Buruli ulcer is a tropical disease reported in about 30 countries, including Ghana, where doctors are this year predicting about 1,000 cases. Credit: Paul Carlucci/IPS

By Paul Carlucci, Henrietta Abayie, and - -
GREATAER ACCRA WEST DISTRICT, Ghana, Nov 24 2011 (IPS)

For the past 10 years, Buruli ulcer has been eating Benjamin Essel’s leg. The skin above his ankle is totally gone, and a swollen, pulpy and reddish wound rises almost up to his knee and wraps around his calf. Even still, this is an improvement over recent years.

Buruli ulcer is a tropical disease reported in about 30 countries, including Ghana, where doctors are this year predicting about 1,000 cases. Credit: Paul Carlucci/IPS

Buruli ulcer is a tropical disease reported in about 30 countries, including Ghana, where doctors are this year predicting about 1,000 cases. Medical professionals say it is little known in afflicted communities and among staff at local hospitals, even though its early stages are easy to treat. It occurs in wet, rustic areas, and, consequently, its victims tend to be the rural poor.

Researchers know that it is caused by mycobacterium ulcerans, the same thing that causes leprosy and tuberculosis, but they are not sure how it is transmitted, which makes prevention very difficult.

Catching and curbing the disease in its early stages inevitably leads to full recovery with medication like antibiotics, but poverty, ignorance, spiritual beliefs, and underfunded health facilities conspire to stall treatment.

About 50 to 60 percent of this West African country’s victims end up with lesions like Essel’s or larger.

Disfiguration, disability, and amputation are common outcomes. Doctors and nurses are calling for more resources to educate endemic communities and train local health care providers.

“This disease affects rural poor, whose voices are not heard anywhere,” says Dr. Edwin Ampadu, the country’s national Buruli ulcer chief. “The public has very little knowledge about this. When we had opportunities to bring this to the media or TV, people shied away. That is very sad, because when you talk to people, they think the disease is far away. But it is very close to this place.”

According to the World Health Organization (WHO), Buruli first surfaced in Uganda in 1897. Fifty years later, Australian researchers provided the first full description of the disease, and, in 1960, a rash of cases broke out in Buruli County, Uganda, giving the disease its modern handle.

Since 1980, it has spread across West Africa, and, in 1998, WHO began addressing it on a global scale. The disease is present in 30 African countries, as well as the Americas, Asia, and the Western Pacific. In Ghana, there have been 11,000 cases recorded since 1993.

Buruli comes in four progressive stages: nodule, plaque, oedema, and ulcer. The first stage is just a lump in the skin, while the fourth phase can produce wounds several times as dramatic as Essel’s.

While prevention remains a puzzle – some researchers in Australia think the disease may be transmitted by mosquitoes – early treatment could not be easier. According to a 2003 survey, all it takes is 20 to 50 dollars worth of antibiotics. On the other end of the treatment spectrum is a price tag of nearly 1,000 dollars, not to mention the social fallout from that degree of illness.

“Education is ongoing,” says Martin Oppong, the Buruli ulcer programme coordinator for the Ga West District, where Amasaman Hospital is located. “But it’s a disease that no one can pinpoint as to the mode of transmission, so people’s perception as to the cause determines where they seek help.”

Some, like 50-year-old Ama Foa, think they have been cursed. Others, like 50-year-old Victoria Oppong, think it is a boil. Like Essel, both women let the disease progress before getting treatment. Now none of the three can work, and Essel and Victoria Oppong live in the ward.

Ghana’s National Buruli Ulcer Control Programme was struck in 2002, almost 30 years after the disease was first detected in the coastal province of Greater Accra Region. But doctors complain that it is grossly underfunded.

Amasaman Hospital’s ward exists mostly with the help of World Vision, the Christian relief, development and advocacy non-governmental organisation. In 2005, World Vision introduced a three-year programme to help with dressings, surgery, drugs, and general care, all of which are allocated from the government, but only every four months, and not in sufficient quantities.

