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Hon. Aquinas Tawiah Quansah
Hon. Queenster Maame Pokua Sawyerr

A total of 233, 239 housing units were listed in the Central Region in the last census. The district with the highest number of housing units is Assin (14.9%) which also happens to be the district with the largest population. Gomoa (11.6%), Mfantsiman (9.2%) and Awutu-Efutu-Senya (8.8%) follow in that order. An interesting phenomenon is that Cape Coast, the regional capital, unlike other regional capitals does not have the highest number of structures. It is even among the districts with relatively few houses. The districts with the least number of houses have about 6.0 per cent each. These include Asikuma-Odoben-Brakwa (5.8%), Cape Coast (6.0%), Abura-Asebu-Kwamankese (6.2%) and Ajumako-Enyan-Essiam (6.4%). It is also significant to note that Asikuma-Odoben-Brakwa, which is the district with the lowest population, also has the least number of houses.

With the exception of Cape Coast (2.2) and Agona (2.1), the average number of households per house is less than 2, ranging from 1.2 in Assin to 1.9 in Awutu-Efutu-Senya. The average number of people in a house in the region is 7.1. There are five districts with figures above this. Cape Coast has the highest figure of 8.7 followed by Awutu-Efutu Senya with 8.6 percent, while Assin has the lowest of 5.9. This implies that even though Assin has the largest population in the region it has a corresponding large number of houses to go with it.

Type of Ownership
Majority of houses (78.5%) are owned either by a household member (58.3%) or a relative who is not a household member (20.2%). An additional 0.7 per cent are under an arrangement for purchase. Housing units not owned or being purchased by household members or a relative are either owned by private individuals (16.3%), employer (1.8%), private agency (0.4%) or public/government (1.6%) who have rented these out to the occupants. Cape Coast has a proportion (30.6%) that is thrice as those renting from private individuals in Ajumako-Enyan- Essiam (9.5%).

Private employers own 1.8 per cent of dwelling units, but in Ajumako-Enyan-Essiam (3.2%), Assin (3.0%), Twifo-Hemang-Lower Denkyira (3.6%) and Upper Denkyira (2.6%), the proportion is about 3 per cent. Although Government owns 1.6 per cent of houses in the region, in Cape Coast it is 6 per cent.

Housing Condition - Materials for Floor
Various materials used for the floors of buildings include earth and concrete. Majority (82.4%) of households in the region live in houses in which the floor is made of mainly concrete or cement. Only four districts; Asikuma-Odoben-Brakwa (68.9%), Assin (71.3%), Twifo-Hemang-Lower Denkyira (70.4%) and Upper Denkyira (79.2%), fall below the 80 per cent mark.

Less than a sixth (15.5%) of households live in housing units in which the floor is made of earth. There are however three districts, Asikuma-Odoben-Brakwa (30.3%), Assin (27.4%) and Twifo-Hemang-Lower Denkyira (29%), in which the proportions are twice as much. As expected, in Cape Coast, only 3.6 per cent of households live in housing units which have earth used in constructing the floor.

Very few (2.1%) of households live in housing units in which the floor is made of material other than concrete or earth. In Cape Coast, 2.5 per cent of households live in housing units with floors made of terrazzo/marble, while in Awutu-Efutu- Senya 1.2 per cent of dwelling units have floors made of wood.

Materials for Roof

Just as there are different materials for constructing floors, the materials used for roofing also vary. More than four-fifths (82.0%) of households live in housing units with roofs made from corrugated metal sheets (60.9%) and slate/asbestos (21.1%). In three districts, the combined proportions is about 90 per cent or more. These are Mfantsiman (89.8%), Ajumako-Enyan-Essiam (90.7%) and Agona (93.4%). In Asikuma-Odoben-Brakwa, Assin, Twifo-Hemang-Lower Denkyira and Upper Denkyira however, significantly higher proportions of households live in housing units whose roofs are made from thatch.

Two other materials, bamboo (3.4%) and concrete/cement (2.4%), are also used in fairly substantial quantities. Bamboo is used for a significant proportion of housing units, particularly in Komenda-Edina-Eguafo-Abirem (9.2%) and Twifo-Hemang-Lower Denkyira (7.3%) as roofing material, while Cape Coast has (12.4%) of housing units with concrete.

