Population Ageing in Ghana: a Profile and Emerging Issues

African Population Studies Vol 25, 2 (Dec 2011)

Population ageing in Ghana: a profile and emerging issues

E.O. Tawiah, Ph.D Regional Institute for Population Studies University of Ghana, P. O. Box LG 96, Legon, Ghana [email protected]

Abstract Population ageing in Ghana is a consequence of a gradual fertility decline which is also occurring in many sub-Saharan African countries. Data from the 2005/2006 Ghana Living Standards Survey show that the percentage of the elderly (persons aged 60 years and above) has increased from 4.9 in 1960 to 5.3 in 1970, 5.8 in 1984 and 7.2 in 2000. Median age has increased from 17 years in 1970 to 18.1 years in 1984 and 19.4 years in 2000, implying a 14.1 percentage increase in 30 years. Socio-economic indicators show that elderly females are more vulnerable and disadvantaged than their male counterparts due in part to low educational attainment resulting in low female participation in the formal sector with its attendant low remuneration and inadequate retirement package. One important emerging issue is the branding of elderly females as witches and subjecting them to abuse and torture in certain parts of the country. This harmful practice infringes upon the human rights of these women and the government of Ghana should do well to abolish the witches’ camps. A large proportion of workers engaged in the informal sector of the economy do not contribute to the Social Security Scheme and this makes it extremely difficult for them to cater for their needs in old age particularly when the extended family is unable to provide support and care. The government of Ghana should make strenuous efforts to bridge the gap between producing a concise National Ageing Policy and its implementation.

Introduction December 2004, the African Union Population ageing, a direct conse- Commission launched the Policy quence of the demographic transition, Framework and Plan of Action at a cer- began to receive increasing attention emony so as to raise awareness about with the adoption of the International the special situation, needs and welfare Plan of Action on Ageing in 1982 by the of elderly people on the continent (Eco- United Nations (UN). Since then issues nomic Commission for Africa, 2004). of population ageing have been recog- The main goal of the Policy Framework nized as important at the international, and Plan of Action is to guide African regional, sub-regional and national lev- Union Member States to design, imple- els. In July 2002, Heads of State and ment, monitor and evaluate appropri- Government of the African Union ate integrated national policies and adopted the African Policy Framework programmes to meet the individual and and Plan of Action on Ageing and in collective needs of the elderly.

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Population ageing has brought in its factors that affect living arrangements train a host of security, health, social of elderly persons in Ghana and else- and economic consequences ranging where (Mba, 2007; Mba, 2002; United from high demands on welfare and Nations, 2005). Elderly men in Ghana social needs to changes in family struc- are more likely to live in nuclear house- ture. In addition, Ghana like most sub- holds, while older women are more Saharan African countries, has also to likely to live in extended family house- combat long standing problems related holds (Mba, 2007). to education, health, poverty and The age-old compact extended employment which remain largely un- family system in Ghana and elsewhere resolved. Persisting economic crisis in sub-Saharan Africa ensured that the afflicting most sub-Saharan African elderly are cared for by the younger countries is adding to the financial bur- members of the family. It was like the den of older people thereby making modern social security system. It ob- them more vulnerable. The problem of liged its members to assist each other in population ageing has been heightened times of crises and share the achieve- particularly because it is taking place ments and glory that its members bring with neither a comprehensive formal (Apt, 1993). Elderly persons have social security system nor a well-func- depended on the younger generation tioning traditional care system in place for financial, social and health care sup- for elderly people (National Research port. It has been pointed out that tradi- Council, 2006). It is worth echoing Gro tional source of support is dwindling in Harlem Brundtland’s main Assembly the face of ever-growing numbers of statement at the Second World Assem- the elderly (Apt, 1996). The wind of bly on Ageing in 2002, that “While modernization, migration and urbaniza- developed countries grew affluent tion is partly responsible for the gradual before they became old, developing changeover from extended to nuclear countries are growing old before they family, resulting in shifting a greater part get affluent … While in Europe we have of the burden of providing care to the seen the demographic shift towards an elderly on the nuclear family, which is older population take place gradually somewhat ill-prepared to shoulder the over a period of a century, the pace of responsibility. Apt (1993) lists some the shift taking place in the developing social and economic conditions which countries far outstrips these countries’ influence the ability of the nuclear fam- socio-economic development”. It ily to provide adequate care to the eld- needs to be stressed also that popula- erly, namely limited financial resources, tion ageing is the positive result of two rising cost of living in urban areas, victories that humanity has sought for unemployment and underemployment. centuries and is still seeking, namely the Coping with old age has been a victory over unwanted births and that major challenge particularly to elderly over premature deaths (Golini, 2004). women who have been subjected to The challenges facing the elderly abuse, human rights violation, neglect, are legion. Several studies have exam- marginalization, disrespect, exploita- ined demographic and socio-economic tion, violence and destitution (Apt,

