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Hon. Paul Evans Aidoo
Hon. Alfred Ekow Gyan

Housing Stock
For the Western Region there are 410,142 households in 259,874 houses, which give an average of 1.6 households per house for the region.

The number of households per house is similar to the regional figure for all the districts, except Shama-Ahanta East, where it is 2.4. The high figure in Shama-Ahanta East may be due to the many single-person households and pressure on residential accommodation.

Shama-Ahanta East, particularly Takoradi, also has very huge compound houses with single rooms and shared toilet and bath facilities, which are rented out to several individuals or families, either in single room or two or maximum three-room entities.

Most were built in the cocoa and timber economic boom years of the late 1950s and early 1960s. The low income group or single household members normally rent them. Some of these houses can have as many as 40 rooms in the entire building, and there can be as many as 100 persons living in any one such building. This phenomenon contributes significantly to the very high households per house ratio in that district.

There is therefore congestion in many houses, creating an inner-city slum situation. The high population per house of 10.2 in the metropolis also confirms this. In recent times, some of these houses have been converted into low class hotels and restaurants or office buildings due to high maintenance costs, which cannot be met from the meagre rents paid by the low-income tenants.

A high proportion of the total housing stock is in Shama-Ahanta East (13.9%) and Wassa West (13.2%). Wassa Amenfi (14.1%) and Juabeso-Bia (13.9%) also have sizeable proportions of the housing stock. These high figures for such rural districts like Mpohor- Wassa East, Wassa-Amenfi, Aowin-Suaman, Juabeso-Bia may be due to ease of acquiring land and building a house in these districts.

The average household size is fairly even for all districts, ranging from 4.1 in Ahanta West to 5.2 in Juabeso-Bia. The relatively low figures in the urban areas of Shama-Ahanta East (4.2), Ahanta West (4.1), and Wassa West (4.4) may suggest a high percentage of single-person households in these districts.

Type of Dwelling
Thus in Shama-Ahanta East, about a third of the population live in houses owned privately by other individuals (renting) while another third live in their own houses. It can therefore be observed that rural districts like Wassa Amenfi (71.7%), Juabeso- Bia (71.9%) Jomoro (69.5%) and Nzema East (68.7%) have higher owner-occupied houses than Shama-Ahanta East (33.6%), Bibiani-Anhwiaso-Bekwai (44%) and Wassa West (49.8%). These districts have high migrant labour that is likely to rent dwelling units and not possess houses.

The old system of the government building housing estates in the peri-urban and urban districts such as Sekondi-Takoradi, Tarkwa and Aboso, and the workers estates constructed by the mining and railway companies used to provide a good stock of housing in the region.

This practice unfortunately has stopped, leaving provision of housing in the hands of individuals, with no proper planning. This has led to haphazard development, particularly in the cities and major towns. Government should consider reviving this system of housing provision to cater for workers who cannot afford to build their own houses in the cities in which they work. The private employers such as the mining companies, the cement factory and other industries are rather doing better in this regard, compared to the Government, in providing housing for workers.

As discussed earlier, over a half of households own their dwelling. About a fifth each rent their dwelling for a charge. Rent-free housing is common, because of the extended family system. The owners of these houses may have moved to live in the city to work and may give rooms to relatives to stay in for free, with the implicit understanding that the occupants have no rights of ownership of their dwelling units and could be asked to vacate or relocate by the wishes of the owner, though this rarely happens.

There are 409,282 occupied dwelling units in 259,874 houses, giving an average of 1.6 occupied dwelling units per house. Most households (80.0%) in the region use one or two rooms as living quarters. Since most housing units or dwellings in the rural districts are built of mud bricks and not well ventilated, overcrowding can result in serious health and environmental problems.

The population per sleeping room is higher than the national average of 2.3, in nine of the 11 districts, with the highest being in Mpohor-Wassa East (3.1) and the lowest in Juabeso-Bia (1.8). Only Jomoro (2.3) and Juabeso-Bia (1.8) have populations per sleeping room lower than the regional average of 2.5, which is itself higher than the national average. Generally, the more urbanized a district, the higher the population per sleeping room. Any density per sleeping room above 2.0 can be considered to be on the threshold of over-crowding.

