GHANA COUNTRY ANALYSIS September 15, 2010

GHANA COUNTRY ANALYSIS September 2010

A. Table of Contents

Contents A. Table of Contents...... ii B. Acronyms...... v C. Executive Summary...... viii

CHAPTER 1: INTRODUCTION. 1.1. BACKGROUND ...... ‐ 1 ‐

1.2. PURPOSE OF THE COUNTRY ANALYSIS ...... ‐ 1 ‐

1.3. COUNTRY ANALYSIS PROCESS ...... ‐ 1 ‐

CHAPTER 2: GOVERNANCE AND HUMAN RIGHTS...... ‐ 3 ‐ 2.1. POLITICS AND GOVERNANCE ...... ‐ 3 ‐

2.2. CONFLICT PREVENTION ...... ‐ 7 ‐

2.3. HUMAN RIGHTS SITUATION ...... ‐ 8 ‐

2.4. NATIONAL RESPONSE AND STRATEGY ...... ‐ 10 ‐

2.5. EMERGING PRIORITIES FOR THE UN ...... ‐ 12 ‐

CHAPTER 3: ECONOMIC DEVELOPMENT...... ‐ 15 ‐ 3.1. MACRO‐ECONOMIC SITUATION ...... ‐ 15 ‐

3.2. PERFORMANCE OF THE KEY SECTORS AND SUB‐SECTORS ...... ‐ 16 ‐

3.3. EMPLOYMENT SITUATION ...... ‐ 18 ‐

3.4. PRIVATE SECTOR PERFORMANCE ...... ‐ 19 ‐

3.5. INFRASTRUCTURE ...... ‐ 20 ‐

3.6. NATIONAL RESPONSE AND STRATEGY ...... ‐ 22 ‐

3.7. EMERGING PRIORITIES FOR THE UN ...... ‐ 24 ‐

CHAPTER 4: MDG ACHIEVEMENT...... ‐ 25 ‐ 4.1. EXTREME POVERTY AND HUNGER ...... ‐ 29 ‐

4.2. UNIVERSAL PRIMARY EDUCATION ...... ‐ 33 ‐

GHANA COUNTRY ANALYSIS September 15, 2010

4.3. GENDER EQUALITY AND WOMEN’S EMPOWERMENT ...... ‐ 37 ‐

4.4. UNDER‐FIVE MORTALITY ...... ‐ 43 ‐

4.5. MATERNAL MORTALITY ...... ‐ 47 ‐

4.6 HIV/AIDS AND MALARIA ...... ‐ 52 ‐

4.7. ENVIRONMENTAL SUSTAINABILITY ...... ‐ 60 ‐

4.8. PARTNERSHIP FOR DEVELOPMENT ...... ‐ 68 ‐

CHAPTER 5: INSTITUTIONAL ANALYSIS...... ‐ 71 ‐ 5.1. MINISTRIES, DEPARTMENTS AND GOVERNMENTAL AGENCIES (MDAS) ...... ‐ 71 ‐

5.2. TRAINING AND CAPACITY BUILDING INSTITUTIONS ...... ‐ 72 ‐

5.3. DATA MANAGEMENT CAPACITY ...... ‐ 73 ‐

5.4. EXISTING GAPS ...... ‐ 73 ‐

5.5. NATIONAL RESPONSE AND STRATEGIES ...... ‐ 74 ‐

5.6. EMERGING PRIORITIES FOR THE UN ...... ‐ 76 ‐

CHAPTER 6: EMERGING CHALLENGES, RISKS & POTENTIAL OPPORTUNITIES...... ‐ 76 ‐ 6.1. BACKGROUND ...... ‐ 77 ‐

6.2. GLOBAL FINANCIAL AND FOOD CRISIS ...... ‐ 78 ‐

6.3. VULNERABILITY TO NATURAL DISASTERS ...... ‐ 80 ‐

6.4. CLIMATE CHANGE...... ‐ 80‐

6.5. NATIONAL RESPONSE AND STRATEGIES...... ‐82‐

6.6. EMERGING PRIORITIES FOR THE UN ...... ‐ 82 ‐

CHAPTER 7: THEMATIC AREAS FOR COMMON RESULTS...... ‐ 85 ‐ 7.1. AGRICULTURAL MODERNIZATION AND FOOD SECURITY (WITH FOCUS ON NUTRITION)

7.2. SUSTAINABLE ENVIRONMENT, ENERGY AND HUMAN SETTLEMENTS...... ‐88‐ ERROR! BOOKMARK NOT DEFINED.

7.3. HUMAN DEVELOPMENT AND PRODUCTIVE CAPACITY FOR IMPROVED SOCIAL SERVICES...‐ 90‐

7.4. TRANSPARENT AND ACCOUNTABLE GOVERNANCE...... ‐ 92‐

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ANNEXES...... ‐ 94 ‐ ANNEX 1: DOCUMENTS REVIEWED ...... ‐ 94 ‐

ANNEX 2: INDIVIDUALS INTERVIEWED ...... ‐ 97 ‐

ANNEX 3: INTERVIEW GUIDE ...... ‐ 101 ‐

ANNEX 4: INTERNATIONAL TREATIES SIGNED BY GHANA ...... ‐ 102 ‐

ANNEX 5: BRIEF CASELOAD STATISTICS FOR THE COURTS (2008 ‐09) ...... ‐ 104 ‐

ANNEX 6: BASIC LABOUR MARKET INDICATORS, 2006 ...... ‐ 105 ‐

LIST OF FIGURES AND TABLES

1 Table 1: State of Human Rights in Ghana ...... 8 2 Table 2: Growth Rates for Key Sectors (2005‐09) ...... 15 3 Table 3: Ghana’s Infrastructure Compared to African Countries ...... 20 4 Table 4:Food Security and Vulnerability by Region……………………………………………...... 30 5 Table 5: Net Enrolment Trends by Region (2004‐08) ...... 33 6 Table 6: Trends in HIV Prevalence in Ghana ...... 52 7 Table 7: Rural‐Urban Portable Water Coverage by Region ...... 61 8 Table 8: Gaps in Key Policies in Government ...... 72 9 Table 9: Excerpts of Some Key Macroeconomic Indicators ...... 78 10 Table 10: Ghana’s Exposure to Floods and Drought ...... 79 11 Table 11: Impact of Climate Change on Human Security ...... 82

1 Figure 1: Ghana’s Governance Performance (1996 ‐2008)...... 4 2 Figure 2: Comparison of Budget Allocation to Estimates (LRC 2009‐10) ...... 12 3 Figure3: School Attendance Rates Aged 6‐14 by Poverty Quintile………………………………………….34 4 Figure 4: Individual NHIS membership by Socio‐Economic Group ...... 44 5 Figure 5: Assistance in Childbirth by Skilled Health Worker...... 48

6 Figure 6: Forest Area and Agriculture Land in Ghana (2000‐07) ...... 80

GHANA COUNTRY ANALYSIS September 15, 2010

B. Acronyms

AAP Affirmative Action Plan ACBF African Capacity Building Foundation AGI Association of Ghana Industries AIDS Acquired Immunity Deficiency Syndrome APRM African Peer Review Mechanism ARI Acute Respiratory Infections ARHR Alliance for Reproductive Health Rights BBPD Barrels per Day CD Capacity Development CEDAW Convention on the Elimination of all Forms of Discrimination Against Women CEPA Center for Economic and Policy Analysis CFSVA Comprehensive Food Security and Vulnerability Assessment CHRAJ Commission for Human Rights and Administrative Justice CIDA Canadian International Development Agency CSO Civil Society Organization DANIDA Danish Aid Agency DP Development Partner(s) DPAC District Peace Advisory Council(s) EITI Extractive Industries Transparency Initiative EmOC Emergency Obstetrics Care EPA Environment Protection Agency ESP Education Strategic Plan FAO Food and Agriculture Organization FCUBE Free Compulsory Universal Basic Education FGM Female Genital Mutilation GDHS Ghana Demographic and Health Survey GDP Gross Domestic Product GER Gross Enrolment Rate GET Ghana Education Trust GHc Ghana Cede (currency) GHS Ghana Health Service GIMPA Ghana Institute of Management and Public Administration GIS Geographical Information System GJA Ghana Journalists Association G‐JAS Ghana Joint Assistance Strategy GPI Gender Parity Index GPRS Growth and Poverty Reduction Strategy

GHANA COUNTRY ANALYSIS September 15, 2010

GSHRDC Gender Studies Human Rights and Documentation Centre GSS Ghana Statistical Service GTZ German Aid Agency HIV Human Immunodeficiency Virus ILGS Institute of Local Government Service IMF International Monetary Fund IOM International Organization for Migration ISSER Institute of Statistical, Social and Economic Research JHS Junior High School KG Kindergarten LEAP Livelihood Empowerment Against Poverty LED Local Economic Development LGSS Local Government Secretariat LRC Law Reform Commission MDAs Ministries, Departments and Agencies MDGs Millennium Development Goals MESW Ministry of Employment and Social Welfare MiDA Millennium Development Authority MLGRD Ministry of Local Government and Rural Development MMDA Metropolitan, Municipal and District Assemblies MOE Ministry of Education MOFA Ministry of Food and Agriculture MOFEP Ministry of Finance and Economic Planning MOH Ministry of Health MOWAC Ministry of Women and Children’s Affairs MTI Ministry of Trade and Industries MWRWH Ministry of Water Resources Works and Housing NADMO National Disaster Management Office NAP+ Network of People Living with HIV NCCE National Commission for Civic Education NDPC National Development Planning Commission NEA National Education Assessment NER Net Enrolment Rate NGO Non‐Governmental Organization NHIS National Health Insurance Scheme NH of C National House of Chiefs NMCP National Malaria Control Programme NPC National Peace Council NPC National Population Council OCHA Office for the Coordination of Humanitarian Assistance ODA Official Development Assistance

GHANA COUNTRY ANALYSIS September 15, 2010

ODC Overseas Development Center OHCS Office of the Head of Civil Service OVC Orphans and Vulnerable Children PSRC Public Service Reform Commission PSS Public Service School PTR Pupil Teacher Ratio RCC Regional Coordination Council(s) SADA Savannah Accelerated Development Authority SME Small and Medium Enterprises SFO Serious Fraud Office STI Sexually Transmitted Infections UG University of Ghana UNCT United Nations Country Team UNDAF United Nations Development Assistance Framework UNDP United Nations Development Programme UNESCO United Nations Educational, Scientific and Cultural Organization UNFPA United Nations Population Fund UN‐HABITAT United Nations Human Settlements Programme UNHCR United Nations High Commission for Refugees UNICEF United Nations Children’s Fund UNIDO United Nations Industrial Development Organization UNIFEM United Nations Development Fund for Women UPE Universal Primary Education USAID United States Agency for International Development UTDBE Untrained Teachers Diploma in Basic Education WFP World Food Programme WHO World Health Organization WSMP Water and Sanitation Monitoring Platform

C. Executive Summary

Introduction

As part of the process to develop the United Nations Development Assistance Framework (UNDAF) 2012 ‐2016, the United Nations Country Team (UNCT) in Ghana undertook a Country Analysis for Ghana to support and strengthen the national analytical processes and products. The Country Analysis was guided by the five UN programming

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GHANA COUNTRY ANALYSIS September 15, 2010 principles of human rights‐based approach, gender equality, environmental sustainability, results‐based management, and capacity development. The objectives of the analysis were to identify priority problems and their causes, as well as the requisite capacity development needs that are required to generate action at all levels. A total of 63 meetings were held and 154 individuals were consulted, from across the spectrum of Ghanaian society and development players, including Government, UN agencies, development partners, private sector, civil society organizations (CSOs) and academia. The Country Analysis report is presented in seven chapters. Chapter 1 introduces the report; Chapter 2 focuses on Governance and Human Rights; Chapter 3 presents an analysis of the Economic Developments; Chapter 4 is on MDG Achievements; Chapter 5 focuses on Institutional Analysis; Chapter 6 discusses Potential Risks and Emerging Challenges; and Chapter 7 makes recommendations on Thematic Areas for Common Results.

Governance and Human Rights

Ghana’s political rights, civil liberties and freedom of press rankings are renowned to be among the best in Africa and comparable to those recorded by countries with much higher levels of development. Ghana is widely regarded as an example of successful economic and political reform in Africa, in part due to its recent history of holding free and fair elections and peaceful transfer of power. This has generated investor confidence and attracted foreign investment that has led to general economic growth. Ghana has positive ratings in rule of law, political stability human rights and accountability. However, although Ghana’s international ranking on corruption indicators is one of the best among low‐income African countries; recent trends indicate a steady decline in its ranking. While there are no specific statistics that attest to the effect of corruption on development, the Serious Fraud Office (SFO) the government agency with responsibility for combating economic crime claimed that indications suggest that between 5‐30 per cent of national revenue goes to waste due to fraudulent practices like over‐invoicing and tax evasion.

Considering the role that local governments play with regard to delivery of basic public services due to their close proximity to the communities; as well as their ability to scale up the implementation of MDGs at local level, Ghana’s policy for decentralization is a critical component for its development strategy. However, progress in decentralization has been slow and some stakeholders expressed concern that it was not working as it should. A recent Ghana Joint Assistance Strategy (G‐JAS) report observed that citizens’ assessment of the quality of governance related to District Assemblies showed a dissatisfaction rating of 62 per cent and a satisfaction rating of 27 per cent. The report further noted that part of the delay in decentralizing staff and fiscal resources was due to concerns about local capacity, combined with reluctance of “the center” to lose resources and influence.

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Ghana’s history has been largely free of armed conflict and violence. However, there are disturbing developments of latent conflict in some parts of the country, particularly in the Northern Region, which mainly revolves around the issue of land. There is also an increase in the proliferation of small arms and light weapons. In the area of Human Rights, Ghana has received positive reviews from various international organizations and human rights “watch dogs”. Ghana has ratified many of the major international treaties relating to the promotion of human rights, including those of women, and the rule of law, its record had been consistently improving since 1993 after the adoption of Constitutional rule. Ghana also has an impressive record of encouraging public education on fundamental human rights as a means to improve citizens’ access to justice, with several Non‐Governmental Organizations (NGOs) engaged in human rights promotion to complement the education programmes conducted by the Commission on Human Rights and Administrative Justice (CHRAJ) and the National Commission on Civic Education (NCCE). However, access to justice was constantly hampered by a geographic imbalance in court distribution that was concentrated in areas of high economic activity instead of areas with high density of population, and some reports indicate a high caseload of close to 2,500 detainees who had not been brought before the court for periods in excess of what the law provides. The juvenile justice system is also affected by lack of adequate detention centers for youth, causing them to share facilities with adults, where they lack access to basic necessities like education that are vital to their rehabilitation.

In order to strengthen Governance and Human Rights in Ghana, the UN may wish to prioritize the following:

b) To support the decentralization process and strengthen local government capacities in participatory planning and resource management, in order to better respond to the needs of their communities and scale‐up MDG achievement at local level. c) To develop capacities of state and civic institutions in combating corruption and strengthening reform of the public sector and justice delivery system. d) Strengthen national capacities in conflict prevention and conflict resolution, including through control of illicit small arms and weapons. e) Support Government efforts in job creation with specific emphasis on youth employment. f) Strengthen the capacity of the Law Reform Commission to enhance its ability to review all statutory provisions to bring them into compliance with the Constitution and international human rights standards. g) To strengthen juvenile justice system and promote children’s rights.

GHANA COUNTRY ANALYSIS September 15, 2010

h) Support efforts aimed at speeding up the implementation of CEDAW and the twelve critical areas of the Beijing Platform for Action

Economic Development The Ghanaian economy experienced an unprecedented growth of 7.2 per cent in 2008. Despite this good performance, the economy had a deficit of GH¢2,557.6 million (excluding divestiture receipts) representing 14.9 per cent of GDP with a consequential increase in the rate of year on year inflation from 12.8 per cent in 2007 to 18.1 per cent in 2008. With the discovery of oil in Ghana, expectations are high, while there are also concerns about how the country will manage this new resource. This development could either positively affect the economy with additional revenue to finance developmental activities, or negatively affect the economy through the phenomenon of “Dutch Disease”.

The Agricultural sector continues to be the largest sector with about 39% of total GDP, thus maintaining the historical dominant position in economic structure of the country. The Services sector accounts for about 35% of total GDP while the Industry sector accounts for about 26%. Though the structure of the economy has remained basically unchanged over the years, a slight shift has occurred between the relative shares of Agriculture and Services while Industry’s share in GDP has remained fairly constant. Whereas Agriculture’s share in GDP has declined from its historical levels of about 45% to about 39% in recent years, the Services sector’s relative share in GDP has increased from around 30% to 35%1. Tourism2, including cultural and ecotourism, is one of the most essential and fastest growing areas of the Ghanaian economy and remains among the country’s largest foreign income earners. The Ghanaian Government has placed great emphasis upon the expansion and development of tourism services.

With regards to employment, Ghana faces a challenge of timely availability and in‐ depth sex disaggregation of statistics. However, informed estimates indicate that Ghana’s working population in 2009 was about 14.3 million of which the labor force (defined as economically active population aged 15 years or over, working or not working) was 9.6 million. Wage employment accounts for only 17.5 per cent as against 55 per cent and 20.4 percent in self‐employment and contributing to family livelihood respectively. This yields a vulnerability employment rate of 75.4 per cent. About 26 per cent of employed people are working poor (i.e. living in households that earn below the upper poverty line), while 16 per cent are considered extremely working poor (i.e. living in households that earn below the lower poverty line). Women are generally concentrated in sectors with high risk of poverty. For example, the 1999 Ghana Living Standards Survey (GLSS 4, 1999) found that 37.5 per

1 Medium Term Development Framework – Ghana Shared Growth and Development Agenda (2010‐2013) 2 Ghana is projected to have the 4th largest growth in tourism receipts in Africa for the period 2007‐2012 (Euromonitor International and Ghana Tourism Federation (GHATOF).

GHANA COUNTRY ANALYSIS September 15, 2010 cent of women compared to 15.8 per cent men were self‐employed in the informal non‐ agricultural sector; while only 4.2 per cent of women, compared to 12.6 per cent of men were informal wage workers in the non‐agricultural sector.

In the private sector, a survey by the Association of Ghana Industries (AGI) noted high cost of raw materials, high price of utilities, high cost of credit and competition from imported goods among some of the major challenges to employment creation and productivity. The Center for Economic and Policy Analysis (CEPA) noted that “the private sector is not placed in the position to take up the mantle and play its assigned role as the lead engine of growth and job creation, until the problems of financial intermediation have been resolved”.

With regards to infrastructure, only 24 per cent of Ghana’s rural population lives within two kilometers of an all season road, which is below the ratio of 60 per cent in Africa’s middle income countries. In order to achieve the 60 per cent threshold of the middle income African countries, Ghana requires an additional 26,000 kilometers of rural road network. In the rural water sub‐ sector, surface water reliance reduced substantially from 47 per cent in 1993 to 32 per cent in 2003 and 18 per cent in 2008.

The UN in Ghana can contribute effectively to reduction of poverty by focusing on the following: a) Strengthening and supporting government efforts to develop labor‐intensive sectors and policies that encourage employment‐generating investment and opportunities, including through SME and creative and cultural industries development. b) Strengthening support to development of human capital through increased access to tertiary and vocational skills training, science and technology, and integrating the informal sectors into the mainstream economy. c) Support construction and access of economic infrastructure by marginalized communities in rural areas and the underdeveloped regions particularly the northern regions. d) Support the use of heritage sites for educational as well as cultural tourism

MDG Achievement

While Ghana is on track to achieve MDGs 1 and 2, Ghana’s progress towards the achievement of the MDGs is mixed, requiring increased efforts and resources for fuller achievement.

1) Eradication of Poverty and Hunger. Poverty declined from 51 per cent in 1991 to 28.5 per cent in 2005/06. However, these aggregated averages tend to mask the vast regional disparities that exist. For example, 18.2 per cent of Ghanaians still live in extreme

GHANA COUNTRY ANALYSIS September 15, 2010 poverty. 54 per cent of the extreme poor live in the northern regions alone, which is home to only 17.2 per cent of the country’s population. The Upper East, Upper West and Northern regions together make up for 70 per cent of the 28.5 per cent of the poor at the national level. With regards to food, the evidence indicates that food is available but not accessible to all sections of the population. 12 per cent of children under the age of five years are reportedly underweight; 22 per cent are stunted or too short for their age; and 7 per cent are too thin for their height. To contribute effectively to eradication of poverty and hunger, the UN may consider:

a) Strengthening initiatives to enhance support for livelihoods for the poor, particularly by improving agricultural practices for food security and diversifying their income sources. b) Supporting government efforts in strengthening systems targeting the poor and vulnerable and providing social protection and safety nets for the poor. c) Strengthening the policy environment and scaling up interventions to improve nutritional status, especially for pregnant and lactating women, as well as children under the age of 5 years; safe drinking water and sanitation.

2) Universal Primary Education. Despite significant progress in the expansion of school enrollment over the past decade, data from the Ministry of Education (MOE) indicates that there are still some 450,000 children of primary school age not enrolled. Regional disparities continue to exist in terms of both access and gender parity. Significant enrolment gaps also remain between the poorest and the wealthiest children. In addition, those children who do enroll in school struggle to complete their basic education. The school completion rate still stands at 86.3 per cent at primary level and 75.0 per cent at junior high school level in 2008/09. Furthermore, the quality of teaching and learning remains a major concern in Ghana’s basic education sector. Due to the substantial and rapid increase in school enrolment, classrooms have become over‐crowded in many areas. Schools generally lack basic learning materials, qualified teachers, and water and sanitation facilities and thus do not adhere to child‐friendly standards. As a result of these quality challenges, students’ learning achievement level remains low. The UN should continue to support government strategies through: a) Supporting evidence‐based policy and decision making through strengthening institutional capacity at all levels on systematic monitoring and evaluation b) Strengthen focused interventions that cater to the most marginalized and disadvantaged groups such as girls, the poor, remote rural populations, children with disabilities and working children, including skills training for income generation c) Supporting holistic school quality improvement based on the national child‐ friendly school standards.

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3) Gender Equality and Empowering Women. Ghana has ratified the major international conventions, treaties and protocols on the rights of women and children including the Convention on the Elimination of all Forms of Discrimination against Women (CEDAW) and the Beijing Platform for Action and reports on these, although CEDAW is yet to be legislated into national law. However, women’s representation in Parliament fell from 11 per cent in 2007 to 9 per cent in 2008. Seventy per cent of food crop farmers are women, and responsible for food security in their households, and yet women’s access to and control over land, information on land rights issues, access to formal credit from the banks, as well as storage, processing and marketing facilities limit their ability to engage in these activities independently. With regards to violence against women, for example, about 9 to 15% of Ghana’s approximately 24 million population is believed to engage in female genital mutilation (FGM), particularly in the rural savannah and the Northern, Upper East and Upper West regions. While the Government established the Ministry of Women and Children’s Affairs (MOWAC), it is laden with challenges, including inadequate staffing, infrastructure and finance as well as lack of capacity for decentralization and representation at district level. In 2009 total budget allocation to MOWAC was less than 1 per cent of the national budget. UN should;

a) Support capacity building for decentralizing processes including planning, monitoring & evaluation, as well as the integration of Gender Responsive Budgeting into the fiscal policy planning, for improved delivery of essential services for women and children. b) Support capacity building for civil society organizations to focus on the advancement and empowerment of women, to develop their potential, creativity and skills for national development and bring coherence in collaboration with MOWAC by facilitating a coordinated gender and rights based approach to promoting all gender interventions across line ministries and women organizations to increase the impact of all gender‐oriented interventions. c) Strengthen evidence‐based advocacy at various levels to guide policy discussions, decision making, resource allocation and legislation, including through support to civil society. d) Support advocacy for the domestication of CEDAW and strengthening of the institutional capacity of MOWAC to effectively deliver on its mandate. e) Support for strategies and capacity building efforts to improve access to justice by poor and vulnerable groups particularly women and children. f) Support for women’s economic empowerment including their ability to earn decent incomes and hold decent jobs to access market. g) Support women’s participation and representation in decision‐making and political leadership. h) Support girls education to reduce gender disparity index for upper primary and junior high schools

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4) Under‐five Mortality. Although Ghana’s efforts to reduce infant and under‐five mortality has experienced some progress, much still remains to be done to achieve the target of reducing under‐five mortality to 53 per 1,000 live births by 2015. The Ghana Demography and Health Survey (GDHS) report for 2008 indicates that under‐five mortality was 80 per 1,000 live births, representing a 28 per cent improvement from 111/1,000 live births during the period 2003 – 2006. There are also regional variations that indicate that four out of the 10 regions – Upper East, Western, Brong Ahafo and Volta regions – were on track to achieve the MDG goal of reducing under‐five mortality, while the rest were not. UN should support efforts aimed at a) Increasing access to high impact child survival interventions at facility and community level, especially those focusing on the prevention and treatment of major childhood killers, including malaria, pneumonia and diarrhea. b) Increasing access to skilled health‐care workers and better quality care during pregnancy, delivery and the neonatal period to accelerate reduction in the neonatal mortality rate. c) Scaling‐up proven interventions to prevent and treat child malnutrition and under nutrition. d) Improving access to nutritious food, clean water, sanitation and hygiene which are critical to addressing infant and child mortality. e) Provision of supplementary feeding to poor malnourished children.

5) Maternal Mortality. Ghana is not likely to meet the goal of reducing maternal mortality ratio (MMR) to the expected 185 maternal deaths per 100,000 live births by 2015. However, according to the United Nations Maternal Mortality Estimates Inter‐agency Group (MMEIG), the MMR in Ghana is 630 maternal deaths for every 100,000 live births in 1990 and 350 maternal deaths for every 100,000 live births in 2008 which shows that Ghana is making progress towards the achievement of MDG 5 by 2015. But there are wide geographic disparities in maternal mortality. For example, there are rural‐urban disparities in health care services – 43 per cent of births in rural areas as opposed to 84 per cent of births in urban areas are likely to occur in a health facility. Modern contraceptive use also declined from 19 per cent in 2003 to 17 per cent in 2008, while there is a high unmet need for family planning (36%). There is also fragmented health information system with inadequate capacity for data management. In addition, government financing of health service delivery is poor. In 2009, Government spends 9.6 per cent of its budget (Ghana is a signatory to the Abuja Declaration which commits governments to allocate 15% of their national budgets to health) on the health sector, out of which 94 per cent is for the wage bill. Malnutrition in pregnant women resulting from poverty and ignorance also contributes heavily too high maternal mortality and constitutes a major challenge. The UN may consider prioritizing the following:

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a) Strengthen policy dialogue and advocacy for more commitment of resources by Government to improve maternal health (to at least 15% as declared in Abuja) to improve health as well as maternal health. b) Support development of policies and strategies for improved access to skilled attendance at birth, emergency obstetric care for women who develop complications, and improved access to family planning. c) Support development of strategies to enhance training and deployment of more midwives to deprived communities, including through increased engagement of CSOs and the private sector in strengthening health care systems. d) Support for the creation of enabling environment for rights holders to participate in planning and decisions on health, and strengthen their capacities to engage with duty bearers for the formulation, implementation, monitoring and evaluation of pro‐poor policies that enhance access to health services by disadvantaged groups. e) Support development of integrated health management information systems in order to enhance decision‐making. f) Supplementary feeding and nutrition education and linking such programme with food fortification and income generating activities.

6) Combat HIV/AIDS and Malaria and Tuberculosis. Ghana has made good progress towards combating HIV and AIDS. The HIV and AIDS epidemic in Ghana is a mature, low‐level, generalized epidemic with pockets of high prevalence among certain sub‐populations and geographic areas. Its defining characteristic is that infection in the general population depends to great extent on continuous bridging from core high prevalence sub‐populations, such as female sex workers (FSW), their clients and non‐paying partners (NPP), and men who have sex with men (MSM). Data from the Sentinel Surveillance show that HIV prevalence among pregnant women attending antenatal care seemed to be on a downward trend, declining from a high of 3.6 per cent in 2003, to 2.9 per cent in 2009 as shown in Table 7 below. Based on national estimates and projections, the national HIV prevalence in 2009 was 1.9%.3 The main drivers of the epidemic in Ghana are multiple concurrent partnerships, early sexual debut, low levels of condom use, inter‐generational sex, mobility and migration, all compounded by underlying gender inequalities and sexual violence To contribute to the goal of combating HIV and malaria, the UN may consider these priorities:

3 UNGASS 2010 Country Report Ghana

GHANA COUNTRY ANALYSIS September 15, 2010

b) Focus on Most at Risk Population groups and remove the legal barriers: Continuous attention and efforts focused on Most at Risk Population groups to encourage their uptake of prevention, treatment, care and support services. Special attention to remove the punitive laws, policies, practices affecting the accessibility and uptake of services by Most at Risk Population groups. c) Focus on the youth: Support their access to prevention, care and support and continuous efforts aimed at encouraging behavioral change. d) Scaling up of services: Provide strategic support to scale up prevention of mother to child transmission, ARV treatment and care and support for those infected and affected by HIV. e) Improve basic social and protection services to mitigate HIV impact on development: Support programmes geared towards minimizing the socioeconomic impact of HIV and AIDS, the increasing numbers of orphans, vulnerability due to poverty and food insecurity, increased morbidity associated with HIV/ AIDS, f) Support human rights and gender based responses and address stigma: Support the country to adopt a human rights and gender based approach in all HIV responses, as well as reduce the stigma and discrimination associated with HIV through increased knowledge, advocacy and constructive use of mass communication strategies.

Malaria is the leading cause of morbidity in Ghana and is the single most important cause of mortality among children under five years and pregnant women. Malaria is responsible for a substantial number of miscarriages and low birth weight. Though malaria remains a public health concern, under‐five malaria case fatality has declined steadily over the years from 3.7 per cent in 2002 to 2.4 per cent in 2005. While the total number of fatalities among pregnant women and children continue to decrease – an indication of improved access to health care programmes and facilities ‐ the total number of malaria cases has increased steadily. A major challenge to the control and prevention of malaria in Ghana relates to the lack of proper waste disposal system and poor drainage systems. The UN can contribute to the fight against malaria through: a) Strengthening efforts towards elimination of malaria parasite and complete eradication of malaria, including through reduction of mosquito breeding conditions such as poor sanitation, drainage and waste disposal that pose heath challenges.

b) Increasing the capacity of the malaria control programme to monitor and address the key challenges including capacity constraints and sustainability issues.

c) Supporting advocacy to increase funding for interventions to combat malaria in the most affected regions.

Ghana is making progress in Tuberculosis control and achieved 100% DOTS coverage in 2005. The reported number of TB cases has been increasing rising from 7,425 in 1996 to

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15,067 in 2009. TB case management has improved with default rates declining from 11% in 2005 to 2.3% in 2008. The present treatment success rate for the 2008 cohort of patients is 85.3%. A major challenge has been a low TB case detection rate (smear positives) estimated at 36% (2007). This may in part be due to insufficient case finding implementation strategies as well as challenges in accurately estimating the burden of TB in Ghana. The UN can contribute to TB control in Ghana by:

a) Increasing capacity to implement evidenced based innovative strategies to improve case finding b) Supporting capacity building of laboratory to improve TB case detection including drug resistant (DR)TB c) Providing technical support to conduct a National TB prevalence survey to establish the true burden of TB in Ghana and guide program operations.

7) Environmental Sustainability.