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1993; Mba, 2007; Ferreira and Lind- 2009). gren, 2008). The increasing incidence of Population ageing in Ghana has superstition and some traditional beliefs been brought about mainly by a reduc- and practices have effectively combined tion in fertility rates and improvement to worsen the lot of the elderly. Using in survival rates due to medical inter- case study data, Apt (1993) reports that ventions based on the use of advanced the traditional belief among a certain technology and drugs. Ghana’s total fer- community in the Upper West region of tility rate has declined from 6.47 in Ghana that the closest grandchild dies 1979/80 to 4.0 in 2008 (Ghana Statisti- almost immediately after the grandpar- cal Service and Ghana Health Service, ent’s death has immense influence on 2009). Increasing longevity also contrib- the care and attention given to elderly utes to population ageing. The male life people in this community. The practice expectancy estimated for the period of accusing an elderly woman of being a 2010-2015 is to increase from 57.1 witch often results in stigmatization and years to 67.5 years in 2045-2050. The banishment as a witch, poverty, malnu- corresponding figures for females are trition and desertion by her family. The 59.0 years and 70.5 years and 58.0 accused witch is left to her own devices years and 69.0 for both sexes combined and her children and other family mem- (United Nations, 2009). bers feel justified in being absolved of The objectives of this paper are to their responsibilities of providing care (i) analyse the situation of the elderly, and other kinds of help. (ii) identify some emerging issues and The population of Africa is in transi- (iii) propose some possible policy res- tion to the ageing process. With declin- ponses/options for dealing with prob- ing fertility and mortality, it is estimated lems of population ageing. that Africa will be one of the continents with the fastest growing elderly popula- Data sources tion in the world during the period The analyses are based on the 1960, 1998 to 2050 (Kalasa, 2001). Although 1970, 1984 and 2000 Ghana population persons aged 60 years and above are a census reports, Ghana Living Standards small proportion of the total population Survey 5 (GLSS 5) conducted in 2005/ in most sub-Saharan African countries, 2006 and secondary data from relevant 4.8 percent in 2005 (United Nations, national and international publications. 2005), the number of older people is The censuses collected basic demo- growing. In 2005, there were 34 million graphic and socio-economic data which people aged 60 years and above in sub- permit analysis of the age-sex structure Saharan Africa and this number is pro- of the population of Ghana. GLSS 5 jected to increase to over 67 million by covered a nationally representative 2030 (Velkoff and Kowal, 2006). The sample of 8,687 households in 580 enu- medium variant projections of the meration areas with 37,128 household United Nations for sub-Saharan Africa members. It has two household ques- indicate an increase in median age from tionnaires (Parts A and B). The Part A 18.6 years in 2010 to 27.2 years in household questionnaire which has 2050, a 46% increase (United Nations, seven sections collected information on

http://aps.journals.ac.za 625 African Population Studies Vol 25, 2 (Dec 2011) household roster, education, health, Ghana which states that “A public employment and time use, migration, officer shall, except as otherwise pro- domestic and outbound tourism and vided in this Constitution, retire from housing. Section 1 collected data on the public service on attaining the age demographic and socio-economic vari- of sixty years” (Republic of Ghana, ables. The question on current marital 1992). Although it is recognized that status was restricted to persons aged the living arrangements, care and sup- 12 years or older. Section 3 of the ques- port for elderly persons aged 60-69 tionnaire collected information on years differ from those aged 70-79 health condition in the last two weeks years and 80 years and over, the age as well as insurance from household data for persons aged 60 years or more members. have not been grouped into five-year or The paper uses a definition of the ten-year age groups. This is to over- elderly as persons aged 60 years and come age misreporting, particularly over in consonance with United arising from a tendency to exaggerate Nations’ definition of elderly persons. length of life at advanced ages which is The 60 years’ cut-off point is also in characteristic of sub-Saharan African agreement with Article 199 (1) of the population data (Kpedekpo, 1982; Gai- 1992 Constitution of the Republic of sie, 2005).

Table 1 Percentage of elderly persons (60 years and over) by sex, Ghana 1960–2000 Years Male Female Total 1960 5.2 4.7 4.9 1970 5.5 5.2 5.3 1984 5.6 5.9 5.8 2000 7.2 7.2 7.2 Source: Compiled from 1960, 1970, 1984, and 2000 Ghana Population Census Reports.

Trends in ageing population in 2050 (United Nations, 2009). The pace of ageing is relatively Population ageing as a process of con- more rapid for elderly females than for tinuous increase in the population of elderly males. Whereas the proportion persons aged 60 years and over in the of elderly females has increased from total population is shown in Table 1. 4.7 percent to 7.2 percent in 1960 and The percentage of elderly persons (60 2000 respectively the corresponding years and above) has increased from figures for elderly males are 5.2 percent 4.9 in 1960 to 5.3 in 1970, 5.8 in 1984 and 7.2 percent. The percentages of and 7.2 in 2000. In terms of absolute elderly males and females based on the numbers, the population of the elderly 2008 Ghana Demographic and Health has increased from 331,516 in 1960 to Survey are 7.1 and 7.5 respectively 1,365,291 in 2000, a four-fold increase (Ghana Statistical Service, 2009). This is in 40 years. The population of the eld- to be expected in view of higher female erly is projected to reach 5,336,000 than male life expectancy. Median age representing 11.8 percent of the total which is used as an indicator of popula-

626 http://aps.journals.ac.za African Population Studies Vol 25, 2 (Dec 2011) tion ageing has increased from 17 years show an increase in median age from in 1970 to 18.1 years in 1984 and 19.4 20.6 years in 2010 to 22.4 years in years in 2000, implying 14.1 percent 2020, 24.4 years in 2030, 26.8 years in increase in 30 years (see Figure 1). The 2040 and 29.1 years in 2050 (United median variant projections for Ghana Nations, 2009).

Figure 1 Trends in median age, Ghana 1970-2050

Relationship to household by sex of the elderly person. As shown head in Table 2, nine out of 10 elderly males are heads of household compared to To some extent information on the eld- one out of two elderly females. One erly population by relationship to the out of five elderly females is a spouse of head of a household can be used to get the household head compared to 1.4 an insight into who is taking care of the percent of elderly males. Table 2 also elderly. Table 2 presents a percentage shows that 21.4 percent of elderly distribution of elderly persons accord- females are parents or parents-in-law of ing to relationship to household head the household head; the corresponding and sex. It is seen that 69.2 percent of figure for elderly males is 4.5 percent. elderly persons are household heads, In other words, elderly females are 4.8 13.7 percent are parents or parents-in- times more likely to be parents or pat- law and 4.5 percent are other relatives ents-in-law of the household head than of the head of household. The pattern their male counterparts. This situation of relationship to household head varies seems to point to the elderly females’

http://aps.journals.ac.za 627 African Population Studies Vol 25, 2 (Dec 2011) disadvantageous position which may whereas elderly female household compel them to live with their children heads, spouses and parents or parents- and in-laws. Compared with elderly in-law together make up 92.6 percent, males, elderly females are three times elderly male household heads alone more likely to be other relatives of the make up 91.9 percent. head of household. It is noted that

Table 2 Percentage distribution of elderly persons by relationship to household head and sex Relationship Male Female Total Head 91.9 50.1 69.2 Spouse 1.4 21.1 12.1 Child 0.5 0.3 Parent/parent-in -law 4.5 21.4 13.7 Son/daughter-in -law 0.1 Other relatives 2.1 6.6 4.5 Non-relatives 0.1 0.1 0.1 Total 100 100 100 Number* 1,144 1,362 2,506 *Totals do not agree with those of Tables 4, 5 and 6 because of missing cases. Computed from GLSS 5 dataset.