The number of people sleeping “on the street” (7,322) is 12.1 per cent of the national figure, and 0.4 per cent of the region’s population. They constitute 860 (0.2%) of the households in the region. These are high, and require urgent measures to address. The problem, however, seems to be concentrated in Shama-Ahanta East, with 44.3 per cent of the “homeless” households, and Juabeso-Bia (43.1%), even though Juabeso-Bia has the lowest population per sleeping room in the entire region.

Walls Of Dwellings
The main construction materials used for the walls of dwellings. The main construction material used in most districts is mud/mud brick. More than 40 per cent of all dwellings in almost all the districts, except Shama-Ahanta East, are constructed with mud.

In Shama-Ahanta East, about 67 per cent of the dwellings have cement or concrete block walls. Wood is used to some extent in Wassa Amenfi, more than the other districts.

Whether this is a direct manifestation of the availability of raw or sawn timber in the district, or in the adjoining districts of Aowin-Suaman, Sefwi-Wiawso and Juabeso-Bia which also have fairly high proportions of wooden buildings, is not immediately clear.

A large proportion of the dwellings in Jomoro (23.2%) and Nzema East (7.9%) are built with the mid rib of the raffia palm leaf as walls and the entire leaf, or coconut palm leaves, are used as thatch for the roofs. This material is abundant and cheap in the wetlands and forests of these two districts. The use of burnt bricks or stones for house construction is still relatively rare in the region.

Floor Of Dwellings
More than 60 per cent of all dwellings in every district have cement screeding as the main floor material, except Aowin-Suaman (48.9%) and Juabeso-Bia (43.7%). In Aowin-Suaman the commonest floor material is earth (50.1%), while 41.2 per cent of houses in Juabeso-Bia have earth floors. Shama-Ahanta East also has some few dwellings with wood (1.6%) or Terrazzo/ceramic tiles (2.4%) as the floor materials. Despite the relative abundance of timber products in the region, wooden floors are not very common because they are prone to termite attacks.

Roof Of Dwellings
In the case of main roofing material, corrugated metal is very popular in the region. Except in Jomoro (26.9%) and Nzema East (31.5%), dwelling units in all other districts have 41 per cent or more of roofs made of corrugated metal sheets. More than 40 per cent of the dwellings in Jomoro and Aowin-Suaman have thatch/palm leaf as roofing materials. Nzema East, Mpohor-Wassa East, Juabeso-Bia and Sefwi-Wiawso have about 30 per cent of their dwellings roofed with thatch/palm leaves.

Thatched roofs are therefore mainly a rural phenomenon, notwithstanding the fact that they keep rooms much cooler than metal roofs. About 33 per cent of dwellings in Shama-Ahanta East also have asbestos/slate and 20 per cent cement/concrete tiles or screeds as roofing materials. Many buildings with concrete roofs are uncompleted multiple storey buildings with at least one completed and occupied floor, for the remaining floors to be built later. Others are deliberately designed to have concrete roofs, but they are becoming less and less common due to the structural problems they create later.

Bamboo is also used to some extent as roofing material in Ahanta West, Mpohor-Wassa East, Nzema East and Wassa Amenfi, all of which have large natural forests of bamboo.

Housing Condition

The main sources of lighting are kerosene lamp and electricity. Between them they provide lighting for about 99 per cent of households in the region. In the urban areas of Shama- Ahanta East (83.2%) and Wassa West (56.5%), electricity is used by the majority of households while in the rural districts, kerosene is the source of lighting for majority of households. The semi-urban areas of Bibiani, Jomoro and Nzema East have about half of their dwellings with electricity. About 1.0 per cent of dwellings in Juabeso-Bia use solar energy on a pilot basis to study its feasibility in rural areas.

Source Of Water
The sources of drinking water may be grouped into three categories: pipe-borne water (inside, outside, tanker supply), well (well, borehole) and natural (spring, river, stream, lakes, rain water, dugout). About 50 per cent of the dwellings in Bibiani, Sefwi- Wiawso, Juabeso-Bia, and Ahanta West use wells as their main source of water. In Wassa Amenfi, Aowin-Suaman, Nzema East and Jomoro, about 60 per cent of households use natural sources or wells, whilst the remaining 10 per cent use pipe-borne water located outside the dwelling places.

In Shama-Ahanta East about 88 per cent have access to pipe borne water while another 9 per cent have access to wells or bore holes. Hence in this highly urbanized district, there is almost 100 per cent availability of, or accessibility to, potable water. The problem is with efficiency of supply either as a result of poor maintenance of infra-structure, or drastic reduction of the volume of water in the reservoir at Inchaban during the dry season, which leads to frequent water shortage in parts of the city.