While Ghana is likely to achieve target on drinking water, Ghana is not likely to achieve MDG 7 as a whole by 2015 because among other reasons, its forest cover is declining rapidly. Although current data is not available, it has been estimated that Ghana’s forest cover has declined from 32.7 per cent to 24.2 per cent between 1990 and 2005. In 1990, the forest cover was estimated at 7,448,000 hectares, and this has declined at an average rate of 1.8 per cent annually to 5,517,000 hectares in 2005. With regards to safe drinking water, recent estimates indicate improvements in the trends of access to safe water sources for both rural and urban populations. According to the 2010 update of the recent government WHO/UNICEF Joint Monitoring Programme reports, overall, 82% per cent of the rural population has access to improved drinking water sources but there is disparity between the rural and urban population with 74 per cent of rural and 90 percent of the urban population haves access to safe water sources. In the area of sanitation, 7 per percent of the rural population and 18 per cent of the urban population and 13 per cent of the overall population make use of an improved toilet. In urban housing, increasing urbanization as a result of rapid population growth and rural‐urban migration without effective housing delivery systems to meet the growing demand over the years has created strains in the existing housing stock and infrastructure in the urban areas. This has resulted in overcrowding, declining quality and access to services and the development of slums in many places. Available estimates show that urban population has increased from 28.9 per cent in 1970 to 43.8 per cent in 2000. On the other hand population with access to secure housing has stagnated at about 12 per cent over the past five years and if the trend continues, the proportion with access to secure housing will increase by only 6 per cent by 2020. In addition, against the backdrop of Climate Change, the rate at which the nation is losing its natural resources owing to human activities raises concern about the sustainability of natural resources. Available evidence on the rate of forest depletion shows that, between

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1990 and 2005, the forest cover has declined from 32.7% to 24.2%. Issues such as low institutional capacity for environmental management, low awareness on the effects of human activities on the environment and limited resources (human and financial) to implement reforestation and other environmental management programmes need to be urgently addressed. UN may consider prioritizing the following in order to contribute to sustainable environment in Ghana: a) Strengthening policy formulation and implementation capacities for sustainable environment management, in particular water resources and forests. b) Support to GoG’s initiatives for adaptation to climate change. c) Support the development of policies designed to address climate induced migration with specific emphasis on protecting rights of migrants and their access to social services d) Support efforts towards use of data to inform planning and development of poverty‐environment initiatives in energy and water sectors. e) Support for development of policies and strategies for urban development, housing and slum upgrading to manage the increasing urbanization and its impact on quality of life natural resources. f) Support for the implementation of the National Environmental Sanitation Strategy and Action Plan for improvement in environmental sanitation. g) Support for the implementation of GoG’s Science, Technology and Innovation Policy, to enhance sustainable development h) Support for strengthening mechanisms and systems for post construction management of operation and maintenance of water schemes. i) Support for scaling up implementation of Community Led Total Sanitation (CLTS) and other community approaches to total sanitation (CATS) in order to improve access to basic sanitation. j) Support for the implementation of Sector Wide Approaches (SWAp) for the Water and Sanitation Sector including support for the development and implementation of the Water and Sanitation Sector Strategic Development Plan.

8) Partnership for Development. An analysis of Official Development Assistance (ODA) inflows to Ghana shows that aid inflows has increased from US$ 578.96 million in 2001 in nominal terms to US$1,433.23 million in 2008, constituting an average annual increment of about 23% per cent during the period. Project aid constitutes the bulk (about 64%) of ODA portfolio in Ghana, increasing steadily during the period, whereas programme aid has virtually stagnated over the period 2004 and 2007. The average annual programme aid as a percentage of total ODA was estimated at 38 per cent between 2003 and 2008, while that for the period 1999 – 2002 stood at 42 per cent. This implies ODA portfolio in Ghana continued to be dominated by project aid which is usually off‐budget, and lends itself to non‐use of country systems, creation of parallel system for its management and excessive rigidity in its administration. A major weakness in aid administration in Ghana is the

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absence of a comprehensive framework, guidelines and targets to facilitate effective aid delivery. The remittttances and other potential contributions from diasporas remain to be tapped into. The Government indicated that the participatory process towards formulating a National Aid Policy was currently in progress and the draft policy had since been presented to Cabinet for approval. To strengthen partnership for development in Ghana, the UN may consider:

a) Strengthening support to MOFEP, including a functional process review to enhance institutional capacity and strengthen results‐based budgeting in the Ministry.

b) Playing a leading role towards “working smarter” by leading in the coordination of DPs to develop common strategies and results frameworks at sector level.

c) Enhancing processes towards harmonized and coordinated programming among UN agencies. d) Support of UN agencies to strengthen the capacity of line ministries. e) Strengthening strategic partnerships with CSOs, the private sector, and bi and multilateral agencies to effectively participate in development planning and realize full benefits of both internally and externally generated resources.

Institutional Analysis There are inherent challenges in operational efficiency and service delivery in the public service. The challenges relate to identified capacity gaps with respect to the adequate number of staff with the appropriate skills mix to undertake policy, planning, monitoring and evaluation tasks as well as public financial management. The Public Service also faces challenges with regards to lack of clear mandates, policies and legal framework to perform their duties. For example, the relation between the Ministry of Finance and Economic Planning (MOFEP) on one hand and the National Development Planning Commission (NDPC) on the other hand is not very clear. The Ghana Statistical Service in particular faces challenges due to the varying conceptual and methodological approaches in capturing data by the GSS and the sector institutions which also capture data as service providers. Although GSS indicated that sex disaggregated data was available, MOWAC identified insufficient sex disaggregated data for national development as a key challenge in Ghana’s third progress report on the implementation of the African and Beijing Platform for Action and review report for Beijing + 15 (2009).

Capacity development should therefore be considered an ongoing effort, and the UN should mainstream CD in all its programming to ensure that government interventions and programmes yield sustainable results, while specifically focusing on the following priorities:

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a) Support to development of sector policies to enhance system‐wide coherence within government. b) Strengthening partnership and support of the various government CD institutions. c) Support for the operationalisation of the Statistical Development Strategy, including strengthening of sector specific routine data systems as well as modernization of GSS as well as supporting the Gender Statistics Working Group (GSWG) to ensure timely and accurate provision of disaggregated data to enhance policy and decision making. d) Promote the demand for and utilization of M&E results in planning, budgeting and oversight processes.

Potential Risks and Emerging Challenges Ghana is ranked high among African countries most exposed to risks from multiple weather‐related hazards. The combined effects of poverty and rapid population growth contribute to environmental degradation and resource depletion in both rural and urban areas. Ghana had an average annual population growth of 2.2 percent from 2002 to 2008, which although lower than the average for Sub‐Saharan Africa (2.5%), is still higher than the average for low income and developed countries ‐ (2.1% and 0.6% respectively). The high dependence on natural resources in rural areas (more than 60 per cent of Ghana’s population depend directly on agriculture), added to the lack of formal and informal social security safety nets exacerbate Ghana’s vulnerability.

With respect to climate change, the EPA has predicted that by 2080, cocoa will fail to grow due to climate change effects. Ghana is currently the world’s second largest exporter of cocoa. Cassava yields are projected to decline by 3 per cent by 2020, and by up to 53 per cent by 2080; while cocoyam yields will fall by 11.8 per cent by 2020 and up to 68 per cent by 2080 and this will contribute to food security. Together, these tuber crops also generate about 75 per cent of Government earnings and employ about 70 per cent of the population. Ghana also grapples with the other side of the climate change equation – control of carbon dioxide emissions arising from deforestation. Some reports indicate that Ghana lost about 1.9 million hectares of forests over the last decade.

Since its inception under the NADMO Act (1996), the National Disaster Management Organisation (NADMO) has contributed considerably to the management of disasters despite perennial constraints to obtain resources and maintain response capacity on the ground. NADMO has undertaken interventions to build public awareness and social mobilization in disaster preparedness. Some innovative approaches and tools have been developed across sectors in areas of agriculture and rural livelihoods, watershed management, ecosystem management, urban governance and risk transfer. However, NADMO has so far only engaged from an emergency response perspective, rather than from a perspective of mainstreaming DRR in sector programmes and strategies.

GHANA COUNTRY ANALYSIS September 15, 2010

Considering that the majority of the people in Ghana depend on agriculture and the environment for their livelihood, and about 25 per cent live in coastal areas a large proportion of them depending on fisheries for their livelihoods, it is clear that climate change will have enormous impact on the socio‐economic lives of the people. It is therefore imperative that a long‐term view of the effects of climate change should be considered to assess the potential risks of climate change and assess its interactions with other aspects of human and environmental systems to guide policy responses. Some of the key areas for the UN to contribute include:

a) Support for increasing resilience for climate change impacts through development of early warning systems. b) Support for development of national capacities in monitoring of climate change and support studies of environmental risk factors to human security and livelihoods. c) Support for capacity development for upstream strategic policy, coordination and dialogue as well as effective engagement with global fora on climate change. d) To support development of a national climate change finance framework for climate change and development. e) Support for capacity development for institutionalization of climate change convention within national legal frameworks. f) Support for the development of appropriate policies and strategies to make Ghana a low‐carbon economy and to move towards greater utilization of renewable energy sources. g) Support Government efforts and strengthen national capacities in sustainable environment management with specific emphasis on water resources. h) Support Government efforts and strengthen national capacities in sustainable management of the marine environment with specific emphasis on prevention and control of sea pollution by ships and offshore oil platforms i) Support for the use of accumulated traditional knowledge and community practices of environmental management for sustainability j) Support development of policies designed to address climate induced migration with specific emphasis on protecting rights of migrants and their access to social services k) Support to Government’s interventions in assisting people affected by natural disasters.

Thematic Areas for Common Results The foregoing analysis has revealed interesting trends across the socio‐economic spectrum of Ghana. Some of the data indicates remarkable progress towards sustainable development in general, and achievement of the MDGs in particular. However, some of the

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GHANA COUNTRY ANALYSIS September 15, 2010 data also points to a milieu of challenges and potential setbacks that could have far‐reaching impact on Ghana’s development and human security.

For the UN system in Ghana to be effective, it will have to prioritize its thematic intervention areas based on a limited number of key criteria. For Ghana, the following criteria for the selection of the key thematic areas for common results are being proposed:

Key capacity gaps emanating from the analysis and aligned to the national priorities are summarized in the Ghana Shared Growth and Development Agenda (GSGDA) 2010‐ 20134. After the implementation of GPRS 1 (2003‐2005) and GPRS II (2006‐2009), the GSGDA 2010‐2013 (2010‐2013) aims to lay the foundation for the structural transformation of the economy within the decade ending 2020, through industrialization, modernized agriculture and sustainable exploitation of Ghana’s natural resources. The GSGDA 2010‐2013 identifies 7 main thematic areas5, which are further sub‐divided into sub‐themes. During the Mid Term Review of the UNDAF (2006‐2010) in 2008, the UN system decided to extend the UNDAF cycle till the end of 2011, to ensure the availability of the new Government planning document that would replace GPRS II. Alignment with Government priorities identified in the GSGDA 2010‐2013 provides an important opportunity for the UN system in Ghana to show its commitment to the principles and practices of the Paris Declaration and the Accra Agenda for Action. Alignment with government priorities will also help to strengthen the role of UN agencies in processes of donor harmonization and donor coordination, which have been operational in Ghana for a number of years. At present, there are 14 sector working groups, which rely on active participation from sector ministries, departments and agencies such as the Ministry of Finance and Economic Planning (MoFEP), the National Development Planning Commission (NDPC), development partners (including UN agencies) and CSOs and which provide important opportunities for overall policy and political dialogue on inclusive development and equitable growth with a clear focus on the realization of the MDGs by 2015.

Key capacity gaps emanating from the latest MDG report. The MDG targets which are unlikely to be met by 2015 have been identified in Chapter 4 of this report. In a nutshell, targets 1a and 7c (on poverty reduction and access to safe drinking water) have already been achieved at national level, but many regional disparities remain. Targets 5a, 7a and 7c (on reduction of maternal mortality, integration of principles of sustainable development in countries polices and access to improved sanitation) are unlikely to be met. The probability of achieving the other MDG targets is assessed as ‘probably’ or ‘potentially’. In section 7 of the GSGDA the Government of Ghana acknowledges the progress made

4 GoG/NDPC, September 7, 2010. 5 1) Ensuring and sustaining macroeconomic stability; 2) Enhancing competitiveness in Ghana’s private sector; 3) Accelerated agricultural modernization and sustainable natural resource management; 4) Oil and gas development; 5) Infrastructure, energy and human settlement development; 6) Human development, productivity and employment; and 7) Transparent and accountable governance.

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GHANA COUNTRY ANALYSIS September 15, 2010 towards achieving the MDGs but at the same time identifies the need to identify and reduce spatial and income inequalities across the country to ensure that all MDGs are met in a sustainable and equitable manner.

Comparative advantage of the UN agencies in Ghana. When deciding on key intervention areas supported by the UN system in the next five‐six years, existing UN agencies’ capacities and the capacity of UN agencies to respond to current and emerging capacity gaps have to be considered.

When using these criteria, four GSGDA thematic areas emerge, with which the UN system in Ghana could align itself and which can be used as a basis for further identification of potential intervention areas and ‘delivering as one’ priorities:

1. Agricultural Modernization and Food Security (with Focus on Nutrition)

2. Sustainable Environment, Energy and Human Settlements;

3. Human Development and Productive Capacity for Improved Social Services;

4. Transparent and Accountable Governance;

7.1 Thematic Area 1: Agricultural Modernization and Food Security (with Focus on Nutrition)

While Ghana is reportedly on track to achieve MDG 1 on eradicating poverty, major challenges in eradicating hunger have been identified in the analysis whilst the nation’s economy is heavily dependent on agriculture which accounts for 39% of the total GDP6. Among some of the main challenges are the slow growth of agriculture due to a combination of factors that reduce farmer incentives to invest and produce, including poor basic infrastructure (road and irrigation); socio‐cultural factors (gender and land rights); and agricultural‐related services. The negative impact of climate change (droughts and floods) on agricultural production was also highlighted. Food is available the country, but it is not accessible to all sections of the population, especially the vulnerable. In some parts of the country, food can be accessed but proper utilization is lacking. This has put 1.2 million people into chronic food insecurity and a further 2.07 million becoming vulnerable to food insecurity7.

The MDG1 is also related to other MDGs, including MDG4 and MDG5. The food insecurity is well mirrored in the level of malnutrition among children under five years and

6 Mid‐term National Development Framework – Ghana Shared Growth and Development Agenda (2010‐2013) 7 WFP 2009 Comprehensive Food Security and Vulnerability Analysis

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GHANA COUNTRY ANALYSIS September 15, 2010 lactating women. Twelve per cent of children under the age of five years are reportedly underweight; 22 per cent are stunted or too short for their age; and 7 per cent are too thin for their height. Malnutrition has contributed greatly to high under‐five and maternal mortality.

Addressing these challenges requires the development of sustainable and comprehensive food security and nutrition policy and strategies that cut across many sectors, including agriculture, health, education, natural resources, environment and planning. Food security and nutrition is one of the major focuses that the GSGDA gives special attention.

Ghana as signatory of The Comprehensive Africa Agriculture Development Programme Compact (CAADP) since October 2008 has committed to allocating 10% of the annual budget for agricultural development. CAAP has four main pillars: i) Extending the Area under Sustainable Land Management and Reliable Water Control Systems (including soil fertility management and conservation, agricultural water use and irrigation, and land policy and administration); ii) Increasing Market Access through Improved Rural Infrastructure and other Trade Related Interventions (including supply chain development, quality control and management system development, export infrastructure, and global trade policies and agreements; iii) Increasing food supply and reducing hunger across the region by increasing smallholder productivity and improving responses to food emergencies (including emergency food supply management, nutrition, school feeding schemes, HIV/AIDS support strategies, attention to priority livelihood sectors) and iv) Improving agricultural research and systems to disseminate appropriate new technologies and increasing the support given to help farmers adopt them (including technology development, access and dissemination; innovation systems platforms; building research capacity and training). The CAADP is now aligned with the Ghana’s FASDEP (Food and Agriculture Sector Development Policy).

Other programmes namely Imagine Ghana Free of Malnutrition (GHS 2005), Integrated Anemia Control Strategy (GHS 2003), Vitamin A Policy (MOH 1998), Infant and Young Child Feeding Strategy for Ghana (GHS 2007), Breastfeeding Promotion Regulations (MOH, 1995), Food and Drug Law and Amendments: Universal Salt Iodisation (MOH 1995), etc. have been put in place but no concerted efforts have been put in place to address the nutrition situation in Ghana.

The government, development partners and NGOs have attempted to address the nutrition situation using multi‐sectoral coordinating mechanisms to oversee or harmonize nutrition‐related work in the country. Several working groups, Task Forces, Advisory and Coordinating bodies such as the Interagency Nutrition Partners Group, Anemia Control Coordinating Committee, Baby Friendly Health Institution Authority, Food and Drugs Board Code Monitoring Task Force, National Salt Iodisation Committee (NSIC) have been established over the years. There is therefore a need to strengthen these interventions,

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GHANA COUNTRY ANALYSIS September 15, 2010 including through a coordinated approach under a Food Security and Nutrition Theme Group.

Due to the absence of proper nutrtion policy of the country and that is a major constraint to addressing malnutrtion, the Government has committed in its Midterm National Development Framwork such policy.

7.2 Thematic Area 2: Sustainable Environment, Energy and Human Settlements

Ghana is not likely to achieve MDG 7 by 2015 because among other reasons, its forest cover is declining rapidly. It has been estimated that Ghana’s forest cover has declined from 32.7 per cent to 24.2 per cent between 1990 and 2005. In 1990, the forest cover was estimated at 7,448,000 hectares, and this has declined at an average rate of 1.8 per cent annually to 5,517,000 hectares in 2005.8 There are several factors that contribute to the depletion of forests, including livelihood activities, land degradation, and the rapid growth and expansion of unplanned cities. Human activities such as logging, fuel production caused by lack of access to clean and efficient energy sources and unsustainable farming practices are the main causes of forest loss. Much of the logging is illegal and is often done with little consideration for the environment. Land degradation has a significant impact on the environment and natural resource base of the country. About 69% of total land area is prone to severe or very severe erosion due to farming practices, removal of vegetative cover, deforestation and mining activities, especially illegal mining. Furthermore, loss of biodiversity is proceeding at alarming rate. In the backdrop of all these phenomena is the increasingly serious impact of Climate Change, including recurrent natural disasters, which are recognized as major human security issues especially for the poor due to their dependence on natural environment for their livelihood.

A number of UN‐HABITAT empirical data suggests that housing improvement has a strong correlation with social and economic indicators such as disease control, environmental improvement and increased school enrolment among others. However, despite the critical importance of housing, national development policies and programmes have in the past often treated housing as something to be tolerated rather than desired. Out of 3.88 million dwelling units recorded in 2000 in Ghana, less than 50 per cent were classified as houses, while the remaining were dwelling units constructed with poor quality mud bricks and earth, mostly with thatched roof and poor floor construction materials. In addition, 74,000 kiosks and containers housed several hundred thousand people and a large number of people in urban areas sleep on pavements, walkways and on streets. Current estimates indicate that the country needs 1,000,000 housing units annually while supply is estimated at 35 percent of the total need.

8 NDPC/Government of Ghana, UNDP (2010), Ghana: Millennium Development Goals Report.

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Rural housing problem in Ghana has been that of quality and almost entirely produces by the private sector using mostly traditional building materials. Most building materials used for rural housing have been known not to be able to resist disasters as such houses need to be rebuilt in short periods. On the other hand, rapid increase in urban population has resulted in a high housing deficit in most cities in the country.

Ghana is likely to meet the MDG target on sustainable access to safe drinking water, but off track to achieve the target on basic sanitation. An important strategy high‐lighted in the GSGDA 2010‐2013 to develop infrastructure and human settlements is the improvement of water and environmental sanitation and hygiene services in urban and rural areas. Various sector policy instruments (including the National Water Policy, the National Environmental Sanitation Policy), investment plans and implementation strategies have been developed, a sector wide approach to programming has been agreed and is being implemented, while the development a water and sanitation sector strategic development plan is underway to provide the basis for a coordinated sector programming founded on the principles of aid effectiveness.

The recently completed Ghana Compact on Sanitation and Water for All (which was agreed between the Ministry of Local Government and Rural Development, the Ministry of Water resources, Works and Housing and the Ministry of Finance and Economic Planning) emphasizes the importance of sanitation and water. It provides a clear policy framework till 2015 with a financial commitment by the Government of Ghana of US$350 million per year for sanitation and water infrastructure, an additional 0.5% of GDP for hygiene promotion and an invitation to civil society and development partners to work together to enhance the quality of life.

The various sector policies and strategies, investment plans, the new Ghana Compact policy framework on sanitation and water, the upcoming sector strategic development plan and the comparative advantage the UN has demonstrated in the past 5 years in Ghana (with important contributions made to the eradication of Guinea Worm) provide important opportunities for the UN system to help Ghana meet the MDG targets on sustainable access to safe drinking water and basic sanitation by 2015. According to the Government of Ghana, these water and sanitation targets are ‘the core of achieving all the MDGs’9, with clear positive spin‐off effects for the sustainable and equitable achievement of all health, gender and education related MDGs. The key entry points for the UN will be supporting the

9 Government of Ghana (April 2010). The Ghana Compact. Sanitation and Water for All: a Global Framework for Action (SWA).

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GHANA COUNTRY ANALYSIS September 15, 2010 implementation of policies, strengthening institutional and human resource capacity, strengthening sector coordination and promoting behavior change on improved hygiene practices and climate change adaptation measures related to integrated water resources management.

7.3. Thematic Area 3: Human Development and Productive Capacity for Improved Social Services

The need to harness the innate talents and energies of all Ghanaians (especially the youth) in order to ensure economic growth and political stability cannot be over‐ emphasized. The absence of gainful and productive economic opportunities during the lean season was cited as one of the main causes of conflict in northern Ghana. The challenge of inadequate basic services in the major urban areas is also largely driven by increasing rural‐ urban migration, particularly among the youth in search of economic opportunities. It is also noteworthy that Ghana does not have a National Employment Policy. In the meantime, the government launched the National Youth Policy in August 2010 and this requires support for implementation. Related to this is the national ageing policy for which support for implementation strategies is required.

Another major challenge that cuts across throughout the analysis is persisting, and in some cases, increasing disparities and inequalities in development, including gender inequalities. Existing evidence shows that disadvantaged groups, including women and children, the poor, rural remote populations, migrants, people with disabilities, and those affected by conflict, are disproportionately affected by the acute shortages of basic public services and infrastructure. Often times poverty, gender, location, and other characteristics interact to create magnifying layers of disadvantage that restrict development opportunity and hinder social mobility.10 For example, World Bank studies indicate that in the non‐SADA southern districts where poverty is less endemic, female‐headed households constitute the larger proportion of the poor than male‐headed households.11 The issues involving conflict around land tenure affect mostly women, who due to cultural stereotypes continue to lack the right to own or inherit land, which for the poor is their main source of livelihood. Data on Reproductive Health and maternal mortality also shows very little progress achieved particularly among the poor and rural populations. The rapid deforestation and rising temperatures causing the drying of river beds and boreholes in some parts of the country, mostly affect women and children in poor households in rural areas who bear the brunt of fetching wood fuel and water for domestic consumption.

10 UNESCO (2010). EFA Global Monitoring Report 2010. 11 UNICEF (2010), Reaching the Lowest Quintile in Ghana: Lessons from the Evidence.

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The analysis revealed a number of important issues related to delivery of essential services (especially to vulnerable and excluded groups) which could seriously jeopardize the sustained human development in Ghana.

In education, national net enrolment rates have improved substantially, but there are still some 450,000 children of primary school age not enrolled and completion rates for boys and girls are low, with large disparities between districts and income quintiles.

In the health sector, Ghana has not progressed adequately on the health‐related MDGs because effective, evidence‐based, primary health care interventions are not available to most Ghanaians, especially women, children, the poor and those living in rural areas. This situation needs to be addressed by

a) Strengthening health systems in 6 areas: service delivery, the health workforce, health information systems, access to medical products, vaccines and technology, health financing, and governance.

b) Addressing the social determinants of health, including poverty, education, employment, environment and women’s empowerment. These are fundamentally responsible for inequities in health outcomes.

Because of its broad mandate for human development, and the diverse technical expertise in its various agencies, the UN system is well positioned to support health systems strengthening, to contribute to strong evidence‐based policies and sector plans, and to promote inter‐sectoral mechanisms to address the social determinants of health.

Further, Female Genital Mutilation (FGM) practices in parts of the Northern Regions, makes women vulnerable and can contribute to maternal death. Cases of sexual abuse and exploitation of children are on the rise. With regard to HIV and AIDS, the most affected groups are women and young people, especially girls. Stigma and discrimination of persons living with HIV remains a major challenge in the community and amongst service providers.

Thematic Area 3 is an area which requires substantial policy support and capacity development at institutional, individual and community levels. The development of operational manuals to guide both government and civil society organizations would be one area for the UN to demonstrate its comparative advantages. Entry points for UN agencies in Ghana to deliver as one include development of policies and strategies to reduce maternal death, improve the quality of primary education, reduce poverty and income inequalities and enhance the delivery of social protection and other basic services to the most vulnerable and disadvantaged groups.

7.4. Thematic Area 4: Transparent and Accountable Governance

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Throughout the analysis, the issue of accountability and equitable development has emerged as a major factor affecting Ghana’s progress and development. Ghana has emerged as a good example of economic and political reform in Africa, attracting investor interest and confidence. This is in part due to the country’s political stability as evidence for instance by its ability to conduct free and fair elections and transfer power in a peaceful manner. This has generated investor confidence in the rule of law, credible and predictable institutions as well as a peaceful and stable environment leading to a growth in foreign investment and greater economic growth. Ghana’s human rights record and absence of violent conflict has also contributed to the stability that is vital to development.

There are however lingering gaps and challenges that remain, particularly in the justice sector and combating of corruption. The government is cognizant of these gaps and has prioritized them in its Ghana Shared Growth and Development Agenda ( GSGDA 2010 – 2013). The role that good governance plays in specific sectors is also very apparent, as for example limited government responsiveness to emerging issues; weak transparency and accountability; as well as the mismatch between resources and sector plans were all identified among the major bottlenecks to reducing maternal mortality. The UN should therefore leverage its comparative advantages in governance to assist Ghana to strengthen its institutions of governance and support the development of appropriate policies as one of the pillars of growth and achievement of the MDGs.

In many sectors, the evidence shows that progress has been uneven across the regions, with the northern regions being the most affected. This underscores the need for the strengthening of processes of democratic governance at central and local level as a pillar for achieving the MDGs. To contribute to this outcome, the UN in Ghana can assist the Government of Ghana to achieve a number of policy priorities outlined in the GSGDA such as the strengthening of systems of local government; strengthening of systems of rule of law and justice; the empowerment of women and strengthening of systems of evidence based decision making.

Evidence based decision‐making relies strongly on data collection, processing management and utilization strengthens transparent and accountable governance. As observed above, the infrastructure and the processing and management of the statistical data generated by GSS from the decentralized level remains a considerable bottleneck for data harmonization. A joint approach by the UN to augment the capacity of GSS to gather, manage and harmonize data in real time on a common platform will be imperative for effective policy making, planning purposes. Assistance would be required from the collective comparative advantage of the UN in support of government to revise and implement the current national strategy for statistical development. An immediate element of such support is that for seeing to it that the ongoing Ghana 2010 Population and Housing Census is successfully concluded.

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Strengthening the M&E and statistical system through capacity development of government institutions such as the National Development Planning Commission, MDAs, and MMDA must be one of the overarching foci, of the UN system within the UNDAP. An important emphasis would be laid on streamlining the operations of the institutions involved. There is also the need for capacity development of an independent civil society M&E systems as strongly recommended by the 2009 MDBS Forum. This effort, already carried out on an ad hoc basis by a number of UN agencies must be institutionalized within the next five years.

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CHAPTER 1: INTRODUCTION

1.1. Background

1. At country level, the UN uses a common planning framework called the United Nations Development Assistance Framework (UNDAF), which lays the foundation for cooperation among UN agencies, Government and other Development Partners, and enables the UN system to achieve results‐oriented collaboration, coherence and mutual reinforcement. The UN agencies in collaboration with the Government of Ghana have started the process to develop a new UNDAF covering the period 2012 – 2016. As part of that process, the United Nations Country Team (UNCT) in Ghana undertook a Country Analysis for Ghana to support and strengthen the national analytical processes and products. The Country Analysis was guided by the basic elements and principles of the UN, and was designed to strengthen the national development framework by identifying priority problems and their causes, as well as the requisite capacity development needs that are required to generate action and achieve results at all levels.

1.2. Purpose of the Country Analysis

2. The purpose of the Country Analysis is to identify the root causes of poverty and other development challenges; their impact on the population, particularly on the excluded, vulnerable and disadvantaged groups such as women, youth and ethnic minorities. The analysis was focused on MDG achievement in Ghana, and was guided by the five UN programming principles; (i) human rights‐based approach, (ii) gender equality, (iii) environmental sustainability, (iv)results‐based management, and (v) capacity development.

1.3. Country Analysis Process

3. The Country Analysis was driven by the UNCT to complement the analytical work already undertaken by the national authorities, with the support of a team of consultants comprising an international consultant as team leader and two national consultants. The analysis was done through a consultative and participatory process involving four stages – planning, data collection, data analysis and reporting. Stage 1 of planning was completed in a period of 4 days, and involved four meetings – the first with the staff of the Resident Coordinator’s Office, in which the consultants were given a briefing on the background and

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expectations of the UNCT, and development of a work plan. In the second meeting, the consultants’ team briefed the UNDAF Core Group comprising Deputy heads of all resident UN agencies and representatives from the Government, on their proposed methodology and approach to the assignment. The UNDAF Core Group provided guidance on areas of focus and the specific gaps that needed to be addressed in the Country Analysis. The third and final planning meeting was held with UN agency programme staff who provided the consultants with information on the areas targeted for analysis as well as the key sources of data.

4. Stage 2 involved the collection of data from secondary and primary sources. This Country Analysis was primarily driven by the UNCT to complement the analytical work already undertaken by the national authorities, as the Government had already begun the process to develop the Ghana Shared Growth and Development Agenda 2010 – 2013 of which a draft was pending final approval. The main data sources therefore included review of official government reports and publications; official reports and publications of the UN agencies and other development partners. The list of documents reviewed is provided at Annex 1. Information was also obtained through interviews with individuals and officials of various organizations, institutions and departments of government, civil society, private sector and academia. A total of 45 meetings were held and 124 individuals were consulted. The list of institutions consulted and individuals interviewed is shown at Annex 2, while Annex 3 provides the Interview Guide that was used to generate discussions. Stage 3 of analysis involved collation and synthesis of the collected data using appropriate qualitative and quantitative techniques to define trends, themes and patterns to attribute meaning to the data. The Country Analysis report is presented in seven chapters. Chapter 1 introduces the report; Chapter 2 focuses on Governance and Human Rights; Chapter 3 presents an analysis of the Economic Developments; Chapter 4 is on MDG Achievements; Chapter 5 focuses on Institutional Analysis; Chapter 6 discusses Potential Risks and Emerging Challenges; and Chapter 7 makes recommendations on Thematic Areas for Common Results.

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CHAPTER 2: GOVERNANCE AND HUMAN RIGHTS

2.1. Politics and Governance

5. The presidential elections in 2008 and subsequent runoff elections in 2008/09 were notable for their closeness and peaceful passing. The elections were confirmed as free and fair by both national regional and international observers. Ultimately, they marked the second peaceful transition of power to an opposition party in Ghana and promoted the nation as a bastion for democracy in a region that is renowned for its volatility and violent conflict. In addition, consistently free elections since 1992 and the accompanying political stability are in contrast to Ghana’s own history when previous republics had been constantly interrupted by periods of military rule. As a result, Ghana’s political rights, civil liberties and freedom of press rankings are renowned to be among the best in Africa and comparable to those recorded by countries with much higher levels of development.

6. Ghana is widely regarded as an example of successful economic and political reform in Africa, and was among the first group of countries to sign the Memorandum of Understanding for the African Peer Review Mechanism in 2003. Ghana has also been able to change its political governments through the electoral process in a manner generally regarded as free and fair. The 2000, 2004 and 2008 elections have confirmed the citizens’ acceptance of the electoral principle as the legitimate mechanism for acquiring political power and assuming leadership of the institutions of governance. This has reflected positively on the country and contributed to the goodwill that has generated investor confidence leading to growth in foreign investments.

