Ghana held its First National SAPRI Forum in Accra on 10-12 November. The lead organization in Ghana, the Integrated Social Development Centre (ISODEC), and the broad-based steering committee representing the local civil-society network, SAPRIN, organized the Forum. Over 250 people participated, including representatives of civil-society organizations from across the country, the government and the World Bank. The civil-society participants represented a broad range of citizens' groups, including labor unions, organizations of miners, teachers, women, children, the disabled, students and academics, as well as religious associations, small-business groups, and environmental and development organizations. The Forum built upon an extensive process of citizen outreach that included workshops in ten administrative regions of the country and involved a broad cross-section of civil-society actors. These groups identified issues of basic concern and selected the representatives to attend the Forum.

The chair of the Forum, Akilagpa Sawyerr, opened the proceedings by noting that the SAPRI process presented an opportunity to bring voices not normally heard into the economic-policymaking debate. Although the government presence was small, an official representative reiterated its commitment to SAPRI and emphasized that the exercise is seen as a means to examine the outcome of economic policies in order to ensure a fairer distribution of national wealth. Justice D.F. Annan, Speaker of Parliament, added that SAPRI will be able to examine why adjustment policies have not met their stated objectives, while at the same time legitimizing local knowledge that can bring about changes that will benefit people. He stressed the willingness of Parliament to initiate a debate on economic policy with the input of civil society.

I. The Impact of User Fees and Retrenchment on Education and Health Care

Civil-society participants noted that the quality of Ghana's education system has declined since the onset of the adjustment program. The results from over $400 million in World Bank loans and a raft of institutional reforms since the early 1980s have been extremely poor. Most of the foreign loans (85 percent) has financed basic education, leaving secondary and tertiary levels virtually unfunded. In addition, donor funds have been primarily dedicated to capital expenditures for infrastructure, rather than to investment in educational-quality improvements. As a result, Ghana is now producing students without the necessary skills for the meager number of formal-sector jobs being created each year.

The imposition of user fees has led to reduced enrollment rates, particularly in rural areas. With many children also being pulled out of school to contribute to family income, there is currently a 40-percent drop-out rate in primary school. As a result, there are real concerns that by the year 2020 Ghana's population will be largely illiterate. The situation is exacerbated by the fact that fees rise sharply at the secondary level and total enrollment at the tertiary level now stands at 50,000 in a population of nearly 20 million. In addition, user fees have led to even greater inequalities both between and within communities, as the better-off increase their educational levels and the poor fall even farther behind. Those families who do manage to scrape together the money to pay the fees find that they have to cut back on essential household expenditures. The impact of these policies is often more severe for women and girls. Lower levels of education for girls increases the already high levels of poverty among women.

Retrenchment in the civil service and a decline in the real wages of teachers have led to higher student-teacher ratios. Reforms did not address the difficult working conditions teachers face, leading to declining morale. Meanwhile, despite the imposition of user fees, there is still a widespread shortage of textbooks. These factors have led to an erosion of confidence in public schools, causing those parents who can afford it to send their children to private schools, thus further undermining the viability of the public-school system.

In the area of health care, while funding increased in the early years of the SAP, it has since declined. Civil-society participants in the Forum pointed to large discrepancies in the quality of health care between rural and urban areas, as well as a large north-south divide. Access to services is still limited. Meanwhile, cost-recovery measures in the health-care sector were implemented at a time when many people had been laid off and income levels were extremely low. The introduction of user fees has thus led to reductions in outpatient attendance by up to 33 percent, particularly in rural areas. Many poor people are turned away for lack of funds. The payment arrangements are cumbersome, too much staff time is devoted to collecting fees, and the funds that are collected are often misused. The poor are simply being priced out of hospital care, and a two-tiered health-care system now exists, with better facilities for those who can afford to pay. Once again, women often bear the brunt of these policies. According to official surveys, poor women access government services and subsidies much less, and the official social safety-net has not helped change this situation.

The Government highlighted systemic advances in health care -- maintaining, for example, that the proportion of the population with access to health services has increased from 45 to 65 percent -- and linked them to the adjustment program. Although some people believe that the program led to the neglect of clinical care, the Government's focus on public health has resulted in an increase in immunization coverage. The incidence of leprosy has fallen, river blindness is being eradicated, and polio is targeted for eradication. There has also been a strengthening of district capacity to administer services. According to the civil-society participants, however, most of the country's improvements in life expectancy and infant mortality can be attributed to programs and policies promoted by UNICEF and WHO. The quality of health care has also been undermined by retrenchment. In addition, the health sector lost many qualified people during the brain drain of the 1970s and 1980s, and poor working conditions for health providers means that many young doctors leave the country as soon as they qualify. The effects of the adjustment program have rekindled within the government the need for social equity to be a key part of health-care policy. As official policy is that no one should be denied health services because of his or her inability to pay, the Health Ministry's two main goals in the coming years are to increase public access to, and the quality and efficiency of, health care.