Although residents of about 40 per cent of dwellings in Wassa West have access to pipeborne water, residents of about 25 per cent use rivers or streams as their source of water. The situation in these two highly urbanized districts is in sharp contrast to rural districts such as Aowin-Suaman where over 60 per cent use rivers, streams, dugouts or spring or rain water as their main source of water, with only 8.7 per cent having access to processed pipe-borne water.

In the region as a whole, only 32 per cent of houses have access to treated pipe-borne water with only 8.5 per cent having this available within the dwelling place. This situation is not satisfactory, and programmes to provide potable water, particularly in the rural areas, need to be intensified to minimize the prevalence of water-borne diseases such as diarrhoea diseases including cholera, filariasis, guinea worm, schistosomiasis, and typhoid, which are all very common in the region.

Toilet Facilities
The availability of toilet facilities seems to be a major problem in the region, as about 40 per cent of dwellings in the region have either no toilet facility or use a public toilet. Only four districts, namely Mpohor-Wassa East (57.9%), Aowin-Suaman (62.8%), Juabeso-Bia (67.5%) and Sefwi-Wiawso (52.7%), have most of the households with a toilet facility in the housing unit, in the form of a pit latrine, a KVIP, a bucket or pan or a water closet (WC).

Even in these districts, most of these in-house toilet facilities are ordinary pit latrines, constituting about 50 per cent in each case. The remaining 40 per cent use public toilets which may include KVIPs or pit latrines. On the other hand, Ahanta West and Jomoro

This is a most disturbing situation indeed, especially considering that these are two districts with a great tourist potential. The District Assemblies will need to address this situation very urgently by enforcing byelaws and also providing more hygienic facilities for human waste disposal.

The most common form of toilet facility in the region is the public toilet, which may be a KVIP, a pit latrine or a bucket/pan system, with its usage quite prevalent among households in Shama-Ahanta East (45.9%), Wassa-West (41.9%), and Bibiani (45.9%).

The pit latrine is also used extensively in the rural areas of Mpohor-Wassa East (44.5%), Wassa Amenfi (43.5%), Aowin-Suaman (57.9%), Juabeso-Bia (48.3%) and Sefwi-Wiawso (45.0%). Because of the unhygienic nature of the pit latrine and the bucket or pan system, these must be phased out and resources and education be directed to the promotion of KVIPs for such rural areas.

The W.C. is also used by about 23 per cent of households in Shama-Ahanta East, followed by Juabeso-Bia (8%). It is rather surprising that Wassa West has only 4.7 per cent of houses with WC. A rich mining and cocoa-growing district of its kind, with towns such as Tarkwa, Nsuta, Aboso, Prestea, Bogoso, Nsuaem and Huni Valley, cannot be left with such poor toilet facilities in the various households.

Indeed, it is a fact that for a very long time, Tarkwa, the third largest urban centre in the region, had a vast majority of its inhabitants using the bucketpan toilet system, a most unhygienic and unsatisfactory method of human waste disposal.

It still has 8.7 per cent of households in the district using this system, the highest in the whole region. It is also unacceptable that Shama-Ahanta East, with the regional capital, Sekondi- Takoradi, has only 22.9 per cent of the households using water closets (WCs) and as high as 45.4 per cent using public toilets. It is rather surprising that Shama-Ahanta East, which has 27.3 per cent of households having in-house pipe-borne water, does not use the water closet system of human waste disposal more extensively.

The common practice of the environs of public toilets also serving as solid waste dumps is one of the most serious health hazards posed in many of the urban and peri-urban localities. The District Assemblies therefore need to tackle this problem in the entire region and ensure that all households resort to more efficient and hygienic methods of human and solid waste disposal.

Bathing Facilities
A bathroom may not necessarily be located inside the house. It may be a small walled enclosure or cubicle built either with cement or wood, normally without a roof but with a door that can be locked both from inside and outside, and located outside the house. In the typical forest areas of Wassa Amenfi, Aowin-Suaman, Juabeso-Bia and Sefwi-Wiawso, about a quarter of all households in these districts share bathrooms while the rest of the districts have about 30 per cent of households sharing bathrooms. About 20 per cent of all households in all the districts have their own bathrooms except Juabeso-Bia where a third own bathrooms.

