Do new democracies deliver social welfare? Political regimes and health policy in Ghana and Cameroon

Democratic reform processes often go hand in hand with expectations of social welfare improvements. While the connection between the emergence of democracy and the development of welfare states in the West has been the object of several studies, however, there is a scant empirical literature on the effects of recent democratization processes on welfare policies in developing countries. This is particularly true for Africa. In a dramatically poor environment, Africans often anticipated that the democratic reforms many sub-Saharan states undertook during the early 1990s would deliver welfare dividends. This article investigates whether and how the advent of democracy affected social policies – focusing, in particular, on health policy – by examining one of the continent’s most successful cases of recent democratization (Ghana) and comparing it with developments in a country of enduring authoritarian rule (Cameroon). Evidence shows that democracy can indeed be instrumental to the expansion and strengthening of social policies. In Ghana, new participatory and competitive pressures pushed the government towards devising and adopting an ambitious health reform. Despite fac¸ade elections, no similar pressures could be detected in undemocratic Cameroon and health policy remained almost entirely dictated by foreign donors.