Marital status of elderly percent of elderly females are widows. persons This high percentage of widows cor- roborates Mba’s (2002) finding based Table 3 shows that half of elderly per- on the 1996 Lesotho census data file sons are married, a third are widowed which showed that 54.8 percent of and 9.8 percent are divorced. This high Lesotho elderly females are widows. proportion of widows and widowers The large proportion of widows has suggests high mortality at older ages. several social and financial implications Analysis by sex shows that three out of for the elderly female population. every four elderly males are married Because men are usually older than compared to 29.4 percent of elderly their wives and have lower life expect- females. In other words, elderly males ancy, and because a large proportion of are 2.6 times more likely to be married females depend on their husbands, the as compared to their female counter- onset of widowhood makes elderly parts. Because traditional norms favour females become more disadvantaged male dominance which is associated and vulnerable to the vicissitudes of life. with power, males are more likely to The divorcees and widows make up have their way in matters of marriage 65.5 percent of the elderly female pop- and divorce. Unlike females, males may ulation and this large group of elderly find it easier to re-marry after the death females has to fend for themselves in and divorce of their spouses. the absence of financial assistance, sup- It is important to note that 53.2 port and care from their children, rela-

628 http://aps.journals.ac.za African Population Studies Vol 25, 2 (Dec 2011) tives and other social support networks.

Table 3 Percentage distribution of elderly population according to marital status and sex Marital status Male Female Total Married 75.2 29.4 50.3 Consensual union 4.8 1.8 3.2 Separated 2.2 3.0 2.6 Divorced 6.9 12.3 9.8 Widowed 9.9 53.2 33.4 Never married 1.0 3.0 0.6 Total Number 1144 1362 2506 Source: Computed from GLSS 5 dataset.

School attendance of elderly members aged 3 years or over. The persons percentage distribution of the elderly population by school attendance and Schooling is crucial for elderly females’ sex is shown in Table 4. As expected, future particularly in view of higher school attendance is low among the male mortality which in some cases deprives women of financial and social elderly population. This is not unrelated support. School attendance is more to an inadequate number of schools and likely to open windows of opportunity poor access to education earlier in life. particularly in the area of formal paid Twenty six percent of elderly persons employment which may bring in its have attended school. The percentage wake social security benefits that may of elderly males who have attended compensate for lack of extended family school is 2.4 times that of the corre- support in old age. Educated individuals sponding female figure. The low school are more likely to get better jobs, attendance of females is due in part to higher income, and greater access to relatively less emphasis put on female health insurance and social ties and education. It also forecloses formal job resources. All these serve as armour in opportunities with attendant economic old age. The GLSS 5 collected school benefits and thereby giving rise to low attendance data from all household quality of life in old age.

Table 4 Percentage distribution of elderly persons by school attendance and sex School attendance Male Female Total Yes 39.1 16.1 26.2 No 60.9 83.9 73.4 Total 100.0 100.0 100.0 Number 1,139 1,349 2,488 Source: Computed from GLSS 5 dataset.

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Health condition of elderly members. It is worth noting that population respondents were not asked about the One of the numerous challenges of old kind of illness they suffered from. Part F age is how to win the never-ending war of the Health module also collected against poor health arising particularly information on the person who pays for from degenerative and man-made dis- the greatest portions of the health eases such as diabetes, heart diseases, expenses including consultations and hypertension, stroke, malignant neo- hospital stays as well as insurance from plasm and trachoma and blindness that all household members. Table 5 shows often lead to complications and perma- that one out of three elderly persons nent incapacity. The Health module of suffered from some kind of illness and the GLSS 5 collected data on health injury in the last two weeks before the condition in the last two weeks before survey. With regard to illness, elderly the survey from all household mem- females register a larger percentage bers. Although the data are not detailed (34.7 percent) compared to 28.6 per- enough and limited in several respects, cent for elderly males, whereas the they provide a bird’s eye view of the reverse is the case for injury; 1.8 per- general health condition of household cent compared with 1.3 percent.

Table 5 Percentage distribution of elderly population according to health condition and sex Suffered from illness Male Female Total Neither 69.1 63.4 66.0 Illness 28.6 34.7 31.9 Injury 1.8 1.3 1.5 Both 0.5 0.6 0.6 Total 100.0 100.0 100.0 Number 1,138 1,349 2,487 Source: Computed from GLSS 5 dataset.

The percentage distribution of persons females (67.6 percent). It is noted that who pay for the greatest portions of the other relatives settle 20.6 percent of health expenses including consultations medical bills for elderly females com- and hospital admissions for elderly per- pared to a corresponding figure of 8.9 sons is shown in Table 6. Health expen- ditures are borne mainly by household percent for elderly males. Spouses and heads (74.7 percent), other relatives health insurance bear 8.4 percent of (15.2 percent) and spouses (4.3 per- medical bills for elderly females com- cent), while 2.9 percent are settled pared with 5.8 percent for elderly through health insurance. Government males. The relatively higher payment or employers’ support is less than 1 made for elderly females may not be percent. The pattern of persons who pay for medical bills differs according to unrelated to the poor financial position sex of the elderly person. Heads of of women particularly elderly females households feature prominently for who are not covered by any social secu- both elderly males (89.2 percent) and rity scheme.

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Table 6 Percentage distribution of who pays for health expenses of elderly persons according to sex Person paying for medical bill Male Female Total Head 82.9 67.6 74.7 Spouse 3.3 5.2 4.3 Child 0.7 1.2 1.0 Grandchild 0.4 0.2 0.3 Parent/parent-in-law 0.2 0.3 0.2 Son/daughter-in-law 0.1 Other relative 8.9 20.6 15.2 Adopted/foster/stepchild 0.2 0.1 Non-relative 0.1 0.1 0.1 Government 0.4 0.5 0.5 Employer 0.2 0.1 Household member’s employer 0.1 0.1 0.1 Health insurance 2.5 3.2 2.9 Other 0.3 0.7 0.5 Total 100.0 100.0 100.0 Number 1,138 1,349 2,487 Computed from GLSS 5 dataset.