Public bathrooms are common in Shama-Ahanta East, while open spaces are used in Nzema East, Jomoro, Amenfi and Aowin-Suaman Districts. Cubicles, whether private or shared, are also commonly used as bathrooms in all the districts. It is significant that rivers and lakes/ponds are not that commonly used as bath places. In many districts, even those who use river water prefer to go and fetch the water from the riverside and bring it home. It is encouraging to note that in many communities, having a bath is still regarded as a private matter that ought not to be exposed to public attention. This used to be the case for urination and defecation as well, but are unfortunately no longer the case, even in some of the urban areas.

Children however have the freedom to have their bath anywhere, including rivers, lakes and streams. This practice exposes them to diseases such as bilharzia (schistosomiasis), forest area onchocerciasis and guinea worm. It is a practice that district assemblies will need to effectively discourage and educate the general public on if these diseases are to be controlled and eventually eliminated from the various communities.

Fuel For Cooking
The main source of cooking fuel in the region is wood. The great majority of households in all the districts use wood for cooking, except Shama-Ahanta East, where charcoal is used by about 60 per cent of households. About 16 per cent of the households in Shama-Ahanta East also use wood. Other districts where charcoal is used fairly intensively are Ahanta West (25%), Wassa West (38.3%), Nzema East (20.0%), Jomoro (16.5%), and Bibiani (14%).

Liquid petroleum gas (LPG) ranks as the third largest source of cooking fuel in Shama- Ahanta East (11.3%). It is also used in Juabeso-Bia (6.3%), Wassa West (3.7%) and Jomoro (1.6%). It is understood that there has recently been a deliberate promotional exercise of the single-ring small cylinder LPG cooker in Juabeso-Bia, hence the unusually high usage of this fuel in such a relatively rural area. This means that it is possible to promote this fuel even in the rural areas, so as to save the forests from over-exploitation as fuel-wood and for making charcoal.

Coconut husks are also used in Jomoro (6.1%) Juabeso-Bia (4.0%) and Nzema East (0.6%) as a source of fuel for cooking. The relatively low use of this fuel source in Nzema East is rather surprising, and may be due to the recent devastating effect of the Cape Saint Paul Wilt Disease, which has destroyed many coconut plantations in the district, particularly between Ankobra and Aiyinasie. (The plantations are in the process of being rehabilitated with disease resistant strains). The use of electricity for cooking is minimal, with Shama-Ahanta East (2.9%) and Wassa West (2.7%) being the most significant.

Disposal Of Solid Waste
Solid waste refers to rubbish generated by members of a household or occupants of a living quarter. Dumping either at specified dumping sites or indiscriminate, is the predominant mode of rubbish disposal in the region. About 60 per cent of all households in all the districts use a specified public dump while an additional 29 per cent use an unauthorised dumping place. Only 2.2 per cent of households have their rubbish collected by local authorities and properly disposed of.

Burning and burying of rubbish account for about a tenth of household solid disposal methods. Households in Shama-Ahanta East, more than any other districts, use collection agencies and public dumping sites. Solid waste management seems to be more efficiently done in this district than the other districts. It is worth noting that dumping waste elsewhere is the least practised by households in this district (9.4%), compared with 52.5 per cent in.

Disposal Of Liquid Waste
Liquid waste refers to water from kitchens, bathrooms and washing of clothes and dishes. Liquid waste is disposed of in the region by throwing it into gutters (24%), on the compound of the house (37%) or onto the street outside (35%). The same methods of disposal are used in all the districts, but with varying emphases.

In Ahanta West, Mpohor-Wassa East, Wassa Amenfi, Aowin-Suaman and Juabeso-Bia, the most prevalent method of disposing of liquid waste is throwing it onto the compound. Households in Shama-Ahanta East and Wassa West use the gutter more than the other means of disposal while in Jomoro, Nzema East, Sefwi-Wiawso, and Bibiani-Anhwiaso-Bekwai, more than 40 per cent of households throw their liquid waste onto the street or outside the house. Quite a few (10%) of households in Shama-Ahanta East use the sewerage system or septic tank to dispose of liquid waste

Post Office
Households in 36.0 per cent of localities in Shama-Ahanta East metropolis have access to a post office within the locality, while an additional 30.3 per cent access one within 10 kilometres. For Jomoro, inhabitants of about a quarter of its localities

Two types of telephone systems are in operation in the country. These are the fixed line telephones and the mobile telephone systems. Over 95 per cent of the fixed line telephones in the country are operated by the Ghana Telecom Company (GT) while the largest mobile telephone operator is Scancom now MTN, which operates the spacefon (MTN) mobile telephone facility.

