Aging and Demographic Transition in Ghana: State of the Elderly and Emerging Issues

Abstract

Although the population of Ghana is young and generally youthful, there is evidence of rapid increases in the size of the elderly cohort. Although demographic projections estimate that the proportion of the population younger than 15 years will experience continuous decline overtime due in part to decline in fertility, the rise in the elderly population is expected to also continue due to declining mortality rates resulting in longevity. Unfortunately, the growth in the elderly proportion of the population is occurring at the same time traditional systems of protection and care for the aged are breaking down on account of urbanization, socioeconomic development, and globalization. This has implications for public policy and the overall wellbeing of the elderly. This paper provides a snapshot overview of the demographic dynamics of Ghana focusing on the characteristics of aging, the challenges confronting the elderly, policy interventions, and gaps, as well as some pertinent issues including emerging research that are shaping deliberations about the elderly in the country.

In March 2017, Ghana celebrated 60 years of independence from British colonial rule. That celebration also symbolized the transition of all persons in Ghana, born before or in the year of the liberation from colonial rule and are still living, to the category of the population described as the elderly. The population of Ghana is relatively youthful but changing demographic trends since the 1950s show signs of gradual increase in the size of the elderly population defined as persons 60 years and older (Ghana Statistical Service, 2013b). Drawing on data, from the Population and Housing Censuses and the periodic Ghana Living Standards Survey (GSS) reports produced by the Ghana Statistical Service (GSS), as well as other secondary sources, this paper discusses the phenomenon of demographic transitions occurring in Ghana with particular attention to its gerontological dimensions and implications for the livelihood of the elderly, research, and public policy. In what follows, the paper is divided into four parts starting with a review of the signs of aging in Ghana, the structure of aging in Ghana, existing policy interventions and their inadequacies, and contemporary issues relating to national aging policy, research, professionalization of care shaping the country’s aging deliberation, in that sequential order.

Signs of Aging in Ghana

Ghana’s total population in 2017 is over 28 million representing 0.38% of the world’s population, and raking 48 on global league table of countries by population size (United Nations Department of Economic and Social Affairs Population Division, 2017). From a modest population size of 6.7 million in 1960, 18.9 million in 2000, and 24.2 million in 2010, Ghana’s population has witnessed rapid growth, and the rate of growth so far been at a yearly average of 2.4%. The population of Ghana is projected to reach 33.4 million by 2025, and about 50 million by 2050 (Ghana Statistical Service, 2013b). As can be observed in Figure 1 below, the structure of the country’s population is in the form of a pyramid with persons 15 years and below constituting 40% of the entire population. Majority of the people are within the 15 to 59 years group, and the elderly form less than 8% of the entire population. The youthful nature of the population is influenced by factors such as high rates of fertility and declining mortality rate especially among infants (Ghana Statistical Service, 2012).

Notwithstanding the overall youthful nature of Ghana’s population, there are shifts occurring at several levels. For instance, over 50% of the population now lives in urban areas due to migration and progress in socioeconomic development. Similarly, the age structure has also been undergoing gradual transitions as the adolescents and young adults grouped in the ages 15–24, which consists of approximately 20% of the total population over the years, has experienced systematic increases from 1.1 million in 1960 to 2.3 million, 3.5 million, and 4.9 million in 1984, 2000, and 2010, respectively. Changes have also been observed in those aged between 25 and 59 years. Although the proportion of persons in this age bracket constituted 30.6% of the total population in 1970, the size increased to 33.1% in 2000, 35% in 2010 (Ghana Statistical Service, 2013b), and this trend is expected to continue as the broad base of the population pyramid makes a gradual transition to the top.

Already, evidence shows that the proportion of persons aged 60 years and older is on the rise in Ghana. The first postcolonial census showed the share of the elderly population in 1960 was 4.6% of the total population. This has increased to 5.2% in 1970, 5.9% in 1984, 7.2% in 2000, and declined slightly to 6.7% of the total population in 2010 (Ghana Statistical Service, 2013b). Although the population 60 years and older decreased from 7.2% in 2000 to 6.7% in 2010, the absolute numbers show an increase from 215,258 in 1960 to 1,643,978 in 2010 representing 770% rise in the elderly population size (Ghana Statistical Service, 2013a, 2013b; Kwankye, 2013). Following this trend, it is projected that Ghana’s elderly population will reach 2.5 million by 2025 and 6.3 million by 2050 (Ghana Statistical Service, 2013a).

