At Work Around the World

Ghana

Read about the Center's peace work in Ghana.

Building Hope

Despite Ghana's wealth of natural resources and history as one of the first African colonies to achieve independence (1957), drought, disease, and political inefficiency have hindered Ghana's path to prosperity. For The Carter Center, Ghana represents two decades of increasing potential for this nation of people to enjoy good health and live in peace.

Through partnerships with the Ghanaian government and local and international nongovernmental organizations, The Carter Center has waged peace through election observation, fought disease, and built hope for the future through agricultural development.

Fighting Disease
Eradicating Guinea Worm Disease

Current status: Endemic
Indigenous cases reported in 2007: 3,358

When The Carter Center began its Guinea Worm Eradication Program in 1986, Ghana and Pakistan were the first nations to receive assistance to eliminate the disease. The Carter Center's relationship with the Ghanaian Ministry of Health has remained strong as the international eradication campaign has grown to include other partners, such as the U.S. Centers for Disease Control and Prevention, the World Health Organization, and UNICEF.

Currently the second most endemic country in the world, Ghana accounts for approximately 35 percent of cases worldwide and 89 percent of those outside Sudan in 2007. However, since work began on the ground, Ghana has reduced its cases of Guinea worm disease from 180,000 in 1987 to 3,358 cases reported in 2007, the fewest number of cases ever reported since the program began.

Read the press release: Carter Center Releases Action Plan for Guinea Worm Eradication, Targets Ghana, Nigeria, and Sudan.

Guinea worm disease, or dracunculiasis, is a 3,000-year-old parasitic disease that rarely makes headlines but is so painful and debilitating that its effects reach far beyond a single victim. Guinea worm is contracted when humans drink water contaminated with the infected larvae of microscopic water flea-like organisms called copepods. One year after the larvae are ingested, a worm up to 1 meter long emerges through a blister in the victim's skin, causing fever, nausea, and other symptoms. The peak transmission season in Ghana is from November to June, coinciding with the end of the raining season when water sources become stagnant and susceptable to Guinea worm transmission. Of 110 districts in Ghana, 23 districts have reported indigenous transmission and only five districts reported over 100 cases--all in Ghana's Northern Region--which represents 88 percent of the country's cases of Guinea worm disease.

Ghana's Guinea worm eradication campaign made significant progress early on in the campaign, reporting only 8,432 cases in 1994. However, ethnic fighting that year in the highest endemic area - the eastern part of the Northern Region - disrupted health efforts, creating programmatic instability and safety concerns.

Had it not been for programmatic setbacks in the mid-1990s, the campaign would have been much closer to eliminating Guinea worm not only in Ghana but also in Western Africa. As the most endemic country, Ghana's complete elimination is vital not only to the eradication of Guinea worm disease from the Earth but also to neighboring countries. As long as Ghana has cases of Guinea worm disease, other countries in West Africa remain at risk.

The Ghana Guinea Worm Eradication Program has introduced the following approaches in local communities: health education; the distribution of nylon household filters and pipe filters to strain out water fleas with infected larvae; safe, monthly treatment of stagnant water sources with ABATE® Larvicide, donated by the BASF Corporation; direct advocacy with water organizations; and increased efforts to build safer hand-dug wells. Village volunteers, who are trained, supplied, and supervised by the program, carry out monthly surveillance and interventions.

While the program in Ghana's south has successfully eliminated Guinea worm disease, the northern regions continue to report the majority of the disease, particularly among marginalized and migratory populations. During the 2006-2007 peak transmission season, the town of Savelugu in the district of Savelugu-Nanton reported a large outbreak of cases due to a breakdown in the main water supply in 2005-2006. Despite this set back, in May 2008 Ghana reported its 14th consecutive month of reduced cases, exceeding 70 percent reduction each month since October 2007 and suppressing the upsurge in cases normally expected at the beginning of the annual peak transmission season.

