By Keshia Osei-Kufour
In line with the Millennium Development Goals (MDGs) set in 2000, Ghana successfully achieved most of the indicators specified in 4 out of the 8 goals by 2015 that it aimed to take into consideration, according to the final Millennium Development Goals report issued by the UNDP. These goals were initially discussed in 1999, set in 2000 and delivered to developing countries with the global goal of improving the welfare of citizens. The eight MDG goals were:
– Eradicate Extreme Poverty and Hunger
– Achieve Universal Primary Education
– Promote Gender Equality and Empower Women
– Reduce Child Mortality
– Improve Maternal Health
– Combat HIV/AIDS, Malaria and other Diseases
– Ensure Environmental Sustainability
– Global Partnership for Development
The four goals Ghana had largely achieved by 2015 were to eradicate extreme poverty and hunger, to achieve universal primary education, to reduce child mortality, and to develop a global partnership for development. However, the fact that Ghana was successful in achieving these goals doesn’t represent the full story about improvements in welfare for Ghanaians. Focusing on these goals, and working to achieve the specific targets within them, may have led to some other key areas being missed. This article aims to critically assess Ghana’s performance as relates to the MDGs they were successful with, to observe whether or not Ghana concentrated too much on the MDGs to the detriment of actually improving development.
In order to achieve the MDGs, Ghana undertook many different poverty reduction strategies, as a way of implementing the goals at a local level. These measures were outlined in their poverty reduction strategies, the Ghana Poverty Reduction Strategy (GPRS I), the Ghana Poverty Reduction Strategy II (GPRS II), the Ghana Shared Growth and Development Agenda (GSGDA I) and the Ghana Shared Growth and Development Agenda II (GSGDA II).
In the decade before Ghana adopted the MDGs, in 1991/1992, 51.3% of the population were living below the upper poverty line of GHS370.89 per year. At the time of the adoption of the MDGs, in 1998/99, the upper poverty rate for the nation was 39.5%, while, after the adoption of the MDGs, using a new measure of poverty, with the upper poverty line of GHS1,314 per year, this reduced to 31.95% in 2005/2006 and 24.2% in 2012/2013.
Before 2001, the government had mostly focused its efforts on achieving macro-economic stabilisation rather than on poverty reduction. That being said, poverty still reduced by 11.8%. This could have been the result of the growth Ghana achieved in that time, where it sustained a GDP growth rate of 4-5% during the 1990s.
However, this figure doesn’t tell the whole story as relates to the poverty levels prevalent in Ghana. In the rural areas, i.e. the Northern, Upper East and Upper West regions, poverty is still an issue. By 2013, the incidence of poverty, measured by the upper poverty measurement, was 71%. In the Northern region, this was 50%, and in Upper East it was 44%. The disparity in figures around the country reflects the inequality that is present.
Even though the government had Poverty Reduction Strategies at the time that were in line with the MDGs, certain areas were ignored in these strategies, which could have further improved development in Ghana. Some areas where the GPRS I could have done better were if it had targeted employment, income distribution, and if it had attempted to tackle the informal sector of the economy.
A 2004 report published by the International Labour Organisation titled ‘Working out of poverty in Ghana’ stated that Ghana’s Poverty Reduction, which ran from 2003-2005, had failed to address certain aspects that pose a challenge to poverty reduction. Some of these aspects were employment targeting, public procurement, productivity and income distribution, an informal sector strategy and more focus on economically engaging people with disabilities. None of these recommended areas were specified in the MDG goals as something that a country should aim to improve, however they all affect development and welfare.
It has been estimated that 88% of the Ghanaian workforce is currently employed in the informal sector, which is an increase from the 2011 estimate of 80%. This could be a problem while addressing poverty, as these people are unlikely to receive a steady wage and are at risk of dangerous work conditions since they aren’t subjected to any employment regulations. The increase in the informal sector may be caused by the slight rise in unemployment from 4.2% in 2011, to 4.6% in 2013. A report by University of Malta, states that ‘the serious problem of poverty cannot be tackled without paying closer attention to the informal sector’. If those in informal employment were rather engaged in formal employment, where there is more regulation of employment, it could be possible to further reduce poverty.
