US embassy cable - 04ACCRA63

UNCLAS SECTION 01 OF 04 ACCRA 000063 
 
SIPDIS 
 
HHS PLEASE PASS TO NINA WADHWA 
PRETORIA FOR HEALTH ATTACHE HANDELY 
 
E.O. 12958: N/A 
TAGS: TBIO, OTRA, PGOV, AMGT, ECON, GH 
SUBJECT: SCENESETTER FOR HHS DEPUTY SECRETARY ALLEN: GHANA 
 
REF: A. SECSTATE 5237 
 
     B. SECSTATE 2003 350482 
     C. SECSTATE 2003 340696 
 
 
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Introduction and Welcome 
------------------------ 
 
1.  Your visit to Ghana provides an opportunity to encourage 
further momentum to Ghana's efforts to build capacity to 
address basic health concerns on infant, child and maternal 
mortality and morbidity, and help prevent HIV/AIDS 
transmission and mitigate its impact on Ghana's population. 
Ghana's childhood immunization coverage has been increasing 
steadily and is currently more than 80 percent. It is 
supported by GOG commitment to vaccine availability and 
program sustainability. Ghana is committed to the 2000 
African Heads of State Abuja Conference goals for malarial 
prevention, including effective treatment of uncomplicated 
cases, intermittent presumptive treatment for pregnant women 
and the promotion and use of insecticide-treated bed nets. 
Ghana's HIV/AIDS infection rate, at approximately 3.4 
percent, is well below the critical 5 percent threshold and 
AIDS prevention campaigns, with broad-based support across 
sectors, are widely prevalent. The Ghana AIDS Commission, 
established in 2000 under the leadership of the President, is 
the coordinating body for all HIV/AIDS-related activities in 
Ghana and oversees an expanded response to the epidemic. End 
Introduction. 
 
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USG Interests in Ghana 
---------------------- 
 
2.  U.S. interests center on support for Ghana's ten-year-old 
democracy and promotion of open markets.  The long-term 
success of Ghana's constitutional democracy is not 
guaranteed.  Government institutions are still evolving, and 
economic challenges, left unresolved, could erode popular 
support for democracy.  A top Mission priority is to 
encourage respect for rule of law, individual rights and 
accessible, open, corruption-free civic institutions.  This 
effort goes hand-in-hand with our support for economic policy 
reform and pursuit of market-based growth, primary education, 
and combating HIV/AIDS.  The events of September 11 have led 
to increased emphasis on anti-terrorism, particularly in 
successfully lobbying the Ghanaian Government on 
anti-terrorism conventions and suggesting improvements to 
Ghana's financial systems. 
 
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Development Assistance 
---------------------- 
 
3. Ghana is one of USAID's largest programs in Sub-Saharan 
Africa, receiving approximately USD 55 million in grant 
assistance and food aid per year.  USAID works in the 
education, health/population and HIV/AIDS, environment, trade 
and investment, and democracy/governance sectors.  The trade 
and investment program focuses on macroeconomic and trade 
policy reform, and technical assistance to business groups 
and individual entrepreneurs. USAID has also provided 
technical assistance to the GOG in its efforts to conclude an 
agreement for the West African Gas Pipeline and to establish 
a West African Power Pool.  In February 2000, Ghana launched 
a USAID-funded "Stop AIDS, Love Life" campaign to help slow 
the rate of infection. 
 
4.  September 2003 marked the Peace Corps' 42nd anniversary 
in Ghana, the first country in the world to receive Peace 
Corps volunteers.  Ghana currently hosts some 130 volunteers 
who are working as teachers, agro-foresters, small business 
and water/sanitation advisers, and youth development 
volunteers.  The USG-funded African Development Foundation 
supports grassroots development and small-scale 
community-based enterprises, including micro-financing 
projects.  Ghana also participates in the Leland (computer 
and internet connectivity) and Education for Democracy and 
Development (EDDI) initiatives through USAID.  Accra was 
recently the venue for Peace Corps' annual Africa Region 
Country Directors Conference.  Peace Corps Director Gaddi 
Vasquez visited Ghana, met with the Vice President and 
addressed the conference. 
 