Migratory farming populations, such as the Nanumba, Konkomba, and Dagomba ethnic groups, often have diverse community infrastructures, requiring the program to create alternative approaches to Guinea worm health education such as: targeted radio messages, continued community volunteer recruitment, and the development of additional educational materials. Because migratory groups rarely gather water from the same permanent water sources, simply digging a well or holding health education sessions at the local school is not enough.

For instance, young men, usually farmers and cattle herders, find themselves at greater risk for disease because they are often away for weeks from the community base where household filtered water should be available. Instead they drink from numerous unprotected water sources while working in the field. The use of pipe filters has been one solution to this problem. The Guinea worm pipe filter - a hard plastic straw covered at one end by a filter material - is used to strain out the microscopic water fleas from the water, preventing people from contracting Guinea worm disease when away from the community. In 2005, approximately 144,000 new pipe filters were distributed to every eligible person over 5 years of age in each household in the seven most endemic districts in Ghana.

Those who are responsible for water-related activities, such as gathering drinking water, washing, and cooking - often women and children - bear an additional risk. Recognizing women's role and responsibility for water, The Carter Center engaged the women of the Ghana Red Cross Society in 2001 to work with and support village volunteers in the most affected districts. The Red Cross Society women, currently totaling 5,433, play an important role in the fight against Guinea worm disease. The eyes and ears of the community, these women report cases, ensure proper use of filters, and prevent worm contamination in water sources.


Ghana's Guinea worm eradication program, in partnership with The Carter Center, sponsors performances by local drama groups to increase health education among at-risk populations. The plays mark one more avenue for spreading the word about how to prevent the disease. In the play "Let's Eradicate Guinea Worm," performed by the Suhuyini Drama Group, emphasis is placed on filtering water to prevent Guinea worm disease, and stopping people with Guinea worm from entering and contaminating water sources.

Read: Laughter Is the Best Medicine: Group's Humor Aids in Guinea Worm Education

From November-June each year, Ghana's peak transmission season, case containment centers are opened in strategic endemic areas. At these care centers, people with Guinea worm disease are treated and given health education. Patients stay free of charge until their Guinea worms have fully emerged to ensure they will not inadvertently infect community water supplies.

Addressing stigma associated with Guinea worm disease is yet another difficulty. Through a public awareness campaign, the Ghana Guinea Worm Eradication Program publicizes the importance of immediately reporting all cases of Guinea worm disease and emphasizes that infection is not necessarily the fault of the individual. To help educate the public and raise awareness about Guinea worm disease, The Carter Center enlisted U. N. Secretary-general and Ghanaian Kofi Annan to record Guinea worm public service announcements for radio and television aired in Ghana and throughout Africa.

After winning the crown of Miss Ghana in 2005, Lamisi Mbillah, 22, has set out to bring attention to the efforts of Ghana's Guinea Worm Eradication Program. In 2006, she visited dozens of endemic villages to provide health education and participate in community mobilization activities to prevent the disease. In 2008, she continues to be actively involved in eradication activities.

Watch/Listen to the Secretary-General's Guinea worm public service announcement

Read: Miss Ghana Vows to Fight Guinea Worm Disease in Her Home Country

Such support encourages Ghanaian leaders to ensure that Guinea worm eradication is a priority. It is crucial that Ghana join a final push to eliminate Guinea worm from West Africa in the next few years. All Ghanaian regions, endemic or nonendemic, must report cases immediately to stop the spread of the disease. Without Ghana's eradication of Guinea worm disease, all of West Africa will continue to be at risk.


Updated MAY 2008

• Read To the Source: Guinea Worm Eradication in Africa (Emory Magazine, Summer 2004)
• Learn more about the Carter Center's Guinea Worm Eradication Program.

Controlling Trachoma

Trachoma is the leading cause of preventable blindness in the world and endemic to underserved rural communities in developing countries. In Ghana, trachoma is the third leading cause of blindness, endemic to the hot and dry areas of the northern part of the country, particularly the Northern and Upper West regions.