Health insurance and the premium under the Community Mutual elderly Health Insurance Scheme. However, One of the most important health persons aged 70 years and over should safety nets to cushion and protect the register to enjoy NHIS benefits. Figure elderly against poor health in old age is 2 shows that 20 percent of the elderly the National Health Insurance Scheme are either registered or covered by the (NHIS) which was established under NHIS, while eight out of 10 elderly per- Act 650 in 2003 by the Government of sons have neither registered nor are Ghana (GoG) to provide basic health covered by the scheme. It is worth care services to persons resident in mentioning that the National Health Ghana through mutual and private Insurance Scheme had just started at health insurance schemes. Children the time of data collection of GLSS 5. who are less than 18 years and whose There is not much variation by sex. The parents or guardians are contributors are covered. Then too, all persons who low coverage (20 percent) for elderly are Social Security and National Insur- persons suggests that the NHIS is yet to ance Trust (SSNIT) pensioners or aged make an impact particularly on one of 70 years and over who are resident in the vulnerable groups that needs its Ghana are exempted from payment of services most.

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Figure 2 Percentage distribution of elderly persons by health insurance status and sex

Table 7 Percentage distribution of elderly persons who have not registered with health insurance by reason for non-registration and sex Reason for non-registration Male Female Total High premium 39.3 40.4 39.9 Don't have confidence in operators 5.8 4.1 4.9 Covered 2.0 1.2 1.6 No knowledge of any scheme 15.0 19.3 17.3 Other 38.0 35.0 36.4 Total 100.0 100.0 100.0 Number 916 1,064 1,980 Computed from GLSS 5 dataset.

The data on health condition of house- attribute non-registration to the “high hold members in the last two weeks premium” to be paid to the scheme. It preceding the survey also provide a may well be that elderly persons who window of opportunity to analyse the have retired from formal paid employ- respondents’ reasons for non-registra- ment as well as those in agriculture and tion of the NHIS. It is seen in Table 7 the informal sector may not have ade- that four out of 10 elderly persons quate financial resources to cater for

632 http://aps.journals.ac.za African Population Studies Vol 25, 2 (Dec 2011) their needs in old age let alone to pay females do not have confidence in the for “high” annual health insurance pre- operators of the scheme. It is pertinent mium. It is also seen that 17 percent of to note that many diseases that afflict the elderly did not register because the elderly are yet to be included in the they have no knowledge of any insur- NHIS drug list leaving elderly persons ance scheme. With regard to having no vulnerable. It is shown in Table 7 that knowledge about the scheme the per- more than one out of every three eld- centages are 19.3 and 15.0 for elderly females and males respectively. The erly persons gave “other reasons” for low educational attainment of females non-registration. This definitely calls for may partly account for the higher more intensive and sustained public female percentage. A relatively larger education on the scheme in order to percentage of elderly males than register more contributors.

Table 8 Proportion of the household population aged 60 years and over living alone by sex Country Date Percentage alone Total Male Female Benin 2001 10.3 9.0 11.7 Burkina Faso 1998/99 2.3 2.3 2.4 Cameroon 1998 8.3 8.0 8.6 Cote d’Ivoire 1998/99 4.0 5.0 2.9 Ghana 1998 21.6 20.2 22.7 Kenya 1998 17.3 9.0 25.2 Malawi 2000 11.4 8.4 13.9 Mali 2001 6.8 5.1 9.8 Nigeria 1999 6.4 3.3 10.7 South Africa 1998 8.1 8.0 8.2 Togo 1998 8.0 6.9 9.0 Uganda 1995 12.1 11.9 12.2 United Rep. of Tanzania 1999 7.5 7.3 7.8 Zambia 2001/02 8.8 5.5 12.3 Zimbabwe 1999 8.8 8.1 9.4 Source: United Nations, 2005 Table 11.1, page 16.

Living arrangements of the side assistance in the case of illness or elderly disability and are at greater risk of social Living arrangements play an integral isolation. An attempt has been made to part in the well-being of elderly per- assemble comparative data on living sons, in that; residential quality and sat- arrangements of the elderly for some isfaction are indicators of quality of life selected sub-Saharan African countries (United Nations, 2005). Elderly persons including Ghana. It is noted that living alone are more likely to need out- although the data pertain to the period

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1995 through 2001 they mirror the liv- grandchildren varies from 63.6 in Kenya ing arrangements of the elderly in these to 82.8 in Burkina Faso. In Ghana, two countries in the past 15 years or so. In out of three elderly persons live with view of increasing urbanization and their children or grandchildren. Living modernization it is more likely that the with other relatives features less promi- current living arrangements will be nently in the living arrangements of the more disadvantageous to the elderly. elderly. There is a considerable range of val- Elderly persons are more likely to ues as shown in Table 8. The propor- live with their older than younger chil- tion of elderly population living alone dren probably because older children ranges from 2.3 percent in Burkina Faso are more likely to have more financial to 21.6 percent in Ghana. Although the resources than their younger siblings to median percentage living alone in Africa care for the aged parents. As shown in is only 8 percent (United Nations, Table 9, the percentage of elderly per- 2005), 22 percent of elderly persons sons in Ghana living with their children live alone in Ghana. Except in Cote or grandchildren aged 25 years or more d’Ivoire where the male percentage is is 27.5 compared with 22.3 percent for higher than the female value the other those living with their children or selected countries have higher propor- grandchildren aged less than 25 years. tion of females than males living alone. Couples who live together in the The higher female than male percent- same household are more likely to care ages seem to suggest that elderly for and assist each other in carrying out females will bear the bigger share of various tasks and activities. Living constraints caused by lack of appropri- together also tends to provide an addi- ate policies and plans aimed at improv- tional dimension to a relationship. GLSS ing the welfare the aged (United 5 asked respondents aged 12 years or Nations, 2005). Women also stand older who were married or were in more disadvantaged in terms of finan- consensual unions whether their cial resources because of dependence spouses “live in this household”. The on their husbands and living alone percentage distribution of elderly per- worsens an already difficult situation. It sons according to whether spouse lives is noted that in Kenya elderly females in the household is shown in Figure 3. are 2.8 times more likely to live alone As expected, elderly persons live with compared to their male counterparts. their spouses in the same household. Because elderly women live longer than Ninety percent of elderly males live in their male counterparts their status as the same household with their spouses dependents tends to extend for a compared with 73.4 percent for elderly longer period of time especially when females. The relatively larger percent- they become ill or disabled and need age of elderly females who do not live care. in the same household with their The percentage distribution of the spouses may be partly due to the prev- elderly population according to house- alence of polygyny which allows for hold composition is shown in Table 9. separate living arrangements. Elderly Ghana is among the countries with females in polygynous unions who do smallest percentages (5 percent) of not live with their spouses in the same couples living independently of others, household are probably more likely to while Mali has the largest percentage experience financial hardship and hence (18.3 percent). The percentage of eld- become more disadvantaged and vul- erly persons living with their children or nerable.