The other materials (mud, wood, and roofing tiles) are hardly used. Roofing tiles, which are a new phenomenon in the building industry is the cities, are not yet widely used in the region, where only 0.2 per cent of dwelling units are roofed with tiles. The relatively greater use in Awutu-Efutu-Senya (0.6%) may be due to the siting of two roofing tile factories in the district.

Materials for Walls

A little over a half (56.1%) of households in the region live in houses with walls made of mud/mud-brick/earth. Seven of the twelve districts have at least three-fifths of households living in houses with walls made of these materials, the highest being in Twifo-Hemang- Lower Denkyira (83.3%). Households in the region that live in houses with walls made of concrete constitute 35.4 percent, with Cape Coast (59.5%) and Awutu-Efutu-Senya (62.1%) having the highest proportion. Very few households live in houses with walls made of stone (0.1%) and bamboo (0.2%).

Housing Facilities - Number of Rooms
About half (49.4%) of the houses in the region have single rooms. This means that those rooms serve as both bedrooms and living rooms. It is only in Ajumako-Enyan-Esiam and Assin that the proportions are well below half. In addition, about a fifth of the houses in the districts have two rooms with the exception of Mfantsiman with a proportion slightly below 20 per cent. Also, about a tenth of all houses in all districts have three rooms. As the number of rooms increases the percentage distribution also reduces until nine or more rooms when the percentages increase. However, the increment is more pronounced in Mfantsiman (6.5%) and Ajumako-Enyan-Esiam (5.9%).

International norms dictate that any room occupancy greater than 2 persons per room is an indication of overcrowding, which has both health and social implications. The regional average of population per sleeping room is 2.3, is the same as the national average. Of the twelve districts, 10 have sleeping room occupancy higher than 2 while 8 have levels equal to or higher than the national average. The highest is in Twifo-Hemang-Lower Denkyira (2.7) and the lowest in Ajumako-Enyan-Essiam (1.7) and Mfantsiman (1.8).

Generally, the more urbanized a district, the higher the population per sleeping room. A value of 2.3 for Cape Coast is therefore not surprising. It is however unusual that a rural district like Twifo-Hemang-Lower Denkyira has the highest population per sleeping room in the region.

This could be because the district attracts several migrant farmers and farm labourers to its cocoa and oil palm plantations, and these migrants tend to share rooms either with the host farmers or farmer employers while seeking permanent accommodation. Overcrowding in sleeping rooms appears to be a major problem in the region, and needs to be addressed with a sound and viable housing policy. People, particularly in the rural areas, should be educated on house construction regulations and specifications, and these should be enforced within the limits of the realities on the ground.

A relatively high proportion of the region’s population was captured outside the home. This includes institutional population (hospitals, hotels, camping parties) and floating population (in transit at train, lorry stations, in the street, etc). One-eighth (12.6%) of the national figure (60,687) is from the region, compared to its share of total national population of 8.4 per cent. As a proportion of the regional total population, this non-house population is 0.5 percent, which is higher than the national average of 0.3 per cent. The total of 169 households, constituting 0.5 per cent of all households in the region, were not in a regular home or dwelling structure.

The problem of “homelessness” does not appear to be a major problem as yet, ranging from 2 households in Awutu-Efutu-Senya to 47 in Komenda-Edina-Eguafo-Abirem and 39 in Cape Coast. These relatively low figures however should not blind district assemblies and the regional administration into complacency, since the ideal situation should be that in which no household is homeless. Moreover, with increasing urbanization, the problem is likely to grow if no proactive measures are taken to address the current situation and prepare for any future developments.

Lighting

The main sources of lighting in the region are electricity (40.1%) and kerosene (58.9%), with kerosene being used more widely. In Cape Coast (83.0%) and Mfantsiman (51.6%) electricity is more widely used than kerosene. In 3 of the 12 districts, Assin (81.2%), Asikuma-Odoben-Brakwa (71.6%) and Upper Denkyira (70.1%), more than 70 per cent of households use kerosene as source of lighting.

Water Supply
Pipe borne water, one of the main sources of potable water, is enjoyed by only half of the households in the region even though only 9.4 per cent have the facility in the home. Cape Coast (37.7%) has the highest proportion of households with the facility at home while Assin (0.4%) has the lowest. Of the districts where households have pipe-borne water outside the home, Komenda-Edina- Eguafo-Abirem (61.1%), Gomoa (60.9%) and Agona (60.5%) have the highest proportions with Assin the lowest (4.6%). Most households in Assin rather depend on borehole (39.9%), well (28.7%) and river/stream (19%). Other districts where there is significant use of borehole as source of drinking water are Upper Denkyira (41.7%), Twifo-Hemang-Lower Denkyira (39%), Asikuma-Odoben-Brakwa (37.4%) and Abura-Asebu-Kwamankese (33.2%).