5.  Donor coordination is excellent in Ghana, with active 
coordination groups in 14 sectors including health, 
education, and governance/democracy.  Assistance to Ghana in 
forms of grants and concessional loans from over 20 
multilateral and bilateral donors was approximately USD 1 
billion in 2002.  The United States ranks third among 
bilateral donors and contributes approximately 6 percent of 
that total.  Japan is the largest bilateral donor with 
programs in education, health, and agriculture, and Great 
Britain is second with programs in public administration, 
health, education, rural infrastructure, and agriculture. 
Other major donors to Ghana include the World Bank 
(infrastructure, education, and health), United Nations 
agencies, the European Union, Denmark, the Netherlands, 
Germany, France, Canada, Italy, and Spain.  Ghana signed a 
new IMF Poverty Reduction and Growth Facility (PRGF) program 
in May 2003.  Ghana's performance under the previous PRGF was 
problematic, but it met all its targets during the September 
2003 review of the new program. 
 
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Health Overview 
--------------- 
 
6. In the health sector, Ghana has achieved significant 
results in reducing under-five mortality and total fertility 
rates and has come a long way in addressing the basic health 
needs of its population. USAID/Ghana's Health program, at 
approximately USD 17 million per year, focuses on USAID 
priority areas in child survival, reproductive health 
including family planning, and HIV/AIDS, and seeks to support 
and maintain the positive trends of recent years. USAID,s 
program lends leadership in the areas of community health 
service provision and technical assistance to increase 
coverage and quality of services in all areas. The program 
promotes behavior changes and the adoption of positive health 
practices, social marketing and other private sector 
approaches. USAID also has significant comparative advantages 
in the HIV/AIDS care and support area, including the 
introduction of anti-retrovirals, home-based and orphan care, 
establishing voluntary counseling and testing centers, and 
prevention of mother-to-child transmission. Additional areas 
of USAID,s leadership are in highly technical interventions 
such as logistics management, surveillance and program 
monitoring, evaluation and research, including operations 
research, and in mutual health organization/health insurance 
development. USAID,s approach is to maintain and expand 
positive trends in health status building on the SWAP (sector 
wide approach), add limited new interventions based on 
lessons-learned and research, and focus activities 
geographically and programmatically to maximize impact and 
better complement other donor programs. 
 
7. Child Health: In child health, USAID aims to improve 
immunization coverage, use of insecticide treated bed nets, 
care of the sick child, and nutrition. Working with the 
Ministry of Health, UNICEF and WHO, USAID supports increased 
availability of immunization services through outreach and 
expanded service. USAID also supports efforts to promote 
purchase and re-treatment of bed nets from commercial 
suppliers. USAID has supported the development of improved 
guidelines for integrated case management of childhood 
illness, training to disseminate these guidelines and 
activities focused on the household and community to improve 
care of children before they reach health facilities, as well 
as the establishment of an infectious disease surveillance 
capability in the north, currently being expanded to other 
regions. With its partners, USAID is advocating for increased 
attention to the nutritional problems. USAID is supporting 
community-based groups to educate caretakers and the Ministry 
of Health to improve national guidelines and health worker 
training and nutrition. 
 
8. Reproductive Health/Family Planning: Recognized as the 
primary donor in this field, USAID is credited with making 
substantial contributions to the success of national family 
planning efforts in Ghana. USAID,s programs offer technical 
assistance and support for: policy development; improved 
service delivery; information campaigns; training and 
contraceptive commodities. Public awareness of family 
planning is high, and contraceptive use is increasing 
slightly.  USAID,s program works to decrease the abortion 
rate by promoting family planning for married couples, 
educating girls and boys on abstinence and delayed sexual 
initiation, and advocating faithfulness between married 
partners (school-based curricula, Life Choices media 
campaigns and the Church's Counseling curriculum are 
examples). The Ghana Health Service and Ministry of Health 
work toward improving health care access, equity and quality 
through several initiatives, including the Community-based 
Health Planning and Services Initiative (CHPS).  USAID 
supports the Ministry in CHPS and technical assistance, 
training and minor equipment for safe deliveries, the 
development of a self-paced safe motherhood curriculum, and 
the review of safe motherhood protocols. The result of all 
our support will be improved provider competency for 
antenatal, delivery and post-natal care and improved access 
to services in the communities. 
 
