From Africa Recovery, Vol.11#3 (February 1998), page 6 (part of Country Focus: Ghana)

Tight spending undermines health and education

Some 45 per cent of Ghanaians lived below the poverty line in 1992, says the World Bank. It also acknowledges that Ghana's Bank-funded strategy for economic growth could have "adverse effects on poverty." With human development now an established criterion for national progress, trends in the key sectors of health and education give cause for concern.

Ghana has clearly made gains in significant areas such as life expectancy, now at 57 years, and adult literacy of 65 per cent. But public funding is falling for health and education, its distribution favours the rich, and the incidence of sickness and death from preventable diseases remains high. Half of all deaths in recent years have been of children under-5 who are only a fifth of the population, notes the Ghana Human Development Report, 1997.

In 1989-92, the share of the health budget spent on the poorest one-fifth of Ghanaians fell from 12 to 11 per cent, while the share for the richest one-fifth rose from 31 to 34 per cent. Ghana's poor had the lowest share of public health spending in a Bank survey of eight developing countries (including Kenya).

Ghana's total health spending (markedly urban-biased) in 1990 was $14 per capita, while the sub-Saharan average was $24. Since then, the share of health in total recurrent spending is down from 9.7 to 5 per cent. And with the emphasis on "cost-recovery" by charging "user-fees" (including for drugs, a practice known locally as "cash-and-carry"), the poorest Ghanaians bear the greatest burden. They accounted for 31 per cent of total household spending on health, while the richest households spent 17 per cent. One difference in education sector spending in 1988-92 was that the share of the poorest one-fifth fell from 17 to 16 per cent of the sectoral budget, and also fell from 24 to 21 per cent for the richest one-fifth.

The government launched major education "reforms" in September 1986, guided by advice and a $232 mn loan from the World Bank. The aim was to expand access to quality education at all levels and to cut public costs.

There are now six years of primary school, three of junior secondary school (JSS) and three of senior secondary school (SSS). But while secondary school enrolment has risen satisfactorily, the rise at primary level has not kept pace with population growth. The Bank says localized school management and cost-sharing have brought higher primary and secondary fees "that hurt the poor more than the rich."

But "most disappointing and worrisome," the Bank says, are the qualitative results. In two successive years of tests at sixth grade primary level in the early 1990s, only some 2 per cent of students could correctly answer more than 60 per cent of "relatively simple mathematics and English questions." The Bank concedes that the measures it pushed were too rushed and allowed inadequate time for debate among stakeholders, training of teachers and curriculum development.

Now, there is still a wide gap between rural and urban areas in access to quality schooling, says An Assessment of National Capacity-Building in Ghana, a World-Bank sponsored report issued in August 1996 by a team of Ghanaians. Low output from Ghana's Teacher Training Colleges also cannot replace untrained teachers at primary and JSS levels, let alone cater for the expansion required in the plans for free, universal, basic education.

And due to the steep educational pyramid, only 30 per cent of JSS leavers enter SSS. The rest are expected to enter the job-market or technical and vocational schools. But such schools are too few, and many JSS leavers "become unemployed and unemployable," says the capacity-building report.

Further up the pyramid, only 10 per cent of SSS graduates enter tertiary institutions, and many of the rest are ill-prepared for employment. All this leads to a "serious waste of human resources and a frightening deficiency of the new educational system."

In the 1990s, the share of universities and polytechnics in the education budget is down from 15 to 12 per cent. This will fall further if, as planned, more is spent at primary and secondary levels. Currently, four-fifths goes to the five universities, leaving little for the six polytechnics and any other tertiary institutions. All, however, spend some 85 per cent of their funds on salaries while facilities are overburdened with increased student intake. And due to the material problems at earlier levels, the quality of students has declined. As one senior academic says: "Through no fault of their own, many students entering university don't know how to use a library."

At the summit of the pyramid, there is no national commitment to research and little funding, says the capacity-building report. Grants for the Institute of Statistical, Social and Economic Research at Legon fell from 52 per cent of its budget request in 1990 to 29 per cent in 1996. Without such funding, research institutions may tend to produce foreign donor-driven studies, "whose policy relevance or academic content is not always obvious," the report says. And many lecturers now hunt for lucrative consultancies at the expense of students.

Although more and more young Ghanaians are now getting an education, the report observes, the quality is increasingly unsatisfactory and "less than is required for managing sustained growth into the next century."

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