There were 376,204 dwelling units in 264,451 houses, across the region, during the 2000 census (26, March 2000). This represents an increase of 52.8 per cent in the housing stock since March 1984. About four-fifth (78.7%) of the stock of houses are in the rural areas. In all, there are 345,821 households in the region, which translates into a ratio of 1.3 households per house, the lowest in the country. On the average, there are 6.2 persons per house and 4.7 persons per household.
Two-thirds of households in the region occupy their own dwelling units. Relatives who are not household members own 12.4 per cent of housing units, while the remaining are owned by other private individuals and employers, and others.
Ownership of occupied dwelling units in six districts are similar to the regional pattern. In the six other districts, South Tongu, Keta, Ketu, Akatsi, North Tongu and Kpandu, the number of dwelling units belonging to relatives who are not members of the household is more than that owned by private individuals.
Except for the Kadjebi District, where about a quarter of dwelling units are rental units, in all other districts, less than a fifth of dwelling units are rented. In six of the 12 districts, South Tongu, Keta, Ketu, Ho, Kpandu and Kadjebi, about a fifth of the households in each of these districts reside in rent-free units. It is only in Krachi that less than a tenth of households live in rent-free dwelling units.
The main type of dwelling unit in all the districts is the separate house, which accounts for 46.4 per cent of all types of dwelling unit. The makeshift type of dwelling unit, such as the tent, kiosk, container or attachments to shops, constitutes 0.9 per cent and appears to be an emerging urban phenomenon.
The proportion of dwelling units with walls made of mud/mud bricks/earth is about twice that of dwellings with cement block/concrete walls. Corrugated metal sheets are the main roofing materials in nine of the 12 districts. In the Krachi, Nkwanta and Akatsi Districts, there are more thatch/palm leaf roofed dwelling units than in any other district.
In the districts in the southern part of the region, especially in the Keta district, a substantial number of dwelling units are roofed with asbestos sheets, probably because this roofing material may be more resistant to constant seawater corrosion.
At least 50 per cent of dwelling units in every district has a cement floor. In six of the 12 districts, South Tongu, Keta, North Tongu, Ho, Kpandu and Hohoe, over a third of households use pipe-borne water as the main source of drinking water.
The river/stream is available to at least a third of households in every district, except the Keta, Ketu and Akatsi, Districts. In the Keta and Ketu Districts, wells are the main source of drinking water for majority of the households and in the Akatsi District in particular, 34.1 per cent of the households rely on other sources such as dams, springs and rainfall.
The Kerosene lamp is the main source of lighting in many households in every district in the region, ahead of electricity. Gas lamps are not common in any of the districts while solar energy, as a source of lighting, is rarely used in the districts.
More than 90.0 per cent of households in every district use wood and charcoal (a product from wood) as the main fuel for cooking. Apart from the Ho, Keta, Hohoe and Kpando districts, less than two per cent of households, in all other districts, use gas for cooking.
It is worth noting that a quarter of the households in the region do not have any toilet facility. This situation is more serious in the Nkwanta and Keta Districts, where nearly half of the people do not have any particular place as their toilet. Apart from the Ho, Kpandu, North Tongu and Keta, Districts, less than two per cent of the households in the other districts use the water closet. Public toilets (21.2%) and pit latrines (30.8%) serve the needs of households in each district.
Data on household liquid waste disposal indicate that less than 2 per cent of households in the region use the sewerage system, except in Ho and North Tongu Districts. At least 80.0 per cent of households in every district dispose of their liquid waste on the compound of houses and on the streets outside.
Policy Implications And Recommendations
Age And Sex Structure
The age-sex composition of the population, at a given time, has a substantial influence on the potential for population growth in the future. For example, an extreme preponderance of one sex would tend to result in a lowered fertility and slower growth rate of the population.
Such imbalances also affect the social, household and economic composition of the population. In the region, there is a slightly higher male preponderance in the younger age segments while females tend to be in the majority in the economically active age segment and the older ages. Differences in birth rates are the principal explanation for differences in age composition.
Districts with high birth rates, particularly Krachi and Nkwanta, have a young age composition whereas those with relatively low birth rates have a relatively older age composition.
There is therefore the need to continue with, and intensify, fertility education programmes that target child spacing and contraceptive practices which are necessary to reduce the high levels of fertility in the districts. Non-contraceptive and non family planning practices and attitudes that reduce high fertility also need to be encouraged and sustained.
For improved and enhanced quality living of communities, it is necessary that each household has access to pipe borne water, electricity and a water closet toilet. The results of this report show, however, that most of these facilities tend to be non-existent in all but a small fraction of homes.
In sum, households tend to consist of about five persons in a few rooms, without running water, electricity, or water closet toilets. Rapid strides are however being made to provide electricity to both rural and urban households, in addition to improving upon the quality of urban housing.
