The Millennium Development Goals: Can Ghana achieve them by 2015?

Credit: Kojo Appiah-Kubi (PHD)

In 2000 Ghana joined about 189 other countries in adopting the UN Millennium Declaration, which lays out eight time bound development goals that have come to be known as the Millennium Development Goals (MDGs) and accepted as a common development framework to improve upon the lives of people living in poverty. The MDGs sets out objectives with monitorable targets from 1990 indicator levels to be achieved by 2015. Ghana has since then adopted the MDGs as its long-term minimum set of socio-economic development objectives that have influenced the determination of the country’s strategic priorities for national development, eradication of poverty and hunger as well as improvement of its human development indicators.

The declaration has now only five years remaining of the duration set for achieving the declared goals and targets. In general the country appears to have made substantial progress towards achieving the MDG indicators. However, progress has been slow on some indicators and uneven among geographical areas and sexes. This has heightened anxiety that the country may miss out on some important goals and human development indicators by 2015 or backslide on some of the goals that have already been achieved. For instance, whilst the country has already met the MDG 1 ahead of schedule and can potentially achieve many other goals and set targets, it faces serious challenges in achieving other important goals and even risks missing out totally on the important goals of 4 (improving child health) and 5 (improving maternal health). The country also faces the high risk of backsliding on some of the goals that are already being met in the face of the global food, fuel and financial crises and the re-emergence of macroeconomic imbalances on the fiscal front and balance of payment accounts that can potentially impact negatively on human development indicators.

These developments call into focus the need for concerted actions on the part of the government to develop appropriate pro poor policies, and on the part of other stakeholders to live up to the challenge of ensuring transparent, accountable, and responsive governance to accelerate the achievement of the MDGs. This is indeed unavoidable in the light of the serious challenges countries like Ghana face in meeting some of the targets and the limited target duration remaining to meet the set targets. It is also against this background that the UN is organising a high-level MDG summit in September 2010 in New York to review progress on the MDGs. For this summit governments have been asked to come prepared with their own individual breakthrough plans to facilitate a “Summit MDG breakthrough strategy”. This article reviews the country’s progress on the MDGs to elicit better understanding and create public awareness of the relevance of the MDGs for their prioritisation in national policy making and for “MDG-based’ development policy planning and making. The following gives a brief summary of Ghana’s MDG report card.

The first MDG objective deals with the eradication of extreme poverty and hunger and that is the area Ghana seems to have made substantial progress. From a relatively high level, greater than the Sub-Sahara African average of about 47%, the country has reduced the poverty incidence rate successively from 51.7% in 1991/92 to 26.5% in 2008. With this current trend of decline in overall poverty levels, experts estimate that it is possible for the country to reduce the incidence of overall poverty level substantially to about 12% by 2015.

In terms of efforts to halve the proportion of people living in extreme poverty policy reforms and macroeconomic stability in the past decade seems to have paid off by creating the necessary platform for strategic investments in agriculture and other pro-poor sectors. Consequently the incidence of extreme poverty has declined substantially from 36.5% in 1991/1992 to about 16% in 2008. This has also led to significant declines in malnutrition levels. Data from the Ghana Demographic and Health Survey of 2008, for instance, indicates a decline of underweight children (too thin for their age) under-five years from about 30% in 1988 to 14% in 2008, stunted children (too short for their age) from 35% in 2003 to 28% in 2008 whilst wasted children (too thin for their height) dropped to 9%. Exclusive breastfeeding for children up to six months has also improved from 54% in 2006 to 64% in 2008. Consequently child and infant mortality ratios have declined from 155 and 77 deaths per 1,000 live births in 1988 to 80 and 50 in 2008 respectively.

The MDG 2 deals with efforts at achieving universal access to primary education by 2015. Recent policy measures including free school feeding programme, capitation grant, free exercise books and school uniforms have contributed to put Ghana on track to achieving this goal. As a result net enrolment rates at the primary level, for instance, have risen from a low base of about 60% in 2004 to 88.5% in the 2008/09 academic year. The gross admission rates (GAR) into primary one has also risen beyond the 100% mark even though the net admission rate seems to have stagnated at 72.1% in 2008/09 after rising from 26.1% in 2004/05 successively to peak at 74.3% in 2007/08.

The MDG 3 seeks to eliminate gender disparity in primary and secondary education by 2005 and in all levels no later than 2015. Increasing focus over the past decade especially with promotion of girl child education and capitation grant schemes has contributed significantly to female enrolments. Information available reveals that the Gender Parity Index (GPI) has improved from 0.92 to 0.96 during 2001/2002 and 2007/08 with that at the kindergarten level already at 1.03, but with wide geographical differences. The index at the junior secondary school level, even though lower than that of the primary level, has also stabilized from a low level at 0.96. Female participation at tertiary level seems to be lowest of all the three levels of education, with the GPI having stagnated for a long time at 33%. Given the wide geographical imbalances in the GPI and stagnation of the GPI at the senior high and tertiary levels, it appears that more additional resources would be required to undertake targeted interventions in difficult and vulnerable areas to attract and retain girls in school as well as improve survival rates of girls at these levels.