634 http://aps.journals.ac.za African Population Studies Vol 25, 2 (Dec 2011) relative With non- With other relative 7.2 18.0 3.4 9.3 5.4 1.3 9.3 6.7 1.1 8.6 4.3 0.3 6.8 6.9 1.0 8.3 16.6 1.6 not child Grandchild but but Grandchild Child Aged < 25 years 25 25+ years Living grandchild or with child With Total Total Aged only Livingindependently othersof Date Total Alone Couple 1998/99 7.2 4.0 3.2 71.3 64.1 44.2 20.0 1999 14.4 6.4 8.0 78.8 69.5 35.5 34.1 1998 32.1 17.3 14.8 63.6 49.7 25.7 24.0 13.9 2.9 1.5 2001 15.5 10.3 5.2 76.7 67.4 38.1 29.3 1998 13.4 8.0 5.4 76.3 65.9 41.8 24.1 10.4 9.7 0.6 1998 19.5 8.1 11.4 72.0 54.1 44.5 9.7 17.9 6.7 1.7 1998 14.9 8.3 6.6 66.9 58.6 38.9 19.7 2001 25.1 6.8 18.3 70.2 61.6 22.0 39.6 1995 20.6 12.0 8.6 70.9 48.4 24.7 23.7 22.5 7.7 0.8 1998/99 9.4 2.3 7.1 82.8 76.0 34.4 41.6 19982000 26.6 21.6 23.1 5.0 11.4 67.7 11.7 49.8 71.5 27.5 46.5 23.1 22.3 23.4 17.9 25.0 5.5 5.0 0.2 0.6 1999 18.0 8.8 9.2 74.6 56.2 32.4 23.8 18.4 5.9 1.5 2001/02 18.6 8.8 9.8 74.8 53.5 32.1 21.4 21.3 5.3 1.2

Percentage distribution of the population aged 60 years or over by householdPercentage composition distribution of the population aged 60 Benin Faso Burkina Cameroon Country Cote Cote d’Ivoire Ghana Kenya Malawi Mali Nigeria AfricaSouth Togo Uganda United Rep.Tanzania of 1999Zambia 15.0 7.6 7.4 72.8 60.4 36.3 24.1 12.4 11.1 1.2 Zimbabwe Table 9Table 33. page 11.4, Table 2005, Nations, United Source:

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Figure 3 Percentage distribution of elderly persons according to whether spouse lives in household and sex.

Emerging issues witches’ camp in the northern parts of Ghana strips them of their dignity and The ageing challenges that elderly per- human rights. sons face are mainly in the social, eco- The existence of the so-called nomic and health domains. One of the witches’ camp that can be described as main social concerns that have a blot on the conscience of the nation is attracted considerable attention is the regarded by some people as safe haven issue of witchcraft and cultural practices for women, men and children who have in certain parts of the country that all been abandoned by their families and dehumanize people especially women. communities after being branded as The belief in witchcraft is widespread in witches for one reason or another. Ghana and transcends educational lev- What is most unsettling is that at the els, social status and type of religious time that these elderly women need affiliation (Sefah-Dadeh, 2004; Drucker- sympathy, protection, support and care, Brown, 1993). The branding of women some of their own children have joined as witches and subjecting them to abuse in perpetuating cruelty against their and torture is a matter of great concern own parents. as it is against the laws of Ghana and The witches’ camp issue is multidi- several international laws to which mensional. It has socio-cultural, reli- Ghana is a signatory. The banishment of gious, socio-political, legal and human elderly women to live in the so-called rights dimensions and it is also an issue

636 http://aps.journals.ac.za African Population Studies Vol 25, 2 (Dec 2011) of ignorance and lack of knowledge tered by the then Department of Pen- about disease causation. The inhuman sions and the State Insurance treatment of women in the witches’ Corporation. Until 1991, SSNIT admin- camp has prompted civil society organi- istered a Provident Fund Scheme and zations, faith based organizations and this was converted into a social insur- human rights activists to call on the gov- ance pension scheme (SSNIT, 2007). ernment of Ghana to take urgent steps The social insurance pension scheme to abolish the witches’ camps in the was reformed in January 2010 by an Act northern parts of the country because of Parliament, Act 677. they are not only grounds for human SSNIT is governed by the National rights violations, but more importantly Pensions Act, 2008 (Act 766) which has the rights and dignity of the people a contributory three-tier pension accused as witches and wizards. scheme. The objectives of the National Pensions Act are to i) provide pension Social security scheme benefits to ensure retirement income security for workers ii) ensure that Population ageing poses challenges in every worker receives retirement and terms of financing pensions, social care related benefits as and when due and iii) and health care as well as supplying the establish a uniform set of rules and economy with labour (Bengtsson and Scott, 2011). The mandatory retire- standards for the administration, payment age of 60 years in Ghana means ment of retirement and related benefits that elderly persons need additional for workers in both the public and pri- resources to support them in their old vate sectors. age either from younger persons of Unlike the South African social pen- their own families or from a social secu- sion programme which is financed rity or pension scheme. The main for- through general tax revenue (National mal social protection scheme in Ghana Research Council, 2006), Ghana’s pen- is the national social insurance scheme sion scheme is financed by contribu- administered by the Social Security and tions from employers and employees. National Insurance Trust (SSNIT). The Membership of the SSNIT scheme is SSNIT social insurance pension open to all workers in Ghana except schemes are old age income security officers and men of the Ghana Armed arrangements that pay retirement ben- Forces and any other person who is efits to retirees out of contributions expressly exempted by law. The from current employees. The capacity Scheme is also optional for the self-em- of elderly persons in Ghana to cope ployed. Under the new National Pen- with economic challenges in old age in sions Act, 2008 (Act 766), the worker the absence of adequate support and contributes 5.5 percent of his/her basic care from children and the extended salary and the employer adds 13.0 per- family unit has not been increased by cent of the worker’s basic salary, mak- the establishment of SSNIT in 1972 ing a total of 18.5 percent. Thirteen and under the National Redemption Coun- a half percent of the 18.5 percent is cil Decree 127. Before 1972, the social remitted to the mandatory first tier security scheme was jointly adminis- which is managed by SSSNIT, while the