One of the objectives of preparing a district report such as this one is to emphasize the importance of district specific concerns for various development strategies. The overall analysis suggests a gross inadequacy in the provision of community amenities.
Of major concern is the non-availability of toilet and waste disposal facilities. In particular, the absence of W.Cs could have been made up for by the construction of KVIPs. These two facilities are, however, not common to most households in the districts, most probably because of the cost of construction and the need for piped water into the household to enhance the use of a water closet.
The fact that most of the households use public toilets, pit latrines or go to toilet in the bush, and at the same time dispose of waste (liquid and solid) into gutters and compounds, is indeed a great cause for public health hazards.
Another area of concern is the use of wood as the main source of fuel for domestic consumption. While electricity is available for street lighting, it is not so much patronized as a domestic (or household) consumption good, particularly in the rural areas. Neither is the use of gas for cooking patronized even in most urban areas.
The major obstacle to the use of gas for cooking is the relatively high cost. The problem for planners is to look for a way to cut down on the use of wood by encouraging the use of gas, as a replacement for wood, as a cooking fuel. The pattern of fuel use in the region essentially depicts the extent of deforestation in the region and, if unchecked, may lead to a total deforestation in the region
Household Composition And Structure
Given that the average household of 4.7 persons is a mix of parents (head with or without spouses), children and other relatives, it seems that the ideal housing situation would be an average of about three rooms per household.
If room occupancy is examined from the angle of crowding, however, it would seem that two rooms should be a minimum for a household of five persons. It is, however, evident from the data that most households have inadequate sleeping rooms, particularly when personal property and household belongings occupy a sizable portion of sleeping rooms.
On the basis of a rough generalization that the higher the standard of living in a district, the larger the average number of rooms in the housing units, then the Jasikan, Kadjebi and Nkwanta Districts will be the most deprived in terms of room occupancy. To measure crowding, it is necessary to calculate the number of persons per room.
It is argued that the coming into being of the Volta Lake, after the construction of the Akosombo dam, caused the cocoa industry in the region to die out. Whatever the validity of this assertion, the fact remains that the death of the cocoa industry in the region is a significant contributing factor to the high rates of unemployment and poverty in the districts, particularly in the northern half of the region. Regrettably, the Volta Lake does not also appear to be giving maximum benefits to the fishing industry and modern irrigation facilities to boost year-round agricultural productivity in the region.
On the other hand, while the Krachi and Nkwanta Districts have very suitable land for cultivating yam and maize in commercial quantities, the road network has always been in such a deplorable state that the little that is produced can hardly be transported to large urban areas for sale. The consensus often reached by analysts is that the poor performance of the agricultural sector is at the core of the growth problem in Ghana as a whole and hence the need to seriously tackle the structural problems of the sector. In this respect, and on the basis of the results from the analysis, the following are suggested:
Sustained efforts need to be intensified and focused towards modernization of agricultural production, using appropriate technologies to increase productivity and output. This may have to imply a vigorous implementation of the Youth in Agriculture Programmes in all the districts in the region. Agricultural workers need to be assisted to enable farmers acquire implements and small-to medium scale irrigation equipment that will facilitate farming throughout the year. Industrial establishments need to be based on locally available inputs that will generate employment and make them more efficient.
The sizes of industries need to be carefully assessed vis-à-vis the available market so that the appropriate technology and the right proportions of factor inputs are employed. Attempts at producing the requisite middle-level manpower, through the establishment of Polytechnics, must be sustained and strengthened to enhance technological proficiency.
Products of the Polytechnics should be offered lucrative job opportunities to motivate them to remain in the districts, where they are most needed. The service sector in the districts needs to be encouraged to update its infrastructure to enhance efficiency and technological proficiency.
Projects and programmes need to be developed and implemented in all the districts. The percentage of the national income (10.0%), which is distributed annually as the District Assembly Common Fund, is woefully inadequate and should be increased or alternative reliable sources of funding to be seriously explored by the Regional and District Administrations, in order to effectively implement earmarked development projects in the region. Accessible and easily recoverable soft loan facilities should be provided to identifiable private sector organizations and employers to create employment and ensure increased productivity per worker.
An optimum strategy for reducing migration in the region and increasing rural income, would be to:
- Increase the private component of rural income by creating jobs, by direct income policy, by tax reductions or by price policy and or
- Increase the social component of rural income by investing in infrastructure, especially rural and urban roads, in the 12 districts
The northern districts of Nkwanta and Krachi are the most deprived districts in the region, outside of Akatsi in the south. These two northern districts have good agricultural land. It is important for stakeholders in the region to seriously work towards the rebuilding of the major trunk roads to linkup the two districts to the Northern Region and the rest of the districts to the south.
That way, food produced in the northern districts will not be left to waste. It is also important to revisit the irrigation projects in the Krachi District that were planned alongside with the creation of the Volta Dam, some years ago. In tune with the benefits of the creation of the Volta Dam, is the development of a modern port at Torkor, Kpandu. It is also possible to consider building a mini seaport at Keta, now that the land is being reclaimed. Such a port, if built, would help in decongesting the Tema harbour.