The two main sources of pipe-borne water in the region are the Kwenyaku water supply system which serves the eastern districts of the region and the Brimso water supply system which serves Cape Coast and other southern districts. In recent times, the capacity of the Brimso Dam has fallen considerably due to poor environmental practices and obsolete machinery.

This has created serious water problems in the surrounding districts. Notwithstanding the relatively high proportion of households with access to pipe-borne water, these problems of water supply may deny real access to households if effort is not made to stabilize the water delivery system in the region and diversify the sources.

Toilet Facilities
An important facility needed by households is a toilet. The distribution of toilet facilities in the region is given in. Some of these facilities, within the house, are water closet, pit latrine, KVIP and bucket/pan latrine. Among these, the one mainly used is the pit latrine (25.1%). Among the districts, it is mainly used in Twifo-Hemang-Lower Denkyira (47.8%) and least used in Cape Coast (7%); few households use the KVIP (7%).

The only district with a slightly higher percentage is Awutu-Efutu-Senya (11.4%). Even fewer households use buckets (2.8%) although the percentages for Cape Coast (5.2%) and Awutu-Efutu-Senya (5.9%) are higher. The water closet, which is considered the most modern of toilet facilities, is used by barely 5 per cent of households in the region. It is only in Cape Coast that it is used by a quarter of households (24.5%). This facility needs water and it has already been pointed out earlier that water is scarce in the districts, including even Cape Coast.

Most households which do not have toilet facilities in their homes, use public toilets (37.6%). The figures range from 28.8 per cent in Assin to 48.5 per cent in Asikuma-Odoben-Brakwa. There are some households which use toilet facilities in other houses (4.4%). This is more common with households in Asikuma-Odoben-Brakwa (5.7%), Ajumako-Enyan-Essiam (8.2%), Assin (8.6%) and Lower Denkyira (9.5%). This facility is used to a less extent in Komenda-Edina-Eguafo-Abirem (1.9%) and Gomoa (1.9%).

It is significant to note that nearly a fifth (18%) of the region’s households do not have any toilet facility at all and use the bush, beach or the fields for the purpose. The situation is most serious in the coastal districts of Awutu-Efutu-Senya (24.3%), Abura-Asebu-Kwamankese (27.5%), Komenda-Edina-Eguafo-Abirem (28.6%), Gomoa (28.9%) and Mfantsiman (33.3%).

Housing toilet facilities are shared between households occupying the house and/or with households from other houses. Only about a third of the facility is owned exclusively by household members. This pattern is also seen in the districts with the exception of Upper-Denkyira where a high proportion (40.8%) of households exclusively use their toilet facility; Agona (22.0%) and Gomoa (22.3%) have the lowest proportions.

Cooking Space
A third of the households (34.8%) in the region have a room exclusively used for cooking. An additional 13.8 per cent have a room purposely for cooking but shared with other households. There are some districts that have a higher proportion of separate rooms exclusively used by households than the regional average but it is more significant in two districts (Upper Denkyira 50% and Assin 52%). In the case of rooms shared by other households, there are more of such facilities in Agona (21.1%) and Upper Denkyira (19.5%).

A fifth (21.7%) of households in the region cook in the open space, as an alternative to the kitchen. For 8 of the districts, the open space is the main or a significant second cooking facility for households. The districts where it is the main cooking facility are Mfantsiman (29.5%), Gomoa (33.3%) and Awutu-Efutu-Senya (34.1%).

Another cooking space used quite often is the veranda. Since most households have a single room or at best two rooms, a number of households cook on their veranda. Cape Coast (17.6%) and Awutu-Efutu-Senya (15.3%) have more households that do their cooking on verandas than any other district. Related to the use of verandas as cooking space is the use of bedrooms/halls also. Nearly 2 per cent of households in the region use bedrooms/halls for cooking. Cape Coast has the highest proportion (3.8%).

About a tenth of households in Agona (10.2%) and Ajumako-Enyan-Essiam (9.7%) cook in structures with roof but without walls. Barely 2 per cent of households in all districts cook in enclosures without roof.

7 per cent of households in the region do no cooking at all, ranging from 5.4 per cent in Twifo-Hemang-Lower Denkyira to 9.3 per cent in Abura-Asebu- Kwamankese.