Since 1999, the Carter Center's Trachoma Control Program has supported Ghana Health Service to prevent trachoma through health education on subjects such as proper hygiene, facilitating improvements in environmental factors to reduce trachoma, and coordinating mass distribution of antibiotics. The Carter Center supports the Ghana Health Service in their aim of eliminating blinding trachoma in Ghana by 2010. Village health workers, trained schoolteachers, and even radio stations in trachoma-endemic areas have participated in the hygiene improvement awareness campaigns sponsored by the Ghanaian Trachoma Control Program. More than 8,000 front-line workers, including teachers, environmental health officers, community health workers, and village volunteers also have been trained to deliver the core program messages to rural villages.

In 2003, more than 100,000 people received Pfizer-donated azithromycin (Zithromax®) to help prevent the infection of the eye that can lead to blindness. The number of treatments has steadly increased over the years with 899,065 treatments distributed by the national program in 2007.

Additionally, the Ghana Health Service has been offering free lid surgery in health centers and in the community for those with trichiasis who are at immediate risk of blindness.

Radio broadcasts are one of the most effective ways to reach Ghanaian villagers - especially those living in some of the most isolated and remote areas of the country. Since 2002, jingles have been broadcast delivering simple and captivating messages in local languages.

Read more: Ghana Evaluates Impact of Radio Learning Groups, Eye of the Eagle Newsletter, Volume 5, Number 2 (PDF).

To make sure that people incorporate radio lessons into their daily lives, the program supports "radio-listening clubs" in the Upper West region. The program donates wind-up radios (removing the need to buy batteries) to selected villages and supports local radio stations in the production and broadcast of weekly trachoma shows. After the shows are broadcast, club members discuss the messages among each other and consider how they are affected.

Read the article: Trachoma Radio-listening Club Volunteer Spreads Health Messages Across Ghana

In 2005, The Carter Center focused on meeting the increasing demand for household latrines in Ghana. A new latrine strategy hopes to reach the "poorest of the poor" in endemic communities. The Ghana Health Service has set a target of constructing 25,000 household latrines for trachoma-endemic committees by 2009. The Carter Center and its partners have accepted the challenge to try and meet this target. So far, progress is being made with 9,296 latrines built since 2004.

Learn more about the Carter Center's Trachoma Control Program.

Increasing Food Production

Working hand in hand with the Ghanaian Ministry of Farming and Agriculture, the Carter Center's Sasakawa-Global 2000 Program has assisted farmers in the Ashanti and Central regions of Ghana since 1986 to improve food security. The program, in partnership with the Sasakawa Africa Association, led by Nobel Peace Prize winner Norman Borlaug, is part of a larger joint initiative that has helped more than 4 million sub-Saharan farmers.

The prescription is simple: Farmers are provided with credit for fertilizers and seeds to grow production test plots. Following successful harvests, which usually exceed previous harvests by 200 to 400 percent, farmers teach their neighbors about the new technologies, creating a ripple effect to stimulate food self-reliance in the nation.

The program also has assisted the Ghanaian people to develop and cultivate "obantanpa," or "good nursing mother," an improved type of maize that yields as much corn per acre as other maize varieties yet contains a more complete form of protein. Obantanpa, also known as quality protein maize, is especially important for infants weaned off their mothers' breast milk with maize porridge, a food with low nutritional value. Infant mortality in Ghana is often linked to malnutrition, primarily because the maize porridge lacks complete nutrition, preventing the development of strong, healthy bodies that can ward off disease and infection. More than 6 million of the 12 million annual, worldwide deaths of children younger than 5 are linked to malnutrition.

Today, 60 percent of Ghana's corn production is obantanpa. The introduction and production of this superior maize has decreased the incidence of protein malnutrition significantly. Recent, unpublished results of community nutrition studies of infants in Ghana found infants fed quality protein maize - also known as QPM - had reduced stunted growth and sickness by 50 percent and decreased their risk for infant death by one-third.

Read the article: Altered Corn Helps Ghana's Children Fight Malnutrition Atlanta Journal-Constitution

Improving crop yields is only half the battle, as farmers then must find ways to sell their surplus crops. Transporting these surpluses can be costly and inefficient. Often, road conditions are poor or impassable, and farmers rarely have places to store their harvested crops. These obstacles often force farmers to sell their harvest during peak harvesting season alongside other farmers, greatly reducing the margin of profit.