9. HIV/AIDS/STD Prevention and Impact Mitigation: USAID,s 
strategy to reduce the rate of HIV transmission consists of 
behavior change directed particularly at high risk groups and 
aims at sensitizing audiences to risk perception and the need 
for preventative behaviors. The program also supports 
training of health workers and strengthening laboratory 
capabilities and surveillance. Increasing demands on care and 
support services also mean that USAID,s program has expanded 
in this direction to provide technical assistance and 
strategic support to the establishment of comprehensive 
prevention, care and treatment services to infected 
individuals and their families in the hardest hit areas in 
Ghana. Interventions address prophylaxis and treatment of 
opportunistic infections, home-based care, clinical 
management of HIV-related conditions, voluntary counseling 
and testing, prevention of mother-to-child transmission of 
HIV, prevention and treatment of sexually transmitted 
infections, provision of anti-retroviral therapy and programs 
to serve orphans and vulnerable children. 
 
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Internal Political Situation 
---------------------------- 
 
10.  President Kufuor took office January 7, 2001, after 
defeating former Vice President John Atta Mills in a free and 
fair election.  His party controls 103 of the 200 seats in 
Parliament.  The National Democratic Congress (NDC) has 89 
seats, and smaller parties and independents hold the 
remaining eight.  Kufuor promised an inclusive government and 
has delivered:  his Vice President Alhaji Aliu Mahama is a 
northern Muslim, and ministers and other appointees come from 
all ten regions of Ghana.  The tone and volume of political 
discourse between the NPP government and the NDC opposition, 
always a vigorous debate, will likely harden as the December 
2004 Presidential and Parliamentary election season unfolds. 
 
11.  The Kufuor government frequently proclaims its 
dedication to the rule of law and to constitutional 
government.  It repealed colonial-era criminal libel laws, 
dropped a number of libel suits against journalists, 
initiated abolition of sometimes abusive community tribunals, 
establish a juvenile justice system, and generally takes a 
more balanced attitude toward individual freedoms and 
personal expression.  The President signed a new labor bill 
into law in October, bringing its law into conformity with 
ILO conventions. 
 
------------------- 
Economics and Trade 
------------------- 
 
12.  In 2000, the Kufuor Government inherited a distressed 
economy: high levels of debt, accelerating inflation, 
interest rates above 50 percent, a plummeting currency (the 
"cedi"), all exacerbated by declining world cocoa and gold 
prices (the main foreign exchange earners), and rising crude 
oil prices (heavily subsidized on the local market).  The 
government moved to restore macroeconomic stability, and 
promised a new Golden Age of Business.  It imposed 
badly-needed fuel, water and energy price hikes, and reined 
in spending by deferring some infrastructure projects and 
also by accumulating arrears to creditors.  The GOG's moves 
were in good measure successful; the 12-month inflation rate, 
after spiking to 30 percent after increasing fuel prices in 
February 2003, is rapidly declining.  Interest rates were 
reduced to approximately 24 percent, and the cedi has 
stabilized.  The decision  to seek debt relief under the 
Heavily Indebted Poor Countries (HIPC) program was a 
controversial move, but afforded Ghana roughly USD 250 
million in debt relief in 2002. 
 
13.  The government still has much to do to create its Golden 
Age of Business.  While voicing support for divestiture, the 
government has yet to sell its big assets - the utilities, 
the airline, and telecommunications.  Ghana continues to rely 
on multilateral and bilateral donors to provide over one 
third of its total revenue.  Looming revenue constraints, 
spending pressures, high interest rates, and major 
inefficiencies in agriculture continue to limit growth and 
hamper poverty reduction.  A number of nettlesome commercial 
disputes involving U.S. companies raise questions about the 
long-term investment climate.  While each dispute has its 
unique characteristics, most involve a sustained GOG failure 
to pay creditors in a timely fashion or a failure to abide by 
contractual obligations. 
 
