily on government records, published books, articles and newspaper publications, we argue that formulating appropriate financial reform strategies requires a proper understanding of how national identities intersect with, and shape the politics, design, and operation of social programs to inform policy outcomes. The article suggests that the sustainability of Ghana’s NHIS rests on strategic reform measures including, cost containment, diversified funding and operational arrangement, as well as depoliticization of the health regime. Keywords:Health insurance, health politics, social protection, social citizenship, cost recovery, health financing DOI: 10.7176/PPAR/11-1-05 Publication date: January 31st 202

A profile of social isolation and the influence of demographics in older persons living in residential care, Durban, South Africa

Introduction: Residential care settings have shown high social isolation rates with incumbent risks necessitating measurement to formulate health promotion policies. Objective: To measure social isolation levels in older persons living in a lower socio-economic residential care setting in South Africa. Method: A cross sectional survey with older persons from four inner city residential care facilities. A researcher administered questionnaire was developed based on the Working Paper No.66, Oxford Poverty and Human Development Initiative. Data were analysed to describe social isolation and assess the influence of demographics. Results: The response rate was 72.14% (n = 277) and representative of the residential care population for age and gender. Nearly half of the respondents (47.3%) met criteria for social isolation in terms of social network support and density and almost 20% for perceived isolation through decreased levels of friendship. Conclusion: Although residential care does not prevent social isolation, the residents in the setting may provide a buffering in the provision of some social suppor

Reciprocity, Mutuality, and Shared Expectations: The Role of Informal Institutions in Social Protection in Africa

Contemporary research in institutional analysis shows that institutions, broadly defined to include rules, policy, laws, conventions, shared expectations, and repeated practices, are instrumental in shaping human behaviour. This insight raises questions for understanding the dynamics of social care and protection in African countries where formal and informal institutions interact and compete in an environment characterized by two publics. Analytically, African countries reflect the notions of modern state, however due to their inability to connect with majority of the population informal rules practices that derived their logic of appropriateness and legitimacy from familial and kinship relationships have become essential institutional rules that mediate interaction and social exchange in social protection and beyond. The overbearing influence of informal institutional practices is however often ignored in the scholarly analysis of development and policies in the region, and this is due partly to a narrow focus on formal institutional reforms and a penchant for perceiving informality as deviant behaviour. This paper discusses the interface between informal institutions and social protection in Africa and draws attention to the role such institutions play in shaping the incentive structures and choices of political actors and citizens as well as the implications of informality in sub-Saharan African countries for broader socio-economic transformation