7. Reports by the World Bank Institute show steady improvement in the country’s performance over the period 1996‐2008 in six governance dimensions: (i) Voice and accountability; (ii) Political stability and lack of violence; (iii) Government effectiveness; (iv) Regulatory quality; (v) Rule of law; and (vi) Control of corruption.12 The following figures provide a synopsis of Ghana’s ranking compared to other countries worldwide on four indicators. The percentile ranks (vertical axis) indicate percentage of countries worldwide that rank below Ghana in the respective indicator. Percentile rank indicates the percentage of countries worldwide that rate below the selected country. Higher values indicate better governance ratings. Thus for example, in Voice and Accountability, which measures the public

12 Country Data Report for Ghana, 1996‐2008; www.worldbank.org/wbi/governance.

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participation in governance and government’s accountability to the public, Ghana was rated better than 40% of countries worldwide in 1996 but improved to rank better than 60% of countries in 2008. Ghana’s performance on the Mo Ibrahim governance index is indicated below, over the period 2003 to 2007 Ghana’s performance has been consistent. In the overall ranking the country is ranked 7th on the continent.

Source: http://www.moibrahimfoundation.org

Figure 1: Ghana’s Governance Performance (1996 – 2008)

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8. Although Ghana’s international ranking on corruption indicators is one of the best among low‐income African countries, recent trends indicate a steady decline in its ranking in recent years as shown in the figure above. A national survey conducted in 2005 found that 75 per cent of all households regarded corruption as a serious national problem, with 80 per cent

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saying that it had worsened in recent years.13 The system of checks and balances and a civil service that is widely regarded as politicized creates opportunities for corruption. There are no specific statistics that attest to the effect of corruption on development, but the Serious Fraud Office (SRO) the government agency with responsibility for combating economic crime claimed that indications suggest that between 5‐30 per cent of national revenue goes to waste due to fraudulent practices like over‐invoicing and tax evasion; while the revenue lost due to customs irregularities is considered to be as high as 70 per cent.

9. Considering the role that local governments have with regards to delivery of basic public services due to their close proximity to the communities; as well as their ability to scale up the implementation of MDGs at local level, Ghana’s policy for decentralization is a critical component for its development strategy. However, progress in decentralization has been slow and some stakeholders expressed concern that it was not working as it should. In a report of the African Peer Review Mechanism (APRM), a governance initiative of the African Union, stakeholders noted that real power – administrative, political and financial – should be delegated and extended from the center to the decentralized structures at regional, metropolitan, municipal and district levels. This would ensure accountable, participatory and transparent political governance, financial management and socio‐economic development at these critical grassroots levels. The APRM report also noted that stakeholders had expressed a strong preference for elected district chief executives, which are currently appointed by the Presidency.14 Information obtained through interviews indicated that these recommendations were yet to be addressed. The G‐JAS report also observed that citizens’ assessment of the quality of governance related to District Assemblies showed a dissatisfaction rating of 62 per cent and a satisfaction rating of 27 per cent.15 The report further noted that part of the delay in decentralizing staff and fiscal resources was due to concerns about local capacity, combined with reluctance of “the center” to lose resources and influence.

10. There also appears to be some conflict between the traditional (Chieftaincy‐based) and modern forms of local government. In its 2009 Bulletin,16 the National House of Chiefs notes:

“The role of chiefs in the decentralization process – i.e. Local Government – should be critically re‐ examined to remove the current token of Nananom in District Assemblies. Chiefs must remain active participants in, and constructive contributors to the process of decentralization, democratization and sustainable development”.

13 Ghana Joint Assistance Strategy (G‐JAS); February 2007. 14 African Peer Review Mechanism, Country Review Report and Programme of Action of the Republic of Ghana; June 2005. 15 Ibid –p6. 16 National House of Chiefs (2009); Chieftaincy Bulletin, Vol. 1, No. 1, November 2009.

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The current structure of District Assemblies is 70 per cent elected and 30 per cent appointed by the President to represent specific interest groups such as women and traditional chiefs. The Traditional Chiefs are reluctant to subject themselves to the election process and would like the 30 per cent to be wholly reserved for them.

2.2. Conflict Prevention

11. Ghana’s history has been largely free of armed conflict and violence. However, there are disturbing situation of protracted but latent conflict in some parts of the country, particularly in the Northern region. Information from stakeholders interviewed noted several cases of conflicts among Chieftaincies around the issue of land. Tidal waves in coastal regions have also pushed people inland, creating pressures for land. The youth are reportedly involved in violence when they are not engaged in productive activities between harvests in the dry season. In addition, some stakeholders expressed concern about potential conflict when commercial oil extraction commences in the Western region, noting the experiences of neighboring countries where oil resources have been a major cause of conflict. In addition, there is an increase in the numbers of illicit small arms and light weapons which are sometimes used to Some years ago, the Katamanso Chief gave some of perpetuate armed violence. A conflict his land to the Anwahia Chief and his people for mapping exercise is currently ongoing in farming. He however sold that land to a real estate agent who later found that part of the land had been the country to assess the risk of conflict sold to someone else by the chief’s son after the as part of efforts towards Conflict death of the Chief. Both father and son had sold land Transformation and Small Arms Control. that belonged to a neighboring clan. Source: Wermann 2002 in Eschban (2008), Land Conflicts 12. In recent times, there have also arisen increasing risks of conflict among the Chieftaincy that have control and ownership of land. Some reports have noted that Traditional Chiefs often sell land that they are supposed to hold in trust causing landlessness among their people and thereby increasing the risk of conflict among their own people, among the Chieftaincies and also between the Chieftaincy and the state. The same report also noted that in Accra, many plots are sold by different people to different clients. While one buyer starts construction, another buyer appears or sends land‐ guards to destroy the structures, sometimes even attacking the caretakers on the site. In 2004, Ghana’s Chief Justice noted that there were about 60,000 cases involving land disputes pending in the courts.

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2.3. Human Rights Situation

13. Ghana has received positive reviews from various international organizations and human rights “watch dogs”. Table 1 below shows extracts from a recent Human Rights Watch report.

Table 1: State of Human Rights in Ghana

a) Arbitrary or unlawful deprivation of life No reports that the Government or its agents committed politically inspired killing. b) Disappearance No reports of politically motivated disappearance. c) Torture and other cruel, inhuman and The constitution and the law prohibit such practices; but there degrading treatment or punishment were reports of severe beatings in police custody. d) Arbitrary arrests or detention The constitution and the law prohibits such practices. e) Denial of fair public trial The constitution and the law provide for an independent judiciary; however, the judiciary was ineffective and subject to influence and corruption. a) Freedom of speech and press The constitution and law provide for these rights; and Government generally respected them in practice. b) Freedom of peaceful assembly and The constitution and law provide for these rights; but sometimes association the Government restricted the rights. c) Freedom of religion The constitution and law provide for these rights; and the Government generally respected them in practice. d) Freedom of movement, internally The constitution and law provide for these rights; and the displaced persons, protection of refugees Government generally respected them in practice. Source: Extracts from 2009 Country Reports on Human Rights Practices, March 2010

14. A 2007 report by AfriMap noted that Ghana had ratified many of the major international treaties relating to the promotion of human rights and the rule of law, and that its record had been consistently improving since 1993.17 The report further noted, however, that Ghana was yet to sign up for some important provisions, including several that allow individual complaints to be heard by the treaty monitoring bodies. The list of international human rights treaties signed and ratified by Ghana is provided at Annex 4 to this report.

15. Ghana also has an impressive record of encouraging public education on fundamental human rights as a means to improve citizens’ access to justice, with several Non‐Governmental Organizations (NGOs) engaged in human rights promotion to complement the education programmes conducted by the Commission on Human Rights and Administrative Justice

17 Ghana: Justice Sector and the Rule of Law; A review by AfriMap and the Open Society Initiative for West Africa and The Institute for Democratic Governance, 2007.

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(CHRAJ) and the National Commission on Civic Education (NCCE). The report however, also asserts that access to justice was constantly hampered by a geographic imbalance in court distribution that was concentrated in areas of high economic activity instead of areas with high density of population. Some interviewees noted that currently there were about 2,500 detainees who had not been brought before the court for long periods in excess of what the law provides due to various reasons, including missing dockets. The UN has however supported the Government to establish a High Level Dialogue that brings together officials from the Ministry of Justice, the Attorney General’s Office, the Police and Prisons to discuss how this matter could be addressed. In addition, corruption in the justice system and delays in justice delivery are reported to have eroded public confidence in the justice system, while at the district court level, significant shortages of magistrates were reported. The caseload statistics for the period 2008 – 2009 shown at Annex 5 indicates that the court system is overwhelmed at all levels.

16. While the rule of law is an entrenched reality in Ghana, several stakeholders noted that some sections of the population are routinely denied access to justice because they cannot afford the cost of legal representation. The judiciary itself suffers from lack of adequate capacity to administer justice. Availability of office space and courtrooms is a major problem both in Accra and countrywide. Each year, budgetary allocations have been insufficient to meet the growing infrastructure needs of the judiciary. This affects the easy flow of justice and ultimately the rule of law.

17. The Juvenile Justice Act of 2003 empowers the Chief Justice to designate a district court as a juvenile court, with powers to hear and determine civil or criminal cases involving persons under the age of 18 years. However, evidence from stakeholders suggested that access to justice by children is affected by the inadequate budgetary allocation for the services provided for under the Act. Significant delays in the cases are caused by the inability of the Police to complete the investigation process before presenting the juvenile in Court, resulting in extended detention of juveniles. Evidence from stakeholders suggested that furthermore, juvenile justice was affected by lack of proper detention centers for juveniles, who are often detained together with adult offenders. In addition, while in detention, children do not have access to basic necessities such as education, skills training and other psycho‐social services vital to their development. Children have no access to legal aid which further delays the process of justice; the UN agencies have however been supporting legal aid through NGOs and individual lawyers.

18. Amnesty International also presented to the President when he assumed office, a report articulating some of the outstanding human rights issues that required attention in order to consolidate the human rights situation in Ghana. The list of issues included: (1) Abolition of the

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death penalty; (2) reduction of over‐crowding in Ghana’s prisons; (3) Eradicating the widespread violence against women; (4) Stopping and preventing the practice of forced evictions; (5) Ending illegal detentions and ensuring prompt and fair trial; and (6) Full compliance with Ghana’s international and regional human rights obligations.

Challenges to Governance identified in GPRS II 2.4. National Response and  Strengthening the process of democratization Strategy  Improving existing institutional, legislative and policy 19. Ghana’s progress in environment  Evidence‐based decision making consolidating democracy was  Ensuring gender equality acknowledged in the report of the  Fostering greater civic responsibility APRM. However, the report also  Integrating traditional authorities into formal noted that some daunting institutional structures for governance challenges still remained to be addressed, including capacity constraints, gender equity, corruption, decentralization, land issues and chieftaincy. However, the government has indicated that it understands the need to consolidate these political achievements, and has been an active participant in the African Peer Review Mechanism having been the first country to be reviewed under this initiative.

20. In the GPRS II (2006 – 2009), Government undertook a review of governance under GPRS I and noted that the broad objective of good governance and civic participation was to empower state and non‐state entities to participate in the development process and to collaborate in promoting peace and stability in the body politic. Government strategy to achieve the objective of good governance under GPRS II was to promote effective, responsible and accountable state machinery with improved capacity to engage the productive private sector and civil society in formulating policies and strategies for accelerated growth and poverty reduction; and in implementation, and monitoring and evaluation.

21. Among its key policy priorities for governance, the Government had focused on strengthening parliament, enhancing decentralization, protecting rights under rule of law, ensuring public safety and security, managing public policy, empowering women and vulnerable groups, increasing access to information, right to food and promoting civic responsibility. The challenges in these areas are ongoing and Government continues to view them as priorities in the new Medium Term Development Agenda.18 One of the priorities in the new development strategy is “Transparent and Accountable Government,” which includes: (1) Promoting the practice of democracy and reform agenda; (2) Strengthening governance and decentralization (against the backdrop of the Decentralization Policy Framework and the Action

18 Draft Medium Term Development Agenda, 2010 – 2013; June 2009.

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Plan); (3) Improve policy management and public sector reforms; (4) Promoting women empowerment; (5) Fighting corruption and economic crime; (6) Enhancing rule of law and justice; (7) Improving access to rights and entitlements.

22. The government also approved a bill to expand and rename the Serious Fraud Office as Economic and Organized Crime Office, which (at the time of writing) is before parliament. If the Bill is passed, it will expand the mandate of the Office to include economic crime, money laundering and financing terrorism, human trafficking, narcotics and sexual exploitation. With regards to conflict prevention the government developed the National Peace Architecture to enable and facilitate the development of mechanisms for cooperation among stakeholders in peace‐building by promoting cooperative problem solving and institutionalizing the processes of conflict resolution. The structure of the national peace architecture includes a National Peace Council (NPC) and District Peace Advisory Councils (DPAC), which are already established in all districts.

23. In the area of human rights, the CHRAJ and NCCE were reported to be effective and impartial. For example, in September 2008, the CHRAJ issued a report entitled, “The state of human rights in mining communities”, which found evidence of widespread violations of human rights. The NCCE also conducts effective programmes to educate citizens on human rights issues. A 2002 study of “Civic knowledge among the youth of Ghana” found that, while the majority of respondents had little knowledge of the Constitution, a substantial number of them were aware of their fundamental rights. A very high percentage of respondents (71 per cent) had never seen a copy of the 1992 Constitution. On knowledge of human rights issues; 91.8 per cent considered the right to a fair trial as a human rights issue; 88.1 per cent considered the right to information as human rights issues; and 92.1 per cent considered freedom of religion as a human rights issue.19 Recently (July 2010) the CHRAJ also launched audio services of the CHRAJ Act 456 and the Disability Act 715 for persons with hearing disability. In September 2009, the CHRAJ launched the process to develop a National Human Rights Action Plan that will serve as a basis for public policy for promoting and protecting fundamental human rights in Ghana.

24. Ghana also has a Law Reform Commission (LRC) established since 1968 to review statutory and customary laws and propose reforms, but its efforts towards law reform have been reported to be slow and its contribution marginal due to limited resources and backlog in the legislative agenda of Parliament. Actual budget allocations to the LRC for 2009 and 2010 were less than 50 per cent of the budget estimates as shown in Figure 2 below.

19 NCCE: “Civic Knowledge among the Youth of Ghana in 2002” (November 2002. The survey was conducted to assess the efficacy of the NCCE’s civic education programmes and to get the youth interested in the attempts at sustaining constitutional democracy.

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Figure 2: Comparison of Actual Allocations to Budget Estimates to the LRC for 2009 and 2010.

Source: Law Reform Commission (2010), Budget Provision Summary Report

Law reforms in Ghana have therefore been driven by civil society, often working with the CHRAJ. For example, CSOs were the leading force behind two important statutes, the Disability Act of 2006 and the Domestic Violence Act of 2007.

2.5. Emerging Priorities for the UN

A: Politics and Governance

25. Democratic governance is widely regarded to create the conditions necessary for sustainable development and poverty reduction. Experience has also shown that efforts aimed at achieving the Millennium Development Goals (MDGs) need to be focused at the local level, and therefore requires the involvement of local authorities and participation of local communities. Local authorities can play a major role by ensuring more effective and accessible local infrastructure and service delivery for the poor and disadvantaged groups; and by improving dialogue between the state and the citizenry. The focus and emphasis by Government on strengthening decentralization and promoting civic participation is therefore central to ensuring sustainable development and equitable resource allocation.

26. The UN can leverage its comparative advantage as a trusted and impartial development partner as well as its access to global best practices, to influence policy and develop capacity of local governments and civil society. The main priorities for the UN therefore should be:

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a) To strengthen the capacity of civil society to demand services as a right, while holding both central and local government accountable for delivery of services and creating the environment for broad based participation in decision‐making. b) To support the decentralization process and strengthen local government capacities in participatory planning and resource management and economic development, in order to better respond to the needs of their communities and scale‐up MDG achievement at local level. c) To develop capacities of state and civic institutions in combating corruption and strengthening reform of the public sector and justice delivery system.

B: Conflict Prevention

27. Studies have shown that latent conflict will always exist in any society. What is important is the ability to manage the conflict so that it does not escalate to levels that are counter‐ productive. In that regard, the UN should continue to strengthen support to the Government and civil society to develop mechanisms for early warning in order to detect and address potential conflict at an early stage as well as mechanisms for dialogue in order to manage and resolve conflict in a peaceful manner. Among its priorities therefore, the UN should:

a) Strengthen national capacities in conflict prevention and conflict resolution, including through control of illicit small arms and weapons. b) Support Government efforts in job creation with specific emphasis on youth employment. c) Strengthen national capacities for human and institutional capacity for maritime security within Ghana’s exclusive economic zone to prevent potential armed robbery and piracy against ships and oil platforms.

C: Human Rights Situation

28. Due to the growing recognition of the crucial links between human rights violations, poverty, vulnerability and conflict, approaches to human rights and development have converged and become inseparable. For instance, there are a lot of commonalities between human rights and MDGs. They have common guiding principles such as participation, empowerment, national ownership; they serve as tools for accountable reporting; and more importantly, they share the ultimate objective of promoting human well‐being and honoring the dignity of all people.

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29. As a trusted development partner, the UN can therefore play the catalyst role to make the convergence of human rights and development a reality by ensuring that claim holders are aware of and demand their rights, while the duty bearers feel obligated and have the capacity to deliver on their obligations. In this effort, the priorities for the UN should be:

a) To strengthen the capacity of the Law Reform Commission to enhance its ability to review all statutory provisions to bring them into compliance with the Constitution and international human rights standards. b) To strengthen Parliament’s institutional capacity to enable it to be an effective part of the law reform process. c) To strengthen the juvenile justice system and children’s access to justice. d) Strengthen women’s access to justice and to other basic social services

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CHAPTER 3: ECONOMIC DEVELOPMENT

3.1. Macro‐economic situation

30. The Ghanaian economy experienced an unprecedented growth of 7.2 per cent in 2008, but declined to 4.1 per cent in 2009 mainly due to the effects of worldwide financial and economic crises leading to decline in demand for goods and services in Ghana’s major trading partners. The modest growth performance compare to 2009 rate is attributable to the favorable market prices of gold and cocoa in the international market and good rainfall with positive result on agricultural outputs. However, despite the good growth performance in 2008, during the same year, the Ghanaian economy recorded a deficit of GH¢2,557.6 million (excluding divestiture receipts) representing 14.9 per cent of GDP with a consequential increase in the rate of year on year inflation from 12.8 per cent in 2007 to 18.1 per cent in 2008.

3.2. Performance of the Key Sectors and Sub‐sectors

31. The agricultural sector continues to be the main driver of the economy. For the period 2005‐2009, the contribution of agriculture to national output has been higher than the other sectors. The recent ISSER report observed that “with a growth rate of 6.2 per cent in 2009, the agricultural sector grew faster than other sectors”.20 Table 2 below provides performance data for the key sectors and sub sectors from 1998 ‐2009.

Table 2: Growth Rates for Key Sector and Sub‐sectors from 2005 – 2009 (adjusted for inflation) 2005 2006 2007 2008 2009 Real GDP Growth 5.9 6.4 5.7 7.3 4.7

Agriculture 4.1 4.5 2.5 5.1 6.2 Crops and Livestock 3.3 3.5 3.1 5.8 7.0 Cocoa production and Marketing 13.2 2.0 (3.5) 5.0 5.0 Forestry and Logging 5.6 2.6 2.3 3.5 3.5 Fisheries (1.2) 15.0 5.0 3.0 5.0

Industry 7.7 9.5 5.1 8.1 3.8 Manufacturing 5.0 4.2 (2.3) 4.5 5.0 Electricity and Water 12.4 24.2 (17.2) 19.4 9.0 Construction 10.0 8.2 15.0 12.0 (1.0)

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Services 6.9 6.7 10.0 9.3 4.6 Transport, Storage and Communications 7.9 7.2 9.8 8.9 7.0 Wholesale and Retail Trade; Restaurants and Hotels 10.0 7.5 10.6 10.2 2.0 Finance, Insurance, Real Estate and Business Services 7.6 9.0 14.4 9.6 10.0 Government Services 5.0 5.7 9.2 9.7 3.0 Community, Social and Personal Services 4.3 4.2 5.0 4.5 4.5 Not for Profit Services 3.6 4.0 5.0 5.0 4.0 Source: National Development Planning Commission, Accra, July 2010.

A main challenge to Ghana’s economic growth is the inequality between the Southern and Northern parts of the country and pockets of vulnerability with urban settings and regions. Despite continued investments poverty is concentrated in the Northern regions of Ghana due to remaining pockets of conflicts, inadequate socio‐economic infrastructure and vulnerability to natural disasters. A number of steps already in place to address inequality in Ghana include the recently floated Savannah Accelerated Development Authority (SADA) under the current administration to address some of the structural challenges from a spatial development perspective.

During the first quarter of 2010, the Cedi started appreciating against the major currencies, notably the Dollar, Pound sterling and the Euro. This trend is expected to continue until the end of the year. The Institute of Statistical, Social and Economic Research (ISSER) observed that, the production of oil could result in the emergence of a full blown dimension of the “Dutch Disease”, a phenomenon which manifests itself when a country discovers an important mineral resulting in a situation where many resources are attracted to the sector to the disadvantage of the growth of other sectors.21 This is evident foreign exchange flows as a result of real appreciation of the currency thereby making the economy less competitive. CEPA also made the same observation:

“The key to sustaining growth when the initial oil production hump is passed is to keep up growth in the non‐oil sector, and this in turn will depend on not allowing the currency to be overvalued”

The risks associated with Dutch Disease are the stifling of the growth and employment potentials of the agricultural and manufacturing sectors of the economy. The appreciation of the cedi under these circumstances poses a risk to the competitiveness of locally manufactured goods against imported goods. With respect to exports, made in Ghana goods would be over priced on foreign markets while imported products into Ghana would be cheaper than those

21 ISSER (2009), University of Ghana: The State of the Ghanaian Economy in 2010.

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made locally. Under both circumstances, local producers would suffer an initial reduction of profits and subsequently the collapse of the enterprises with consequential loss of jobs.22

32. With the discovery of oil in Ghana, expectations are high, while there are also concerns about how the country will manage this new resource. For close to a century, Cocoa has been the most dominant economic activity in the country in terms of contributions to the revenue of the central government, and incomes of families; and as a major source of foreign exchange earnings. Unless measures are taken to avoid it, the cocoa economy is likely to change into an oil economy on the commencement of commercial oil production either in the last quarter of 2010 or in the first quarter of 2011. In the short‐term, this phenomenon could positively affect the economy with additional revenue to finance developmental activities. However, completed reliance on oil, which could at a maximum contribute two billion dollars per annum could have implications on growth and job creation. Therefore, the government should create the appropriate environment for the utilization of the oil revenues while at the same time remain its focus on the traditional sectors of the economy of the country. The characteristics of such an environment include transparency in oil revenue and its allocation in the budget, increased competence in managing the supplementary revenue for investments in projects with higher social returns and removal of bottlenecks and constraints in the economy. The Oil Revenue Management bill currently before Parliament is a step in the right direction. Furthermore, within the framework of the Extractive Industries Transparency Initiative (EITI) of 1991, to which Ghana is a signatory, the country has declared publicly, the estimated production of oil and gas for the first five years (2011‐2016). While oil production is estimated at between 120,000 and 240,000 barrels per day (BBPD), gas production is also estimated and at between 120,000 and 240,000 million standard cubic feet per day.

33. The additional revenue from the oil production and the on‐going rebasing of GDP could propel Ghana to a Middle Income Country with implications on development partners funding. Some opinions have been expressed in some partner capitals and quarters on whether the DPs should continue to financially support Ghana’s developmental agenda at the current levels as when oil comes on stream. From the recently concluded Consultative Group Meeting with DPs, it was understood that, even though Ghana is likely to become a middle income country, the country needs a transitions period of between 5‐10 years. The main reasons included the fact that the fiscal space previously available to Ghana in terms of HIPIC and MDR funding is no longer available, while at the same time the country has to deal with key issues such as the risk of oil, improve efficiency in public service, agricultural modernization, infrastructural development, Dutch disease, Public Finance Management, Anti‐corruption, work of Parliament

22 CEPA (2010), From a Cocoa Economy to an Oil Economy, Assembly Press, Accra p, 10

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etc. The government on its part would have to be transparent in the use of the oil revenue, effective planning and justification for continued donor support.

3.3. Employment Situation

34. While responding to questions raised in Parliament, the Minister of Employment and social Welfare (MESW) observed that “…one major challenge facing the Ghanaian labour market is lack of regular and timely availability of statistics”.23 However, based on the fifth round of Ghana Living Standard Survey 2005/06, the Minister estimated that Ghana’s working population in 2009 at 14.3 million of which the labour force (defined as economically active population aged 15 years or over, working or not working) was 9.6 million. The unemployment rate (people available for work and actively looking for jobs) was estimated at 6.5 per cent overall, and 13.5 per cent among the youth. Wage employment accounts for only 17.5 per cent as against 55 per cent and 20.4 percent in self‐employment and contributing to family livelihood respectively. This yields vulnerability employment rate of 75.4 per cent. It is also estimated that about 26 per cent of employed people are working poor (i.e. living in households that earn below the upper poverty line), while 16 per cent are considered extremely working poor (i.e. living in households that earn below the lower poverty line). About 37 per cent of the labour force is considered to be in urban areas and 62.9 per cent in rural areas. Thirty‐five per cent of the labour force had no formal education, while 51 per cent had completed basic education; and only 7 per cent and 2.5 per cent had some secondary and tertiary education respectively. This indicates a very high lack of skilled workers in the economy. A summary of the basic labour market indicators for 2006 is provided at Annex 6.

35. Although there are no recent studies specific to gender and employment, women are generally concentrated in sectors with high risk of poverty. For example, the 1999 Ghana Living Standards Survey (GLSS 4, 1999) found that 37.5 per cent of women compared to 15.8 per cent men were self‐employed in the informal non‐agricultural sector; while only 4.2 per cent of women, compared to 12.6 per cent of men were informal wage workers in the non‐agricultural sector. In the agricultural sector, 46.4 per cent of women were unpaid family workers compared to 9.6 per cent of men.

23 Government of Ghana (2010), White Paper in Response to Parliamentary Question on “The Labour Strength of the Country as at January 2009”.

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3.4. Private Sector Performance

36. Among the main strategies in both GPRS I, GPRS II, and GSGDA was to strengthen the private sector and enhance its capacity to function as the engine of growth and prosperity. Although several initiatives were made under both programmes, critical issues remain. The private sector is active in the agricultural, industrial and services sectors and has been assigned the lead engine for Ghana’s economic growth. Notwithstanding the expected contribution of the private sector to catapult the economy, it faces a myriad of challenges which hinder its growth and development, including: (1) a lengthy process for registering business and opening of bank accounts; (2) difficulty with accessing credit and investment capital; (3) high cost of credit; (4) irregular supply of utilities (power and water); (5) high utility tariffs; and (6) lack of adequate skills in the labour market. A survey by the Association of Ghana Industries (AGI) noted high cost of raw materials, high price of utilities, high cost of credit and competition from imported goods among some of the major challenges.24 The exhibit above shows the ranking of the major challenges from the survey. Nonetheless, Ghana’s record of support for private sector development is significantly strong. Specifically, Ghana ranked 92 out of 183 countries compared in the Ease of Doing Business Index (EDBI), a composite of several factors affecting the ease of doing business. These factors include ease of; starting business, getting credit, employing workers, registering property, trading across borders, etc. By and large, it can be asserted that the conduciveness of business environment in Ghana is better than most of the SSA, including upper Middle income countries. The ongoing work on regional integration in economic activities will further contribute to the growth of SMEs sector and Ghanaian industry in general.

37. With respect to the Small and Medium Enterprises (SMEs) the high cost of credit was identified as the number one challenge. The challenge of the high cost of credit has been of interest to both policy makers and entrepreneurs alike, particularly in an environment of decline in the rate of inflation. While the Bank of Ghana has reduced the prime rate to 15% as at the end of June 2010, the commercial banks have not reduced their base rates substantially; most banks still have rates in the range of 21‐26 per cent. The actual lending rates to the

24 Association of Ghana industries (2010); Business Barometer Survey for Second Quarter of 2010.

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majority of customers (particularly the SMEs is about 30 per cent) The reason for the continuous high cost of credit is due to the high default of loans granted as noted by CEPA: “…as of February this year, one fifth of all loans and advances in the banking system were classified as non –performing”. Given the high default rate in the payment of loans, the SMEs are considered incapable of repaying their debts and are therefore confronted with higher interest rates, commissions and fees. These SMEs are confronted with stringent conditions including loan covenants and collaterals so as to tighten the net for credit to them. It is therefore not surprising that the manufacturing sub‐ sector’s growth of 4.5 per cent in 2008 was the least contributor to the industrial sector that year and actually declined to ‐1.3 per cent in 2009. The outlook in terms of non‐performing loan especially those owed to banks by State‐ owned Enterprise is gloomy but promising. With the payment plan devised by government and the banks, the latter may soon have enough resources to lend again.

38. Additionally, Government is committed to promoting tourism ‐ including cultural and ecotourism and has adopted a number of measures to create a conducive environment with positive impact on SMEs, as well as foreign exchange earnings and more generally contribution to Ghana’s inclusive growth.

3.5. Infrastructure

39. Between 2003 and 2007, improvements in infrastructure in Ghana contributed a little over one percentage point to Ghana’s per capita growth rate.25 Despite this seemingly low contribution to the per capita growth rate, infrastructure has consistently made impressive progress in the power, water, telecommunication and road sectors compared to other low income countries in Africa. Table 3 below illustrates the comparison with other countries.

Table 3: Ghana’s Infrastructure Compared to African Countries Average for Low Infrastructure type Ghana Income African (service) countries Mobile telephone 74.6% 15% penetration Power access 56% 15% Utility water coverage 40% 26% Source: The World Bank (2010), AICD Report, National Communication Authority / Ministry of Communications Second Quarter Report‐June 2010.

25 World Bank (2010), Africa Infrastructure Country Diagnostic (AICD), Country Report : Ghana’s Infrastructure. A Continental Perspective, 2010, p 6

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Within the ICT sector, a number of reforms have been implemented to strengthen the private sector and improve government efficiency and accountability. This includes the Enterprise Architecture (EA) and e‐government interoperability framework, which aims to enhance efficiency of service delivery, promote transparency and accountability in government. It also addresses challenges facing government agencies, even as citizens demand new and improved services. The national fiber optic back bone infrastructure, which is 60% completed will play a significant role in positioning Ghana for electronic governance and business investment; and create employment opportunities within the Information Technology Enabling Services (ITES) sector. The telecom market by the end of June 2010 experienced a growth of 12.6% over the 2009 figure of 15,376,305 (source NCA).

40. According to the World Bank report, 75 per cent of the paved network in urban area is in good or fair condition, while 74 per cent of the unpaved network is in good or fair condition. However, there are challenges with respect to the rural road network. Only 24 per cent of Ghana’s rural population lives within two kilometers of an all season road, which is below the ratio of 60 per cent in Africa’s middle income countries. In order to achieve the 60 per cent threshold of the middle income African countries, Ghana requires an additional 26,000 kilometers of rural road network. Some stakeholders have suggested that Ghana should only concentrate on improving the rural road network in those areas where 80 per cent of the country’s agricultural output is produced, arguing that this would reduce the requirement of additional rural road network to match the 60 per cent threshold by half. However, such an approach also negates the principle of equitable development and would mostly disadvantage the poor communities. In the rural water sub‐ sector, “surface water reliance reduced substantially from 47 per cent in 1993 to 32 per cent in 2003 and 18 per cent in 2008”. In addition to the physical improvements in the various sectors, institutional reforms have been undertaken in the Information and Communication Technologies (ICT), ports, roads and the water sectors.

41. Although Ghana has made some progress in improving access to infrastructure services, there still remain some challenges relating to the quality of the services being provided. One of the most critical challenges is in the power sector where high cost diesel fuel is used for thermal power generation during periods of inadequate water in the Volta Lake. In the urban water sector, technical losses result in only 50 per cent of the water produced reaching consumers, a situation which contributes to the intermittent water supply. The World Bank noted in its report that this issue needed to be addressed urgently to ensure that Ghana’s “technical achievement of the Millennium Development Goals does not remain a hollow victory”. Although the state of Ghana’s infrastructure is relatively better than its peers in other African low income countries, it is below standard for the African middle income countries, a situation that

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deserves serious review, given Ghana’s objective of becoming a middle income country by 2020.

