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Why menace of open defecation still looms in Ghana

When Awo was told by her benevolent absentee landlord to leave the house that she has been the homekeeper, for close to 10 years that was the least of her worries. Her main worry was whether she will be able to afford a place of her own with a decent toilet facility.

Ghana
Toilet facility provided under the Ghana Water and Sanitation Project (GAMA) at the Madina Cluster of Schools in the La Nkwantanang Madina Municipal Area

She did get a place for her money’s worth, but not to her heart’s desire, in one of the low-income settlements springing up in Accra. It was a chamber and hall with a small porch that served as kitchen in a “compound house” with one bath and a semblance of a toilet facility shared by about 10 families including that of the landlord’s.

Awo never used the toilet because she was worried that she will get an infection. The surrounding was never clean, the stench was horrible, plus, it was the abode of cockroaches. Her co-tenants taught her how to manage. “Get a chamber pot, line it with black polythene, squat over it, do it in, wrap it up and throw it away.” Case solved.

Clearly, a shared household toilet facility is a minus and not a plus to hygiene and well-being. However, under the prevailing circumstances in cities, where low income earners have to settle for dwellings with or without shared toilet facilities, one wonders if people will appreciate the need to make provision for enough toilets in rental houses they build targeting low income earners.

Sanitation experts are of the view that this situation exacerbates open defecation, which is still a big issue in Ghana. Popularly known as “free range” among Ghanaians, open defecation is basically characterised by people attending to nature’s call in the open and leaving the faeces exposed to the elements.

It is deemed the riskiest of all sanitation practices, posing the greatest danger to human health and can have fatal consequences – especially in young children. The risk lies in the fact that human contact with human excreta can transmit many infectious diseases including cholera and typhoid.

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Research has shown that shared toilet facilities whether in households or public places contribute significantly to open defecation. Besides, such toilet facilities do not ensure hygienic separation of human excreta from human contact. This is because shared toilets are usually poorly maintained, dirty and end up posing a health risk rather that reducing the threat.

“Therefore, in providing household toilet facilities, the preference should be one toilet per one household unit and not one facility to serve many different families,” says Attah Arhin, WASH Technical Coordinator of World Vision Ghana.

In an interview, he explained that “the idea for homes to have toilets, is to ensure cleanliness, hygiene, safety and general well-being of the users,” adding, “this purpose is defeated in situations where different families are sharing a single facility.”

Mr. Arhin’s point is contextualised by a lecturer at the Great Lakes University of Kisumu, Kenya, Sheillah Simiyu in her study to understand why and how shared sanitation facilities in informal settlements in Kisumu are dirty.

She found out that “these toilets were left unclean, because a number of households didn’t want to take responsibility to clean a facility that was used by other people.”

The findings of her research published on the website of “The Conversation Edition Africa,” agreed with that of other studies conducted in parts of Ghana, which revealed that people had deep-seated reasons for preferring open defecation to sharing toilet facilities with people who are not members of their own household, especially when the toilets are not the flushing type.

For instance, a study on the Menace of Open Defecation and Diseases in the Nadowli-Kaleo District, in Ghana’s Upper West Region, found that people will not use shared toilet facilities because, “it is culturally impermissible for squatting on someone’s faeces…as such a practice will incur curses … and that person would be unsuccessful in life.”

This study conducted by Stephen Ameyaw and Felicia Safoa Odame of the University for Development Studies, Wa Campus, Ghana, was published in the Volume 7, Issue 12, December 2017 edition of the International Journal of Scientific and Research Publications.

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The essence of their findings is that shared toilets, whether in households or public places, are usually poorly maintained and dirty, and end up posing health risks rather than reducing the threats. Unfortunately, there seems to be a high tendency for sections of the population to build houses without toilet facilities, even in this age. This attitude is attributable to high population density in some settlements and the associated demand for rental accommodation in slums that has compelled some landlords to convert toilets into living rooms.

According to a report titled: “Ghana’s post-MDGs sanitation situation: an overview,” the prevalent sharing of sanitation facilities in Ghana, is a thorny issue with a widespread occurrence.

The report, put together by a team of six researchers including Dr. Kwabena Nyarko of the Kwame Nkrumah University of Science and Technology (KNUST), is published in the Volume 9, Issue 3, September 1, 2019 edition of the Journal of Water, Sanitation and Hygiene for Development.

Aside giving a general picture of shared toilet facilities in Ghana, the report highlights efforts being made under various projects such as the World Bank funded Ghana Greater Accra Metropolitan Assembly (GAMA) Sanitation and Water Project, to address the situation.

The World Bank provided a grant of $150 million to help curb open defecation and improve sanitation and water supply in the capital and it is environs. The project, which started on June 6, 2013, has been working to increase access to improved sanitation and water supply in low-income communities (LICs) within GAMA.

With six months to its completion on December 31st, 2020, the project has provided 28,245 household toilets benefitting a total of 205,400 people, thereby exceeding the initial project target of 8,800 households to benefit 44, 336 people.

But does this scheme meet the goals of hygiene and good health?

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To ensure that the facilities serve the goals of hygiene and good health, beneficiary households needed to fulfil some key conditions such as – the facility could not be used by more than eight people. Thus, households with more than eight occupants had to have an additional facility.

Of course, it came at a cost, which was a third (30 %) of the total cost that households had to contribute to supplement the seed money provided under the project. It was minimal with a flexible payment scheme that made it easy for beneficiaries to pay.  The initial amount per household was GHS 2000, but this was later reduced to GHS 1,100 to encourage more households to join.

Undoubtedly, the GAMA Water Sanitation Project has made an impact in enhancing household toilet facilities and reducing open defecation to some extent. But the threat of open defecation with its associated health and socio-economic problems is still looming. This is because, ad hoc settlements with houses without toilets targeting low income earners like Awo, are still springing up in the peripherals of planned settlements.

Besides, what about the 1000s of ordinary people who are providing vital services but cannot afford to even rent a home without toilet. These are the ones who either sleep in front of shops or makeshift homes and of course because they eat, they must shit, wherever they can find space.

GAMA Water and Sanitation Project is about to end. But Metropolitan Municipal and District Assemblies (MMDAs), can take a cue from the project and come up with an innovative housing scheme specially targeting houseless segments of the population. This innovation could take the form of simple homes like that provided by Habitat for Humanity or basic boarding homes.

Agreeably, it is easier said than done. But a journey of a thousand miles, starts with one step.

By Ama Kudom-Agyemang

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