SCENESETTER FOR HHS DEPUTY SECRETARY ALLEN: GHANA

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
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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
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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
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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
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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
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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.

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Economics and Trade
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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
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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.

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Peacekeeping/Military Cooperation
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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
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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