The MDG 4, which seeks to reduce the under-five mortality by two-thirds by 2015, has registered improvements after a deterioration in the indicator trends in the early part of this decade. The latest available data show a 28% decline in the under-five mortality ratio in Ghana to 80 per 1,000 live births. Similarly the infant mortality rate has also experienced a decline by about 30%. Other important indicators on child survival also underscore positive progress. For example, under-five malaria case fatality has declined steadily over the years, from 3.7% in 2002 to 1.8 per cent in 2008. Immunization coverage of children between 12-23 months in 2008 has risen consistently over the years from 62% in 1998 to 69% to level of at 79% in 2008. However, Penta 3 coverage has shown a slight dip from 88 per cent in 2007 to 87 per cent in 2009. Indeed progress has been slow in this area and Ghana must double its efforts if it were to achieve this goal.

In spite of several interventions initiated by the government to achieve MDG 5 and thereby, reduce by three-quarters the maternal mortality ratio by 2015, progress seems to be very slow. Together with MDG 4 Ghana stands to miss out on the important goal 5 unless the country does extra more during the remaining period. As a result of the slow progress so far made the government in 2008 launched a national emergency programme to enhance maternal health care services including free health care for pregnant women and deliveries through the National Health Insurance Scheme. Consequently estimates of the Maternal Mortality Ratio have improved from 560 maternal deaths per 100,000 live births in 2003 to 451 maternal deaths per 100,000 live births to 2008.

Other maternal health indicators such as supervised deliveries and ANC have also experienced some improvements. Proportion of deliveries supervised by trained medical professional, for example, has increased again from 35% in 2007 to almost 40% in 2008 after falling from a peak level of 48% in 2006. Antenatal care coverage has also improved in respect of at least one visit from 89.5% in 2007 to 95%; and for four or more visits from 69% in 2003 to 78 per cent in 2008. Total fertility also decreased from 4.4 in 2006 to 4.2 in 2008 and the use of family planning services have increased but the use of modern methods has also gone down.

The MDG 6 seeks to halt and reverse the spread of HIV/AIDS. The national prevalence of HIV, after peaking at the level of 3.6% in 2003, appears to have gradually stabilised at about 1.9% in 2009. The current rate represents but an increase from the 1.7% level in 2007. According to the Ghana Aids Commission the current up-and-down movement in the prevalence rate signals only a stabilization of the epidemic. There are however increasing concerns about large regional differences and increasing signs of unprotected sex among youths. The country has also managed to achieve relative success by increasing its HIV clients on ART from about 7,338 people in barely two years ago (2006) to 23,614 as at the end of 2008.

As the single most important cause of mortality and morbidity especially among children under-five years and pregnant women, accounting for about 44.5% of all outpatient illnesses, 36.9% of all admissions and 19% of all deaths in health facilities in Ghana, the government has devoted intensive government attention at controlling. The latest in the arsenal of measures is the strategic National Malaria Control Programme (NMCP), launched in 2008, which seeks to promote the availability and use of ITNs. As a result of these programmes the use of ITNs in the country has gone up substantially from 3.5% in 2002 for children less than 5 years of age to 32.3% in 2006 and from 2.7% of pregnant women to 46.3% during this period.

Progress with MDG 7 to halve the proportion of persons without access to safe drinking water by 2015 seems to be slow, despite the fact that about 70% of all diseases seem to be caused by lack of clean water and proper sanitation. For this reason the government has over time devoted increasing attention to the provision of potable water and proper sanitation. As a result of increasing attention of the government the sectors have of late experienced significant improvements, with national access to potable drinking water estimated to have increased from 42% of the population to a little over 77%. Similarly rural water coverage has also improved from 55% to 76% between 2003 and 2008. However, for the urban population, safe water coverage seems to have declined from 83% to 79% over the same period.

Indeed the low coverage of sanitation continues to be a source of concern. National coverage of sanitation still hovers at very low levels, even though the coverage ratio seems to have increased from 8% in 2003 to 11% in 2008. Coverage in urban areas seems to be higher than national average, but has improved only insignificantly from 15% to 16% between 2003 and 2008, while rural communities made a more than three-fold jump, but from a very low base of 2% in 2003 to 7% in 2008. This is indeed a worrying situation, given the significant amounts being spent on sanitation, especially in the big cities.

Government efforts to achieve MDG 8 and thus strengthen Government and Donor Partnership have in the past sought to deal comprehensively with debts of the country to ensure its sustainability in the long run. Indeed these efforts have influenced the current aid architecture in Ghana positively and brought mutual benefits to both parties. An analysis of the ODA flows to Ghana shows that both project and programme aid to finance the national development strategies experienced significant increases over the last decade. Since 2005, ODA receipts by GoG have been estimated by the MoFEP to have reached in excess of US$1.5 billion, equivalent to 9% of GDP. These inflows have also been enhanced by the HIPC and the Multilateral Debt Relief Initiatives, which have contributed to reduce the net present value of public indebtedness to manageable levels and from 224% of exports and 163% of GDP in 2000 to only about 65.9% of exports and 45.42% of GDP in 2008.