3.6. National Response and Strategy

42. The Government formulated a new macro‐economic policy framework for a 3‐year stabilization programme in concert with the International Monetary Fund (IMF) under its Extended Credit Facility, (formerly known as the Poverty Reduction and Growth Facility). Components of the stabilization programme include strong fiscal discipline with a complementary monetary regime aimed at reducing inflation. As part of the disinflationary measures contained in the stabilization programme, inflation was going to be reduced from 16 per cent in December 2009 to 10.3 percent in December 2010. The disinflation process is considered to have been successful as reflected by the progressive decline in inflation to 9.46 percent at the end of July 2010.

43. However, the success of the process of disinflation has not been without its own risks to growth. According to CEPA, the reduction of inflation from 16 per cent to 10.3 per cent by the end of 2010 will result in a corresponding loss of output equivalent to 5.7 per cent of GDP.26 While it is estimated that the process of disinflation would continue into the third quarter of 2010, the trend is expected to be reversed with gradual increases in inflation with the commencement of the 3 year inflation cycle. The increase in inflation is projected to reach its peak in 2012. The absence of employment opportunities for increased productivity is a manifestation of this phenomenon. This will have negative effect mostly on the youth and small scale farmers. CEPA notes in its position papers that:

“This will be particularly severe for new entrants into the labour force i.e. the youth, but also small scale farmers may find themselves saddled with unsold produce with possible adverse effects and future consequences for investment and production” (CEPA:2010, p 3)

Ghana also adopted the Second Medium Term Private Sector Development Strategy (PSDS II) with a vision of developing “A Thriving Private Sector that creates jobs and enhances livelihoods for all”. PSDS II has five policy objectives:  Establishing an investment climate that helps to broaden investment and encourages greater enterprise and innovation.  Supporting transformation into a diversified, efficiency driven economy.  Increasing productivity, especially amongst small businesses.  Providing greater incentives to create formal jobs.

26 CEPA (2010), From a Cocoa Economy to an Oil Economy, Assembly Press, Accra p.3

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 Increasing economic opportunity for the poor especially in underdeveloped regions. Also, the National Employment Policy and Implementation Action Plan have been developed and approved by government with the overarching goal of “achieving full employment in the various sectors of the economy to enable all citizens who are available and willing to work to attain secured and sustainable livelihoods through full productive and freely chosen employment. In a related area, the Government also established the National Service Scheme for University Graduates to do one year obligatory service in the country to increase the employability of youth. Following this, the National Youth Policy was launched in August 2010

44. Ghana’s total debt stock of GH¢8,442 million in 2003, was reduced to GH¢7,804 million in 2004 as a result of the debt relief from the HIPC initiative. The debt stock grew to GH¢8,043 million in 2005 but declined to GH¢5,297 million in 2006 when Ghana reached the HIPC completion point. However, the debt has been growing since then, reaching GH¢7,295 million (2007); GH¢8,542 million (2008) and GH¢11,976 million in 2009. The surge in 2007 and 2008 was attributed to the country’s $750 million Eurobond issue at the end of 2007.27 As a way of containing the debt position, in its 2008 budget statement, the government projected a decline of the net domestic debt to GDP ratio from 12 percent in 2007 to 8 percent in 2007.28 To ensure the attainment of the objective of debt sustainability, the government in 2008 undertook a debt management performance assessment and a medium term debt sustainability analysis. The analyses indicated desirable debt compositions and corresponding financing strategies consistent with maintaining debt at sustainable levels.29 In 2009, the World Bank and the International Monetary Fund (IMF) jointly carried out a debt sustainability analysis (DSA) on Ghana spanning the period 2006 ‐2029 taking into consideration, the oil production capacity of the country from 2011. The DSA indicates that Ghana’s public debt which at the end of 2008 was estimated at 58 per cent of GDP would fall during the medium term from 73 per cent in 2010 to 37 per cent by 2029. It also indicates that the country remains at moderate risk of debt distress due to short and medium term vulnerability from two factors: oil revenues and fiscal performance30.

27 ISSER 2009: The State of the Ghanaian Economy in 2008, Institute of Statistical, Social and Economic Research, University of Ghana, August 2009. 28 Republic of Ghana, 2009: Implementation of the Growth and Poverty Reduction Strategy 2006‐2009. 2008 Annual Progress Report. National Development Planning Commission, Accra. September, 2009, p26 29 ibid 30 IDA/IMF 2009: Ghana, Joint Bank‐Fund Debt Sustainability Analysis. International Development Association/ International Monetary Fund, June 2009.

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3.7. Emerging Priorities for the UN

45. Many developing countries have been affected by lack of focus on employment creation and long‐term sustainable growth. In sub‐Saharan Africa, some counties have undertaken macro‐economic reforms that have not produced substantial reduction in poverty. In order to successfully achieve pro‐poor growth, Ghana should develop policies and strategies that take into account its internal environment and resource conditions. With its technical expertise and global outreach on international best practices, the UN in Ghana can contribute effectively to reduction of poverty by focusing on the following: a) Strengthening and supporting government efforts to develop labour‐intensive sectors and policies that encourage employment‐generating investment and opportunities, including through SME development, tourism and creative industries sector b) Strengthening support to development of human capital through increased access to tertiary and vocational skills training, and integrating the informal sectors into the mainstream economy. c) Support construction and access of economic infrastructure by marginalized communities in rural areas and the underdeveloped regions particularly the northern regions. d) Supporting measures31 to ensure trafficked children who are in exploitative labour are rescued, rehabilitated, reunited with families, and reintegrated into the mainstream education, a complementary initiative to Ghana’s plan of achieving primary universal education

31 IOM’s Assisted Voluntary Rescue, Rehabilitation, Return, and Reintegration of Ghanaian Children Victims of Trafficking for Labour Exploitation in Fishing Communities in Ghana Project

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CHAPTER 4: MDG ACHIEVEMENT

Overview of Current Situation

45. The Assessment of Ghana’s progress and likelihood of achieving the MDGs by 2015, regularly carried out by the government indicates that, although Ghana is doing well in MDGs, there are still major gaps and challenges to be addressed.32 The exhibit below provides a summary of Ghana’s progress in each MDG goal.

Goal MDG Target Progress 1 Eradicate extreme poverty and hunger 2 Achieve universal primary education 3 Promote gender equality and empower women 4 Reduce child mortality 5 Improve maternal health 6 Combat HIV/AIDS, malaria and TB 7 Ensure environmental sustainability 8 Develop a global partnership for development www.undp‐gha.org/mdg‐php

MDG 1: According to 2010 MDG Report, Ghana is mainly on track to achieve the MDG 1. The overall poverty rate has declined substantially over the past two decades from 51.7% in 1991/92 to 28.5% in 2005/2006. The proportion of the population living below the extreme poverty line also declined from 36.5% to 18.2% over the same period against the 2015 national target of 26% and 19% respectively. Although trends in economic growth suggest decline in poverty at national level between 2006 and 2008; income poverty declined, other kinds of poverty – education and health; and regional, occupational and gender disparities exist. High levels of poverty persist in the three Northern regions. Statistics show that over 70% of people whose incomes are below the poverty line can be found in the Savannah areas. The high economic growth rate has not necessarily led to improved human development indicators as the country continues to face challenges with health and other social services. This in evident in the 2009 Human Development Report (HDR) that shows high inequality and a decline in Ghana’s Human Development Index (HDI) ranking. Ghana has made progress in the proportion of people who suffer from hunger, but chronic child undernutrition remains unacceptably high

32 (Action CAP MOH, Govt. of Ghana, UN Country Team (2010), Millennium Development Goals Acceleration Framework (MAF) Country Plan).

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thereby posing a serious challenge to the long term physical and cognitive development of children in Ghana. The incidence of wasting has declined from a peak level of 11.4% in 1993 to 5.3% in 2008, while the occurrence of underweight has declined from about 31% in 1988 to 13.9% in 2008. The number of districts facing chronic food production deficits, has reduced from 22 in 2005 to 15 in 2006, and further down to 12 in 2008. These achievements were as a result of programmes such fertilizer subsidy, support to farmers with agricultural inputs (i.e. fertilizer, improved seed, ploughing and labour cost).

MDG 2: Ghana is on track to achieve MDG 2 on universal primary education. Available data and trend analysis on MDG 2 of achieving Universal primary education show that Ghana is on track to achieving both the gross and net enrolment targets by 2015. The number of schools and enrolment rates has increased tremendously over the years due to various reforms and new policy measures instituted by the government. The number of kindergartens (KG) has increased from 14,246 in 2006/07 to 15,449 in 2007/08 following government’s policy of mandating each primary school to have a kindergarten attached to it. The Gross Enrolment Ratio (GER) for KG has subsequently increased from 89.0% in 2006/07 to 89.9% in 2007/08. The number of primary schools rose from 16,903 in 2006/07 to 17,315 in 2007/08, while the GER increased from 93.7% to 95.2% over the same period. The areas still posing some challenges are survival rate that has stagnated at 88% in 2007/08 from 85.4% in 2006/07, and the poor quality of education. There needs to be accelerated implementation of current strategies with greater focus on the SADA district.

MDG 3: Gender disparity at primary and junior secondary education will be achieved if current interventions continue. On MDG 3 target of ensuring gender parity especially at the Primary and Junior High school (JHS) levels, trends show that Ghana is on track in achieving both targets, although primary level parity has stagnated at 0.96 since 2006/07, while the parity at the JHS increased slightly from 0.91 in 2006/07 to 0.92 in 2007/08. On the other hand, the parity at the KG has declined slightly from 0.99 in 2006/07 to 0.98 in 2007/08. Progress towards increasing the number of women in public life suffered a setback with the reduction of the number of women elected into Parliament during the 2008 elections declining from 25 to 20. This had reduced the proportion to below 10%, and puts Ghana under the international average of 13%. Areas of focus towards 2015 are the retention of girls in schools, and low representation of women in parliament, which is currently below the international average of 13 per cent. Attention should also be paid to enhanced collection of sex disaggregated data for policy formulation, especially for women employed outside the agricultural sector.

MDG 4: Although evidence shows that there has been significant reduction in both infant and under‐five mortality rates in recent times, without additional efforts, it is unlikely that the 2015

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target of reducing under five mortality rates by two‐thirds will be achieved. The Ghana Demographic and Health Survey (GDHS) 2008 showed a 30% reduction in the under‐five mortality rate, as it declined from 111 per 1000 live births in 2003 to 80 per 1000 live births in 2008, while infant mortality rate as at 2008 stood at 50 per 1000 live births compared to 64 per 1000 live births in 2003. Neonatal mortality rate also has seen a decrease from 43 per 1000 live births in 2003 to 30 per 1000 live births in 2008. The proportion of children aged 12‐23 months who received measles vaccine has increased from 83% in 2003 to 90% in 2008 showing an improvement of the coverage of one of the key child survival interventions including nutrition for children (Ministry of Health (MOH), 2008 and GHS, 2003). To reach the MDG target, coordinated and sustained efforts must be made to equitably scale‐up the essential package of recent child survival interventions which have and focusing specifically on increasing the coverage of interventions for reducing deaths that occur in the neonatal period (first 4 weeks of life).

MDG 5: While Ghana is making progress towards reducing maternal mortality, the pace of progress has been slow and not sufficient to achieve the MDG goal of reducing maternal mortality by three‐quarters by 2015. With the current population growth rate of 2.7%, substantive increases in the number of women of child bearing age will make reduction of maternal mortality further difficult if population issues are not adequately addressed. Maternal health care has improved over the past 20 years albeit at a slow pace. Between 1990 and 2005, maternal mortality ratio reduced from 740 per 100,000 live births to 503 per 100,000 live births, and then to 451 per 100,000 lives births in 2008. If the current trends continue, maternal mortality will be reduced to only 340 per 100,000 by 2015 instead of the MDG target of 185 per 100,000 by 2015. The improvement however, is not the same for all regions. There are disparities in maternal mortality ratio (institutional) across the 10 regions in Ghana from 1992‐ 2008. Maternal mortality ratio decreased by up to, 195.2 per 100,000 in Central and Upper East regions; 141 per 100,000 in Northern and Western Regions; 120.1 per 100,000 in Volta and Eastern Regions; and 59.7 per 100,000 in Upper West, Brong Ahafo and Ashanti regions. The only region where maternal mortality ratio has worsened is in Greater Accra (by 87.6 per 100,000). Maternal death was declared notifiable within 7 days in Ghana in January 2006 and notification rate in 2007 was 71.8%. A quarter (75.4%) of 751 maternal deaths in Ghana (2007) was audited.

MDG 6: HIV prevalence in the country experienced a downward trend from 3.6 per cent in 2003, to 2.7 per cent in 2005, then increased to 3.2 per cent in 2006, then reduced to 2.2 per cent in 2008 (95% cl 2.18‐2.22) and increased to 2.9% (95% cl 2.49‐3.31) in 2009. Using the national estimates and projections for HIV the national HIV prevalence in 2009 was 1.9 per cent. Social, economic and cultural factors that fuel infection must be addressed to maintain

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gains and achieve further decline in prevalence rate. Most children with HIV acquire the infection through vertical transmission and more needs to be done to prevent mother‐to‐child transmission (MTCT) of HIV and ensure a HIV and AIDS free generation in Ghana. According to the Ghana AIDS Commission, the current up‐and‐down movement in the prevalence rate between 2003 and 2008 signals only a leveling effect or stabilization of the epidemic.

MDG 7: Although Ghana is on track of achieving the target on halving the proportion without access to safe water, critical challenges exist in achieving the targets on reversing the loss of environmental resources, reducing the proportion of people without access to improved sanitation, and achieving significant improvement in the lives of people living in slum areas. If current progress is maintained, Ghana may well meet or surpass the target of halving by 2015, the proportion of persons without sustainable access to safe drinking water from 44 per cent in 1990 to 22 per cent in 2015.33 UN user‐based data indicates that the proportion of Ghanaian population with access to safe drinking water was 82 per cent in 2008, which is in excess of the target set for 2015 by 4 per cent. Despite this progress, it should be noted that, while access to access to safe drinking water in rural areas has improved considerably, there has been slow progress with access within urban settings. Ghana has made progress in reducing the proportion of the population without access to improved sanitation, but with the trends, the target of halving by 2015 will be difficult to meet. At the current trend, the proportion of the population with access to improved sanitation will reach 21.2% by 2015 instead of 52%, while the proportion of urban population with access to improved sanitation will be 23.4% instead of 55% by 2015. In the rural areas, only 20.6% would have access to improved sanitation instead of 50.5%. Although there was a slight decline of population living in urban slums, with the current trends, a significant proportion (about 14%) of the population will still be living in slums by 2015. In addition, against the backdrop of Climate Change, the rate at which the nation is losing its natural resources owing to human activities raises concern about the sustainability of natural resources. Available evidence on the rate of forest depletion shows that, between 1990 and 2005, the forest cover has declined from 32.7% to 24.2%. Issues such as low institutional capacity for environmental management, low awareness on the effects of human activities on the environment and limited resources (human and financial) to implement reforestation and other environmental management programmes need to be urgently addressed.

MDG 8: Many developed countries have not met the 0.7% GNP target for aid. However, aid inflows to Ghana appear to have increased in nominal terms from US$578.96 million in 2001 to US$1,433.23 million in 2008. However, in real terms, ODA inflows to Ghana stagnated at about 8.7 per cent of GDP between 2002 and 2008. The portfolio of aid inflows is also dominated by

33 NDPC/Government of Ghana, UNDP (2010), Ghana Millennium Development Goals Report.

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project aid which constitutes more than 60 per cent of ODA inflows. The global financial, oil and food crisis appear to have impacted negatively on the public debt position of Ghana, which is gradually approaching unsustainable levels in recent times. Ghana’s public debt as a percentage of GDP has increased from 41.4% in 2006 to 55.2% in 2008. There are concerns that the oil find and re‐profiling of Ghana to a middle‐income country may affect ODA inflows.

4.1. Extreme Poverty and Hunger

4.1.1 Overview

46. Ghana is on track to achieve the MDG goal of reducing poverty and hunger by half by 2015. Poverty declined from 51 per cent in 1991 to 28.5 per cent in 2005/06. However, these aggregated averages tend to mask the vast regional disparities that exist. For example, 18.2 per cent of Ghanaians still live in extreme poverty. 54 per cent of the extreme poor live in the northern regions alone, which is home to only 17.2 per cent of the country’s population. The Upper East, Upper West and Northern regions together make up for 70 per cent of the 28.5 per cent of the poor at the national level.34

47. With regards to food security and nutrition, the evidence indicates that food is available but not accessible to all sections of the population. Availability of good quality food at household level is a problem in many areas of the country and 12 per cent of children under the age of five years are reportedly underweight; 22 per cent are stunted or too short for their age; and 7 per cent are too thin for their height. The Comprehensive Food Security and Vulnerability Analysis (CFSVA) also found that 5 per cent of the population (about 1.2 million people) have very limited access to sufficient and nutritious food and are defined as food insecure.35 In addition, about 2.07 million people are vulnerable to becoming food insecure. Again, this aggregated statistic masks the true nature and extent of the problem in different regions. Table 4 below illustrates the regional disparities in food security and vulnerability to food insecurity indicators by region.

34 WFP (2009), Comprehensive Food Security and Vulnerability Analysis. 35 Ibid.

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Table 4: Food Security and Vulnerability by Region Region Population Food Vulnerability Maternal Size Insecure to food CHILD MALNUTRITION Malnutrition insecurity Wasting Stunting Underweight (BMI<18.5) Upper East 984,000 15% 20% 11% 27% 16% 12% Upper West 625,000 34% 14% 12% 26% 17% 10% Northern 2,166,000 10% 17% 8% 30% 18% 12% Volta 1,822,000 3% 7% 9% 18% 10% 12% Western 2,424,000 1% 6% 5% 23% 9% 8% Central 1,802,000 3% 5% 7% 22% 15% 9% Greater Accra 4,057,000 1% 3% 6% 11% 7% 5% Eastern 2,268,000 4% 8% 7% 19% 8% 10% Ashanti 4,589,000 7% 10% 7% 28% 14% 6% Brong Ahafo 2,165,000 3% 11% 6% 22% 11% 7% Nat’l Average 22,901,000 5% 9% 7% 22% 12% 8% Source: Comprehensive Food Security and Vulnerability Analysis, WFP. The table shows that food insecurity is concentrated in the poorest regions of the country, also the ones most prone to adverse weather conditions, and that have been disproportionately affected by high food prices. The very poor therefore are mostly food crop farmers who constitute about 48 per cent of the population in the Northern savannah zone, have the lowest average per capita incomes below poverty threshold of Ghc1.47 per day. The level of chronic childhood under‐nutrition as measured by the stunting prevalence continues to be unacceptably high and has not decreased significantly in the past 5 years. This can potentially impede full cognitive development in Ghanaian children thus contributing to decreased individual earnings as adults and economic growth in the country.

4.1.2. National Response and Strategies 48. As a way of ameliorating poverty in the 3 northern regions, the government in 2008, proposed the establishment of the Northern Development Authority to handle the developmental challenges in these regions. In 2009, the initiative was re‐named the Savannah Accelerated Development Authority (SADA) and its range and geographical scope widened to include some District Assemblies in parts of the Brong‐Ahafo and Volta regions that share borders with the northern regions. As part of operationalisation of the initiative, SADA is to be mainstreamed into national policy and development plan. Complementary to the integration into national policy and development, government has enacted the Savannah Accelerated Development Authority Act, 2010 to provide legal backing to the initiative. However, Government funding to SADA has been inadequate. In 2009, no funds were released to the organization and in 2010, only GHC1million was released out of a budgetary provision of GHC25million.

49. Ghana signed the Comprehensive Africa Agriculture Development Programme Compact (CAADP) on October 27th, 2008 and has agreed to allocate 10% of its budget towards

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agriculture, particularly to improving the productivity of the subsistence smallholder farmers. In this regard, mechanization centers are to be set up in every district and increased access to fertilizers and irrigation facilities provided to small holder farmers. This forms the cornerstone of the agricultural strategy. A 20% increase in the number of vulnerable households reached with agricultural services is a stated goal of the Ghana CAADP Compact, as well as improved management of food emergencies and emergency preparedness, with emphasis on strengthening of early warning systems and prevention of disasters.

50. Ghana CAADP Compact is linked to Food and Agriculture Sector Development Policy (FASDEP) which aims to modernize agriculture in a way that provides critical linkage between agriculture and industry, and is based on science and technology and sustainable land management and environment practices. The agriculture sector is targeted to grow at 6‐8% per annum to support the national output growth and the achievement of middle income by 201536. This has been well stated in the final draft of Ghana Shared Growth and Development Agenda 2010‐2013.

51. Ghana does not have a national social policy, although a national social protection strategy exists. In addition the country does not have a National Disaster Management Policy although the majority of the poor and food insecure live in those areas that are prone to natural disasters such as floods and other weather‐related calamities. Government has however developed some pro‐poor strategies, including the Livelihood Empowerment Against Poverty (LEAP) programme, which offers direct opportunities to the disadvantaged and vulnerable. It is a cash transfer system for the extreme poor. The programme, which at present is being implemented in 80 out of the 170 districts currently, supports about 38,000 households out of the target of 164,000 households by 2012. The criteria for selection of beneficiaries are: a) Community residents aged over 65 years, living on less than $1 per day and without subsistence support. b) Caregivers of orphans and vulnerable children (OVCs). c) Severely disabled persons without any productive capacity.

Payments to beneficiaries range between GHC8 and GHC15 per month depending on the size of the family. To make the social interventions holistic, the government intends to prepare a comprehensive single national register of the poor which would serve as a single targeting mechanism for improved pro poor delivery. In addition to the LEAP, the government has also introduced the school feeding and capitation grant programmes as well as the national health insurance scheme as complementary social welfare interventions. A social security and national insurance scheme has been in existence since 1972 for employees in the formal sector.

36 ECOWAS Agricultural Policy (ECOWAS)/Comprehensive African Agriculture Development Programme (CAADP)

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However, Ghana does not have a National Nutrition Policy or strategy that can serve as a basis for strengthening the sectoral coordination, coherence and partnerships for scaling up of proven nutrition interventions in the country.

4.1.3. Emerging Priorities for the UN

52. The UN should consider strengthening and upscaling its poverty reduction and livelihood enhancement programmes, mostly in the northern regions, but also in those districts such as Ashanti rural where food insecurity and vulnerability to food insecurity is high. The UN can also support with the strengthening of existing monitoring and emergency preparedness measures to detect and address emergencies related to climate change, deterioration in food security, health and nutrition, focusing particularly on: a) Strengthening initiatives to enhance support for livelihoods for the poor, particularly by improving agricultural practices to raise the relatively low levels of productivity which relates to the above are the low application of fertilizers and the use of irrigation farming methods and diversifying their income sources, especially the value chain for smallholder farmers, . b) Supporting government efforts in strengthening systems targeting the poor and vulnerable and providing social protection and safety nets for the poor. This should aim at addressing spatial and gender disparities that persists. c) Strengthening the policy environment and scaling upsectoral coordination to and equitably scaling up proven nutrition interventions to improve nutritional status, especially for pregnant and lactating women, as well as children under the age of 5 years; with a specific focus on reducing both acute (wasting) and chronic undernutrition (stunting);. safe drinking water and sanitation

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4.2. Universal Primary Education

4.2.1. Current Situation

53. There have been steady and significant increases in the number and proportion of children enrolled in all the levels of basic schools (kindergarten, primary and junior high schools) as shown in the figure below. The Gross Enrolment Ratio (GER) increased from 60.1 per cent to 92.9 per cent at KG level, from 87.5 per cent to 94.9 per cent at primary level, and from 70.2 per cent to 80.6 percent at junior high school (JHS) level between 2004/05 and 2008/09. Similarly, the Net Enrolment Ration (NER) increased from 38.5 per cent to 63.6 per cent, from 59.1 per cent to 88.5 per cent, and from 31.6 per cent to 47.6 per cent at the three levels respectively during the same period as shown in Figure 3 below. The gender gaps are also steadily closing at all basic education levels. The gender parity index (GPI) stands at 0.99 (KG), 0.96 (primary), and 0.92 (JHS) in 2008/09.

Net Enrolment and Completion trends from 2004 to 2008.

Source: Education Management Information System (EMIS), Ministry of Education.

54. Despite such significant progress, data from the Ministry of Education (MOE) indicates that there are still some 450,000 children of primary school age not enrolled. Regional disparities continue to exist in terms of both access and gender parity with some districts showing girls’ NER as low as 50 per cent and Gender Parity Index (GPI) lower than 0.70. In general the three northern regions (Northern, Upper East and Upper West) are lagging behind,

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all showing NER below the national average. Data from the Ghana Demographic and Health Survey (GDHS) indicates that while there has been clear improvement in providing educational access to the poorest Ghanaians, significant enrolment gaps remain between the poorest and the wealthiest children. Children in the poorest 20 per cent of households are three times more likely to be out of school than those in the richest quintile (Figure 4).

Figure 3: School Attendance Rates Aged 6‐14 by Poverty Quintile, 2003‐2008

100

80 School

60 Current 2003 in

40 Year 2008 Rate 20 Attendance

Source: GDHS 2003, 2008

55. Furthermore, those children who do enroll in school struggle to complete their basic education. While good progress has been made over the past years, the completion rate still stands at 86.3 per cent at primary level and 75.0 per cent at JHS level in 2008/09. Completion rates for girls have remained consistently lower than that of boys even though the gap has been closing. Existing evidence indicates both demand‐side and supply‐side constraints affect child’s schooling. Economic and socio‐cultural factors on the demand side include poverty, child labor, migration, gender stereotyping, early marriage, teenage pregnancy, and customary fostering. Supply‐side factors include distance to school and the low quality of education in general.

56. The quality of teaching and learning remains a major concern in Ghana’s basic education sector. Due to the substantial and rapid increase in school enrolment, classrooms have become over‐crowded in many areas. While the primary pupil‐teacher ratio (PTR) is 34:1 on national average in 2008/09, the PTR is as high as 60:1 in many remote districts. Many schools do not adhere to child‐friendly standards. Schools generally lack basic learning materials including textbooks. Less than 60 percent of primary teachers have had proper professional training. Half of public primary schools do not have latrines and nearly 40 percent of them do not have running water; which makes the issues of health and sanitation, and menstrual management for adolescent girls, major concerns. Corporal punishment is widely

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practiced in schools. High incidence of teacher absenteeism reduces students’ time on task. Weak accountability mechanisms and inadequate parental and community involvement in school management also affect the quality of education. As a result of these quality challenges, students’ learning achievement level is generally low. The results of the National Education Assessment (NEA) in 2007 indicate that only 11 per cent of Ghana’s grade 6 students reach proficiency levels in mathematics, and 26 per cent attain proficiency in English.

4.2.2 Gap to be closed to achieve the MDG by 2015 57. Some of the key gaps and challenges that still exist and may be constraining progress towards achieving universal basic education include: a) Disparities and inequalities that exist among regions and socioeconomic groups in terms of both access to and quality of education b) Increasing student dropout rates at both primary and JHS levels c) High pupils/teacher ratio and multi‐grade classroom teaching, particularly in rural area schools d) Low quality of education and student learning achievement e) Inadequate attention to skills training to prepare the youths for the world of work f) Weak management capacity and accountability mechanism especially at decentralised levels g) Inadequate Education Management Information System to provide complete, timely and reliable information on education situation h) Inadequate number, commitment levels and quality of human resources in the education system to improve the quality of teaching and learning i) Poor targeting under the Ghana school feeding programme.

4.2.3. National Response and Strategy

58. In order to address the persisting challenges highlighted above, the Government of Ghana through the Ministry of Education and Ghana Education Service (GES) has developed and implemented a number of important polices and strategies over the past years. Key policy interventions made towards the attainment of quality basic education for all include: the abolition of school fees and introduction of the capitation grant; establishment of the Ghana Education Trust (GET) fund; expansion of the school feeding programme jointly by the Government and the UN; inclusion of KG as part of the Free Compulsory Universal Basic Education (FCUBE); introduction of free school uniform and exercise book schemes; construction/rehabilitation of classrooms; expansion of complementary basic education

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programmes in partnership with CBOs and NGOs; and implementation of the Untrained Teachers Diploma in Basic Education (UTDBE) programme.

59. Ghana’s new Education Strategic Plan (ESP) 2010‐2020 provides the strategic framework for the development of the education sector. The ESP underlines, among other things, the following guiding principles: 1) to eliminate gender and other disparities that arise from exclusion and poverty; 2) to improve the quality of learning and teaching; and 3) to strengthen monitoring and accountability in the education sector. The ESP’s strategic goal for the basic education sub‐sector aspires to provide equitable access to good quality child‐friendly universal basic education by improving opportunities for all children in the first cycle of education at KG, primary and JHS levels. More attention should be given to other levels of education such as Technical and Vocational Education, Teacher Training education.

4.2.4. Emerging Priorities for the UN 60. The recent trends in education suggest that Ghana has been steadily progressing towards the MDG goal of universal primary education in terms of enrolment at the national aggregate level. The most prominent areas of challenge, however, relate to: 1) the inclusion of the most vulnerable and disadvantaged children in education; 2) students’ retention in and completion of basic education; 3) improvement of all aspects of the quality of education; and 4) lack of monitoring and accountability mechanisms. This suggests that the UN should continue to assist government strategies aimed at improving access, efficiency and quality of basic education through: a) Supporting evidence‐based policy and decision making through strengthening institutional capacities at all levels in systematic monitoring and evaluation b) Strengthening focused interventions that cater to the most marginalized and disadvantaged groups such as girls, the poor, remote rural populations, children with disabilities and working children, including skills training for income generation c) Supporting holistic school quality improvement based on the national child‐friendly school standards

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4.3. Gender Equality and Women’s Empowerment

4.3.1. Current Situation

61. According to the World Bank, Ghana scores above average (70.8 out of 100 points) on women’s legal and social status compared to other countries world‐wide. Ghana has also ratified major international conventions, treaties and protocols on the rights of women and children including the Convention on the Elimination of all Forms of Discrimination Against Women (CEDAW), Convention On the rights of the child (CRC), and the Beijing Platform for Action and reports on these, although CEDAW is yet to be legislated into national law. This would suggest that Ghana has made good progress in this area. Yet there still exist major challenges with regards to gender equality.

Low Representation of Women in Decision Making 62. Representation of women in administrative and political leadership is low. Women’s representation in Parliament fell from 11 per cent in 2007 to 9 per cent in 200837. Socio‐cultural prejudice rooted in gender stereotypes prevent women from standing for political positions and from being voted into such positions. Among the factors that limit women’s participation in governance/politics are lack of financial resources as women’s access to and control of productive resources is minimal, limited education that has made it impossible for women to be employed in gainful employment that is well paying to give them extra income to invest in electioneering, and women’s lack of time resulting from the need to combine reproductive and productive responsibilities.38 Women also lack support from their families because of the notion that politics is the domain of men. Besides, lack of self confidence and self POSITION TOTAL % OF TOTAL esteem as a result of low level of formal Chief Justice 1 - education does not place them in a leverage Chief Director 22position with their male counterparts. The Supreme Court Judges 12 High Court Judges 22negative self‐concept that many women Members of Parliament 2 9 hold about themselves, difficulties faced by District Assembly Appointee 1,956 2 women in gaining access to productive District Assembly Elected 4,830 1 resources because of their limited decision making and bargaining powers, and limited

37 NDPC (2008), Annual Progress Report, The implementation of the growth and poverty reduction strategy (GPRS II 2006‐ 2009). 38 ABANTU for Development, The Olof Palme International Centre, (2010) Women’s Participation in Governance and Politics in Ghana.

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access to information are all constraining factors. The exhibit above shows data of women in politics and decision making.

