Sunday, April 19, 2015

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The Blind Side: Disability and Development in Ghana

Helping Ghana's disabled could provide economic as well as social benefits.
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People in the street market in Kumasi, by Petr Kosina.

Accra, Ghana:

You see them scattered all across Accra: the disabled of body or mind, blind and begging in traffic, paralysed and lying on the sidewalk. These people are some of Ghana’s estimated 2.5 million disabled, themselves part of the world’s one billion, 80% of whom are thought to live in developing countries like this one.

Not only do they represent a human rights disaster, but also a serious impediment to socio-economic development. This at a time when Ghana is considered, however controversially, to be a lower-middle income nation and whose oil sector is expected to fuel double digit economic growth.

The link between disability and poverty has been stressed by civil society groups and international bodies like the World Health Organization (WHO) and World Bank, even if quantifying the connection remains a tricky business. Disabled people experience enormous challenges when it comes to accessing education, employment, and healthcare. Accordingly, disability should be viewed through the lens of the Millennium Development Goals (MDG), a point recognised in the UN’s 2010 MDG report, which called for policies and actions specifically addressing disability.

Left unchecked, the problem multiplies. As they stand, Ghana’s disability laws are failing its people and hindering the country’s development. The Persons with Disabilities Act (PDA) has not been wholly implemented, and the Mental Health Bill (MHB) has been in parliamentary limbo for years. 

Ghana’s legal context

In 2006, after four years of habitual dithering, Ghana passed the PDA. Advocates like the Ghana Federation of the Disabled (GFD), which is composed of six disability organisations, were optimistic, but, five years later, few of the bill’s provisions have been enacted. Disabled people acknowledge incremental change but say their lives are mostly the same.

On paper, the PDA builds on the country’s 1992 constitution, which has eight provisions guaranteeing the rights of the disabled. A year after passing the act, Ghana signed but has not ratified the Convention for the Rights of Persons with Disabilities, which also supports the PDA. 

The PDA ostensibly delivers social, cultural and civil rights to the country’s disabled. An umbrella provision guarantees dignity in social, political, cultural, recreational, and creative pursuits. Subsequent provisions promise job training, employment, an accessible built environment, accessible transportation, free healthcare, protection from discrimination, and a National Council on Persons with Disability (NCPD).

A 10-year transition period was built into the law. And the GFD says much of the built environment remains unchanged, so much so that the remaining five years are unlikely to be enough to update infrastructure in time. The situation is epitomised by Accra’s ministries district, where government departments mark their central locations: only one of the ministries is accessible. Complicating the issue is WHO’s finding that 75 - 80% of Africa’s approximately 81 million disabled live in rural areas. The idea of manoeuvring a wheelchair – or maybe just some plywood with castors – down one of Ghana’s country roads is a daunting one.

Earning a living

There are also complaints about employment. The government says it’s addressing the issue with tax incentives for employers who hire disabled staff, training programmes, and community-based rehabilitation, which trains participants with local resources. But few disabled people, even those with good jobs, think these advances are adequate. They describe a reality of mostly inaccessible workplaces, discriminatory employers, and uneducated job-seekers, many of whom wind up relying on family for financial support.

That kind of support can strain families, and society at large for the expenditures associated with disability are extensive. Food insecurity is often experienced by developing world families with disabled members, and crime springs eternal from that kind of poverty.

According to the World Bank, research linking disability to economics is mostly undertaken in developed countries. There are few reliable figures for Africa. However, the Martin Prosperity Institute, a Canadian think tank, says that country’s province of Ontario misses out on $4.8 billion a year due to the marginalisation of the disabled.

In Ghana, public financial support is supposed to come from local governments, which manage the District Common Funds set up during a 1990s decentralisation exercise. Before the act, 2% of the funds were earmarked for the disabled, but the assemblies seldom transferred the money, claiming the distribution guidelines were unclear. After the act, the NCPD was tasked with writing guidelines, and local governments were told to set up specific committees and accounts. The allotment rose to 3%. Even still, civil society groups say the transfers are delayed, sporadic, or absent entirely.

The list of grievances is extensive. NGOs say school lack facilities for the disabled, the NCPD is grossly underfunded, and the entirety of the act has been lost in the slow-cooker of Ghana’s bureaucracy.

The mental health bill

People with mental illness in Ghana have scant hope of treatment or recovery. According to WHO, about 650,000 people suffer from a severe mental illness, while another two million have milder disorders. The country has just three psychiatric hospitals, and only a dozen or so psychiatrists. There’s a reported 98% treatment gap, meaning only two of every 100 get medical help. Discarded by their families, many mentally ill people are shunted off to so-called prayer camps, where they endure preposterous conditions and cruel confinement.

In 2004, the MHB was drafted. Seven years later, it has yet to be passed, placing it in the neglected ranks of other potentially emancipatory laws, like the Right to Information Bill, itself in limbo for almost ten years. The current Mental Health Act dates back to 1972 and focuses on centralised, institutional care, permitting decades of involuntary confinement.

The draft MHB, developed in partnership with WHO, proposes the creation of a Mental Health Service that would operate at the level of primary health care and focus on community delivery. District and regional services would also be established to deliver prevention, treatment, care, rehabilitation, and counselling. The government would have access to private sector facilities, which is what the prayer camps are considered.

The draft sets out parameters for voluntary and involuntary treatment, including standards for food, bedding, sanitation, staff qualifications, and essential medicines. It has further clauses protecting at-risk groups like women and children. Human rights are also addressed, with clauses articulating privacy and autonomy, access to medical records, access to personal money for in-patients, and access to employment and education.

A question of investment

Ghana’s politicians need to view these issues through a development lens, as MDGs or general national priorities. Government expediency is too often a question of elitist political priorities, like last summer’s $3 billion loan from the Chinese, approved at breakneck speed for the oil-producing Western Region. There is no reason the MHB could not be passed with at least a shadow of the same expediency.

Excuses about the high costs of fully implementing the PDA – or, when it is finally passed, the MHB – are flimsy at best, and, when one considers the reported $4 billion lost every year to corruption, those same excuses are just cynical.

Mentally and physically disabled people are human resources in the same way other members of society are. If they live in an environment that promotes their social, economic and civil rights, they will inevitably produce wealth – as consumers, units of taxation, or contributors to development. Implementing protective laws is a simple investment; it is neglecting them that is expensive. 

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This is one of the most imformative articles on disability and mental health law in Ghana I have ever read (if not the only one). I appreciate the exposure and honesty on issue of government negligence. Great work! Please keep it up!

Visiting Ghana gives one a strong sense of how the mentally and physically disabled are ignored and abandoned. Some months ago the President made noises about getting them "off the streets" but gave no alternative to where these people can go. A massive problem in Ghana, but one that I'm sure will be low on the priority list.

Thank you for such a great contribution in the life of the mentally ill and disabled people in Ghana. You have done  a great job. I hope the politicians of Ghana have access to this article and rethink about how they are ruling the country in their own interest. They claimed the Law is passed, yet there is no enforcement. How do we hold people accountable if the law is not implemented? Only God knows the plight of these people in Ghana.Once again, keep talking for these small groups till something positive happens in their lives.God bless you.