Keta (14.7%), Ketu (14.0%) and Ho (11.9%) account for 40.6 per cent of all houses in the region. On the other hand Kadjebi, (3.1%), South Tongu (4.2%), North Tongu (5.8%) and Akatsi (7.7%) together constitute 20.8 per cent of houses and less than 20.0 per cent of households in the region.
The three districts, with the largest share of the region’s housing stock, also account for the largest share of households. In essence, districts with larger than average regional share of houses also have larger than average size of households. Also worth noting is that the average household size in the region does not vary much among districts. For the region as a whole, the average household size is 4.7 with variation from 4.1 in Akatsi to 6.0 in Nkwanta.
A total of 376,204 dwelling units are identified in the region. The main type of dwelling is the separate house, (46.4%) while a room in a compound is the second most common type of dwelling in the districts (26.2%), followed by the semi detached unit (16.3%).
Flats/apartments are not very common (1.3%), except in urban localities. Makeshift dwelling units such as tents (0.1%), kiosks containers (0.5%) attachments to shops or offices (0.3%) together constitute about 0.9 per cent of dwelling units and appear to be an urban phenomenon.
Many housing facilities are available not so much to individual households as to members in a house. The pressure on such facilities depends, therefore, on the population per house rather than on the average household size. About one in three (31.8%) households reside in two-room occupancy units, followed by households in one-room occupancy units, (22.3%).
A little under a fifth (18.1%) of households reside in three-room occupancy units and about a tenth (10.3%) are in four room occupancy units. The prevalence of the next occupancy levels are: five (6.4%), six (4%), seven (2.3%), eight (1.7%) and nine or more (3.2%) room occupancy units coming in that order.
Rooms In Occupied Units
The number of sleeping rooms in the region appears to follow the same pattern as the room occupancy rates but with some notable deviations. Single-person sleeping rooms constitute 39.1 per cent of the total. Five-person sleeping rooms (35%) and two-person sleeping rooms (29%) closely follow.
Three person-sleeping rooms account for 14.9 per cent of all the sleeping rooms in the region while four-person sleeping rooms constitute 7.5 per cent of all sleeping rooms.
The remaining 6 per cent of households are in six-person sleeping rooms (2.4%), seven-person sleeping rooms (1.2%), eight-person sleeping rooms (0.9%), and nine or more person sleeping rooms (1.5%). 82.4 per cent of households in the region live in 1-4 room dwelling units beyond which the proportion decreases. The highest proportion of households, in all the districts occupies two-room dwellings, varying from 23.8 per cent in Nkwanta to 41.3 per cent in Akatsi.
In Ketu in the south, and Ho to Kadjebi in the north, the single room dwelling is the second commonest dwelling unit, occupied by households varying from 22.8 per cent in Kpandu to 28.4 per cent in Ho. On the other hand, the three-room unit is the second commonest dwelling unit for households in the two northern districts, Krachi and Nkwanta and the southern districts from North Tongu, except Ketu. In all districts, about 10.0 per cent of households occupy four-room dwelling units. The proportion occupying five rooms or more is however lower than 10.0 per cent in all districts.
In examining the housing condition of the region, the census gathered data that could be used to determine the extent of overcrowding in households occupying dwelling units. As is internationally accepted, the ideal room occupancy is two persons per room, and any figure above this threshold is regarded as evidence of overcrowding, which has both health and social implications.
The regional average of the population per sleeping room is 2.0, which is below the national average of 2.3. No district in the region has average room occupancy equal to or, higher than, the national average. There are five districts with the average population per sleeping room below, or equal to, the threshold of 2.0.
The lowest is in Keta (1.8%), and the highest is 2.1, in seven districts. The low room occupancy ratio for Keta may be a reflection of the declining population of the town over the years due to sea erosion. Now that resettlement programmes, through the reconstruction of new housing units in the district have started, it will be informative to observe whether the new type of resettlement houses being built would further solve, or rather exacerbate, the problem of overcrowding.
The region therefore does not as yet face a critical overcrowding situation, but the potential exists, and can occur, if housing policy measures and regulations do not take into account sleeping room occupancy as an important factor in the planning and provision of housing. The number of people in group quarters, institutions or floating (4,117), is 6.9 per cent of the national figure, and 0.2 per cent of the region’s population.
Ownership Of Occupied Units
Nearly two thirds of households in the region own the dwelling units they occupy. Relatives who are not household members own 12.4 per cent of the available housing units, while other private individuals own 13.0 per cent of the housing units in the region.
Keta is the only district in the region with a relatively larger than average ownership by relatives who are not household members (20.8%) compared to the regional average (12.4%). Kadjebi has the largest proportion of other private individual owners (25.8%) as well as ownership by private employers (9.9%) compared to the regional average (4.2%).
