Some steps forward, some steps back
Ghana Social Watch Coalition
The lack of political will seems to be the main obstacle on Ghana’s road to development and human well-being, but it is not the only one. This West African country has walked a long way towards poverty eradication, food security and education to all. But it cannot yet provide medical services to all the population and despite free health care to all pregnant women, maternal mortality remains very high, as do gender inequities. In the meantime, the economy experiences a sustained growth.
Ghana’s progress in attaining the targets set out in the Millennium Development Goals (MDG) has been a mixed one. Much effort has been made to reduce the numbers of the poor, to improve food security and to increase enrollment in primary schools. But progress has not been enough to meet other MDG goals and targets. By 2007, Ghana was hailed as one of the first countries in Sub-Saharan Africa on the right track to reach the target of poverty reduction. Between 1992 and 2006 the proportion of those living below the poverty line fell from 36.5% to 18.2%.
A key target was enrollment in primary and secondary education. From 1991 to 2008 the numbers of children registered in kindergarten increased from approximately 56% to nearly 90%. In the same period primary school enrollment increased from 74%d to nearly 95%, and at the level of junior high school it increased from 70% to 79%. Strides were made on MDG Goals 1 and 2.
It has been less successful in respect of other goals and targets.
Sadly in Ghana the number of women who die during child birth remains stubbornly high. Despite progress has been made with overall maternal mortality ratios falling from 540 per 100,000 live births to 450 per 100,000 live births between 1992 and 2008, attaining the MDG target of 185 per 100,000 live births is proving to be an even greater challenge and is unlikely to be met by 2015.
One major obstacle has been the shortage of skilled health care personnel. Currently coverage by skilled birth attendants is low. There is a challenge in that there are not enough trainees to take the place of the midwives who retire. There is also a gap between rural and urban areas in terms of access to health care. Rural areas are shortchanged by less access to qualified maternal care. The distances to health care facilities and to skilled personnel are also an issue for most. A pregnant woman’s decisions with regards to medical attention also depends on her level of poverty. Poor women are less likely to seek health care except when the situation is critical.
The promotion of gender equality and women’s empowerment, Goal 3, is another target that Ghana is unlikely to meet. Instead of increasing the numbers of women in decision-making positions in the public sector, today there are even less women in key areas. For example from 25 female members of the 200 member Parliament 2000, there are currently 19 women out of 230, a drop from 10% to 8.3 %. Women make up only 16% of the ministerial positions and 10% of the deputy ministers. There are also few women in decision-making ranks at the local government level. This inequality has been attributed to a lack of commitment from the government to meet the international commitments on the matter.
The picture then …
When the international community agreed the MDGs in 2000, Ghana was emerging from three decades of economic and political falls and recovery – the debt crisis of the 70s and 80s, the structural adjustment programs of the 80s and the slow recovery in the 90s.
Between 2000 and 2008, Africa experienced a period of sustained growth, with yearly averages of nearly 5%. These were attributed to internal and external factors, among them a high demand for commodities, inflows of aid, foreign investment primarily channeled into the extractive sector, the reform of state institutions to support private capital and the institutionalization of economic liberalization. The political stability in a number of countries in the region was also a factor. In this context, Ghana has been described as a beacon of peace and reliability in West Africa, and that image attracted investments and aid and boosted the economic growth.
With an economy that remains highly dependent on minerals and primary commodities exports, the record high prices of gold and cocoa boosted Ghana’s growth. The price of cocoa, the main agricultural export of this country, soared to a 32-year high in reaching USD 3,500 per metric ton. In that same year national cocoa production also reached a high of one million metric tons. Production was also boosted by incentives given to producers – higher farm gate prices, fertilizer and spraying programs to name just two. On the other hand, gold prices topped USD 1,900 per ounce in 2011. Nearly 1.5 million ounces were produced accruing revenues of USD 2.2 billion. According to the Ghana Chamber of Mines this represented an increase of over 30%. Ghana’s economy received a further boost with the discovery of commercial quantities of oil. Production and export commenced in 2010. In an apparent sign of the nation’s growing fortunes, Ghana was declared a middle income country in 2011.
Foreign aid has been an important source of development financing. Ghana is in many ways a donor darling and over the years has received aid in the form of budgetary and projects support. From under USD 300 million during the 1990s, aid reached a peak USD 924 million in 2004. By 2009, aid to Ghana was about USD 820 million. Expert Robert Osei notes that the bulk of the aid was directed at the energy sector in the form of loans, although a high percentage of grants were directed at the health sector. He argues that government seemed to place a high premium on infrastructure investment while donors where keen to support social sectors.