Women’s Vulnerability to Poverty 63. The majority of Ghanaian women depend on agriculture for their livelihood. 70 per cent of food crop farmers are women, and are responsible for food security in their households. And yet women’s access to and control over land, information on land rights issues, access to formal credit from the banks, as well as storage, processing and marketing facilities limit their ability to engage in these activities independently.39 Access to and control of property including land is determined by the type of marriage and is vested in males. Access to finance is constrained by women’s limited education and institutional barriers. The structural subordination and marginalization of women, their limited decision making powers, education and access to information, training and other opportunities account for their predominance and yet marginalization in the agricultural sector, where they are predominately found in small scale farming. This limits their life choices and makes them vulnerable to poverty. Women also carry the burden of caring for the sick and orphaned, further entrenching gender stereotypes and making them more vulnerable to poverty. Women’s vulnerability to poverty is further exacerbated by erratic rainfall, droughts and floods due to the effects of climate change. Single mothers, widows and female headed households are particularly vulnerable to poverty as a result of inadequate access to productive resources. No data is available for assessing the share of women in wage employment in the non‐agricultural sector. However, if population growth is stabilized, development can be enhanced by empowering women and providing them with more choices through expanded access to economic and political power, as well as education and health services.40

Gender‐based Violence 64. Female Genital Mutilation (FGM), practiced particularly in the rural Savannah and the Northern, Upper East and Upper West regions,41 makes women vulnerable to infections and maternal death. However, because this is a longstanding cultural and religious practice, legislation has not been sufficiently able to halt the practice. Domestic violence and sexual abuse continues to be a problem for women and girls in particular. Cases of sexual abuse and exploitation of children are steadily and consistently on the rise. While in 2000 the former Women and Juvenile Unit (now known as Domestic Violence and Victims Support Unit) of the Greater Accra Region reported 181 defilement cases, the number increased to 425 in 2002 and

39 UNIFEM (2008), UNIFEM (2008) Aid Effectiveness and Gender Equality in Ghana 2004 – 2006: A Study by the EC/UN partnership on gender equality for development and peace. 40 UNFPA (2010), Population Issues and Their Interrelationships with Socio‐Economic Development 41 UNICEF (2008), Universal Periodic Review of the Human Rights Council, December 2008.

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by June 2003 stood at 278 42 . Strategies and capacity building efforts, including the establishment of Alternative Dispute Resolutions (ADR) and community mediation centers by the UN and government to promote access to justice by the poor and vulnerable have helped. Yet, there are still difficulties in law enforcement and in addressing challenge faced by the poor, particularly women in accessing the judicial system. Poverty and cultural beliefs and practices prevent women from demanding their right to justice particularly those related to domestic violence and sexual abuse. The Domestic Violence and Victim Support Unit of the Ghana Police Service recorded an increase in gender‐based violence offences from 11,773 in 2005 to 12,245 in 2008.43 Yet there is inadequate institutional support for ensuring access to justice and redress.

Violence Against Children 65. Cases of sexual abuse and exploitation of children are steadily and consistently on the rise. While in 2000 the former Women and Juvenile Unit (now known as Domestic Violence and Victims Support Unit) of the Greater Accra Region reported 181 defilement cases, the number increased to 425 in 2002 and by June 2003 stood at 27844. There are difficulties in law enforcement and addressing challenge faced by women and children in accessing the judicial system.

66. According to a 2003 study45 in Ghana, child labour manifests itself in different ways: Approximately 242,074 children between 13‐17 years old were engaged in mining and quarrying, hotels and restaurants, and fishing – activities which are considered as hazardous work; 220,891 children were found to be engaged in night work; 14,221 of them work for more than four hours; and about 1,590,765 children were attending school while working, which is 64.3 per cent of children engaged in usual economic activity. Research by the African Centre for Human Development46 suggests that Ghana is both a source, transit and destination country for trafficked children47.

42 This may also be an indication of greater public awareness and of increased confidence in the criminal justice system further seen by an increase in the number of convicted perpetrators with accompanying higher sentences than before. 43 Ministry of Women and Children’s Affairs (2009) Ghana’s Third Progress Report on the Implementation of the African and Beijing Platform of Action and Review Report for Beijing + 15 44 This may also be an indication of greater public awareness and of increased confidence in the criminal justice system further seen by an increase in the number of convicted perpetrators with accompanying higher sentences than before. 45, Ghana Child Labour Survey, Ghana Statistical Service and International Labour Organisation, March 2003. 46 Tengey, Wilbert and Oguaah, E., (2003), ‘The Little Ghanaian Slaves Cry For Help: A Report on Child Trafficking in Ghana’, African Centre for Human Development, Accra, 2002. 47 US‐TIP reports from 2006‐2009]

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67. The migration of children from rural to urban areas seems to be increasing, due to factors like economic hardships and lack of opportunities (educational, apprenticeship, and job opportunities) in the rural areas. One group of children who have become a source of concern of abuse and violence are the ‘kayayee’ (head porters). These are mostly girls under 18 who have migrated mostly to the big cities of Accra, Kumasi and Takoradi to engage in head porterage. These girls are among the most vulnerable child laborers, as many engage in prostitution or may be sexually exploited in exchange for protection while living on the streets. In addition are the children in the fishing, galamsey and cocoa sectors. Cases of sexual abuse and exploitation of children are steadily and consistently on the rise. While in 2000 the former Women and Juvenile Unit (now known as Domestic Violence and Victims Support Unit) of the Greater Accra Region reported 181 defilement cases, the number increased to 425 in 2002 and by June 2003 stood at 27848. Yet, there are still difficulties in law enforcement and in addressing challenge faced by the poor, particularly women in accessing the judicial system. Poverty and cultural beliefs and practices prevent women from demanding their right to justice particularly those related to domestic violence and sexual abuse. The Domestic Violence and Victim Support Unit of the Ghana Police Service recorded an increase in gender‐based violence offences from 11,773 in 2005 to 12,245 in 2008.49 Yet there is inadequate institutional support for ensuring access to justice and redress.

Gender Parity in Primary Education 68. Due to concerted interventions by Government and development partners, gender parity index (GPI)50 has improved over the years and stood at 0.99 for KG, 0.96 for primary and 0.92 for JHS in 2008/09 at the national aggregate level. 51 Regional disparities exist in GPI, however. For instance the primary GPI for Northern Region is still 0.87 and some districts within the region show the GPI as low as 0.70. Furthermore, significant gender gaps remain in school completion rates. In 2004/2005 the primary completion rate was 75% for girls and 82% for boys, with the GPI of 0.91 at the national level. The GPI for primary completion has slightly improved in 2008/09 to 0.93. Again, there exist large regional disparities with Northern Region showing the GPI of 0.85. This suggests while the interventions aimed at bridging gender gaps have been effective in promoting girls’ participation in education, further efforts are needed to keep girls in school at least until they complete basic education particularly in those regions and districts that still show large gender gaps.

48 This may also be an indication of greater public awareness and of increased confidence in the criminal justice system further seen by an increase in the number of convicted perpetrators with accompanying higher sentences than before.

50 The Gender Parity Index (GPI), commonly used to assess gender differences, is the value of an indicator for girls divided by that for boys. A value of less than one indicates differences in favor of boys, whereas a value near one indicates that parity has been more or less achieved. 51 Education Management Information Management System of the Ministry of Education (2008/09)

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4.3.2. National Response and Strategy 69. In 2008, the Gender and Agricultural Development strategy was assessed by the Ministry of Food and Agriculture (MOFA), resulting in recommendations to improve the situation of women in agriculture. A draft gender strategy for the Land Administrative Project and the land sector agencies was also developed in January 2009. The strategy seeks to ensure the rights of women’s to their existing land holdings, equitable information and access to opportunities, as well participation in decision making on land administration in Ghana. There is an affirmative action policy for appointing women to one‐third of the district assembly, but the policy is undocumented, making adherence and accountability virtually impossible. 52 In addition, government is committed to a 40 per cent representation of women in public decision making in its Affirmative Action Proposal (AAP) paper, but there has been no consistent strategy for achieving this.

70. While the Government established the Ministry of Women and Children’s Affairs (MOWAC) to fulfill its obligation for establishing national machinery under the Beijing Platform for Action, it is laden with challenges, including inadequate staffing, infrastructure and finance as well as lack of capacity for decentralization and representation at district level. With UN assistance, requisite legislative and institutional frameworks in support of gender mainstreaming strategies that are compatible with international conventions have been established. However, there is weak interagency collaboration and the leadership of MOWAC is constrained by a lack of resources and weak decentralization structures. In 2009 total budget allocation to MOWAC was less than 1 per cent of the national budget. A recent assessment of the ministry also found that there was a low absorptive capacity for donor funds.53 There are still major challenges therefore, with regards to policies, particularly in Financing for Gender Equality in the context of the Aid Effectiveness Agenda and Accra Agenda for Action. Another policy gap relates to mainstreaming gender in sector policies; and this is closely linked to the non‐availability of sex disaggregated data. For example the Domestic Violence Act was passed in 2007, and a national plan of action which focuses on coordination, social services, prevention and protection is in place but there are challenges relating to the capacities of sectors to implement it, while MOWAC is yet to finalize its implementation strategy and mainstream it in all sectors. Also, while Gender budgeting has been piloted in the three ministries of Agriculture, Education and Health, it is not integrated into the national budget process. However, in collaboration with development partners, MOWAC is implementing the Gender Responsive Skills and Community Development Project, which covers the period 2009 – 2013, and involves institutional strengthening for MOWAC, selected line ministries and district assemblies for

52 Ibid., (UNIFEM, 2008 ‐ pp 24). 53 Institutional Assessment of the Ministry of Women and Children’s Affairs.

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enhancing gender mainstreaming; as well as support for skills training and gainful employment, and entrepreneurial development of women and youth. While MOWAC is mandated to and manages the Human Trafficking Management Board, capacity within MOWAC to undertake this is seriously challenged resulting in the lack of monitoring of the National Plan of Action on Trafficking. The Department of Children under MOWAC has an issue of lack of resources‐both human and financial. This impedes the coordination and monitoring of the implementation of the recommendations of the Committee on the Rights of the Child.

Gaps to be closed to achieve the MDG by 2015 71. Some of the key remaining gaps to gender equality and women empowerment are: a) Lack of disaggregated data to support evidence‐based policy and decision‐making in primary school enrolment and completion rates by gender. b) Women’s vulnerability to poverty. c) Women’s low participation in decision making. d) Inadequate institutional support particularly at district level for ensuring access to basic social goods and services justice and redress for Gender based violence. e) Gender stereotypes by societies including the negative self‐concept that many women hold about themselves as individuals and as a group.

4.3.3. Emerging Priorities for the UN 72. Conventional wisdom has long recognized that a country cannot achieve its full potential if half of its population continues to be marginalized and left behind. Gender equality and women’s empowerment is therefore no longer an option, but an imperative for sustainable development; and UN support for MOWAC should therefore be intensified. The UN in Ghana may wish to consider the following as its contribution to government efforts towards gender equality: a) Support capacity building for decentralizing processes including planning, monitoring & evaluation, as well as the integration of Gender Responsive Budgeting into the fiscal policy planning, for improved delivery of essential services for women and children. b) Support capacity building for civil society organizations to focus on the advancement and empowerment of women, to develop their potential, creativity and skills for national development and bring coherence in collaboration with MOWAC by facilitating a coordinated gender and rights based approach to promoting all gender interventions across line ministries and women organizations to increase the impact of all gender‐oriented interventions. c) Strengthen evidence‐based advocacy at various levels to guide policy discussions, decision making, resource allocation and legislation, including through support to civil society.

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d) Support advocacy for the domestication of CEDAW and strengthening of the institutional capacity of MOWAC to effectively deliver on its mandate. e) Support for strategies and capacity building efforts to improve access to justice by poor and vulnerable groups particularly women and children. f) Support for women’s economic empowerment including their ability to earn decent incomes and hold decent jobs. g) Support women’s participation and representation in decision‐making and political leadership.

4.4. Under‐Five Mortality

4.4.1. Current Situation

73. Although Ghana’s efforts to reduce infant and under‐five mortality has experienced some progress, much still remains to be done to achieve the target of reducing under‐five mortality to 53 per 1,000 live births by 2015. The Ghana Demography and Health Survey (GDHS) report for 2008 indicates that under‐five mortality was 80 per 1,000 live births, representing a 28 per cent improvement from 111/1,000 live births during the period 2003 – 2006. There are also regional variations that indicate that four out of the 10 regions – Upper East, Western, Brong Ahafo and Volta regions – were on track to achieve the MDG goal of reducing under‐five mortality, while the rest were not.54 With regards to infant mortality, the GDHS report also indicates steady improvement to 50 per 1,000 live births in 2008, from 64/1,000 in the period 2003 – 06. This is in part attributed to the improvements in immunization against measles of under‐one year olds from a low of 61 per cent in 1998 to 90.2 per cent in 2008. Regional disparities also indicate that the same four regions achieved the highest improvements, while Ashanti, Eastern and Upper Western regions had the worst performance over the period 1998 to 2008.

74. The improvement in health service delivery such as the national health insurance scheme, high vaccination coverage, increasing access to effective malaria treatment and prevention, as well as the decline in guinea worm cases and improved treatment for Tuberculosis (TB), also contributed to reducing under‐five mortality, but not at the pace required to achieve the MDG target. Moreover there has been very little progress in reducing neonatal mortality and deaths during this period constitute almost 40% of deaths among

54 Republic of Ghana (2010), Ghana MDG Report 2008.

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children under the age of 5 years. Anaemia, child malnutrition and poor maternal health also contribute to the high under‐five mortality rates.

75. Evidence from recent studies indicates that there is a strong correlation between poverty and under‐five mortality. In addition, mortality rates are observed to be higher in rural areas compared to urban areas, and among mothers with no education than among mothers with secondary or higher level education. It is therefore evident that mortality rates are influenced by socio‐economic and geographic factors surrounding availability of basic services and poverty levels. For example, children from poor families have less access to National Health Insurance Scheme (NHIS) which reflects accessibility to healthcare. Figure 3 below compares membership to NHIS by socio‐economic group. The diagram shows that children in poor families have less access to NHIS. Less than 30 per cent of the bottom socio‐economic groups are members in NHIS while almost 64 percent of the wealthy are members. Figure 4: Individual NHIS membership by socio‐economic group.

Source: 2008 NDPC PM&E Survey

76. Available data also indicates that malnutrition among children, acute respiratory infections (ARI), diarrhea, anemia, measles and other neonatal cases are some of the major causes for deaths among infants. The Ghana Health Services (GHS) indicates that malnutrition is estimated to be the underlying cause of 55 per cent of mortality cases among children under five years, in addition to poor health care, feeding practices, limited access to nutritious food and safe drinking water and lack of adequate health facilities. In a report by the Overseas Development Institute (ODI), Ghana was not included among the top ten developing countries that had made overall absolute and relative progress on under‐five mortality.55 This means that

55 ODI (2010), Millennium Development Report Card: Learning From Progress. (In sub‐Saharan Africa, 5 countries are included in the top ten – Angola, Ethiopia, Guinea, Malawi and Niger).

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child survival interventions should be targeted at populations that are more vulnerable including rural communities and population groups living in poverty in both rural and urban areas. Increased urban slums and lack of nutritious food, safe water and sanitation, and housing make urban poor populations equally vulnerable to under‐five mortality (sometimes much more so due to rapid spread of communicable diseases in densely populated areas). Key challenges that weigh down the target of reducing under‐five mortality in Ghana include socio‐ economic and socio‐cultural factors ‐ low female literacy rate; low level of decision making by women about household healthcare choices and practices, including decisions about the healthcare practices.

4.4.2. National Response and Strategy

77. Ghana launched a new Child Health Policy and Child Health Strategy which outlines the High Impact Rapid Delivery (HIRD) approach for achieving MDG 4 and 5 including the key interventions to be scaled up at facility and community level and along the continuum of care focusing on improving access to, quality of, and demand for essential services. The UN is also supporting Government to implement the various disease–specific programmes, (malaria, immunization etc.) that have an impact on under‐five mortality, while also the MOH with support of the UN is implementing a guinea worm education programme. Some of the key interventions and policy initiatives currently underway include: (a) Integrated campaigns to improve coverage of key child survival interventions e.g. vaccination, vitamin A, de‐worming, growth monitoring, birth registration and Insecticide Treated Nets (ITN) distribution; (b) Expanded programme of immunization as well as supplementary immunization activities (SIAs) which involves reaching out to every district has resulted in high immunization coverage; (c) Infant and young child feeding interventions; (d) Prevention of Mother‐to‐Child Transmission (PMTCT) with a focus on increasing HIV‐free child survival; (e) De‐coupling children from their parents for NHIS coverage; (f) Developing guidelines for neonatal care; (g) Establishment of at least one fully operational and furnished hospital in every district to deal with maternal complications during and immediately after delivery; (h) Result‐oriented strategies for under‐ five, maternal health care and malnutrition; (j) Increased access to health services under the national health insurance scheme; (k) Increased use of Insecticide Treated Nets (ITNs); (l) Continuous advocacy to District Assemblies and DHMTs to devote more resources to maternal and child health; (m) Expansion of community‐based health service delivery; and (n) Development of guidelines for neonatal care as well as management of malaria, pneumonia and diarrhea in the community. However, it should be noted that the absence of a proper nutrition policy for Ghana is a major constraint to addressing malnutrition.

Gap to be closed to achieve the MDG by 2015

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78. Some of the key gaps and challenges that still exist and may be constraining progress towards reducing child mortality include: a) Inadequate and unsustainable funding for key components of the child health strategy (e.g. the Expanded Programme of Immunization (EPI), community IMCI), and lack of innovative and sustainable resource mobilization and allocation to the child health programme. b) Inadequate and inequitable coverage of preventative and therapeutic interventions at primary care level e.g. facility and community Integrated Management of Neonatal and Childhood Illnesses (IMNCIs), skilled deliveries, and postnatal care and , nutrition interventions. c) Inequitable access to health care due to limited health service coverage. d) Low awareness and of the uptake of non‐medical preventive health care. e) Inadequate availability and national utilization of data to provide complete and reliable information on child health at national and sub‐national level. f) Insufficient human resources, especially at mid and lower levels. of the health system to improve the quality of care g) Absence of proper nutrition policy for Ghana

4.4.3. Emerging priorities for the UN

79. Improving infant and under‐five mortality can be done, as evidenced by progress made by some developing countries, including some in sub‐Saharan Africa such as Malawi, Ethiopia and Tanzania. The Overseas Development Center (ODC) notes in one of its Policy Papers:56

“Where there has been progress towards MDG 4 ‘to reduce by two thirds the mortality rate among children under five’, it has been when strong government leadership and good policies are combined with adequate financial and technical support”.

The case of Egypt, the only country to have achieved MDG 4 by 2006, even more forcefully demonstrates that political will is the key to success. The government launched a major initiative called “healthy mother, healthy child” to improve health conditions in poor areas. The UN can contribute by supporting government to develop similar policies and strategies and strengthen management and implementation capacity of the government, particularly at the decentralized level in the following areas:

56 OECD (2008), Policy Insight No. 65, April 2008: Combating Under‐five Mortality in Africa.

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a) Increasing access to high impact child survival interventions at facility and community level, especially those focusing on the prevention and treatment of major childhood killers, including malaria, pneumonia and diarrhea. b) Increasing access to skilled health‐care workers and better quality care during pregnancy, delivery and the neonatal period to accelerate reduction in the neonatal mortality rate. c) Scaling‐up proven interventions to prevent and treat child malnutrition and under nutrition. d) Improving access to nutrition education, clean water, sanitation, hygiene and nutritious food, which are critical to addressing infant and child mortality. e) Better use of data for action at regional and district level.

4.5. Maternal Mortality

4.5.1. Current Situation

80. The importance of improving maternal health for poverty reduction is well recognized. Yet, Ghana is not likely to meet the goal of reducing maternal mortality ratio by three quarters. A recent release of the UN MMEIG indicates that the MMR in Ghana is 630 maternal deaths for every 100,000 live births in 1990 and 350 maternal deaths for every 100,000 live births in 2008 which represents a decline of 44% in Ghana’s MMR. In other words, the number of maternal deaths per annum declined from 4,410 in 1990 to 3,230 in 2008 in Ghana. By the MMEIG recent release, Ghana is classified as “making progress” towards the achievement of MDG 5 by 2015. However, there are wide geographic disparities in maternal mortality ratios as illustrated in the recent release of the MMERG “Trends in Maternal Mortality: 1990 to 2008”.

81. Improved ante‐natal care coverage of four or more visits (from 89% in 1998 to 95% in 2008) has contributed to the decline in maternal mortality. Severe bleeding, hypertensive diseases, infections and abortions are the most prevalent causes of maternal mortality.57 Improvements in antenatal care visits and immunization services between 1998 and 2008 do not correspond to improvements in supervised delivery by pregnant women. This means that delivery by non medical personnel is pervasive. As Figure 4 illustrates below, women who reside in rural communities, women with little or no education, in other words poor women are less likely to have their babies delivered by trained medical personnel.

57 Ibid. NDPC (2008) Annual Progress Report.

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Figure 5: Assistance in Childbirth by Skilled Health Worker

Source: Ghana Demographic and Health Survey 2008. GSS, GHS

82. Unassisted deliveries remain significantly high at 43 per cent endangering the lives of many women of reproductive age.58 There are rural‐urban disparities in health care services – 43 per cent of births in rural areas as opposed to 84 per cent of births in urban areas are likely to occur in a health facility.59 Economic, social, cultural and financial factors account for these. With regards to Emergency Obstetric and Neonatal Care (EmONC), there are insufficient EmONC packages such as blood banks and ambulance or adequate transport facilities to support access to and referrals to health facilities. Health facilities also lack adequate health staff to offer services. However, the nurse‐population ratio is reported to have improved from 1,508 in 2005 to 1,190 in 2008, although the ratio is still very high. These factors render the health systems weak in rendering quality services resulting in maternal mortality.

83. Modern contraceptive use declined from 19 per cent in 2003 to 17 per cent in 2008, while there is a high unmet need for family planning (36%).60 This contributes to increase in

58 Ghana Statistical Service (2009) Ghana Demographic and Health Survey 2008 59 Ibid. 60 Ibid.

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unwanted pregnancies, preventing pregnancy related complications, unsafe abortions and childbirth related complications, especially among the youth. In addition, adolescent and youth friendly services have received insufficient attention even though adolescents are considered as a vulnerable group that requires increased access to health services.

4.5.2 National Response and Strategies 84. Family planning, skilled delivery services and emergency obstetrics and neonatal care are three key interventions that Government and civil society organizations, with the support of UN agencies have used to positively impact on maternal mortality.61 Other key policies, strategies and interventions include: a) Reproductive health strategy; b) The National Contingency Plan c) Road Map for Accelerating the Attainment of the MDGs related to Maternal and Newborn Health in Ghana; d) Standards and Protocols for Prevention and Management of Unsafe Abortion: Comprehensive Abortion Care Services; e) Wheel for Improving Access to Quality Care in Family Planning: Medical Eligibility Criteria (MEC) for Contraceptive Use; f) Road Map for Repositioning Family Planning; g) Campaign on Accelerated Reduction of Maternal Mortality (CARMMA) h) Declaring maternal mortality a national emergency in 2008 and a programme of free health care for pregnant women including deliveries through the national health insurance scheme; i) Strengthening of Community Health Planning Services (CHPS) to facilitate the provision of maternal health services; and expansion of community‐based health service delivery; j) Provision of nutritional support and education to child bearing age women. k) At the districts level, the range of approaches that are used to increase supervised delivery, includes targeting pregnant women for NHIS registration, raising community awareness through CHPS zones, Community Health Officers outreach education and mobilization of community leaders, among others; l) Continuous education to traditional maternal health service providers to ensure preventable maternal deaths; m) On‐going process of making maternal death a notifiable event backed by legislation;

61 Ministry of Health, Government of Ghana, United Nations Country Team (2010), Ghana: Millennium Development Goals Acceleration Framework (MAF) Country Action Plan (CAP).

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n) Establishment of the steps aimed at revising the guidelines for the conduct of maternal death audits and for establishing a system of Confidential Enquiry into maternal death; o) Piloting of an integrated approach to addressing maternal health and poverty issues at district level.

85. However, in spite of these initiatives, there still remain major challenges. The Ghana MDG Acceleration Framework and Country Action Plan (MAF‐CAP) report shows that accessibility, availability, coverage, knowledge, acceptance, poverty, quality and inter‐sectoral coordination are among major bottlenecks to key interventions. Other key challenges include, gender inequity, socio‐cultural beliefs and practices that prevent women (especially the less educated) from accessing health and family planning services; and delays in seeking health care due to the geographic distance to health care facilities. Other problems relate to delay in receiving help at health care facilities due to the lack or absence of health care staff as well as insufficient health care staff mostly in rural areas due to a preference to work in urban areas where there are better public services. There is also fragmented health information system with inadequate capacity for data management. In addition, resource allocation to the health sector only increased in nominal terms over the years, but as a percentage of the national budget it declined from 16 per cent in 2006 to about 12.7 per cent in 2009.62 Government financing of health service delivery is poor and the government spends 9.6 per cent of its budget on the health sector, out of which 94 per cent is for the wage bill (Ghana is a signatory to the Abuja Declaration which commits governments to allocate 15% of their national budgets to health). Malnourishment in pregnant women resulting from poverty and ignorance also constitute a major challenge. Available evidence also shows that there is very little private sector involvement and collaboration in addressing the issue of maternal mortality.

4.5.3 Remaining gaps to be addressed in order to achieve the MDG by 2015 86. Some of the major gaps that remain in order to achieve the goal of reducing maternal mortality by 2015 include: (a) inadequate family planning, skilled delivery, emergency obstetric and neonatal care; (b) inadequate resource mobilization for maternal health interventions; (c) weak individual and institutional capacities and weak partnership coordination; (d) weak governance especially at local government levels; (e) weak data generation and management capacity; (f) socio‐cultural and economic factors that prevent women from using health care facilities especially for sexual and reproductive health services; and (g) substantial increase in the number of females of childbearing age and the pressure this puts on expansion of sexual

62 Ministry of Health, Government of Ghana, United Nations Country Team (2010), Ghana: Millennium Development Goals Acceleration Framework (MAF) Country Action Plan (CAP)

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and reproductive health facilities and services, which are currently inadequate and contribute to high maternal mortality.

4.5.4 Emerging Priorities for the UN 87. In order to make faster progress in reducing maternal mortality, Ghana needs to focus on both policy and practical interventions and combine them with the interventions of its development partners. In addition, there is a need to strengthen monitoring and accountability mechanisms in order to ensure that decision‐making is based on specific evidence that takes into account the needs of deprived communities, particularly rural women and young mothers. The UN can contribute to these processes by: a) Strengthening policy dialogue and advocacy for more commitment of resources by Government to improve maternal health and care. b) Supporting development of strategies to enhance training and deployment of more midwives to deprived communities, including through increased engagement of CSOs and the private sector to strengthen health care systems, with particular emphasis on increasing awareness for gender, health and nutrition issues, as well as adolescent reproductive health. c) Support for the creation of enabling environment for rights holders to participate in planning and decisions on health, and strengthen their capacities to engage with duty bearers for the formulation, implementation, monitoring and evaluation of pro‐poor policies that enhance the access of marginalized groups to health services. d) Supporting development of integrated health management information systems in order to enhance decision‐making. e) Improving nutritional status of females of child bearing ages through nutrition education and training in income generating activities for the poor females.

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4.6 HIV and AIDS, MALARIA and TUBERCULOSIS

4.6.1 Current situation

88. The HIV and AIDS epidemic in Ghana is a mature, low‐level, generalized epidemic with pockets of high prevalence among certain sub‐populations and geographic areas. Its defining characteristic is that infection in the general population depends to great extent on continuous bridging from core high prevalence sub‐populations, such as female sex workers (FSW), their clients and non‐paying partners (NPP), and men who have sex with men (MSM). There are signs that the epidemic is stabilizing, although it is unacceptably high among certain population groups and geographical pockets. Data from the Sentinel Surveillance show that HIV prevalence among pregnant women attending antenatal care seemed to be on a downward trend, declining from a high of 3.6 per cent in 2003, to 2.9 per cent in 2009 as shown in Table 7 below. Based on national estimates and projections, the national HIV prevalence in 2009 was 1.9%.63 The main drivers of the epidemic in Ghana are multiple concurrent partnerships, early sexual debut, low levels of condom use, inter‐generational sex, mobility and migration, all compounded by underlying gender inequalities and sexual violence

Table 6: Trends in HIV/AIDS Prevalence Rate in Ghana, 1999‐2009 (Antenatal) 199 200 200 200 200 200 200 200 200 200 200 Year 9 0 1 2 3 4 5 6 7 8 9 HIV/AIDS Prevalence 1.5 2.3 2.9 3.4 3.6 3.1 2.7 3.2 2.6 2.2 2.9 Rate (%)T Source: HIV Sentinel Survey Report 2009

89. The HIV prevalence varies considerably in geographic region, gender, age, and residence. According to the 2009 HSS, the prevalence in antenatal attendants ranged from 0.7% in North Tongu in the Volta Region to 5.8% in Agomanya and Koforidua in the Eastern Region. The Regional HIV prevalence ranged from 2.0% in the Northern Region to 4.2% in the Eastern Region. Six of the ten regions (Eastern, Ashanti, Greater Accra, Western, Upper West and Central) had HIV prevalence 3% or more. The median and mean HIV prevalence in urban areas is slightly higher than in rural areas.

63 UNGASS 2010 Country Report Ghana

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4.6.2 National Response and Strategy

90. In response to the epidemic, the Government of Ghana adopted an HIV/AIDS National Strategic Framework (NSF II) to cover the year 2006‐2010. The goals of this Strategic Framework, are to reduce new infections, mitigate the health and socio‐economic impact of HIV/AIDS, and promote healthy lifestyles. Since 2006, the country has made remarkable progress in applying the "Three Ones" principles to scale up prevention, treatment, care and support interventions in the country with particular emphasis laid on the Health Sector Response and provision of Anti‐retroviral therapy (ART). Some of the key interventions undertaken to reduce the spread of the disease during this period include raising awareness for the practice of safe sex especially among the most vulnerable; reducing mother‐to‐child transmission; promoting voluntary counseling and testing; and increasing use of Anti‐Retroviral Therapy (ART) for Persons Living with HIV/AIDS (PLWHAs). Other initiatives include training of health care workers from district level facilities in the management of HIV/AIDS; providing nutritional support for PLHIVs/AIDS; strengthening referrals and collaboration Key results that have been achieved through the Joint between facilities and communities to UNAIDS Programme include: increase ART uptake and adherence; 132. Coordinated response to reduce duplication. support to the most‐at‐risk‐population 133. Allowed smaller agencies to be actively involved in the National HIV response through collaboration. (MARP) and coordinated District 134. Strengthened comparative advantage of the UN Response Initiative to HIV. A campaign in technical assistance and technical support. known as ‘Know Your Status’ was launched to bring HIV counseling and testing to close to the people in their communities.

The NSF also formed the basis of resource mobilization and proposals submitted to various funding agencies including the GFATM Round 8 (RD8). The Universal Access targets were integrated into this national strategic plan. Annual Programmes of work were developed for each year from 2006 to 2010 which spelt out specific interventions and expected output to implementing partners to ensure the strategic framework was implemented. A comprehensive NSF II review has been undertaken in 2010 to inform the development of the National Strategic Plan 2011‐2015 that would focus on better planning, budgeting, funding and direction for implementation of prioritized activities over the next five years (2011‐2015)

Funding for the national response during this period was mainly through the World Bank supported Multi‐sectoral HIV and AIDS Project and Treatment Acceleration Program. Other sources of support (technical and financial) are derived from bi‐lateral organizations such as,

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DFID, USAID, DANIDA and the Netherlands. The Global Fund has emerged as one of the major grant providers to support HIV and AIDS activities in Ghana

91. Some major challenges have been identified as limiting progress in achieving Universal Access targets and retaining the desired impact of interventions designed and implemented within the national response.

a. Insufficient Political Commitment and action Although Ghana has developed policies and strategies to scale‐up its response to the epidemic; insufficient political commitment and action at various level; limited technical and financial resources at the district levels are responsible for the slow progress in the national response. b. Weak decentralized response: Inadequate human and financial resources for effective coordination and management at regional and district levels are a major problem. This affects the efficient monitoring and accountability on HIV and AIDS related programmes and also restricts development of an effective multisectoral response. Synergies have increased among major stakeholders who now coordinate their programmes within the National HIV and AIDS Framework. However, the major challenge is that multi‐sectoral participation is not yet broad enough from government, civil society and the private sector with a number of vulnerable groups under‐represented. This situation is mirrored at the district level where most district AIDS coordinating committees are poorly resourced, or inactive, or operating with little or no civil society participation. These groups can be very effective because of their direct reach within their constituencies and their grassroots knowledge of local needs. However, due to the weak coordination and various reporting requirements the resource flow mechanism is not streamlined c. Stigma and Discrimination. The stigma associated with HIV and the resulting discrimination remains a major challenge in the community and among service providers. This greatly influences the lower uptake of HIV preventive services, including under‐ or non‐ participation in HIV testing and seeking appropriate care and treatment, thus fueling the spread of infection. Reducing HIV and AIDS related stigma is therefore critical in preventing further transmission of HIV and reducing the high levels of sero‐discordance among consensual unions and marriages. Stigma and discrimination among most at risk population groups especially among men who have sex with men received little attention. d. Vulnerability of women and girls to HIV. Whilst the HIV epidemic is generalized to all population groups, women and young adults are the hardest hit. Women and young girls are particularly vulnerable to HIV infection not because they engage in high risk behavior, but because of social and cultural factors that support male dominance in the area of sexuality and reproduction. Men engage more in risky sexual behaviors and infect their partners. In 2008, 11.3 per cent of male and 1 per cent of female respondents aged 15 – 49

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years had more than one sexual partner in the past 12 months.64 Poor negotiation skills on the part of women creates a situation where, although women may want their partners to use condoms (or to abstain from sex altogether), they often lack the power to make them do so. Women’s limited control over their bodies is undermined even further because they are vulnerable to forced sex. Statistics show that although it is not only women who are forced into having sex, they make up the majority of victims of forced sexual encounters.65 Poverty, early marriage and inadequate access to reproductive health services all contribute to increased vulnerability. Gender based violence and trafficking also places greater risks on girls.

