Community facilities such post offices, telephones health and education facilities are also discussed in this report. In the region, postal facilities are fairly accessible in the AMA area but in the other districts, inhabitants of some districts such as Dangme West are 30 kilometres or more away from such facilities. Questions were asked about the availability of some facilities in each community. Such facilities include post and telecommunications, health facilities and education facilities. For facilities that were not available in the community, the distance to the nearest available facility was recorded.

Post And Telecommunications
Post Office
The post office is available in all the districts in Greater Accra. Not all communities have this facility, but all in AMA have this facility. For the rest of the districts, availability of a post office facility ranges from 1.3 per cent of communities in Ga to 8.8 per cent in Tema.

Telephone facility, like the post office, is available in all the districts; again, not all communities have this facility. In the AMA, the facility is available in all the communities and the distance to the nearest facility is less than 1 kilometre. More than half of the communities in Tema have telephone facility. On average, the distance to the nearest telephone facility in the district is 0.9 kilometre. In Ga, Dangme West and Dangme East, the availability of telephones to most communities is very low, ranging from 4 per cent of communities in Dangme West and Dangme East to 5.5 per cent of communities in Ga. For this reason, for some communities, particularly in Dangme West, the maximum distance to the nearest facility is 65 kilometres. On average however, travel distances to the nearest facility is between 5.4 kilometres for Dangme East and 15.2 kilometres in Ga.

Greater Accra is covered by all the telephone operators of the country. The average teledensity for Greater Accra is 3.2 per 100 persons, about five times that of the national average (0.7), indicating that most of the fixed line and mobile telephones of the country are concentrated in the region. All the 7 telephone companies in Ghana operate in the region.

Ghana Telecom now Vodafone covers Greater Accra from three locations, namely Accra metropolis, which has several main and sub70 transmission stations in the sub-metropolitan areas, Tema and Ada. Other providers of fixed line and radio telephone systems, though on a relatively small scale, are Westel and Capital.

Out of its 67 coverage locations nationwide, Scancom, operators of Areeba mobile systems, covers the region from 6 locations, namely Accra, Ada, Dawhenya, Dawa, Kpong and Tema. Coverage of the entire region, particularly Dangme West, is yet to be achieved. Millicom now Tigo, which operates the Mobitel system, covers the region from four locations, namely Tema, Weija, Accra metropolis and Pokuasi. The two Dangme districts, including important towns such as Dodowa and Asutsuare, are yet to be covered. Other operators of mobile systems are One-touch (Ghana Telecom) now Vodafone and Kasapa

Health Facilities
The health facilities in the districts include traditional healing facilities, hospital and maternity home/clinic.

Traditional Healing Facilities
Traditional healing facilities are available in all the districts in proportions ranging from 90.9 per cent to 100 per cent of communities in the districts. On average, the distance to the nearest traditional healing facilities is under 1 kilometre, with the maximum distance ranging from less than 1 kilometre for AMA to 10.0 kilometres in Ga. Notwithstanding the relatively better but unevenly distributed orthodox medical facilities in Greater Accra, traditional healing facilities also play a very important role in health care delivery in the region, particularly in the rural districts. As has been stated, hardly any locality is without a traditional healing facility within a 10 kilometre radius.

The regional population to traditional healer of 2,407 is much higher than the national average of 953 to one healer. The rural districts of Dangme East and West, however, have ratios far below the national average, indicating their reliance on this source of health care delivery in the absence of adequate allopathic medical facilities such as hospitals and clinics. In Dangme West for example, the maximum distance from a locality to a hospital is 49 kilometres while the maximum distance from a locality to a traditional healing facility is 4 kilometres.

There are hospitals located within all communities in the AMA and in 14.9 per cent of communities in Tema. On the other hand, hospitals are not available in Dangme West and Dangme East. For instance, the maximum distance to the nearest hospital in Dangme West is 49 kilometres. Of the 2008 doctors nationwide, over 50 per cent (53.9%) live and work in Greater Accra, the population of which is only 15.4 per cent of the country’s total population. Greater Accra has a total of 1082 doctors, 864 of whom are in the public sector (Ministry of Health and Ghana Medical Association, 2003). This is about the same as the number of traditional healers (1,207).