Notwithstanding the fact that children less than 15 years constituted about 40% and the elderly 6.1% in 2010, the population younger than 15 years is projected to decline to 29.4% as that of those 60 years and older increase to 8.6% of the total population by 2030. Again, the cohort of the population under 15 years is expected to decrease further to 22.3% as the elderly population witness upward movement to 14.1% in 2050. Similarly, it is projected that the proportion of persons 80 years and older will continue to increase and peak at 1.4% in the next three decades. In addition, the median age of the country’s population is also expected to change in line with the general demographic trends. From a median age of 21 in 2010, Ghana is projected to enter into an intermediate population bracket with a median age of 21.5 years in 2020 and old population of 31.7 median age in 2050. The trends of aging in Ghana also shows that the “coming decades will witness remarkable shifts in Ghana’s population age structure towards older ages as a result of decline in the proportion of children under 15 years” (Mba, 2010, p. 5). Thus, the argument that “declining birth rates, increasing life expectancy, and modern medicine, will eventually alter the age structure of societies in both developed and developing nations” (McCutcheon & Pruchno, 2011; p. 423) is beginning to resonate in Ghana.

Demographic of Aging in Ghana

Social characteristics such as educational attainment, economic activity, living arrangements, and marital status are important variables that provide information about the overall living condition of the elderly in society. Records show that 54.1% of the elderly in Ghana live in the rural areas notwithstanding the fact that majority of Ghana’s population are urban based (Ghana Statistical Service, 2013a). Given that the population most excluded from the benefits of education and other social services are those ushered into the elderly cohort with country’s attainment of 60 years, it is reasonable to expect that majority of the present elderly population have no formal education. Educational qualification is crucial because even in old age, high educational attainment can be used to leverage re-entry and participation in the labor market, and by extension obtain access to income and therefore afford quality health care and other services.

As illustrated in Table 1 earlier, data from the last population census also show that more than 60% of the elderly have never had any formal education or training, and only a little less than 40% had some form of education. For instance, 10.5% of the elderly attained secondary or higher levels of education. Those who have Middle/Junior Secondary education recorded the highest proportion of 20.5%, followed by those who have primary education (9%). Gender disparity in the educational attainment in favor of males among the elderly suggests that majority of older women are unable to enter the formal job market, thereby raising the possibility of elderly females falling into abject poverty more than their males counterparts. In much the same way, there are relatively more elderly persons with no formal education living in the rural areas compared to the urban areas. As one report noted, “almost two-thirds of the rural residents never attended school compared with less than half (49%) of their urban counterparts” (Ghana Statistical Service, 2013a, p. 44). Given the role of education in securing livelihood opportunities and preparation toward retirement, the urban elderly may be enjoying better conditions than their rural colleagues.

In terms of economic activity, the elderly mostly live in the same household with other family members, help with taking care of grandchildren and other relatives to enable the economically active population in the family focus on their work. The working generation provides support for the elderly, in an arrangement that suggests that the cost associated with raising that working generation when they were young is an investment and insurance against the uncertainties of life in old age. Therefore, the elderly continue to contribute to the overall welfare of the family by helping to raise, educate, and transmit time-honored indigenous wisdom and traditional values to the younger generation in their care, while also supporting with the performance of minimal house keeping duties, where health conditions allow. This traditional form of providing care and support for the elderly is a “complex system that includes reciprocal care and assistance among generations, with the older people not only on the receiving end, but also fulfilling an active, giving role” (Apt, 2002, p. 41).

