Political settlements and the implementation of maternal health policy in the developing world: A comparative case study of Rwanda, Ghana, Uganda and Bangladesh – Kelsall (2020)


This paper compares the experience of Rwanda, Bangladesh, Uganda and Ghana in reducing maternal mortality by relating their policy commitments and implementation to the underlying balance of power structures and institutions, or political settlement, that make up these countries politics. Maternal health is an important feature of the global health policy agenda; however it rarely becomes a political priority at the national level, and policy implementation regarding maternal health has been proven to be consistently inadequate. This paper explores whether political settlements, where the ruling group has a power majority, will have a better capability to implement successful policies, such as maternal health. Specifically, Kelsall address two main questions: (1) how do political settlements influence progress in maternal health?, and (2) how can better results be acquired under different types of political settlement? By analysing these questions, Kelsall argues that policy reformers should try to implement a strategy that prioritises supporting the recipient government in more dominant development settlements. Additionally, in other types of political settlements, practitioners should try and build out from pockets of effectiveness and engage non-state actors.