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Sanitation: the neglected Siamese twin of water in achieving the millennium development goals (MDGs) in Ghana

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Abstract

While inadequate water and sanitation services have both been implicated in a number of mortality and morbidity situations all over the world, the improvement in sanitation provision lags far behind that of water. This paper therefore seeks to examine the spatial variation in sanitation provision in Ghana and assess the factors that have contributed to the low investment in sanitation infrastructure as well as how sanitation can be improved. It revealed that the low sanitation has its roots in somewhat complicated political, institutional, economic and socio-cultural factors, including inadequate political commitment, poor monitoring, higher negative externalities associated with sanitation compared with water, and low sanitation demand resulting from poor social marketing for sanitation. Sanitation should therefore be marketed as a concept that has public health benefits and not merely as a toilet facility. Proper social marketing for sanitation and scaling up the community-led total sanitation approach should be pursued to stimulate individual demand for private sanitation.

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Source: Water and Sanitation Programme (2011)

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References

  • Amo-Adjei, J., Mariwah, S., & Anima, P. (Forthcoming). What has poverty got to do with it? Analysis of household access to improved sanitation in Ghana. Journal of Water, Sanitation and Hygiene for Development.

  • Ayee, J., & Crook, R. (2003). “Toilet wars”: Urban sanitation services and the politics of public-private partnerships in Ghana. Brighton: Institute of Development Studies.

    Google Scholar 

  • Bandie, B. (2003) Assessment of environmental health, sanitation and hygiene strategies and practices. District Capacity Building Project (DISCAP) Final Report, Bolgatanga.

  • Biswas, A. K. (2010). Water for a thirsty urban world. The Brown Journal of World Affairs, 15(1), 147–166.

    Google Scholar 

  • Black, R. E., Cousens, S., Johnson, H. L., Lawn, J. E., Rudan, I., Bassani, D. G., et al. (2010). Global, regional, and national causes of child mortality in 2008: A systematic analysis. The Lancet, 375(9730), 1969–1987.

    Article  Google Scholar 

  • Black, M., & Fawcett, B. (2008). The last taboo: Opening the door on the global sanitation crisis (p. 254). London: Earthscan.

    Google Scholar 

  • Bohman, A. (2010). Framing the water and sanitation challenge: A history of urban water supply and sanitation in Ghana 1909–2005. Unpublished Doctoral Dissertation in Economic History, Umeå University.

  • Boschi-Pinto, C., Velebit, L., & Shibuya, K. (2008). Estimating child mortality due to diarrhoea in developing countries. Bulletin of World Health Organisation, 86(9), 710–717.

    Article  Google Scholar 

  • Cairncross, S., Hunt, C., Boisson, S., Bostoen, K., Curtis, V., Fung, I. C. H., et al. (2010). Water, sanitation and hygiene for the prevention of diarrhoea. International Journal of Epidemiology, 39(1), i193–i205.

    Article  Google Scholar 

  • Card, N., & Sparkman, D. (2010). Sanitation market analysis: Kyarusozi sub-country, Kyenjojo District, Uganda. Draft Report Prepared for Water for People, October 21, 2010.

  • Chambers, R., & Myers, J. (2016). Norms, knowledge and usage. In Frontiers of CLTS: Innovations and insights Issue 7, Brighton: IDS.

  • Cheng, J. J., Schuster-Wallace, C. J., Watt, S., Newbold, B. K., & Mente, A. (2012). An ecological quantification of the relationships between water, sanitation and infant, child, and maternal mortality. Environmental Health, 11(4), 1–8.

    Google Scholar 

  • Community Water and Sanitation Agency (CWSA). (2007). Update of the strategic investment plan, 2008–2015 & the medium-term plan, 2008–2012, Board Draft. Accra: CWSA.

    Google Scholar 

  • Community Water and Sanitation Agency (CWSA). (2009). Annual report. Accra: CWSA.

    Google Scholar 

  • Crook, R., & Ayee, J. (2006). Urban service partnerships, ‘street-level bureaucrats’ and environmental sanitation in Kumasi and Accra, Ghana: Coping with organizational change in the public bureaucracy. Development Policy Review, 24(1), 51–73.

    Article  Google Scholar 

  • Cumming, O. (2009). The sanitation imperative: A strategic response to a development crisis. Desalination, 248(1), 8–13.

    Article  Google Scholar 

  • Drangert, J.-O., Schonning, C., & Vineras, B. (2010). Sustainable sanitation in the 21st century: A sourcebook. Stockholm: EcosanRes.

    Google Scholar 

  • Esrey, S. A., Potash, J. B., Roberts, L., & Shiff, C. (1991). Effects of improved water supply and sanitation on ascariasis, diarrhea, dracunculiasis, hookworm infection, schistosomiasis, and trachoma. Bulletin of the World Health Organization, 69(5), 609–621.

    Google Scholar 

  • Farmer, P. (2004). An anthropology of structural violence. Current Anthropology, 45(3), 305–325.