14.  Despite these problems, the United States and Ghana 
experience a relatively dynamic trade relationship.  Ghana 
ranks fifth among African markets for U.S. goods (after South 
Africa, Kenya, Angola, and Nigeria).  In 2002 U.S. exports 
rounded to USD 200 million, principally heavy equipment and 
machinery, building materials, and food.  Ghanaian exports to 
the U.S. in 2002 amounted to some USD 116 million, primarily 
cocoa, gold and timber.  Volta Aluminum Company (VALCO), the 
Star-Kist tuna plant owned by Heinz, and the CMS Energy 
thermal power plant are the largest U.S. investments in 
Ghana.  Ghana has taken steps to take advantage of the Africa 
Growth and Opportunity Act (AGOA); it was the first country 
in Africa to receive certification for AGOA apparel benefits. 
 Secretary of Commerce Donald Evans formally opened a 
Department of Commerce office in Accra in November 2002. 
 
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Corruption 
---------- 
 
15.  The Kufuor government claims a "zero tolerance" policy 
for corruption and has pursued some high-profile 
prosecutions, including its Minister of Youth and Sports and 
several former high-level government officials.  In July 
2003, the President established an Office of Accountability 
within his office to ensure government appointees and public 
servants abide by the code of ethics for government 
employees.  It is still unclear, however, if this initiative 
is sufficient for the government to pursue corruption 
effectively against its own senior officials, and if it will 
succeed against working-level corruption pervasive in Ghana's 
public sector. 
 
--------------------------------- 
Peacekeeping/Military Cooperation 
--------------------------------- 
 
16.  Ghana's military establishment is characterized by its 
allegiance to elected civilian leadership, a rich 
peacekeeping tradition and a close relationship with the 
United States.  Since 1960, 80,000 Ghanaian soldiers and 
police have participated in peacekeeping missions, including 
those who currently serve in the sub-region as well as 
Lebanon and the Congo.  The Ghana Armed Forces (GAF) has 
received peacekeeping training under ACOTA, (the USG's Africa 
Contingency Operations, Training and Assistance), and 
Operation Focus Relief.  Many of Ghana's top brass have 
benefited from the USG's International Military Education and 
Training program, (including all Ghanaian military leaders in 
the recent ECOWAS Liberian Peacekeeping Operation 
deployment), while the Navy received three ships from the 
U.S. Excess Defense Article program.  In addition, DOD/EUCOM 
humanitarian assistance programs have constructed and 
equipped a new clinic in the Western Region, rebuilt a 
destroyed dam in the Upper West Region, and assisted 
small-scale community-based self-help projects throughout the 
country, including an HIV/AIDS hospice in Tamale.  A recent 
four day Naval West African Training Cruise Medical Outreach 
program in the Takoradi area treated over 1,000 patients a 
day in eight villages. 
 
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Counter-Terrorism 
----------------- 
 
17. The GOG condemned the September 11 attacks, publicly and 
privately, and expressed its sympathy, again publicly and 
privately, for the victims of the attacks.  Local security 
forces have offered enhanced cooperation, both in terms of 
security of Mission personnel and in exchange of information. 
 The Government in December 2001 signed the Convention on 
Suppression of Terrorist Financing, and has indicated its 
willingness to exercise greater oversight of suspicious 
transactions.  The Bank of Ghana drafted anti-money 
laundering legislation, which is currently waiting 
Parliamentary approval.  The Ministry of Justice is amending 
local laws to bring them into conformity with this and other 
anti-terror conventions.  In July 2002, the GOG ratified the 
five remaining conventions to which it was not yet a party, 
and now subscribes to all 12 conventions. 
 
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Comment 
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18. Post warmly welcomes the Deputy Secretary's visit and 
will provide a tailored country team briefing on January 19, 
2004. 
Yates