Ho, has a private employer ownership rate that is only half the private employer ownership for Kadjebi. Provision of dwelling units by private employers is low in the region as a whole (4.2%). In fact, in the districts, the proportion of private employer owned dwellings is almost the same as the regional average.
The relatively high proportion of private employer owned units in Kadjebi (9.9%) may be explained in terms of the economic decline in the district, which may not encourage private real estate development. This means that many households rent their dwelling units.
In the region, almost two-thirds (64.1%) of housing units are owneroccupied. The rates in the districts appear to conform to the regional pattern except for Nkwanta (75.2%) and Krachi (78.4%), where the rates are far in excess of the regional average and in Kadjebi, where the proportion is as low as 51.9 per cent.
The other types of tenure in the region include rent free (18.7%) and living in rental units (16.1%). The rent-free tenure system is less common in Nkwanta (11.4%) and in Krachi (9.1%) than in any other district in the region. Districts with higher than average rent-free tenure are South Tongu (28.3%), Kadjebi (24.1%), Ketu (22.3%), Keta (22.0%) and Kpandu (21.5%). Kadjebi has the highest rental unit tenure in the region (23.1%) compared to the regional average (16.1%). Two other districts, with relatively higher than average tenure for rental units, are Ho (19.7%) and Jasikan (19.3%).
Material Of Outer Walls
In the region, walls of dwelling units are made of two main construction materials: mud/mud brick/earth (60.1%) and cement block/concrete (32.9%). Walls made of thatch/palm leaf, (2.0%), sancrete/lancrete (1.5%) and wood (1.5%) are not common in the region. The use of mud/brick/earth for walls account for more than half of the dwelling units in the region except Ketu (37.1%) and Keta (14.3%). At the district level, the use of mud/mud brick/earth for walls increases from 50.3 per cent of dwellings from South Tongu northwards to 93.7 per cent in Nkwanta district.
Cement/block/concrete, the second most widely used material in the region (32.9%), accounts for 70.6 per cent of walls of dwelling units in Keta, 54.6 per cent in Ketu and reduces to 8.5 per cent in Kadjebi and 2.3 per cent in Nkwanta. Palm leaf/thatch walls are not common in the region (2.0%) but are found in small but significant/proportions in the coastal districts of Keta (10.7%) and Ketu (4.4%). Wood is also rarely used for walls, the highest use being in Hohoe, where it accounts for 2.0 per cent walls of dwelling units.
Floor materials for households are made mainly of cement/concrete and earth/mud bricks. Nearly three out of every four (71.3%) households use cement/concrete while about a quarter (27.6%) of households use earth/mud for the floor. 0.4 per cent of households in the districts use other materials such as stone, wood, terrazzo, burnt brick, vinyl/tiles and ceramic/marble tiles for the floor of dwelling units.
In Akatsi, North Tongu, Krachi, South Tongu and Nkwanta, three out of five households use cement/concrete for the floor. Districts in which significant proportions of floors (higher than the regional average) of dwelling units of households are made with earth or mud bricks include Akatsi, North Tongu and Krachi and, to a lesser extent, Nkwanta.
In the region as a whole, 61.2 per cent of households have dwelling units roofed with corrugated metal sheets while 29.6 per cent of households live in units roofed with thatch/palm leaves. Dwelling units of between 40.7 per cent and 89.4 per cent of households in the 12 districts are roofed with corrugated metal sheets.
The proportions are, however, higher in Ho, Kpandu, Hohoe, Jasikan and Kadjebi. In the remaining districts on the other hand, only about two out of every five households live in houses roofed with corrugated roofing materials.
In Nkwanta and Krachi, almost about half of the households (50.9%-58.2%) live in buildings roofed with thatch or palm leaves. The situation is similar in Akatsi (50.5%) and North Tongu (45.8%). The use of slates or asbestos as roofing material is relatively high in the coastal districts of Keta, Ketu and South Tongu, probably because of its resistance to sea corrosion.
Main Source Of Drinking Water
Households in the region derive their drinking water from diverse sources but the five main sources are river/stream, well, standing pipes, dugout and borehole, which together, constitute the main source for 93.0 per cent of households. Spring and rainwater are more common sources of drinking water for households in Ketu and Hohoe, than in any other district.
On the other hand, dugouts are common in households in Akatsi, North Tongu and Krachi. Boreholes are similarly common in households in Kpandu, Jasikan and Nkwanta, suggesting a distribution pattern that follows the rainfall pattern in the region. Water piped into homes constitutes just 4.6 per cent of all the water sources in households in the region and is shared largely by households in Ho, (12%), Kpandu (8.4%), Hohoe (5.5%) and Keta (4.1%). Households in Akatsi and Nkwanta (0.6 each) are the two least proportion for districts in terms of water piped into homes in the region.