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5 percent is remitted to the mandatory ues of their benefits are eroded by infla- fully-funded second tier privately man- tion and mismanagement, thereby per- aged occupational scheme. The third petuating poverty in old age (Ministry of tier is a voluntary fully-funded and pri- Employment and Social Welfare, 2010). vately managed provident fund and per- The majority of workers in the pri- sonal pension scheme. It is not likely vate informal sector such as farmers, that the third tier of the pension fishermen, transport conductors, retail scheme will be subscribed as expected. market traders, hawkers, street and This is mainly due to poor saving habits pavement vendors are not contribu- of the majority of workers arising from tors to the scheme and hence have no poor remuneration and high cost of liv- pension benefits or any other form of ing. reliable social security. This large popu- The SSNIT level of coverage of the lation of non-contributors in the private social security of the labour force is informal sector poses a serious chal- very low. The total number of regis- lenge to SSNIT in her quest to attain tered active contributors nationwide as nationwide coverage. The implication is at March 2011 is 895,476, representing that a majority of these workers in the 12.1 percent of employed persons aged private informal sector will have to 15 years and older (7,428,374) in 2000. devise ways and means of getting finan- The 2000 Ghana Population and Hous- cial resources to tide them over in old ing Census indicated that 6.4 percent of age. Workers engaged in subsistence employed persons aged 15 years and agriculture or other forms of subsist- over were in the public sector, while ence living are likely to rely on their 83.9 percent were in the private infor- families for support and protection mal sector which remains the largest when they can no longer work. Elderly concentration of the working popula- women are more likely to be disadvan- tion and much of this is in agriculture taged because a larger female than male and related activities. The percentages percentage of workers is in the private of the employed males and females informal sector. SSNIT should target aged 15 years or more in the private the rural areas where most workers do informal sector were 79.1 and 88.8 not belong to any institution and have respectively. Because a majority of the no retirement pension. The perception contributors are likely to be public sec- of the elderly as a burden for their adult tor workers who comprised 6.4 per- children appears to be a myth in Brazil, cent of the employed persons aged 15 Chile, Costa Rica, Mexico, Uruguay and years or more in Ghana in 2000, the the United States of America where the scheme’s impact on the economic wel- elderly far from being an economic bur- fare of the elderly is minimal. It is worth den to their families are an economic mentioning that 8.3 percent of asset (Rosero-Bixby, 2011). It has been employed males aged 15 years and over pointed out that on balance the elderly were in the public sector compared to do not rely on contributions from their 4.4 percent of employed females. It children to meet consumption needs. must be stated that for those covered This is not the case in Ghana where net by the social security scheme, the val- private transfers play a key role in sup-

638 http://aps.journals.ac.za African Population Studies Vol 25, 2 (Dec 2011) porting the elderly. bilities into the society and facilitate the Health security is one of the basic adoption of children … Appropriate prerequisites of enjoyable and active life policy environment will also be created for the elderly. The issue of income to enable the aged feel secure and use- security is closely linked to that of ful in society” (National Population health security. The analysis of the Council, no date). social security scheme and pension The establishment of a national pol- benefits suggests that the majority of icy on ageing in 2010 is a policy workers are not covered by the social response initiated by government to security scheme and hence are not enti- address the social, economic and health tled to any pension benefits in old age. challenges of the elderly. It is also an Because of inadequate retirement pen- indication of government’s commit- sion whose value is eroded by inflation, ment to address ageing issues in Ghana. elderly persons who are aged between The Policy document promulgated by 60 and 69 years are less likely to access Parliament in 2010 and entitled quality health care which is a sine qua “National Ageing Policy: Ageing with non in old age. Security and Dignity” states that the overarching goal is “to achieve the Policy responses overall social, economic and cultural re- integration of older persons into main- The Government of Ghana has long stream society, to enable them as far as been aware of population ageing and its practicable to participate fully in the social, cultural, health, environmental national development process” (Minis- and economic challenges for sustainable try of Employment and Social Welfare, socio-economic development. These 2010). In order to achieve the goal of challenges are at the micro-level for giving adequate opportunity to the eld- individuals and households and at the erly to continue to contribute to society macro-level for populations and sub- after retirement, the Policy spells out populations (Golini, 1999). They policies and strategies which include: require shift of financial, physical and • Upholding the fundamental human human resources from one segment of rights of older persons the population to another. The Govern- • Ensuring active participation of ment of Ghana has initiated policy older persons in society and responses that target potential effects development of demographic trends on the welfare • Reducing poverty among older of the elderly. In line with this aware- persons ness Ghana commemorates July 1, • Improving health, nutrition and Republic Day, as Senior Citizens Day in well-being of older persons • Improving housing and living envi- recognition of the diverse and immense ronment of older persons contributions of elderly persons to the • Strengthening the family and com- development of the country. The 1994 munity to provide adequate sup- Revised Ghana Population Policy states port to older persons that “Policies will be adopted to ensure • Improving income security and that adequate upkeep and full integra- enhanced social welfare for older tion of the aged and persons with disa- persons

