COUNTRY PROFILE INDEX INTRA II GHANA

Transcription

1 COUNTRY PROFILE INDEX INTRA II GHANA MARCH 2004

2 TABLE OF CONTENTS TABLE OF CONTENTS... ii LIST OF TABLES... iv 1. INTRODUCTION Historical background of Ghana Socio-economic background of Ghana Population- age and sex structure Population density The Economy The Extent of Poverty Health Education DEMOGRAPHIC TRENDS Mortality Rates Fertility Cumulative Fertility Proximate determinants of fertility Age at first marriage and fertility Contraception POPULATION: GENERAL ASSESSMENTS Sources of income Working Status Economically Active (50 years and above) as against Employment Sector Economically Active (50 years and above) as against Occupation Economically Active (50 years and above) as against Industry Employment Status for Economically Active Population (50 years and above) Educational Levels by age groups Housing and living arrangements Ownership of Household Dwellings for Occupied Unit POPULATION: HEALTH INDICATORS Mortality rates and other related indicators Utilization of health services Main causes of death HIV/AIDS Morbidity rates and chronic disability BRIEF DESCRIPTION OF THE HEALTH CARE SYSTEM Historical organization and role of Primary health care in Ghana The Sector Programme of Work and the Ghana Poverty Reduction Strategy Health profile Disease profile Present organization of the public health sector Private non - profit providers Private for profit ii

3 5.3. Development of the health sector Structure composition and size of private health care in Ghana Private-not-for-profit Private-for-Profit Traditional Healers Traditional Birth Attendants Complementary or Alternative Medicine Quantity and quality of output of the private sector Financing of the public and private sectors Sources of funding for the public health sector Sources of funding in the mission sector Payment for services in the Private Sector REFERENCES AND ADDITIONAL READING iii

4 LIST OF TABLES Table 1. Infant and childhood mortality by urban-rural place of residence... 5 Table 2: Age-Specific Fertility Rates (per 1000 women) and Total Fertility Rates and the Crude Birth Rates for selected survey, Ghana Table 3: Total fertility rate by selected background characteristics, Ghana 1988, 1993, 1998 and Table 4: Childbearing Percentage distribution of all women according to number of Children ever born by current Age, Ghana 1979, 1988, 1993 and Table 5: Median age at first marriage among women age years by selected Background characteristics, Ghana Table 6: Percentage of all women and currently married women who are currently using a contraceptive method, Ghana Table 7: Percentage Distribution of Ghana s Age-Sex Structure by Five-Year Age Groups: Table 8: Percentage Distribution of Ghana s Future Elderly Population: Table 10. Health facilities by type and ownership NATIONAL Table 11. Rational Drug Use Indicators in the public & private sectors iv

5 MAP OF GHANA SHOWING REGIONAL CAPITALS 1

6 1. INTRODUCTION 1.1. Historical background of Ghana Ghana is located in West Africa. It is bordered on the north and north west by Burkina Faso, on the east by Togo, on the west by Cote d Ivoire and on the south by the Gulf of Guinea. The country covers an area of 238,537 square kilometres (92,100 sq.ml) and has an estimated population of over 18.9 million people (2000 Population and Housing Census) of which 56.2 percent live in rural areas. A former British colony of the Gold Coast, the country gained its independence in 1957, but since that time Ghana has spent more than half of its years of independence under military rule. At independence in 1957 Ghana had one of the most promising economies in Sub- Saharan Africa. However the country experienced severe economic crisis in the 1970s which was characterised by high inflation rates, low productivity, falling exports, and sluggish GDP growth Socio-economic background of Ghana Population- age and sex structure At an annual growth rate of 2.6 percent, the country in 2000 registered a population increase of 53.8 percent over the 1984 population. Like most developing countries, Ghana has a very youthful population; 41.3 percent of the population are children (< 15) implying a high dependency ratio. The proportion of elderly persons (64 years and above) has increased to 5.3 per cent (from 4.0 per cent in 1984). The dependency population has thus dropped to 46.6 percent (from 49.0 per cent in 1984) giving an overall dependency ratio of 87.1 compared to 96.2 in The gender composition on the other hand, is fairly even; females account for 50.5 percent of the population, while males account for 49.5 percent. The proportion of the elderly (65 yrs and above) at 5.3% (998,940), a substantial increase from the 4.0% in 1984, is also a reflection of improvement in health and life expectancy which is 7.3% (1,365,291) for 60 years and above. It is 12.2% (2,287,587) for 50 years and above. The ratio of the elderly to children also increased from 8.5 in 1984 to 12.8 in 2000, which is further indication of increase in ageing of the population, though slight. The fact that the population is ageing is also reflected in the increase of the median age from 18.1 years in 1984 to 19.4 years in This increase is more pronounced among females, an indication that females have benefited from improvement in health and life expectancy more than males. It is also in line with the general universal pattern whereby life expectancy is higher for females than males Population density The 2000 population figure yields a density of 79.3 persons per sq. km. While this may indicate no great pressure of population on land, the same cannot be said of pressure on resources or what the land can generate. The most populous region is Ashanti (19.1 percent), followed by Greater Accra the capital (15.4) and Eastern (11.1 percent) Greater Accra is however, the most densely populated region with persons per sq. km., followed by Central (162.2 persons) and Ashanti (148.1 persons). Apart from 2