Of the 7 telephone companies operating in the country, only two, Westel and Ghana Telecom now Vodafone operate fixed line systems. Five others including Ghana Telecom (Vodafone) operate mobile systems, while Capital Telecom operates wireless, radio telephone and satellite communications systems.

The various telecommunication companies operating in Ghana and their current and projected subscriber/customer market performances as obtained from the National Communications Authority come up to 718,831 1,123,945

The total number of subscribers as at January 2003 was 718,831, expected to rise to about 1.1 million by January 2004. The estimated market size in Ghana is 2.5 subscribers. This implies that as at 2003, there was a gap of about 1.8 million subscribers yet to be filled, expected to narrow to about 1.4 million by January 2004, and this leaves a lot of room for service expansion.

The situation with access to telephones in the Western Region is not any better than that of post offices. Of the 12,850 fixed lines in the region as at 2000, 11,046 or 86.0 per cent serve the Shama-Ahanta East metropolis. Of the 11 districts, only 6 have fixed line telephone transmission facilities provided by Ghana Telecom (Vodafone). These are Aowin-Suaman (Enchi), Wassa Amenfi (Samreboi and Asankragua), Jomoro (Elubo), Shama-Ahanta East (Sekondi and Takoradi), Wassa West (Tarkwa), and Nzema East (Axim).

Some of the other districts are served by radio telephone and other systems by private companies such as Capital Telecommunications. For example, Mpohor-Wassa East and Ahanta West are served by wireless telephone (WILL) systems while Sefwi-Wiawso, Awaso in the Bibiani-Anhwiaso-Bekwai, and Juabeso-Bia are served by radio links.

Tarkwa and Awaso are served by Capital Telecommunications, the smallest telecommunications operator in the country. Indeed it appears as if Tarkwa is about the only town which is very well served by all the telecommunications systems in the country, perhaps because of the mining companies which require several different types of communications systems for efficient operation.

The ratio of telephones per population is not encouraging. Apart from Shama-Ahanta East, the other districts have ratios lower than the regional average of 1:148. Teledensity in the region is 0.3 telephones per 100 persons, which is below the national average of 0.7. This is however the third highest in the country, an indication of the extremely low teledensity in the country as a whole. Greater Accra has the highest teledensity of 3.2 telephones per 100 persons.

An additional 32 per cent have access within 10 kilometres. Household members in a large proportion of localities in Jomoro (41.7%), Ahanta West (46.0%), Wassa West (41.0%) and Bibiani-Anhwiaso-Bekwai (44.2%) have to travel 6 to 15 kilometres to reach the nearest telephone facility.

In more than half of the localities in Nzema East, Mpohor-Wassa East, and Juabeso-Bia one has to travel more than 30 kilometres before having access to telephone. For Wassa Amenfi and Aowin-Suaman, the corresponding figure is about 30 and 25 per cent of the localities, respectively. Residents in over 40 per cent of the localities in Wassa Amenfi and Aowin- Suaman also have to travel 6-20 kilometres to have access to a telephone.

A new but very significant phenomenon that has assumed considerable importance in telecommunication in Ghana in recent times is the mobile or cell phone. This, and internet facilities in a rapidly growing number of internet cafes all over the country, are beginning to have a modest but significant impact on information and communications technology (ICT) in Ghana.

The Western region is one of the regions where cell or mobile phones are beginning to impact telecommunications significantly The region is one of the most extensively covered by the various mobile telephone operators, probably due to the high usage by the mining and other industries in the region.

The region has the second highest location coverage by Scancom Ltd.(MTN), operators of Spacefon(MTN), the largest mobile telephone system in the country.

The company covers all the ten regions of the country. Millicom, operators of the Mobitel mobile telephone system, also covers the Western Region and five other regions of the country. Of the 76 transmission locations used by Spacefon (MTN) to cover various regions of the country, 15 are in the Western Region (19.7%), second to the Eastern Region which is covered through 19 locations (25%).

The locations in the Western Region are Apimanim, Bawdia, Bibiani, Bogoso, Bosomoiso, Elubo, Mpohor, Prestea, Sefwi Anhwiaso, Sefwi Awaso, Sefwi-Wiawso, Sekondi, Ituma, Takoradi and Tarkwa.