World Vision also helps feed patients, who would otherwise have to fend for themselves, as the hospital does not pay for food. In 2008, the NGO renewed the programme. This September, it expired.

“Maybe they will renew,” says Oppong. “Maybe they won’t.”

Meanwhile, Ampadu is trying to build capacity in other endemic jurisdictions. He wants to train more local health care providers on detection, so the disease can be caught and stopped in its early stages. He also wants to build surgical capacity, so doctors can perform skin grafts and other surgeries with minimal damage to the patient.

So far, capacity is spotty. While Amasaman has one doctor who can assist in operations with the guidance of a surgeon from Korle Bu Teaching Hospital, one of the country’s central medical facilities, larger places like Nsawam in Eastern Region have no one. Ampadu chalks this up to professional interest.

“The gaps are many in terms of capacity building,” he says. “We have very few doctors who have shown serious interest. The cases are not many if you compare to tropical diseases.”

And then there are the financial limitations. Ampadu frames the whole thing as an issue of corporate responsibility. As it happens, many of the afflicted rural areas are also hotspots for Ghanaian industries like farming and mining. He’s calling on more companies to provide funds for education and outreach so the disease can increasingly be stopped in its early stages, which is currently the closest thing to prevention available. It should be an easy fix.

“If we invest seriously in early prevention,” he says, “maybe in three years time I can assume that we will not see this ugly lesion.”

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By Paul Carlucci, Jamila Akweley Okertchiri, and - -
ACCRA, Nov 3 2011 (IPS)

On the grubby edge of Old Fadama, Accra’s infamous illegal slum settlement, 67-year-old Mariana Sayitou sits under a parasol and tends to her livelihood – selling several dozen kola nuts and a few piles of bagged beans to passers-by.

Sixty-seven-year-old Mariana Sayitou sells kola nuts and beans on the edge of Old Fadama. Credit: Paul Carlucci/IPS

Gender activists say the situation of women like Sayitou is caused by a confluence of factors, from low rates of female education to increasingly nuclear family structures, and from social policy vacuums to cultural discrimination. Compounding the picture are Ghana’s labour markets, which, because of longstanding gender roles, herd women into the informal sector.

“We need to realise that the majority of our women are the mainstay of our economy,” says Elizabeth Quarcor Akpalu, executive director of Advocates for Gender Equity. “We need to do something to help them in their old age. They are dying in pain.”

Sayitou’s husband divorced her after their families had a row and she raises three of their four kids herself. She buys them clothes, food, and pays for their education with the less than 19 dollars she makes every day (some of which also goes to her own food, clothing, and business supplies budget).

“I want to take care of my children,” she says, “but I also feel the pain of living alone. I pray that my children are in good health, so tomorrow they can take care of me when I can’t do anything.”

Deeper in the slum, 70-year-old Sanatu Seidu sits on a wooden bench among an open-air foundation of crumbling cement. She is surrounded by bubbling pots worried over by women wrapped in robes. This is Valne, her northern foods restaurant. Like Sayitou, she is part of the informal economy.

When she first started almost fifteen years ago, Seidu quickly turned big profits, building the business into a 15-staff, 375-dollar-a-day phenomenon. But the flow of job-seeking migrants to Old Fadama is never-ending, and competition from other businesses has driven her profits down to between 60 and 90 dollars a day.

She uses that money to pay a staff of six, keep the business stocked, feed and clothe herself and her four children, two of whom live in Northern Region, and look after her sick husband, who also lives in the north.

“I face a lot of difficulties because of my age,” she says. “Sometimes, I can’t come out and help. Sometimes, I just lie down because I’m tired or I’m having pain in my body.”

There are pension schemes in Ghana. The biggest is a statutory programme run by the Social Security and National Insurance Trust (SSNIT) which, as of the end of 2010, included 107,312 people from the private and public sectors. Only 17,229 of them were women, because the scheme is for formal sector employees.

“There are more men certainly than women,” says Edward Ameyibor, general secretary of the National Pensioners Association. “In our system, it’s the men who work in the formal sector. It’s women who work in the informal sector.”

