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Table 1 Summary of Ghanaian historical context and key health system events

From: Towards universal health coverage: a mixed-method study mapping the development of the faith-based non-profit sector in the Ghanaian health system

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  
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  
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   Maude Commission into policy
1967   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   PHC strategy formed (influenced by Alma Ata)
1981 Jerry Rawlings takes power through a military coup  
1985   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   CHPS launched
2000 John Kufour of the New Patriotic Party (NPP) wins election (presidency 2001–2009)  
2003   CHAG-MOH MOU signed
2004   NHIS introduced
CHAG received immediate NHIS accreditation
2005   National roll-out of CHPS
2006   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  
2011 John Mahama of NDC wins election (presidency 2012–2016)  
2016 Nana Afuko-Addo of NPP wins election (presidency 2017-present)  
  1. Source: author. This table provides a brief context of the political, social and economic history of Ghana as well as significant events in the development of the public-private health system. A detailed history and analysis of the development of the national health system is reported in a forthcoming article by Olivier and Kwamie (2018)