MoWAC & UNICEF SITUATION ANALYSIS REPORT A Situation Analysis of Ghanaian Children and Women A Call for Reducing Disparities and Improving Equity UNICEF and Ministry of Women & Children’s Affairs, Ghana October 2011 SITUATION ANALYSIS REPORT MoWAC & UNICEF MoWAC & UNICEF SITUATION ANALYSIS REPORT PREFACE CONTENTS Over the past few years, Ghana has earned international credit as a model of political stability, good governance and democratic openness, with well-developed institutional capacities and an overall Preface II welcoming environment for the advancement and protection of women’s and children’s interests and rights. This Situation Analysis of Ghanaian children and women provide the status of some of List of Tables and Figures V the progress made, acknowledging that children living in poverty face deprivations of many of their List of Acronyms and Abbreviations VI rights, namely the rights to survive, to develop, to participate and to be protected. The report provides Map of Ghana IX comprehensive overview encompassing the latest data in economy, health, education, water and Executive Summary X sanitation, and child and social protection. What emerges is a story of success, challenges and Introduction 1 opportunities. PART ONE: The indings show that signiicant advances have been made towards the realisation of children’s rights, with Ghana likely to meet some of the MDGs, due to the right investment choices, policies THE COUNTRY CONTEXT and priorities. For example, MDG1a on reducing the population below the poverty line has been met; school enrolment is steadily increasing, the gender gap is closing at the basic education level, Chapter One: child mortality has sharply declined, full immunization coverage has nearly been achieved, and the The Governance Environment 6 MDG on access to safe water has been met. A .Political Framework 6 B. Policy Framework 7 However, the report acknowledges that challenges remain in relation to particular areas of child development, such as nutrition, in maternal mortality reduction and access to improved sanitation, and the evidence indicates that some groups of children, such as those living in rural areas and Chapter Two: in northern Ghana and those that are orphaned and vulnerable, are not beneiting from growth The Development Environment 13 and poverty reduction as much as other children. These poorest and most vulnerable children are A. Composition of Society 13 increasingly bearing a disproportionate proportion of the disease burden, of deprivation and of B. The Economic Environment 15 rights violations. The report also highlights the importance of capacity development for sustainable C. The Enduring Challenge of Poverty 21 improvements in child friendly services. D. Social Protection Policies and Strategies 26 The achievements of the Government will be measured, not just by the improvement in the political and economic situation, but by how successful it has been in helping women and children, Chapter Three: especially the poorest and most vulnerable, to realize their rights. The Situation Analysis provides The Human Rights Environment for Children and Women 32 useful insights on the extent and depth of some of the achievements, opportunities and challenges. A. Legislative and Normative Framework 32 The analysis goes beyond the national averages to uncover some of the trends in inequity and B. Gaps and Disparities in Fulilment of Human Rights 33 vulnerability by geography, gender and by socio-economic quintiles, among other variables. Hence, beyond describing the problem, it illustrates some examples of successful programmes that are addressing these problems and, where available, provides information on lessons learned and makes important recommendations that Government and its stakeholders could use in improving PART TWO: the situation of children and women in the country. It provides a baseline for the Government of MATERNAL AND CHILD SURVIVAL AND Ghana/UNICEF 2012-2016 Programme of Collaboration. DEVELOPMENT Overall, there is a strong commitment to accelerating results for the survival and development Chapter One: of Ghana’s children and women, and there is a greatly improved operating environment for implementing the necessary activities. While many vital steps dentiiedare i in the plans and policies Health of Children and Women 39 of many of the sector ministries, the Situation Analysis provides a comprehensive overview, allowing A. Maternal Survival, Health, and Nutrition 40 us to understand the overarching situation of children and women in Ghana today, pointing to areas B. Child Survival 44 where closer collaboration can increase eficiency and effectiveness, and highlighting some of the C. Childhood Illnesses 46 challenges that exist in prioritizing our actions