According to SSNIT’s 2010 annual report, beneficiaries get between 26 and 1,250-plus dollars a month. Some beneficiaries on the low end retired in the 1990s, when Ghana’s salaries were much lower and the corresponding contributions were fewer.

Those on the high end worked in high-income employment, earning larger salaries and making larger contributions. There are 94 men receiving pensions of 1,250-plus dollars, compared to 11 women. Over 50 percent of beneficiaries receive less than 62 dollars a month.

The National Pensioners Association has been battling SSNIT to have the baselines increased, but there have not been any breakthroughs. Up until recently, SSNIT had been giving percentage increases every year based on the fund’s investment returns. Last year, they gave an across the board increase of six dollars a month. The association is calling for a minimum benefit of 62 dollars a month.

Meanwhile, SSNIT does have a scheme for the informal sector. It started as a pilot project in 2005 and went national three years later. It is a flexible programme, allowing members to contribute what they can when they can. The contributions are stored in two accounts, one for retirement and one for working life. The latter account can be tapped after five months of contributions, a feature SSNIT says attracts younger workers into early savings programmes.

But just 32 percent of the account’s 90,000 contributors are female. Ghana’s 24 million people are almost equally divided among the sexes, though women live longer. And while there are plenty of men in the informal sector – hawkers, fishermen, masons – advocates say it is primarily a woman’s realm. However, there is no reason why so few women belong to this scheme.

“That’s where you find the majority of women, in the informal sector,” says Akpalu. “Without good education, it’ll be impossible for a lot to be in the formal sector. Even some with education, if you look at where they are placed, it’s a pyramid. They’re at the bottom section and lower echelon.”

Other than pensions, there is the government’s Livelihood Empowerment Against Poverty (LEAP) programme, which is designed for the extremely poor, the orphaned, the disabled, and the elderly. The programme, which grows year over year, currently targets 55,000 households, of which 35 percent are elderly. Of the latter number, 65 percent are female.

Depending on the size of the household, benefits are between five and nine dollars a month, paid six times a year.

“The LEAP is so little and insignificant,” says Akpalu. “It doesn’t address any problem.”

Additional support comes from a smattering of non-governmental organisations, church groups, and extended families.

Currently, Ghana’s 20-year-old constitution is under review. A review panel, formed in 2010, toured the country hearing from stakeholders, and a final report is in the works. The Network for Women’s Rights in Ghana sought to broaden the definition of discrimination in the constitution to include discrimination caused by economic and cultural systems, as well as address a host of rights issues.

“(The committee) didn’t take a lot of it on board,” says Akpalu.

Sayitou is not bothered with advocacy. She is accepting of her lot, and proud of her accomplishments. Everything else is just life.

“Some people, when they grow up, they’ve suffered since childhood,” she says. “But through that, the person can do anything for herself, because she has the capacity to succeed. Some people grow up rich and when they are aged they can’t work. They don’t know how to work.”

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By Paul Carlucci and Henrietta Abayie
ACCRA, Oct 26 2011 (IPS)

Mary Mingle thought she had a boil on her breast, so she bought some medication and tried to treat it at home. Two months later, bothered by persistent pain, she went to the doctor.

Mary Mingle has kept her double mastectomy secret for 20 years, due to fear of stigma. Credit: Paul Carlucci/IPS

There were eleven lumps in her breasts. She had first stage cancer, and her breasts, along with her uterus, would have to be removed.

“The doctor encouraged me,” she says. “The earlier I got them removed, the better. Otherwise, I would lose my life.”

Now, years after her surgery, only five people in her personal life know about her double mastectomy: her three children, her sister, and her husband. She’s been carrying her secret for about 20 years, hiding it from her extended family with a padded bra because she is afraid she will be stigmatised. She also hides it from her church, for the same reason.

“I don’t want them to be aware,” she says, her voice a tiny whisper.