Main Source Of Household Lighting
Almost three out of four households use kerosene lamps in the region. This is about the same for South Tongu (77.4%), Keta (76.8%), Ketu (79.4%), North Tongu (79.4%) and a little more than four out of five households in Nkwanta, Krachi and Akatsi. Hohoe is the only district in the region where the proportion of households using electricity is higher than the national average of 43.7 per cent. In Ho, 40.0 per cent and Hohoe, 44.0 per cent of households, use electricity for lighting.
Other districts where households use electricity substantially above the regional average (26.5%) are Kpando (38.2%), Jasikan (37.9%) and Kadjebi (34.4%). Districts with low to medium use of electricity include South Tongu (21.9%), Keta (22.5%), Ketu (20%) and North Tongu (19.7%). The least users of electricity in households in the region are Nkwanta (14%), Akatsi (9.5%) and Krachi (8%).
As a result of the rural electrification programme, many households have access to electricity but the use of electricity by households is limited by the ability to pay relatively high electricity bills. It is pertinent to note that in the districts most affected by the damming of the Volta River, very few households, in North Tongu (19.7%), South Tongu (21.9%) Nkwanta (14.0%) and Krachi (8.0%) use electricity as their main source of lighting.
Liquid Waste Disposal
The pattern of household liquid waste disposal is nearly uniform throughout the 12 districts. Most households dispose of liquid waste on the compound (46.7%) or on to the street (41.4%). The use of a gutter in front of the house is minimal in households in South Tongu, Keta, Ketu and the Akatsi but is relatively higher than the regional average in Ho, Kpandu, Hohoe, Jasikan and Kadjebi. In essence, Akatsi, Ho, Kpandu and Jasikan are the districts where few households dispose of waste into the street or a place outside the house.
Solid Waste Disposal
In the region, 46.5 per cent of households dispose of solid waste at public dumps. Similarly, 31.6 per cent of households dispose of solid waste elsewhere. Poor maintenance of such public dumpsites may pose health hazards. In five districts, Hohoe, Ho, Kadjebi, Jasikan and Kpandu, about half of households dispose of their solid waste in public dumps while in another four districts namely, South Tongu, Nkwanta, Akatsi, and Ketu, about a third of households carry their solid waste to public dumps.
On the other hand, just 2.4 per cent of the region’s households mainly in North Tongu (4.9%), Nkwanta (4.1%), Krachi (3.9%) and Jasikan (3.3%), have their solid waste collected and disposed of by sanitary officers. Burning of solid waste by households is rather rare compared to dumping, but it is more prevalent than burying.
In South Tongu, five times the proportion of households (35.9%) burn their solid waste than bury it (6.5%). The other districts where households burn relatively a good amount of solid waste is Akatsi (18.9%), North Tongu (17.3%), Kpandu (16.0%) and Keta (15.4%), but the number of households that do so is just about half that of South Tongu.
There are four main sources of household bathing facilities in the region, these include bathroom for exclusive use, shared bathrooms, open cubicle for private use and shared open cubicles.
Together these constitute about 85.5 per cent of household facilities for bathing. However, bathroom for exclusive use predominates and is available to nearly two out of every seven households in the region. It is used by about one in every three households in the Keta, North Tongu, Jasikan, Nkwanta and Krachi districts.
This section presents information on the distribution of social, health and educational facilities in the 6,540 identified settlements in the 12 districts of the region during the 2000 Census. The most urbanised districts have the largest concentrations of post offices and, to some extent, telephone facilities.
This leaves out districts such as South Tongu, Akatsi, Kadjebi, Nkwanta and Krachi with fewer than the average regional share of the social amenities. The most popular health facility in the region is the traditional healing facility, which constitutes about 54.0 per cent of all the health facilities in most districts.
Clinics constitute 37.0 per cent of the health facilities while hospitals constitute just about seven per cent. The greatest concentration of hospitals and clinics are in Keta, Ketu, North Tongu and Kpandu, with Hohoe having just one hospital but as many as 14 clinics.
Primary schools constitute the largest proportion of educational facilities in the district (56%) followed by the JSS (34.5%) and the SSS (9.5%). The pattern of distribution of the Senior Secondary Schools suggests, however, that South Tongu, Akatsi, Kadjebi, Nkwanta and Krachi have far fewer schools than the regional average. Districts with the largest number of SSS facilities are Ho, the district capital, North Tongu, Ketu and Kpandu.
Compared to the regional average, Keta, Kpandu, Hohoe and Ho are the only districts where more than 2.2 per cent of localities have a post office located within a walking distance. Keta has the largest proportion with a percentage share (10.1%) that is more than twice the share of Kpandu, (4.7%) and Hohoe (3.1%).
Keta also has higher than the average regional distribution of post office facilities. For most districts in the region, a fifth (21.5%) of localities are within five kilometres of a post office and a quarter (25.3%) are with in six to ten kilometres of such a facility. More than half the localities in Nkwanta and Krachi, are further than 30 kilometres from a post office facility.
