INTRODUCTION 1 1.1 GEOGRAPHY, HISTORY, AND ECONOMY 1.1.1 Geography The Republic of Ghana is centrally located in West Africa and has a total land area of 238,537 square kilometres. It is bordered by French-speaking countries, on the east by the Republic of Togo, on the north and northwest by Burkina Faso, and on the west by Côte d’Ivoire. The Gulf of Guinea lies to the south and stretches across the 560 kilometres of the country’s coastline. Ghana is a lowland country, except for a range of hills that lie on the eastern border and Mt. Afadjato, the highest point of about 884 metres above sea level, which is to the west of the Volta River. Ghana can be divided into three distinguishable ecological zones: the sandy coastline backed by a coastal plain that is crossed by several rivers and streams; the middle belt and western parts of the country, heavily forested with many streams and rivers; and an undulating savannah to the north that is drained mainly by the Black and White Volta Rivers. The Volta Lake, created as a result of a hydroelectric dam in the east, is one of the largest artificial lakes in the world. The climate of Ghana is tropical, but temperatures and rainfall vary by distance from the coast and elevation. The average annual temperature is about 26ºC (79º F). There are two distinct rainy seasons, April to June and September to November. In the north, however, the rainy season begins in March and lasts until September. Annual rainfall ranges from about 1,015 millimetres (40 inches) in the north to about 2,030 millimetres (80 inches) in the southwest. The harmattan, a dry desert wind, blows from the northeast between December and March, lowering the humidity and creating very warm days and cool nights in the north. In the south, the effects of the harmattan are felt mainly in January. 1.1.2 History Ghana gained its independence from British rule on 6 March 1957, and on 1 July 1960 became a sovereign state in the British Commonwealth of Nations. The administrative and political capital of the country is Accra, with a population of 1.7 million (GSS, 2002). Ghana is a constitutional democracy and currently operates a multi-party democratic presidential system of government following the promulgation of the 1992 fourth Republic Constitution of Ghana. The country has an Executive Presidency elected for four years with a maximum of two terms. There is a parliament elected every four years, an independent judiciary, and a vibrant media. The population is made up of several ethnic groups. The Akans constitute the largest ethnic group (49 percent) followed by the Mole-Dagbon (17 percent), Ewe (13 percent), and Ga/Dangme (8 percent). Various smaller ethnic groups can also be found in many parts of the country (GSS, 2002). Ghana is divided into 10 administrative regions, Western, Central, Greater Accra, Volta, Eastern, Ashanti, Brong Ahafo, Northern, Upper East, and Upper West. The regions are further divided into 138 districts to ensure efficient and effective administration at the local levels. Introduction | 1 1.1.3 Economy The structure of the economy has not changed much over the past two decades. Agriculture, mining, logging, and retail trade are still the most important areas of economic activity. Agriculture is the main sector and employs about 50 percent of the population (GSS, 2002). High proportions of the working population in Ghana are concentrated in the informal sector, made up largely of self-employed persons. The leading exports of the country are cocoa, gold, and timber. In recent times, the economy has diversified and includes exports of non-traditional commodities such as pineapples, bananas, yams, and cashew nuts. Tourism is fast gaining prominence as a foreign exchange earner. The overriding objective of the Government of Ghana’s (GoG) economic development programme is poverty reduction and general improvement in the welfare of all Ghanaians. In 1995, the GoG developed the Vision 2020 strategy for poverty reduction, which emphasises economic growth, integrated rural development, expansion of employment opportunities, and improved access, especially by the rural and urban poor, to basic public services such as education, health care, water and sanitation, and family planning services (World Bank, 2003). Under this strategy, it is envisaged that national income will grow by at least 8 percent from the current 4-5 percent. 