CHAPTER ONE INTRODUCTION 1.1 Background of the Study Global economic issues such as unemployment, low income levels, unequitable distribution of resources, forced marriage, family breakdown, lack of education, peer influence have forced a lot of people to move from their places of origin; mostly rural areas to major cities instead of staying with their loved ones (Van den Berg, 2007). Also, De Han (2006), cited in Hujismans (2012) explains that, migration has become part of people’s lives especially the young people who are mostly in search of greener pastures. In Ghana, the high poverty levels in the northern parts of the country, that is, the Upper West, Upper East and Northern Regions, compel girls and women to migrate to the southern parts, mostly to the capital cities like Accra and Kumasi, to engage in the “Kaya business” (Boateng & Korang-Okrah, 2013). “Kaya business” in this study refers to the act of carrying load on the head for a fee. Most of the girls and women who engage in head porterage (Kaya business) are mainly from the Commented [A1]: Your paragraphs need to be clearly indicated0. You either indent on the left, using the ‘Tab’ key, Mamprusi, Gonja, Kotokoli, Mossi, Frafra, Bimoba, and Dagomba ethnic groups which are all or you space out by pressing the ‘enter’ button once. located in the Northern parts of Ghana, with a few of the Kayayei from Burkina Faso and Togo (UNFDP Evidence and Action Report, (2006-2011); Opare (2003) and Ziblim (2013). Also, Agarwal et al (1994) and Opare (2003) assert that, most of these female migrants who travel down south and to the middle belts are young ladies who are mostly between the ages of 10 and 35 and have limited or no formal education. As a result of this little or no formal education, these female migrants have no prospects of gaining employment in the formal sector at the cities (Yeboah & Appiah- Yeboah, 2009), and as such engage in the Kaya business as a means of earning income. However, Agarwal et al (1994) state that, the Kayayei see the Kaya business as short term business 1 to accumulate enough money to enter into other profitable ventures in the future. According to Opare (2003), some Kayayei engage in the Kaya business to acquire possessions like utensils, clothes in the preparations towards marriage while others save money to enable them undergo apprenticeship in hair dressing or dress making. Additionally, some Kayayei want to earn, save and send remittances to their families back home as Tanle (2007); Boateng & Korang- Okrah (2013) and Alfers (2013) mention that, the Kayayei usually leave behind relatives like husbands, children and parents in their hometowns. When the female migrants arrive at the urban areas to become Kayayei, most of them do not have any relations at the urban areas to support them financially. This leads them to settle in slum areas where accommodation comes at a cheap cost and of poor quality (Tufuor, 2009). Securing such cheap accommodation is one of the survival strategies employed by the Kayayei in the quest to spend little and save more money Agarwal et al (1994). However, such cheap accommodation in slum areas among other lifestyle practices such as poor hygiene have a negative impact on the health of the Kayayei. The Kayayei migratory vulnerabilities like accommodation in slum areas, harsh working conditions among other factors leave them exposed to occupational hazards (primarily back pain and headaches), sexual violence and hygiene/sanitation-related illness such as diarrhoea and malaria. 1.2 Statement of Problem Despite the fact that Kaya business serves as a source of income for most female migrants from Northern Ghana, (Agarwal et al (1994) and Tanle (2007), the activity exposes (Kayayei) to various health conditions like diarrhoea, malaria and Sexually Transmitted Infections (STIs). Researchers like Opare (2003); Kwankye et al (2007) and Ziblim (2013) have noted that, various lifestyle 2 practices such as spending nights in the open and at market centers, eating from unhygienic places which forms part of their environment heightens the Kayayei’s risk to some of these health problems mentioned above. Also, the District and Analytical Report of La Nkwantanang-Madina Municipal (2014) concludes that, liquid and solid waste is improperly disposed in the municipality. This has severe health implications for the Kayayei in the Madina municipality as they are exposed to these unsanitary conditions. The health of Kayayei is a concern since it contributes to determining their ability to make ends meet and honour the major reason for migrating to the cities which is to seek greener pastures. This is because without a stable mind and body, the Kayayei will not be in a position to perform any of their daily tasks of carrying luggage and goods for people, which Agarwal et al (1994) observed has become an important aspect of the transport business usually at market centres. Though