Ghana has the full range of diseases endemic to a sub-Saharan country. According to WHO, common diseases include cholera, typhoid, pulmonary tuberculosis, anthrax, pertussis, tetanus, chicken pox, yellow fever, measles, infectious hepatitis, trachoma, malaria, and schistosomiasis. Others are guinea worm or dracunculiasi, various kinds of dysentery, river blindness or onchocerciasis, several kinds of pneumonia, dehydration, venereal diseases, and poliomyelitis. According to a 1974 report, more than 75 percent of all preventable diseases at that time were waterborne. In addition, malnutrition and diseases acquired through insect bites continued to be common. WHO lists malaria and measles as the leading causes of premature death in Ghana. Among children under five years of age, 70 percent of deaths are caused by infections compounded by malnutrition. Guinea worm reached epidemic proportions, especially in the northern part of the country, in 1988-89. Cerebral spinal meningitis also spread in the country and claimed a number of victims in the late 1980s. All these afflictions are either typical of tropical regions or common in developing countries. To improve health conditions in Ghana, the Ministry of Health emphasized health services research in the 1970s. In addition, WHO and the government worked closely in the early 1980s to control schistosomiasis in man-made bodies of water. Efforts have been intensified since 1980 to improve the nation's sanitation facilities and access to safe water. The percentage of the national population that had access to safe water rose from 49.2 in 1980 to 57.2 percent in 1987. During that same period, the 25.6 percent of the population with access to sanitation services (public latrines, rubbish disposal, etc.) rose to 30.3 percent. According to WHO, however, many of the reported sanitation advances have been made in urban areas and not in rural communities where the majority of the population lives. On the whole, however, Ghana's health conditions are improving. The result is reflected in the decline in infant mortality from 120 per 1,000 live births in 1965 to 86 per 1,000 live births in 1989, and a rate of overall life expectancy that increased from an average of forty-four years in 1970 to fifty-six years in 1993. To reduce the country's infant mortality rate further, the government initiated the Expanded Program on Immunization in February 1989 as part of a ten-year Health Action Plan to improve the delivery of health services. The government action was taken a step further by the Greater Accra Municipal Council, which declared child immunization a prerequisite for admission to public schools. Modern medical services in Ghana are provided by the central government, local institutions, Christian missions (private nonprofit agencies), and a relatively small number of private forprofit practitioners. According to the United Nations, about 60.2 percent of the country's total population in 1975 depended on government or quasi-government health centers for medical care. Of the available health facilities represented in the 1984 census, about 62.9 percent were still described as government and quasi-government institutions. Mission hospitals represented a large percentage of the remainder, while private hospitals constituted less than 2 percent of modern medical care facilities. The medical system in Ghana comes under the jurisdiction of the Ministry of Health, which is also charged with the control of dangerous drugs, narcotics, scientific research, and the professional qualifications of medical personnel. Regional and district medical matters fall under the jurisdiction of trained medical superintendents. Members of the national Psychic and Healers' Association have also been recognized by the government since 1969. Over the years, all administrative branches of the Ministry of Health have worked closely with city, town, and village councils in educating the population in sanitation matters. Many modern medical facilities exist in Ghana, but these are not evenly distributed across the country. Ministry of Health figures for 1990 showed that there were 18,477 beds for the estimated national population of 15 million. World Bank figures showed that in 1965 there was one physician to every 13,740 patients in Ghana. The ratio increased to one to 20,460 in 1989. In neighboring Togo, the doctor-to-patient ratio of one to 23,240 in 1965 improved to one to 8,700 in 1989; it was one to 29,530 in 1965 and one to 6,160 in 1989 for Nigeria, whereas in Burkina, the ratio of one to 73,960 in 1965 worsened to one to 265,250 in 1989. These figures show that while the doctor-patient ratio in Ghana gradually became less favorable, the ratio in neighboring countries, with the exception of Burkina, was rapidly improving. The ratio of nurses to patients in Ghana (one to 3,730 in 1965), however, improved to one to per 1,670 by 1989. Compared to Togo (one nurse to 4,990 patients in 1965 and one to 1,240 in 1989) and Burkina (one to 4,150 in 1965 and one to 1,680 in 1989), the rate of improvement in Ghana was slow. Nigeria's nurse-to-patient ratio of one to 6,160 in 1965 and one to 1,900 in 1989 was exceptional. A rapidly growing Ghanaian population was not the only reason for unfavorable ratios of medical staff to patients; similar population growth was experienced in neighboring West African countries. Insofar as the Ghana Medical Association and the various nurses associations were concerned, better salaries and working conditions in Nigeria, for example, were significant variables in explaining the attraction of that country for Ghanaian physicians and other medical personnel. This attraction was especially true for male and, therefore, more mobile medical workers, as shown by the arguments of various health workers' associations in 1990 during demonstrations in support of claims for pay raises and improved working conditions. Ghana adopted a number of policies to ensure an improved health sector. These included the introduction of minimum fees paid by patients to augment state funding for health services and a national insurance plan introduced in 1989. Also in 1989, the construction of additional health centers was intensified to expand primary health care to about 60 percent of the rural community. Hitherto, less than 40 percent of the rural population had access to primary health care, and less than half of Ghanaian children were immunized against various childhood diseases. The training of village health workers, community health workers, and traditional birth attendants was also intensified in the mid-1980s in order to create a pool of personnel to educate the population about preventive measures necessary for a healthy community. Since 1986 efforts to improve health conditions in Ghana have been strengthened through the efforts of Global 2000. Although primarily an agricultural program, Global 2000 has also provided basic health education, especially in the northern parts of the country where the spread of guinea worm reached epidemic proportions in 1989. Reports on the impact of Global 2000 have been positive. For example, participating farmers have significantly increased their agricultural output--a development that has contributed to a decline in malnutrition. Also, the number of cases of guinea worm had dropped significantly by early 1993.
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