Cooking Fuel

The main sources of fuel used for cooking in the region are wood (60.9%) and charcoal (29.2%) making them the cooking fuel used by 90.1 per cent of households. The use of wood as cooking fuel is lowest in Cape Coast (12.0%) while it is less than half in Mfantsiman (41.5%), Awutu-Efutu-Senya (44.2%) and Komenda-Edina-Eguafo-Abirem (48.5%). In the forest districts of Upper Denkyira (75.8%), Asikuma-Odoben-Brakwa (84.7%), Ajumako-Enyan-Essiam (82.1%), Assin (84.5%) and Twifo-Hemang-Lower Denkyira (83.6%) the use of wood as cooking fuel is very high.

In the case of charcoal, three districts have proportions similar to that of the region, Abura- Asebu-Kwamankese (28.3%), Gomoa (26.2%) and Agona (25.1%). In five other districts, use of charcoal as cooking fuel is below 18.0 percent, while in 4 others it is more than 40 per cent of households, with highest usage being in Cape Coast (63.5%).

Gas, which is currently being promoted, is the third most used fuel, (3.1%) in the region. It is used more in Cape Coast (13%) than in any other district. Other districts in which significant proportions of households also use gas are Awutu-Efutu-Senya (5.2%) and Agona (3.7%), probably because they are more urbanised.

Kerosene is used by 1.7 per cent of households in the region. Although the same proportion of households in most districts use Kerosene, it is less used in Twifo-Hemang-Lower Denkyira (0.9%), while in Cape Coast it is used by 3.5 per cent of households. Other sources of fuel (coconut husks and electricity) are hardly used in the region as each is used by less than one per cent of the households. Coconut husks are however used by nearly 2 per cent of households in Mfantsiman and electricity by 2.4 per cent of households in Cape Coast. A small proportion (3.7%) of households do no cooking, though the proportion is relatively higher in Agona (6.1%) and Cape Coast (5.1%).

Bathing Facilities
The analysis of bathing facilities distinguishes between the availability of a separate room for bathing in living quarters, a cubicle for bathing in the house, a public bath house and other forms of bathing space. Bathing facilities in the districts are mostly shared (60.2%) with other households. A third (31.2%) of households in the region share a separate bathroom with other households. Other households also share bathing facilities, which are an open cubicle.

This is used by a fifth (21.0%) of households in the region. The open cubicle is more common in Awutu-Efutu- Senya (26.4%) and Twifo-Hemang-Lower Denkyira (28.0%) and least common in Upper Denkyira (15.1%). Households which share bathing facilities in another house constitute 8 per cent of households in the region. The practice is most common in Gomoa (12.6%) and least in Cape Coast (4.8%).

Apart from the bathing facilities discussed above there are those that are by nature public and therefore shared, such as the open space, public bathhouses and riverside. Some households (7.2%) use the open space around the house. With the exception of Cape Coast (2.9%) and Twifo-Hemang-Lower Denkyira (4.5%), in all the districts at least 5 per cent of households use this type of facility.

There are some households that have bathrooms in their houses exclusively used by household members (19.3%). Apart from three districts: Abura-Asebu-Kwamankese (14.7%) Mfantsiman (16.8%) and Agona (13.6%) all the districts have about a fifth of their households with this facility. The proportion is even higher in Upper-Denkyira where a quarter of households have this facility. A little less than a tenth (8.6%) of households in the region also have a private open cubicle. The open cubicle is least used in Cape Coast (3.7%) followed by Agona (5.6%) and most used in Assin (16.4%).

Nearly 4 per cent of households in the region use public bathhouses, mostly in Komenda- Edina-Eguafo-Abirem (11.2%), Abura-Asebu-Kwamankese (9.0%), Cape Coast (7.4%) and Mfantsiman (7.3%). Households in Assin (0.4%) and Asikuma Odoben-Brakwa (0.4%) hardly use this facility.

Other bathing facilities include the riverside and the lake/pond, used by less than one per cent of households in the region. In the districts, it is only Mfantsiman and Twifo-Hemang-Lower Denkyira that have one per cent of their households using the river, lake or pond as a bathing facility.

