SOCIAL WELFARE POLICY IN GHANA: CURRENT PROVISIONS, REACH, AND CHALLENGES

Abstract

Social welfare policies are intended to address social inequality arising from social structures that marginalize sections of the population. Ghana has pursued a near universal welfare policy since independence in 1957. However, economic decline in the 1970s and 1980s led to a rethink about such provisions. The chapter will review Ghana's attempt to re-institute universal welfare provisions that were scraped as part of the implementation of structural adjustment policies of the World Bank and IMF designed to stabilize the nation's economy in 1980s. It will detail education, health and other social policies and critically discuss their relevance within the framework of distributive and recgonitive justice, the challenges of implementing such policies and ways to for improve service delivery.

Headnote

ABSTRACT

Social welfare policies are intended to address social inequality arising from social structures that marginalize sections of the population. Ghana has pursued a near universal welfare policy since independence in 1957. However, economic decline in the 1970s and 1980s led to a rethink about such provisions.

The chapter will review Ghana's attempt to re-institute universal welfare provisions that were scraped as part of the implementation of structural adjustment policies of the World Bank and IMF designed to stabilize the nation's economy in 1980s. It will detail education, health and other social policies and critically discuss their relevance within the framework of distributive and recgonitive justice, the challenges of implementing such policies and ways to for improve service delivery.

INTRODUCTION

Both anecdotal and formal reports (Ghana Statistical Service, 1989, 2008) indicate that inequality in Ghana is gender and community based. There is a considerable disparity between man and women and between urban and rural communities. Women are generally poorer than men, due to cultural and historical restrictions on women's participation in education, which have led to their exclusion in the formal employment sector. There are also glaring differences in wealth creation between rural and turban areas, attributable to the centre-periphery model of development, which creates more opportunities in urban areas than in rural areas. It is also obvious that natural resource allocation across different regions of Ghana is unequal, with communities near the coast and in the southern rainforest belt better endowed than those away from the coast and the Savannah north. These inequalities are reflected in the composition of poverty in Ghana and affect families and children differently.

Social welfare policies are intended to address social inequality arising from social structures that marginalize sections of the population. Ghana has pursued a near universal welfare policy since independence in 1957. However, economic decline in the 1970s and 1980s led to a rethink about such provisions. The chapter will review Ghana's attempt to re-institute semi universal welfare provisions that were scraped as part of the implementation of structural adjustment policies of the World Bank and IMF designed to stabilize the nation's economy in 1980s. It will detail education, health and other social policies and discuss their relevance within the framework of distributive and recgonitive justice, the challenges of implementing such policies and ways to improve service delivery.

HISTORY AND PHILOSOPHY OF WELFARE IN GHANA

Historically the development of the welfare state began with the institution of pensions for formal sector workers and their families by the colonial government workers after World War I (Jones, Ahadzie & Doh, 2009). Like other countries, Ghana's welfare regime is underpinned by principles that issue from the notion of social justice and it will be fair to characterise the operating principles as relating to recognitive and distributive justice.

Over all, Ghana's approach to achieving both recognitive and distributive justice has been a combination of the characteristics of Universalists and Restrictive approaches to welfare provision. The Universalist approach began with the British colonial administration and covered areas such as water supply and health in the first half of the 20th Century. Education was still not universal although public schools, where they were available, were open to all children. Thus the bulk of social protection in the form of mutual support remained largely traditional until independence in 1957.

At independence, the Nkrumah Government instituted many universal welfare policies covering education, health, physical and social infrastructure such as roads, water, and public-places of convenience, among others. This predominantly Universalist welfare climate in Ghana, which endured for three decades, resulted in the provision of fully funded public health services, universal primary and free tertiary education. Under these arrangements, pre- tertiary education was free in northern Ghana in every respect while there was limited cost-bearing for parents in southern Ghana. Citizens also received free medical care for every medical condition. For this reason very few private medical facilities operating a fee-paying regime were in service in the country. This arrangement inculcated into Ghanaians the notion of government as burden bearer.

What is worth noting about such universal provisions is that they provided protection against structural inequalities, which ultimately create extreme disadvantage and marginalisation. The other aspect of these universal provisions was that service seekers were not means-tested, which meant that both rich and poor alike could access the same services. Such a nondiscriminatory approach stands the risk of being overwhelmed with increases in population and demand for services. As Ghana's population increased from about 4 million in the 1960s to about 8 million in the 1980s, and economic progress began to decline, it became obvious that the system was not sustainable, because government revenue was lagging unacceptably far behind expenditure.

