November 19th, 2022 is World Toilet Day, a day set aside by the international community to draw attention to the fact that a whopping 2.5 billion people in the world, representing 37% of the world’s total population, do not have a safe place to defecate. A lot of people the world over struggle every day just to attend a simple nature’s call. Some are bitten by reptiles, have cuts, and get maimed. Our innocent girls and women are raped and live with psychological trauma for life.
November 19th is the day the world unites to create awareness and make noise about this global sanitation challenge. It is commemorated across the globe and people from all walks of life such as the media, private sector, development partners, civil society, Government agencies, Children and Women join hands to advocate for clean and safe toilets for all. This year, the day is commemorated around the theme “Sanitation and Groundwater,” with the campaign tag “Making the Invisible Visible” and this seeks to draw public attention to the correlation between Sanitation and Groundwater sources. One of the commonest practices, which contributes to the pollution of groundwater, is open defecation.
On this unique day of awareness raising on access to toilets, one cannot forget the problem one is forced to deal with in our small towns, peri-urban and major cities virtually on daily basis; it is the issue of Open Defecation. This is the practice where our water bodies, beaches, bushes, open spaces, gutters, refuse dumps, under bridges and channels, uncompleted buildings, backyards, and indeed every available space is used as a “toilet.” In some cases, people defecate into plastic bags, old newspapers, and chamber pots which are eventually thrown into the environment. As a country how have we fared in our journey towards eliminating Open defecation and increasing access to improved household toilet facilities?
The 2021 Population and Housing Census reports that three in five households (59.3%) have access to toilet facilities (both exclusive use and shared) and the proportion is higher among urban (65.9%) than rural (49.1%) households.
Again, about 18% of households in Ghana do not have access to any form of toilet facility with the proportion being over three times as much among rural (31.3%) as urban (8.9%) households and over 90% of these households practice open defecation. In all the 16 administrative regions, open defecation is prevalent, with the five regions of the north recording more than 50%.
Though the journey of eliminating Open defecation from Ghana has been tiring, daunting, slow, and bumpy, the lessons along the way, have been inspiring and given sanitation stakeholders the renewed hope to work even harder towards our national and global development targets.
A critical look at the data sets from WHO/ UNICEF JMP 2000, 2015, 2020, GSS MICS 2017, and GSS PHC 2021 tells us that as a country we have increased access to basic sanitation by 14% points across a 21-year span, similarly shared/limited facilities did an 11% upward jump, whiles unimproved was reduced from 22% in the year 2000 to 1% in 2021.
These are encouraging under the circumstance we find ourselves but I will be the first to admit that we need to do more, especially if we want to be on track to achieve our SDG targets on sanitation as a nation. The worst performing indicator is Open defecation where, as a country, we were able to do a mere 4% reduction over two decades.
This is a snail pace reduction. Currently, over 5.8 million Ghanaians defecate in the open every day. Open Defecation is deadly and pollutes the environment around communities with pathogens like bacteria, viruses, eggs of intestinal worms, and this is the compelling reason why Stakeholders and Partners of the Sanitation sector in Ghana have resolved to wage a relentless war on open defecation with all the available ammunitions and from all fronts. Moreover, We have an ambitious target of eliminating Open defecation by the end of 2030, as part of our SDG commitments. This is just 8 years away.
In 2011, the Water and Sanitation Programme (WSP) of the World Bank did a study on Ghana, in which it was revealed that a typical Ghanaian spends two and half days every year to look for an obscure or ‘private’ place to defecate. This causes huge losses in economic terms.
As a nation, it costs us close to US$79 million per year due to this unholy practice of open defecation. It is even scarier to know that just One gram of human faeces may contain ten million viruses, one million bacteria, 1,000 parasite cysts, and 100 parasite eggs. These pathogens spread diseases of all kinds leading to deaths and maiming of our citizens. It also causes intestinal worms, which are major contributors to stunted growth in children, malnutrition, and hold back their physical and mental growth. Stopping open defecation in our communities calls for concerted action by all and the time to do something about it is now.