4.6.3 Emerging priorities for the UN

92. As formulated in the UNDAF 2006‐2010, the UN response to the epidemic of the past years aimed to strengthen the national response to HIV and AIDS through Joint UN programme of Support (JUNPS). To this end, the UN focused on the following issues: reducing a further spread of HIV infection amongst most vulnerable and high risk groups; and the improvement of equal access to quality services; the improvement of management and coordination of the national response. Other priority areas of the UN during this period were: the prevention of mother to child transmission; treatment, care and support for those living with HIV which includes programs aimed to combat stigma and discrimination. UN has extensively supported the review of the National Strategic Framework II 2006‐2010 and the development of the National Strategic Plan 2011 ‐ 2015.

The following are the potential areas for UN to provide support in the coming years to strengthen the national response:

a) Coordinate, monitor and evaluate, and manage the response according to the Three Ones principle: Strengthen decentralized coordinating structures, their capacities, promoting meaningful involvement of the public sector, civil society, the private sector and development partners, and support strengthening a decentralized strategic information system including monitoring of new infections and behaviors that promote spread of HIV. b) Focus on Most at Risk Population groups and remove the legal barriers: Continuous attention and efforts focus on Most at Risk Population groups to encourage their uptake of prevention, treatment, care and support services. Special attention to remove the punitive laws, policies, practices affecting the accessibility and uptake of services by Most at Risk Population groups. c) Focus on the youth: Support their access to prevention, care and support and continuous efforts aimed at encouraging behavioral change.

64 Ghana Demographic and Health Survey Report (2008). 65 Akumatey Betty, Darkwa A (2009), Gender Norms, Domestic Violence and Women’s Vulnerability to HIV/AIDS.

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d) Scaling up of services: Provide strategic support to scale up prevention of mother to child transmission, ARV treatment and care and support for those infected and affected by HIV. e) Improve basic social and protection services to mitigate HIV impact on development: Support programmes geared towards minimizing the socioeconomic impact of HIV and AIDS, the increasing numbers of orphans, vulnerability due to poverty and food insecurity, increased morbidity associated with HIV/ AIDS, f) Support human rights and gender based responses and address stigma: Support the country to adopt a human rights and gender based approach in all HIV responses, as well as reduce the stigma and discrimination associated with HIV through increased knowledge, advocacy and constructive use of mass communication strategies.

4.6.4 MALARIA

4.6.4.1 Current Situation

93. Malaria is the leading cause of morbidity in Ghana and is the single most important cause of mortality among children under five years and pregnant women. Malaria is responsible for a substantial number of miscarriages and low birth weight among pregnant women. Malaria case fatality (number of persons with malaria who die) has declined from 3.7% in 2002 to 2.1% in 2009. While the total number of fatalities among pregnant women and children continue to decrease – an indication of improved access to health care programmes and facilities ‐ the total number of malaria cases has increased steadily. A major challenge to the control and prevention of malaria in Ghana relates to the lack of proper waste disposal system in the country and poor drainage systems in the cities which ensures that stagnant waters are always collected across the city. Another challenge relates to poor sanitation habits by many city dwellers, while also rapid urbanization and the development of slums contribute to the problem. The poor also lack adequate access to Insecticide Treated Nets (ITNs). Use of ITNs increased successively from 3.3 per cent in 2003 to 22 per cent in 2008. However, the proportion of children under five years sleeping under ITNs declined significantly to 40.5 per cent in 2008.66 Similarly ITN use among pregnant women also declined to 30.2 per cent in 2008 from 52.5 per cent in 2007. In ITN use is higher in rural than urban areas (reference survey). Effective treatment for malaria using a new class of medicines called Artemesinin‐based Combination Therapies (ACT) is now national policy and these drugs are widely available at an affordable price.

66 Ghana MDG report 2008.

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4.6.4.2. National Response

94. With the support of UN and other development partners, government has carried out many initiatives directed towards the prevention, control and treatment of malaria in the country. Major initiatives include: a) The Abuja Declaration on Roll Back Malaria in Africa which aimed to achieve 60 per cent coverage of malaria interventions by the year 2005 with a focus on pregnant women and children under‐five years. b) The National Malaria Control Programme (NMCP) intended to promote the use and availability of ITNs through public‐private sector partnership. c) Malaria prevention and control through clinical trials of indigenous medicines, distribution of insecticide treated nets, indoor residual spraying and scaling up bio‐ larviciding. d) Initiatives to enhance preventive measures such as: (a) Promoting chemoprophylaxis for pregnant women and improving environmental sanitation; and (b) Introduction of an Anti‐Malaria Drug known as Artesunate‐Amodiaquine to cater for the treatment of uncomplicated malaria cases across the country. Two alternative drugs known as Artemether‐Lumefantrine and Dihydroartemisinin‐Piperaquine were added to cater for those who remain hypertensive to Artesunate‐Amodiaquine.

4.6.4.3. Remaining Gaps to achieve MDG by 2015.

95. The main gaps that continue to constrain effective control of malaria involve poor environmental management including poor sanitation and drainage systems in urban areas that promote the breeding of mosquitoes and insufficient coverage of cause health diseases, including poor sanitation and drainage systems in urban areas and evidence‐based interventions for prevention and treatment of malaria such as ITNs and ACTs. There is also lack of sustainable funding for malaria control programmes. A Ghana Macroeconomics and Health Initiative report estimated that an investment of about 0.45 per cent of GDP was required annually to combat malaria and achieve the MDG goal by 2015.

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4.6.4.4. Emerging Priorities for the UN.

96. The UN can contribute to this goal by focusing on the following: a) Strengthen efforts towards elimination of malaria parasite, including through reduction of malaria breeding conditions such as poor sanitation, drainage and waste disposal. b) Increase the capacity of the malaria control programme to scale‐up and monitor key preventive and therapeutic interventions for malaria such as ITNs and ACTs monitor and address the key health system challenges including capacity constraints and sustainability issues. c) Support advocacy to increase funding for interventions to combat malaria in the most affected regions.

4.6.5 Tuberculosis

4.6.5.1. Current Situation

97. While the exact burden of TB in Ghana is not known, in 2009, 15,067 TB cases were reported increasing from 7,425 in 1996. There are regional variations in case notification with the Greater Accra Region recording the highest notification rate (83/100 000 population in 2008) and Brong‐Ahafo Region recording the lowest notification rate of 30/100 000 population in the same year

98. In Ghana the peak age group for TB in women is 25 to 34 years; for men it is 35 to 44 years. The overall male to female ratio of TB patients is 2:1. Between 60‐70% of those affected with TB are in the economically productive age group. Default rates have declined from 11% in 2005 to 2.3% in 2008. The participation of private sector and civil society no doubt has led to improvement in case holding. The reduction in default rate is partly attributable to the NTP’s initiative of implementing operational and performance based incentives for patients and health care providers known as Enablers Package and Community Based TB Care. Treatment supporters and volunteers have been successfully used to support patients and to achieve sustained improvement in treatment success rate. The present treatment success rate is 85.3% (2008 Cohort). TB case fatality rate is high at 9% despite the low HIV prevalence (1.7%)67 in the general population.

67 NACP HSS report 2009 (complete reference)

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4.6.5.2. National Response

99. The National TB Programme (NTP) is currently implementing the WHO Stop TB Strategy With support from the Global Fund and other partners; the NTP has successfully integrated TB control activities into the general public health system. Ghana has achieved 100 percent DOTS Coverage since 2005 with a network of TB microscopy laboratories. A quality assurance system for the laboratories has been established. Over the past four years, the number of patients evaluated at the end of treatment has increased remarkably. Treatment outcome is now reported for 99.7 percent of sputum smear–positive patients (2007) Case management and holding has also improved, and the treatment success rate continues to increase The NTP achieved countrywide rollout of the WHO‐recommended fixed dose combination (FDC) regimen provided in patient kits in less than 1 year. Since 2005, Ghana has adopted the WHO interim policy on TB/HIV and has been implementing almost all the activities.

4.6.5.3. Remaining Gaps to achieve MDG by 2015. 100. The overall objective of the NTP is to achieve the World Health Assembly (WHA), STOP TB Partnership and the Millennium Development Goal (MDG) targets of detecting at least 70% of incident smear positive TB cases and to half TB deaths by 2015 compared with the level in 1990. A major gap in the program has been a low TB case detection rate (smear positives) estimated at 36% (2007). This may in part be due to insufficient case finding implementation strategies as well as challenges in accurately estimating the burden of TB in Ghana.

4.6.5.4. Emerging Priorities for the UN. 101. The UN can contribute to TB control in Ghana by focusing on:

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4.7 ENVIRONMENTAL SUSTAINABILITY

4.7.1 Proportion of Land Covered by Forests

102. Ghana is not likely to achieve MDG 7 by 2015 because among other reasons, its forest cover is declining rapidly. Against the backdrop of Climate Change, which is increasing its impact on the livelihood of Ghanaians, the rate at which the nation is losing its natural resources owing to human activities raises concern about the sustainability of natural resources. Available evidence on the rate of forest depletion shows that, between 1990 and 2005, the forest cover has declined from 32.7% to 24.2% at an average rate of 1.7% annually. Issues such as low institutional capacity for environmental management, low awareness on the effects of human activities on the environment and limited resources (human and financial) to implement reforestation and other environmental management programmes need to be urgently addressed. There are several additional factors that contribute to the depletion of forests, including livelihood activities, land degradation, and the rapid growth and expansion of unplanned cities. Human activities such as logging, fuel production and farming are the main causes of forest loss. Much of the logging is illegal and is often done with little consideration for the environment. In many cases, matured trees are cut for timber and other uses but they are not replaced. Although several number of timber companies are required to replant trees, monitoring to ensure strict compliance is often weak or non‐existent because the institutions mandated to do so are under‐staffed and/or poorly resourced. Land degradation has a significant impact on the environment and natural resource base of the country. About 69% of total land area is prone to severe or very severe erosion due to farming practices, removal of vegetative cover, deforestation and mining activities, especially illegal mining. Other factors include livelihood activities, population pressures and conflict in traditional land practices explain why the country’s forest is being depleted at such an alarming rate. Furthermore, loss of biodiversity is proceeding at alarming rate.

103. In addition, Ghana’s agricultural practice has not seen any significant transformation for a long time. Most farmers still practice slash and burn methods and continue to use crude and obsolete farming implements that are not environment friendly. These old farming practices expose the top layer of the soil, thus causing land degradation, while also the slash and burn practice causes the release of environmental gases, adding to air pollution in addition to the pollution of rivers and the destruction of other water bodies.

104. With regard to the marine environment, Ghana’s capacity for combating and controlling marine pollution from ships and offshore oil drilling platforms is very limited both in terms of

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legislation and human resource capacity. As a result, one reported case in 2010 involved pollution by one of the offshore oil companies in Ghana, but the company is challenging the legal basis for a fine imposed on it by the Government for the pollution citing the lack of regulatory framework in Ghana on such matters

4.7.2. Potable Water

105. The prevention of diseases especially water‐borne diseases like guinea worm infections require improved access to clean potable water for both rural and urban households. With regards to safe drinking water, recent estimates indicate improvements in the trends of access to safe water sources for both rural and urban populations. According to recent government reports, 74 per cent of rural population and 90 per cent of the urban population have has access to an improved safe drinking water source, which is higher than the 55 per cent of urban population with access to safe water.68 The UN consistently makes use of the official global mechanism (the WHO/UNICEF JMP Report) for monitoring progress on the water and sanitation MDG targets as this provides a more comprehensive assessment of the situation. It, however, notes that there are other mechanisms which give statistics on the Water and Sanitation coverage using information from the service providers rather than from the users. Based on the JMP figures the proportion of Ghanaian population with access to safe drinking water increased from 54% in 1990 to 82% in 2008.69 For the same period, Urban drinking water coverage increased marginally by 6 per cent (from 84% to 90%) while the corresponding increase for rural areas was 37 per cent (from 37% to 74%). As the WHO/UNICEF JMP Report does not provide statistics on sub‐national coverage for access to drinking water, the Water and Sanitation Monitoring Platform70 coverage by region varied, with the Upper West region recording the highest coverage of 97% and Greater Accra the lowest coverage of 61 per cent. Table 7 below illustrates the regional disparities from the provider‐based perspective used by the government.

Table 7: Rural‐Urban Potable Water Coverage by Region, 2008 Estimated Rural % Covered Estimated Urban % Covered in Region Population in 2008 Population 2008 Ashanti 2,622,826 72.95% 2,106,118 44% Brong Ahafo 1,926,214 53.51% 549,919 30% Central 1,426,514 44.35% 1,188,410 49% Eastern 1,565.265 58.88% 1,069,916 29%

69 WHO/UNICEF Joint Monitoring Programe on Water and Sanitation, 2010 Update. Progress on Sanitation and Drinking Water. 70 Water and Sanitation Monitoring Platform (2009), Status of Ghana’s Water and Sanitation Sector: Summary Sheet 2009.

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Greater Accra 640,946 59.03% 4,047,244 65% Northern 2,009,927 57.97% 594,513 89% Upper East 1,028,325 52.24% 181,591 41%

Upper West 604,630 76.76% 121,825 15% Volta 1,487,221 54.26% 606,772 39% Western 1,534,023 41.27% 772,487 57%

National 14,845,991 57.14% 11,235,795 55% Sources: NDPC 2008 Annual Progress Report, (GPRS II 2006 – 2009).

106. One of the major challenges to providing adequate and clean water to communities is population growth. This is particularly so for regions experiencing higher growth rates such as Greater Accra.71 Other challenges include shortage of skilled staff that is often exacerbated by competition between the Community Water and Sanitation Agency (CWSA) and the private sector for technical expertise; inadequate finances required to undertake and maintain huge water projects; perennial water problems that continue to plague both the rural and urban communities; and substantial regional variations in availability of easy to develop groundwater and surface water resources. In addition, climate change effects have resulted in Ghana losing water from some of its major water basins (Tano and Oti rivers). Dwindling water resources and inadequate capacity of the state to supply safe drinking water for rural and urban populations will result in water scarcity and could be a source of conflict in communities.

4.7.3. Sanitation

107. Low coverage of toilet facilities results in the practice of open defecation, thus exposing people to pathogenic organisms and makes them vulnerable to disease. The WHO/UNICEF Joint Monitoring Programme Platform (JMP) defines an improved sanitation facility as one that hygienically separates human excreta from human contact. By this definition, only users of improved sanitation facilities are considered as having access to sanitation on condition that the facility is not shared by multiple households.72 National coverage for improved sanitation increased from7 per cent to 13 per cent between 1990 and 2008, with urban coverage improving from 11 per cent to 18 per cent while rural coverage improved from 4 per cent to 7 per cent.73 Government officials noted that data was scarce but estimated that Ghana has 13 per cent sanitation coverage, and is the worst in Africa after Sudan.74 At the regional level,

71 Gaisie S. K, P. G. Boakye (2007); in Chucks J. Mba and Stephen O. Kwankye edited: Population, Health and Development in Ghana: Attaining the Millennium Development Goals. 72 NDPC/Government of Ghana, UNDP (2010), Ghana Millennium Development Goals Report. 73 Ibid – JMP (2010) 74 Information obtained from Sanitation Directorate of the Ministry of Local Government and Rural Development.

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access to improved sanitation facilities varied considerably in 2008. The proportion of population in the Greater Accra and Eastern regions who had access to improved sanitation was above the national average of 13 per cent, while those in the Western and Central regions were close to national average. The rest of the regions including Ashanti and Brong Ahafo regions recorded less than the national average. A large proportion of the population in the three northern regions (Northern, Upper East and Upper West) are less likely to have access to improved sanitation facilities as an average of 4 per cent of the population have access to improved sanitation facilities (not shared) compared to 25 per cent in the Greater Accra and 15 per cent in the Eastern region.

4.7.4. Housing, Urban Development and Slum Upgrading

108. Improved housing promotes socio‐economic development and brings about social cohesion. The right to adequate housing is intricately linked to the enjoyment of other human rights like security of person, education and health. A number of UN‐HABITAT empirical data suggests that housing improvement has a strong correlation with social and economic indicators such as disease control, environmental improvement and increased school enrolment among others. However, despite the critical importance of housing, national development policies and programmes have in the past often treated housing as something to be tolerated rather than desired. . Available statistics from the 2000 population and housing census shows that, out of 3.88 million dwelling units recorded in 2000 in Ghana, less than 50 per cent were classified as houses, while the remaining were dwelling units constructed with poor quality mud bricks and earth, mostly with thatched roof and poor floor construction materials. In addition, 74,000 kiosks and containers housed several hundred thousand people and a large number of people in urban areas sleep on pavements, walkways and on streets. Current estimates indicate that the country needs 1,000,000 housing units annually while supply is estimated at 35 percent of the total need. Rural housing problem in Ghana has been that of quality and almost entirely produces by the private sector using mostly traditional building materials. Most building materials used for rural housing have been known not to be able to resist disasters as such houses need to be rebuilt in short periods. On the other hand, rapid increase in urban population has resulted in a high housing deficit in most cities in the country. This has resulted in overcrowding and development of slums in many places. Available estimates show that urban population has increased from 28.9 per cent in 1970 to 43.8 per cent in 2000. On the other hand population with access to secure housing has stagnated at about 12 per cent over the past five years and if the trend continues, the proportion with access to secure housing will increase by only 6 per cent by 2020.75 This means that significant proportion of urban population will remain without access to secure housing.

75 Ghana MDG Report 2008.

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109. In 1990, the total number of people living in slums in Ghana was estimated at 4.1million, and increased to 4.99 million in 2001 and then to 5.5 million people in 2008. In Greater Accra alone it is estimated that nearly one‐third of the population live in slums. Unless adequately addressed, population expansion will exacerbate the problem, creating more demand for infrastructure such as roads, schools, hospitals, electricity water and telephones. Major challenges relate to the inability of housing delivery system to meet effective demand for housing over the years, the unorganized market for land and cumbersome legal and administrative systems for procuring land; and the upsurge in rural‐urban migration coupled with limited supply of land and regulatory frameworks that are not addressing the needs of urban poor and have aggravated the phenomenon of slum creation.

4.7.5. National Response and Strategies

110. Recent estimates (2006 Country Environmental Assessment) of the cost of degradation suggest that an equivalent of 10 percent of GDP is lost annually through unsustainable management of the country’s natural wealth (forests, wildlife, fisheries, and land resources), as well as from health costs related to urban environmental problems (water supply and sanitation, and indoor and outdoor air pollution). In a bid to arrest the degradation of the environment and regain loss of the forest cover, the Government of Ghana and its Development Partners initiated a Natural Resources and Environmental Governance (NREG) support mechanism with prioritized activities and time‐bound targets in order to reverse the persistent trend of high environmental degradation in a coordinated and sustainable manner. To ensure the sustainability of natural resources, in 2008, the government implemented key policy measures within the framework of the GPRS II, including (a) strategies to secure the current natural resources through the promotion of sustainable natural resource management practices and the restoration of degraded natural resources; and (b) improving environmental and natural resources governance through the building of the requisite institutions and strengthening of the regulatory framework. Some of the findings from the 2008 monitoring report of the key targets indicated that: “the cost of degradation suggest that an equivalent of 10 percent of GDP is lost annually through unsustainable management of the country’s natural wealth (forests, wildlife, fisheries, and land resources), as well as from health costs related to urban environmental problems (water supply and sanitation, and indoor and outdoor air pollution) as this is the current information on national environmental cost to GDP.

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Forests 111. 10,146 hectares of degraded forest, mining, dry and wet lands was rehabilitated or restored in 2008 as compared to 17,000 the previous year. Cumulatively, 123,750 hectares of degraded forest has been established since 2002.76

Potable Water 112. In the water and sanitation sector, the government adopted a sector wide approach to water and sanitation provision as a means of ensuring effective sector coordination to achieve geographic equity in the distribution of investments and aid effectiveness... District Assemblies have been provided technical support to prepare and implement strategic District Water and Sanitation Plans(DWSPs) as well as District Environmental Sanitation Strategy and Action Plans (DESSAPs),but their efforts have been largely constrained by inadequate funding. The recent launch of the Ghana Compact on Sanitation and Water for All represents substantial increase in Government of Ghana’s political and financial commitment to the water and sanitation sector, but its implementation will need to be closely monitored to ensure that this translates into concrete results for the people of Ghana. Other measures in support of the water sector include increased investments in the construction and rehabilitation of water facilities in both rural and urban areas by government, and full subsidy by government for provision of water in guinea worm endemic areas.

Housing, Urban Development and Slum Upgrading 113. In relation to urban housing and slums, policy measures by Government and the UN to provide affordable and decent housing for Ghanaians include: Review of the national housing policy to be comprehensive to meet adequate, decent and affordable housing needs of all Ghanaians; acquisition of land by government as land banks for national housing programmes and construction of housing units for middle and low income groups. . Develop a comprehensive urban policy to guide the growth of cities towards achieving the goal of sustainable human settlements.

4.7.6. Gaps to be closed to achieve MDG by 1015

114. The major gaps and challenges that will likely constrain progress towards ensuring environmental sustainability by 2015 include: a) Rapidly increasing population.

76 Republic of Ghana (2010), Draft Medium Term Development Agenda, 2010‐2013, July 2010. p59.

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b) Ineffective implementation of government policy due to capacity and resource constraints. c) Inadequate awareness and capacity of stakeholders to mitigate the impact of and adapt to the increasing impact of Climate Change d) Low institutional capacity for sustainable environmental management especially at the decentralized level of government. e) Low awareness on the effects of human activities on the environment including the inter‐linkages with gender. f) Limited resources (human and financial) to implement reforestation and other environmental management programmes. g) Weak inter linkage between issues of human development, climate change and sustainable environment management. h) Lack of a clear comprehensive sector strategic development plan for water and sanitation i) Poor access to improved sanitation in urban and rural areas particularly in the three northern regions. j) Inadequate infrastructure especially energy, water and sanitation. k) Inadequate financing options for the development of low‐income housing l) Low level of patronage of local developed building materials and technology by housing research institutions in Ghana (BRRI, Department of Rural Housing) m) Low level of support to urban and low‐income housing oriented NGOs in Ghana n) Inadequate data on slums and low‐income housing.

4.7.7. Emerging priorities for the UN

115. Given that over 60 per cent of Ghana’s population depends on the natural environment for their livelihood, mostly in crop farming, the need for sustainable management of the environment cannot be overemphasized. This should include support to increase awareness of the effects of human activities on the environment and the inter‐linkages between human activities, the environment and gender; and limited resources (human and financial) to implement reforestation and other environmental management programmes. Other areas of support should include strengthening the policy environment and implementation capacities for sustainable environment management, in particular water resources, sanitation and forests. Consideration should also be given to emerging issues of climate change as well as land degradation, as well as support for the coordination and dialogue to mainstream environment and natural resource management into plans at national and district levels. In particular, the UN may wish to consider the following:

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a) Strengthening the policy environment and implementation capacities for Climate Change, sustainable environment management, in particular water resources, sanitation and forests. b) Support efforts to enhance the data use to inform planning and development of poverty‐environment initiatives e.g. in energy and water related sectors. c) Support for development of policies and strategies for urban development, housing and slum upgrading to manage the increasing urbanisation and its impact on quality of life and natural resources. d) Support for the implementation of the National Environmental Sanitation Strategy and Action Plan for improvement in environmental sanitation. e) Support for the development and implementation of drinking water quality management framework f) Support for strengthening mechanisms and systems for post construction management of operation and maintenance of water schemes. g) Support for scaling up implementation of Community Led Total Sanitation (CLTS) and other community approaches to total sanitation (CATS) in order to improve access to basic sanitation. h) Support for the implementation of Sector Wide Approaches (SWAp) for the Water and Sanitation Sector including support for the development and implementation of the Water and Sanitation Sector Strategic Development Plan. i) Support to data collection and updating of slum and low‐income communities. j) Support to Government efforts to develop requisite legislation and strengthen national capacities to for the prevention and control of sea pollution by ships and offshore oil platforms k) Strengthening the cooperation and coordination of sustainable land management programmes l) Support harmonization of biodiversity related agreements m) Support to the implementation of the water and sanitation policy objectives of the Medium Term National Development Policy Framework n) Support for the implementation of GoG’s Science, Technology Policy to enhance sustainable development

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4.8. Partnership for Development

4.8.1. Current Situation 116. Ghana enjoys the support of a range of Development Partners. At present, ODA (grants and loans) finances about 24 per cent of Government spending and is expected to continue, albeit with decreasing proportion with the onset of oil.77 There are several multilateral and bilateral development partners that are active in Ghana, including the World Bank, Canadian International Development Agency (CIDA), Danish Development Agency (DANIDA), German Aid Agency (GTZ) and United States Agency for International development (USAID). Although it was not possible to obtain the actual data on funding by individual donors, some of the donors had already signed cooperation agreements for 3‐4 year programmes to be implemented up to 2015. For example, the World Bank has already developed several new projects: (1) a new project for urban water and sanitation to provide support to low‐income and peri‐urban populations; and (2) US$75 million under the Sustainable Rural Water Services project. DANIDA has programmes on poverty reduction; health; basic public services, particularly roads and water; and private sector development. DANIDA uses a mixed approach of multi‐donor budget support and sector budget support, specifically for health. Ghana is also a recipient of the Millennium Challenge Account Funding of US$ 547 million. The fund is managed locally by the Millennium Development Authority (MiDA) a private‐public enterprise established by an Act of Parliament in 2006. The programme is active in the agricultural sector, with objectives (1) to enhance the production and productivity of high value food cash crops (mango, pineapple, yams, rice, sorghum and soya beans); and (2) to enhance competitiveness of the food and cash crops in the local, sub‐regional and international markets. The programme is currently being implemented in 30 districts that are predominantly agricultural and according to the Ghana Living Standards Survey (GLSS2) had recorded poverty incidence ranging from 42 percent to 92 per cent.78

117. An analysis of ODA inflows to Ghana shows that aid inflows has increased from US$ 578.96 million in 2001 in nominal terms to US$1,433.23 million in 2008, constituting an average annual increment of about 23% per cent during the period.79 Project aid constitutes the bulk (about 64%) of ODA portfolio in Ghana, increasing steadily during the period, whereas

77 World Bank (2010), Country Assistance Strategy Report for Ghana, March 2010. 78 Nine districts in the Afram Basin Zone, 5 districts in the northern agricultural zone, and 16 districts in southern horticulture belt. 79 Ghana MDG Report 2008.

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programme aid has virtually stagnated over the period 2004 and 2007. The average annual programme aid as a percentage of total ODA was estimated at 38 per cent between 2003 and 2008, while that for the period 1999 – 2002 stood at 42 per cent. This implies ODA portfolio in Ghana continued to be dominated by project aid which is usually off‐budget, and lends itself to non‐use of country systems, creation of parallel system for its management and excessive rigidity in its administration. General budget support, for instance, has increased by only 46 per cent (constituting an average annual increase of about 8%) over the period 2001 and 2008. The relative levels of both types of aid, in spite of the different trends, remained relatively higher than the levels recorded in the second half of the nineties. The improvement in General Budget Support (GBS) from US$85.07 in 2002 to US$378.37 in 2008 has been largely attributed to the introduction of the Multi‐Donor Budgetary Support (MDBS) mechanism in 2003 which allows donors to contribute to a common basket to support the national budget. The MDBS which currently constitute about 30 per cent of donor inflows in Ghana has improved commitment and predictability of aid inflows.

118. There are concerns however, that with the repositioning of Ghana as a middle income country by 2015, this might change the dynamics of its relations with the donor community leading to a flight of funding. However, government feels that there will be a need to sustain assistance during the transition period, and any sudden withdrawal of funding may lead to a reversal of the gains and progress that has been achieved. On the other hand, the donor community also feels that the government should demonstrate its commitment by developing sound macro‐economic management policies, particularly with regards to the utilization of its oil revenue.

4.8.2. Gaps to be closed to achieve the MDG goal by 2015

119. A major weakness in aid administration in Ghana is the absence of a Comprehensive framework, guidelines and targets to facilitate effective aid delivery. The Government indicated that the participatory process towards formulating a National Aid Policy was currently in progress and the draft policy had since been presented to Cabinet for approval. The Comprehensive National Aid Policy, once approved would outline and document a country owned set of codes as an instrument for formalizing GOG/DP partnership, incorporating a strong commitment to the key elements of the Paris Declaration on Aid effectiveness and the Accra Agenda for Action.

4.8.3. National Response and Strategy

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120. The government established the Savannah Accelerated Development Authority (SADA) to provide coordinated planning and execution of its agenda in the deprived savannah zone. However, evidence suggests that MOFEP has not been focusing attention on the real sectors, such as Agriculture, Industry and SMEs. The recent Ghana Joint Assistance Strategy Review (2007 ‐2010) found that progress was made in a number of areas of harmonization but also underlined weak Government leadership as well as low quality of dialogue between DPs and the Government. For example, the World Bank was reviewing its participation in sector groups, with a view to reducing the number of sectors in which it participates, and deepen its engagement in targeted sectors. As a response, the government, through MOFEP is developing the Aid Policy, to harmonize coordination with DPs. In this regard, government also expressed a desire to see a more coordinated and harmonized approach on the part of the UN system, in line with the principles of the Paris declaration and Aid effectiveness and the Accra Agenda for Action.

121. The Gender Equality Sector Group (GESG) was established in 2004 and is co‐chaired by MOWAC and development partners. GESG provides a platform for dialogue and action on the integration of gender equality issues into key national development policy frameworks and processes, including poverty reduction strategies. However, in spite of its specific commitments and targets, donor harmonized funding has not been realized. Programming continues to be fragmented and it is very difficult to ascertain with any level of precision the exact funding allocated to gender equality activities by different partners.

4.8.4. Emerging Priorities for the UN

122. The UN should leverage its comparative advantage as a trusted and impartial partner to play a leading and catalytic role to influence government policies in the area of donor coordination. In particular, the UN may wish to consider the following among its priorities:

a) Strengthen support to MOFEP, including a functional process review to enhance institutional capacity and strengthen results‐based budgeting in the Ministry. b) Play a leading role towards “working smarter” by leading coordination of DPs to develop common strategies and results frameworks at sector level. c) Enhance processes towards harmonized and coordinated programming among UN agencies. d) Capacity building for all line ministries

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CHAPTER 5: INSTITUTIONAL ANALYSIS

5.1. Ministries, Departments and Governmental Agencies (MDAs)

123. The machinery of government is supported by the staff of the public service particularly, the civil service and the local government service. The other components of the broader public service, namely the education service, health service, statistical service also offer complementary support to the machinery of government. The fire service, immigration service, internal revenue service, customs excise and preventive service, judicial service, the prisons service, the police service and the armed forces also constitute part of the country’s public administration system. Given the centrality of the civil service in the policy formulation process and the role of the local government service in the implementation of policies at the local government level, the discussion on institutional capacity in the public service is concentrated on the civil service. This is due to the fact that the local government service is a nascent creation which is in the process of being separated from the civil service.

