Introduction

Because of the relationship that exists between health, productivity and equitable development, health improvements form a key element of development. Since independence in 1957, the government of Ghana has implemented a number of policies aimed at improving the health status of its people. Its seven-year and five-year development plans in the early days of independence, as well as economic policies in recent decades, contain various measures to reduce the economic burden of disease, with a particular focus on morbidity, mortality and malnutrition among children. Indeed, the economic reforms and structural adjustment programmes that have been pursued since 1983 have gradually been accompanied by reforms in the health sector, which put more emphasis on primary health-care and stressed the importance of prevention of disease. The government of Ghana embarked on a health sector reform in the early 1990s to improve the accessibility and quality of services. The Health Service Act of 1996 and the Medium-Term Health Strategy based on Vision-2020 are further moves towards an efficient health-care delivery system (World Bank, 1997; MoH, 2000; GoG, 2003).

Over the years, several health indicators have shown positive trends. For example, the mortality rate of children under the age of five has successfully been reduced from 215 per 1000 in 1960 to 157 in 1980 and further to 112 in 2000 (World Bank, 2001; GSS and MI, 1999). Likewise, life expectancy at birth has increased from 45 years in 1960 to 53 in 1980 and further to 57 in 2000.