The program helps train farmers to better market themselves and identify local markets where they can sell their produce. Projects also focus on post-harvest technologies, including methods for processing and storing grains. In Ghana, farmers can get loans from the national Agricultural Development Bank through membership in a farming association, and association members are responsible for repayment as a group. Neighboring countries in the program that share crop seasons are encouraged to foster lasting cooperative efforts to share farming techniques and market their produce to each other. Currently, officials from Tanzania, Malawi, Ethiopia, Mali, Guinea, and Senegal are studying Ghana's experience with the hope of establishing similar agricultural programs in their own countries.

These successes and others in agricultural development programming led the joint effort to end its in-country agricultural activities in Ghana on Dec. 31, 2003.

Learn more about the Carter Center's Agriculture Program.

Waging Peace

Monitoring Elections

By monitoring elections, The Carter Center helps oversee formal transitions to democracy in the Western Hemisphere and Africa. Center staff also work with new democracies to strengthen the economy, establish institutions to safeguard human rights, encourage free media, improve health care, and promote sustainable development.

Although Ghana was the first African colony to achieve its independence, the Ghanaian people have struggled with democracy. Following a long period of political upheaval, the Ghanaian Constitution was suspended from use in 1981, and all political parties were banned. A new constitution was enacted 11 years later that re-established a multiparty political system.

In 1992, The Carter Center sent an election-monitoring team to Ghana's first democratic presidential election in more than 30 years. Jerry Rawlings, in power since 1981, won with 58 percent of the vote. Election monitors in Ghana observed ballot counting, the installation of voting booths and ballot boxes, the numbering of ballot packs, and postelection activities to assess the transparency of the election. Four hundred Ghanaians were recruited and trained as local monitors. Although opposition parties protested the results, the observers declared the election free and fair.

Since 1992, four national elections have been held and power has alternated between the two largest political parties.  This year, with no presidential incumbent and no clear frontrunner, the political environment is intensifying.  Public confidence in elected officials is waning and sporadic violence has been reported in parts of the country.  The 2008 elections are widely seen as a watershed moment in Ghana's history that could move the country toward democratic consolidation.  On the contrary, if elections are not executed properly, Ghana's electoral institutions and practices could be undermined. The Carter Center hopes the presence of its international observers will encourage fairness in the electoral process and acceptance of the election results by all political stakeholders.

To that end, The Carter Center has launched the first phase of its 2008 Ghana election observation project.  Four teams of observers have been deployed to four regions around the country.  Observers will focus on the recently announced limited voter registration exercise and the pre-election political environment.  In September, The Carter Center is planning to deploy a delegation of long-term observers during Ghana's campaign period. They will remain in the country for three months and be joined by a 50-person short-term delegation closer to the December elections.  The Center is also working with and providing technical assistance to domestic observer groups to reinforce their capacity.

Learn more about the Carter Center's Democracy Program.

Election Reports

Oct. 27, 2008: Carter Center Delegation to Assess Pre-Electoral Climate in Ghana
A Carter Center delegation will visit Ghana from Oct. 27 –31 to assess the ongoing difficulties and irregularities with voter registration processes and other concerns ahead of the Dec. 7 presidential and parliamentary elections.

Aug.26, 2008: Carter Center Releases Findings From its Observation of Ghana's Voter Registration
Carter Center observers in Ghana found the voter registration process that took place July 31 – August 12 to be generally successful but hampered by several irregularities.

July 25, 2008: Carter Center Launches Election Observation Mission to Ghana
The Carter Center launched an international election observation mission in Ghana this week with the deployment of four teams of observers to four regions around the country.

Final Report: Observing the 1992 Ghana Elections (PDF), released Nov. 6, 1992
The members of the Carter Center Ghana Election Mission observed the November 1992 election proceedings.

UPDATED AUGUST 2008