7 Greater Accra (87.7 percent) and Ashanti (51.3 percent), the rest of the country remains predominantly rural, in spite of the substantial increase in the level of urbanization since 1984 (43.8 percent compared to 32.0 percent in 1984) The Economy The Economic Reform Programme of 1983 marked a major shift in government s approach to promoting growth and development by removing impediments to the smooth functioning of markets. It represented a change in policy direction from a state controlled economy to a market driven economy. Key Development Indicators Indicator Va lue Year Population size 18.6 million 2000 Population growth rate 2.6% 2000 Life expectancy at birth GDP growth rate 4.0%* 2001 Real per capita growth 1.4%* 2001 % Population below national poverty line 39.5% 1998/99 Estimates HIV prevalence rat e (15-49 age group) Population with access to safe water supplies 40% 1998/99 Proportion of underweight children (under 5 years) 25% 1998 Gross primary enrolment rate 77.6% 2000 Net primary enrol ment rate Gross primary enrolment rate for girls 71% 2000 Under-five mortality rate (per 1,000 live births) 108/1, Maternal mortality rate (per 100,000) /100, Delivery supervised by doctor/traine d nurse/midwife Immunisation coverage *P rojec ted Source- MDG, 2002 With macro-economic stabilization as a priority objective, the ERP focused primarily on fiscal, monetary and trade reform. Key features of the new policy regime included price and interest rate deregulation, trade liberalization and a gradual shift from a fixed to a floating exchange regime. Trade liberalization was associated with the abolishment of the import licensing system, tariff reduction and rationalization. In spite of these programs however, the country failed to achieve sustained periods of macro-stability. The ERP was followed by the Structural Adjustment Programmes (SAPs), which focused on structural reforms particularly public, legal and regulatory reforms. Furthermore, the structural reforms, which largely focused on public, financial, legal and regulatory framework, have not yielded the expected outcomes. The Vision 2020 originally the National Development Policy Framework represented an attempt to achieve middle income status by the year 2020 thereby reducing poverty and improving the welfare of all Ghanaians. However, its implementation was plagued by a lack of coordination between the planning (i.e., the National Development Planning Commission) and budgetary (the Ministry of Finance) institutions. This discord was reflected in marked disparities between Plan targets and budgetary forecasts (MDG, 2002). The economy of Ghana is largely agrarian as evidenced by the dominance of agriculture (about 36 percent) in total GDP. Although agriculture accounts for the largest share of 3

8 GDP, its growth rate has lagged the other sectors largely on account of inefficient farming practices, dependence on rain-fed agriculture and poor transport and distribution channels. Although overall agricultural growth averaged 4.1 percent over the periods, growth in the crops and livestock sector, which accounts for approximately 25 percent of GDP, has ranged between 2 and three percent for the same period. Current Presidential Special Initiatives (PSIs) in cassava and oil palm among others are supposed to help boost the agricultural sector. Efforts such as the increase in producer price of cocoa, bonus payment s, and, mass spraying s are all in attempt to boost the cocoa industry in Ghana The Extent of Poverty The fourth Ghana Living Standards Survey revealed that while overall poverty rates improved (i.e. poverty fell 12 percentage points from 51.7 percent to 39.5 percent between 1991/92 and 1998/99) there is growing evidence of deepening poverty among some groups and regions of the country particularly in the northern and central regions of the country. Five out of ten regions in the country had more than 40 percent of their population living in poverty in Of the ten regions, six experienced increases in poverty and extreme poverty in Food-crop farmers experienced the highest incidence of poverty in Ghana. Approximately 60 percent of those engaged in this economic activity (majority being women) fell below the poverty line in 1998/1999. In effect, improving agricultural productivity must be central to any initiatives aimed at addressing poverty in Ghana and reducing gender disparities in the distribution of income Health Access to health facilities, defined by proportion of population living within one-hour travel time (by any means) from the health facility, is 60 percent for the total population (92 percent in urban and 45 percent in rural). Using a half-hour travel time, half of the population does not have access. Access is also hindered by the organisation of services. Primary facilities provide a limited range of services, thus making many health services (including basic diagnostic services) unavailable. There is limited access to specialists. Indeed, data from the study on Poverty Trends in Ghana in the 1990s indicated that Ghanaians were less likely to go to hospital or consult well-qualified health personnel in 1998/1999 compared to 1991/1992. Increasing numbers were not consulting anyone at all. The proportion of rural dwellers that did not consult health personnel increased from 44.1percent to 51.5percent during the period. Life expectancy increased from 54 years in 1988 to 57 in 1998, and is now estimated at 60 years. The infant mortality rate has dropped from 83 live births per 1000 in 1988 and to 56.7 in Under-five mortality rate has dropped from per 1000 to per 1000 live births in the same period. In spite of this improvement the six main causes of morbidity among children persist. Malaria, Acute Respiratory Infections, pneumonia, diarrhoea, malnutrition, anaemia, measles account for 50 percent of all childhood admissions into hospitals and 30 percent of childhood deaths. Although the situation has witness slow improvements, it is noted that disease pattern and ill-health have not changed much, with new emerging epidemics including HIV/AIDS and drug-related mental health conditions. 4

