A study of the survival strategies of poor households in meeting their basic needs in Yilo Krobo District: a case study of health needs.

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For more than a decade, Ghana embarked upon an economic recovery programme in response to certain macro-economic and structural imbalances in the national economy. The implementation of the economic recovery programme necessitated the introduction of certain economic measures with drastic consequences on the mass of the people. The withdrawal of subsidies on social services such as health has reduced access to these facilities by the poor. It is common knowledge that poverty in Ghana is essentially a rural phenomenon. The problems of disease prevalence, malnutrition, lack of education, low life expectancy and substandard housing are more accentuated in the rural areas. A World Bank report, released in 1996, affirmed that rural areas account for more than 70 per cent of national poverty, and that the majority of the poor are food crop and export crop farmers with average per capita incomes below one-third the national average. Against this background, government spending in the social sector is still biased against the poorest 20 per cent. The poor are therefore trapped in a vicious cycle of poverty. The need therefore to adopt coping strategies to meet their basic need for food, shelter, health and education has become more imperative. The ability to meet these needs is contingent on their health status, since their most precious asset is their labour. The problems enumerated above are more prevalent in the Yilo Krobo District where 40 per cent of the population earns only 17 per cent of the wealth and 20 per cent of the population earn 43 per cent of the wealth. Malnutrition and infectious diseases are equally prevalent and increased school drop out rates contribute to high rates of illiteracy in the district. The survey therefore focused on how poor households are able to satisfy their basic human needs with special emphasis on health needs. Two Area Councils that is, Oterkpolu and Obawale Area Councils and Somanya Town Council were surveyed. Participatory Rural Appraisal approaches were used to identify community perception of poverty. It was revealed that communities’ perceptions of poverty transcend the official poverty line, which is denominated on money income. Some of the perceptions include: showing symptoms of malnutrition, inability to educate their children, do peasant farming, have poor housing, depend on others for the essential needs of life, just to mention a few. Both farmers and traders were identified as being poor. The coping strategies for these groups of poor people are basically the same even though the farmers are perceived as being better than the traders since they normally have food crops on their farms for which they can feed themselves and their families. The traders on the other hand rely mostly on the proceeds from their trade to buy food. They therefore subsist mainly on cheaper and lower —quality food, which adversely affects their nutritional status. Health officials have identified malnutrition as a major problem among this group of people. Coping strategies ranged from substituting lower quality food for protein and vitamin- enriched food for feeding their families. Children are also withdrawn from school to assist on the farm, borrowing money for medical expenses, receiving medical treatment on credit and relying on the extended family system for support. Quite a number of respondents indicated that they practise self-medication or resort to herbalists during illness when they are unable to raise money for hospital treatment. Some of these coping strategies have adverse effects on the poor, whilst some are more likely to trap them in persistent poverty. A reversal of this trend demands concerted effort by the District authorities, non-governmental organisations and all concerned.
A Thesis Submitted to the School of Graduate Studies, University of Science and Technology, Kumasi in partial fulfilment of the requirements for the degree of Master of Science (M.Sc.) in Development Planning and Management, 2001