Access to basic sanitation services in Ghana: Are we making progress as a country?

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 defecate in the open. About 2.3 billion people lack access to basic sanitation services, per the WHO/UNICEF Joint Monitoring Program report. Open defecation perpetuates a vicious cycle of disease and poverty.

World Health Organization (WHO) reports that countries where open defecation 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 defecation is a significant issue in Ghana since only around twenty-three percent (23%) of the population can access better sanitation facilities.

In 2021, twenty-four percent (24fifteen (15%) 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 recognize 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) program 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% of the population to use improved water sources within 30 minutes round trip by 2025, eliminate open defecation by 2025, especially among the poorest quintile, 100% 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 using appropriate menstrual hygiene materials. All schools should have 100% functional basic water, sanitation, and hygiene services, and all healthcare facilities should have 100% functional WASH services.

The rapid rate of urbanization in Ghana, with about 58% urban status, is impacting heavily on municipal sanitation and waste management services.

Also, persistent inequities in basic sanitation services are problematic, suggesting that effective targeting 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 and the public and private sectors do not prioritize funding sanitation services due to limited technical capacity, high capital costs, and a perception that sanitation is not a priority.

Interventions

In rural areas, open defecation has been a longstanding issue. As a result, the Government has made efforts to address it through various initiatives, such as the Community-Led Total Sanitation (CLTS) program.

The CLTS program 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 program has significantly enhanced school access to water and sanitation facilities. In 2021, compared to fifty-one percent (51%) in 2015, Seventy-one percent (71%) 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 programs, UNICEF has funded the construction of latrines and hand washing stations in schools.

A few privately owned organizations 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 programs, and other SDG 6 businesses and NGOs. One of their flagship programs 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 urbanization, thereby putting a strain on infrastructure and the provision of sanitation facilities, particularly in urban areas.

As of 2015, eight percent (8%) of urban residents defecate in the open, one percent (1%) of rural households use improved toilets, and thirty percent (30%) engage in open defecation, according to UNICEF. No district in Ghana has achieved open defecation-free status.

According to Ghana's 2021 VNR report, three in five households (59.3%) have access to a household toilet facility, and the proportion is higher among urban (65.9%) than rural (49.1%) households, compared to forty-six percent 46%) in 2010. Urban households had greater access to toilets than rural households in both 2010 and 2020. The percentage of households utilizing public restrooms dropped by 12% in 2021 to 23%.

In addition, open defecation decreased by 2.3 percentage points in 2021, reaching 17.7 percent of the population. About eighteen percent (18%) of households do not have access to a toilet facility, which is over three times as much among rural (31.3%) as urban (8.9%) households. Per the 2021 population and housing census report, open defecation is prevalent in all sixteen (16) administrative regions, with five regions (Northeast, Upper East, Northern, Upper West, and Savanna) recording more than fifty percent (50%).

For households without toilet facilities, the point of defecation 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% or above) defecate 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% to 41.5%, according to data from the 2021 JMP report.

The Ghana 2021 VNR report estimates that as of 2020, roughly 47 percent of the urban population have 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%), and this occurs in rural (88.9%) as well as urban (58.7%) areas.

The least is through sewerage system (2.3%), 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%) being three times as high as for rural (6.3%) areas.

More than half (54.5%) of households store solid waste in improvised containers, with the proportion higher in rural (65.3%) than urban (47.5%) areas.

One in 10 households (11.1%) does not have any form of receptacle for solid waste generated, and the proportion in rural areas (18.0%) is almost three times as high as in urban (6.7%) areas. One in five households in six regions (Upper East, Upper West, Savannah, Volta, Northeast, and Northern) do not have any form of receptacle for solid waste generated.

Challenges

Despite progress, the records presented above 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% 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 programs due to limited personnel in multiple organizations and limited resources for capacity building and program 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% of the sector budget) with low public investment and limited leveraging of private sector resources. The World Bank estimates an annual funding requirement of USD 946 million to achieve Ghana's SDGs. Current sector funding at USD 114 million 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 defecation by 2030, Ghana must reduce the number of people without access to toilets by an average of two percent (2%) per year. To end poor hygiene and open defecation, 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 noncompliant 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 service. The situation can be improved with private and state investments in providing basic sanitation services and prioritizing 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, Dr. Simon Ofori Ametepey, is a Senior Lecturer and Director of the Centre for Sustainable Development (CenSuD) at Koforidua Technical University, Ghana. You can reach him on simon.ametepey@ktu.edu.gh