In Nkwanta, Kadjebi and Krachi, telephone facilities are located more than 30 kilometres from about two-thirds (65.0%) of the localities. In the Hohoe District on the other hand, 94.7 per cent of the localities can access a telephone facility within ten kilometres.
The Volta Region is not very well endowed with telecommunication facilities. Ghana Telecom’s fixed landline telephone system, as well as the various mobile telephone companies serve the region. Teledensity for the region is the lowest in the country (0.1 per 100 persons), a position it shares with Brong Ahafo, Northern and Upper East regions. The national average is 0.7, compared with 3.2 per 100 persons for Greater Accra.
The Mobile or Cell phone as a telecommunication facility is also available in the region. Scancom, operators of the Areeba mobile system, now MTN operates from seven of the company’s 76 nationwide locations. These are Aflao, Agbakope, Akatsi, Ho, Hohoe, Kpandu and Sogakope, covering six of the region’s 12 districts. Millicom (Mobitel) now TIGO does not as yet operate in the region, though it has plans to do so. Ghana Telecom’s One Touch also migrated to VODAFONE mobile service also operates in the region.
Traditional Healing Facilities
Traditional healers have been a major source of health care delivery in the Volta Region for a very long time. Traditional healers from the region have been known for their pioneering contribution to several innovations in the health care delivery system. There is no locality without a traditional healing facility within a five-kilometre radius.
The regional population per registered traditional medical practitioner is 605, compared to a national average of 953 to one healer (Addae-Mensah, 2003/2004). This figure is a gross underestimation, since the process of registration of practitioners is an on-going programme, and may not as yet have captured all healers.
Indeed a survey published in 1988 gave a ratio of one traditional healer to 185 persons for the region, the lowest ratio in the whole country. Traditional healers are within easy reach of the entire population of all the districts. In eight out of the 12 districts, over 90.0 per cent of localities have a traditional healing facility within the locality, with Keta having a facility in every locality.
With a regional population to orthodox medical practitioner ratio of about 1 to 22,000, it becomes imperative that due attention is given to the development and integration of this system of health care delivery into the nation’s health system, for without them, the hospitals and clinics where orthodox medicine is practiced, will be unable to cope with the large numbers of patients.
Almost all the 12 districts in the region, a traditional healer is within a walking distance in almost every locality. In fact, in Keta, all the 129 localities have a traditional healer within a walking distance; and in Akatsi, North Tongu and the Ketu, the proportion of people who have to travel between one to five kilometres is very small to be of any significance at all.
There are 76 doctors in the region, 60 in the public sector and 16 in the private sector. This represents only 3.8 per cent of the total number of 2,008 doctors in the country, for a region with 8.6 per cent of the national population.
Apart from the insufficiency of doctors in the region, their distribution is grossly distorted in relation to the population sizes of the districts. Two districts, Ketu and Hohoe, coincidentally have the same proportion of doctors (14.5% and 9.2%) as their share of the regional population (14.5% and 9.4%), compared with Nkwanta with the same regional population share (9.2%) as Hohoe having only 1.3 per cent of doctors.
The percentage of doctors in South and North Tongu (5.3% and 9.2%) is however slightly higher than their share of the regional population (4.0% and 8.0%). These two districts are slightly better off in terms of regional doctors/population share, but not to the same extent as Kpandu, with a regional population share of 6.9 per cent, the same as Jasikan but with 2.4 times the proportional share of (doctors (9.2%) in the region.
The Ho district has the greatest disportional share of doctors (31.6%) compared with its share of the regional population (14.4%). This distortion can not be justified on the sole ground that the district capital is also the regional capital.
However, if one considers the fact that Ho municipality has one (1) of the only three (3) ultra modern hospitals in the country, then such a concentration of doctors in Ho may be justified. The investment in such an ultra modern hospital must be matched by requisite staffing with doctors of various specialties, to be capable of handling serious and referred cases from the region as a whole.
Analysis of the district distribution of doctors shows that the regional share of doctors is higher than the regional share of the population in six out of the eight south-most districts of the region. The remaining two districts with lower regional doctor share (Keta 5.3% and Akatsi 3.9%) than the population share (Keta 8.2% and Akatsi 5.7%) are still better off than the northern-most districts, except Kadjebi.
The northern-most districts, particularly Nkwanta and Krachi, are deprived in health facilities and personnel. The region as a whole does not have adequate number of doctors relative to its population. This is underscored by the fact that all the districts have doctorpopulation ratios far above the regional figure (1:21,519), except Ho, which doctor to about 9,800 people.
South Tongu, North Tongu and Kpandu also have doctor population ratios below the regional ratio. The Krachi district has a population of 53,308 to every doctor. Nkwanta, one of the most deprived districts of the region, has only one doctor for a population of 151,275.