With a coverage radius of between 10 and 50 kilometres per location depending on the transmitter system in use, this is quite a wide coverage for the region. Mobitel covers Sekondi-Takoradi, Tarkwa and Damang, while Ghana Telecom’s One Touch system covers Sekondi-Takoradi, Tarkwa and Prestea. In all, 7 of the 11 districts have locations from where the mobile telephone system covers the region.

Medical Facilities
Various types of medical facilities and personnel provide primary health care in the region. These include hospitals and allopathic (orthodox) doctors and their support staff including nurses, pharmacists and public health personnel on the one hand, and traditional healing facilities and traditional healers including herbalists, spiritualists, homeopaths and other nonconventional health service providers on the other hand.

The official national norm is that no citizen should be more than 8 kilometres away from the nearest health facility. The following discussion reveals the extent to which the region has been able to meet these national norms for the various types of health delivery systems.

Traditional Healers And Traditional Healing Facilities
Traditional healers are mainly health practitioners who use mainly herbs and herbal preparations in the treatment of ailments. In the country as a whole, it is estimated that between 60 and 80 per cent of the population rely mainly on these healers for primary health care.

Traditional healers are in almost every community in the region and in every district. Over 90 per cent of the population can reach them within a radius of 5 kilometers. Indeed, in all the districts, between 60 and 92 per cent of the localities have traditional healers within the locality. Even in a fully urbanized district such as Shama-Ahanta East, 92 per cent of the localities have traditional healers within the locality, the highest in the region.

The lowest is in Jomoro, where 60.2 per cent of localities have the facility in the locality and 30.9 per cent are within a 5-kilometre radius. In Juabeso-Bia, where there is only one doctor for the entire population of about 250,000, 87.4 per cent of the localities have traditional healers within the locality while another 11.3 per cent have them within 5 kilometres. The same applies to Jomoro, where there is only one doctor for the entire population of over 110,000, but there are over 90 per cent of localities with traditional healers within 5 kilometres.

Obviously, without these healers, primary health care in these and many other districts would be an unmitigated disaster. Hardly anybody in any district travels more than 10 kilometres to reach a traditional healer.

Traditional healing facilities are therefore well within the official limits for the provision of primary health care. The regional traditional healer to patient ratio is estimated at about 1 to 370, which compares favourably with the national average of about 1 to 400.

The ratio of registered traditional medical practitioners to the population for the region is 1 to 1,127. Jomoro has the lowest ratio of 1 to 502, while Juabeso-Bia has the highest ratio of 1 to 2,694. Since there are many other practitioners who may not be registered with the Ministry of Health, it is estimated that the true number of traditional medical practitioners in the region is about twice the number of registered practitioners, with a regional ratio of about 1 practitioner to 500 people.

In a region where hospitals are very few, and where the doctor to patient ratio is currently estimated at about 1 to 18,500, the importance of these healers to health care delivery can bear repeating. There is therefore the need for them to be properly organized and their talents and services properly coordinated as an officially recognised integral part of the health care delivery system.

 The population per publicly owned health facility of 10,140 as at 2001 is slightly below the national average of 11,289, and is the third lowest in the country, coming after the Volta Region (6,984) and Greater Accra (8,605). The ratio for the region is about two-thirds that of the Eastern Region, (16,706), which is the highest in the country.

Notwithstanding these seemingly encouraging figures, not every community has easy access to a hospital. For instance, in Nzema East, Mpohor-Wassa East and Juabeso-Bia, about 60 per cent of their localities are situated more than 30 kilometers from a hospital.

The situation is particularly bad in the riverine areas of the Dwira traditional area of Nzema East, where the poor road network makes it even virtually impossible for inhabitants to travel more than 30 kilometers to the nearest hospital.

They have to travel by canoe on the Ankobra River either to Axim or to Enimbil-Dominase or Prestea before they can get a vehicle to Axim, Tarkwa or Prestea hospital. Substantial proportions of localities in Jomoro (43%), Wassa Amenfi (32%) and Aowin-Suaman (24%) are also more than 30 kilometres away from a hospital.

Districts with substantial proportions of their localities within 6-20 kilometres of a hospital are Ahanta West (69%), Bibiani-Anhwiaso-Bekwai (68%) and Wassa West (57%). Shama- Ahanta East has 36 per cent of its localities enjoying hospital facilities within the locality, and 9.7 per cent within 5 kilometres.

