Why toilets?

Like the name of the dead or a very powerful and dreaded deity, it is not mentioned often, and even when it is, certainly not in public.
Just the mention of toilets brings a grimace to the face of many and a disapproving look of disgust.

It is also considered uncultured for anyone to blurt it out without using appropriate synonyms or universally accepted coinage, either to disguise the word, or tone down its impact on hearers.

However, even though it is especially considered a taboo in Ghana for the word toilet to be mentioned during meals, it is an undisputable fact that it is a basic need of every living being and no human can continue to live without being able to use the toilet after eating. Imagine eating all the good food one can think of, without being able to ease one’s self.

But that is the reality of the situation in Ghana and some parts of the world, where many do not have access to sanitation facilities such as toilets to empty their bowels after they have eaten and are belly-full.

According to the most recent report on sanitation of the Joint Monitoring Programme (JMP) of the World Health Organisation (WHO) and UNICEF, only about 2.2 million people in Ghana have access to decent household toilets. This means the remainder are using shared facilities or engaging in open defecation.

Shared and public latrines

According to the Environmental Health Sanitation Directorate (EHSD) of the Ministry of Local Government and Rural Development, public toilets are mainly built for transient populations and areas of heavy public activity. However, there are still quite a number of communities in both rural and urban areas that use public latrines as their main place of convenience due to absence of household toilets.

However, although the JMP reports that more than 11 million people in Ghana (51%) use shared or public facilities, for the sake of international comparison, the JMP does not include shared or public facilities, with the main reason that they are not hygienic enough compared to household latrines.

In view of this, toilets can no longer be mentioned in private, as it has become a matter of public concern and so open for public discourse, even though it may bring discomfiture to some.

In Ghana, the absence of basic toilet facilities in households has not only resulted in open defecation known as ‘free range’, but also long toilet queues at public places of convenience mostly in the mornings and what has now been labelled as ‘wrap and throw’ where people ease themselves, wrap their excreta in black polythene bags and throw it over their walls or into public drains.

Open defecation

According to the JMP report on sanitation in Africa, open defecation rate in Ghana reduced marginally from 24% in 1990 to 20% in 2006. This negative practice is therefore still quite phenomenal in the country.

Both local and international reports indicate that more than four million people in Ghana resort to defecating in bushes, drains, and in fields.

According to the Ghana Statistical Service Multiple Indicator Cluster Survey report for 2006, open defecation is prevalent in all the ten regions but most widespread in the Upper East Region with about 82% without any form of latrine, followed by the Upper West Region with about 79% and then the Northern Region with about 73%.

The incidence of open defecation was confirmed when a team of journalists belonging to the Ghana Water and Sanitation Journalists Network visited a Gozakope, a village in the Dangme West District of the Greater Accra Region last year.

The Gozakope indigenes acquiesced that until WaterAid Ghana and ProNet, two non-governmental organisations had gone to their rescue, they had no places of convenience and so defecated indiscriminately in the bushes around them.

The practice resulted in a very repulsive stench in the whole community and also brought about various diseases such as diarrhoea, dysentery and cholera.

However, since the introduction of a Community Led Total Sanitation (CLTS) programme in the village that taught the community members the importance of good sanitation practices, all that has changed.

CLTS is a programme that inspires community members to take up the responsibility of ensuring proper sanitation through the stimulation of a sense of disgust and shame about open defecation and its negative impact on the community.

Commenting on the issue, Lukman Salifu, Consultant to Ghana’s Technical Committee on Sanitation and Water for All Global Partnership (SWA), open defecation is increasing the country’s common diseases burden.

Addressing a Consultative Workshop on preparation towards the first annual High Level Meeting (HLM) on SWA in Accra on Tuesday March 16, 2010, he quoted the open defecation rates in Ghana by region for 2006 which was published in 2008, as ranging from 3.4% for the Ashanti Region to 81.9% for the Upper East Region.

Between them is the Eastern Region with 5.5%, Brong Ahafo, 6.4%; Greater Accra, 8.1%; Western, 12.8%; Central, 18.1%; Volta, 13.8%; Northern, 72.9% and Upper West, 78.7%.

Pan latrines

Further, Lukman Salifu lamented that out of an estimated 20,000 pan latrines country-wide currently, Accra alone has 5,200 still in operation.

He continued that although the Supreme Court has banned the use of pan latrines effective July 8, 2008, it will not be until 2013 that they would be completely discarded, as the court gave a period of five years for pan latrines to be phased out in Accra.