124. All the public services are decentralized and have staff at District levels. Notwithstanding the relatively high educational level and training of the senior cadre of these services, there are inherent challenges in operational efficiency and service delivery in the public service, including ICT knowledge and infrastructure. The challenges relate to identified capacity gaps with respect to the adequate number of staff with the appropriate skills mix to undertake policy, planning, monitoring and evaluation tasks as well as public financial management. Notwithstanding the dearth of adequate numbers of personnel with these critical skills whose services are required in a modern professional public service, there are many senior officials in the civil and local government services (usually in the Administrative Class) who perform generally administrative and support services. Even though there is no concrete data, anecdotal evidence indicates a disproportionate number of officials of administrative and support staff as against the experts with specialized skills. With the exception of a few cases, promotion to the position of Director and Chief Director in the ministries continues to be the preserve of the members of the Administrative Class, who do not always have specialized knowledge.

125. The Public Service also faces challenges with regards to lack of clear mandates, policies and legal framework to perform their duties. For example, the relation between the Ministry of Finance and Economic Planning (MOFEP) on one hand and the National Development Planning Commission (NDPC) on the other hand is not very clear; while also the same situation exists

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with regards to the functional relation between MOWAC and the Department of Social Welfare (DSW). In the Health Sector, evidence obtained indicated that the relation between the Ministry and Ghana Health Service (GHS) is not sufficiently understood by all concerned. For example, some observers have suggested that the Ministry has taken over administration of the health professionals, which should be in the domain of GHS, their employer. With regards to the CHRAJ, some observers have suggested that its mandate is too loaded, which renders it ineffective. The Commission has three mandates – human rights, ombudsman and anti corruption. On the other hand, it has also been suggested that the distinction and role of the Serious Fraud Office (SFO) are not sufficiently clear among key players who consider it to be the government agency responsible for anti corruption, while in fact it is only responsible for economic crime. At the policy level, evidence suggests that there are a lot of key policy gaps in the sector ministries. Some of the major ones are illustrated in Table 8 below.

Table 8: Gaps in Key Policies in Government Sector Sector Policy Gaps Social 1. Comprehensive National Social Policy 2. National Employment Policy 3. Gender in Sector Policies 4. Housing Policy 5. Urban Development Policy 6. Disaster Management Policy 7. Migration Policy Health National AIDS Policy – outdated There is no proper nutrition policy yet Communications National Broadcast law

5.2. Training and Capacity Building Institutions

126. There are two key national level institutions that provide training support to the public service. While the Ghana Institute of Management and Public Administration (GIMPA) offers training for officers at both the central and local levels, the training programmes of the Institute of Local Government Service (ILGS) are limited to the staff of the local government institutions. GIMPA has been divided into a number of schools/centers, namely: a) Public Service school b) School of Governance, Leadership and Public Management c) Business school(now known as Centre for Management Development) d) Greenhill college (offering undergraduate degree programmes)

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e) School of technology f) Law school

127. The training of public servants is mainly undertaken at the Public Service School (PSS). However, the other schools also offer some training programmes to public servants. The main training programmes offered at the PSS are the following:

a) Certificate in Public Administration b) Diploma in Public Administration c) Senior Management Development Programme d) Chief Executive Programme e) Health Administration and Management f) Diploma in Agricultural Administration

128. The African Capacity Building Foundation (ACBF) sponsors participants to pursue a Master’s degree programme in Public Sector Management at the School of Governance, Leadership and Public Management. Even though this is an international programme, Ghanaian public servants with the requisite qualification can participate.

129. The Institute of Local Government Studies conducts short training programmes for the staff of Metropolitan, Municipal and District Assemblies (MMDAs). One of the significant courses offered is the training programme on Local Economic Development (LED) which dovetails into the LED concept being piloted by the UN on its Millennium Villages Project in the Amansie West district in the Ashanti region. The Institute also organizes outreach training programmes for key staff of the Regional Coordinating Councils (RCCs) with a view to strengthening their capacity to monitor and provide backstopping services to the MMDAs. The Institute is on the threshold of obtaining accreditation from the National Council for Tertiary Education to commence a Master’s degree programme in Local Government Administration. A key challenge confronting the Institute is the lack of clarity between its mandate and that of the Local Government Service Secretariat with respect to the organization of training programmes for the staff of MMDAs. The role of both institutions needs to be clarified as early as possible.

5.3. Data management capacity

130. The Ghana Statistical Service (GSS) is the official government institution responsible for the collection, compilation, abstraction, analysis and dissemination of official statistics in the country. The GSS is also responsible for all national surveys and censuses; it provides technical support to other state agencies that produce data, e.g. sample surveys, enumeration area maps and experts to guide in the preparation of these surveys. The statistics generated by GSS is used

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for policy making, planning and other official decisions. Even though GSS has the mandate and overall responsibility for data management, many MDAs have also instituted systems for the collection and analysis of data. While this system is helpful, it lacks adequate coordination and coherence resulting in the dissemination of conflicting data within sectors and between GSS and the MDAs concerned.

131. Notwithstanding the clarity in the mandate of the GSS, data consistency and reliability is a challenge in the country given the existence of different data on the various sectors. This challenge is due to the varying conceptual and methodological approaches in capturing data by the GSS and the sector institutions which also capture data as service providers. Although GSS indicated that sex disaggregated data was available, MOWAC identified insufficient sex disaggregated data for national development as a key challenge in Ghana’s third progress report on the implementation of the African and Beijing Platform for Action and review report for Beijing + 15 (2009), further noting that the 2010 census was expected to address this challenge. With respect to the other sector institutions, the team was unable to examine the data produced to ascertain the veracity of the assertion that the data produced is disaggregated by sex. These notwithstanding, the GSS has put in place a Gender Statistics Working Group (GSWG) to ensure that users and producers of data are working together to produce data that is relevant for development purposes.

132. Although a detailed capacity assessment of the GSS was not undertaken, the evidence suggests that it is affected by capacity constraints at institutional and skills level. For example, it does not have appropriate technology to enable transition to a Geographical Information System (GIS). This has affected the ability of the GSS to migrate to the preparation of digitized maps from the current traditional method. Some of the statisticians lack competence in the application of computer software such as Epi Info and SPSS, a phenomenon which retards the pace of work given the over reliance on paper work in lieu of computers.

5.4. Existing Gaps

133. One of the major gaps is that the monitoring and evaluation (M&E) systems of the MDAs are not aligned and harmonized with the national M&E framework developed by NDPC. This phenomenon is partly due to DPs supporting different M&E systems in the various sectors. This situation contributes to the variation in the data presented in the annual progress reports prepared by NDPC and sector institutions. In addition, the infrastructure and modus operandi of processing and management of the statistical data generated by GSS from the decentralized level remains a considerable bottleneck for data harmonization. A joint approach by the UN to

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augment the capacity of GSS to gather, manage and harmonize data in real time on a common platform will be imperative for effective policy making, planning purposes. The infrastructure and the processing and management of the statistical data generated by GSS from the decentralized level remains a considerable bottleneck for data harmonization. A joint approach by the UN to augment the capacity of GSS to gather, manage and harmonize data in real time on a common platform will be imperative for effective policy making, planning purposes.

5.5. National Response and Strategies

134. In response to meeting some of the challenges of data management capacity, a 5 year Ghana Statistical Development Plan (GSDP) has been prepared. A draft long term (2010‐2020) programme has also been prepared for conducting censuses and surveys. The Government has also instituted a number of connectivity arrangements to promote the use of ICT in governance and data management and has commenced the implementation of the e‐government infrastructure initiative to provide a national network for the networking of Ministries, Department, Metropolitan, Municipal and District Assemblies, and other public sector organizations. In addition, the government has been implementing various Public Sector Reforms since the late 1990s with a view to creating a conducive environment to engender private sector growth. However these reform initiatives have at best been described as moderate. In 2009, the government redesigned a new public sector architecture in which the responsibility for undertaking the reforms was relocated to the various ministries. Under the redesigned public sector architecture dubbed “A New Approach to Public Sector Reform” the Cabinet office at the Presidency would be the focal point for the coordination of the reforms while the Public Sector Reform Secretariat (under the office of the President) would be responsible for the following: a) Reviewing reform proposals of Ministries for the consideration of the cabinet. b) Providing technical back‐stopping to the various reform areas. c) Mobilizing resources in support of public sector reform programmes.80

80 Public Sector Reform Secretariat, Office of the President: A New Approach to Public Sector Reform under the Office of the President, January 2010.

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135. Although the reforms have only been implemented for a limited period, some identifiable achievements have been recorded. Firstly, the pay reform initiative has been completed and the single spine salary structure for some public institutions has been approved. Indeed, implementation of the single spine salary structure has commenced in the Ghana Police Service with the others expected to come on board before the end of 2010. Secondly, the reforms have been located in the Office of the President, which ensures cabinet accountability for the reforms and the facilitation of the provision of technical advice, coordination and access to resources. Thirdly, the reforms have established ownership at the Ministerial level through the integration of activities into their mainstream policies and strategies.

136. Additionally, The Government has instituted a number of connectivity arrangements to promote the use of ICT in governance and data management. Government has also commenced the implementation of the e‐government infrastructure initiative to provide a national network for the networking of Ministries, Department, Metropolitan, Municipal and District assemblies, and other public sector organizations. It essentially focuses on a shared and secured interoperable government IT architecture which will ensure that the dispersed government IT platforms and data are more effectively unified, managed and aligned to provide streamlined support for government applications and inclusive citizenry participation

5.6. Emerging Priorities for the UN

137. At the individual skills level, there is always movement of personnel within the public sector and from the public sector to the private and development sectors. Capacity development should therefore be considered an ongoing effort, and the UN should mainstream CD in all its programming to ensure that government interventions and programmes yield sustainable results. The UN may also wish to consider the following among its priorities: a) Support to development of sector policies to enhance system‐wide coherence. b) Strengthening partnership and support of the various government CD institutions. c) Support the operationalisation of the Statistics Development Strategy that includes strengthening of sector routine data systems, as well as modernization of GSS to ensure timely and accurate provision of disaggregated data to enhance decision‐ making. d) Promote the demand for and utilization of M&E results in planning, budgeting and oversight. e) Support the operations and functioning of the GSWG

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CHAPTER 6: EMERGING CHALLENGES, RISKS AND POTENTIAL OPPORTUNITIES

6.1. Background

138. Ghana is ranked high among African countries most exposed to risks from multiple weather‐related hazards. The economy is exposed to floods and droughts, particularly in the Northern Savannah belt; high coastal erosion, especially in the Eastern coastline; and seismic hazards in areas around Accra, including the Akosombo Dam.81 Global warming and climate change are also recognized as a major human security issue with catastrophic impact on the world’s poor due to their dependence on the natural environment for their livelihood.

139. These events present enormous challenges for the Government and its development partners in pursuing the development agenda because there is a strong correlation between natural disasters and development. Development plays an important role in decreasing or increasing disaster risk, while conversely, disasters can negatively affect development. The combined effects of poverty and rapid population growth contribute to environmental degradation and resource depletion in both rural and urban areas. Ghana had an average annual population growth of 2.2 percent from 2002 to 2008, which although lower than the average for Sub‐Saharan Africa (2.5%), is still higher than the average for low income and developed countries ‐ (2.1% and 0.6% respectively).82 This puts increasing pressure on land arising from competing demands for economic and residential purposes.

6.2. Global Financial and Food Crisis

140. By and large, Ghana appears not to have been significantly affected by the global financial crisis due to high prices of its major export commodities – cocoa and gold – and official financial flows. Though many household were affected, this is most evident in the composition of financial flows, remittances, timber exports and lower aid flows. An official 2010 study indicates that GDP growth rate declined to 3.5 per cent in 2009 (from a high of 7.3 percent in 2008 and

81 Amoko et al (2009); Hazard Mapping in Ghana: Report to NADMO. 82 World Bank (2009), World Development indicators (See also: Boadu (2000), Population Growth Rate and Development in Ghana).

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5.7 per cent in 2007), but remained positive in contrast to many other developing countries.83 Table 10 below shows trends in some of the macroeconomic indicators for Ghana from 2006 to 2009. Table 9: Excerpts of some key macroeconomic indicators for Ghana

2006 2007 2008 2009 2010e GDP growth (%) 6.4 5.7 7.3 3.5 4.5 Exports (US$ million) 3.727 4,172 5,270 5,840 6,800 Cocoa 1,187 1,133 1,502 1,900 Gold 1,277 1,734 2,246 2,600 Timber 207 249 305 207 Source: WFP Study (2010) e ‐ estimate

141. The report however also indicates that the impact of high food prices in 2008 and 2009 was disproportionally felt by the poor and vulnerable groups in Ghana. Smallholder farmers who represent about 25 per cent of households reported that they were affected by higher food prices and lower incomes e.g. from shea‐nut sales, an important source of lean‐season income for women in Northern Ghana. The study also found that the urban poor were affected by high food prices and declining economic opportunities. The shock in incomes was attributed to a depressed labour market in which wage rates for unskilled labour dropped by 20 per cent compared to a year ago. Remittances, which also account for 5 – 10 per cent of household incomes declined from a high of US$126 million in 2008 to $123 million in 2009.

142. The Government responded by strengthening social protection systems. A large number of people were supported through an emergency Livelihood Empowerment Against Poverty (LEAP) programme in the flood‐affected Northern regions. The Ministry of Employment and Social Welfare targeted 15,000 people in 2008 and expanded by an additional 11,000 in 2009. The Government also removed import duty subsidies on rice and wheat to improve food security, but later reversed the policy due to absence of evidence of a price reduction to consumers.

6.3. Vulnerability to Natural Disasters

143. In 2007, Ghana experienced some floods in the North that affected more than 325,000 people, with close to 100,000 requiring assistance to restore livelihoods. The incidence of flooding in northern Ghana is partly a result of spillage from the opening of Bangre and Compienga dams in neighboring Burkina Faso, which, added with rainfall precipitation,

83 WFP (2010), Assessing the Impact of the Global Financial Crisis on Vulnerable Households in Ghana.

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topography levels, and less than sufficient capacity to cope with flooding, leads to disaster. While the flooding in Northern Ghana was significant in its scale and impact, smaller scale flooding was observed across the nation in subsequent years. This underscores the need to support trans‐boundary watershed management as well as the need for capacity building of key national institutions to mitigate and respond in a timely manner to flood and other natural disasters. The 2007 floods followed immediately after a period of drought that damaged the maize harvest – indicating increasing incidence of high variation in rainfalls and rainfall patterns as a result of the Climate Change. Between 1991 and 2008, the country experienced six major floods, with almost 2 million people affected in 1991 alone.84 Table 9 below illustrates Ghana’s vulnerability to the risk of floods and droughts.

Table 10: Ghana’s exposure to floods and drought

Hazard type Population exposed % of population Country ranking Ratio of GDP exposed exposed Drought 2,844,810 12% 25 out of 184 N/A Floods 234,427 0.01% 67 out of 162 0.01 Source: 2009 Global Assessment Report: Global Disaster Risk Platform (www.preventionweb.net/Ghana)

The table above shows that more people are exposed to the risk of drought than floods. This is in part a reflection of the high proportion of the population that depends on agriculture for their livelihood, which indicates the disproportionate impact of drought on the poor. The data also shows that Ghana has a very high exposure to drought, ranked number 25 out of 184 countries assessed. While no data was provided for the proportion of GDP exposed to drought, almost US$167 million of GDP (2008 figures) is exposed to the risk of flooding.

144. The high dependence on natural resources in rural areas (more than 60 per cent of Ghana’s population depend directly on agriculture), added to the lack of formal and informal social security safety nets exacerbate Ghana’s vulnerability. In addition, there are widespread epidemic diseases, including HIV and AIDS and malaria, which put more people at risk of disasters related to rural poverty, rapid urbanization, growth of informal urban and coastal neighborhoods and declining eco‐systems. The risk is greater in Northern Ghana where 54 per cent out of the 18 percent of the population that live in extreme poverty are located. Northern Ghana, especially the Upper East region is also most exposed to land degradation and soil erosion. Land degradation accelerates run‐off and reduces soil fertility, and thus mostly affects crop farmers who constitute the majority of the poor.

84 2009 Global Natural Disaster Risk Assessment Report: Ghana Disaster Risk Profile

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145. Since the majority of rural households depend on small‐scale agriculture and lack access to markets and infrastructure necessary to improve farming practices, they often engage in non‐farm income generating activities and urban migration that put more pressure on the environment and natural resources. The rapid population growth and pressure on land resources are also usually accompanied by unsustainable agricultural intensification, including expansion of cultivation, deforestation and depletion of vegetation cover due to over‐grazing. Figure 5 below illustrates the correlation between the expansion of agricultural land and depletion of forest area in Ghana over the period 2000 to 2007.

146. High food prices and global financial crisis could impact on Ghana’s vulnerable populations and its economy.

Figure 6: Forest Area and Agricultural Land in Ghana (2000 – 2007)

Source: World Development Indicators, April 2010

The graph shows that as the total forest area declined from 60.9 thousand square kilometers in 2000, to 52.9 thousand square kilometers in 2007, total agricultural land increased as percent of total land area over the same period (from 63.5% in 2000 to 65.3% in 2007). This is a clear indication of the increasing pressure on land for agricultural purposes and the resultant depletion of the natural resource – forests. If the utilization of wood fuel by the poor were to be factored in, the impact on land degradation could even be more severe.

6.4. Climate Change

147. In all regions of Ghana, farm yields are extremely sensitive to the vagaries of rainfall. Although rainfall has decreased by 2.4 per cent per decade since 1960, climate change predictions for the region admit to uncertainty as to the future trend.85 Some reports indicate that some boreholes are drying up, while other reports attest to decline in the accumulation of

85 http://uk.oneworld.net/guide/ghana

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water in the Volta Basin, including the Tano and Oti rivers due to increasing temperatures. Climate variability will also have serious repercussions on Ghana’s economy because of its dependence on climate sensitive sectors such as agriculture, forestry and energy. The Akosombo Dam which used to provide 70 per cent of the country’s energy need presently produces 30 per cent due to low level of water in the dam. This has serious implications for industrialization and private sector development.86 The Environment Protection Agency (EPA), vulnerability assessment reports that by 2080, cocoa production in Ghana will drastically fall due to impacts of climate change. Ghana is currently the world’s second largest exporter of cocoa. Projections on climate change impacts estimate that cassava yields will decline by 3 per cent by 2020, and by up to 53 per cent by 2080; while cocoyam yields will fall by 11.8 per cent by 2020 and up to 68 per cent by 2080.87 Ghana currently has an estimated per capita consumption of 151.4 kg of cassava, 43 kg of yam and 56 kg of cocoyam, which accounts for 58 per cent of the per capita food consumption. Together, these tuber crops also generate about 75 per cent of Government earnings and employ about 70 per cent of the population.

148. Coastal populations are at risk from rising sea levels and the country lives with a worrying link between its primary energy supply and climate, as was vividly illustrated in 2007. A long period of drought reduced the level of the Volta Lake below the point at which the hydro‐ electric turbines could function, effectively switching off about 60 per cent of Ghana’s power supply with fundamental economic consequences. Then exceptional rainfall dramatically reversed the situation but caused catastrophic flooding in the northern region, affecting nearly 400,000 people and creating serious short‐term food shortages. The effects of climate change on the fisheries sector are as yet unclear; however, fish represents about 65 per cent of animal protein intake for Ghanaians, making it the single most important source of low‐cost protein. The Fisheries sector also contributes about 3 per cent to national GDP and 5 per cent of agricultural GDP.

149. The effect of climate change in the other sectors is also quire phenomenal, and affects women disproportionately. Table 11 below illustrates some of the major impacts of climate change on human security and the consequent vulnerability for women.

86 Republic of Ghana (2009), Ghana Climate Change Impacts, Vulnerability and Adaptation Assessments 87 Ibid.

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Table 11: Impact of climate change on human security Impact on human Sector Vulnerability of women security Crop failure Agriculture Household food shortage; increased agriculture work Fuel shortage Energy Household fuel provision; food‐fuel conflicts Shortage of safe Health and Sanitation Exposure to contaminated sources clean water Resource scarcity Livelihood, Education Lack of land tenure; school dropouts; early marriage Increase in natural Social Greater incidence of mortality; reduction of life disasters expectancy Increase in diseases Health Lack of access to health care; increased burden of care Displacement Social Loss of livelihood; lack of adequate shelter. Escalation of conflict Social Loss of livelihood, sexual exploitation. Source: WEDO (2008), Gender, Climate Change and Human Security

150. Ghana also grapples with the other side of the climate change equation – control the increase of carbon dioxide emissions arising from deforestation. Some reports indicate that Ghana lost about 1.9 million hectares of forests over the last decade. Other reports estimate that about 80 per cent of the forests have already been lost partly due to illegal logging which supplies markets in Europe and partly due to the dependence on wood for fuel by nearly 75 per cent of all households. EPA projections indicate that if present trends in deforestation as climate change continue, the national forest in the managed and protected tropical forest reserves would decrease by 45, 000 hectares; total cleared forests would decrease by 343,000 hectares; and national savannah woodland by about 600,000 hectares. In addition, if the sea were to rise as projected, a total of 1,110 square kilometers of land may be lost affecting a total population of 132,000 mostly living within the east coast area.88It has been observed that the rapid loss of forests and expansion of savanna especially in the North has had negative effects on agricultural productivity due to soil erosion, and thereby affects the poor who depend on crop farming, cattle raising etc for their livelihoods. These tend to further aggravate the already vulnerable situation of women and children, who often suffer first and most from consequences of deterioration of their environment.

6.5. National Response and Strategies

151. Since its inception under the NADMO Act (1996), the National Disaster Management Organisation (NADMO) has contributed considerably to the management of disasters despite perennial constraints to obtain resources and maintain response capacity on the ground. NADMO has undertaken interventions to build public awareness and social mobilization in

88 ELIAMEP (2008); Gender, Climate Change and Human Security: Lessons from Bangladesh, Ghana and Senegal.

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disaster preparedness. In addition, an increasing number of Government and donor sector programmes are addressing disaster risk reduction (DRR) and related issues of vulnerability and sustainable land management. Some innovative approaches and tools have been developed across sectors in areas of agriculture and rural livelihoods, watershed management, ecosystem management, urban governance and risk transfer. However, NADMO has so far only engaged from an emergency response perspective, rather than from a perspective of mainstreaming DRR in sector programmes and strategies.

6.6. Emerging Priorities for the UN

152. Considering that the majority of the people in Ghana depend on agriculture and the environment for their livelihood, and about 25 per cent live in coastal areas a large proportion of them depending on fisheries for their livelihoods, it is clear that climate change will have enormous impact on the socio‐economic lives of the people. It is therefore imperative that a long‐term view of the effects of climate change should be considered to assess the potential risks of climate change and assess its interactions with other aspects of human and environmental systems to guide policy responses.

153. Some of the key emerging priorities for the UN are therefore: a) To support development of national capacities in monitoring of climate change and support studies of environmental risk factors to human security and livelihoods, with a view to increasing resilience for climate change impacts through e.g. development of early warning systems. b) To support capacity development for upstream strategic policy, coordination and dialogue as well as effective engagement with global fora on climate change. c) To support development of a national climate change finance framework for climate change and development. d) To support capacity development for institutionalization of climate change convention within national legal frameworks. e) To support the development of appropriate policies and strategies to make Ghana a low‐carbon economy and to move towards greater utilization of renewable energy sources. f) To support Government efforts and strengthen national capacities in sustainable environment management with specific emphasis on water resources as well as trans‐ boundary water management g) To support the capacity development and implementation of necessary policies and strategies that will spell out roles and responsibilities of appropriate Government institutions such as NADMO in preparing, mitigating, coordinating and managing

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disasters including mainstreaming of DRR in recovery efforts and development initiatives. h) To support and advocate for allocation of adequate resources that will enable responsible actors, including recognized women’s groups at the community level , to implement necessary programmes to address risk management in totality. i) Support development of policies designed to address climate induced migration to protect rights of migrants and their access to social services

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CHAPTER 7: THEMATIC AREAS FOR COMMON RESULTS

154. The foregoing analysis has revealed interesting trends across the socio‐economic spectrum of Ghana. Some of the data indicates remarkable progress towards sustainable development in general, and achievement of the MDGs in particular. However, some of the data also points to a milieu of challenges and potential setbacks that could have far‐reaching impact on Ghana’s development and human security.

155. For the UN system in Ghana to be effective, it will have to prioritize its thematic intervention areas based on a limited number of key criteria. For Ghana, the following criteria for the selection of the key thematic areas for common results are being proposed:

Key capacity gaps emanating from the analysis and aligned to the national priorities are summarized in the Ghana Shared Growth and Development Agenda (GSGDA) 2010‐201389. After the implementation of GPRS 1 (2003‐2005) and GPRS II (2006‐2009), the GSGDA 2010‐ 2013 (2010‐2013) aims to lay the foundation for the structural transformation of the economy within the decade ending 2020, through industrialization, modernized agriculture and sustainable exploitation of Ghana’s natural resources. The GSGDA 2010‐2013 identifies 7 main thematic areas90, which are further sub‐divided into sub‐themes. During the Mid Term Review of the UNDAF (2006‐2010) in 2008, the UN system decided to extend the UNDAF cycle till the end of 2011, to ensure the availability of the new Government planning document that would replace GPRS II. Alignment with Government priorities identified in the GSGDA 2010‐2013 provides an important opportunity for the UN system in Ghana to show its commitment to the principles and practices of the Paris Declaration and the Accra Agenda for Action. Alignment with government priorities will also help to strengthen the role of UN agencies in processes of donor harmonization and donor coordination, which have been operational in Ghana for a number of years. At present, there are 14 sector working groups, which rely on active participation from sector ministries, departments and agencies such as the Ministry of Finance and Economic Planning (MoFEP), the National Development Planning Commission (NDPC), development partners (including UN agencies) and CSOs and which provide important

89 GoG/NDPC, September 7, 2010. 90 1) Ensuring and sustaining macroeconomic stability; 2) Enhancing competitiveness in Ghana’s private sector; 3) Accelerated agricultural modernization and sustainable natural resource management; 4) Oil and gas development; 5) Infrastructure, energy and human settlement development; 6) Human development, productivity and employment; and 7) Transparent and accountable governance.

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opportunities for overall policy and political dialogue on inclusive development and equitable growth with a clear focus on the realization of the MDGs by 2015.

156. When using these criteria, four GSGDA thematic areas emerge, with which the UN system in Ghana could align itself and which can be used as a basis for further identification of potential intervention areas and ‘delivering as one’ priorities:

5. Agricultural Modernization and Food Security (with Focus on Nutrition);

6. Sustainable Environment, Energy and Human Settlements;

7. Human Development and Productive Capacity for Improved Social Services;

8. Transparent and Accountable Governance;

7.1 Thematic Area 1: Agricultural Modernization and Food Security (with Focus on Nutrition)

157. While Ghana is reportedly on track to achieve MDG 1 on eradicating poverty, major challenges in eradicating hunger have been identified in the analysis whilst the nation’s economy is heavily dependent on agriculture which accounts for 39% of the total GDP91. Among some of the main challenges are the slow growth of agriculture due to a combination of

91 Mid‐term National Development Framework – Ghana Shared Growth and Development Agenda (2010‐2013)

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factors that reduce farmer incentives to invest and produce, including poor basic infrastructure (road and irrigation); socio‐cultural factors (gender and land rights); and agricultural‐related services. The negative impact of climate change (droughts and floods) on agricultural production was also highlighted. Food is available the country, but it is not accessible to all sections of the population, especially the vulnerable. In some parts of the country, food can be accessed but proper utilization is lacking. This has put 1.2 million people into chronic food insecurity and a further 2.07 million becoming vulnerable to food insecurity92.

158. The MDG1 is also related to other MDGs, including MDG4 and MDG5. The food insecurity is well mirrored in the level of malnutrition among children under five years and lactating women. Twelve per cent of children under the age of five years are reportedly underweight; 22 per cent are stunted or too short for their age; and 7 per cent are too thin for their height. Malnutrition has contributed greatly to high under‐five and maternal mortality.

159. Addressing these challenges requires the development of sustainable and comprehensive food security and nutrition policy and strategies that cut across many sectors, including agriculture, health, education, natural resources, environment and planning. Food security and nutrition is one of the major focuses that the GSGDA gives special attention.

160. Ghana as signatory of The Comprehensive Africa Agriculture Development Programme Compact (CAADP) since October 2008 has committed to allocating 10% of the annual budget for agricultural development. CAAP has four main pillars: i) Extending the Area under Sustainable Land Management and Reliable Water Control Systems (including soil fertility management and conservation, agricultural water use and irrigation, and land policy and administration); ii) Increasing Market Access through Improved Rural Infrastructure and other Trade Related Interventions (including supply chain development, quality control and management system development, export infrastructure, and global trade policies and agreements; iii) Increasing food supply and reducing hunger across the region by increasing smallholder productivity and improving responses to food emergencies (including emergency food supply management, nutrition, school feeding schemes, HIV/AIDS support strategies, attention to priority livelihood sectors) and iv) Improving agricultural research and systems to disseminate appropriate new technologies and increasing the support given to help farmers adopt them (including technology development, access and dissemination; innovation systems platforms; building research capacity and training). The CAADP is now aligned with the Ghana’s FASDEP (Food and Agriculture Sector Development Policy).

161. Other programmes namely Imagine Ghana Free of Malnutrition (GHS 2005), Integrated Anemia Control Strategy (GHS 2003), Vitamin A Policy (MOH 1998), Infant and Young Child

92 WFP 2009 Comprehensive Food Security and Vulnerability Analysis

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Feeding Strategy for Ghana (GHS 2007), Breastfeeding Promotion Regulations (MOH, 1995), Food and Drug Law and Amendments: Universal Salt Iodisation (MOH 1995), etc. have been put in place but no concerted efforts have been put in place to address the nutrition situation in Ghana.

162. The government, development partners and NGOs have attempted to address the nutrition situation using multi‐sectoral coordinating mechanisms to oversee or harmonize nutrition‐related work in the country. Several working groups, Task Forces, Advisory and Coordinating bodies such as the Interagency Nutrition Partners Group, Anemia Control Coordinating Committee, Baby Friendly Health Institution Authority, Food and Drugs Board Code Monitoring Task Force, National Salt Iodisation Committee (NSIC) have been established over the years. There is therefore a need to strengthen these interventions, including through a coordinated approach under a Food Security and Nutrition Theme Group.

163. Due to the absence of proper nutrtion policy of the country and that is a major constraint to addressing malnutrtion, the Government has committed in its Midterm National Development Framwork such policy.

7.2 Thematic Area 2: Sustainable Environment, Energy and Human Settlements

164. Ghana is not likely to achieve MDG 7 by 2015 because among other reasons, its forest cover is declining rapidly. It has been estimated that Ghana’s forest cover has declined from 32.7 per cent to 24.2 per cent between 1990 and 2005. In 1990, the forest cover was estimated at 7,448,000 hectares, and this has declined at an average rate of 1.8 per cent annually to 5,517,000 hectares in 2005.93 There are several factors that contribute to the depletion of forests, including livelihood activities, land degradation, and the rapid growth and expansion of unplanned cities. Human activities such as logging, fuel production caused by lack of access to clean and efficient energy sources and unsustainable farming practices are the main causes of forest loss. Much of the logging is illegal and is often done with little consideration for the environment. Land degradation has a significant impact on the environment and natural resource base of the country. About 69% of total land area is prone to severe or very severe erosion due to farming practices, removal of vegetative cover, deforestation and mining activities, especially illegal mining. Furthermore, loss of biodiversity is proceeding at alarming rate. In the backdrop of all these phenomena is the increasingly serious impact of Climate Change, including recurrent natural disasters, which are recognized as major human security issues especially for the poor due to their dependence on natural environment for their livelihood.