9 Education The Free Compulsory Universal Basic Education (FCUBE) programme has contributed to marginal increases in access to basic education mainly through the building of additional basic schools. At the end of 1999, there were 13,014 public and private primary schools, with a total enrolment of 2,333,347 pupils, and 5,879 Junior Secondary Schools. While overall enrolment increased at a rate of 3.1 percent between 1990 and 1996, the rate of increase was considered to be slow. The gross enrolment ratio (GER) rose marginally from 76.5 percent in 1996 to 77.3 percent in 1999/2000. This was far less than the targeted figure of 82 percent. Gender parity has been steadily improving; rising from 0.82 females to males in primary school in 1990, to 0.87 in There is still a high dropout rate, though. Approximately 20 percent of boys and 30 percent of girls drop out before completing their basic education. Of those who continue up the education ladder, 15 percent of boys and 21 percent of girls drop out before completing the Junior Secondary School. Drop out rates in parts of the Northern Region remain high. Gender parity in the three northern regions is significantly below the national average. In Northern Region, it is 0.6 to 0.44 in primary and junior secondary schools. 2. DEMOGRAPHIC TRENDS 2.1. Mortality Rates Studies have shown that there is a relationship between level of infant mortality and fertility. For instance, Freedman (1966) found that one of the necessary conditions of low levels of fertility through birth control is a substantial fall in infant mortality. Findings from the Ghana Fertility Survey and the Ghana Demographic and Health Surveys show that infant and child mortality rates are on the decline (Table 1 and Fig. 1). The GFS rates appear to be underestimated and therefore could not be the true mortality levels and this has been explained (Owusu, 1984). The GDHS mortality rates for succeeding years are higher but declined substantially after Thus, infant mortality increased to 77 per1000 live births during the period but reduced to 57 in 1000 for the period There is a slight rise in infant mortality for the period Similar pattern is observed for the under-five. There was initial rise in the under-five mortality for the period but decline steadily after. There is however a rise in the under-five mortality during the period Similar rise was noticed for under-one year which will be reflection of low nutritional status of children. Table 1. Survey Year Infant and childhood mortality by urban-rural place of residence Approximate Infant Under-five Calendar Mortality Mortality Period (1q0) (5q0) Source: GFS ( ), GDHS (1988, 1993, 1998 and

10 Figure 1: Trends in infant and Under-five Mortality - Ghana, Deaths per 1,000 births Infant Mortality Under-five Mortality Survey Year The first post independence national population census was conducted in The result of the census showed that Ghana s population was 6.7 million. The next population census of Ghana was conducted in It recorded the number of people in the country had increase to 8.6 million showing an annual rate of increase of 2.4 percent. The third population census of Ghana conducted in 1984 showed the size of Ghana s population as 12.3 million which put the inter-censal growth rate at 2.6 percent. By 2000 the population of Ghana has increased to 18.9 million showing an increase of 53.8 percent over the 1984 population of 12.3 million and represents an inter-censal growth rate of 2.7 percent. The result of the 2000 census has indicated a tripling of the population of Ghana between 1957 and 2000 or doubling of the 1970 population within 30 years Fertility With a substantial proportion of Ghana s population under fifteen years of age, fertility level in Ghana is expected to be high. Indeed, successive fertility surveys (Table 2 and Fig. 2) since 1979 point to high fertility rates which have been the case especially for 1979 (6.3), 1988 (6.4) and 1993 (5.5). Fertility levels have however not been constant. It is observed that there has been a steady decline in the TFR from 6.4 in 1988 to 4.4 in