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• Ensuring adequate attention to centage of the District Assembly Com- gender variations in ageing mon Fund as their contribution to the • Strengthening research, informa- AAF in their districts. Other stakehold- tion gathering and processing, and ers such as private sector employers, coordination and management of NGOs, development partners and phi- data on older persons lanthropists will be encouraged to con- • Strengthening capacity to formu- tribute to the Active Ageing Fund. late, implement, monitor and The National Ageing Policy has an evaluate policies on ageing elaborate implementation action plan • Improving funding of programmes whose purpose is to provide details of on older persons to ensure imple- policy actions and implementation mentation sustainability (Ministry activities needed to achieve the policy of Employment and Social Wel- fare, 2010). goals and objectives. The Action Plan focuses on the following five key result In addition, the institutional framework areas: for policy implementation specifies the role of government, family and commu- • Enhancing effective planning and mainstreaming of ageing issues nity, private sector, employers and into national development organized labour, older persons’ groups • Reducing poverty and ensuring and associations, non-governmental income security of older persons organizations (NGOs), civil society, • Improving health and nutrition for development partners and National older persons Council on Ageing. • Creating a supportive environ- The implementation of some legis- ment for active ageing lation and development policies such as • Enhancing implementation capac- the 1994 Revised National Population ity of policies and programmes of Policy, National HIV/AIDS Policy 2002, older persons (Ministry of Livelihood Empowerment Against Pov- Employment and Social Welfare, erty (LEAP) Social Grants Programme, 2010). Persons with Disability Act, 2006 (Act Each key result area has policy objec- 715), Growth and Poverty Reduction tives, activities, time frame and output Strategy (GPRS 11) 2006-2009, and for each activity, indicators, means of National Social Protection Strategy that verification and responsible agency seek to protect the elderly has been (lead agency and collaborating agen- hindered by lack of adequate financial cies). resources. However, the financing of The National Ageing Policy’s elabo- the National Ageing Policy will be done rate implementation action plan re- by Government through the establish- quires adequate financial resources to ment of the Active Ageing Fund (AAF) see it through. The crux of the matter is as a development fund to support the whether the government is committed implementation of the Policy. Govern- to allocate adequate financial resources ment will provide seed money for the to promote active ageing with security AAF and each year Metropolitan, and dignity in view of other numerous Municipal and District Assemblies and competing demands on the national (MMDAs) will contribute a specific per- budget. It is not likely that the zeal

640 http://aps.journals.ac.za African Population Studies Vol 25, 2 (Dec 2011) which ensured the development and tion of rights of older persons, promulgation of the Policy document research, relief supplies and projects’ will come in handy at the level of imple- support to older persons/age care mentation of activities. There is a world organizations. The activities in the area of difference between developing a of health cover community clinic/health concise action plan and making ade- screening, training/awareness creation, quate financial resources available for eye care, purchase of prescribed drugs its implementation. Ghana is yet to for poor older persons, adoption and master how to effectively link the two support of the two geriatric wards of sides of the same coin. the Accra Psychiatric Hospital and run- The intervention activities to pro- ning of a health post at HAG Day Cen- mote active ageing are not the preserve tre at Osu, Accra. of government only. HelpAge Ghana The continued existence of the (HAG), a non-governmental organiza- witches’ camp in certain parts of north- tion which is affiliated to HelpAge Inter- ern Ghana has brought to the fore the national based in the United Kingdom, need for National Commission on Civic and established in 1988 has designed Education (NCCE), traditional and intervention activities to address ageing opinion leaders, churches, assembly issues and problems facing older per- men and women and NGOs to embark sons. Its mission is “to advance the upon vigorous public education on the interest and welfare of older persons in issue of witchcraft and abusive practices Ghana”. HAG’s activities are on a very that dehumanize elderly persons, espe- small scale and yet they are making an cially the vulnerable like elderly impact in their little corners. HAG runs women. Public education should sensi- two day centres at Derby Avenue, tize communities about issues of human Accra and Bubiashie, a suburb of Accra rights. People should be made to where poor older persons are provided understand the falsehood, and cruelty, with lunch and recreation facilities. The of the superstition of witchcraft as well third day centre at Osu, Accra provides as the causes of diseases and epidemics. health care in addition to the two serv- The public education should also ensure ices already mentioned. Each older per- that elderly women who have toiled to son contributes 50 pesewas (about nurture sons and daughters are US$0.33) towards the cost of lunch. A accorded the recognition, gratitude, major objective of the day centres is to security and dignity they deserve. Chil- build the capacity of older persons to dren should be sensitized to feel proud manage their own affairs. to provide care and support for their The major challenge facing HAG is elderly parents when they retire or are financial. HAG relies heavily on dona- unable to work any longer. Govern- tions from individuals, organizations and ment should pass a law to dismantle the project grants to implement its major witches’ camps and their inmates inte- programmes and activities in the areas grated into mainstream society as was of health, adopt-a-granny scheme, done in the case of the Trokosi girls. building and support for day centres, Trokosi is a belief system in which infants advocacy, awareness creation, promo- and virgin girls are dedicated to serve in

http://aps.journals.ac.za 641 African Population Studies Vol 25, 2 (Dec 2011) a shrine by their kin to atone for sins pervasive high youth unemployment and taboo breaches. The victims are have made it more difficult for the not themselves the offenders. younger generation to provide ade- The mandatory retirement age of quate care and support to the elderly as 60 years as specified in the 1992 Con- expected. The disadvantageous finan- stitution of Ghana must be raised cial position of children and relatives because it makes it difficult for the pub- makes it extremely difficult to adopt lic sector to re-engage the services of 1996 China’s People Congress Law of retired persons who could still contrib- Security of the Right of the Elderly ute to the development of the country. which stipulates that taking care of eld- Raising the retirement age seems to be erly parents is the duty of children the appropriate response to increasing (Qiao, 2001). It means that children life expectancy. A gradual retirement would be in violation of the law if they process to take place between ages 60 did not support and care for their eld- and 65 can be considered by govern- erly parents. In Ghana, the great expec- ment. There is high unemployment tation of parents that their children will especially among the youth and policies reciprocate the care and support they to increase labour force participation by provided them when they were young the youth need to embrace skills devel- is disappearing fast, with the result that opment; there seems to be a mismatch elderly persons tend to be left in the between courses taught at the tertiary lurch and elderly females become rela- level and requirements of the business tively more disadvantaged because they sector. The failure of the Ghanaian tend to have less financial resources. economy to expand to absorb the rap- The Social Security Scheme’s level idly growing labour force does not of coverage is very low coupled with favour the proposition that enough job inadequate retirement pension whose opportunities should be created for the value is constantly eroded by inflation. elderly who are healthy and can still The main challenge facing SSNIT is how work. Government will have to seri- to increase coverage particularly among ously consider the trade-off because of informal sector workers. SSNIT should the lack of requisite skills by the youth liaise with Information Services Depart- for the current job market situation. ment to mount continuous public education on the importance of con- Discussion tributing to the social security scheme The era of globalization, urbanization among petty traders, farmers, fisher- and modernization have combined to men, carpenters, masons, etc. The deal a severe blow to the time-tested third tier of the National Pensions Act extended family unit which has pro- 2008, provides for a voluntary fully- vided care and support to the elderly. funded and privately managed provi- The widely-held view that having chil- dent fund and personal pension dren is a kind of investment and secu- scheme. However, the inadequate rity for parents against the vicissitudes remuneration received by workers in of old age has come under close scru- paid employment may not encourage tiny. Adverse economic conditions and subscription to the third tier. In addi-

