Abstract

The individuals and other actors’ involvement in policy processes is informed by their own perceptions about their ability to influence social outcomes through participation. Using the implementation of Ghana’s National Health Insurance Scheme (NHIS), this chapter assesses the democratisation of policy implementation processes. It establishes policy underperformance in challenges of policy alienation like unbalanced power relations and information asymmetry in favour of official policy actors over policy beneficiaries and other non-authoritative players in the implementation of the NHIS. The relevant community structures are not engaged, and there is little room for beneficiaries to provide feedback to implementers. We show how common non-participatory approaches can hinder democratic policy implementation frameworks in Africa. This calls for the ‘operational democratisation’ of the implementation process to guarantee active engagement and participation of all stakeholders for better governance.