By Alex Ababio | Ghanaian Watch
THE WOMAN IN THE ROOM
The room measures perhaps three metres by four. Its walls, once whitewashed, now bear the brown stains of decades of rain seeping through a corroded roof. Inside, a 72-year-old woman I will call Efua sits on a wooden stool, her hands resting on a faded cloth that was once her husband’s. Her sons left for Accra fifteen years ago. They call occasionally. They send money when they can. But the money rarely comes, and when it does, it is never enough.
Efua is registered on the National Health Insurance Scheme (NHIS). But the nearest clinic is more than four kilometres away, and she cannot afford the transport. When she fell last year and injured her hip, she waited three days before a neighbour found her and helped her to the road. By then, the fracture had worsened.
Efua is not an outlier. She is the face of a demographic transformation that Ghana’s policy framework has failed to address. According to the Ghana Statistical Service, the country’s population is projected at 34.4 million in 2026, with older persons—those aged 60 and above—now constituting 6.5 per cent of the total and rising. By 2050, that share will double to approximately 13 per cent.
THE POLICY THAT NEVER WAS
In October 2010, the Government of Ghana approved the National Ageing Policy, bearing the aspirational title “Ageing with Security and Dignity.” The policy envisioned a Ghana where older persons would be re-integrated into mainstream society and empowered to participate fully in national development. It promised a National Council on Older People to coordinate implementation across ministries.
Fifteen years later, that Council does not exist. The policy has never been funded. And a 2014 assessment by the World Health Organization concluded with a damning verdict: “Very little has happened towards implementing the National Ageing Policy and Implementation Action Plan.”
The WHO report, titled Ghana Country Assessment Report on Ageing and Health, documented systemic failure across multiple fronts. The Ghana Health Service—the institution expected to implement the health and nutrition component of the policy—”does not have a plan for its implementation.” Knowledge about the policy was “very limited among key senior health staff.” There were “no guidelines or standards on health-care provision or rehabilitation services for older people.” And the health insurance scheme, the report noted, “does not cover male cancers, only breast and cervical cancers.”
The report identified the barriers with clinical precision: “absence of a National Council on Older People; apparent lack of commitment and interest in issues involving older people by MMDAs, politicians, diplomatic missions as well as the donor community; inadequate funding due to competition for scarce resources which usually target children, adolescents, and women of reproductive age.”
This is the de jure promise. The de facto reality is Efua’s room.
A PENSION SYSTEM THAT FAILS THE MANY
The numbers tell a story of exclusion on a massive scale. Of the nearly two million Ghanaians aged 60 and above, fewer than 300,000 receive pensions from the Social Security and National Insurance Trust (SSNIT). According to Paul Kofi Mante, a pension policy expert, 96 per cent of those pensioners live on GH¢5,000 or less monthly.
The regional disparity is stark. According to World Bank estimates based on the Ghana Living Standards Survey 2016/17, SSNIT pension coverage rates for those aged 60 and above range from 0.2 per cent in the Northern Region to 14 per cent in Greater Accra.
A 2026 study published in the Journal of Cross-Cultural Gerontology examined 437 SSNIT pensioners in Greater Accra and found they had “at best a moderate social, physical, psychological, and environmental quality of life.” The study recommended “policy actions aimed at enhancing pension adequacy, strengthening social support and community engagement opportunities, and improving access to health and welfare services.”
The Concerned SSNIT Pensioners Forum has rejected recent increases as “grossly inadequate,” noting that the minimum monthly pension of GH¢409.56 is “woefully inadequate to even cover medication.”
LEAP AND ITS LIMITS
In the absence of a universal social pension, the Livelihood Empowerment Against Poverty (LEAP) programme serves as the primary social protection intervention for older persons living in extreme poverty. According to the Ministry of Gender, Children and Social Protection, the 98th Cycle payment, which began on October 8, 2025, was valued at an estimated GH¢135 million and reached 350,580 households across all 16 regions.
Elderly persons aged 65 and above constitute 27 per cent of LEAP beneficiaries. Persons with severe disabilities constitute 17 per cent. Orphaned and vulnerable children constitute 45 per cent. Extremely poor pregnant women and infants constitute 11 per cent.
The benefit structure provides GH¢320.00 for a one-member household, GH¢380.00 for two members, GH¢440.00 for three, and GH¢530.00 for four or more.
But LEAP’s reach remains limited. According to the Ghana Statistical Service, 8.2 per cent of Ghana’s population—approximately 2.4 million people—live in extreme poverty. LEAP reaches only 1.5 per cent of the national population. The programme excludes the 60–64 age bracket, creating a five-year gap in social protection coverage.
A 2025 qualitative study found that “some of the participants were aware of the LEAP program but advocated for something different because they had reservations about the LEAP program.” One respondent stated plainly: “The current LEAP program is not sufficient, and is even politicized. It does not work.”
THE HEALTHCARE PARADOX
Ghana’s NHIS was designed to reduce financial barriers to healthcare. But for older persons, insurance coverage does not guarantee access.
Research published in Critical Public Health (2025) found that 48.7 per cent of older Ghanaians with functional limitations encounter transportation barriers to care, 33.5 per cent experience long travel times, 26.4 per cent face long waiting times, and 57.6 per cent report high healthcare expenditure. The study found that 75.1 per cent of respondents received income of US$38.56 or below every month.