According to a news report on the ban that was published in the Friday July 18, 2008 issue of The Ghanaian Times, the Supreme Court instructed the Accra Metropolitan Assembly (AMA), to construct 1,500 water closets and KVIPs within the period as well as arrange subsidies for those who will convert their pan latrines.

The court also directed the AMA to stop granting permits to building plans that do not have adequate provision for WC or KVIP and asked the Assembly to prosecute anyone who engages people to carry human excreta after the period.

The directive from the Supreme Court followed the filing of a writ by an Accra-based legal practitioner, Nana Adjei Ampofo, in February 2008, against the AMA, challenging the Assembly’s constitutional right to engage people to carry human excreta from pan latrines.

Indicating that less than 50% of the Ghanaian populace have access to water closets or flush toilets, Lukman Salifu gave the breakdown as follows; WC – 45%, VIP – 23%, Pit latrines – 17%, KVIP – 7%, Others 7%, Pan latrines – 3% and STL – 1%.

However, the most recent report from the Ghana Statistical Service indicates that about 180,000 people, representing about 0.8% of the population still use the pan or bucket latrines in Ghana whereas this has been declared globally as unsafe and nationally as both unsafe and illegal.

Also, according to the Environmental Health and Sanitation Directorate (EHSD), only about 4.5% of Ghanaians have access to sewerage systems.

But even then, apart from Tema, many of those satellite systems are found within institutions like government ministries, academic institutions, and hospitals rather than in settlements.

Benefits of good sanitation

Touching on the benefits of ensuring good sanitation, the consultant said financing sanitation and drinking water has high economic returns, disclosing that improved sanitation in developing countries yields an average of US$9 for every US$1 spent.

He added that meeting the Millennium Development Goals (MDG) targets on sanitation and drinking water in the countries that are “off-track” could have an annual economic benefit of US $38 billion.

Despite this fact, a briefing note prepared for Ghana’s Ministry of Finance states that based on the most recent coverage data in 2008, Ghana has seven years to raise sanitation coverage from 18% to 61.5% in urban areas, and from 7% to 55% in rural areas.

Sanitation is at the heart of quality of life

Quoting from the United Nations Development Programme (UNDP) Human Development Report (HDR) of 2006, Lukman Salifu said “Sanitation and clean water can make or break human development’  as  ‘ exclusion from clean water and basic sanitation destroys more lives than any war or terrorist act’ and yet sanitation seldom figures prominently on the national political agenda.

He added that “At any given time close to half the people in the developing world are suffering from one or more of the main diseases associated with inadequate provision of water and sanitation … these diseases fill half the hospital beds in developing countries.”

In fact, a World Bank country environmental analysis conducted in Ghana has shown that health costs resulting from poor water, sanitation and hygiene cost the country the equivalent of 2.1% of annual Gross Domestic Product (GDP). The indirect effects of malnutrition – to which poor water and sanitation contribute 50%, according to WHO – cost even more than the direct effects, taking the total health cost to 5.2% of annual GDP in Ghana.

This figure includes the value of at least 8,000 deaths of children under five caused by diarrheal disease. Further, studies demonstrate that poor water and sanitation significantly contribute to malnutrition which leads to lower school productivity and work productivity from impaired cognitive function and learning capacity. Rates of moderate and severe stunting and underweight are high in children under five in Ghana, at 29% and 14%, respectively.

Meanwhile, according to the United Nations Development Programme (UNDP), although sanitation and drinking water underpin all aspects of human and economic development, some 2.5 billion people lack access to basic sanitation, of which 1.2 billion open defecators lack any facilities at all.

It maintains that if current trends continue, it is estimated that the MDG target related to sanitation will not be met globally until 2076.

More importantly, Since JMP standards are used as the yardstick for measuring global performance and progress towards achieving the MDGs, instead of Ghana achieving about 30% as at 2006 so that the country could be at 53% by 2015, only 10% had been achieved as at 2006, which is an indication that if the rate of progress should remain as it is now, Ghana will achieve just about 15% by 2015.

The UNDP states that investing in sustainable sanitation and drinking water improves health, reduces health care costs, boosts productivity and increases the return on investments in education, while the economic benefits of achieving universal access to sanitation and drinking water are estimated at US $171 billion per year.

By: Edmund Smith-Asante on Special Assignment to ghanabusinessnews.com

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