Health officials in Ghana say breast cancer is a growing problem compounded by untrained medical practitioners, a lack of equipment, and unhealthy, sometimes fatal, cultural beliefs.

Historically, breast cancer has received scant attention in this West African country. International donors and institutions have been focused on communicable diseases like malaria and HIV/AIDS. Despite the fact that, according to Ghana Health Services (GHS), non-communicable diseases are the leading causes of death.

“It’s only now that attention is being drawn to it,” says Dr. Kofi Nyarko, head of the GHS cancer control programme.

There aren’t any solid statistics yet. In the capital of Accra, the Korle Bu Teaching Hospital, one of two full service cancer facilities in the country, is building an in-hospital registry of cases. In Kumasi, the country’s second biggest city in Ashanti Region, Komfo Anokye Teaching Hospital is also working on a database.

According to Dr. Verne Vanderpuye, a clinical oncologist at Korle Bu, the hospital gets about 3,000 breast cancer referrals a year.

“The main problem is that people don’t come early,” she says. “In an untreated case, when it’s moved beyond the breast, the average lifespan is one-and-a-half to two years. It will move from the breast, to the lymphs, to the lungs, to the liver, to the bones, and to the brain.”

Nyarko says the hospitals have gathered enough information for officials to know that breast cancer is becoming more prevalent, and its victims are younger and younger.

“It’s no longer a disease for the old,” he adds.

About three years ago, a focus on non-communicable disease began to take shape. In 2008, in collaboration with the World Health Organization (WHO), the Ministry of Health set up a national Cancer Steering Committee. The following year, Nyarko became the government’s cancer chief.

Working with WHO, GHS has identified cost effective treatment and detection strategies. Radiology equipment is scarce in Ghana – there are 10 mammogram machines in the whole country, six of which are in private institutions – so there will be a focus on clinical examinations, with mammograms for follow ups. It is a strategy that will require training.

“You need human resources,” Nyarko says. “You need infrastructure. You need certain equipment in place. You need all these things and money for training. The fact that you are a doctor or you are a nurse does not mean you can examine someone and say, ‘You are free (of cancer).’ You need to be trained.”

Nyarko expects a comprehensive national strategy will be launched by the end of the year. In addition to increased clinical examinations, the government would also like to build a full service hospital in Tamale, the biggest city in Ghana’s relatively undeveloped Northern Region.

There is also a big emphasis on prevention and awareness, with a series of posters and leaflets produced in partnership with the Geneva-based Union for International Cancer Control. Aside from promoting exercise and fresh food diets, the campaign is also meant to chip away at Ghana’s cultural oppression of breast cancer victims.

“People think that cancer is a call to death, but we are telling them that cancer can be cured,” Nyarko says. “We are aware that awareness is very low, even amongst the social elite. So we are working on that.”

It is not uncommon for victims to be shunned by their husbands or families. And in a country where women do a good deal of work, both around the house and in markets, husbands are reluctant to lose their wives to months of treatment.

Furthermore, chemotherapy is not covered by health insurance and can cost almost 2,000 dollars in just two weeks.

According to the World Bank, Ghana’s 24 million people live on an average of 1,283 dollars a year. The Jubilee oil find in the country’s Western Region is expected to help push GDP growth to 13.4 per cent in 2011, but there is no guarantee that will influence the average annual income.

“There’s also the fact that you could lose your breast,” says Vanderpuye. “We have a polygamous society, whether we like it or not. They might say you are not a whole woman.”

Like many African countries, Ghana is hugely religious. Many pastors tell their flocks that cancer is a spiritual illness, and that the answer is prayer, not surgery. As a result, some women do not go to the hospital until the tumours have spread. And then they die.

“They say the surgery kills, but they wait so long that the cancer spreads, so it appears surgery kills,” says Gladys Boateng, a breast cancer survivor and the founder of Reach for Recovery.

Civil society groups like Reach for Recovery also play a role in spreading awareness. Formed after Boateng survived her own bout with breast cancer, the group has reached 3,000 sufferers in the past eight years. Survivors give back to the group, visiting women in hospitals and helping with screening missions in remote or rural areas.

