State Corporatizaton of Social Services: A Study of Ghana’s Experiment in the Health Sector

University of Ghana Business School Ghana

University of Ghana Business School

Accra, Ghana

State Corporatization of Social Services: A study of Ghana’s Experiment in the Health Sector

Background

In many countries, whether developed or developing, the state has always had a role to play in the delivery of essential public goods. A major argument advanced in favour of state participation in the production of public goods revolved around the issue of market failure and the quest for equity and fairness. However, the upsurge of conservative ideas in the late 1970s and early 1980s, and the argument that the public sector constituted a grossly inefficient machinery popularized neoliberal propositions for the production and distribution of public goods. Several countries in Europe have employed neoliberal channels to produce and distribute public services, especially those with commercial significance (i.e. utilities, public transportation etc.).

Although the existing literature is not conclusive on the benefits of using neoliberal vehicles to produce and distribute public goods, there are countries especially in Africa that seek to expand the use of neoliberal vehicles (i.e. the use of pure private sector principles and mechanisms) for the production and distributions of critical social services such as health and education. In Ghana for example, the policy of government in the recent past has been that public institutions seeking funds to support their operations, borrow on the strength of their balance sheet. This means that such organisations will be responsible for the repayment of such funds borrowed and not the central government. This also implies that such state organisations may need to operate purely as commercial entities to be able to repay such loan, thus undermining their social welfare function.

The subject matter of this course is a 650, 420 and 130 bed hospitals constructed with public funds. The first two are run by pure state-owned organisations, with funds for the construction of the hospitals secured by the central government, but on the basis that the hospitals will work to repay the loan. On the other, the last one is run by a quasi-state-owned organization with the funds for the construction provided from the operations of the parent organisation. Against the background of high levels of morbidity and mortality, poverty and the ever-increasing levels of inequality in Ghana, the key question that remains to be answered is whether neoliberal models for the production and distribution of critical social services such as healthcare will maximise the social welfare function of the Ghanaian citizen?, and  if so, under what condition will such experiment be successful?

Course Objective

The objective of this course is to help participants to

  1. Understand the nuanced nature of the production and distribution of social services in the context of developing countries such as Ghana.
  2. To explore the appropriate use of neoliberal vehicles for the production and distribution of social services

Scope of the Course

The course is be made up of two parts; classroom work that is expected to take about 50% of the time of participants in the course and field work expected to cover the remaining 50% of participants’ time.

The classroom work will cover two sub-modules as spelt out in detail below:

  1. Literature, History, Models and Context of State Corporatization

This aspect of the course is possibly the most important, and seeks to help participants to understand capitalist development from the mid-1970s through the concept of ‘neoliberalism in relation to society, economics, politics and culture. The objectives of this aspect of the course will be to:

  1. introduce participants to the idea of “neoliberalism” as a means of understanding capitalist development since the mid-1970s;
  2. explore neoliberalism as a totality, showing the inter-relationship between economy, polity, society and culture; and
  3. show how social theory in general and sociology in particular has responded to neoliberalism.

By the end of this very important sub-module, participants are expected to be able to:

  1. explain the extent to which neoliberalism constitutes a distinct stage in the development of capitalism;
  2. identify the different phases of the neoliberal era, from its origins through the successive ‘vanguard’, ‘social’ and current ‘crisis’ modes
  3. assess the different theoretical approaches to neoliberalism, ranging from those who see it as primarily ideologically-driven to those who see it primarily as a pragmatic response to economic crisis
  4. judge the extent to which neoliberalism involves both continuity with and change from the previous period of ‘embedded social-democracy’
  5. Use the above as a lens to understand neoliberal transitions in Ghana

Reading Materials:

  1. David Harvey (2007) A Brief History of Neoliberalism, Oxford University Press, Oxford.
  2. Steger, M. B. and Roy, R. K. (2010) Neo-liberalism, A Very Short Introduction, Oxford University Press, Oxford.
  3. Agyenim-Boateng, C., Stafford, A. and Stapleton, P. (2017) ‘The role of structure in manipulating PPP accountability’, Accounting, Auditing & Accountability Journal, Vol. 30 Iss: 1, pp. 1-26

Facilitator

 

  1. Strategy

This module will help participants to understand the complexity of managing such complex transitions especially from a purely public not-for-profit orientation to that of a public for-profit orientation. The focus of this module will be threefold as below:

  1. The political implications of managing such a complex change and will include
    1. the concept of change
    2. reaction to change
    3. strategies for managing such complex changes

 

  1. The role of a strong corporate strategy for managing such a complex change and this will focus on the role of the following on the probability of success:
    1. understanding of the markets
    2. existence of a mission and vision
    3. medium-term strategy with corresponding tactical plans
    4. knowing the revenue and cost implications of the medium-term strategy

Reading Materials:

  1. Cameron, E., & Green, M. (2015). Making Sense of Change Management: A Complete Guide to the Models, Tools and Techniques of Organizational Change (4th Ed). London; K
  2. Luke, R.D., Walston, S.L., & Plummer, P.M. (2004). Healthcare strategy: In pursuit of competitive advantage. Chicago, IL: AUPHA-HAP

Facilitators:

The second aspect of this course will be practical (consulting) work to be undertaken by participants. The rational is to test the ability of participants to apply the theoretical knowledge acquired in analyzing complex practical problems. The practical work will revolve around the three hospitals mentioned above. Specifically, groups will be formed around functional areas (e.g. marketing, finance, human resources etc.) to evaluate the adequacy and appropriateness of strategies put in place by the three hospitals to carry out their operations. The evaluation will be based on background information that will be sent to students before arriving in Ghana, information gathered from visits to the said hospital by participants during the course and finally participants’ knowledge of the healthcare market in Ghana and for that matter Africa. Each of the functional teams will be expected to prepare a report (in summary form) capturing their diagnosis and recommendations for improvements. Based on the reports of the functional teams, participants will work together to produce a unified corporate roadmap that captures strategic actions to be taken by the hospitals both in the short, medium and long term.

To ensure that participants are able to appropriately handle this aspect of the course, we advise that they spend time privately to gather adequate and appropriate information on the healthcare market in Ghana and for that matter Africa.

Why do you have to come to UGBS?

We are of the view that we have provided you a compelling reason for you to come to Ghana. First and foremost, the course, “State corporatization of Social Services” constitute an important conversation which is high on the agenda of both developed and developing countries. The opportunity to have such an important conversation with diverse perspectives (geography, culture, economic and political systems etc) will be incredible. Besides the above, the opportunity to practically evaluate how hospitals involved in such a complex change environment have or are handling their operations will be an incredible experience.

Note also that there will be tea breaks and lunch will also be provided free of charge. In addition to this, UGBS will make available a bus to send participants to some of Ghana’s most beautiful and historic sites and participants will not need to pay any fee of the services of the bus.