Only 0.8 per cent of localities in Wassa West, the second most urbanized district in the region, have hospitals within the locality, and 18.4 per cent are within 5 kilometres of the facility. Even though mining companies such as Tarkwa Goldfields, Nsuta Manganese Company and Prestea/Bogoso Goldfields have fully-fledged hospitals in this district, these are by and large restricted to only the employees and their dependants, meaning that physical accessibility is further out of reach of many households.

Shama-Ahanta East has over 80 per cent of its localities, where households can have access to such a facility within a 10 kilometre radius. Ahanta West has over 60 per cent of its localities having clinics within this same radius.

Residents of less than 10 per cent of localities in these two districts are located more than 30 kilometres from the nearest clinic. This is in sharp contrast to Nzema East, where 47.7 per cent of localities are more than 30 kilometres from the nearest clinic. Other districts where significant proportions of the localities have clinics located at considerable distances are Wassa West (13.9%), Wassa Amenfi (15.6%) and Aowin-Suaman (25.1%).

Generally, the staffing situation in health facilities in the region is very critical and needs serious attention. There are only 104 doctors in the entire region, made up of 77 in the public sector and 27 in the private sector, with a large proportion (61.5%) in Shama-Ahanta East metropolis alone.

The total number of doctors in the whole country as at November 2003 is 2,008 (Human Resource Division, Ministry of Health, 2002, and the Ghana Medical Association 2003). Western Region therefore has only 5.2 per cent of the total number of doctors in the country. In Juabeso-Bia, there is only 1 doctor for the entire population of 245,035, while in Jomoro there is only one doctor for the entire population of 111,348.

With orthodox medical facilities largely inaccessible to the rural communities, herbal or traditional healers are the main providers of health care. Charlatans and other drug peddlers also use the situation to their advantage by selling fake or counterfeit drugs, or parading the rural areas as qualified medical practitioners and administering all sorts of dangerous drugs to patients, thereby creating more complications.

Most of the districts have doctor-population ratios far above the regional figure (1:24,362) except Shama-Ahanta East and Nzema East. The nurse-population ratio is also not very encouraging, falling far below the national average in most of the districts.

There are 13,743 professional and auxilliary nurses in the public sector in the country, with 1,077 of them in the Western Region, in both the public and private sector. It is not immediately clear how many of these form part of the public sector nursing corps, but with the number of private hospitals and clinics catering for various organizations in the region, quite a substantial number of these nurses must be in the private sector.

Access To Education
One of the most important factors that determine whether children of school-going age will actually enrol in a school is how easily accessible educational facilities are to them. Among factors that determine accessibility are distance from the nearest facility, affordability and the available facilities in a given school. Access to the various levels of education in various districts is discussed.

Primary Schools
Primary education is a necessary input for the development of any child between the ages of 6 and 12. Easy access should therefore be of concern to all districts. Ghana’s official policy on primary education is that all children of school-going age should have free compulsory universal basic education. Basic education consists of primary and junior secondary education. Free compulsory universal basic education implies that not only should there be enough schools to absorb all children, but that these schools should also be within easy reach of the children at no tuition cost.

The official policy of the Ministry of Education is that no child should travel more than 5 kilometres to the nearest basic school (primary or junior secondary). There are 1,320 primary schools in the region, of which 1,240 are public and 80 private. 9 of the 11 districts have less than 20 per cent of their localities having primary schools within the locality. Only Shama-Ahanta East (52.0%) and Ahanta West (29.9%) have more than 20 per cent of the localities having schools within less than a kilometre.

The districts with less than 10 per cent of localities having primary schools within the locality are Jomoro (7.8%), Mpohor-Wassa East (7.6%) and Aowin-Suaman (9.5%). In accordance with the policy, therefore, 9 of the 11 districts have the majority (more than 60%) of their localities within 5 kilometres of a primary school. The exceptions are Jomoro (37.9%), Nzema East (44.7%).

Hence, even though many of the localities have not reached the ideal national norms, accessibility to primary schools in both the rural and urban localities of the region is fairly good. Except Jomoro where children in about 30 per cent of the localities are16 kilometres or more from the nearest school, in all the other districts children of over 80 per cent of localities do not have to travel more than 10 kilometres to attend the nearest school. The District Assembly will need to evolve policies to increase access and reduce distances to the nearest primary school.