11 Figure 2: Total Fertility Rates - Ghana, TFR GFS (1979) GDHS (1988) GDHS (1993) 5.5 Survey GDHS (1998) GDHS (2003) Table 2: Age-Specific Fertility Rates (per 1000 women) and Total Fertility Rates and the Crude Birth Rates for selected survey, Ghana Age Groups GFS 1979 GDHS 1988 GDHS 1993 GDHS 1998 GDHS TFR (women age 15-49) Crude Birth Rate (CBR) Sources: GFS ( ), GDHS 1988, 1993, 1998 and 2003 Table 2 shows differences in the age specific fertility rates from 1979 to The differences is explained on cultural practices in Ghana which is reflected in the wide variation in fertility rates in urban rural place of residence and the regions (Table 2) where fertility level is persistently higher for the rural areas compared with the urban areas. Among the regions, fertility rate is lowest for Greater Accra Region but highest for the Northern Region. The various surveys conducted in Ghana, namely: the Ghana Fertility Survey (GFS, 1979), the Ghana Demographic and Health Surveys (GDHS 1988, 1993, 1998 and 2003) ascertained for the country the fertility levels, infant and child mortality levels as well as other fertility and mortality related issues. The Ghana Fertility Survey was the first and the most comprehensive fertility survey ever undertaken in Ghana to collect detailed fertility data (Owusu, 1979). The data like all the successive fertility surveys, were derived from birth and pregnancy histories collected from females aged years. To minimize any omission or errors for which many retrospective survey data are known, 7

12 female respondents were first asked to state the number of sons and daughters. Out of this the female respondent was to state which of the children live in the households and those who lived elsewhere and the number who had died. Table 3: Total fertility rate by selected background characteristics, Ghana 1988, 1993, 1998 and Selected Background Total Fertility Rate Characteristics Residence Urban Rural Region Western Central Greater Accra Volta Eastern Ashanti Brong Ahafo Northern Upper East Upper West Education No Education Primary Middle/JSS Secondary Total Sources: GDHS 1988, 1993, 1998 and 2003 Socio-cultural value of children Socio-cultural factors contributed immensely to fertility levels in Ghana. For example, the Ghanaian society has placed high economic and social values on children. Childlessness is not entertained and among some ethnic groups in Ghana, a deceased childless adult undergoes some rituals as a form of punishment to ensure that in the next life (reincarnation) the deceased childless adult would endeavour to have children. On some marriage occasions, the prayer offered for those about to marry is may you have 30 children (Gaisie, 1968). As an economic value, having many children is an insurance against old age. In a largely rural agrarian communities children are source of labour. 8

13 These socio-economic factors influence greatly fertility levels in Ghana to the extent that the monetary cost and time spent in bringing up children are over looked Cumulative Fertility Results of the surveys show that the rate of childbearing is not extremely high at young ages (Table 4). The rate has been increasing over the years. For instance, the GFS found that 78.7 percent of year-olds and 24.1 percent of year-olds were childless but the percentage of childlessness at ages for GDHS 1988, 1993 and 1998 was 80.7, 81.4 and 88.3 in that order showing an increase in childlessness over time. The pattern is the same for ages where childlessness went up from 24.1 percent in 1979 to 39.2 percent in It however is evident from the data that the number of children ever born increases consistently with age. Thus, by age 44 years almost ninety-eight percent of women in Ghana have had a child. This means that primary infertility and sub-fecundity are very low among women in Ghana. Table 4: Childbearing Percentage distribution of all women according to number of Children ever born by current Age, Ghana 1979, 1988, 1993 and 1998 Current Age GFS 1979 GDHS 1988 GDHS 1993 GDHS 1998 No. of No. of No. of No. of Women % Women % Women % Women % Total Sources: GFS (1979), GDHS (1988, 1993 and 1998) Proximate determinants of fertility With the exception of contraception which regulates fertility, there are other well known and very important factors that affect a woman s risk of becoming pregnant known as proximate determinants. These include nuptiality, sexual activity, post partum amenorrhoea and abstinence from sexual relations and termination of exposure to pregnancy. It must be noted that marriage and sexual relations relate to childbearing while post partum amenorrhoea and abstinence affect the intervals between births. All these factors are important for understanding fertility behaviour. But the salient one is the age at first marriage because it is basic to a woman s exposure to child bearing (Coale, 1977; Bongaarts, 1982). 9

