By Prof. Stephen B. Kendie
Venue: University Auditorium, UCC
My first major research project at the Institute for Development Studies was a baseline
survey of water and sanitation conditions in rural communities in five selected districts
spanning all the ecological zones of Ghana. That project was sponsored by UNICEF
(Ghana) in 1985 and formed part of the intense global interest then in rural water and
sanitation especially in developing countries. This was almost in the middle of the
International Drinking Water Supply and Sanitation Decade – 1980-1990 (IDWSD)
declared by the United Nations (the Mar del Plata declaration) in 1979. UNICEF was
intent on contributing to the efforts of the Ghana government in this sector.
I coordinated the project in the Techiman and the Lawra districts. It was an exciting, yet
challenging experience given the difficulties associated with rural visits in developing
countries. The poor road infrastructure was not the major problem that afflicted the
villages: in many of the communities that we visited, guinea-worm was a major public
health menace. In one village, even the chief was down with the disease. This gory
experience of people barely able to walk because of guinea-worm disease left me with a
life-long desire to continue to research into and train all who come through my classes on
the need to see basic issues of development (food, shelter, water, sanitation, education
and health) as the starting point to achieve long term improvements in living standards
(see my publications on these issues: Kendie, 1990; 1992; 1993a,b; 1996; Amonoo,
Akaba & Kendie, 1985;)
I want to devote a few paragraphs here to present some facts about guinea worm to show
not only how debilitating the disease can be but also how it helps to reduce productivity
and hence entrenches poverty in already deprived and poor rural areas. Guinea-worm, or
dracunculiasis, is a parasitic worm infection that occurs mainly in Africa.
(htt://www.dhpe.org/infect/guinea.html). People get infected when they drink standing
water containing a tiny water flea that is infected with even tinier larvae of the guinea-
worm. Over the course of a year in the human body, the immature worms pierce the
intestinal wall, grow to adulthood, and mate. The males die, and the females make their
way through the body, maturing to a length of as much as three feet, and ending up near
the surface of the skin, usually in the lower limbs. The worms cause swelling and painful,
burning blisters. To soothe the burning, sufferers tend to go into the water, where the
blisters burst, allowing the worm to emerge and release a new generation of millions of
larvae. In the water, the larvae are swallowed by small water fleas, and the cycle begins
During the time that the worm is emerging and being removed, the affected person
suffers intense pain and often cannot work or resume daily activities for months. Farmers
cannot tend their crops, parents cannot care for children, and children miss school. Even
after the worms are gone, people are often left with scarring and permanent crippling.
Infection does not produce immunity, and many people in affected villages suffer the
disease year after year.
Many organizations, including UNICEF, the World Health Organization, and the Carter
Presidential Centre, are helping governments of countries where guinea-worm is found to
eliminate the disease. Since 1986, when an estimated 3.5 million people were infected,
the international campaign has eliminated much of the disease and prevented millions of
cases. In 1995, the total number of infected people worldwide had dropped to about
130,000, less than 4% of the total in 1986. These reductions have been rather slow for
Ghana. In 1989, there were 179,558 cases of the disease in Ghana and this was found in
all the regions. These reduced to 66,697 in 1991, 17,918 in 1993, and 8,894 in 1995, but
increased slightly to 8,921 in 1997 and reduced to 7402 in 2000 (see Figure 1). Ghana
set target dates of 1993, 1995, 1997, 2000 and 2007 to eradicate the disease completely.
But as the data show, for some of those target years the number of cases actually
increased. By 2006, the Government of Ghana and the Carter Presidential Centre had
spent about US$5 million and US$9 million respectively on the eradication effort.
However, Ghana missed all five target dates. The last target date was 2007 to coincide
with the 50th anniversary of independence. At the end of that year, Ghana recorded 3,358
cases. In 2007, Ghana had the “infamous record of having the world‟s second highest
prevalence of guinea worm, after Sudan” (UNDP, 2007) 1. I will return to this issue at the
end of the lecture.
The Ghana guinea-worm case count for 2007 showed that of the 3,358 cases nationwide,
3,237 were in the Northern Region alone, and this is not by chance. The spatial dynamics
of underdevelopment of Ghana as a dependent economy finds its crudest expression in
the active underdevelopment of northern Ghana since colonial times. It is not surprising
then that on all indicators of development, the north lags substantially behind the south of
Ghana and this is a major drag on the ability of this country to sustain economic growth.
Issues of differential spatial development, pitting the rural against the urban in the
classical dual economy and the north versus the south of Ghana and environmental
degradation are important developmental challenges that government and all stakeholders
must grapple with (see Kendie, 1981, 1990, 1992, 2010).
The social and economic conditions prevailing in rural Ghana at the time when I first set
out on my academic journey have barely changed in many communities so that facilities
that are taken for granted and which are indeed essential for human survival have become
objects of political horse-trading, intense NGO work and sterile intellectual debates. It
must be made clear that guinea-worm is not the only disease afflicting rural people in
Ghana. Nearly one-half of the 120,000 inhabitants of communities along the southern belt
of the Lower Volta River are infected with bilharzia (The Mirror, August 29, 2009:3).
Malaria is a known killer, infant malnutrition leading to high infant mortalities due
mainly to poverty and high maternal mortalities, characterise rural living.