1.2 DEMOGRAPHIC PROFILE Ghana has undertaken four censuses since independence in 1957. The first was conducted in 1960, recording a population of 6.7 million. The 1970 Census reported Ghana’s population as 8.6 million with an intercensal growth rate of 2.4 percent. The 1984 and 2000 censuses put the population at 12.3 million and 18.9 million, respectively, with an average growth rate of 2.7 percent between the two census periods (Table 1.1). The population density per square kilometre has more than doubled from 36 persons in 1970 to 79 persons in 2000. The proportion urban increased significantly from 29 percent in 1970 to 44 percent in 2000. Table 1.1 Basic demographic indicators Selected demographic indicators for Ghana, 1970, 1984, 2000 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Indicator 1970 1984 2000 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Population (millions) 8.6 12.3 18.9 Intercensal growth rate (percent) 2.4 2.6 2.7 Density (pop./km2) 36.0 52.0 79.3 Percent urban 28.9 32.0 43.8 Sex ratio 98.5 97.3 97.9 Proportion age 0-14 years 46.9 45.0 41.3 Proportion age 65+ 3.6 4.0 5.3 Life expectancy (years) Male u 50.3 55.4 Female u 53.8 59.6 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– u=Unknown (Not available) Source: GSO, 1979; GSS, 1985; GSS, 2002 The sex ratio over the last 30 years has fallen slightly from 98.5 males per 100 females in 1970 to 97.9 in 2000. The proportion of the population under 15 years however, has decreased from 47 percent in 1970 to 41 percent in 2000, while the proportion 65 years and older increased from less than 4 percent to a little more than 5 percent over the same period. The changes observed in the age structure may be attributed to 2 | Introduction declining fertility and improvements in the health conditions of the people. Life expectancy at birth has increased from 50 years among males in 1984 to 55 years in 2000 and among females from 54 years to 60 years over the same period. 1.3 POPULATION POLICY AND REPRODUCTIVE HEALTH PROGRAMMES Ghana’s population policy was formulated and adopted in 1969 in recognition of the high population growth and fertility rates observed at the time. After 25 years of implementation, however, the 1969 population policy made only a modest impact. It was therefore revised in 1994 to take into account emerging issues such as HIV/AIDS, population and the environment, concerns about the elderly and children, and also to develop new strategies that would ensure the achievement of the revised policy objectives. This meant ensuring the systematic integration of population issues in all areas of development planning. Major targets aimed at achieving these objectives include the following: the reduction of the total fertility rate from 5.5 in 1993 to 5.0 by the year 2000; the achievement of a contraceptive prevalence rate of 15 percent for modern methods by the year 2000, and 50 percent by the year 2020; and the reduction in the annual population growth rate from about 3 percent per annum to 2 percent by the year 2020 (World Bank, 2003). The attainment of these policy goals is recognised as integral components of the national strategy to accelerate the pace of economic development, eradicate poverty, and enhance the quality of life of all citizens as outlined in the Vision 2020 Plan of Action. It is expected that these goals would propel Ghana into middle- income country status by the year 2020. The National Population Council and its Secretariat were established in 1992 as the highest statutory body to advise the government on population related issues as well as to facilitate, monitor, coordinate, and evaluate the implementation of population programmes of other organisations both public and private within the country. Ghana, in collaboration with the United Nations Fund for Population Activities (UNFPA), the United States Agency for International Development (USAID), the World Bank, and other development partners, has implemented several projects aimed at reducing reproductive health problems among the population. The support from these agencies is geared towards strategies on policy coordination and implementation as well as service delivery. The government is committed to improving access and equity of access to essential health care, and ensuring that the health sector plays a key role in the Ghana Poverty Reduction Strategy (GPRS). The priority health intervention areas identified include addressing the problems of HIV/AIDS and other sexually transmitted infections (STIs), malaria, tuberculosis, guinea worm disease, poliomyelitis, reproductive health, maternal and child health, accidents and emergencies, non-communicable diseases, oral health and eye care, and specialised services. The spread of HIV/AIDS is currently receiving considerable attention from the government and its development partners, with the immediate challenges including ensuring implementation of the Ghana HIV/AIDS Strategic Framework: 2001-2005 (World Bank, 2003). The objectives of the framework include reducing new HIV infections among the 15-49 age group and other vulnerable groups, and especially among the youth by the year 2005, improving service delivery and mitigating the impact of HIV/AIDS on individuals, the family, and the community by the year 2005, reducing individual and societal vulnerability and susceptibility to HIV/AIDS through the creation of an enabling environment for the implementation of the national response, and establishing a well managed multi-sectoral and multi-disciplinary institutional framework for the coordination and implementation of HIV/AIDS programmes in the country.