14 Age at first marriage and fertility The principal factor which influences fertility is the age at first marriage. This is because women who marry early are exposed to a relatively longer period of childbearing. A young age at first marriage would therefore imply early age at childbearing and a higher level of fertility for the society. For example, GFS (1979) found that those who married under age 15 have more children than their counterparts who married at age 25 and above. It is observed (Table 5) that the median age at first marriage in Ghana has been rising slowly over the past decades. The overall median age for women age is 18.3 in 1988, 18.8 in 1993 and 19.1 in 1998, showing an increase of 4.4 percent. The data suggest that rural women get married one year earlier because while the median age at which rural women marry is 19 years that of their urban counterpart is 20 years. Table 5: Median age at first marriage among women age years by selected Background characteristics, Ghana Background Characteristics Residence Urban Rural GFS Total Fertility Rate GDHS GDHS GDHS Region Western Central Greater Accra Volta Eastern Ashanti Brong Ahafo Northern Upper East Upper West Education No Education Primary Middle/JSS Secondary Total Sources: GFS 1979, GDHS 1988, 1993 and

15 Contraception There is a relationship between fertility and contraceptive prevalence. For this reason, it is strange that a country where an official contraceptive programme has been operating for almost 30 years, the use of contraceptives among women is very low in Ghana. Even though, current use (Table 6) increased from 13 percent in 1988 to 20 percent in 1993 to 22 percent in 1998 and 25 percent in Yet the prevalence is very low. Several factors may have accounted for the low use of contraceptives in Ghana. One of such reasons is the desire for more children, and fear of side effects. Table 6: Percentage of all women and currently married women who are currently Using a contraceptive method, Ghana Contraceptive Use GFS 1979 GDHS 1988 GDHS 1993 GDHS 1998 All Women Any method Any modern method Currently Married Women Any method Any modern method Sources: GFS 1979, GDHS 1988, 1993and Trends In Age And Sex Structure The dynamics of a country s age-sex structure are pivotal to most demographic, health, social and economic studies. In particular, the demographic profile of a country is incomplete without an examination of the country s age and sex distribution. Knowledge of the proportion of persons in the conventional five-year age groups and broad age groups has implications for planning in health, education, and social services. The age and sex structure of Ghana s population for the period is presented in Table 7. The age and sex distribution reveals that there are more persons in the younger age groups due to past high fertility and concomitant rapid population growth. However, because of the impact of mortality, which increases with age, the proportion of persons decreases with advancing age. The table shows that children below 15 years of age have consistently constituted the largest proportion of the country s population over the years. About 4 in every 10 Ghanaians are children aged 0-14 years, implying that Ghana is still a young population, a situation that is characteristic of a developing country. However, the proportion of these children has been declining since 1984 as a result of declining fertility and uptake in female formal education. The proportion of persons aged years, conventionally referred to as the economically active population, has generally remained around 50 percent over the years, while persons aged 65 years and above have the least proportion in the population. 11

16 Table 7: Percentage Distribution of Ghana s Age-Sex Structure by Five-Year Age Groups: Age Group Both Male Female Both Male Female Both Male Female Both Male Female Sexes Sexes Sexes Sexes Total Number 6,726,815 3,399,908 3,326,907 8,559,313 4,212,883 4,349,430 12,296,081 6,063,526 6,232,555 18,912,079 9,357,382 9,554,697 Sources: The 1960, 1970, 1984, and 2000 Population Censuses of Ghana. 12

17 What can be said of both sexes applies also to either sex. But whereas there were more males than females in 1960, the sex ratio (the proportion of males per 100 females) shifted in favour of females in subsequent censuses. It is interesting to note that although Ghana s age-sex structure has not changed much during the period under review, both the number and proportion of persons aged 50 years and over have been increasing population breakdown Table 8 depicts the percentage distribution of Ghana s elderly population, that is persons aged 50 years and over, by sex for the period As should be expected, there are more people aged years than in the succeeding age groups since they are much younger and ceteris paribus the force of mortality is felt much more in the older than younger ages. This pattern is maintained for both sexes and each sex. What is striking about the table is that the proportion of the aged population in each age group has generally risen over the years. Additionally, both the number and proportion of the elderly to the total population have been consistent for both sexes and for each sex. The proportion of the elderly to the total population increased from 9 percent in 1960 to 12 percent in 2000, while the number rose from 0.6 million to 2.3 million over the same period. The increase in the number and proportion of the elderly persons lend itself to a number of factors. Paramount among these are improvements in life expectancy (resulting in more people surviving to old age) precipitated by improved public health measures, better nutrition and personal hygiene; and declining fertility, which reduces the share of the young children to the total population. 13

18 Table 8: Percentage Distribution of Ghana s Elderly Population by Sex: Age Group Both Male Female Both Male Female Both Male Female Both Male Female Sexes Sexes Sexes Sexes Total Number 616, , , , , ,583 1,284, , ,576 2,292,144 1,137,858 1,152,296 Sources: The 1960, 1970, 1984, and 2000 Population Censuses of Ghana. Note: The percentages refer to proportions of the aged population to the total country population. 14