Table 1 earlier provides detail information on the employment status of the elderly in Ghana. Overall, due to the low levels of educational attainment among the elderly, only small fraction of 2.7%, 2.2%, and 1.3% are engaged in managerial, professional, and technical areas of employment, respectively. Furthermore, over 70% of the economically active portion of the elderly population is self-employed without any other employees and mostly in the informal sector, with only 5.8% in the formal sector. Although the elderly make up less than a tenth of the total national population, they constitute 8.8% of the total labor force of the country. Of the total labor force in Ghana, elderly male constitute 9.2% slightly higher than 8.6 elderly females. Overall, participation in the labor market declines with age ranging from about 3% in the 60–64 age group to 0.9% in the 75–79 age group, and increases slightly to a little over one percent among those aged 80 years and older (Ghana Statistical Service, 2013a). Even though about 96.3% of the economically active (those able and willing to engage in economic activities) among the elderly are employed; the proportion of unemployed is slightly higher among females.

More than half of the elderly in Ghana are in some form of marital union, which is either being married, or living together. While a significant proportion of the elderly population previously married (now either divorced, widowed, or separated), only about 4% has never married. In addition, among those who were previously married, about 62.5% are females compared to about 18.53% of male counterparts. Of those in marital unions (married and consensual unions), 77% are male and only 34.6% females. In terms of the rural–urban disparity in marital status, 53% of the elderly in the rural and 49% in urban areas are married. The proportion of urban elderly who have never married is slightly higher than those with similar experiences in the rural areas.

The gradual emergence of unmarried adults in Ghanaian society where child bearing has always been seen as investment and security against the uncertainties of old age, is one example of the modernization induced transformations shaping the society. For these unmarried elderly and those without children, preparation for care and support in old age meant fostering other children if they are to avoid falling into the trap of elderly neglect. Similarly, the elderly in the category of divorcees and widows have to “fend for themselves in the absence of financial assistance, support and care from children, relatives and other social support networks” (Tawiah, 2011, p. 628). Early research on aging in Ghana has shown that the protection offered the elderly in Ghanaian society has come under some pressures from modernization, urbanization, and search for better livelihood (Aboderin, 2006; Apt, 1992, 2002; Mba, 2010).

In some parts of Ghana, elderly persons are also subjected to cruel treatment resulting from sociocultural beliefs. For instance, it is not uncommon for elderly women in parts of Northern Ghana to be accused of witchcraft and banished from their communities. Once ostracized, such elderly persons are stigmatized, deserted and subjected to neglect by family members who feel “justified in being absolved of their responsibilities of providing care and other kinds of help” (Tawiah, 2011, p. 625). This inhumane practice has the potential to impose on the elderly victims loneliness, separation, insomnia, and persistent anxiety. One study in 2012 shows that the elderly population in Ghana is exposed to several health risks from smoking, alcoholism, obesity, hypertension, insufficient nutritional intake, and very low physical activity emanating largely from the breakdown of the familial care arrangement as well as absence of protection by the state. The enormity of the challenges confronting the elderly population in Ghana is illustrated by the coping strategies ranging from self-medication, living off the streets by begging, cohabiting with others as a strategy for paying lower rents, working for others as laborers or house helps, selling productive and valuable assets, borrowing money from people, eating rotten foods, to deliberating skipping, delaying, or eating fewer meals. Overall, the level of poverty among the elderly is high and so is the level of disability among them (United Nations Population Fund, 2012). Atobrah (2016) observed that the challenges imposed by abject poverty on the elderly has often compelled them to sell personal belongings in order to enable them meet other social obligations.

Key Aging-Related Policy Interventions

Notwithstanding the rapid pace of aging, the country is yet to develop specific policies targeted primarily at addressing the various vulnerabilities associated with aging. Aspects of existing public policies such as the (a) the Pensions Program, (b) the National Health Insurance Scheme (NHIS), and the (c) Livelihood Empowerment Against Poverty (LEAP) designed to address the challenges of income insecurity, health care needs, and other constraints imposed by abject poverty among the elderly have, as discussed below, proven palpably inadequate.

For instance, the first pension programs which were established in the colonial administration were targeted not at providing retirement income security of the elderly but were designed to serve as reward for loyalty awarded to Africans who served the Crown diligently and without blemish (Kpessa, 2012). After independence, a new pension program known as the Provident Fund was introduced but was designed as a contributory program based on formal sector earnings. Later, these provident funds were changed to a social insurance program known as the Social Security and National Insurance Trust (SSNIT) that pays both one lump sum amount and subsequently regular monthly benefits to contributors when they retire. Recently, the scheme has been transformed into a three-tier pension system that allows for diversification of retirement income through private sector participation in the provision of old age income security (Kpessa, 2012).

