Linking Community Initiatives to National Institutions: Ghana

The ILO has developed an innovative concept of global solidarity for social security — the Global Social Trust — which supports the development of national social protection systems through international financing. The concept is ready to be tested nationally and the present paper proposes a pilot project for Ghana. The paper considers the virtues and weaknesses of developing‐country social security healthcare systems and community‐based voluntary insurance schemes, their lack of informal sector coverage on the one hand and their financial disequilibria on the other. It outlines the socio‐economic and macro‐policy context of Ghana and the current health policy environment. It argues for a fusion of the social health insurance and mutual health organization concepts in Ghana, thus linking community initiatives to national institutions, enhancing coverage and the quality of services for all. The paper outlines a basic model that could apply to Ghana, its organizational structure, practical functioning, financing arrangements and expected outputs. In particular it seeks to develop a model for the cross‐subsidization of insurance premiums for the poor. It describes a concept that would combine local ownership initiatives with national responsibility and financing, arguing for a truly interrelated network of social protection. The authors welcome feedback and comments from the wider social security audience.