    Article  Google Scholar 

  • Ghana Statistical Serve (GSS). (1993). Ghana demographic and health survey report. Maryland: Ghana Statistical Serve, ICF Macro Calverton.

    Google Scholar 

  • Ghana Statistical Serve (GSS). (1998). Ghana demographic and health survey report. Maryland: Ghana Statistical Serve, ICF Macro Calverton.

    Google Scholar 

  • Ghana Statistical Serve (GSS). (2003). Ghana demographic and health survey report. Maryland: Ghana Statistical Serve, ICF Macro Calverton.

    Google Scholar 

  • Ghana Statistical Serve (GSS). (2008). Ghana demographic and health survey report. Maryland: Ghana Statistical Serve, ICF Macro Calverton.

    Google Scholar 

  • Ghana Statistical Serve (GSS). (2014). Ghana demographic and health survey report. Maryland: Ghana Statistical Serve, ICF Macro Calverton.

    Google Scholar 

  • Government of Ghana (GoG). (1999). Ministry of Local Government and Rural Development “Environmental Sanitation Policy”. April 1999.

  • Hampshire, K. R., Panter-Brick, C., Kilpatrick, K., & Casiday, R. E. (2009). Saving lives, preserving livelihoods: Understanding risk, decision-making and child health in a food crisis. Social Science and Medicine, 68(4), 758–765.

    Article  Google Scholar 

  • Hutchings, M. T., Dev, A., Palaniappan, M., Srinivasan, V., Ramanathan, N., & Taylor, J. (2012). mWASH: Mobile phone applications for the water, sanitation, and hygiene sector. California: Pacific Institute and Nexleaf Analytics.

    Google Scholar 

  • Jenkins, M. W., & Scottb, B. (2007). Behavioural indicators of household decision-making and demand for sanitation and potential gains from social marketing in Ghana. Social Science and Medicine, 64(12), 2427–2442.

    Article  Google Scholar 

  • Kar, K., & Pasteur, K. (2005). Subsidy or self-respect? Community-led total sanitation. An update on recent development. IDS Working Paper 257, Brighton, IDS.

  • Katukiza, A. Y., Ronteltap, M., Niwagaba, C. B., Foppen, J. W. A., Kansiime, F., & Lens, P. N. L. (2012). Sustainable sanitation technology options for urban slums. Biotechnology Advances, 30(5), 964–978.

    Article  Google Scholar 

  • Kendie, S. B. (1994). Willingness to pay more for rural drinking water services in Ghana and Togo. Discussion Paper 3, Cape Coast: University of Cape Coast, Centre for Development Studies.

  • Kolspy, P., & Diop, O. (2004). Frameworks for upscaling sustainable sanitation: Issues, principles and experiences. Presentation given at the Sustainable Sanitation Seminar, Stockholm Water Week, 15th August 2004.

  • Mara, D., & Evans, B. (2011). Sanitation and water supply in developing countries. Telluride, CO: Ventus Publishing ApS.

    Google Scholar 

  • McGarvey, S. T., Buszin, J., Reed, H., Smith, D. C., Rahman, Z., Andrzejewski, C., et al. (2008). Community and household determinants of water quality in coastal Ghana. Journal of Water and Health, 6(3), 339–349.

    Article  Google Scholar 

  • McGranahan, G., & Mulenga, M. (2009). Community organisation and alternative paradigms for improving water and sanitation in deprived settlements. In J. E. Castro & L. Heller (Eds.), Water and sanitation services: Public policy and management. Sterling: Earthscan.

    Google Scholar 

  • Ministry of Local Government and Rural Development. (2010). Environmental sanitation policy—Revised draft. Ghana: Accra.

    Google Scholar 

  • Moser, C. O. N. (2006). Asset-based approaches to poverty reduction in a globalized context: An introduction to asset accumulation policy and summary of workshop findings. The Brookings Institution’s Global Economy and Development Working Paper #01.

  • O’Reilly, K., & Louis, E. (2014). The toilet tripod: Understanding successful sanitation in rural India. Health and Place, 29, 43–51.

    Article  Google Scholar 

  • Overseas Development Institute (ODI). (2006). Sanitation and hygiene: Knocking on new doors. ODI Briefing Paper 13.

  • Patterson, K. D. (1979). Health in Urban Ghana: The case of Accra 1900–1914. Social Science and Medicine, 13B(4), 251–268.

    Google Scholar 

  • Pruss, A., Kay, D., Fewtrell, L., & Bartram, J. (2002). Estimating the burden of disease from water, sanitation, and hygiene at a global level. Environmental Health Perspectives, 110(5), 537–542.

    Article  Google Scholar 

  • Pruss-Ustun, A., Bos, R., Gore, F., & Bartram, J. (2008). Safer water, better health: Costs, benefits and sustainability of interventions to protect and promote health. Geneva: WHO.

    Google Scholar 

  • Rosenquist, L. E. D. (2005). A psychosocial analysis of the human-sanitation nexus. Journal of Environmental Psychology, 25(3), 335–346.

