Paper short abstract:

Based on oral histories, a study of generational memories of the shifting diffusion of 'global health' policies in Ghana from 1966-2018 - the implication of these policy shifts and diffusions for conceptions of the public good and an equitable provision of health services.

Paper long abstract:

From 1966, following the overthrow of sub-Saharan Africa's first independent government, Ghana's health system entered a period of relative stasis and dissolution. Although its achievements were uneven and not sustained, the independence-era government had invested in the expansion of some health services, guided by 5-year national plans. The country was ruled by six governments in the 15 years from 1966-1981, when the authoritarian government of Jerry Rawlings took power - at a time of apparent reform and renewal in the world of international health. Rawlings oversaw the imposition of Structural Adjustment in Ghana, and the country's return to multi-party elections in 1993. From the mid-1960s and into the era of Structural Adjustment, health services in Ghana declined. Since the late 1990s they have entered an unsteady phase of renewal, with the creation of a community-based health service and a national health insurance scheme. In the past decade talk has turned to Universal Health Coverage, an imprecise term with many possible meanings and implications.

Based on interviews with officials who oversaw health services from the 1970s to 2018, and with healthworkers and communities who witnessed successive changes from the 1950s, this paper discusses how shifting policies, aspirations and debates about financing - emerging at the international level from specific constellations of actors - diffused by various routes to shape Ghana's health system over time. It examines the effect that these changes may have had on generational expectations for health services, and discusses the value of oral history for postcolonial health research.