[Source: World Bank, 2015]
Instead, Ghana’s poverty reduction policies have mostly focused on stabilising the macroeconomic environment. The I-PRSP was initially introduced to fulfil regulations pertaining to the eligibility of the Enhanced HIPC initiative, which state that, for a country to be eligible to receive funds it must have a Poverty Reduction Plan in place and in effect for at least one year. Hence, the I-PRSP was developed with the World Bank’s 2000-2003 country Assistance Strategy document in mind, implying that it was trying to secure the funds of the Enhanced HIPC initiative.
In 2003, after the abandonment of the I-PRSP, the Ghanaian government decided to embark on a new poverty reduction strategy called the Ghana Poverty Reduction Strategy (GPRS I), which was agreed upon with the IMF and followed from 2003-2005. The GPRS I led the government to focus on macroeconomic policies as a means of driving growth and reducing poverty and mostly focused on strengthening the private sector. This was possibly to the detriment of other factors, such as providing structural reforms and improving infrastructure. The Asian Development Bank stated that ‘public policy reforms and investment in physical infrastructure will significantly contribute to the pursuit of socially inclusive development’. Over the years 2003-2005, Ghana spent relatively less on infrastructure than some other Sub-Saharan African countries and had an infrastructure gap of 7% of GDP in the mid-2000s, which resulted in the infrastructure only contributing 0.5% to per capita growth from 2001-2005, below the ECOWAS average of 1%. Of the total investment on infrastructure of 2.7% of GDP in 2005, the majority came from private and state-owned enterprises, rather than from the government’s budget.
Based on a critical assessment of the GPRS I and some of its faults, such as complexity and non-transparency of regulations, lack of information on existing regulations, falling but still fairly high interest rates, and failure of the government to properly monitor and evaluate private sector policies, the Ghana Poverty Reduction Strategy II (GPRS II) was then released and implemented from 2006-2009. This strategy involved facilitating innovation and entrepreneurship, facilitating private sector access to capital, improving Ghana’s access to markets, increasing agricultural productivity, and diversifying the export base, to name but a few of the policies. However, this strategy had some challenges. It was linked to the Medium Term Expenditure Framework (MTEF). And resources were slightly mismanaged and were prioritised towards developing private sector competitiveness, and governance and civic responsibility, rather than towards developing human resources.
Despite the fact that Ghana achieved the goal of halving poverty before the deadline of 2015, in 2006/2007, more could have been done to improve the depth of poverty. Ghana could have focused more on the regional disparities in poverty and other underlying factors, such as the tackling the infrastructure gap and informal employment, in order to affect poverty positively.
Achieving Universal Education
Another MDG that Ghana achieved before the 2015 deadline was to accomplish universal education, meaning to have a 100% enrolment rate in primary education. In 1991, the primary Gross Enrolment Rate (GER) was 79.94%. By 2000, the year that the MDGs commenced, the GER in Ghana had improved to 86.02%, meaning a seven percent increase in this measurement. The goal to achieve 100% GER in primary school was achieved by 2007 in Ghana, when the nation’s GER figure reached 100.96%. By 2014, the GER was 106.85%, meaning that Ghana had exceeded their goal and in less time than was necessary. The post-MDG increase in school enrolment rates has been 20%, which is almost three times the rate of increase achieved in the decade before the MDGs were brought in. Ghana consistently spends more than 20% of government expenditure, which is the recommended amount of expenditure on education by the FTI.
Source: World Bank, 2015
However, Ghana did not achieve full Net Enrolment Ratio (NER). The difference between the GER and the NER is that the NER only accounts for the enrolment ratios of pupils who are of school age, while the GER accounts for all pupils, regardless of their age, meaning that pupils who start school early, or who, for whatever reason, finish primary school later than the national school age.
With regard to the NER, Ghana was just short of achieving this, and by 2014, the nation’s NER stood at 88.9%.
Source: World Bank Database, 2015; World Economic Forum Global Competitiveness Report 2011-2012
As part of the GPRS I, Ghana implemented their Educational Strategy Plan (ESP). This was implemented from 2003-2015. Some of the measures that the government used to improve school enrolment rates were to provide free school meals, school uniforms, exercise books, and others, to improve school infrastructure and the capitation grant. These measures have mostly been to increase the demand for education.
However, there are several problems within the education system that the government have failed to address, particularly in the supply of education, possibly because they weren’t the focus of the MDGs. These include that there is a lack of qualified and motivated teaching staff. In 2009, it was estimated that 40% of new teachers were under-qualified. The number of trained teachers has reduced over the years, from 71.8% in 1999 to 52.4% in 2014.
