Even though significant progress has been made in expanding access to basic sanitation services, billions of people worldwide, mostly in rural areas, still do not have these services. According to the United Nations, more than 673 million people defaecate in the open. About 2.3 billion people lack access to basic sanitation services, per the WHO/UNICEF Joint Monitoring Programme report.
Open defaecation perpetuates a vicious cycle of disease and poverty. World Health Organisation (WHO) reports that countries where open defaecation is most widespread have the highest number of deaths of children under five years as well as the highest levels of malnutrition and significant disparities in wealth.
According to UNICEF, open defaecation is a significant issue in Ghana since only around 23 percent of the population can access better sanitation facilities while in 2021, 24 percent did, and 15 percent in 2015, per the Joint Monitoring Program (JMP) report. With the inception of the Sustainable Development Goals (SDGs) in 2015, the Government of Ghana is making every effort to meet all its Sanitation and Water targets by 2030.
Ghana further endorsed the United Nations 2010 declaration of water and sanitation as a right and is committed to taking progressive steps to make it happen. Besides, universal access to basic sanitation services also finds expression in Ghana’s 1992 Constitution under the directive principles of state policy. The current national sanitation policies also recognise basic sanitation services as social goods with economic value, hence, enabling development.
The Government of Ghana’s vision for the Water and Sanitation sector is for all persons to have access to sustainable water and sanitation as outlined in the national Water, Sanitation, and Hygiene (WASH) programme report. This is in line with Sustainable Development Goal six, which is to ensure the availability of safe, adequate and affordable water and sanitation in a sustainable manner for the well-being of all people in the country.
According to the Ministry of Sanitation and Water Resources, Ghana’s national drinking water target is for 100 percent of the population to use improved water sources within 30 minutes round trip by 2025; eliminate open defaecation by 2025, especially among the poorest quintile; 100 percent access to essential sanitation services as well as faecal sludge treated to national standards by 2025.
Households should have basic hand-washing facilities with soap, and women and girls should use appropriate menstrual hygiene materials. All schools should have 100 percent functional basic water, sanitation and hygiene services, and all healthcare facilities should have 100 percent functional WASH services.
The rapid rate of urbanisation in Ghana, with about 58 percent urban status, is impacting heavily on municipal sanitation and waste management services. Also, persistent inequities in basic sanitation services are problematic, suggesting that effective targetting is needed to reach disadvantaged groups in communities, schools and health centres.
As a result of the poor sanitation services in Ghana, there exist high disease prevalence, groundwater contamination, and a lack of safety and dignity for many Ghanaians. Additionally, households, the public and private sectors do not prioritise funding sanitation services due to limited technical capacity, high capital costs and a perception that sanitation is not a priority.
In rural areas, open defaecation has been a long-standing issue. As a result, the government has made efforts to address it through various initiatives, such as the Community-Led Total Sanitation (CLTS) programme. The CLTS programme promotes behavioural change and encourages communities to take ownership of their sanitation needs.
In addition, the Ghanaian Government has implemented policies and initiatives to increase access to improved sanitation facilities in schools, healthcare facilities and public spaces. The Ghana School WASH programme has significantly enhanced school access to water and sanitation facilities. In 2021, compared to 51 percent in 2015, 71 percent of schools had access to basic sanitation facilities.
UNICEF has also worked to improve access to sanitation facilities in schools, where a lack of such facilities can lead to high absenteeism rates, particularly among girls. In addition to hygiene education programmes, UNICEF has funded the construction of latrines and hand-washing stations in schools. A few privately-owned organisations working in Ghana’s sanitation sector are also contributing to the country’s basic sanitation services.
An exemplar is Zoomlion company limited, a private company operating within the sanitation sector in Ghana. Zoomlion has contributed to SDG six immensely by establishing projects in collaboration with the government, WASH programmes, and other SDG 6 businesses and NGOs. One of their flagship programmes is the ‘One Million Waste Bin’ project, where five Metropolitan, Municipal and District Assemblies (MMDAs) in the Greater Accra Region received free bins as of 2021.
Records of the status of the sanitation sector in Ghana
Ghana’s 2021 Voluntary National Review (VNR) report, a comprehensive UN-government progress report on SDGs, indicates that while considerable strides have been made toward achieving the SDG target on water, the same cannot be said of sanitation. Ghana faces severe constraints in providing adequate and improved sanitation for its urban and rural inhabitants. Economic growth has been accompanied by rapid urbanisation, thereby putting a strain on infrastructure and the provision of sanitation facilities, particularly in urban areas.
As at 2015, 8 percent of urban residents defaecated in the open, 1 percent of rural households used improved toilets while 30 percent engaged in open defaecation, according to UNICEF. No district in Ghana has achieved open defaecation-free status. According to Ghana’s 2021 VNR report, three in five households (59.3 percent) have access to a household toilet facility, and the proportion is higher among urban (65.9 percent) than rural (49.1 percent) households, compared to 46 percent in 2010. Urban households had greater access to toilets than rural households in both 2010 and 2020.