Notwithstanding reforms over the years, the pension program in Ghana continues to be limited scope. Because the state is unable to reach workers in the informal sector through payroll tax deductions, the large majority of the elderly population who spent their entire productive life in the informal economy working as fishermen, farmers, transport conductors, traders, hawkers, street vendors, artisans, domestic helps, and could not contribute the payroll-based pension scheme are left without any pension benefits or any other form of reliable old age income support. This point is further illustrated by reports from the SSNIT showing that as at the end of 2015, the total number of the elderly persons in Ghana receiving statutory old age income support from SSNIT was far less than one percent of that cohort of the population (Social Security and National insurance Trust, 2015). Because the formal sector of the economy is so small, out of 10.9 million economically active population based on the 2010 Population and Housing Census data (Ghana Statistical Service, 2013b), only about 1% contribute to the pension program by the end of 2015 (Social Security and National insurance Trust, 2015). With this trend, a huge majority of over 99% of the Ghanaian elderly population would be without any form of retirement income security in the future, in a country where the family and community system of care and support for the elderly are fast disintegrating. This situation points to an imminent gerontological crisis if proactive policy interventions are not introduced to avert it.

In 2004, policy makers also introduced a mandatory NHIS financed through subscription premiums and funds allocated by the central government. In addition, there exist on optional basis, community mutual health insurance schemes as well as the private commercial health insurance scheme on the market. By design, the NHIS has specific health challenges and list of drugs that are approved for coverage under the scheme. In other words, the NHIS does not cover all illnesses, diseases, and health challenges. The elderly 70 years and older exempted from paying any premium but can access the services of the scheme for free. Unfortunately, the arrangement does not adequately address the health needs of the elderly for a number of reasons. First, the age at which the elderly qualifies to obtain free health care benefits from the scheme meant that the proportion of the elderly younger than 70 years is left uncovered by the scheme. Second, the bureaucratic delays associated with processing retirement income benefits for pensioners and the fact that most of the elderly are not covered under the retirement income security system meant that the proportion of the elderly between 60 and 69 years group have difficulty subscribing to the NHIS. Third, it is not enough for the NHIS to exempt the elderly 70 years and older especially when their major health challenges such as arthritis, stroke, hypertension, heart diseases, diabetes, malignant neoplasm, trachoma, blindness, and cancers are not covered under the NHIS-approved list of services financed by the Scheme. In effect, the coverage provided for the elderly under the NHIS does not address the health challenges of aging and thus leave the elderly quite vulnerable in the fight against man-made and natural aging-related degenerative diseases.

Another program known as the LEAP was introduced in 2008 to periodically transfer cash from the central government to poor households in Ghana with the dual intension of mitigating poverty and empowering the extreme poor to save and invest. This program is not specifically targeted at addressing the challenges of aging; however, because it addresses poverty, which is a condition that is prevalent among the elderly, it is often cited as a pro-elderly program (Alidu, Dankyi, & Tsiboe-Darko, 2016). LEAP is designed to provide some support for the “bottom 20% of the extreme poor in Ghana who, according to the 2005 Ghana Living Standard Survey, comprise 3.7 million of the country’s population” (Ministry of Gender Children and Social Protection, 2013, p.1). Those who are eligible to receive LEAP cash transfer include households that have orphaned or vulnerable children, the elderly poor (65 years and older), and any person with extreme disability who is unable to work. LEAP is a flagship social protection program implemented by the Department of Social Welfare, under the Ministry of Gender, Children and Social Protection. By the end of 2015, a total of 145, 894 households were receiving LEAP cash transfer.

