An estimated 1 in 5 Ghanaians defecates outside rather than into a toilet; the resulting contamination of water, soil, and food is a major cause of diarrhea, one of the leading killers of children under five worldwide. Among the nation’s poorest, the figures are even more staggering: 53 percent of families in the lowest economic quintile practice open defecation.
Ghana has made great strides in providing clean water, reaching an estimated 80 percent of the population. But only 18 percent have access to a latrine or toilet for their household’s personal use. Why has improving sanitation proved so difficult?
Several factors are at play, says Emmanuel Odotei, WASH management specialist for USAID/Ghana. Migration from rural areas to urban centers has surged, and sanitation improvements haven’t kept pace. And for new housing to be approved, it must have a latrine, but monitoring has been lax and that requirement is not always fulfilled, Odotei says. Meanwhile, in rural areas, most improvements implemented in the past addressed clean water but overlooked sanitation.
The situation has a cultural component as well, Odotei explains. Traditionally, multiple families live in one compound and share a latrine. But maintenance of shared latrines is often poor, and therefore these facilities are classified as “limited service” under development guidelines.
The Rotary-USAID partnership seeks to address this issue by building latrines and changing behavior using a method called community-led total sanitation. Facilitators help community members see for themselves the consequences of open defecation, triggering a collective sense of disgust and embarrassment once they realize that they are consuming one another’s feces through things like utensils washed in contaminated water and flies on food. “When people get triggered, they come out willingly to construct their own latrines,” Odotei says. “We support them with a market-based approach. Then you can get to the point where a whole community is declared ‘open defecation free.’”
About 740 communities in Ghana are open defecation free, “with many more in the pipeline,” Odotei says. “Our collaboration with Rotary is a contributing factor.”
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