Orthodox medical facilities are relatively inaccessible to the rural communities, while traditional healing facilities are within easy reach of between 80.0 to 100.0 per cent of all localities. Many people in the region therefore resort to the services of the traditional healers on whom they rely considerably for their primary health care needs.
Locality based and formulated policy measures to organise and regulate the services of these healers will therefore greatly enhance the efficiency and cost effectiveness of health care delivery in the region. While there is a traditional healer within almost all the localities in the districts, just about 1.4 per cent of the localities in all the 12 districts in the region have a hospital within a walking distance. Keta (3.1%) and Kpandu (5.7%) have the largest proportion of hospitals facility within a walking distance. Nkwanta and Krachi are the only two districts in which a hospital facility is located more than 30 kilometres away for about 60 per cent of the localities.
The distribution pattern of clinics is similar to that of hospitals in all districts except that lower proportions of localities are within distances of more than 10 kilometres of clinics than hospitals. The proportions of localities beyond 30 kilometres of clinics in Nkwanta (31.9%) and Krachi (18.1%) are still high.
Although on the average, 24.0 per cent of localities in the region have a primary school, Kpandu (49.7%), Keta (45.7%) and Ho (32.1%) are much better endowed with primary school facilities within their localities. In addition, about a fifth of the localities in North Tongu (23.4%), Hohoe (22.3%) and South Tongu (20.4%) have primary schools within the locality. The three north most districts and Akatsi and Ketu to the South, have under 20.0 per cent of their localities with a primary school facility within the locality.
The bulk of the localities in the districts, ranging from 44.2 per cent in Krachi to 83.6 per cent in Kadjebi, however have primary schools within one to five kilometre-radius. Thus, apart from the two northern-most districts, Krachi (62.9%) and Nkwanta (70.0%), all other districts have over 80.0 per cent of the localities with a primary school facility, within a radius of five kilometres, ranging from 80.2 per cent in Jasikan to 97.6 per cent in Keta.
No district in the region has satisfied the Ministry of Education’s (M.O.E) policy of a primary school facility within five kilometres from a locality. Primary school facilities are located beyond five Kilometres in about a seventh (14.0%) of the regions 6,540 localities. In fact, six out of the 12 districts (South Tongu, Keta, Ketu, Ho, Kpandu and Kadjebi) are within 10.0 per cent of localities to satisfying the M.O.E’s primary school facility accessibility conditions. Four other districts (Akatsi, North Tongu, Hohoe and Jasikan) have yet to cover 15.0-20.0 per cent of localities to satisfy the M.O.E’s policy requirement. Much effort and resources need to be directed to the two north-most districts, Nkwanta and Krachi, which have as high as 30.0-37.7 per cent of localities with primary school facilities outside the five kilometer accessibility policy of the M.O.E.
The pattern of the distance from a locality to a JSS facility in the region follows closely that of the primary school. 14.0 per cent of localities in the region have a junior Secondary School (JSS) within the locality while an additional 58.1 per cent are located within a five-kilometre radius of a JSS.
In the eight districts from Hohoe Southwards, about three quarters (74.1-92.2%) of localities are within five kilometres from a 83 JSS. This contrasts with the four north-most districts, Jasikan, Kadjebi, Nkwanta and Krachi. Jasikan, with two third of its localities within five kilometres from a JSS facility, however appears to be better endowed with JSS among the four northern districts of the region.
As in the case of Primary Schools, much effort and resources need to be invested in improving access to educational facilities in Nkwanta and Krachi districts in particular. These two districts, with only 50.0 and 33.9 per cent of localities, located within five kilometres of a JSS facility, greatly lag behind other districts in the region.
The distribution suggests that while the quality of education is an important policy issue, it is also imperative that more schools are sited in areas such that children will not have to travel long distances to school. Primary school also need to have the JSS complement not only to facilitate access to JSS but also to ensure that higher proportions of children do not end their education at the Primary School level because of accessibility difficulties.
Senior Secondary School
The picture for the distance to a Senior Secondary school (SSS) is not the same as that of junior secondary schools. Most SSS are located six to ten kilometers from a locality, 45.0 per cent in Hohoe, 40.4 per cent in Ketu and 33.5 per cent in Kadjebi.
The issue of distance does not necessarily arise in the case of SSS since most of such schools may have boarding facilities for students. The main issue, however, is meeting the cost involved in attending a Senior Secondary School. Investment in basic education is essential for all aspects of development in the region and as such should be given the necessary priority not only in regional and district policy planning and implementation but also in resource allocation.
The analysis shows that the region’s population increased by 35.0 per cent over a period of 16 years since the last census in 1984. This means that the average annual rate of growth has increased slightly from 1.8 per cent during the 1970-1984 period to 1.9 per cent in the 1984- 2000 period.
The growth of the population over the years has also increased the density from 59 persons to 79.5 persons per square kilometre, which is almost the same as the national figure of 79.3 persons per square kilometre. The sex ratio, however, declined slightly from 93.9 in 1984 to 93.6 in 2000.
