Ghana was once hailed by the World Bank as a showcase for its policies. Today, after two decades of financial "discipline" the majority of Ghanaians are worse off than before. John Kampfner has been to Ghana tracing the roots of the growing protest movement.
Mary Agyekum breaks stones for a living. Small flint hammer in hand, she sits on the parched ground under the sun, chipping away at boulders.
Usually some of her six young children help her out. They take it in turns to go to school, because each day's tuition costs money.
If she is lucky, Mary takes home 20,000 cedis a week - that's ?2.
A fundamentalist economy
To coin a phrase from Tony Blair, the state of Ghana is a scar on the conscience of the world. The first sub-Saharan country to gain independence, this should not be a case study in poverty.
When the experiment in neo-liberal economic theory began, Ghana was hailed as a "model pupil". But after two decades of IMF and World Bank "structural adjustment", the poor are poorer and the government is more dependent than ever on outside help.
Ghana is a "cash and carry" society. Nothing comes free. You pay for health care, you pay for education; you pay for clean drinking water and sanitation.
Over the past few years, the international institutions and donor governments like Britain have begun to talk of change, but in the villages the same fundamentalist rules are being applied with the same vigour.
A family pays
The Agyekum family are forced to make trade-offs every day.
Each morning begins with a trip to the town's public toilet, a concrete edifice recognisable from far away by the smell. Outside a woman sits in a booth, ready to take 100 cedis from each person. If Mary has run out of money, she begs the woman to allow her to take her children in for free.
They then walk to the nearest borehole where they pay 250 cedis for a bucket of water. They can afford perhaps four buckets a day, for washing, cooking and drinking. That leaves perhaps ?1 a week for food and a trip a week to school. It is no surprise that illiteracy and drop out rates are increasing.
"My life is full of shame," Mary Agyekum says. "My heavy load of stones gives me a headache, a pain in my neck and back, cuts on my fingers. I have difficulty breathing. The two children I still try to send to school are often chased home by the teachers if I haven't paid the fee on time."
Resentfulness grows
Even the practitioners admit things have gone wrong, and that trouble is brewing.
I met Peter Harrold, the World Bank's representative in Ghana shortly after the attacks in New York and Washington. He identified a link between poverty, frustration and terrorism.
"There's a serious danger. The North is getting richer and the South getting poorer, or at least making minute progress," he says. "The disparities cannot continue going on in this way."
There is genuine regard in Ghana for Britain, the former colonial power, and for the United States. Union jack and stars and stripes bumper stickers are ubiquitous. But there is a strong sense of injustice that is now being marshalled into political opposition against western financial institutions.
"Anybody who has seen the images of those terrible events would have condemned them as senseless," says Yao Graham, coordinator of Third World Network, an NGO based in Ghana. "But we're living in a world where so many people are feeling taken for granted that unless the big powers become more sensitive to the demands of weaker countries, all of us are endangered."
Even water is a commodity
Meanwhile, there is a new plan to sell off water in Ghana, a plan which local campaigners say is disastrous. As in Britain, officials in Ghana have become wary of using the word privatisation. They prefer to call it "private-public partnerships".
The World Bank is supporting the sell-off to the tune of $100m. Why, people wonder, must water be self-financing in poor countries, while in the US for example billions of dollars of state money support the industry?
The unprofitable rural water supply will stay in state hands, but local communities now have to make a five to ten per cent down-payment for the "privilege" of installing clean pumps and raise the cash for their maintenance.
In villages where people earn less than $1 a day the system quickly collapses. Still, the experiment is seen by the IMF and World Bank as a template for utility sell-offs across the developing world.
And there is a growing sense that what wealth there is in Ghana, is not benefiting its people.
Gold is of no value
Gold is Ghana's biggest export earner. For decades the mining firms have had a free rein. The government, urged on by the international institutions, gives them tax "holidays" of up to ten years and keeps environmental and other regulation to a minimum.
Two thirds of all Ghanaian land is under concessions. Everywhere you go, you see huge cavities in the ground, discarded pits where thriving villages once stood and where nothing now grows.
In the village of Dumasi, a Canadian-owned and British-managed mining company has been blasting in an open cast pit less than 100 metres away. Flying rocks have damaged huts.
People have been forced off their farming land, losing their only source of income. Compensation is derisory. They fear their homes are next.
The community holds public meetings and sends petitions. "To be sitting on gold, people might before have envied you," Graham told villagers at one such rally. "But today gold spells trouble and poverty."
Healthcare is unaffordable
At the hospital in the regional centre of Tarkwa, I discussed money with Dr Ebenezer Acquah, the Principal Medical Officer, as we walked through a ward with cholera and post-natal patients lying close to each other on the floor.
Patients have to pay for each visit and for the costs of any surgery - gloves, drugs, blood, anaesthetics, gauze, cotton wool. They're not released if they don't pay. If they die, their bodies aren't released until relatives find the cash - all this in an area where multi-national mining companies are making billions.
"Sometimes you lose patients not because you lack skill to save them, but because the equipment doesn't exist," says Dr Acquah. "Sometimes the frustration is overwhelming, but you do what you can."
Change is needed
At the IMF and World Bank, the language has become Blairite. The talk is of "ownership", "listening" and "holistic approaches".
The Heavily Indebted Poor Countries initiative (HIPC) is supposed to relieve countries like Ghana of much of its external debt. But it comes with strings attached. All loans and write-offs are based on "conditionality" - and privatisation of utilities is one of those conditions.
Structural adjustment has been replaced by poverty reduction strategies. But the recipe remains the same.
There is much more work to be done.
Profits of Doom: Sunday 4th November 2001 at 1915 on BBC Two Reporter: John Kampfner
Producer/Director: Stuart Tanner
Editor: Fiona Murch
