Social protection, state capacity and citizenship building in Ghana: Do quasi-universal insurance and targeted social assistance policies generate different feedback effects?

Abstract

Social protection has gained global prominence as a viable policy instrument for inclusive development and has also been promoted as a means of building social contracts through generating socio-political feedback effects. Lessons from some welfare states suggest that if implemented well, programmes may improve state-society relations by building the capacity of states in delivering public services and increasing levels of citizenship voice and participation. Yet, recent research on social protection is deficient in two respects: first, most policy evaluations emphasise technocratic dimensions like income and human development indicators with little attention on socio-political effects; second, the growing focus on the politics of social protection has so far been largely limited to issues of adoption and implementation. Claims about the feedback effects of social protection draw largely on policies with universalistic approaches within contexts where welfare provisioning has advanced furthest. In contrast, most programmes in developing countries are targeted and relatively short-lived. In this thesis, I problematise the causal link between social protection and socio-political feedback effects through case studies on Ghana’s two largest social protection programmes, namely the country’s National Health Insurance Scheme (NHIS) and its flagship cash transfer programme, the Livelihood Empowerment Against Poverty (LEAP). I interrogate the proposition that quasi-universal insurance and targeted social assistance programmes may generate different feedback effects on state capacity and citizenship building. The thesis is based on an in-depth mixed methods study conducted over an 11- month period. Overall, I find evidence of positive effects of LEAP and (in particular) NHIS on state capacity but only weak effects on citizenship building from both programmes. The limited effects are partly due to the way in which the policies are designed (e.g. lack of effective social accountability mechanisms), promoted and delivered (e.g. as a form of patronage), and differences between the ways in which these interventions conceive of citizenship and the social realities of citizenship as a relational phenomenon in Ghana. The thesis provides important lessons for policy actors in their recent efforts to strengthen the social contract between the state and citizens in developing countries through the expansion and consolidation of social protection.

Date of Award	31 Dec 2020
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Thomas Lavers (Supervisor) & Samuel Hickey (Supervisor)