19 Evidence from many countries suggests that women live longer than men (see, for example, United Nations, 2003; 2001; United Nations Economic Commission for Europe, 1999; Martin, 1990; Cowgill, 1986; Traore, 1985). Also, because women marry men much older than themselves, especially in parts of Africa, they are expected to survive their husbands. As a result, more elderly women than men should be expected at older ages. However, Table 8 does not tend to support this hypothesis as there seems to be more older men than women from the census results. Nevertheless, the table seems to suggest that the phenomenon of ageing is emerging in Ghana s population. It is therefore important to find out what the future proportion and size of the elderly population might be on the basis of past and current trends for possible policy interventions. Table 9 depicts the future age and sex structure of Ghana s older population for the period The projection results indicate that both the proportion and number of the elderly population are likely to increase in the coming years. The proportion of persons aged 50 years and above to the total population is expected to rise from 11 percent in 2005 to 13 percent in 2020 and then to 15 percent in 2025, while the corresponding number will increase from 2.4 million in 2005 to 3.8 million in 2020 and then to 4.5 million by There is some inconsistency when Tables 2 and 3 are compared in relation to the older population. This is due to the fact that values in Table 2 are the reported unadjusted census results, while values in Table 3 are based on the medium variant projection assumptions of the United Nations (2003) for Ghana. 15

20 Table 9: Percentage Distribution of Ghana s Future Elderly Population: Age Group Both Male Female Both Male Female Both Male Sexes Sexes Sexes Total Number 2,360,000 1,115,000 1,214,000 2,776,000 1,310,000 1,467,000 3,810,000 1,817,000 Source: United Nations, World Population Prospects, The 2002 Revision Vol. I: Comprehensive Tables. Department of Economic and Social Affairs, Population Division, ST/ESA/SER.A/222. New York. Note: Estimates are based on medium variant projections. The percentages refer to proportions of the aged population to the total country population. 16

21 It is expected that both the proportion and number of the female elderly population will be greater than their male counterpart in the coming years. The proportion of the older women to the total population is anticipated to rise from 11 percent in 2005 to 14 percent in 2020 and to 15 percent by 2025, while that of the older men is expected to increase from 10 percent in 2005 to 13 percent in 2020 and to 14 percent by Furthermore, the number of the female elderly population will rise from 1.2 million in 2005 to 2.0 million in 2020 and then to 2.4 million in 2025, while the number of the male older population will increase from 1.1 million in 2005 to 1.8 million in 2020 and then to 2.2 million by The preceding tables point to the fact that ageing should be one of the most important issues that need to be addressed in the country. In the developed countries, the demographic transition process leading to an ageing population has taken place over the span of about a century (Angel and Angel, 1997; Caldwell, 1982; Olson, 1994). This furnished plenty of warning and preparation time for increased numbers of elderly people. In Ghana in particular and Africa in general, this process of transition has occurred in a few decades. It should be noted that even countries with a high level of economic and social development would find it difficult adjusting to a rapidly ageing population in such a short time period. Then for countries still struggling with the problems of underdevelopment, where unfortunately most of these African countries are currently located, the challenges will be undeniably formidable. The government of Ghana and indeed African governments should be aware of this 'time bomb' before the situation gets out of hand because there is almost no social security benefits for most of the aged in much of Africa. Moreover, one major problem facing the aged today in Ghana and parts of Africa is the threat to the traditional system stimulated by modernization and economic development (Apt, 1996; Adepoju and Mbugua, 1997). Modernization and urbanization lead increasingly to the nuclearization of the African traditional family system, a system which emphasizes kin or extended family relationships that benefited the elderly. As the ageing of Africa s populations is expected to run concurrently with rapid social changes in the family structure, it is critically important for purposes of planning that attention should be paid to the status of the elderly persons in the society POPULATION: GENERAL ASSESSMENTS 3.1. Sources of income The Social Security and National Insurance Trust (SSNIT) in Ghana operate pension schemes initially for only those who were working in the Public and Private formal sector who are the minority. Majority of the older population are in the informal sector where they are not contributing to the social security scheme. This affects them in their older age. Currently, we have less than 66,000 pensioners on the SSNIT scheme. The minimum income from the scheme is One Hundred Thousand cedis ( 100,000) and the maximum income paying as at 2004 is twenty-one million cedis ( 21, 000,000.00) a month. There is no current statistics to represent the current sources of income of the targeted population under review (50 years and above.) However previous researches and work