This scenario of population growth and economic decline led to sweeping changes in the welfare provisions in1980s.

In the early 1980s the Rawlings Government bowed to the reality of economic decline and sought financial support from the International Monetary Fund (IMF) and the World Bank, who observed that public expenditure was too big owing to huge spending on universal welfare and wages. The IMF and the World Bank therefore recommended that Government recast spending on health, education and other social services, under the scheme called Economic Recovery Program (ERP) (White, 2004).

Within the framework of the IMF/World Bank supported Economic Recovery Program (ERP), Ghana agreed to implement the lending bodies' Structural Adjustment Program (SAP). Central to the philosophy of SAP was the World Bank's idea that developing countries should rethink the role of the state; that is, to stir away from the state as sole provider of welfare, including health and education, to one of enabler and quality assurer with a focus on strengthening labour market linkages (Kuyini, 2013; Konadu-Agyemang, 2000). This entailed scrapping many universal welfare provisions over night and this had huge structural and social implications for the population.

Rolling back the frontiers of welfare as part of the structural adjustment program entailed cut back on government expenditure especially on social spending and the introduction of user charges for public services like health and education. A common and yet inevitable outcome of this policy position in Ghana and other developing countries such as Uganda was that structural adjustment led to the deepening of existing inequalities (Alexander, 2001; Kraus 1991). Applying the IMF and World Bank SAP principles to health and educational meant commercialization of health and education in a fragile economy. The effect of these measures on health was poor quality health outcomes for the majority of people who could not pay for healthcare and a decline in school enrolments and educational participation among poor families and communities from the late 1980s to early part of the 1990s (Kuyini, 2013, Tsikata, 1995; World Bank, 2012).

Public sector workers, who were retrenched to reduce the wage bill, received no unemployment benefits. In the face of these changes, large numbers of the population were forced to rely more on the traditional forms of protection strongly rooted in Ghanaian culture, which Jones, Ahadzie and Doh, (2009) note has been eroding under the influence of modernization. The glaring impact of the limited formal social protection measures and the extreme reliance on traditional protection mechanisms was that general wellbeing declined among the poorest sections of the population.

SAP had created a structural problem which altered the system of production, income generation and support systems with in the Ghanaian society and adversely affect social wellbeing Several Government and international reports indicated that poverty levels had significantly increased with SAP, which led the IMF and World Bank to institute a program known as Program of Action to Mitigate the Social Cost of Adjustment (PAMSCAD). PAMSCAD was started in 1988 as a policy response aimed at providing quick relief to the "new poor" (retrenched public sector workers), vulnerable low income households, and the "Structural Poor" (those in rural areas with limited access to land and other income generating opportunities (Brydon & Legge, 1996). PAMSCAD was an irrefutable admission as well as a recognition that the IMF and World Bank's Western cultural and power intoxicated discourse about allowing the unfettered rule of market forces and cutting public spending was not appropriate for a developing country like Ghana. Thus, the institution of PAMSCAD was the beginning of a "U-Turn" on the part of the IMF/World Bank and the Government with regard to the welfare agenda under SAP. It was also a new watershed for the reintroduction of protective measures for the most vulnerable.

GHANA'S ATTEMPT TO RE-INSTITUTE UNIVERSAL WELFARE PROVISIONS

Following the implementation of the structural adjustment programs and their devastating consequences on the social well-being of the many of Ghanaians, attempts were made to reintroduce universal policies albeit on a much smaller scale in education, healthcare, agriculture, and other public services. In 1995, with assistance from the IMF, the Ghana government introduced a new policy framework dubbed 'Ghana Vision 2020' as a blue print for sustainable development. The government and the IMF envisaged that the new development framework would foster stronger economic growth and better living standards for the people of Ghana (IMF, 1999). The primary objective of Vision 2020 was to streamline fiscal, monetary, and social policies that will encourage private sector involvement, export expansion, and balanced social and regional development (IMF, 1999). In 1996, the first visible effort by government to provide such protective welfare began with the implementation of Free Compulsory Universal Basic Education (FCUBE) policy designed to boost educational participation. This was followed by other measures.

