Transnational actors and health care reform: Why international organizations initially opposed, and later supported, social health insurance in Ghana
Bibliographic record
Abstract
Much has been written about the impact of transnational actors on health and social policy. In this article, we show how some international organizations’ efforts to prevent Ghana from enacting a social health insurance program in 2003 failed. We then explain why the Ghanaian government ignored these organizations’ advice and even excluded them from the policy formulation process altogether. Finally, we explore these organizations’ logic as they came to accept and even promote the new Ghanaian policy internationally. As argued, a temporal perspective on the impact of transnational actors and the way their prescriptions change over time is necessary if one is to capture transnational policy influence and its limitations. A temporal perspective is also important in explaining the logic of accommodation on the part of these actors, since this only becomes apparent over time. This is precisely why our qualitative analysis traces both domestic policy development and the changing nature of transnational ideas and prescriptions.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.006 | 0.019 |
| Scholarly communication | 0.004 | 0.006 |
| Open science | 0.000 | 0.004 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".