One of the main reasons why people still practice open defecation is the lack of or inadequate toilet facilities in our homes, schools, public places, and workplaces. Where they even exist, they are usually poorly maintained. These facilities have become sources of disease transmission and the pungent smell emanating from these places of ‘inconvenience’ leaves a lot to be desired. Some have become death traps and breeding grounds for all types of insects, reptiles, rodents, etc. This situation de-motivates people and put them off from using these facilities and thereby resorts to open defecation.
Notwithstanding the above-stated reasons, several people like to defecate in the open for the pleasure of it. For them squatting in the open places to defecate comes with the unintended fringe benefits of ‘free air-conditioning,’ for which reason satisfied ‘users’ find it extremely difficult to let this behaviour go. I read a story about a rich family in India, who pack themselves into a Mercedes Benz Saloon Car every morning and go to the outskirts of the city, into bushes, to defecate. This family has three toilets in their house and the question is, why are they not using them? It is simply a case of old habits-die-hard. I can cite so many such examples in Ghana as well.
To say the least, the challenge of open defecation has become what social scientists refer to as a “Social Dilemma and Tragedy of the Commons.” It is a Social Dilemma because what is in the best interest of one individual makes everyone worse off. Thus, ten tenants who use the bush as ‘toilet’, is good for only one landowner who has converted a toilet into a living room, but the dire consequences will be borne by the entire community through disease transmission and outbreak. Again, it is a Tragedy of the Commons because now more individuals are practicing open defecation and are unconsciously polluting the groundwater sources and the entire society is paying so much for treated water and in some cases experiencing water shortages.
As a country, we need to achieve Open Defecation Free Ghana sooner than later as we can no longer bear the social and economic cost of open defecation. The challenges of open defecation may look complex but the consequences of not tackling them now are even more expensive and more complex. In Ghana, we would need about 500,000 toilets every year till 2030 to be able to achieve our SDG target on sanitation. Already the needed demand has been created now through the flagship Community Led Total Sanitation (CLTS) approach and households are on their own investing in household toilets, but this needs to be scaled up.
There is therefore an urgent need for the government and all and sundry to prioritise sanitation as a social service. As a country, we need to target the sanitation sub-sector for investment. The current investment into sanitation is far below the financial needs of the sector, looking at the current huge gap in disposal and Treatment facilities. Investments are required not only for the populace to enjoy maximum health and hygiene benefits but to also reduce economic losses.
Our Metropolitan, Municipal, and District Assemblies need to enforce their bye-laws on the construction of household toilets. In our major cities and towns, building regulations are being flouted with impunity by landowners who convert toilets and other sanitary facilities in their houses into living rooms and rent them out to unsuspecting tenants. The Environmental Health Officers with support from Assembly’s Building Inspectors should be resourced to rigidly enforce these laws using ICT. As a matter of urgency, these officers need to also use moral norms, social norms, and legal norm approaches to convince or when required compel the populace to stop open defecation and own toilets.
Stopping open defecation, like creating access to toilets, is an issue of social and economic justice, aside from the fact that it is a human right issue. It is fundamental to the growth, well-being, dignity, productivity, and prosperity of every citizen. It is achievable through continuous and effective prioritization, adequate investment, proper planning, and forceful enforcement of laws and standards. We will succeed if we all increase our ‘reach’ through vigorous awareness creation on the importance of toilets, increase our influence by identifying new champions and friends to join the discussions, and increase our impact through the implementation of our collective plans and commitments as a system and by holding each other accountable.
Until the Almighty grant us life, grace, and health to commemorate yet another world toilet day next year, we should be each other’s keeper and take the pledge of supporting the national effort of eliminating Open defecation. Talk about it, act, own a toilet in your house, use and maintain your household toilet. It is more dignifying to do so. Your health comes from where you defecate.
Let us step up our individual and collective efforts in eliminating open defecation from Ghana. With all hands on deck, Open defecation Free Ghana is achievable.
By Kweku Quansah
The Writer is a Fellow of the West African Postgraduate College of Environmental Health (WAPCEH)