Solid Waste Disposal
Solid waste is disposed of in several ways but the main way is dumping either at a public dumpsite (69.3%) or elsewhere (19.9%). Disposal of solid waste at a public dumpsite varies between 50.1 per cent in Twifo-Hemang-Lower Denkyira and 84 per cent in Ajumako- Enyan-Esiam. Dumping solid waste elsewhere is mostly in Upper-Denkyira (30.7%), Assin (32.5%) and Twifo-Hemang-Lower Denkyira (41.5%). Ajumako-Enyan-Esiam has the least proportion (9.5%) of household disposing solid waste elsewhere.

Some households in the region (6.4%) burn their waste but there is one district in which the percentage is quite high. This is Awutu-Efutu-Senya (14.4%). Burying of waste is also another means of getting rid of solid waste. Although the proportions may not be high, Assin (4.7%) and Twifo-Hemang-Lower Denkyira (4.6%) have the highest proportions of households which use this method of solid waste disposal.

There is a growing tendency for private and public organisations to collect waste from house to house but since this is a recent phenomenon, less than one per cent of households in the region enjoy this facility although in Cape Coast (1.9%), Awutu-Efutu-Senya (1.2%) and Agona (2.1%) the proportion of households which have their waste collected exceed one per cent.

Liquid Waste Disposal

The three most commonly used method of disposing of liquid waste are the street, the gutter and the compound. Of these, the most common is the street accounting for 41 per cent of methods in the region and used mostly in Mfantsiman (50.8%), Gomoa (51.8%), Asikuma-Odoben-Brakwa (53.4%) and Ajumako-Enyan-Essiam (59.4%). In Cape Coast, the proportion is only 14.1 per cent.

Next in importance for disposal of liquid waste is the compound of the house, which is used by 35.5 per cent of households in the region. This method is the most common means of waste disposal for the following districts Awutu-Efutu-Senya (49.4%), Assin (48.1%) and Twifo-Hemang-Lower Denkyira (60.6%). The gutter, which is the third most commonly used channel by which liquid waste is disposed of in the region, is hardly used in Twifo- Hemang-Lower Denkyira (8.9%) while it is widely used in Cape Coast (52.1%).

Only an average of 2 per cent of households in the region have a proper sewerage system. Cape Coast, which houses the regional capital, has a higher percentage of 8.6 followed by Awutu-Efutu-Senya (4.2%).

Communication Facilities
The advent of information and communication technology (ICT) has revolutionalised and transformed the communication industry. Presently individuals, businesses, ministries, departments and agencies are increasingly relying more and more on the internet and mobile phones to communicate and transact business rather than the conventional means like the post offices and fixed telephone lines.

Nevertheless, poverty levels and inadequate supply of electricity have made most communities continue to patronize the post offices and fixed telephone lines. Currently, some districts like the Twifo-Hemang-Lower Denkyira have established ICT centres to assist residents have access to ICT. The census collected data on post offices and telephone facilities.

Post offices And Telephone Facilities
Very few communities in the region have post offices. According to the Regional Office of Ghana Post, there are only 30 post offices and 54 postal agencies in the region. Agona district has the largest number of post offices. Putting post offices and postal agencies together, however, Gomoa (13), Agona (12), Assin (12) and Lower Denkyira (11) have the largest number of postal systems.

Telephone facilities The distribution of telephone facilities is not different from that of post offices. With the exception of Cape Coast, less than 10% of localities in the other districts have telephone facilities within the communities. The situation is worse in Agona (0.6%), Asikuma-Odoben- Brakwa (0.7%), Assin (0.1%), Twifo-Hemang-Lower Denkyira (0.5%) and Upper Denkyira (0.2%).

Apart from Assin (21.6%), Twifo-Hemang-Lower Denkyira (24.2%) and Upper Denkyira (18.6%), between 30 and 80 per cent of communities in the other districts are located within 10 kilometres of a telephone facility. Another observation is that Upper Denkyira is the district with the highest proportion (43.0%) of communities with a telephone facility within 11-20 kilometres, while Awutu-Efutu-Senya has the lowest proportion (13.9%) of such communities. Similar to what obtains for post offices, districts such as Cape Coast and Mfantsiman do not have any community located beyond 20 kilometres of a telephone facility.

The teledensity for the region is very low (0.3 per 100 persons), compared with the national average of 0.7 and 3.2 for Greater Accra. The mobile or cell phone, as a telecommunication facility has assumed considerable importance in telecommunication in Ghana in recent times. The Central Region is covered by the three major providers, Scancom, Millicom and Ghana Telecom. Scancom, which operates the spacefon system provides the region with the widest coverage from transmission facilities located at 11 of the company’s 76 locations nationwide.