The population per doctor for Greater Accra is 2,686, far better than the national average of 1 doctor to 9,418 people. This is however deceptive in terms of the spread and availability in the region, because 991 (94%) of the 1082 doctors are in the Accra metropolis, with another 83 (7.7%) in the Tema municipality. Ga, Dangme East and West, between them, share only 8 doctors. Of the 991 doctors in the Accra metropolis, 483 (48.7%) work in the Korle-Bu Teaching Hospital while another 116 (11.7%) are in the Military Hospital.

If one takes into consideration the substantial numbers working in other major hospitals such as the Police, the Trust, the Psychiatric and the Ridge Hospitals, as well as those in private practice, this leaves relatively few doctors to serve the rest of the city, the metropolitan area, and the region as a whole.

Indeed, outside of Accra, the population to doctor ratio is worse than some of the most rural districts in the country. This contrasts sharply with the traditional healers, who are within easy reach in all the districts. In planning for the health needs of the region, therefore, there is the need for traditional healers to be properly organized, trained and their talents and services properly coordinated as an officially recognized, integral part of the health care delivery system, with its own peculiar and fully recognized needs and competence, and not as a poor appendage of orthodox medical practice.

Maternity Home/Clinic
With the exception of AMA, the proportion of communities where clinics are available is much higher than that of hospitals. This ranges from 2.9 per cent of communities in Dangme East to 98.9 per cent in AMA. For communities that do not have clinics, the distance to a clinic can be as far as 75.0 kilometres for some communities in Dangme West. On average, the distance to the nearest maternity home/clinic in Ga is about 9 kilometres

Education Facilities
Primary Schools
Of all in the form of schools, availability of primary schools to communities in all the districts is the most encouraging. Primary schools are available to all communities in the AMA where people can travel within 1 kilometre to the nearest primary school. In all the districts in the region, Ga district (11.3%) has the lowest proportion of communities where primary schools are available and therefore some pupils need to travel an average of 2.8 kilometres (up to a maximum of 30km) to the nearest facility. Even though the proportion of communities with primary schools in Dangme West is much higher than that of Ga, children in Dangme West would not attend school or would need to travel 55 kilometres to get to a primary school.

Junior Secondary Schools
Apart from AMA where all the communities in the district have junior secondary schools available to them, the proportion of communities with junior secondary schools in Tema (45.6%), Ga (7.5%), Dangme West (17.4%) and Dangme East (14.1%) is much lower than that of primary schools. The maximum distance to the nearest junior secondary school, from a district, is about 30 kilometres for Ga District; while for Dangme West, it is 55 kilometres.

Senior Secondary Schools
The availability of senior secondary schools to communities in each district is even less than junior secondary schools, even in the AMA. The decrease is much higher for Ga, Dangme West and Dangme East, where it is 6.4 times more likely to have a junior secondary school than it is to have a senior secondary school. For instance, in Dangme West only 1.3 per cent of communities have senior secondary schools. In some communities in the district, the maximum distance to a senior secondary school is 65 kilometres, the longest distance in the whole region.

The issues of availability and affordability are a matter of concern, particularly in Dangme West and Dangme East, the two most deprived districts. Since most senior secondary schools are by and large boarding facilities, the Ministry of Education, Youth and Sports has to revisit the issue of cost of training at the senior secondary school level.

The analysis of health facilities points to a good patronage of traditional healing facilities, which are more easily accessible and affordable than hospitals and clinics. The central government should not scrap the cash and carry system until the envisaged comprehensive health insurance scheme gains a firm footing.

The government has to continue to come to the rescue of the people particularly, women, children and the aged who are unable to pay for medical care. The District Assemblies should collaborate with central government to build at least one well equipped district hospital in the deprived districts.