Implementation Challenges of the National Health Insurance Scheme in Selected Districts in Ghana: Evidence from the Field

Ghana’s National Health Insurance Scheme, introduced in 2003, aims to remove financial barriers to health-care access and bridge the inequality gaps in health care. This paper reports on a study of the implementation process in four local government areas in southern and northern Ghana. The paper profiles key institutional actors and draws on qualitative interview data from 33 in-depth interviews. Findings highlight the gaps and challenges that have emerged in the implementation process. Issues of managerial capacity, inadequate and uneven distribution of medical facilities and health-care professionals, cost escalation, fraud and abuse, and reimbursement of providers threaten the sustainability of the scheme.     

Too Many Black Men: The Sentencing Judge's Dilemma

Legal reform sometimes has unanticipated, even ironic, results. A good example is federal legislation adopted in the 1980s that was supposed to enhance equity in sentencing. Congress, like many state legislatures in this period, reduced judicial control over sentencing by adopting presumptive sentencing guidelines for all serious criminal offenses and mandatory sentences for some specific crimes. Reformers did succeed in reducing judicial discretion in the sentencing process, but racial disparities have gotten much worse. Unprecedented numbers of minorities, particularly black men, are going to jail for long terms. The situation leaves trial judges in a difficult position. They are legally bound to implement a sentencing regime that many of them believe is racially discriminatory. Herbert Jacob's work on criminal trial courts provides a framework for investigating this problem. As Jacob's organizational approach predicts, judges were initially more troubled by the diminution of their powers than by the emerging pattern of increased minority incarceration. Nevertheless, some judges have criticized the racial implications of the sentencing law, protesting in various, resourceful ways. Judicial resistance to a law on moral grounds, though rare, is significant because it represents a break in the ranks of officialdom that enhances the moral credibility of critics of the current law.     

Penal harm and unusual conditions of confinement: Inmate perceptions of ‘hard time’ in jail

Despite the increasingly punitive public policies of the past three decades and the concomitant ‘get tough’ rhetoric aimed at reducing prison and jail amenities, little is known about inmates’ perceptions of punishment. Prison and jail administrators often justify their efforts to increase the “pains of imprisonment” for incarcerated offenders on the basis of retribution and deterrence, but these policies appear to be more symbolic than substantive in nature. Using interview data from 232 inmates about to be released from a large county jail renown for its ‘get tough ’ policies, this study examined inmate perceptions of their unusual conditions of confinement. Findings suggest that many of these policies were benign or even counterproductive to the extent that they promoted a defiant response from offenders.     

Forensic odontology lessons: multishooting incident at Port Arthur,Tasmania

On Sunday 28 April 1996 a lone gunman killed and injured many people at the historic penal settlement ruins at Port Arthur in South Eastern Tasmania, Australia. Thirty-two victims were shot dead and 19 were injured in a short time inside a cafe and along the roadway leading to the site entrance. The gunman then took one hostage to a nearby guest house which was occupied by a married couple. Police stood siege during the night. Early the next day the cottage began to burn and a man suspected to be the gunman eventually ran unarmed from the building with his clothes alight and was arrested. The house burned to the ground. Three bodies were later located in the burnt ruins. Forensic odontology played a role in the retrieval of evidence and identification of the incinerated victims. Lack of antemortem dental records for one victim necessitated the reliance on a single CT scan radiograph for matching with the remains. Fire scene procedures, evidence collection and other issues were reviewed. The overwhelming scale of this tragedy and its adverse effects on the Tasmanian community, especially the victims' families and survivors, cannot be overestimated. While acknowledging this, it is important that lessons are learnt from tragedies such as these. This paper is presented with a view to assisting forensic odontologists in the investigation of complex incidents.