642 http://aps.journals.ac.za African Population Studies Vol 25, 2 (Dec 2011) tion, the instability of the value of the and relatives must gird up their loins to Ghanaian cedi due to inflation discour- provide adequate care and support to ages workers to register for personal their elderly parents. There is a need life insurance as an additional security to for the government and NGOs to make cater for their needs in old age. strenuous efforts to bridge the big gap The continuous existence of the between producing a concise policy witches’ camps is a blot on the con- document and its implementation. science of the nation which professes to uphold human rights. The human rights Acknowledgement of the women particularly elderly I would like to express my deep appre- women in the witches’ camps are being ciation to the Executive Director of trampled upon. Government’s inter- HelpAge Ghana for stimulating discus- vention through enactment of a law sions on population ageing in Ghana as banning the witches’ camps will bring well as providing me with a copy of the great psychological relief to these National Ageing Policy and its imple- accused women. The passing of the law mentation action plan. banning the witches’ camps should be done with as little delay as possible. In addition, continuous and sustained pub- References lic education to encourage the children Apt, N.A. 1993. Care of the elderly in and relatives of these women to take Ghana: An emerging issue. Journal of the accused women back into the fam- Cross-Cultural Gerontology, 8, 4: ily fold should be vigorously done by 301-312. the Department of Social Welfare, faith ____ 1996. Coping with old age in a based organizations, and NGOs. changing Africa: Social change and The implementation of the National the elderly Ghanaian. Averbury Ageing Policy requires adequate budg- Aldershot, Brookfield. etary allocation of financial resources by Bengtsson, T. and Kirk, S. 2011. government. The Ministry of Employ- Population ageing and the future of ment and Social Welfare must spear- the welfare state: The example of head the implementation of the Sweden. Population and National Ageing Action Plan by ensuring Development Review. A suppl- that both lead and collaborating agen- ement to Volume 31, pp. 158-170. cies effectively play the specific roles Drucker-Brown, S. 1993. Mamprusi assigned to them in the Action Plan. witchcraft, subversion and changing gender relations. Africa 63, 4: 531- Conclusion 549. The consequences of population ageing Economic Commission for Africa go beyond the impacts considered in (South Africa Office). 2004. Mission this paper. The National Ageing Policy Report. ECA/SA/MR/2004/34. and the pension’s system reforms are Ferreira, M. and Lindgren, P. 2008. necessary and urgent. Their sound Elder abuse and neglect in South implementation should bring great Africa: A case of marginalization, dis- relief to the elderly in old age. Children respect, exploitation and violence.

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Journal of Elder Abuse and Neglect, 24, Salvador de Bahia, Brazil. 20, 2: 91-107. Kpedekpo, G.M. K. 1982. Essentials of Gaisie, S. K. 2005. Assessment and demographic analysis for Africa. adjustment of population age and Chapter 3. Heinemann, Ibadan. sex structures, 1960-2000 Ghana Mba, C.J. 2002. Determinants of living censuses. Population data analysis arrangements of Lesotho’s elderly report. Volume 1. Socio-economic female population. Journal of and demographic trends. Chapter 2. International Women’s Studies, 3, 2: Ghana Statistical Service. 2005. 1-22. Population data analysis report. ____ 2007. Gender disparities in living Volume 1. Socio-economic and arrangements of older people in demographic trends. Ghana: Evidence from the 2003 Ghana Statistical Service (GSS), Ghana Ghana Demographic and Health Health Service (GHS) and ICF Survey. Journal of International Macro. 2009. Ghana Demographic Women’s Studies 9, 1: 153-157. and Health Survey 2008. Accra, Ministry of Employment and Social Ghana: GSS, GHS, and ICF Macro. Welfare. 2010. National Ageing Golini, A. 1999. Population ageing: Policy: Ageing with security and current demographic setting and the dignity. future. Paper presented to the ____ 2010. National Ageing Policy: Economic Commission for Europe Ageing with security and dignity. International Conference on State of Implementation Action Plan. the Older Population: Prelude to the National Research Council. 2006. Aging Twenty-first Century, Sion, 13-15 in sub-Saharan Africa: December. Recommendations for furthering ____ 2004. Possible policy responses to research. Panel on policy research population ageing and population and data needs to meet the decline: The case of Italy. Policy challenge of aging in Africa. responses to population decline and Committee on Population. Cohen, ageing. Special Issues Nos. 44/45. B. and Menken, J. (Eds). Washington United Nations. New York. DC: National Academies Press. Ham-Chande, R., Palloni, A. and Wong, Office of the Director-General. 2002. R. 2009. Aging in developing Second World Assembly on Ageing. countries: Building bridges for Main assembly statement. World integrated research agendas. Health Organization. International Union for the Scientific Qiao X. 2001. Aging issues and policy Study of Population policy and choices in rural China. Paper research papers number 22. presented at the International Union Kalasa, B. 2001. Population and ageing for the Scientific Study of in Africa: A policy dilemma? Paper Population’s XXIVth General presented at the International Union Population Conference, Salvador, for the Scientific Study of Brazil, 20-24 August 2001. Population’s XXIVth General Republic of Ghana. 1992. Constitution Population Conference, August 18- of the Republic of Ghana. Tema

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