    Article  Google Scholar 

  • Samantha, B. B., & van Wijk, C. A. (1998). Criteria for successful sanitation programmes in low income countries. Health Policy and Planning, 13(1), 78–86.

    Article  Google Scholar 

  • Schouten, M. A. C., & Mathenge, R. W. (2010). Communal sanitation alternatives for slums: A case study of Kibera, Kenya. Physics and Chemistry of the Earth, Parts A/B/C, 35(13), 815–822.

    Article  Google Scholar 

  • Scott, B. (2005). Social marketing: A consumer-based approach to promoting safe hygiene behaviours. WELL Fact Sheet. http://www.sswm.info/sites/default/files/reference_attachments/SCOTT%202005%20Social%20Marketing%20Well%20Factsheets.pdf. Accessed 20 June 2015

  • Smith-Asante, E. (2014). Govt pledges to invest US$170m in water, sanitation. Daily Graphic. Tuesday, 08 April 2014. http://graphic.com.gh/news/general-news/21019-govt-pledges-to-invest-us-170m-in-water-sanitation.html.

  • Todd, M., & Majerowicz, S. (2012). No longer poor: Ghana’s new income status and implications of graduation from IDA. CGD Working Paper 300. Washington, D.C.: Center for Global Development.

  • Tumwebaze, I. K. (2014). Prevalence and determinants of the cleanliness of shared toilets in Kampala slums, Uganda. Journal of Public Health, 22(1), 33–39. doi:10.1007/s10389-013-0590-7.

    Article  Google Scholar 

  • van der Geest, S. J. (1998). Akan shit: Getting rid of dirt in Ghana. Anthropology Today, 14(3), 8–12.

    Article  Google Scholar 

  • van Rooijen, D., Spalthoff, D., & Raschid-Sally, L. (2008). Domestic water supply in Accra: How physical and social constraints to planning have greater consequences for the poor. In Paper presented at the 33rd WEDC international conference, Accra, Ghana.

  • Water and Sanitation Programme (WSP). (2011). Water supply and sanitation in Ghana: Turning Finance into Services for 2015 and Beyond. The second AMCOW Country Status Overview (CSO2).

  • WaterAid. (2009). Towards total sanitation socio-cultural barriers and triggers to total sanitation in West Africa. London: WaterAid.

    Google Scholar 

  • WaterAid. (2011). Off-track, off-target: Why investment in water, sanitation and hygiene is not reaching those who need it most. A WaterAid Policy Report.

  • World Health Organisation (WHO). (1961). Report of World Health Organisation Consultant Team on water supplies and sewerage in Ghana. Accra MOH//PA/31.61

  • World Health Organisation (WHO), & United Nations Children’s Fund (UNICEF). (2010). A snapshot of drinking water and sanitation in Africa—2010 update. France: WHO and UNICEF.

    Google Scholar 

  • World Health Organisation (WHO), & United Nations Children’s Fund (UNICEF). (2011). A snapshot of drinking water and sanitation in Africa—2010 update. France: WHO and UNICEF.

    Google Scholar 

  • World Health Organisation (WHO), & United Nations Children’s Fund (UNICEF). (2012). WHO (World Health Organisation) and UNICEF (United Nations Children’s Fund) (2004). Meeting the MDG Drinking Water and Sanitation Targets. Joint Monitoring Programme Report. Geneva: WHO.

  • World Health Organisation (WHO), & United Nations Children’s Fund (UNICEF). (2012). Progress on sanitation and drinking water. 2012 update. WHO/UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation.

  • World Health Organisation (WHO), & United Nations Children’s Fund (UNICEF). (2013). Progress on sanitation and drinking-water—2013 update. France: WHO and UNICEF. www.wssinfo.org.

  • World Health Organisation (WHO) & United Nations Children’s Fund (UNICEF). (2015). Progress on drinking water and sanitation: 2015 update and MDG assessment. Geneva: WHO/UNICEF.

    Google Scholar 

  • World Health Organization. (2016). Fact sheet on sanitation, reviewed November 2016. http://www.who.int/mediacentre/factsheets/fs392/en/.

  • Wright, A. (1997). Toward a strategic sanitation approach: Improving the sustainability of urban sanitation in developing countries. Washington, DC: The World Bank.

    Google Scholar 

  • WSMP. (2009). Data puzzle in Ghana’s water and sanitation sector: Causes and suggestions. A water and sanitation sector monitoring platform (WSMP) Ghana briefing note.

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Acknowledgements

The author wishes to thank Brown International Advance Research Institutes (BIARI) and the Watson Institute for International Studies for granting him an Alumni Fellowship at Brown University in preparation of this manuscript.

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  1. Department of Geography and Regional Planning, University of Cape Coast, Cape Coast, Ghana

    Simon Mariwah

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  1. Simon Mariwah
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Mariwah, S. Sanitation: the neglected Siamese twin of water in achieving the millennium development goals (MDGs) in Ghana. GeoJournal 83, 223–236 (2018). https://doi.org/10.1007/s10708-016-9765-4

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