Globally, sanitation has long been a troubling issue. It is estimated that almost half of the world's population live without adequate sanitary provisions, and more children die through hygiene-related illnesses than almost any other cause.
Furthermore, around 1.1 billion people in the developing world lack access to clean water.
In response to the slow progress being made toward the Millennium Development Goal of halving the number of people worldwide living without basic levels of sanitation by 2015, the UN General Assembly declared 2008 as the "International Year of Sanitation”.
Focus has been placed particularly on addressing the stigma attached to sanitation issues, as well as raising awareness of the health and economic benefits of better hygiene and sanitation.
Within Ghana, sanitation is an equally worrying issue, and the country was recently ranked in the three worst African nations for sanitation, coming in the top two in the West African region. According to Health Minister Major (rtd) Courage Quashigah, eight deaths are caused every hour in Ghana through bad sanitation.
Many of the causes of Ghana's low sanitation levels are clearly visible on a daily basis: litter clogs open drains, food is sold and prepared in close proximity to mounds of waste, and in open spaces, piles of rubbish are dumped, to be later burnt, or simply left to rot.
According to the Accra Metropolitan Assembly, in Accra, 1500-1800 tonnes of waste are generated each day, with only 1200 tonnes on average being collected. Surplus waste therefore builds up, blocking drains and collecting in open areas.
The direct correlation between bad sanitation and disease is well known, and it is therefore not surprising that in 2007, diarrhoea was responsible for 425,250 outpatient deaths in Ghana, making the illness the fifth most common mortal ailment in the country.
Following not far behind were fatal cases of intestinal worms, taking 8th place. Upper respiratory track infections - 50% more likely in areas of inadequate sanitation – came second only to malaria as the cause of the most outpatient deaths.
According to the Deputy Minister of Health Abraham Dwuma Odoom, around 80% of ailments reported to health facilities are preventable, being associated with inadequate sanitation. He described diseases of sanitation as “diseases of choices” due to their needless nature.
One of the key problems surrounding Ghana’s sanitation crisis relates to the country’s lack of toilet facilities, with a recent report by the UNICEF and the World Health Organisation revealing that only 10% of Ghanaians have access to improved latrines. Findings from a separate report revealed that around four million Ghanaians practice open defecation – just under 20% of the population.
The United Nations Human Development Report 2006, which focused on issues of water, sanitation and poverty, exposed access to suitable toilet facilities as “one of the strongest determinants of child survival”. The improvement of latrines was identified as having the potential to increase child survival by 30%, with flushing toilets bringing a far larger reduction in child mortality than pit latrines.
The benefits of proper toilet facilities not only affect individuals, but also the community as a whole. “When a household installs a latrine,” the UNHDR reported, “it not only protects them from their own excreta, but also helps to protect their neighbours.”
By way of illustration, the report cited a study carried out in Salvador, Brazil, in which incidences of infant diarrhoea were twice as high in households without latrines, and three times as high in communities without sanitation infrastructures, such as drains and sewers.
As well as providing significant health benefits, better sanitation has also been linked directly to economic growth. According to the Coalition of non-governmental organisations in Water and Sanitation (CONIWAS), every dollar invested in sanitation returns, on average, nine dollars of economic benefits.
This benefit comes mainly through the resultant reduction in medical costs, which allow a greater investment of funds into other areas, such as education, increasing the Gross Domestic Product. Furthermore, loss of labour through sickness is reduced, boosting productivity in the nation’s workforce.
As explained in the UNHDR, “Sanitation improvements can broaden real choices and substantive freedoms that people enjoy, acting as a catalyst for a wide range of human development benefits. They can protect people – especially children – from ill health. They can lift people out of poverty, reducing the risks and vulnerabilities that perpetuate cycles of deprivation.
They can raise productivity, boost economic growth and create employment. And they can build people’s pride in their homes and communities.”
In the wake of such findings, the question remains as to what is being done about Ghana’s sanitation problem. The answer, it seems, lies in a serious of national campaigns - several launched this year - attempting to improve the health and prospects of Ghanaians through sanitary improvements.
In May, the Vice President Alhaji Aliu Mahama announced the launch of a national sanitation campaign, themed 'Repackaging Sanitation for Accelerated National Development’. Organised by CONIWAS in collaboration with WaterAid Ghana, the campaign aimed at raising awareness of Ghana’s sanitation problems and encouraging the treatment of sanitation issues as a national problem.
July saw the launch of the Sixth National Food Safety Week, targeting at highlighting sanitation issues linked with food preparation and vending, launched by the Health Minister.
Speaking at the launch, the Minister urged the public not to underestimate the dangers of bad hygiene and the effect that sanitation-related diseases can have on the economy. “All these diseases cause misery, impede productivity, strain health systems and consign millions of people into abject poverty”, he stressed.
Earlier this month, a further national campaign on sanitation was initiated by Zoomlion Ghana Limited, in collaboration with the Ministry of Health, Local Government, Rural Development and Environment and Manpower, Youth and Employment. Code-named, “Tin Ton Tan”, the campaign called for the improvement of sanitation in Ghana through public education and better hygiene standards in healthcare facilities.
But are such campaigns enough to solve the problem? Speaking to The Statesman, Executive Secretary of CONIWAS Patrick Apoya praised recent sanitation projects, and described 2008 as year with “more media coverage, public discussion and local government involvement in sanitation issues than ever before.”
Campaigns such as the recent Zoomlion initiative, he claimed, would make “considerable improvements” in Ghana’s sanitation problems, with local governments having a “big role to play” in alleviating the crisis.
However, he called for a more unified approach to sanitation across government institutions. “Government departments need to talk to each other, pull together their policies and make sanitation a key point on government agenda,” said Mr Apoya.
He added that a more centralised approach needed to be taken, if real changes are going to be seen: “Rather than dealing with sanitation through a range of different government institutions, a central effort must be seen.”
Mr Apoya called for a “dramatic realisation” of the national crisis that sanitation poses in Ghana, and a better government appreciation of the powerful effect that improved sanitation could have on the health and economy of the nation.
He stressed that, until such a realisation comes about, progress toward a healthier, cleaner, more affluent Ghana will be hindered.