But even advocates keep secrets. Boateng will not discuss her husband’s reaction to her ordeal. She just offers a tight smile and declines comment. Nyarko, who has been watching international dollars lean heavily toward infectious diseases, is predicting a continued sea change in donor awareness. He is ready – all he needs are resources.

“It’s just now that there’s an emphasis on non-communicable diseases,” he stresses. “You know the right thing to do. You know the right thing to say. But you do not have the resources.”

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By Paul Carlucci and Jamila Akweley Okertchiri
Oct 6, Oct 6 2011 (IPS)

Emmanuel Joseph and George Amoah, two disabled Ghanaians, occupy different ends of the spectrum. The former lies on a piece of cardboard in Accra Central, his half-naked body twisted and mostly paralysed, the sun beating down on him while he waits to collect three dollars, the average proceeds of a day’s begging.

Emmanuel Joseph lies on a piece of cardboard in Accra Central. Paralysed from the waist down, he comes here every morning at 7am to beg. Credit: Paul Carlucci/IPS

The latter sits in a wheelchair and wears a tidy three-piece suit, his hair neatly cut and his eyes alert as he works through another day at a major international bank in the same neighbourhood.

They are just two of the country’s estimated two million disabled, who, according to the World Health Organization, account for seven to 10 percent of the population. Five years after its passage, the Persons with Disability Act has brought few changes to their lives.

On paper its provisions promise plentiful employment opportunities, free education, accessible buildings and transportation, and societal acceptance. The reality is much different.

“Sometimes I get insulted,” says Joseph, who says his legs became paralysed after he received a medicinal injection because he fell sick. “Sometimes people also beat me.”

He lives with his brother in a community called Post Office. Every morning, he wheels himself to Central and lies on the sidewalk. People with similar disabilities are all over the area, some pushing themselves around on pieces of plywood, while others wade into traffic snarls to beg for change.

“There is a very subtle discrimination,” says Amoah. “So far as you are physically challenged, you are categorised in a certain way. I do not know if you should only be begging or weaving or whatever. To a large degree, that’s the mind set of corporate Ghana.”

In some ways, Amoah lucked out. He is university educated, and he was able to find a position at the bank after a non-governmental organisation Sight Savers hosted its first annual job fair in 2010.

He is vague about the origins of his disability, but he says it struck him when he was young, and resulted in his missing five years of school. That he managed to get ahead in a country that often regards disability with superstition or derision is a victory. His disabled friends have not been so lucky.

“Obviously, it is a very difficult challenge,” Amoah says. “They have to depend on family. Some will have to find menial jobs, and a few of them (beg). Most of them do jobs that they are way above, but they have to survive.”

None of the Act’s provisions have been fully realised. A draft legislative instrument, which is supposed to flesh out clauses related to employment, education, penalties, and the built environment, has been stalled somewhere between the Ministry of Social Welfare and the Attorney General’s Office.

This comes as the Ghana Federation of the Disabled (GFD) is trying to leverage its relationship with government to make changes.

“If we do not do that, and the draft legislative instrument is passed as it is, there will be a lot of gaps,” says Isaac Tuggon, an advocate with GFD. “It is something that should have been ready a long time ago.”

According to the Act, Ghana’s built environment should be accessible by 2016. While there are accessible buildings in Accra, the city is still laden with barriers, from open gutters to old buildings with only steep steps and no elevators. Tuggon complains that hardly any work has been done to bring buildings up to code, and that even new structures are lacking ramps and other features.

“The government’s hands are tied because the government itself is not doing what is right,” he says.

In Accra Central, where many of the federal ministries are headquartered, only the Ministry of Social Welfare has wheelchair ramps.

“If I can go anywhere, I am not disabled,” says Amoah alluding to the fact that it is very difficult to get around the city. “Sometimes, it is the environment that is disabling.”

The Act also called for the establishment of a National Council on Persons with Disability. The council has been formed, but its executive secretary, Max Vardon, says it is under resourced and under funded.