for children, including, allocating resources to the poorest and most deprived in the society. The Situation Analysis will therefore serve as an excellent Chapter Two: resource for planning, guiding the deinition of goals and the identiication of actions that will prove most effective in delivering results for Ghana’s children and women. Nutrition 52 Chapter Three: HIV and AIDS 59 Hon. (Mrs) Juliana Azumah-Mensah, MP Dr. Iyabode Olusanmi Minister of Women and Children Representative, UNICEF Ghana III SITUATION ANALYSIS REPORT MoWAC & UNICEF MoWAC & UNICEF SITUATION ANALYSIS REPORT Chapter Four: Conclusion; Maternal and Child Survival LIST OF TABLES AND FIGURES and Development 65 A. The Underlying Causes of Child Morbidity and Mortality 65 TABLES B. Policies and Resources to Ensure Equitable Access to Table 1: Table of basic data about children and women in Ghana XV Quality Health Care 66 Table 2 Percentage of male and female inhabitants in urban and rural areas, 1960–2000 14 Table 3 National Health Insurance Scheme – Summary Statistics 28 Table 4 Percentage of trained teachers nationally and by deprived districts, 2003–2008 85 PART THREE: WATER, SANITATION, AND HYGIENE BOXES Water, Sanitation, and Hygiene 70 Box 1: Nutrition’s contributions to the attainment of the MDGs 52 PART FOUR: FIGURES EDUCATION Fig 1 GDP growth rates by sector, 2007–2010 19 A. Basic Education Access, Retention, Fig 2 Share of government of Ghana discretionary funds devoted to the and Completion 80 social sector, 2008–2011 20 B. Quality of Basic Education 84 Fig 3 Trends in poverty and extreme poverty in Ghana, 1991–2006 22 C. Equity in Basic Education 87 Fig 4 Regional trends of poverty in Ghana, 1991–2006 23 Fig 5 Individual NHIS membership by socio–economic group, 2009 29 Fig 6 Trends in maternal care indicators, 1988–2008 41 PART FIVE: Fig 7 Assistance during delivery, 2008 41 CHILD PROTECTION Fig 8 Percentage of women delivered by skilled providers, 2008 42 A. Domestic Violence Against Children 92 Fig 9 Percentage of women with access to emergency obstetric services (C- section), 2008 43 B. Child Labour 93 Fig 10 Trends in childhood mortality in Ghana, 1988–2008 45 C. Street Children 94Fig 11 Regional under- 5 mortality, 2003 and 2008 46 D. Child and Women Traficking 95 Fig 12 Continuum of care for health outcomes, 2008 47 E. Children Affected by Traditional and Harmful Practices 95 Fig 13 Insecticide treated net (ITN) ownership and utilization, 2003–2008 50 F. Children in Conlict with the Law Fig 14 Trends96 in nutritional status for children under- 5 years, 1988–2008 54 G. Birth Registration 97 Fig 15 Percentage of children under- 5 years stunted by region, 2008 55 H. Corporal Punishment 98 Fig 16 Trends in anaemia status among children under–5 years and women 15–49 years, 2003–2008 56 I. Polices and Resources for Child Protection 99 Fig 17 Household consumption of adequately iodisedlt, 2006 sa 57 Fig 18 Percentage of infant under 6 months exclusivelyast fed, bre 1993–2008 58 Fig 19 Breastfeeding status of children under 62008 months, 58 PART SIX: Fig 20 National HIV prevalence among pregnant 2000-2010women, 60 CONCLUSIONS Fig 21 HIV prevalence among pregnant women - trendsion, 2000–2010by reg 61 Fig 22 Drinking water coverage, 2008 71 Annex 1: International Treaties 106 Fig 23 Water and sanitation coverage status andin Ghana,trends 1990 and 2008 72 Annex 2: Status of MDGs in Ghana 108 Fig 24 Improved sanitation coverage and open ndefecatio rate in Ghana, 2006 72 Fig 25 Annual incidence of guinea worm cases in1989–2010 Ghana, 74 Fig 26 Percentage of children 5-14 years who havetended never school, at 2003–2008 80 Fig 27 Primary school attendance by gender and 08region, 20 81 BIBLIOGRAPHY 110 Fig 28 Attendance rates for children 6-14 year, by poverty, gender,d region, an 2003 and 2008 83 Fig 29 Percentage of pupils with minimum competency/proiciency in primary schools, 2009 85 Fig 30 Percentage of children in districts with substandard per capita expenditure at primary level, 2008 88 Fig 31 Birth registration for children under–5 years, 2008 98 Fig 32 Effect of corporal punishment on pupils, 2011 99 IV V SITUATION ANALYSIS REPORT MoWAC & UNICEF MoWAC & UNICEF SITUATION ANALYSIS REPORT GoG Government of Ghana GPI Gender parity index LIST OF ACRONYMS AND GPRS I Ghana Poverty Reduction Strategy (2003–2005) GPRS II Growth and Poverty Reduction Strategy (2006–2009) GSGDA Ghana Shared Growth and Development Agenda (2010–2013) ABBREVIATIONS GSS Ghana Statistical Service HDI Human Development Index ACSD Accelerated Child Survival and Development HIRD High Impact Rapid Delivery AIDS Acquired immunodeiciency syndrome HIV Human immunodeiciency virus ANC Antenatal care IDA International Development Association (World Bank Group) ARI Acute respiratory