22 Country Profile Index Intra II - Ghana done by experts in the field indicates the following as sources of income. Since the retirement age is 65 years, some of the population of our targeted group who are active and in the formal sector are still receiving income. On the whole, rural elderly people appear financially better off compared to the urban elderly population. Yet it is rather doubtful whether the average elderly particularly in the urban area is able to meet his/her economic commitment adequately. On the whole rural residents receive more contributions from children, many of whom are staying in the big towns and cities. The provision for housing by way of rent payment is a very small percentage because the majority of the elderly in the sample either live in family houses or housed built by children which are rent-free Working Status The potential work force of a nation derives from its adult population that is available and able to work. In all societies, however, there is room for those outside of the legally defined group (15-64) to engage in lawful activities for themselves or their families. There is enough evidence in Ghana, for instance, that children as young as 7 years do engage in family enterprise, while retired persons also engage in active economic pursuits. The population of interest, therefore, covers those aged as least 7 years at the time of the census. Of the potential work force, it is known that some may be pursuing legitimate concerns such as schooling that are not economic at the material time and therefore ate properly excluded from those the country can count on the production of goods and service. This category is referred to as economically non-active. At the same time is a category that includes people who did not actually work during the reference period but who, nevertheless are regarded as economically active because they are available and able to work. These are persons with jobs but on temporary leave and those without jobs but who are actively seeking employment, by writing applications or visiting agencies and institutions in search of a job Economically Active (50 years and above) as against Employment Sector Out of the total working Population the private sector provides employment to 91.2 percent of the working population: Out of this 80.4 percent of such work force are in the informal sector, 5.9 percent in Public Sector, 7.8 percent in Private Formal, 0.8 percent are working with NGO or International Organisation, 2.9 percent worked in semi-public and Parastatal and 2.2 percent for others. Among the Population aged 50+, 7.5 percent are in the public sector, 14.7 percent are in the private formal, 75.6 percent are in the Private informal, 0.9 percent are into Semi-Public and Parastatal, Non-Governmental Organisation and International Organisations and 0.7 percent present the other scattered minority sectors Economically Active (50 years and above) as against Occupation Out of the 12.2 percent of the older population aged from 50years and above, (2,284,817), 73 percent (1,687,587) are economically active. Out of this group their occupation varies, 58.9 percent are into Agriculturists, animal husbandmen, fishermen 18

23 Country Profile Index Intra II - Ghana and hunters percent are Sales workers, 9.8 percent are Professionals, technical and related workers. 6.1 percent are into production, transport operators and labourers, 4.5 percent are in service provision, 3.4 percent are clerical and related workers, 0.5 percent are Administrative and managerial workers and 5.1 percent and other workers Economically Active (50 years and above) as against Industry Further breakdown into specific Industry of the older population is as follows; agriculture, hunting and forestry employs 57.9 percent, fishing 2.7 percent, Mining and quarrying (galamsey, stone breaking, and other mining firms) industry engaged 2.5 percent, manufacturing 8.2 percent, electricity, gas and water supply, 0.4 percent, 1.6 percent into construction, 10.7 percent into wholesale and retail trade, 2.3 percent into hotels and restaurants, 2.55 percent into transport, storage and communication, 0.7 percent financial intermediation. In addition, 1.2 percent are into Real estate, renting and business activities, 1.9 percent into Public administration and defence, 3.4 percent into education, 1.2 percent into health and Social Work, 2.1 percent were involved in other community, social personal service activities. 0.6 percent are into private household with employed persons and finally 0.1 percent are into extra-territorial organisations and bodies Employment Status for Economically Active Population (50 years and above) Among the population aged 50 years and above, 71.9 percent are self-employed without employee, that is they engaged in their own work under any of the above category especially in Agriculture, Hunting and forestry Industry percent of them are working as employees of others, 5.9 percent are self-employed with employee, 6.5 percent are unpaid family workers, 0.7 percent are Apprentice, 0.4 percent are domestic Employers and 1.1 percent are into others Educational Levels by age groups Out of the total Population (2,284,817) of older people (50 years and above), 66 percent have never had any formal education of which females are higher than males. 0.2 percent ended up at pre-school, 3.1 percent have primary school education, 14.8 percent completed Middle School, 2.5 percent Secondary School, 1.8 percent had some kind of Vocational or Technical or Commercial School, 2 percent post-secondary and 9.3 percent had some Tertiary education Housing and living arrangements Living Arrangements: According to Apt (1996), small minority live in accommodation requiring payment of rents. The majority therefore live in rent-free accommodation of their own, of their ancestors, children or other relations. Where to live, couple with the increasingly exorbitant rents pertaining particularly in rural areas is a serious economic problem for the aged about to retire worker in the public sector. Many continue to work mainly because of lack of accommodation and the problem is even more compounded by the eve-rising cost of building materials in the country. In this sample of elderly people it is assumed that housing is not a serious economic constraint for the majority. However, in recent times it is becoming a source of concern to urban dwellers or civil and public servants when they come on retirement. 19

