Paper short abstract:

Drawing on ethnographic fieldwork carried out in southwestern Ghana, the paper explores the articulations of informal networks of mental health care (developed both within and beyond institutional services) and neoliberal processes of privatisation, health commodification, and growing inequalities.

Paper long abstract:

Drawing on ethnographic research carried out between 2013 and 2022 in Nzemaland (rural southwestern Ghana), this paper focuses on the ways in which informal networks of mental health care articulate with neoliberal processes of privatisation and growing inequalities. These processes have been a feature of the Ghanaian public health system in recent decades, with the introduction in 1985 of user charges that resulted in substantially reduced access to health services for the poorer sections of the population. The launching of a voluntary prepayment financing mechanism (National Health Insurance Scheme) in the early 2000s was aimed at overcoming this failure and achieving universal health coverage. Prices of enrolment and the ineffectiveness of exemption criteria and processes, however, continue to be major factors in preventing poor people from accessing public health. Interestingly, mental health care should be an exception in this context, being technically ‘free to everyone’ – to the point where it is not even covered by the NHIS. The therapeutic itineraries of patients (and caregivers) I met in Nzemaland, however, were profoundly informed by a de facto (micro and macro) commodification of mental health that often made institutional care unavailable and/or unaffordable. In this scenario marked by scarcity, informal networks of care emerge as crucial: not only largely visible and often discussed religious resources like prayer camps, but also more concealed practices such as informal drug supply and pharmaceutical gifts and debts performed by nurses in the interstices of (an often 'impossible') formal healthcare service provision.