Since the early part of 2000s, the Government has passed several new laws and policies to broaden social protection and address poverty, risks, vulnerability and social exclusion (GoG, 2005a). In 2007 a draft National Social Protection Strategy (NSPS) was completed and this strategy became the springboard for a range of social protection programs with a specific focus on children (Jones, et al., 2009). These policies reflect both Universalists, restrictive approaches. They also reflect recognitive and distributive justice in that they recognise the vulnerable populations as well as domains of welfare where structural inequality remained pervasive.

CURRENT PROVISIONS

The current welfare provisions, which are universal, relate to subsidies on petrol, water and electricity, as well as road and transport provisions that allow toll-free travel across the country. Near universal provisions relate to Health, Education through the National Health Insurance Scheme, free tuition, capitation grants, and the abolition of user and text book fees. Table 1 below shows some of the current provisions.

FREE COMPULSORY UNIVERSAL BASIC EDUCATION (FCUBE)

Following the successful implementation of the 1987 reforms and the subsequent transition to constitutional rule in 1992, the government re-enacted the FCUBE policy in 1996 as mandated by the 1992 Constitution of the Fourth Republic of Ghana. FCUBE is different from the policies that preceded it in that the new policy guaranteed nine years of free basic education for all children of school going age with emphasis on quality teaching and learning, efficient management and sustainability; increased access, and decentralization of education management (GES, 2004; MOE, 1996).

In 2003, the government renewed the FCUBE with a goal to achieving the following: (1) increase universal basic education from 9 to 11 years comprising of two years of kindergarten, 6 years of primary school, and 3 years of junior high school, (2) focus basic education on literacy, creative arts, numeracy, and problem-solving skills, (3) technical and vocational training, (4) upgrade teacher training colleges and offer incentives to teachers in rural areas, and (5) introduce information and communications technology into the curriculum, and provide special education needs at all levels [Government of Ghana, 2007a)]. This constitutes a more innovative and inclusive education policy for two reasons: First, it recognised the critical role of early childhood experiences on the eventual balance of wellbeing outcomes for children. For more than four decades the basic education system concentrated on primary and secondary education, with virtually no attention paid to early childhood education. However, as evidence began to emerge of the declining school entry preparedness of many school-aged children, which led to poor academic outcomes at the Basic Certificate Examination level, the government decided to include early childhood into the basic education fray. This policy not only allows many more poor children to access education early, but also allows them to develop early school-readiness skills that had been more or less exclusive to rich parents. Secondly, the policy recognised the importance of quality teacher training, as an integral part of the effort to equalize educational outcomes through increasing the presence of qualified teachers in all schools (public, private, rural and urban). In this sense the policy reform holds more promise for vulnerable children in the country in terms of their educational needs.

The key issues with FCUBE were that despite its scope, it did not include measures to ensure that rural and remote communities, which did not benefit from school infrastructure provision under PAMSCAD, were provided with schools. FCUBE was also not able to eliminate other school-related costs, which are still substantial for the very poor, such as vulnerable and marginalized youth such as girls, children from low-income families, children with disabilities, and those in rural and remote areas. More importantly, FCUBE policy, which included improved teacher training did not give reasonable attention to teacher deployment, a failure which ahs witnessed unacceptable unequal distribution of qualified teachers between urban and rural areas. In a recent Ghana Education Service Report (GES, 2014, cited on Ghanaweb, 2014) it was found that 404 schools in the Northern Region have no teachers at all. Whilst these 404 schools in mainly rural districts have no teachers, urban and metropolitan districts such as Sagnarigu and Tamale have excess teachers, totaling 1,197 (GES, 2014). Such uneven distribution of school resources has in the past culminated in the reality that full participation was not being realized, as many poor children were still unable to access education. These problems were and are repeated in other areas and led to the introduction of the Education Capitation Grant and School Feeding programs.

THE EDUCATION CAPITATION GRANT AND THE SCHOOL FEEDING PROGRAM

The Capitation Grants and the School Feeding Program were introduced in 2005 and 2004/2008 are Universalist and restrictive provisions respectively. They both align with recognitive and distributive justice in the sense that Government recognised that some sections of the population could still not fully participate in education and that these provision could create more supportive conditions for their participation in education.

The government's introduction of the FCUBE was intended to boost educational participation resulting form abolition of fees. However, as noted above, some children in poor rural communities were still unable to access education due to other costs. The Capitation grant was introduced in 2005 to remove the burden on households to pay fees for basic education, especially poor children whose access to education was being constricted by the fees (Akyeampong, 2011). The program only absorbs the user-fees at the elementary not secondary level in order to increase access, retention, and completion (Jones, Ahadzie, & Doh, 2009; MOE, 2006).