Civil-society participants noted that under the adjustment program there has been a shift in agricultural production, with more land and resources devoted to export crops and less used for the cultivation of basic food crops. This shift, undertaken without the input or consent of farmers, has led to a decline in domestic food production, reduced food security for the poor, lower agricultural investment and an increasing income disparity between export and domestic food producers, thus exacerbating inequalities. Subsistence farmers, who constitute most of the 80 percent of the poor who live in rural areas, have been the hardest hit by the SAPs. Thus, while much attention has been paid to the needs of those who produce for export, the participants inquired about those who produce food for people in Ghana to eat.

The removal of subsidies, which has caused a rise in input prices, and liberalization measures, which have resulted in a flood of cheap imports, have further harmed local food producers. These policies, together with high interest rates and changes in the lending policies of the agricultural development bank, have contributed to a substantial reduction in agricultural investment, leading to declining productivity among food producers. The commercial banking sector does not lend to the agricultural sector at all. Meanwhile, devaluation and domestic inflation have led to higher food prices, which have not been matched by similar increases in wages. For those who still have jobs, wages have not yet regained their 1970-74 levels. And, with increasing layoffs, the one-third of rural households that are net consumers of food are getting poorer and hungrier.

The removal of subsidies and cutbacks in social services have had different impacts on women and men. Women, who produce 60 percent of food, have suffered disproportionately from the elimination of subsidies, the drying up of credit, and the surge of food imports resulting from trade liberalization. Participants also expressed concern about the fate of rural manufacturing tied to the agricultural sector, such as small-scale food processing, much of which is done by women.

Civil-society participants argued that the impact of the mining industry on the real economy in Ghana, as well as on the health and environmental conditions faced by the local population, is an issue in need of further research. Serious concerns were raised regarding the emphasis on mining, as well as the consequent health and environmental impacts, resulting from the export-oriented strategy designed to obtain hard currency in order to meet conditions established under the adjustment program. Policy changes under the adjustment program in the mid-1980s involved privatization of the state-owned gold mines and deregulation of the sector. Although foreign direct investment in the mining sector has since increased, thus raising output, participants argued that, instead of a net gain to the local economy, there may in fact be a net loss if environmental degradation and a decline in the health and welfare of the local population were taken into account. While mining companies and government coffers benefit, people and the environment tend to lose out.

Forum participants also claimed that lax regulations and an ineffectual regulatory mechanism in the mining sector have led to increased hardships for workers and local communities. Working conditions in the industry are very poor. In addition, many families who had made their livelihoods in artisan-style mining activities were forced off the land where they had worked and, in some cases, even the plots on which they lived, as private mining companies staked their claims to newly privatized, mineral-rich land. There have also been severe environmental impacts from the mining operations, particularly in the western region of the country, as surface mining of gold has led to extensive destruction of forests and contamination of water sources.

There was consensus among civil-society participants that the way in which adjustment programs have been implemented in Ghana has excluded civil society from the decisionmaking process. The imposition of SAPs has been effected by a small technocratic elite in alliance with the World Bank in Washington. The Bank had developed a set of "good boys" with whom it could work, and presented economic policies to the people as a fait accompli. Although the Bank expressed its desire to focus on the future rather than rehashing the past, participants felt it was important to understand the past in order to formulate good policies in the future. In addition, civil-society participants took issue with the rather narrow definition of participation that both the Bank and the government had embraced. Even if people are consulted on policy, they noted, it is often after the basic value system and approach have been determined. Some of the problems associated with government/civil-society relations outlined by the participants in the Forum include: a lack of transparency in the civil service; constraints on the ability of members of Parliament to participate meaningfully in deliberations and consult with their constituencies; a lack of representation of women in government; and the persistence of laws which affect the press and thus dampen participation.

The approach to gender in the promotion of SAPs was criticized, as well. There has been an assumption that men and women are affected by, and respond to, policies in the same way, but a proper gender analysis must look at how men and women respond differently. Although it appears that women have suffered the impact of adjustment even more than men, without gender-disaggregated data, it is hard to gauge the differential impact. SAP policies neglect gender at both the conceptual level and the level of understanding impacts. The challenge is to mainstream gender in all of these policies and programs, for which there is an urgent need to improve the availability of data.

In closing remarks from civil-society participants, the gathering was reminded that SAPRI was rooted in the view that the design and implementation of structural adjustment programs have had negative impacts. Overall, it was emphasized that SAPs have worsened the condition of the large majority of Ghanaians and domestic productive capacity has been weakened. Changes that have been implemented have not benefitted the poor. Part of the reason for this lies in the nature of the policies themselves, but the lack of public participation is also a key factor. The country is now faced with the challenge of how to reconstruct basic social services and accept only that foreign investment which is of net benefit to Ghanaian society. The summary re-emphasized the need to mainstream gender into all aspects of policy and not simply attach it as an appendage to mitigate rather than reverse the problem of gender inequity. The goal of economic policy should be to put the interests of Ghana first and to ensure an integration of different sectors. SAPRI should serve to strengthen the capacity of civil society and support democratic processes to ensure that this policy benefits Ghana as a whole.

Photos from the Opening National SAPRI Forum

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