Dialogue as a tool for improving policy implementation: Lessons from Ghana

Implementation research has often tended to focus on what goes wrong or, less frequently, on why success is achieved, rather than identifying tools or instruments to address problems encountered. Yet, identifying tools to avoid typical implementation problems is crucial to successful implementation. Focusing on one such tool, ‘policy dialogue’, and employing a retrospective examination of the implementation process associated with Ghana’s National Health Insurance Scheme (NHIS), we examine the potential that existed to mitigate the risks associated with policy stakeholders’ behaviour during implementation. Policy actor positions in implementation are based on differing values, ideologies, perceptions and power bases, and frequently cause degrees of discordance, as demonstrated in the case of Ghana’s NHIS. Policy dialogue may promote a greater awareness of other actors’ positions and motivations, creating a circumstance in which evidence takes on more significance than it would in more political environments. The study draws extensively from earlier qualitative fieldwork in Ghana, and has been supplemented by desk-based research. Selected key events in the implementation of the NHIS are used to illustrate where and why policy dialogue could have been used to avoid the creation of chokepoints.