A separate study in north-western Ghana found that geographic inaccessibility, high costs of drugs, exclusion of essential services from the NHIS benefits package, and irregular transfer of cash “negatively influence access and utilization of health care among aged LEAP beneficiaries.”
The WHO assessment noted that “the capacity of health-service staff to provide geriatric care is limited both in their number and skills mix,” leading to “the inappropriate labelling of all illnesses among older people as due to old age.”
THE SILENT EPIDEMIC OF LONELINESS
In 2025, a study published in the Journal of Biosocial Science examined 1,201 Ghanaian adults aged 50 and above. It found that 29.5 per cent had probable depression. The prevalence of social isolation was 27.3 per cent, and loneliness was 17.7 per cent.
Loneliness was associated with a threefold increase in the odds of probable depression (OR = 3.15, 95% CI = 3.26–5.28). Social isolation was associated with a 24 per cent increase (OR = 1.24, 95% CI = 1.10–1.41).
The study’s authors labelled loneliness and social isolation “the new geriatric giants.” In rural areas, the association was even more pronounced (OR = 7.06) than in urban areas (OR = 3.43).
Research conducted in the Ada East District—the same region where Efua lives—revealed that 63 per cent of elderly respondents had experienced abuse, not only at home but also at the community level, with hospitals and markets as the leading places where abuse occurs. Nearly half (40 per cent) identified neglect by family and community members as their primary experience of harm.
THE GLOBAL CONTEXT
Ghana’s crisis is not unique, but it is exacerbated by the absence of a universal social pension. Across Africa, countries have implemented models that offer instructive lessons.
South Africa operates a means-tested Old Age Grant from age 60, set at 25 per cent of GDP per capita and 592 per cent of the poverty line. The programme costs 1.14 per cent of GDP. Kenya has implemented a universal social pension for citizens aged 70 and above, providing approximately US$20 per month. Mauritius provides a universal pension from age 60 at 1.70 per cent of GDP. Namibia provides a universal pension from age 60 at 1.36 per cent of GDP.
The World Bank notes that 8 countries in sub-Saharan Africa have national social pension schemes, with annual costs for mature schemes ranging from 0.3 per cent to 1.8 per cent of GDP.
Ghana, by contrast, has no social pension at all. The WHO assessment found “apparent lack of commitment and interest in issues involving older people by MMDAs, politicians, diplomatic missions as well as the donor community.”
THE TREATY THAT COULD CHANGE EVERYTHING
In April 2025, the UN Human Rights Council established an Intergovernmental Working Group to draft a new international treaty on the rights of older persons. In July 2027, the working group will meet to discuss an outline of the treaty’s content. In November 2027, the Chair will present a first draft.
This treaty presents a historic opportunity to establish binding international standards that address not only discrimination and exclusion, but also the conditions that enable older people to experience connection, participation, and belonging.
Ghana’s experience—with its 5 per cent SSNIT coverage, absence of a social pension, and 60 per cent pensioner poverty rate—offers critical lessons for the drafting process.
Contributory systems alone are insufficient. The 95 per cent of older Ghanaians without pensions demonstrate that contributory schemes cannot guarantee income security in countries with large informal sectors.
Social pensions are necessary. Comparative evidence from South Africa, Kenya, Mauritius, and Namibia shows that universal or near-universal social pensions are feasible and effective.
Adequacy matters. Even pensioners in Ghana face 60 per cent poverty rates, demonstrating that coverage without adequacy does not fulfil the right to social security.
Regional equity is essential. The 0.2 per cent coverage rate in Northern Ghana versus 14 per cent in Greater Accra shows that pension systems can entrench geographic inequality.
WHAT MUST BE DONE
The recommendations are clear. Ghana must enact the Aged Persons’ Bill to provide legal backing for the National Ageing Policy and establish the National Council on Older People. Parliament must amend the NHIS Act to grant exemption from premium payments for individuals aged 60 and above. The government must introduce a universal social pension for all Ghanaians aged 65 and above, building on comparative models. LEAP must be expanded to reach all older persons living in extreme poverty, with automatic enrolment for those aged 65 and above without pension coverage. Benefit levels must be increased to reflect the true cost of basic needs, including medication.
But policy reform alone is not enough. The deeper challenge is one of belonging—of ensuring that older Ghanaians like Efua are not just included in policy documents but are valued as members of their communities.
The WHO assessment identified “breakdown of traditional social and family support mechanisms” as a key barrier. Urbanisation and migration have eroded the extended family structures that once provided care for older persons. Over 22 per cent of older respondents in urban Ghana now live alone, a sharp reversal from previous decades when co-residence with adult children was the norm.
CONCLUSION
Efua’s room remains unchanged. The rain still seeps through the roof. The clinic is still four kilometres away. Her sons still call occasionally.
But her story—and the stories of millions of older Ghanaians—is now being heard in Geneva and New York. The UN treaty on the rights of older persons is being drafted. The July 2027 session will discuss the outline. The November 2027 session will present the first draft.
Ghana’s experience—both its policy promises and its implementation failures—can inform the development of a treaty that is truly fit for belonging. The question is whether Ghana’s policymakers will engage with the process, and whether the treaty will have the enforcement mechanisms to ensure that the next Efua does not spend her final years alone in a room with a leaking roof.
The numbers demand urgency. The stories demand action. The treaty demands engagement.
This is the first in a multi-part investigative series on the crisis of care for older persons in Ghana. The series is produced by Ghanaian Watch with support from the African Liberators Economic Institute.