The locations, with corresponding districts in parenthesis, are Anomabo (Mfantsiman), Assin Foso (Assin), Cape Coast (Cape Coast municipality), Dunkwa-on Offin (Upper Denkyira), Elmina (Komenda-Edina-Eguafo-Abirem), Ituma, Kissi (Komenda-Edina-Eguafo-Abirem), Mankessim (Mfantsiman), Saltpond (Mfantsiman), Winneba (Awutu-Efutu-Senya) and Agona Swedru (Agona.) Millicom, operators of the Mobitel mobile telephone system, covers only the Cape Coast township. Other providers of cell phone facilities are KASAPA and Ghana Telecom’s One Touch.

Health Facilities

Good health is necessary for the development of any nation. Among the factors that promote good health are good sanitation, health facilities like hospitals, clinics, health centres/health posts and qualified health personnel like doctors, nurses and other paramedics. Statistics available from the Central Regional Health Administration show that the region, as at 2001, had 128 health facilities made up of 17 hospitals, 54 clinics and 57 health centres/health posts.

Cape Coast, Agona, Assin, Awutu-Efutu-Senya, Komenda- Edina-Eguafo-Abirem and Upper Denkyira were the most endowed districts with 10 or more health facilities. Ajumako-Enyan-Essiam and Lower Denkyira are the only districts without a hospital. The Central Region is fortunate to have one of three highly equipped ultra modern hospitals (Cape Coast Regional Hospital) built in the country recently (the others are the Ho Regional Hospital and the Sunyani Regional Hospital).

Hospital Facilities
There are very few localities, which have hospitals. Apart from Cape Coast (11.4%) Komenda-Edina-Eguafo-Abirem (4.6%) Awutu-Efutu-Senya (2.0%), Mfantsiman (1.7%) and Gomoa (1.2%) the remaining districts have less than one per cent of their localities with hospitals. For communities without hospitals, between 41.1 per cent and 63.2 per cent of those in Asikuma-Odoben-Brakwa, Agona, Abura-Asebu-Kwamankese, Awutu-Efutu-Senya, Gomoa, Mfantsiman and Cape Coast are within 1-10 km. of a hospital facility. However, some communities in Asikuma-Odoben-Brakwa (22.6%), Ajumako- Enyan-Esiam (52.6%), Assin (55.9%), Lower Denkyira (36.6%) and Upper Denkyira 37.2%) are over 20 km. away from hospitals facilities.

Cape Coast is the only district with no community situated beyond 20 kilometres of a hospital facility. For the following districts, Ajumako-Enyan-Esiam (26.9%), Assin (30.3%), Lower Denkyira (25.7%) and Upper Denkyira (19.7%), many localities are at least 31 kilometres. away from hospital facilities.

Clinic Facilities
The proportion of localities with clinic facilities is higher than that of hospitals for all districts. About a fifth (20.3%) of localities in Cape Coast, for instance, have clinic facilities while the proportion for hospitals is 11.4 per cent. For communities without clinic facilities, the majority are located within 10 kilometres of a clinic facility, except for in Assin (41.6%) and Upper Denkyira (47.5%).

The Central Region has a total of 76 doctors, of which 59 are in the public sector and 17 in the private sector. Cape Coast has the largest proportion (71.1%), but the remaining doctors are fairly evenly distributed in all the other districts. All the districts have doctor-population ratios far above the regional figure (1:20,971), except Cape Coast, which has one doctor to about 2700 people.

The total number of doctors in the whole country as at November 2003 is 2,008 (Human Resource Division, Ministry of Health, Government of Ghana, 2002, and the Ghana Medical Association 2003). Central Region’s share is only 3.8 per cent. Assin district, with the highest population in the region, has only one doctor to a population of 196,457. The entire district of Ajumako-Enyan-Essiam has not a single doctor for the entire population of 91,965. The nearest hospitals with doctors will therefore be the facilities at Breman Asikuma in the Asikuma-Odoben-Brakwa District, or Saltpond and Mankessim in the Mfantsiman District.

In a population where orthodox medical practitioners are few, the role of the traditional healer in primary health care delivery in the region becomes very important and should engage the full attention of planners, policy makers and implementers. Indeed, it is quite possible that they contribute considerably to the unusually high child survival rate in Twifo- Hemang-Lower Denkyira, a district with only one orthodox doctor but 166 traditional practitioners.



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