Ghana is a beautiful, rapidly developing country in West Africa, but its rapid development is making it difficult for the timely construction of the infrastructure necessary for proper water, sanitation, and hygiene. In fact, the fifth-highest risk factor for death and disability combined in Ghana is water, sanitation, and hygiene (WaSH). This problem is largely characterized by an urban-rural and class divide. It has been estimated that about 21 percent of Ghanaians have total access to basic sanitation, which means that nearly 80 percent of Ghana’s people do not have proper access to essential hygienic facilities. This is a major public health concern. Clean drinking water is much more widespread (79 percent of the population covered), but geographic disparities still exist. Another concern is the widespread use of shared restroom facilities in low-income urban areas used by about 13 million people nationwide
So, what contributes to poor WaSH coverage in urban areas in Ghana? First, infrastructure is not keeping pace with cities’ expansion and high levels of migration to urban areas like Accra and Kumasi. In Accra, urban slums are rather common and create public health challenges due to the highly concentrated population and lack of basic health services. This high concentration of people results in people living in crowded spaces with inadequate sanitation facilities, further exacerbating health and wealth disparities. Additionally, most urban residents use shared restroom facilities that usually take one of two forms: compound toilets that multiple households share, or public toilets that are accessible for all and usually require some type of fee. Facilities with sewers are uncommon and have few connections within the cities, but municipalities are beginning to develop and expand their fecal sludge management services. Another grave concern is that waste treatment services are not adequate, which contaminates the cities and causes health concerns from waste exposure.
The government of Ghana is working on addressing these concerns, but progress is slow. Since the 1990s, the national government has started programs and legal and regulatory structures to address WaSH concerns, but they have not been implemented to their full capacities, leaving behind ineffective frameworks. Prior to 2016, Ghana had a division between its water and sanitation sectors, each with unique responsibilities and services, but after Nana Akufo-Addo’s rise to the presidency, the Ministry of Sanitation and Water Resources was created. There is also inadequate sanitation financing from the national government, which has dwindled in recent years. Most of the financing for sanitation comes from external donors, but these funds have been reduced as well, especially from the European Union after the 2008 financial crisis. The sanitation spending from the national budget amounted to USD 11.3 million in 2014, but most of the national sanitation expenditure came from individual households (USD 466 million), primarily for the public toilets for which one must pay at every use.
One WaSH success story is the GAMA Sanitation and Water Project, which is a federal government project with the support of the World Bank and the Global Partnership for Output-based Aid that aims to improve sanitation and access to water for low-income communities in the Greater Accra region. The project plans to construct 19,000 private toilets and provide subsidies and savings plans for families to buy their own toilets at reduced prices. In May of 2019, 18,363 toilets had been built in households and 406 had been constructed in schools in the Greater Accra region, which is 96 percent of the target goal.
Pictured: Promotional material for the GAMA Sanitation and Water project that aims to serve low-income populations in urban areas in Ghana. Photo courtesy of World Water Week. Overall, progress has been made in the WaSH sector, but much is left to be done. One key stakeholder in solving this problem would be the private sector because there is a space for new opportunities to create low-cost sanitary facilities in urban areas in Ghana, which will create jobs, increase revenue, and provide clean, safe facilities for people to use. Furthermore, since external donors are dwindling in Ghana, it is wise to secure internal funding for lasting sustainability. The internal funding could be achieved through intergovernmental collaborations across sectors. Another key opportunity would be communications campaigns to increase public awareness about the importance of proper sanitation facilities and to sway people away from public facilities, if possible. These campaigns should also address the specific needs of women, youth, and other vulnerable populations in terms of sanitation and hygiene.
Under Article 25 of the Universal Declaration of Human Rights, every person has the right to “a standard of living adequate for the health and well-being of himself and his family.” This Article clearly encompasses the right to clean water and proper sanitation facilities, since one cannot be healthy without access to proper WaSH services, so it is essential that the Ghanaian government create a cleaner, safer country by working across sectors and addressing the social determinants of health that create inequitable environments for its citizens.