A review of the program by Jones and colleagues (2009) revealed that net primary school enrollment increased from 59% to 69% in school districts where the program was first piloted with the largest increase among girls. Proponents of school fee abolition hail the Capitation Grant and point to high school enrollment numbers and a near parity in enrollments of boys and girls (Osei, Owusu, Asem, & Afutu-Kotey, 2009). Despite this provision, students are still required to pay a number of user-fees including uniforms, books, and PTA dues, which constitute a barrier to participation for many children (Ghana National Education Campaign Coalition, GNECC, 2005). Evidence suggests that 25 percent of children between ages 6 and 17 dropped out of school in 2003 because of these ancillary costs (GNECC, 2005).

Some critics warn that the increased enrolment, if not matched by increased classrooms, trained teachers, and textbooks could reverse the gains. There are many other barriers to educational participation that may not be alleviated by the Capitation Grant unless a more pragmatic approach is adopted. For example, due to inadequate teachers and insufficient school supplies, a fee-free education will be meaningless to a rural child who only sees a teacher once a week or in some instances once a month or not at all. The World Bank (2010) and Kuyini, (2013) also report that access to education is still problematic in terms of geography, ability and level of education, especially secondary education and these issues are likely to endure, especially in Ghana's situation where funding for these programs are based on foreign donor generosity. Specifically, large numbers of children experience inadequate access to education, poor quality teaching and learning and weak management capacity at all levels (Government of Ghana, 2007; World Bank, 2010). Despite the good intentions and contribution of the Free Compulsory Universal Basic Education policy, many children of school going age, either fail to enroll in, or drop out of school for reasons of parental poverty and lack of teachers (GES, 2008a, GES, 2010, Kuyini, 2013). Even with increased educational spending (currently over 10 percent of the GDP), The World Bank (2010) concluded that although many gains have been made, ".... the education sector is under constant pressure from expectations that surpass achievements.... Communities and parents have legitimate concerns with substandard schools, missing teachers, botched exam and lacking services, and lack of facilities [....] Many children are turned away from higher levels of schooling, and many fail to pass final exams and to find post-basic or job opportunities (p. i-v). And as Akyeampong (2011) and Kuyini and Desai, 2008) observe, more is required in terms of teacher time and instructional quality in schools and classrooms than school feeding and capitation grants to secure better educational outcomes.

SCHOOL FEEDING PROGRAM

The program seeks to increase enrolment and attendance, especially for girls, and children in deprived and economically marginalized communities and regions of the country. The program was introduced on a pilot basis in 2004. The government decided to expand the program following the realization of positive outcomes in school enrolment and retention in the pilot program run by the international nonprofit, Catholic Relief Services (CRS) with support from USAID (USAID-EQUIPI, 2004).

The expansion of the School Feeding Program was realised with support from the African Union's New Partnership for Africa's Development (NEPAD) (Jones, et al. (2009). Under the scheme students in basic education schools are provided with at least one hot nutritious meal a day in the poorest areas of the country. The program's long-term goal, according to Jones and colleagues, is to reduce poverty and promote food security by feeding children with locally produced food that will generate wealth for the local farmers.

Some reports since 2008, for example, Akyeampong (2011) indicate that the school feeding programs have several benefits and can be used to successfully target vulnerable groups such as girls and children from poor and rural communities. According to Akyeampong (2011) the main benefit of the program was increase in enrollments in the two districts of his study. However, the dropout rate remained high in those districts, which suggests other factors at play when it comes to retention. In another study, Yunus (2008) noted that there was problem with the distribution of recipient schools. The author attributed this problem to the politicization of the program, which culminated in very needy schools being left out of the pilot program and regional equity somewhat ignored. The Yunus' report led to the conclusion that although the program was suppose to address issues of distributive justice, the mode of selection of schools for school feeding program did not aligned with the ideal of justice since the criteria was not made public and many schools in more geographically disadvantaged communities were left out the program without explanation. In other words, the regional distribution of beneficiary school schools did not reflect the philosophy that the program was meant increase school enrolments, attendance and retention in the more deprived areas of Ghana. The current budgetary constraints are making it difficult for the government to extend the program to other deserving schools.