some research has been done on Head Porterage, only a few of these works like Adams (2012) and Ziblim (2013) are specific to the health of female head porters (Kayayei). Furthermore, some effort have been made by governments and some Organizations to help resolve some of these health related concerns. These efforts include the National Health Insurance Scheme (NHIS) which was established in 2004 to provide affordable health care. Also, Non-Governmental Organizations (NGO) like United Nations Population Fund (UNFPA) and Society for Women against AIDS in Africa (SWAA) have trained and educated some Kayayei on Sexual and Reproductive Health issues. (Ghana News Agency, 5th November, 2013). However, most Kayayei are still are challenged with various health conditions as Van den Berg (2007) and Alfers (2013) have noted that, some Kayayei are unable to afford the NHIS premium, which means they cannot benefit from the NHIS. Alfers (2013) further argues that, apart from the Kayayei inability to pay the NHIS premium, most Kayayei complain that, the NHIS does not work when used in accessing health 3 care. Regardless of the above mentioned efforts put in place by government and some NGOs, the health problems of Kayayei continue to persist. 1.3 Research Objectives The general objective of this study is to examine the health related concerns of Female Head Porters (Kayayei) in Madina. The specific objectives of this study are as follows; 1. To find out the factors that make Kayayei in Madina prone to health problems. 2. To find out the health seeking behaviours of Kayayei in Madina. 3. To find out the challenges faced by Kayayei in Madina when seeking health care. 1.4 Research Questions 1. What factors make Kayayei in Madina Market prone to health problems? 2. What are the health seeking behaviours of Kayayei in Madina? 3. What challenges do Kayayei in Madina face when seeking health care? 1.5 Rationale of the Study Female head porters (Kayayei) are a major disadvantaged group who are vulnerable to various health issues like STIs, Diarrhoea among others. However, Van den Berg (2007); Adams (2012) and Alfers (2013) have noted that, many Kayayei are unable to pay for the NHIS premium to access health services at various clinics and hospitals. The researcher therefore sought to delve into the health related issues of Kayayei in Madina and make some recommendations for possible intervention by individuals, groups and Organizations. 4 1.6 Significance of the Study This study will provide more insight into the lives of Kayayei in relation to the factors that make them prone to various health issues and their health seeking behaviours. The available literature on this topic like Adams (2012) and Ziblim (2013) is scanty, therefore this study is intended to add on to the information available on this topic. This study will also serve as a guide to policy makers and stakeholders when making decisions concerning the health issues of Kayayei. 1.7 Definition of Concepts Kayayei: Kayayoo is a name given to a girl or woman who works as a head porter in market places. (UNFPA, Evidence and Action report 2006-2011). According to Agarwal et al (1994) and Opare (2003), Kaya means luggage/loads or goods in the Hausa language and “yoo” (a singular noun in the Ga language meaning female) has its plural form as “yei” (that is, ‘females’). Therefore the literal meaning of Kayayoo is a woman who carries loads. Health according to the World Health Organization (WHO) is the complete state of physical, social and mental wellbeing, and not mainly the absence of disease and infirmity. 1.8 Organization of the Study This study is organized in five chapters. The first chapter focuses on the introduction of the entire study. The background of the study, statement of the problem, the location of the study, objectives of the research, research questions, rationale for the study, significance of the study, definition of terms and concepts will be discussed. The second chapter reviews available literature in connection with the research topic. The third chapter deals with research methods which include the design to be used, target population, study population, sampling unit, sampling design. The size of the sample, methods of data collection, data handling and analysis and the ethical consideration of the 5 study. Chapter Four presents the findings based on data gathered and analyzed by the researcher. It also discusses findings in relation to the objectives of the study. Chapter five focuses on summary, conclusion and recommendations of the study. 6 CHAPTER TWO LITERATURE REVIEW 2.1 Introduction In this chapter, available literature in relation to the study is reviewed. The researcher will consider other core areas related to head porterage, such as; reasons why females migrate and the opportunities at the urban areas, the “Kaya Business”, Reasons for Engaging in Head Porterage amidst Other Informal Sectors Jobs.