Although part of LEAP that targets the elderly is a form of social pension, the implementation of the program has so far suffered several setbacks. For instance, targeting to ensure that all the elderly poor are reached is a challenge largely because of unreliable household data, which results in errors of inclusion and exclusion. In addition, the scope of LEAP so far is limited covering only few of the elderly who serve as caregivers for orphans and vulnerable children. Thus, the large majority of the elderly poor without caregiving responsibility are excluded. Additionally, the amount of money received by the beneficiaries is woefully inadequate. In its present form, LEAP is heavily dependent on donor funding hence there are questions about its sustainability given that funding from the donors could be stopped at anytime.

Emerging Issues on Aging

A number of emerging aging-related issues in Ghana can be identified. First is the National Aging Policy, which arose from Ghana’s participation in the United Nations World Assembly on Aging in Vienna, Austria in 1982, the African Unions Year of Older People in 1999, and the Second World Assembly on Aging held in Madrid, Spain in April 2002. Ghana eventually adopted a national policy framework in 2011 to serve as a springboard mainstreaming issues affecting the elderly in the public policy processes (Government of Ghana, 2010). This policy document identifies a number of pertinent issues relating to aging for which further research would be instrumental in order to ensure decisions are made on the basis of scientific knowledge and the principles of best practice.

Second, in an attempt to generate a conversation on the subject of aging research in Ghana, the Centre for Social Policy Studies (CSPS) at the University of Ghana organized a symposium in 2014 on the theme Aging in Ghana: Addressing the Multifaceted Needs of Older Ghanaians. This initiative brought together “researchers working on different aspects of aging from anthropology, psychology, public health, social policy studies and sociology” (de-Graft Aikins & Apt, 2016, p. 35) to share experiences, knowledge, and expertise on the subject as a starting point for raising the research and policy profile of the gerontological situation in Ghana. In a recent review of existing literature on aging in Ghana, it was observed that the study of aging in the country has so far focused on (a) demographic profiles and patterns of aging, (b) health status of the elderly, (c) elderly care and support systems, (d) roles and responsibility of the aged, (e) social representation of the elderly, and (f) issues relating to their socioeconomic status (de-Graft Aikins et al., 2016). The authors provide a brief but insightful multidisciplinary collection of reference points for further analysis of aging in Ghana. Subsequently, a multidisciplinary Centre for Ageing Studies (CAS) has been established in 2016 at the University of Ghana, with a mandate not only to conduct aging-related research and share findings to guide policy making but also to offer training in gerontology.

Finally, the country is gradually witnessing the emergence of private professionalized social care for the elderly, arguably as replacements for the deterioration in intergenerational reciprocities. One study in this area suggests that families are resorting to the use of nonfamily care givers, to supplement efforts of the family as a result of constrains on time due to work, formal education, and migration related unavailability (Coe, 2016). In its present form, families that can afford the services of caregivers rely on recruitment agencies or recommendations from others in their social network to recruit trained or untrained caregivers, who often live in the same household with the rest of the family. Under this arrangement, social care for the elderly is outsourced to nonfamily caregivers; however, the services are provided within the regular family settings in the full glare and often with assistance from other family members in the household.

Conclusion

The proportion of the elderly population in Ghana is one of the highest in sub-Saharan Africa and it is increasing rapidly (World Health Organization, 2014). Aging of the population has social and economic implications for public policy and development. The limited scope of the nation’s retirement income security system, the gradual breakdown of the traditional modes of care, the lack of policy attention to medical needs of the elderly, and the nonexistence of training facilities for geriatric care in Ghana raise questions about the preparedness of the country to avert a potential old age crisis. Furthermore, the challenges imposed by HIV/AIDS on some of the elderly in Ghana and other African societies meant that these elderly persons are in a situation where they are “grieving for the adult children” while at the same time living with the stress of caring for their grandchildren (Small, Aldwin, Kowal, & Chatterji, 2017). However, the growing research interest in the subject by scholars and practitioners of diverse disciplinary backgrounds is an excellent starting point to generate needed evidence for policy design and implementation. The opportunities for research, innovation, and creativity offered by population aging is not only limitless, it also traverses disciplinary boundaries and therefore provides avenues for multidisciplinary collaboration among researchers and policy makers in Ghana and beyond.

Conflict of Interest

None reported.

Acknowledgments

The author wishes to acknowledge the support this article received from the Book and Research Allowance provided by the Government of Ghana to academic faculty.

References