NATIONAL HEALTH INSURANCE SCHEME (NHIS)

Health services that are not affordable are discriminatory and the World Health Organisation (WHO) (2001) notes that discrimination often lies at the root of poor health status and social exclusion among people experiencing disadvantage. This was a reality for many poor people after the implementation of SAP. The introduction of the National Health Insurance Scheme (NHIS), which is a near universal health care provision, is similar to the immediate postcolonial provisions terminated in the 1980s.

The NHIS was established through the passing of the National Health Insurance Act of 2003. As a program designed to equalize opportunities for health care, it responds to the principles recognitive and distributive justice because it is a bold attempt to eliminate discrimination in access to health and foster social inclusion via the notion that healthy people are able participate more meaningfully in education, employment and other sectors of society.

The program is funded by Ghanaian taxpayers through payroll deductions and was estimated to cover about 54 percent of the population by the end of 2008. This broader national coverage of healthcare services expanded rapidly providing services to many poor people (Sulzbach, Garshong, & Banahene, 2005). In the initial design of the NHIS individuals were required to pay the minimum membership fee or premium to join the scheme and this entitled them to government supported medical services. Researchers such as Jones et al., (2009) and Sulzbach et al., (2005) have reported that the NHIS has enhanced the health outcomes of many poor people.

However, the scheme has limited coverage and a considerable percentage of poor people have struggled to meet the one-off payment obligation from year to year and therefore technically excluded from the scheme. It has also been observed that although a substantial percentage of NHIS revenue is from government payroll tax, it is used to cover healthcare cost of predominantly high-income households who are able to enroll in the NHIS scheme and the very poor miss out. Critics have therefore argued that the insurance premiums continue to hinder access to health care for the very poor.

The blowout in cost to the government relative to income accruing from the scheme has also led to concern that the NHIS is unsustainable. Recent reports (e.g., Ministry of Health 2012; World Bank, 2012) have raised concerns about the NHIS because the scheme continues to run on a deficit. In September 2012 the Ministry of Health revealed that "Since 2010, the NHIS has run deficits" and that "the stability of the scheme is of great concern to government". This revelation has been corroborated by a 2012 World Bank report, which indicated that the NHIS could collapse by 2013 and that reform is necessary to keep the scheme afloat (World Bank, 2012). These predictions came to pass and in many regions the NHIS was unable to honor payments/reimbursements leading to partial closures in 2013/14. This has necessitated a serious rethink on the part of government about how the scheme can be sustained. The Government has recently flagged the idea that the oneoff payment is not sustainable and individuals must now contribute more than once a year. Such a proposition will no only certainly place additional burden on the very poor, but it also will discriminate against them. According to the UN Human Rights Committee any distinction, exclusion, restriction or preference, which nullifies or impairs the recognition, enjoyment or exercise of people's rights and freedoms on an equal footing is discriminatory. Therefore these proposed changes, without due consideration to their negative impacts on those considered to be "not poor enough" could constitute discrimination. From a structural and critical social work theoretical perspective, it is essential that advocates of equal opportunity find ways to ameliorate the oppressive impacts of the proposed higher/repeated cocontributions to the NHIS scheme on the very poor.

Thus the debate about sustaining the NHIS and simultaneously ensuring access to universal healthcare for all appears overly optimistic and perhaps uninformed. The reality of healthcare provision is that a country's economic growth needs to reach a level whereby it can afford to provide services without compromising other vital welfare areas such a portable water and education. Ghana, a country that still depends on donor support to balance her annual budget is yet to reach that state. And with the ongoing debate in Europe about the fate of the current welfare provisions, the question is: what will happen to the donations from Europe that sustain Ghana's yearly budget? It is obvious that free universal health provision is going to be hard to achieve in the current circumstances.

PROTECTIVE WELFARE PROVISIONS

Protective welfare policies are a response to distributive and recognitive justice. According to the UNICEF (2009) in Report "Social Protection and Children: Opportunities and Challenges in Ghana, the Governments policies on the protective welfare provisions reflect the Devereux and SabatesWheeler's (2004) transformative social protection framework. Thus selective provisions in welfare are underpinned by an agenda of rights, protection and redistribution. In Ghana, they include provisions such those contained in the Children's Act 1998, the Disability Act, 2006 and the Livelihood Empowerment Against Poverty (LEAP) of 2008. Unlike the Universalist programs these target specific segments of the population. Each of these provisions is briefly reviewed.