The percentage of households utilising public restrooms dropped by 12 percent in 2021 to 23 percent. In addition, open defaecation decreased by 2.3 percentage points in 2021, reaching 17.7 percent of the population. About 18 percent of households do not have access to a toilet facility, which is over three times as much among rural (31.3 percent) as urban (8.9 percent) households.
Per the 2021 Population and Housing Census report, open defaecation is prevalent in all 16 administrative regions, with five regions – Northeast, Upper East, Northern, Upper West and Savanna – recording more than 50 percent. For households without toilet facilities, the point of defaecation is bush/open/field/gutter for 90 percent or more of households in all regions, except in three – Central, Western and Greater Accra – where ten percent or more use beach/water bodies. Almost all households with no toilet facility (98 percent or above) defaecate in the bush/open/field/gutter in seven regions.
The percentage of persons using hand washing facilities with soap and water increased slightly between 2017 and 2020 from 41.3 percent to 41.5 percent, according to data from the 2021 JMP report. The Ghana 2021 VNR report estimates that as at 2020, roughly 47 percent of the urban population had access to hand washing facilities with soap and water, compared to 35 percent of the rural population.
With regards to wastewater disposal, per the 2021 Ghana Population and Housing Census report, the most prevalent method of disposing of wastewater is throwing it onto the ground/street/outside (70.6 percent), and this occurs in rural (88.9 percent) as well as urban (58.7 percent) areas. The least is through sewerage system (2.3 percent), with 3.2 percent in urban and 0.9 percent in rural areas.
On the use of solid waste bins, only 14.1 percent of households use standard waste containers, with the proportion for urban (19.2 percent) being three times as high as for rural (6.3 percent) areas. More than half (54.5 percent) of households store solid waste in improvised containers, with the proportion higher in rural (65.3 percent) than urban (47.5 percent) areas. One in 10 households (11.1 percent) does not have any form of receptacle for solid waste generated, and the proportion in rural areas (18 percent) is almost three times as high as in urban (6.7 percent) areas. One in five households in six regions – Upper East, Upper West, Savannah, Volta, North-East and Northern – do not have any form of receptacle for solid waste generated.
Despite progress, the records presented earlier demonstrate that access to sanitation facilities remains challenging for many Ghanaians in both rural and urban areas. According to the same JMP report, only 22 percent of the urban population had access to safely managed sanitation facilities in 2021.
Additionally, issues, such as inadequate funding, weak institutional capacity, and limited public awareness about the importance of sanitation and hygiene, remain barriers to progress. Lack of planning and coordination of sanitation-related programmes due to limited personnel in multiple organisations and limited resources for capacity- building and programme implementation is a significant barrier to providing essential sanitation services in rural areas.
One of the critical bottlenecks to overcome to address WASH inequalities and ensure universal access is the heavy reliance on donor funding – over 80 percent of the sector budget – with low public investment and limited leveraging of private sector resources. The World Bank estimates an annual funding requirement of US$946million to achieve Ghana’s SDGs. Current sector funding at US$114million annually leaves a significant funding gap to gain universal access. Projections of available finances indicate higher allocations and more predictable funding streams from taxes. However, taxes alone will be insufficient to guarantee the aggressive nature of progress required to achieve the SDGs.
Additionally, the current contribution of revenue to operation and maintenance can be further improved if the quality of services is high. A combination of domestic revenues, more efficient allocations, and the use of available financing as well as accessing commercial revenue is needed. In addition, inefficiencies must be curtailed, particularly those emanating from poor revenue collection, poor functionality, and high operating costs, to enable sanitation services to expand coverage and sustain services.
The way forward
There have been significant improvements in sanitation in Ghana. However, much work must be done to ensure all Ghanaians can access safe and sufficient sanitation facilities. In Ghana, UNICEF has focused on promoting behaviour modification, enhancing infrastructure, and expanding access to basic sanitation facilities. These efforts are essential for reducing the incidence of water-borne diseases and improving the health and well-being of the Ghanaian population.
To provide basic sanitation services to all its citizens, the government must create modern public toilet facilities and encourage private sector investment in slum areas to construct private toilet facilities. To eliminate open defaecation by 2030, Ghana must reduce the number of people without access to toilets by an average of 2 percent per year.
To end poor hygiene and open defaecation, the government must review the urban sanitation policies and mandate all MMDAs to ensure that newly constructed homes include toilets, hand-washing stations, showers, and other basic sanitation facilities. Thus, for their inaction, all non-compliant households should be fined.
The government has made only minimal improvements in providing basic sanitation services as shown by the records of the VNR report and the 2021 census report by the Ghana Statistical Services. The situation can be improved with private and state investments in providing basic sanitation services and prioritising the sanitation sector. Providing essential sanitation services for all is an achievable objective but requires a huge commitment from all stakeholders, particularly the government. If the Government of Ghana continues to treat the sanitation sector in the way it does, the targets for SDG 6 on access to sanitation for all cannot be achieved by 2030.
>>>The writer is a Senior Lecturer and Director of the Centre for Sustainable Development (CenSuD) at Koforidua Technical University, Ghana.
You can reach him on [email protected]