Effective WASH services are a source of resilience for communities under threat from COVID-19.
Interview in progress, Peter McIntyre talking to Dr Kodjo Mensah-Abrampa, Director General of the NDPC Ghana
Ghana's development aspirations are aligned with the 2030 Agenda for Sustainable Development and the Sustainable Development Goals (SDGs). Goal 6, which ensures the availability and sustainable management of water and sanitation for all, is a challenge since in 2017 19% of the population did not yet have access to at least a basic level of water services and only 36% were using safely managed water accessible on the premises. Almost one in five (18%) of the population was still practising open defecation. Service sustainability has been further challenged by the large number of non-functional water systems.
In February and early March 2020, a small team from the Ghana National Development Planning Commission and IRC Ghana visited three districts of the country where innovative work is being done towards meeting the Sustainable Development Goal 6. The aim was to collect and document case studies within the WASH sector, share best practices and lessons learned to contribute further to evidence-based innovative development approaches in Ghana. The districts were Wassa East in Western Region, Bongo District in Upper East Region and Asutifi North in Ahafo Region.
The visits took place between February 17 and March 5 2020, meeting leaders of WASH services at district level, representatives of NGOs and development partners, conducting community visits and interviews, and conducting some interviews at national level. The visits were concluded as concern over COVID-19 was developing but before the first cases were found in Ghana. Predictions for future coverage and progress may be affected, depending on the course of the virus in Ghana. However, it should also be noted that effective WASH services are a source of resilience for communities under threat from the virus. COVID-19 highlights the importance of WASH – especially hygiene – as essential protection for communities.
Some common factors can be drawn from these districts, illustrated in the reports that can be found on this website.
Raising the priority of WASH issues was a political imperative in each district. In Wassa East the decision to bring in a more entrepreneurial partner was part of a change in strategic direction. In Bongo district, there was a decision to appeal for outside support to deal with fluoride in groundwater. In Asutifi North, the ANAM process was a decision to become the testing ground for a new approach.
Districts have many partners but the central coordinating, monitoring and oversight role belongs to the District Assembly. There are critical roles at the level of coordinating director, development planning officer, environmental health officer and senior members of the district WASH team who must translate the medium term development into an effective WASH plan and communicate effectively at community level. The three districts had proactive and motivated teams to lead the day to day work.
District Assemblies cannot transform WASH services alone. Each district had at least one specialist implementation partner currently playing a central role in developing services working to the district WASH plan. These partners become familiar brand names in communities. In Wassa East people talked about NUMA water, in Bongo communities progress was linked to “when WaterAid came” and in Asutifi North, one chief had a slogan “where World Vision goes, water flows.”
The example set by influential people within the community is critical in promoting safe water, sanitation and hygiene. If the sub chief is first to build a household latrine, others follow. In one community in Bongo, members of the community water and sanitation management team (WSMT) had the right to inspect latrines and to fine people who defecated in the open. WaterAid Ghana has trained community members to be more active in upholding their rights to water and sanitation. In Wassa East, one Queen Mother is campaigning for household water connections. In Asutifi North, traditional leaders were actively engaged in the development of the Master Plan. Civil society groups play an active role in educating communities to take responsibility for maintaining services.
District Assemblies’ budgets are stretched over a range of services. Financial support is required to implement WASH plans. Donors not only provide funds, they also provide encouragement and support. In Wassa East, capital and central staff costs for Access Development are supported by Water4 which in turn is supported for work in Ghana by the Netherlands’ Enterprise Agency (RVO). The Conrad N. Hilton Foundation provided funds to subsidise the cost of household connections and provided training in marketing. In Bongo, WaterAid Ghana provided funding for health care facilities and schools and for its work in communities. It is looking for further finance to continue work in the district. In Asutifi North, the Conrad N. Hilton Foundation has not only provided finance towards the ANAM process, but brought its grantees together and encouraged them to work collaboratively.
These districts all faced low rates of access to water and sanitation but set ambitious targets for a high level of service delivery. Schools and Community Health Planning and Services (CHPS) centres have been a particular target for improved facilities for the most vulnerable. Mechanised provision is more common, aiming to provide water 24/7, through a combination of solar power and larger water tanks, to remove the need for costly electricity or even solar batteries. One innovation being trialled is to use mobile money to activate water points using a smart card.
Payment systems for water in rural communities often fail to cover the costs of minor repairs, leaving the community without water when there is a breakdown. All three districts are making determined efforts to improve cost recovery levels to cover the costs of minor maintenance. The sums charged are small – 10 pesewas (US$ 0.017) for 20 litres of water, but vital to sustainability. In Wassa East, communities sign an agreement with Access Water to practise ‘pay-as-you-fetch’, with monthly bills for those who have household connections. New systems introduced in Asutifi North are all on the basis of ‘pay-as-you-fetch’ and vendors are trained to ensure that the money is collected and banked. In Bongo, the District Assembly does not give directives about how money is collected but encourages communities to make their payment systems work.
Poor sanitation puts water sources under threat, while good hygiene and handwashing is vital during the threat from COVD-19. In Bongo district, WaterAid Ghana links the provision of water to sanitation and hygiene and has provided some schools and health premises with modern flush toilets. The district is promoting Community-Led Total Sanitation (CLTS), helping communities to see how open defecation threatens their water supply. In Asutifi North, World Vision and the District Assembly are telling communities: “no sanitation, no water.” In Wassa East, the District Assembly is working with Community Water and Sanitation Agency to introduce CLTS in 15 communities with support from the World Bank.
Success is a journey – all three districts are still addressing many challenges:
Although Ghana has adopted Community-led Total Sanitation as official policy, sanitation coverage in all three districts lags far behind water coverage. Promotion of sanitation is still not strong enough to eradicate open defecation and ensure that every household has its own latrine. Hygiene, especially handwashing with soap, is essential in this era of COVID-19 but is impossible to practise in the absence of facilities.
Solid waste is a major concern in all three districts. Traditional methods of dealing with waste have been largely abandoned while there is no effective collection system outside urban areas. Many communities live in a sea of floating plastic which blocks drains and blights community life. The national contract for dealing with solid waste is felt to be unsatisfactory.
Where effective cost recovery is missing, facilities are at risk. In one community which introduced a monthly household fee, some people refused to pay, preferring to use former polluted sources. As a result the payment system collapsed. “Free water” is still promoted by some politicians, when it is not free to collect, clean and deliver. Water and Sanitation Management Teams are becoming better at collecting and banking payments but this needs to become standard practice in every community.
In very rural areas where pits are now being dug, the threat from full pits may seem remote. But as open defecation is eradicated and populations in peri-urban and urban areas grow, the need for a strategy to deal with the contents of pits will become pressing. Transforming faecal waste into safe fertiliser is an aspiration, but the technology and safe practice for doing so have not yet been developed. This longer term threat needs national attention.
Asutifi North is seeking ways to monitor water quality at lower cost. Currently, the cost of testing water points at six monthly intervals is prohibitive.
As social and commercial enterprises become more common in rural WASH, it is essential that new enterprises do not lower standards to cut prices. It has been suggested that national guidelines should be developed to ensure a level playing field and to prevent competition on pricing damaging water quality.