THE CHILDREN'S ACT (560), 19981

The parliament of Ghana passed the Children's Act (Act 560) into law in June 1998. The content of the Act rests on the welfare principles that recognize that the interest of the child shall be central in all matters concerning the child. The law requires that every child would have the right to name and nationality, and grow up with parents. They would also have right to parental property, right to social activity, opinion, education and well-being. The act further sets out to protect the child from exploitative labor, discrimination, torture and degrading treatment, as well as betrothal and marriage. These objectives aside, the Act defines a variety of institutions and individuals and the mechanisms for implementing these noble objectives to enhance the status of children in Ghana.

The promulgation of the act has had positive impact on the lives of many children providing access to education, protection from child labor and other abuses and increased wellbeing of many children (UNICEF, 2000). Many children have been enrolled in schools, maternal and child health services from public and not-for-profit sectors have extended support to those in need. However, The Ghana NGO Coalition on the Rights of the Child (GNCRC), (2005), found that the Child Rights NGOs and almost all institution of State relevant to the promotion and protection of the rights and welfare of children faces serious resource and capacity challenges, including financing and budgetary allocation, and human resources. Recent studies (Kuyini & Mahama, 2009) found that although the law has provided opportunities for tailoring some meaningful services to many children in the study areas of Northern Ghana, there appears to be many unresolved and challenging issues in the districts, including resources and problems with collaboration and demonstrates that effective child protection can be a demanding proposition in Ghana (p.24).

Kuyini & Mahama, 2009, p.19) noted that

The significant barriers emanating from the use of a range of service points, (which needed to coordinate their services); the lack of resources and varying levels of commitment of the different organs of government; inadequate skills training for staff and lack of community awareness of the content and implications of the law remain formidable [....] Another barrier to the implementation of the protective demands of the law has to do with traditional values, beliefs and customs that conflict with the authority of Government and demands of national laws [....] Although most people view the Government as having such powers (providing social order) and as the one to relieve their poverty, they do not yet agree with the intrusion of government into their private lives when it comes to raising children.

The authors concluded that the challenges emerging from the study showed that much still needs to be done to make the child rights law more effective in respecting the rights, protecting and meeting the needs of all children.

The Livelihood Empowerment Against Poverty (LEAP)

The Livelihood Empowerment Against Poverty (LEAP) is a government funded social cash transfer program, which provides cash and health insurance to extremely poor households.

According to the Ministry of Social Welfare, beneficiaries of the program must meet the following eligibility criteria: (1) orphan and vulnerable children (OVC) (2) persons with severe disabilities, and (3) extremely poor elderly persons who are 65 years and older (Government of Ghana, 2007). The impoverished elderly and people with disabilities who have no productive capacity receive unconditional support under the scheme. Children from impoverished households must be enrolled in school, not engage in child labor, and the cash transfer must be used for their feeding and healthcare. Also, beneficiary household members receive free health care under the NHIS (Government of Ghana, 2007).

LEAP is an integral part of the government's vision of creating an allinclusive and socially empowered society through protection provisions to vulnerable groups to ameliorate the ravages of extreme poverty and social and economic exclusion. In this sense, LEAP is a restrictive welfare provision, which aligns with recognitive and distributive justice as well as Devereux and Sabates-Wheeler's (2004) transformative social protection framework. According to this framework, social protection ought to encompass protective, preventative, promotive and transformative dimensions and Jones, Ahadzie & Doh, 2009, p.17) state that:

".....social protection measures may play one or more of the following roles: i) provide protection from adversity (e.g., through 'safety nets'); ii) prevent harmful coping responses, such as the sale of assets or resort to child labour; iii) help promote ways out of poverty and vulnerability, notably by promoting investments in human capital development (especially during childhood); and iv) transform social relations by empowering the oppressed and discriminated.

Beginning in 2008, LEAP was to help alleviate short-term poverty and foster long-term human capital development. The scheme was expanded to cover approximately 35,000 households in 2010 and projected to reach 68,000 households in 100 Districts in 2012 (MESW, 2012). The government announced in 2012 that it was increasing the amount per household from GHc12 to GHc36 (about US$6-18) a month as well as the number of beneficiary households which currently stand at 68,000 to about 200,000 by 2015 (MESW, 2012).