Source: World Bank Database, 2015
This problem is also compounded by the fact that there is a reluctance to be posted in certain places in the country. This has created a spatial disparity in the education system between rural and urban areas.
On top of this, rate of enrolment in levels of education are far behind the rates of enrolment in primary education. This could be the result of less government spending in those education levels. In 2010, the Government of Ghana spent the 27.9% of its educational spending on primary schooling, followed by 20% on tertiary education, with the least funding provided to Non-Formal Education (NFED), Special Education (SPED) and Technical Vocational Education and Training (TVET). The focus on primary education could be as a result of the internationally set goals to achieve full enrolment rates for that level. Focusing more on Teacher Education could also be beneficial to raise the quality of education, making the development of this target more substantial.
Source: Ministry of Education, Education Finance Brief, Ghana, 2012
Reducing Child Mortality
Ghana largely achieved the goal of reducing child mortality. For this measure, there were three targets that Ghana decided to follow, which were to reduce the under-5 mortality rate by two-thirds, to reduce the infant mortality rate by two-thirds, and to increase the proportion of one-year-olds vaccinated against measles to 100%. Ghana fell short on, but made significant progress towards, all three indicators. For under-5 mortalities, Ghana’s rate was 82 per 1,000 live births in 2012, an improvement from 122 per 1,000 live births in 1990, but still short of the target of 40 per 1,000 live births. Ghana’s infant mortality rate had improved only marginally from 1994 to 2012, going from 57 to 53 per 1,000 live births. The number of children under one-year-old who were vaccinated against measles had a bigger improvement. In 1990, the percentage vaccinated was 50%, which rose to 86% in 2013, falling just 14% short of the target of 100% vaccination.
Ghana has many policies aimed at improving infant health, such as the Child Health Policy (2007-2015), the Child Health Strategy, as well as an Expanded Programme on immunisation (EPI) for children. They also have increased the access to the National Health Insurance Scheme (NHIS).
However, despite these policies and programs aimed at improving the health of children in Ghana, there are some problems that Ghana faces. For one, Ghana has a limited amount of trained medical staff. Although Ghana now spends more on healthcare than it previously did before the MDGs came into effect, the physician- to population ratio is still poor. In 1990, the physician ratio stood at 0.1, whereas, in 2010, this had not improved. In 2005, Ghana spent 3.1% of its GDP on healthcare in 1995, which reduced to 3% in 2000, the year the MDGs were established. By 2013, Ghana was spending 5.4% of GDP on healthcare. While this is, overall, an improvement, there are still problems with this system, for example, there is inequality in the healthcare services provided by different regions. Rural areas have the lowest doctor/population ratios.
Source: UNICEF: Children, the GPRS and public expenditure in Ghana, 2015
In areas such as the Volta Region, which contained about 8.6% of the population from 2006-2008, the expenditure in health was disproportionate to the number of people living there. Comparing this to somewhere such as Brong Ahafo Region, which contained more of the population but had a lot less spent on it for these years, the distribution of health expenditure seems be uneven.
A study by UNICEF in 2009 found that internally generated funding for education and healthcare were unreliable and not equitable to the different regions in Ghana. Ghana should, again, focus on fixing the regional disparities and inequality in the healthcare system in order to improve the health of everyone, which would have a more beneficial effect on improving the health of not just infants, but their mothers and whole families, which would help work towards goal 5, reducing the maternal mortality rate.
Global Partnership for Development
For this goal, Ghana chose to follow three targets, namely to address the needs of the Least Developed Countries, to deal comprehensively with the debt problems of developing countries, and to make available the technologies in cooperation with the private sector. This goal was mostly aimed at developed countries, to encourage them to aid developing nations in achieving access to technology, healthcare and facilitate better financial systems.
However, Ghana has successfully tried to specifically increase the mobile phone subscriptions and Internet usage. A recent study assessing the effectiveness of National Plans as relates to the MDGs, showed that countries who received significantly more Official Development Assistance (ODA) were more likely to align their poverty reduction strategies with the MDGs, either by adopting the MDGs into their plans, or by referencing the MDGs in some way and treating them as a guide. These countries were lower-income and lower-middle income countries. It was stated that countries with higher incomes who didn’t have a need for as much ODA and who didn’t need to abide by the conditions specified in the ODA, had a lot more freedom with their budgets and poverty strategies and hence didn’t have to prove to international donors that they were effectively working to improve welfare in this way. This may have been the result of conditions stipulated by donors in order for these countries to receive the ODA, which could determine how they spend their finances.