24 Country Profile Index Intra II - Ghana Against this background the survey (Apt, 1996) indicated that less than 30 per cent of the elderly live in houses of their own. The elderly are mostly living in family or ancestral houses (42 percent both in the urban and rural areas) and living in houses belonging to children is the next common living arrangement. The are more rural elderly in children owned houses than urban ones (rural 19 percent, urban 10.6 percent) which is not surprising since rural housing is cheaper to build than urban ones. Of those elderly parents living in children owned houses, 47 percent of the urban respondents had child owner living in the house with them so that is can be assumed that they (the elderly) are not heads of these households. Similarly in rural areas 27.7 per cent were living with the child who owned the house. A majority nevertheless of 72.3 per cent in rural areas and 53 per cent in urban areas lived in children owned houses were in the houses minus the children and could therefore be considered heads of these households Ownership of Household The 2000 Populations and Housing census, also indicates that most of the household, 69.9%, where the targeted population lived are households owned by a member of the family of their household, they range from Children, brothers, sisters among others who are also living within the same household. 0.9% of the household where they lived were bought by themselves. 10.3% of the household where they lived are owned by a relative who does not lived in the same household with them. 11.8% of the households where rented premises owned by other individuals, 2.9% lived in households owned by Private employers. Others, 0.3% also lived in other private agency buildings, that is, estate agencies among others, 1.6% lived in Government and public households and about 2.3% lived other forms of households apart from the above Dwellings for Occupied Unit The dwellings or the type of houses they lived in are as follows: 24.9% are living in a separate Houses that is they do not share with other families, lived in Semidetached houses, 4.6% lived in Flats and Apartments. However, majority of them, 45.8%, lived in compound houses and in rooms and in a few of them (0.1%) lived Tents. Some of them (4.7%) live in several huts buildings, o.55 lived in Hotels and hostels, 0.75 lived in Kiosks and in containers, 0.3% live in rooms attached to shops and 3.6% lived in other types of building not included in the above POPULATION: HEALTH INDICATORS 4.1 Mortality rates and other related indicators In general, the health status of Ghanaians as measured by mortality, fertility and nutritional indices, has improved since independence. However these improvements are considered to be slow compared to other countries especially in East and Southern Africa. The Demographic and Health Surveys (DHS 1988,1993,1998) shows that Infant Mortality Rate, which was around 133 for every 1000 live births in 1957 (SE) has steadily improved from 83.8 in 1988 to 56.7 deaths per 1000 live births in Over the 20

25 Country Profile Index Intra II - Ghana same period Under Five Mortality Rate has dropped from per 1000 live births to Life Expectancy has increased from 54 years in 1988 to 57 in Maternal Mortality Rate which is quoted at about 214 (GSS,1994) is generally considered to be unacceptably high. Total Fertility Rate (TFR) declined from 6.5 to 5.5 births per woman between 1988 and 1993, with much greater declines in urban areas. The 1998 Demographic and Health Survey (DHS) revealed a greater than expected decrease in TFR to 4.6. In contrast to mortality and fertility indicators which are improving at a faster pace than most of Sub-Saharan Africa, many nutritional indicators in Ghana have remained lower than expected over the years. The 1993 Demographic and Health Survey (DHS) estimated that among children aged 3-36 months, 30 percent were stunted, 31 were underweight, and 8 percent were wasted. In 1998, this had not improved and the DHS (1998) estimates were 26 percent, 31 percent, and 12 percent respectively. Micronutrient deficiency is also common, particularly of vitamin A, iodine, and iron. Between 1992 and 1993, the prevalence of Iodine Deficiency Disorder was 33 percent and 50 percent of pregnant women especially in the Northern Regions suffer from Iron Deficiency Anaemia Utilization of health services Utilization of health services which showed a significant reduction after the introduction of the user fee system in the late 1980 s has shown signs of recovery during the second half of the 1990 s to date. However the recovery is still below expectation when compared to the high levels of 1.6 to 1.8 per capita attendance registered in the 1970 s. Between 1997 and 2002 the per capita attendance increased from 0.38 to 0.49 with a significant rise between 1999 and Hospital admissions present a slightly different picture. One person in 30 is likely to be admitted into a public health facility during the year. This trend has remained consistent over the years. On the average one person is admitted for every 14.3 outpatient contact made in the year with Volta, Upper West, Eastern and Northern Regions being regions where an outpatient contact is most likely to result in admission. The age/sex pattern of admissions shows a peak in childhood (especially for male children), accounting for about a third of the total admissions, followed by a sharp decline in the 5-14 age group. While male admissions showed a plateau in the and age groups, followed by a decline in the older age groups, an increase in female admissions is usually observed in the reproductive ages. 21