93 NDPC/Government of Ghana, UNDP (2010), Ghana: Millennium Development Goals Report.

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165. A number of UN‐HABITAT empirical data suggests that housing improvement has a strong correlation with social and economic indicators such as disease control, environmental improvement and increased school enrolment among others. However, despite the critical importance of housing, national development policies and programmes have in the past often treated housing as something to be tolerated rather than desired. Out of 3.88 million dwelling units recorded in 2000 in Ghana, less than 50 per cent were classified as houses, while the remaining were dwelling units constructed with poor quality mud bricks and earth, mostly with thatched roof and poor floor construction materials. In addition, 74,000 kiosks and containers housed several hundred thousand people and a large number of people in urban areas sleep on pavements, walkways and on streets. Current estimates indicate that the country needs 1,000,000 housing units annually while supply is estimated at 35 percent of the total need.

166. Rural housing problem in Ghana has been that of quality and almost entirely produces by the private sector using mostly traditional building materials. Most building materials used for rural housing have been known not to be able to resist disasters as such houses need to be rebuilt in short periods. On the other hand, rapid increase in urban population has resulted in a high housing deficit in most cities in the country.

167. Ghana is likely to meet the MDG target on sustainable access to safe drinking water, but off track to achieve the target on basic sanitation. An important strategy high‐lighted in the GSGDA 2010‐2013 to develop infrastructure and human settlements is the improvement of water and environmental sanitation and hygiene services in urban and rural areas. Various sector policy instruments (including the National Water Policy, the National Environmental Sanitation Policy), investment plans and implementation strategies have been developed, a sector wide approach to programming has been agreed and is being implemented, while the development a water and sanitation sector strategic development plan is underway to provide the basis for a coordinated sector programming founded on the principles of aid effectiveness.

168. The recently completed Ghana Compact on Sanitation and Water for All (which was agreed between the Ministry of Local Government and Rural Development, the Ministry of Water resources, Works and Housing and the Ministry of Finance and Economic Planning) emphasizes the importance of sanitation and water. It provides a clear policy framework till 2015 with a financial commitment by the Government of Ghana of US$350 million per year for sanitation and water infrastructure, an additional 0.5% of GDP for hygiene promotion and an

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invitation to civil society and development partners to work together to enhance the quality of life.

169. The various sector policies and strategies, investment plans, the new Ghana Compact policy framework on sanitation and water, the upcoming sector strategic development plan and the comparative advantage the UN has demonstrated in the past 5 years in Ghana (with important contributions made to the eradication of Guinea Worm) provide important opportunities for the UN system to help Ghana meet the MDG targets on sustainable access to safe drinking water and basic sanitation by 2015. According to the Government of Ghana, these water and sanitation targets are ‘the core of achieving all the MDGs’94, with clear positive spin‐ off effects for the sustainable and equitable achievement of all health, gender and education related MDGs. The key entry points for the UN will be supporting the implementation of policies, strengthening institutional and human resource capacity, strengthening sector coordination and promoting behavior change on improved hygiene practices and climate change adaptation measures related to integrated water resources management.

7.3. Thematic Area 3: Human Development and Productive Capacity for Improved Social Services

170. The need to harness the innate talents and energies of all Ghanaians (especially the youth) in order to ensure economic growth and political stability cannot be over‐emphasized. The absence of gainful and productive economic opportunities during the lean season was cited as one of the main causes of conflict in northern Ghana. The challenge of inadequate basic services in the major urban areas is also largely driven by increasing rural‐urban migration, particularly among the youth in search of economic opportunities. It is also noteworthy that Ghana does not have a National Employment Policy. In the meantime, the government launched the National Youth Policy in August 2010 and this requires support for implementation. Related to this is the national ageing policy for which support for implementation strategies is required.

171. Another major challenge that cuts across throughout the analysis is persisting, and in some cases, increasing disparities and inequalities in development, including gender inequalities. Existing evidence shows that disadvantaged groups, including women and children, the poor, rural remote populations, migrants, people with disabilities, and those affected by conflict, are disproportionately affected by the acute shortages of basic public

94 Government of Ghana (April 2010). The Ghana Compact. Sanitation and Water for All: a Global Framework for Action (SWA).

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services and infrastructure. Often times poverty, gender, location, and other characteristics interact to create magnifying layers of disadvantage that restrict development opportunity and hinder social mobility.95 For example, World Bank studies indicate that in the non‐SADA southern districts where poverty is less endemic, female‐headed households constitute the larger proportion of the poor than male‐headed households.96 The issues involving conflict around land tenure affect mostly women, who due to cultural stereotypes continue to lack the right to own or inherit land, which for the poor is their main source of livelihood. Data on Reproductive Health and maternal mortality also shows very little progress achieved particularly among the poor and rural populations. The rapid deforestation and rising temperatures causing the drying of river beds and boreholes in some parts of the country, mostly affect women and children in poor households in rural areas who bear the brunt of fetching wood fuel and water for domestic consumption.

172. The analysis revealed a number of important issues related to delivery of essential services (especially to vulnerable and excluded groups) which could seriously jeopardize the sustained human development in Ghana.

c) Strengthening health systems in 6 areas: service delivery, the health workforce, health information systems, access to medical products, vaccines and technology, health financing, and governance.

d) Addressing the social determinants of health, including poverty, education, employment, environment and women’s empowerment. These are fundamentally responsible for inequities in health outcomes.

95 UNESCO (2010). EFA Global Monitoring Report 2010. 96 UNICEF (2010), Reaching the Lowest Quintile in Ghana: Lessons from the Evidence.

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173. Thematic Area 3 is an area which requires substantial policy support and capacity development at institutional, individual and community levels. The development of operational manuals to guide both government and civil society organizations would be one area for the UN to demonstrate its comparative advantages. Entry points for UN agencies in Ghana to deliver as one include development of policies and strategies to reduce maternal death, improve the quality of primary education, reduce poverty and income inequalities and enhance the delivery of social protection and other basic services to the most vulnerable and disadvantaged groups.

7.4. Thematic Area 4: Transparent and Accountable Governance

174. Throughout the analysis, the issue of accountability and equitable development has emerged as a major factor affecting Ghana’s progress and development. Ghana has emerged as a good example of economic and political reform in Africa, attracting investor interest and confidence. This is in part due to the country’s political stability as evidence for instance by its ability to conduct free and fair elections and transfer power in a peaceful manner. This has generated investor confidence in the rule of law, credible and predictable institutions as well as a peaceful and stable environment leading to a growth in foreign investment and greater economic growth. Ghana’s human rights record and absence of violent conflict has also contributed to the stability that is vital to development.

175. There are however lingering gaps and challenges that remain, particularly in the justice sector and combating of corruption. The government is cognizant of these gaps and has prioritized them in its Ghana Shared Growth and Development Agenda ( GSGDA 2010 – 2013). The role that good governance plays in specific sectors is also very apparent, as for example limited government responsiveness to emerging issues; weak transparency and accountability; as well as the mismatch between resources and sector plans were all identified among the major bottlenecks to reducing maternal mortality. The UN should therefore leverage its comparative advantages in governance to assist Ghana to strengthen its institutions of governance and support the development of appropriate policies as one of the pillars of growth and achievement of the MDGs.

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176. In many sectors, the evidence shows that progress has been uneven across the regions, with the northern regions being the most affected. This underscores the need for the strengthening of processes of democratic governance at central and local level as a pillar for achieving the MDGs. To contribute to this outcome, the UN in Ghana can assist the Government of Ghana to achieve a number of policy priorities outlined in the GSGDA such as the strengthening of systems of local government; strengthening of systems of rule of law and justice; the empowerment of women and strengthening of systems of evidence based decision making.

177. Evidence based decision‐making relies strongly on data collection, processing management and utilization strengthens transparent and accountable governance. As observed above, the infrastructure and the processing and management of the statistical data generated by GSS from the decentralized level remains a considerable bottleneck for data harmonization. A joint approach by the UN to augment the capacity of GSS to gather, manage and harmonize data in real time on a common platform will be imperative for effective policy making, planning purposes. Assistance would be required from the collective comparative advantage of the UN in support of government to revise and implement the current national strategy for statistical development. An immediate element of such support is that for seeing to it that the ongoing Ghana 2010 Population and Housing Census is successfully concluded.

178. Strengthening the M&E and statistical system through capacity development of government institutions such as the National Development Planning Commission, MDAs, and MMDA must be one of the overarching foci, of the UN system within the UNDAP. An important emphasis would be laid on streamlining the operations of the institutions involved. There is also the need for capacity development of an independent civil society M&E systems as strongly recommended by the 2009 MDBS Forum. This effort, already carried out on an ad hoc basis by a number of UN agencies must be institutionalized within the next five years.

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ANNEXES

ANNEX 1: DOCUMENTS REVIEWED

1. ABANTU for Development, The Olof Palme International Centre (2010); Women’s Participation in Governance and Politics in Ghana. 2. Africa Peer review mechanism (2005), Country Review Report and Programme of Action for Ghana. 3. Akumatey Betty, Darkwa A (2009), Gender Norms, Domestic Violence and Women’s Vulnerability to HIV/AIDS. 4. Amoko et al (2009), Hazard Mapping in Ghana: Report to NADMO. 5. Association of Ghana Industries (2010), Business Barometer Survey for 2nd Quarter of 2010. 6. Bank of Ghana (2010), Monitoring Policy Committee Report, June 2010. 7. CEPA (2010), from a Cocoa Economy to an Oil Economy. 8. Climate Change and Poverty (www.oneworld.net) 9. Commission on Human Rights and Administrative Justice (2008), Annual Report 2007. 10. Country Data Report for Ghana, 1996‐2008 (www.worldbank.org/wbi/governance) 11. Economist Intelligence Unit (2010), Women Economic Opportunity: A new Global Index and Ranking, June 2010. 12. Republic of Ghana (2009); Education Management Information System, Ministry of Education 13. ELIAMEP (2008), Gender, Climate Change and Human Security: Lessons from Bangladesh, Ghana and Senegal. 14. Gaible, S.K., and P. Boake (2007), Population, Health and development in Ghana: Attaining the MDGs. 15. Ghana Health Service (2009), National Malaria Control programme: Annual Report 2009. 16. Ghana AIDS Commission (2009), Status Report on the National HIV Response, 2009. 17. Ghana Joint Assistance Strategy, February 2007.

18. Government of Ghana (2009), Justice Sector and Rule of Law: A Review by AfriMap and the Open Society Institute of West Africa.

19. IOM (2009), Migration in Ghana.

20. Judicial Services of Ghana (2009), Annual Report 2008/09.

21. Millennium development Authority (2010), A Summary of the MCA Programme.

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22. Ministry of Education, Science and Sports (2007), UNESCO Education Support Strategy (UNESS) 2008‐2010

23. Ministry of Health, Government of Ghana, UN Country Team (2010); Millennium Development Goals Acceleration Framework (MAF) Country Plan).

24. MMEIG, Trends in Maternal Mortality: 1990 to 2008

25. National development Planning Commission, Government of Ghana & UNDP (2010); Ghana: Millennium Development Goals Report.

26. National House of Chiefs (2009), Chieftaincy Bulletin, Vol. 1, No. 1; November 2009.

27. NCCE (2003), Civic Knowledge among the Youth of Ghana in 2002.

28. OECD (2010), Millennium Development Report Card: Learning from Progress.

29. OECD (2008), Policy Insight No. 65: Combating Under‐Five Mortality in Africa.

30. Republic of Ghana (2010), Response to Parliamentary Questions on “The labour Strength of the Economy”.

31. Republic of Ghana (2010), A New Approach to Public Sector Reform, January 2010.

32. Republic of Ghana (2009), Draft Medium Term Development Agenda, 2010 – 13.

33. Republic of Ghana (2009), Institutional Assessment of the Ministry of Women and Children’s Affairs.

34. Republic of Ghana (2009), Ghana Education Strategic Plan 2010 – 2020, September 2009.

35. Republic of Ghana (2009) Ghana’s Third Progress Report on the Implementation of the African and Beijing Platform for Action and Review Report for Beijing + 15.

36. Republic of Ghana (2009) Revised Environmental Sanitation Policy

37. Republic of Ghana and UN (2008/2009), High Impact Rapid Delivery Survey: Monitoring the Situation of Women and Children

38. Republic of Ghana (2007) Food and Agricultural Sector Development Policy (FASEDP 11)

39. Republic of Ghana (2009), Ghana Climate Change Impacts, Vulnerability and Adaptation Assessment.

40. Republic of Ghana (2009), Ghana Demographic and Health Survey 2008.

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41. Republic of Ghana (2008), Annual Progress Report (GPRS II, 2006‐2009).

42. Republic of Ghana (2006), Creating Wealth Through Health: The health Sector programme of Work 2007 – 2011.

43. Republic of Ghana and UN (2006), Ghana MDG report 2006.

44. Republic of Ghana (2005), Growth and Poverty Reduction Strategy (GPRS II), 2006 – 2009.

45. Republic of Ghana and UN (2004), Ghana MDG report 2004.

46. Republic of Ghana (2003), Ghana Poverty Reduction Strategy 2003 – 2005.

47. Republic of Ghana, National Architecture for Peace in Ghana.

48. Republic of Ghana, Judicial Service Charter.

49. Republic of Ghana, Judicial Service: Uniform Practice manual

50. Tengey W. and E. Oguaah (2003), The Little Ghanaian Slaves Cry: A report on Child Trafficking in Ghana.

51. UNCT Ghana (2005), United Nations Development Assistance for Ghana, April 2005.

52. UNDP (2010), Democratic Governance: A pre‐Requisite for the attainment of Human Development and the MDGs.

53. UNDP (2009), 2008 Citizens’ Assessment of the National Health Insurance Scheme.

54. UNICEF (2010); Reaching the Lowest Quintile in Ghana: lessons from the Evidence.

55. UNIFEM (2008), Aid Effectiveness and Gender Equality in Ghana.

56. University of Ghana (2009); The State of the Ghanaian Economy in 2010.

57. Women in Law and Development (2006), Shadow report to Ghana’s Third, Fourth and Fifth Reports on the Implementation of CEDAW in Ghana.

58. World Bank (2010), Africa Infrastructure Country Diagnosis.

59. World Bank (2010), Country Assistance Strategy Report for Ghana, March 2010.

60. World Bank (2009), World Development Indicators: Population Growth rate and Development in Ghana.

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61. WFP (2010), Assessing the Impact of the Global Financial crisis on Vulnerable Households in Ghana.

62. WFP (2010), Gap Analysis on Hunger and Food security in Ghana, July 2010.

63. WFP (2009), Comprehensive Food Security and Vulnerability Assessment.

ANNEX 2: INDIVIDUALS INTERVIEWED

NO Name Title Organization UN Agencies 1 Lorretta Roberts WASH Specialist UNICEF 2 Michael Forson WASH Specialist and OIC UNICEF 3 Adam Thomas WASH Specialist UNICEF 4 Emma Halm Program Assistant UNICEF 5 Charles Dzradosi Social Policy and Planning Specialist UNICEF 6 Chief of Advocacy, Communications, Julianna Lindsey Monitoring and Analysis UNICEF 7 Hiroyuki Hattori Chief of Education UNICEF 8 Nadiez Adam‐Issah Education Officer UNICEF 9 Afua Ansere National Program Coordinator UNIFEM 10 Josephine Dornuki Nartey Program Assistant UNIFEM 11 Pa Lamin Beyai Economic Advisor UNDP 12 Kordzo Sedegah Economic Specialist UNDP 13 Clever Nyathi Senior Governance Advisor UNDP 14 Eric Opoku Programme Analyst UNDP 15 Stephen Dua‐Yentumi ARR/P UNDP 16 Dedier Habimana UNV UNDP 17 Thelma Amarquaye Programme Associate UNDP 18 Christy Ahenkora Banya Head of Unit UNDP 19 Akua Dua‐Agyeman MDG Support Advisor UNDP 20 Chantille Viand Programme Officer HSP UNDP 21 Nicholas Amponsah Project Manager SRLP UNDP 22 Fredrick Ampiah Partnership Advisor UNDP 23 M Bawa Amadu Assistant Representative UNFPA 24 Mercy Osei Konadu NPO – Gender UNFPA 25 Esi Awotwi NPOU ‐ HIV & AIDS UNFPA 26 Ben Treverh NPO ‐ Population & Development UNFPA 27 Mutaru Goro Iddrisu N P Associate UNFPA 28 Bridget O. Asiamah NPO – RH UNFPA 29 Dr. Sebastian Eliason NPO ‐ Reproductive Health UNFPA 30 Fredrica E. Hanson Midwifery Advisor UNFPA 31 Victoria Abankwa Programme Manager UN HABITAT

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32 Abena Mansa Ntori Human Settlement Officer UN HABITAT 34 Ismail Omer Representative and Country Director WFP 35 Nguyen Duc Hoang Head of Programme Unit WFP 36 Elly Sukup Programme Assistant WFP 37 Francis Sarpong‐ Kumankuma Assistant WFP 38 Ama Nettey Programme Officer WFP 39 Emma Anaman Senior Programme Officer WFP 40 Thomas Yeboah Procurement Officer WFP 41 Dr. Leo Zekeng Country Coordinator UNAIDS 42 Loryn de Boer Intern UNAIDS No Name Title Organization 43 Gurumurthy Rangaiyan Advisor UNAIDS 44 Selasi Amah d'Almeida NPO Health Economist WHO 45 Dr. Felicia Owusu‐ Antwi NPO Malaria WHO 46 Dr. Charles Fleischer‐ Djoloto NPO Family Health & Population WHO 47 Dr. Mary Brantuo NPO Child & Adolescent Health WHO 48 Sharon J. Cooper Representative UNHCR 49 Ruel Nettey Associate Programme Officer UNHCR 50 Elsie Yao Kumah Community Services Officer UNHCR 51 Veton Orana Protection Officer UNHCR 52 Mercy Manyala Head Of Humanitarian Support Unit OCHA 53 John Sule Mahama National Humanitarian Affairs Officer OCHA 54 Dr. Elsaid A Yeboah Assistant FAO Representative in Ghana FAO 55 Godfrey Baidoo Tsibu National Programme Assistant FAO 56 Dyane Epstein Chief of Mission IOM 57 Daniel Kweku Sam MiDA Field Officer IOM 58 David Appiah National Programme Officer IOM 59 Moji Okuribido Regional Advisor for Culture UNESCO 60 Tirso A. S. Dos Santos Programme Specialist in Education UNESCO 61 Dr. Leo Zakang Country Coordinator UNAIDS 62 Carl Ampah National Programme Officer UNESCO 63 Abdul Rahman Lamin Social and Human Science Specialist UNESCO 64 Rebecca Tandoh Communication/Information UNESCO 65 Ruby Sandhu‐ Rojon Resident and Humanitarian Coordinator UNCT 66 Wolfgaang Haas UN Coordination Specialist UN RCO 67 Myra Togobo Programme Assistant UN RCO 68 Francis Bartel Representative for Ghana and Togo UNIDO Private Sector 69 Nana Owusu Afari President AGI 70 Public Relations, Marketing and Events Cyril Okpoko Officer AGI Ministries, Departments and Agencies 71 Charles Konglo Support Programme NDPC 72 Jerry Odotei Deputy Director Development Policy NDPC

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Division 73 Deputy Director Plan Coordination Kwaku Adjei Fosu Division NDPC 74 Deputy Director PPME Social Mawutor Ablorh Development NDPC 75 Leonora Adu Larbi Director of Education MESW 76 Mawutor Ablorh Deputy Director PPME MESW 77 Frank Quist Director Of Human Resources Division MESW 78 Kwame Owusu Bonsu DDF Coordinator MESW 79 Senior Town Planning Officer, Urban Kwadwo Yeboa Development Unit MLGRD 80 Programme Officer, Sanitation Kweku Quansah Directorate MLGRD 81 Hon.Hajia Hawawu Boya Gariba Deputy Minister MOWAC 82 Evelyn Asiedu Agyemrfa Director Finance and Admin MOWAC 83 Richard Gaisey Director PPMED MOWAC 84 Christopher Odorkor‐ Teila Assistant Director MOWAC 85 Sylvester Anemana Ag. Chief Director MOH 86 Kafui Kan‐Senaya Head PP & Budget MOH 87 Emmanuel Owusu Ansah M & E MOH No Name Title Organization 88 Dr. Frank N.Nyonator Director PPMED GHS 89 Marian W.A. Kpakpah Ag. Executive Director NPC 90 Effie Simpson Ekuban Chief Director MOFEP 91 Mary Anne Addo Director ERMD MOFEP 92 Stella Williams Head of UN System Unit MOFEP 93 Seth Odoi Economics Officer MOFEP 94 Angela Dannson Deputy Director MOFA 95 Emmanuel Cobbinah Head, Planning and Budget GSS 96 Head, Statistical Coordination and Baah‐Wadieh Capacity Building GSS 97 Sylvester Gyamfi Head, Programmes and Management GSS 98 Nelly Kemevor Ag. Head of Civil Service AHCS 99 Ohene Okai Ag. Chief Director OHCS 100 A.K Agblewornu Ag. Chief Director MOT 101 Adelaide Annor Kumi Director MOT 102 E.L. Annan Assistant Director 1 MOT 103 J.Yaw Appiah Adjei Director Ministry of Energy 104 Kofi Larbi Ag. Chief Director MOTI 105 M. B. Alhassan Coordinating Director LGSS 106 Director (Quality Assurance and J. Cofie‐Agama Technical Services Directorate) LGSS 107 Charles Kotey Director (Human Resource) LGSS 108 K.H Myaing Technical Assistant LGSS 109 Catherine Adu Boadi Head, PAU LGSS 110 J.K.Somuah Chief Accountant LGSS 111 Dr. Sulley Gariba Presidential Adviser on Development SADA

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112 Nana Yaa Osei Brempong Ag. Chief Director PSRS 113 Technical Adviser on Public Sector Felicia Owusu Bonsu Reform PSRS 114 Dr. Angela El‐ Adas Director General GAC 115 Dr. Richard Amenya Director of Technical Services GAC 116 Emmanuel Tettey Larbi M & E Coordinator GAC 117 Deputy Commissioner Legal and Anna Bossman Investigation CHRAJ 118 Gloria Gyedu Programme Coordinator CHRAJ 119 Joseph Whittal Deputy Director Operations CHRAJ 120 Alhaji Yahaya H. Yakubu Director of Housing MWRWH 121 Ruby Aryeteey Project Officer for UNDP & DANIDA Judiciary Service 122 Project Officer for MiDA, World Bank & Gifty Preko LAP Judiciary Service 123 Dr. Odame Larbi Chief Executive Lands Commission 124 Divine Akafua Gender Officer, Girls Education Unit Ministry of Education 125 Charles Aheto‐Tsegah Coordinator of Donor Funds Ministry of Education 126 Ghana Education Emelia Aning Director, PPME Division Service 127 Dr. H.S. Daannaa Director of Research MOCC Civil Society organisations 128 Clement Nana Tandor Country Programme Director IBIS 129 Dr.Rose Mensah‐ Kutin Director ABANTU 130 Ms.Hamida Harrison Programme Manager ABANTU 131 ABANTU Ellen Dzah Senior Programme Officer No Name Title Organization 132 Ransford Tetteh President GJA 133 Bright Blewu General Secretary GJA 134 Affail Monney Vice President GJA 135 Dave Agbenu Organising Secretary GJA 136 Linda Asante Agyei Treasurer GJA 137 Amnesty Lawrence K. Amensu Director International 138 Margaret Brew‐Ward Programme Manager GSHRDC 139 Pugansoa Naa Prof.S. Nabila President NH of C 140 S.R. Takyi Ag.Registrar NH of C 141 Vicky T. Okine Executive Director ARHR 142 Selorme Kofi Azumah M&E Coordinator ARHR 143 Charles Oppong Programme Manager NAP+ Ghana 144 Salamatu Suleimana Secretary NAP+ Ghana 145 Gifty Torkornu Women's Wing Chair Lady NAP+ Ghana 146 Eric Yaw Anim Accountant NAP+ Ghana 147 Dr. Charles Djebuni Core Fellow CEPA Academia

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148 Prof. Kofi Kumado Professor Faculty of Law, U.G 149 Sabra Asante Ag. Dean, Public Services School GIMPA 150 Dr. Esther Offei Director Aboagye ILGS Development Partners 151 Martin Eson‐Benjamin CEO MiDA 152 Veronica Ayi Bonte Programme Officer DANIDA 153 Miriam Onivogui Program Officer USAID

ANNEX 3: INTERVIEW GUIDE

PRAMBLE: Can you give us a brief outline of the situation in Ghana focusing on Governance and Human Rights/Economic Development? (Health/Education sector)? Highlighting the work that you are doing in that area?

1. Could you give us your assessment of the specific challenges that have contributed to this situation; focusing particularly on an analysis of the root causes of the problems; any legal/legislative and/or policy issues that may be relevant; and also any institutional issues, such as capacity, etc. that may also be relevant?

2. Who are your key partners in this area – could you briefly outline what each one of them is doing, including an assessment of how effective they have been in their efforts. Please provide some specific examples.

3. What role is civil society playing and what is their contribution? Do you think that civil society is sufficiently engaged, and does it have adequate capacity to contribute to national dialogue and development in this area (e.g. human rights, etc)? Can you provide some specific examples of what they have done in the past?

4. How would you characterise the situation with regards to availability of information for decision‐making? What would you think can be done to improve decision‐making in order to ensure that development is evenly distributed across all of Ghana?

5. What is the extent of your engagement with the UN in your area? In your opinion, is the UN assistance effective, or in other words, has the UN appropriately positioned itself to contribute effectively using all its resources, skills and comparative advantages?

6. What would you say are the weaknesses (and strengths) of the UN in Ghana? How can the UN improve its coordination with the Government and with other development partners?

7. In your opinion, what are the key areas where the UN should focus on in the next 3‐4 years?

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8. What do you see as the key comparative advantages of the UN vis‐à‐vis other development partners? In light of this, where would you think the UN should focus its interventions and programmes with regards to (a) upstream (policy advocacy) versus downstream (community work), and (b) geographic coverage of the country?

9. Looking at the broader global environment, what would you say are the potential risks and emerging challenges that will affect Ghana in the future with respect to your specific sector? What role do you see the UN playing in mitigating and assisting the Government to address these challenges?

10. Could you please identify one or two key documents or reports where we can get detailed and very specific data and information about the current situation in Ghana with regards to your sector/area.

ANNEX 4: INTERNATIONAL TREATIES SIGNED BY GHANA

Ratification of International Human Rights Treaties and Conventions by Ghana

International Bill of Human Rights Signature Ratification Accession Succession International covenant on economic, social 7 Sept 2000 7 Sept 2000 and cultural rights International covenant on civil and political 7 Sept 2000 7 Sept 2000 rights Optional Protocol on the International 7 Sept 2000 7 Sept 2000 covenant on civil and political rights Second Optional protocol on the Covenant on 7 Sept 2000 7 Sept 2000 Civil and Political rights aiming at abolition of death penalty Prevention of discrimination on the basis of race, religion or belief, and protection of minorities International convention on the elimination 8 Sept 1966 8 Sept 1966 of all forms of discrimination Women’s Human Rights Convention on the elimination of all forms of 17 Jul 1980 2 Jan 1986 discrimination against women Optional Protocol on the Convention on the 24 Feb 2000 elimination of all forms of discrimination 2009* against women United Nations Convention against Not signed transnational organized crime Protocol to prevent, suppress and punish trafficking in persons; especially women and 2009*

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GHANA COUNTRY ANALYSIS September 15, 2010 children Protocol against the smuggling of migrants by 2009* land sea and air Slavery and Slavery‐like Practices Convention for the suppression of traffic in 24 Sept 2003 persons, and of the exploitation of prostitution by others Protection from Torture, Ill treatment and Disappearance Convention against torture and other cruel, 7 Sept 2000 7 Sept 2000 inhuman and degrading treatment or punishment Rights of the Child Convention on the rights of the child 29 Jan 1990 5 Feb 1990 Optional Protocol to the Convention on the 24 Sept 2003 rights of the child on the involvement of children in armed conflict Convention concerning the prohibition and Not signed 13 Jun 2000 immediate action for the elimination of the worst forms of child labour Freedom of Association Convention on freedom of association and 2 Jun 1965 the right to organise Convention on the right to organize and 2 Jul 1959 collective bargaining Employment and Forced Labour Employment policy convention Not signed Convention concerning occupational safety, Not signed health and the working environment Convention on the protection of all migrant 7 Sept 2000 7 Sept 2000 workers and their families Education Convention against discrimination in Not signed Education African Regional Conventions African Charter on Human and People’s Rights 24 Jan 1989 Convention governing the specific aspects of 10 Sept 1969 19 Jun 1975 refugees in Africa Protocol to the African Charter on Human and Not signed people’s Rights on the Rights of Women in Africa Protocol to the African Charter on Human and 9 Jun 1998 People’s Rights on the establishment of an African Court on Human and people’s Rights African Charter on the Rights and Welfare of Aug 1997 the child

Source: Adopted from http://www.umn.edu/humanrts/research/ratification‐ghana.html

Notes: * Ghana ratified these three in 2009 according to the Ghana Government Budget Statement and Economic Policy of 2010.

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ANNEX 5: BRIEF CASELOAD STATISTICS FOR THE COURTS (2008 ‐09)

COURTS

HIGH COURTS OF

NUMBER OF CASES

TRACK

SUPREME COURT COURT APPEAL REGULAR COURT FAST DIVISION COMMERCIAL COURTS REGIONAL TRIBUNALS CIRCUIT COURTS DISTRICT COURTS TOTALS No. of cases pending at the beginning of July 2008 71 1,985 22,467 1,061 1,611 129 48,210 119,461 194,995 No. of cases filed from July 2008 to June 2009 291 1,057 8,156 526 2,247 16 21,534 68,478 102,305 No. of cases concluded from July 2008 to June 2009 309 984 8,179 458 1,649 124 18,729 75,944 106,376 No. of cases pending at the end of June 2009 53 2,058 22,444 1,129 2,209 21 51,015 111,995 190,924 Source: Judicial Service of Ghana (2010); 2008/09 Annual Report

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ANNEX 6: Basic Labour Market Indicators, 2006

Indicator Male Female Rural Urban National Estimated population (million) 10.97 11.65 14.13 8.49 22.62 Working Population, 15 years + (million) 6.39 7.19 8.02 5.56 13.58 Labour Force, 15 years + (million) 4.57 4.85 5.93 3.49 9.42 Highest Education Completed (%) No education 26.0 42.9 45.1 17.1 34.7 Basic education 55.3 47.8 49.1 55.5 51.4 Secondary education 9.4 4.5 3.2 13.1 6.9 Vocational/technical training (nurse, etc) 5.1 3.5 1.8 8.4 4.4 Tertiary education 4.0 1.2 0.7 5.6 2.5 Other 0.2 0.1 0.1 0.3 0.2 Jobless or non‐working (million) 1.22 1.43 1.46 1.19 2.65 Broad unemployment rate (%) Adults 15 years + 6.0 7.0 4.3 10.3 6.5 Youth (15‐24 years) 13.2 13.9 8.9 22.9 13.5 Narrow unemployment (%) Adults 15 years + 3.1 3.0 1.3 6.0 3.0 Youth (15‐24 years) 6.9 6.1 3.4 13.2 6.5 Currently employed (million) 4.43 4.71 5.86 3.28 9.14 By Economic Sector (%) Agriculture 58.8 51.3 75.3 18.3 54.9 Industry 14.2 14.2 9.9 21.9 14.2 Service 27.0 34.5 14.8 59.8 30.9 Status of Employment (%) Wage employment 26.9 8.6 7.9 34.5 17.5 Employer 5.4 3.7 3.5 6.4 4.5 Own account employment 53.1 56.9 59.4 47.2 55.0 Contributing family work 11.7 28.5 27.5 7.6 20.4 Domestic employee 0.1 0.2 0.1 0.3 0.2 Apprentice 2.7 2.0 1.5 3.8 2.3 Other 0.1 0.1 0.1 0.2 0.1 Working Poor Working poverty rate (%) 25.0 26.0 35.2 8.3 25.6 Extreme working poverty rate (%) 15.6 16.4 22.6 4.3 16.1

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