Pupil To Teacher Ratio
A low pupil-to teacher ratio is usually regarded as a good thing, as it enables the teacher to pay closer attention to the pupils. In the Western Region, the average pupil to teacher ratio for the primary school is about 1: 33, the same as the national average. The official Ministry of Education policy is that no class should have more than 35 pupils at the primary level and 45 pupils at the junior secondary level, to a teacher.

Under normal circumstances, therefore, one could say that the region is doing very well in this regard, if this low pupil to teacher ratio had been brought about by the provision of adequate infrastructure and other facilities in all communities. This however does not appear to be the situation. In the case of the primary school level, enrolment is relatively high (86%), hence the pupilteacher ratio that is close to the official standard.

At the junior secondary level, the low ratio appears to be a reflection of the relatively low enrolment rates in some districts, where the actual enrolment is less than 50 per cent of the potential enrolment of all eligible children of school-going age. Even at the primary level, there are some districts where enrolment is far below the regional average. The low enrolment is due mainly to lack of school buildings, inadequate textbooks and the inability of parents to pay the fees charged by schools (both private and public).

Access To Junior Secondary School (JSS)
The type of junior secondary school (JSS) that a child attends determines to a very a large extent, whether the child would progress to a senior secondary school (SSS) and, for that matter, to a tertiary or post-secondary level. There are 694 junior secondary schools in the region, about half the number of primary schools, and this constitutes 10.9 per cent of the total number of JSSs in the country. Since basic education is supposed to be free and compulsory, one would have expected that every primary school will have a corresponding junior secondary school.

That there are only half as many junior secondary schools as there are primary schools means that access would be more difficult for some of the children, and children living in localities where junior secondary schools are not within reasonable distances of the localities, are likely to drop out of school after primary school. Shama-Ahanta East has about 40 per cent of communities that have JSSs within them; and an additional 40 per cent of localities have JSSs within 1-5 kilometres. Ahanta West is the next best, with 19.8 per cent of the localities having schools within the locality and 55.6 per cent within 5 kilometres. While the rest of the districts have limited JSS facilities within the communities, the majority of communities in eight districts are within 5 kilometres of a JSS.

As already indicated, enrolment in junior secondary schools in the region is generally low compared to primary. This indicates a high drop-out between the primary and junior secondary level. This may partly account for the low pupil to teacher ratio, which ranges from 11.9 in Ahanta West to 21.7 pupils in Wassa West. The official standard is 1 to 45, but the ideal figure for a junior secondary school would be about 1 to 30.

Access To Senior Secondary School (SSS)
Access to senior secondary school (SSS) in the region is very poor compared to the primary and JSS. There are 42 senior secondary schools in the region and most of them are concentrated in Shama-Ahanta East, where 36 per cent of the localities in the metropolis have senior secondary schools, with an additional 9.7 per cent being within 5 kilometres of an SSS. In three other districts, Ahanta West (21.9%), Wassa West (12.1%) and Bibiani-Anhwiaso- Bekwai (11.5%), more than a tenth of communities are within a 5 kilometre radius of an SSS.

In Jomoro, Nzema East and Mpohor-Wassa East, children in more than 40 per cent of the communities have to travel over 30 kilometres before attending SSS. Some of these schools do not have boarding facilities, and even those which have, do not have adequate facilities to cater for all the qualified students. If all the schools had adequate boarding facilities, distance would not have been a factor in determining access, as students from the rural areas could be accommodated in school during term time. In such cases, affordability becomes a more important determinant of access.

Many children, particularly those from the rural areas, are therefore unable to have access to senior secondary education in the region because of both distance and affordability. The Government’s official policy of de-boardinisation will therefore need to be critically re-examined and modified to suit the requirements of different communities and districts.

At the senior secondary level, the enrolment of students further reduces, indicating a high drop-out rate from junior to senior secondary levels. There is the need to expand the availability of senior secondary schools in the region. Also, since not all children who complete junior secondary school may wish to, or are capable of pursuing an academic programme, facilities for vocational and technical education should be expanded to absorb the large number of junior secondary school leavers who do not enter senior secondary school.

The Government’s policy of a model Senior Secondary School in each district should be supported and expedited to improve the low level of enrolment. The low level of enrolment also translates into a low student to teacher ratio, the highest ratios being in Ahanta West (29.7) and Sefwi-Wiawso (33.9), while Jomoro (13.5) and Aowin-Suaman (19.1) have very low ratios.


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