The Nkwanta and Krachi Districts have higher proportions of the 0-14 year-age group than the other districts. The regional distribution of the population aged 0-14 years, which is 41.1 per cent, is lower than the 1984 figure of 44.2 per cent.
This is manifested in the drop in the fertility rate from 6.7 live births per woman in 1988 to 3.5 live births per woman in 2000. Females aged 12-17 years, who are in some form of consensual union, constitute 1.3 per cent of all women in similar unions in the region in 2000. There are more teenage births in the six districts to the north than the other six districts to the south of the region.
The population structure indicates that all the districts in the region have a young population, typical of most developing countries. In consequence, the dependency ratio is relatively high for all the districts. For the region as a whole, the dependency ratio is 92.0 dependants per 100 working people. The sex ratio is less than 90.0 in five districts and less than 100.0 in four other districts. The Jasikan, Kadjebi, and Krachi Districts have a sex ratio higher than 100.0.
The proportion of people living in urban areas has increased from 20.5 per cent in 1984 to 27.0 per cent in 2000. This implies that over a quarter of the people in the region now live in an urban locality. The Keta District, with the highest proportion of people living in urban localities, also has one of the urban localities, Keta township, which has been identified as a “dying” town, having declined at the rate of 1.9 per cent per annum over the past 30 years.
Kadjebi, Anyako and Kpedze are also urban localities that have remained virtually the same for the last 30 years. Of all the urban settlements in the region, Juapong, Keta, Krachi, Banda and Worawora are the only localities where males outnumber females. While it is easy to assign reasons for Juapong as the case of a growing industrial township, it is difficult to pinpoint factors affecting the others.
There are 376,204 dwelling units in 264,451 houses across the region, on March 26, 2000, representing an increase of 52.8 per cent in the housing stock since March 1984. In all, there are 345,821 households in the region, which translates into a ratio of 1.3 households per house, the lowest in the country.
Mud/mud and bricks/earth are the main materials used in constructing walls of dwelling units, followed by cement block/concrete, leaf/thatch, wood and burnt brick, in that order. Corrugated metal sheets are the main roofing materials in nine of the 12 districts. In the Krachi, Nkwanta and Akatsi, Districts, there are more thatch/palm leaf roofed houses than in any other district. In the southern part of the region, especially in the Keta District, 30.6 per cent of houses are roofed with asbestos sheets. At least about a third of dwelling units in every district have the floor constructed with cement.
In six of the 15 districts, over a third of the households have pipe-borne water as the main source of drinking water. The river/stream is the main source of drinking water for at least a third of households in the districts, except Keta, Ketu and Akatsi. In the Keta, and Ketu Districts, the well is the main source of drinking water for majority of the households and in the Akatsi District; in particular, a little over a third of the population relies on other sources of water supply such as dams, springs and rainfall. This observation is supported by the fact that in the Ketu, Akatsi and southern Ho, Districts in particular, there are deliberate attempts at harvesting rainwater for household use.
The kerosene lamp is the main source of lighting in many households in every district in the region. Gas lamps are not common in any of the districts while solar energy, as a source of lighting, is not used in eight of the 12 districts.
At least 90.0 per cent of households in every district in the region use wood and charcoal as fuel for cooking. Apart from the Ho (5.0%), Keta (2.8%), Hohoe (2.2%) and Kpandu (2.0%), Districts, less than 2.0 per cent of households, in all other districts, use gas for cooking. About a quarter of the households in the region do not have any toilet facility. The situation is more serious in the Nkwanta and Keta Districts. Less than 8.0 per cent of households in all the districts of the region use the water closet; public toilets and pit latrines serve the needs of an average of 30.8 per cent in the Nkwanta, and 21.2 per cent in the Keta, Districts.
Only a small proportion of households (1.3%) dispose of liquid waste through the sewerage system in the region; this proportion is less than 1.0 per cent in the districts except Ho (3.8%) and North Tongu (2.2%). At least 80.0 per cent of households in every district dispose of liquid waste on the compound of houses and on the streets outside.
In sum, the Nkwanta and Krachi Districts are the most deprived districts in the region, outside of Akatsi in the south. These two districts have good agricultural land but the road network linking them to the rest of the region is in a deplorable condition. It is important for stakeholders in the region to seriously work towards the rebuilding of the major trunk roads to link the two districts to the northern part and the rest of the districts to the south, to avoid food produced in these districts from going waste. It is also important to revisit the irrigation projects in the Krachi District, which were planned alongside the creation of the Volta Dam, some years ago. In tune with the benefits of the creation of the Volta Dam, is the development of a modern port at Torkor, in the Kpandu District. This, as in the case of the irrigation projects, has not been realized and it is time to reconsider this.
It would enhance good health practice if stakeholders can create an awareness that will make communities in the region realize the need to construct toilet facilities (even if pit latrines) so as to reduce the use of the bush and the seashore, as toilet facilities.