The biggest concern about LEAP is whether or not it is sustainable. This is because welfare provisions such as LEAP may start with the notions of protecting the most vulnerable but as economic inequality widens many more people join the queue of "entitlement. This increasing numbers of those requiring assistance implies that economic growth and public income generation must keep pace with demand for social support. In the case of Ghana, the question is whether economic growth can keep pace with the widening net of entitlement pushed forward by political decisions seemingly oblivious to economic reality. The Government is the sole funder of the LEAP and there are concerns that it will be difficult to sustain it over the long term. These concerns are rooted in the knowledge that the NHIS program, which has a user-contribution component to it, has collapsed in some regions, because government is unable to match the individual contributions to sustain the program.

The writing is already on the wall for LEAP, because specified Ministries, Departments and Agencies including the Ministry of Education and Ministry of Health, Ministry of Food and Agriculture and Ministry of Women and Children's Affairs are supposed to provide complementary support and intervention services to recipients of LEAP support as a way to augment their capacities to develop out of circumstances of vulnerability. However, this is not occurring even when LEAP is still on a small scale. In March 2012, The National Program Officer of the National Social Protection Strategy (NSPS) revealed that Ministries, Departments and Agencies (MDAs) failed to implement regulations under a Memorandum of Understand (MoU) signed between them and the Ministry of Employment and Social Welfare.

The other problem is that LEAP is linked to the NHIS, which the government and World Bank (2012) have warned needs some substantial support to continue to operate. In this sense it is unlikely that the complimentary support, which is to come through NHIS will eventuate any time soon. Ghana is a foreign donor-dependent nation and although revenue from oil export is expected to change that status, increasing demand for social services which comes with increasing population means that donor dependency is more likely to endure for some time yet. And therefore Government's capacity to sustain an expanding LEAP program is highly unlikely.

DISABILITY ACT (ACT 715)

Provisions for people with Disability are contained in The 1992 Constitution and the Disability Act of 2006, which align with principle of recognitive justice. These provisions constitute a radical departure from the past in where there were no formal guidelines for the education and support of people with a disability.

The persons with disability Act makes provisions in relation to access to public services by people with a disability and penalties for contravening them, employment, education, rehabilitation, and discrimination in relation to access to services. Specifically, the act requires public employment centres to assist persons with disability to secure jobs and a tax incentive for employers who employ persons with a disability. It requires employers to provide the relevant working tools, and appropriate facilities required by the person with disability for the efficient performance of the functions of their paid job.

In terms of enhancing employability of persons with disability, the Act requires that unemployed persons with a disability be provided appropriate training, necessary tools and materials and be assisted with a loan to start a business.

With respect to rehabilitation and education of persons with a disability, the Act obligates Government to progressively establish rehabilitation centres in regions and districts for persons with disability, offer guidance, counseling and appropriate training for those who are unable to enter into the mainstream of social life. In addition, a Community based rehabilitation approach shall be used such that as far as practicable persons with disability shall be rehabilitated in their communities, to foster their integration.

When it cones to the Education of persons with disability, the act obligates parents, guardians or custodians of a child with disability of school going age to enroll the child in a school. Further, The Minister of Education shall designate schools or institutions in each region, which shall provide the necessary facilities and equipment that will enable persons with disability to fully benefit from the school or institution. More importantly, The Government shall provide free education for a person with disability, and establish special schools for persons with disability who by reason of their disability cannot be enrolled in formal schools. It will also provide appropriate training for basic school graduates who are unable to pursue further formal education and this includes the designation, in each region, of a public technical, vocational and teacher training institutions which shall include in their curricula special education, such as sign language, and Braille writing and reading. Finally, the acts make it an offence for any educational institution to refuse of admission on account of disability. The biggest concerns about these provisions are that they require both fiscal and human resources.

These measures and provisions for persons with a disability are necessary for ensuring social justice and inclusiveness. However they raise a lot of concerns in terms of fulfilling their basic duties around rehabilitation, training and education. The biggest problem with disability service provision has to do with decentralization of service provision to district Assemblies, the lack of balance in social spending which sees current increases in social spending being directed at general education and primary health care. The 1992 Constitution decentralized political and administrative authority to local government called District Assemblies. Under this new arrangement, local governments have to provide economic and social services from central government allocated resources called Common Fund. Each local government jurisdiction should use at least 2% of their funding for disability services, including rehabilitation and educational services. However, the Ghana National Federation of the Disabled observed that although the needs of PWD's to be administered at the district level, are spelled out in the Local Government Act and there is a constitutional requirement to spend 2% of Common Fund on disability services, this has not been effectively supported by a decentralization of resources for running costs or monitoring.