This could be the case with Ghana, a lower-middle income country that receives ODA, which amounted to 12.4% of GNI in 2000 and 2.8% of GNI in 2013, and who aligned their poverty reduction plan with the MDGs. In a report issued by Ghana’s Ministry of Finance & Economic Planning in 2010, it was stated that ‘The use of policy and process conditionalities by DPs (Development Partners) has undermined the delivery of aid in considerable ways…’ Ghana had the highest increase in the amount of Official Development Assistance from 2007-2012. During this time, a number of MDGs were achieved. For example, the national employment-to-population ratio increased by a greater proportion from 2005/06 to 2012/13 (by 8.3) compared to from 1998/99 to 2005/06 (by 5.9).
Source: World Bank database, 2015
Other goals that Ghana didn’t achieve but made significant progress with were Goals 3 and 6, namely to Promote Gender Equality and Empower Women, and to Combat HIV/AIDS, Malaria and other Diseases. Ghana did rather well to promote gender equality in primary schools, with gender parity ranging from 0.91 to 1.01 in the various education levels. However, in other sections of society, there has been little improvement in the gender equality since the adoption of the MDGs. From 1991/92 to 2013, the share of women in wage employment in non-agricultural sectors was still no more than 30.5%, an improvement of just 0.7% from 1991/92. Similarly, since 1990, there had only been 2.9% in 2013 increase in the proportion of seats held by women in government, from 8.0% to 10.9%. The problem of gender equality seems to be a cultural issue, where the patriarchal system can often discourage women to work in certain sectors, such as wage employment.
With regards to goal 6, Ghana has declined in the spread of new cases of HIV/AIDS, from more than 20,000 in 2008 to just under 8,000 new cases in 2013. There is also been a mostly stable number of people living with HIV/AIDS, from over 236,000 in 2008 to over 224,000 in 2013. Access to antiretroviral (ART) drugs has increased but is still not universal. In 2006, only 10.8% of people with advanced HIV were receiving ART compared to 47.4% receiving ART in 2013. The incidence of malaria rose from 79.7 per 1,000 people in 2009 to 108.3 per 1,000 people in 2010. However, there was progress in the number of under-5s sleeping under an Insecticide Treated Net (ITN), form 39% in 2011 to 46.6% in 2013. The halting in progress with this goal has been the result of a number of factors, mainly a lack of funding and access to treatment and a stigmatisation of people with HIV/AIDS.
Goals 5 and 7, to Improve Maternal Health and to Ensure Environmental Sustainability were not achieved at all. The maternal mortality rate has improved from the 1990 level of 216 per 100,000 live births to a rate of 164 per 100,000 live births. However, this still falls short of the 2015 target of 54 per 100,000 live births. Many of the issues with maternal health coincide with the issues of child mortality. There is a lack of access to adequate resources, such as ambulance services and trained medical help, especially regionally.
Environmental Sustainability is an issue that has been given very little priority in Ghana. Since the MDGs were implemented, there is still a high rate of deforestation and a significant deficit in secure housing and a large number of households without basic sanitation. The number of improved water sources, however, is the saving grace in this category, with an increase from 67% of households with access to improved water sources in 1993 to 84% in 2008. However, by 2013, this had fallen to 78.6% of households. The major problem with environmental sustainability is a lack of enforcement of policies and a lack of finance to adequately deal with environmental issues.
While it is commendable that so much was achieved with the MDGs, Ghana could have been too focused on hitting the targets, especially as there were other areas of the economy and of welfare that needed attention. As the Sustainable Development Goals (SDGs) are ushered in, it is pertinent that Ghana does what is best for her as a nation and pays more attention to what is important for its development, rather than what an international body says is important. Issues such as tackling unemployment, building infrastructure, making improvements in the depth of poverty rather than just the incidence, would be relevant to Ghana. More effort needs to be made to manage regional inequalities, rather than just the national average, for many, if not all, of the development targets that Ghana has in the future.
Ms Keshia Osei Kufour is researcher with IMANI. For interviews please contact Keshia on firstname.lastname@example.org
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Ms Keshia Osei Kufour is researcher with IMANI. For interviews please contact Keshia on email@example.com