One of the council’s tasks has been to pass guidelines for disbursing monies set in municipal, metropolitan, or district Common Funds. The funds were established in the 1990s as Ghana sought to decentralise its federal government.

In 2005, in response to advocacy pressure, two percent of those funds were pledged to persons with disabilities. That money was slow in coming, if it came at all. The guidelines were supposed to fix the problem.

“The bottom line is they are not really very interested,” says Vardon. “Ghanaians as a whole are not very interested in disability. We just do not want to know. The people who work in the district assemblies are also Ghanaians. They too have the same attitude. They do not want to know.”

In 2010, the Ministry of Local Government and Rural Development began issuing directives to municipal, metropolitan, and district governments insisting they fall in line with the guidelines, which, among other things, called for a separate account to hold the monies and a committee to determine how they should be disbursed.

Slowly but increasingly, committees are being formed and accounts are being opened. The Accra Metropolitan Assembly (AMA) says it has over 52,000 dollars in an account. According to the AMA’s budget officer, a committee will be fully assembled within a couple weeks.

The AMA also disputes allegations that it had not disbursed money before the imposition of the guidelines. The local government’s budget officer has several documents showing grants for sewing machines and other working tools.

Until the Act’s legislative instrument is passed, there’s no way to penalise people or institutions that contravene its provisions. At the same time, most disability advocates seem to feel change is gradually coming. Some, like Amoah, think it is a slow evolution of corporate Ghana’s mind set. Others, like Vardon, think it is a matter of society reflecting itself in government.

“Over the years,” Vardon says, “this sector has not been as heavily resourced as others, and we reflect the choices we have made as society. If more people made more noise about their cousin, their aunt, their uncle, whatever, who have disability, more people made noise about it, then perhaps government would say, okay, let us make more resources available for that.”

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By Paul Carlucci and Sam Mark Essien
TAKORADI-SEKONDI, Ghana, Sep 22 2011 (IPS)

Kobina’s legs are dappled with scars. He gets them flitting across the beach in Sekondi, in southwest Ghana, slipping in the soot-black mud and clambering over pirogues slippery with fish guts, only to sell a sachet of water or a freshly peeled orange to fishermen working on the shore.

Ten-year-old Kobina (right) and 12-year-old Comfort Essuman (left) are hawkers at Sekondi beach in Ghana's Western Region. Credit: Sam Mark Essien/IPS

He is a child: just 10 years old. But he earns a living selling food to locals.

Comfort Essuman keeps him company, roaming the area selling porridge and deep-fried sugar bread. Two years older than Kobina, she is less shy and more confident. Whereas Kobina will not offer his last name, Comfort readily pronounces hers.

“My mum says I should keep selling and that I will go to school later,” she says, adding that she has not been to school since grade three. “I sell not less than two Ghanaian cedi (just over one dollar) a day and send the proceeds to my mother.” She lives with her aunt, while her mother is in Central Region, one of the West African country’s 10 regions.

Kids like Comfort and Kobina are all over this Western Region metropolis. They are the skinny and scuffed cherubs of Takoradi’s heralded oil era, a newborn epoch that residents say is bringing more trials than triumphs.

Takoradi and Sekondi are the twin capitals of Ghana’s Western Region with a population of about 335,000. Once just sleepy fishing hollows, they were galvanised late last year when the region started producing oil from the offshore Jubilee field. The Ministry of Energy predicts 250,000 barrels per day by the end of the year, with a quarter century total of one billion barrels. And other finds from nearby fields are expected to come online in 2014.

Local chiefs are demanding 10 percent of the expected one billion dollars in annual government revenue from the oil. To kick-start infrastructure, the normally sluggish federal government passed a three billion dollar loan approval through parliament, earmarking 1.8 billion dollars for infrastructure development in Western Region.

Lured by news of oil-driven prosperity, newcomers arrive in droves, each expecting an employment boom that is yet to come. In the meantime, rent goes up. The cost of food increases. Traffic builds. And social malaise multiplies. It is a hydra-headed problem and many of its victims are children, says Deborah Daisy Kwabia, metropolis director for the Regional Department of Social Welfare.