Apart from lack of support for disbursing resources to disability, which the District Assemblies attribute to a lack of guidelines for how the funds should be spent, there is certainly a problem with the amount of resources at the assemblies' disposal and how they can de-prioritize the more dominant sectors in favor of disability. This breeds problems with equality from district to district.

First, in terms of enhancing employability of persons with a disability the Act requires that those who are unemployed for some time be provided appropriate training, necessary tools and materials and assisted with a loan to start a business. This is one area of challenge which is unlikely to be realised any time soon as unemployment is high among those without a disability at all levels. Furthermore, there is no mechanism in Ghana, to ensure equal opportunity in public or private institutions.

Secondly, the few rehabilitation centres that are currently operational are so under-resourced in terms of staff and learning materials, and one wonders whether government is justified in any way to establish new institutions when existing ones cannot be consolidated or improved to deliver the desired outcomes for persons with a disability. Given Ghana's economic situation and the pressure on social spending it is almost unthinkable that government is in a position to establish new institutions. Another segment of the rehabilitation provisions in the act is that Community-based rehabilitation has been proposed as an approach but there are minimal supportive actions in terms of resources, networks and skill development in local communities to achieve such a vision.

Finally the education provisions raise a number of concerns. While it is very important to ensure that children with disabilities are admitted to schools, the most critical issue in Ghana at this stage is not refusal to admit to school but the inability of schools and the lack of effort on the part of teachers to address their learning needs, due in part to inadequate knowledge and skills and the lack of resources (Kuyini &Desai 2007, 2008). A related matter is the need to have technical and vocational schools that would include sign language and Braille reading and writing into their curriculum. The question that arises is how is this possible when public schools don't have resources and no trained teachers, how could we expect such training to take place?

SUMMARY OF WELFARE CHALLENGES AND WAYS TO IMPROVE SERVICE DELIVERY

The analysis in the forgoing pages indicates that the Ghana Government is determined to minimize the effects of the free market on the wellbeing of the poor. It has tried using both Universalist and restrictive welfare policies. However in many areas both the universal and restrictive provisions are facing formidable challenges. Policy makers, service users and researchers continue to wonder how these challenges can be overcome.

As noted earlier, the key challenges to realizing the full benefits of the education policies are related to increasing or optimizing access for the very poor, through expanding the school feeding program and eliminating other user fees as well as improving quality of teaching and learning through good teaching and teacher availability.

Challenges of child protection provisions include limited institutional linkages, which need to be enhanced, especially between formal services and traditional systems in order to fashion out ways to educate the parents and local communities about their obligations under the Children's Act.

Disability service provision is constrained by resources, limited commitment on the part of district assemblies to spend the stipulated 2% of their annual budgets on disability services, general negative attitudes, lack of education about the rights of people with disabilities and pragmatic steps to enhance the role out of inclusive education schools.

For the LEAP program, "Substantial additional funds would be required to take [it ] to scale, reach those still unable to afford health insurance and implement the announced NHIS fee exemptions for children" (Jones, et al.,2009, p. 21)

Overall, one of the most formidable barriers facing all of the protective policies is one of resource constraints. Government simply lacks capacity to expand services due to lack of resources. Jones and other suggest that Institutional and organizational constraints are holding back the expansion of some programmes, and weak interagency coordination is making it difficult to ensure the effective complementarity of programs.

Research on the failures of public programs are clear on the fact that enhancing the effectiveness of service delivery will hinge on measures such as the following:

· Better governance

· Strengthening interagency coordination of services.

· Implementation efficiency

· Better revenue generation

· Training and skill development of all staff

· Community education

CONCLUSION

This chapter has covered the historical development of universal welfare in Ghana and the recent attempts by the government of Ghana to reintroduce protective social policies curtailed under the IMF and World Bank structural adjustment program. It has detailed the provisions, scope and challenges of these policies and advanced ideas about how they can be improved.

There is room for improvement in each of these areas social protection but as donor support declines, the country is going to have to rely on its own resources to meet these obligations. This is a formidable undertaking that will require economic growth to increase to the level that public spending is not overwhelmingly outweighing government revenue. As welfare policy and service delivery are dynamic, it is clear the Government of Ghana has more to do in order to achieve the vision of mitigating the effects of the free market forces on the most vulnerable in the Ghanaian society.

Footnote

Part of the information under this section was drawn from the Children's Act of 1998.

References

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