Table 1 Summary of Ghanaian historical context and key health system events
Alignment to Fig. 4 | Year/Timeline | Socio-Political Context | Key Health System Events (as related to FBNPs) |
|---|---|---|---|
Up to 1949 | Up to 1844 | Pre-colonial era | Little medical missionary work |
1844 | Bond of 1844: Traditional chiefs sign Bond allowing British Government to rule | Â | |
1844–1914 | Period of strong British colonial administration. Colonial structure: Gold Coast colony, Ashanti (interior), Northern Territories Protectorate | Colonial health system and infrastructure established serving largely European populations in coastal (colonial) areas Significant increase in Christian missionary activities especially into the interior but largely focused on education and evangelism | |
1914–1945 | World War I, Great Depression and World War II |  | |
1950–1969 | 1952 | Kwame Nkrumah becomes Prime Minister but shares power with British governor | Maude Commission: Recommends support of the mission health sector Throughout the 1950s, significant growth in mission hospitals |
1956 |  | Agreement around ‘agency’ hospitals – those run by missions but supported by government | |
1957 | Independence: Gold Coast becomes the independent state of Ghana | Â | |
1960 | Nkrumah becomes President (1960–1966) Period following independence characterised by massive political and economic instability | Nkrumah government has a strong focus on social development and welfare state | |
1962 | Â | Maude Commission into policy | |
1967 | Â | CHAG established | |
1970–1989 | 1975 | Continued considerable economic and political instability. | Adibo Commission: Confirms importance of mission hospitals and recommends government pays salaries in CHAG facilities |
1978 | Â | PHC strategy formed (influenced by Alma Ata) | |
1981 | Jerry Rawlings takes power through a military coup | Â | |
1985 | Â | User fees reintroduced | |
1987–1989 | Period of structural adjustment |  | |
1990–2009 | 1992 | Democratic constitution passed Rawlings wins election with National Democratic Congress (NDC) party |  |
1996 | NDC/Rawlings re-elected (presidency 1981–2001) | GHS established | |
1999 | Â | CHPS launched | |
2000 | John Kufour of the New Patriotic Party (NPP) wins election (presidency 2001–2009) |  | |
2003 | Â | CHAG-MOH MOU signed | |
2004 | Â | NHIS introduced CHAG received immediate NHIS accreditation | |
2005 | Â | National roll-out of CHPS | |
2006 | Â | Addendum to CHAG-MOH MOU | |
2008 | John Atta Mills of NDC wins election (presidency 2009–2012) |  | |
2010 onwards | 2010 | Ghana classified as a middle income country | Â |
2011 | John Mahama of NDC wins election (presidency 2012–2016) |  | |
2016 | Nana Afuko-Addo of NPP wins election (presidency 2017-present) | Â |