“A lot of people are streaming into Takoradi-Sekondi in pursuit of greener pastures, whereby it doesn’t exist,” she adds. “It’s voluminous. It’s even increasing.”

For children, marginalisation takes two forms. The first is child labour, which can impact girls and boys differently. Older men may train boys to run drugs or steal from shoppers in Takoradi’s crowded Market Circle. Girls, meanwhile, might cook or wash dishes in ramshackle eateries called chop bars. Or they might move into someone’s house and become a maidservant.

The second is prostitution.

“Because of oil, now they have turned to prostitution,” says Comfort Osei Gerning, a foster mother with Mercy Foundation, a local children’s group. “The girls have turned to prostitution, and we have some boys who have turned to (having sex with men).”

The Zenith Hotel is the seat of downtown Takoradi’s nightlife. It is a bright red building next to a taxi station, and food hawkers crowd its corners late into the evening. Inside, men sip alcohol in a gloomy courtyard while prostitutes cruise the tables.

“Those ones aged 12 to 15, they are a different group,” Gerning says. “They are called the Thousand Girls. They charge cheap because they are kids.”

The name is a reference to Ghana’s old devalued currency. Ten Ghanaian cedi (six dollars) used to be 1,000 Ghanaian cedi. And it is what the girls charge. Apart from the Zenith, child prostitutes are said to haunt the Harbour View bar and the beaches of both Takoradi and Sekondi.

“Before you get to them, you have to pass through some grown-ups,” Gerning says. “They will collect the money from you and show you the place. It is someone’s business.”

This happens despite the existence of Ghana’s 1998 Children’s Act. Its clauses rail against child exploitation.

The act mandates the metropolis’ Social Services Sub-Committee to enforce its labour provisions. No one under 18 is allowed to do hazardous work, like going out to sea. No one under 15 is permitted to do manual labour. And light work is not allowed for anyone under 13. The committee can conduct investigations and recommend police action.

John Davis, representative for the metropolitan electoral area of West Anajy, has been the head of the committee for three months. Though he is aware of both child prostitution and labour in the metropolis, he says there have been no investigations under his tenure, and he is not aware of any conducted by the previous committee.

Davis is not able to offer any statistics at all, though he says assembly members were asked a month ago to gather information in their constituencies.

“We have not given any resources to do it,” he admits. “No resources in terms of vehicles or whatever.”

Instead, the committee will focus on an “education campaign”, speaking about the issue on the radio and elsewhere in public.

A lack of resources characterises much of government’s efforts in upholding the Children’s Act.

Kwaku Agyemang Duah, head of Community Care programmes with the Regional Department of Social Welfare, says the department has about 30 officers at its disposal. It needs a minimum of 80.

They also need a shelter for kids with no homes. The nearest one is four hours away in Accra, the country’s capital. And even if there was a shelter, they would need funds for feeding children as well as general maintenance.

“We present a budget every year,” he says, “but what comes out of it is a different story.”

Duah points to his office as a microcosm of the department’s financial straits. The floor looks like a warehouse. He has a desk and a filing cabinet and some rickety chairs. He has no computer and no office phone. The regional director’s office next door is only marginally better.

“I see it as a problem in developing countries,” says Peter Twineboa-Kodua, the regional director at the department. “We have not gone so far to look at the development of the individual as a human resource. Other (government) agencies on the financial side, they get everything they want. You can see their target. But child health, you cannot see the target.”

Unencumbered by bureaucracy, the Mercy Foundation has been able to make strides in addressing the problem. In the days before oil, when child labour was more a result of parents migrating to Ivory Coast to work in those fishing communities, they ran a school that involved 400 at risk children. It was funded by a World Bank grant that ran dry in 2004.

Smaller donations make other projects possible, however. Children have been re-integrated into the government schooling system. Those who were too de-institutionalised were taught vocations.

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