While the country’s economic fortunes were improving, steps were taken to address social challenges. Up until 2003, the health care sector was known as the ‘cash and carry’ system. It required the patients to pay before receiving care. This system not only deepened inequalities – it was particularly harmful to the poor and vulnerable as well. In response, the National Health Insurance Scheme (NHIS) was introduced in 2003. Its goal was to ensure equitable and universal health care services to all Ghanaians. The system was to be funded from a 2.5% levy on all goods and services, a percentage of social security contributions as well annual premiums. Coverage was to include inpatient and outpatient services, and essential drugs as determined by the scheme. However not all medical procedures and services are covered by the new system.
The Free Maternal Health Care Policy was introduced in 2008. It offers attention to pregnant women to reduce maternal and child mortality, and to encourage ante and post natal supervision.
Prior to the MDGs Ghana had adopted the Free Compulsory Universal Basic Education Programme (FCUBE). In 2005 it introduced both the Capitation Grant and the School Feeding Programme to further encourage enrollment and attendance in primary schools.
... And now
On the surface Ghana has significantly progressed in development issues. But despite the advances, many of the conditions that disempowered the poor and vulnerable remain.
Poverty has a different face. Like several other countries that have seen sustained economic growth over the past decade, Ghana has graduated to the level of lower middle income country. Industry, services and agriculture are still the three main economic sectors. Yet despite the seemingly impressive growth, income and regional income disparities have been exacerbated in some instances – 28% of the population live with less than a dollar a day, according to the UNDP.
Women in Ghana continue to be the heavily represented among the poor. The situation is even worse in the rural areas. Systemic and structural gender disparities hinder women’s access to productive resources and to their livelihoods.
Health costs remain prohibitive for the vulnerable, even with the introduction of the NHIS. Not all health providers accepted to be part of the scheme, which does not cover all drugs for the treatment of common ailments. A number of pharmacy shops withdrew from the system in the fear that government would not pay for medicines dispensed in a timely manner. Many patients must pay over the counter for drugs covered by the scheme. Using the service can be a time consuming experience for those who can afford it.
Despite the cost-free health care policy for pregnant women, maternal mortality ratios continue to be high. This may be tied to the gaps that this policy does not address. According to the Ministry of Women and Children’s Affairs only 24% of women in the lowest quintile of income attend a health facility during childbirth . Many of them are poor women in rural areas, who in turn have large families (four to six children) and can not avail themselves of the free health services.
Addressing the high levels of maternal mortality would require recognize that women are not a homogenous group. Account must be taken not only of the challenges that those in the lowest quintile confront, but also the hurdles of other female groups. Civil society groups such as the Alliance for Reproductive Health Rights continue to advocate for investment in family planning and education and in emergency obstetric care services especially in rural areas.
The low number of women in Ghana’s decision making positions means that, both at the national or at the local level, there are not concrete policy measures to address the structural gender inequalities and to promote women’s participation. The obstacles include traditional prejudices, negative perceptions about women in public positions and the lack of political will of the government and the parties to promote women’s effective participation.
The Women’s Manifesto for Ghana, issued in 2004 by feminist organizations after a broad debate, addresses the issue of the political will. The Manifesto formulates demands to government and political parties on 10 themes including women’s economic empowerment, land, social policy and development, human rights and the law, and politics and decision making. The 12 demands on politics and decision making enjoined the establishment to change the political culture and to ensure the participation of women at all levels.
Further efforts have been made to promote the inclusion of gender equality issues in the Constitution. In 2010 the Constitutional Review Commission called for the submission of recommendations. The Network for Women's Rights in Ghana (NETRIGHT), the Women’s Manifesto Coalition and the Domestic Violence Coalition made their proposals that included the prohibition of discrimination and bias on the grounds of sex or gender, to ensure gender balance and fair representation of marginalized groups in the recruitment and appointment to public office, to increase the participation of women in all public institutions, affirmative action measures for vulnerable groups, and that the amended Constitution adequately incorporates the concerns of women.
The aforementioned challenges are just a few of the many that will make it difficult for Ghana to meet the MDGs. And despite numerous official statements in support of these and other development goals the lack of political will could be the hardest obstacle.
Tackling these many challenges will require a mix of financial resources and strong political will. It may also require the Ministry of Women and Children’s Affairs to play a stronger coordinating and oversight role, although it is not directly responsible for the programs aimed at improving the quality of women’s lives, such as the Free Maternal Health Care Policy. The Ministry’s very limited budget may be a stumbling-block, and it is unlikely that this branch of the government could get more resources in the foreseeable future.
While it is acknowledged that the targets set out by the MDGs are unlikely to be met by 2015, the discussion on the post-2015 development agenda is muted. Civil society continues to demand the government to provide the much needed support, financial and otherwise, to achieve a development that is sustainable and equitable for all.
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Alliance for Reproductive Health Rights (ARHR) , March 2012, Statement of the Alliance for Reproductive Rights
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 In 2006 the UNDP estimated percentage of the population living on less than $2 a day at 51%
 MOWAC Rural Women and the MDGs 1 and 3: Ghana’s Success and Challenges. Technical paper to the 56th UN-CSW