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Takuka, a community of 125 people has no health facility. The closest health care facility is the Daboya Community Health-Based Planning Services (CHPS) compound about six kilometers (6km) away. Diarrhea was a prevalent disease because their only source of water was a river that is usually turbid. It is not the best for consumption but, with no choice, most residents consumed it in its raw state. Only a few purified the water by boiling. Takuka, which used to source water from a river, is the latest community to taste potable water for the very first time.

 
Residents taking turns to fetch water from the borehole

The choice of their community as a site for the construction of a borehole came as good news. Takuka is amongst the communities in the West Mamprusi district of the Northern Region of Ghana that benefited from the USAID funded WASH for Health project.  In June, 2018, after two failed attempts, the third drill gushed out with water to the joy of many. “We thank USAID and Global Communities for this intervention. Now that we don’t drink dirty water, we don’t get diarrhea” were the exact words of Awusi Kwesi, a resident of Takuka community.

Constant availability and close proximity of water via the borehole to the community of farmers and fishermen, is the highlight of this intervention. “Water is always available and I can even fetch water at mid-night without encountering any difficulty”, said Sadia James a resident of Takuka.

Residents filling a drum with clean clear water
from the borehole    

Aside from the health benefits of the water, it saves community members money that was otherwise used to purchase firewood for water purification. “The borehole has reduced cost of treatment of water in terms of the use of firewood to boil and use the water” said Rukayat Nicholas, a homemaker. As a result, the community members frequent the borehole stand with large containers to fill their drums with clean and clear water for domestic purposes.

The Social and Behavioral Change Communication (SBCC) team of the WASH for Health project is undertaking a “Nutrition in Water Access, Sanitation and Hygiene” (NuWASH) sensitization intervention. This intervention educates primary caregivers of children less than five years on the need to practice proper WASH behaviors during feeding and playtime, and the response of community members has been impressive.

Takuka means ‘Stop an enemy from invading’, a name chosen by the early warrior settlers who camped there to prevent other ethnic groups from invading the Mamprugu Kingdom. Decades later, these 21st century warriors are preventing the invasion of WASH related challenges. They were the first community in the West Mamprusi district to be declared Open Defecation Free in 2016.

WASH for Health is a five-year project, with support from USAID, that has been implementing various WASH related projects in deprived communities of 30 districts in five (Northern, Volta, Western, Central and Greater Accra) regions of Ghana since 2015.

 

The Central Region of Ghana is a hub for many historic and attractive tourist sites, including the Cape Coast Castle and Kakum National Park. Soon it will boast of being a ‘zero-cholera’ region. This was made possible through the implementation of preventive measures by Global Communities as part of the USAID-funded WASH for Health project, support from sector players and the sheer willingness of volunteers, in the affected districts. As a result of this intervention, no cholera case has been recorded till date.

  Fumigation of public latrines by
  a volunteer

According to the Ghana Health Service, in 2014 when Ghana was hardest hit with cholera, approximately 29,000 cases with almost 250 deaths were reported from 130 out of the 216 districts in all 10 regions. In Central Region alone, about 600 cases were recorded with five deaths in 2015. It further dwindled to about 150 cholera cases with no known death recorded, in 2016. Since then, no cholera case has been recorded.

Initially, community members were hesitant in embracing interventions to curb the epidemic. However, after further deliberations, the support was overwhelming. Over 300 young and old volunteers embarked on various preventive interventions in 45 communities of six (Mfantseman, Cape Coast Municipal, Twifo Hemang Lower Denkyira, Komenda Edina Eguafo Abirem, Abura Aseabu Kwamankese, Asikuma Odoben Brakwa) cholera-prone districts.

At least 30 volunteers in each district educated people in homes, schools, churches, market places and taxi stations on cholera; distributed Aquatabs (a brand of chlorine tablets for purifying 20 liters of water per tablet in 30 minutes); and disinfected public bath-houses, toilet facilities, dump sites and markets. Installation of Digni-Loos (a durable, affordable plastic slab that serves as an alternative basic sanitation option for households) was recommended by Global Communities to avert the spread of cholera,through open defecation, in the region, as they lacked household latrines.

 

   Digni-Loo installation by the youth

With support from USAID, the region was provided with four (4) Digni-Loos and educated on its installation and use. Aside from the donation, the Chief of the Region, Osabarima Kwesi Atta, purchased and installed 30 Digni-Loos for various communities. This gesture has motivated some households to purchase and install Digni-Loos in their homes. 

Global Communities and USAID are excited that the Central Region has maintained a sanitized environment for close to two years, leading to no recorded cholera case. We look forward to more years of sustaining this feat and a cholera-free Ghana. 

Ghanaian are therefore encouraged to wash their hands regularly under running water (after visiting the toilet, before and after eating, before cooking and before and before feeding infants). Food purchased from vendors must be warmed before consumption, to kill any bacteria. Food must also be properly covered to prevent flies from settling on them. Water from untrusting sources must be treated (boiling, filtering or use of Aquatabs), and handled properly (use of long handle containers for fetching to prevent hand-water contact) before use.

The fight against cholera in the Central Region began in 2014 under the USAID-funded WASH-UP project. It was intensified under the current WASH for Health project also funded by USAID. The focus of this project is to accelerate sustainable improvement in water and sanitation access and improve hygiene behaviours. It was initiated in 2015 and being implemented in targeted communities in 30 districts in five (Greater Accra, Central, Western, Northern and Volta) regions of Ghana.

Some pupils avoid the use of tippy taps due to the sporadic splashes of water that hit the ground during handwashing, imprinting muddy stains on their clothes, shoes and especially their white socks. This inconvenience is gradually fading out as some schools in the Agotime-Ziope District, in the Volta Region, have taken on the use of rock-lined holes dug beneath the gallon dispensing water for handwashing. Aside from the holes lined with rocks, objects are arched around the hole to prevent further splashes.  Rest assured your shoes and cloths will be unstained after washing your hand with the newly improved tippy-tap.

A pupil of Dramave DA Primary School using the newly improved tippy-tap

 A total of 25 basic schools in the Agotime-Ziope District benefitted from the Small Grants program, a sub-component of the USAID funded WASH for Health (W4H) Project through the Center for Integrated Education and Development (CIED). CIED is a beneficiary organization which received funding for the training of head teachers and SHEP coordinators on hand washing, construction of tippy-taps and Menstrual Hygiene Management.

As a result of this training, most of the beneficiary schools have implemented the rock-lined holes as part of the tippy-tap system and reinforced handwashing. Handwashing at critical times of the day; after visiting the toilet, before and after eating, is essential to healthy living. The tippy-tap is one of the innovative and affordable handwashing facilities adopted in most rural areas.

The Small Grants Program supports local organizations to facilitate sustainable, innovative, community-driven projects that improve sanitation, water and hygiene for individuals, households and communities. The Program awards a maximum of $2,000 to successful applicants to complete their proposed project within six months.

About 60 communities in four regions, (Northern, Western, Central, Volta), have so far benefitted from the program. By the end of August 2018, all community projects under the Small Grants program for the will be completed.

At one end of a stream in Bortianor stood a lady washing wringing her clothes from soapy water into the stream. A few minutes later, some children who had gone to harvest sugarcane from the farm, clad in uniforms, washed their shoes, faces, arms and legs at another side of the river.

House-to-house cholera education and Aquatabs distribution at Bortianor

Behind a tree that is partly rooted in the river, one of the schoolgirls hides and relieves herself of urine which trickles into the same stream. After all this, the team of “sugarcane adventurers” wash their sugarcane in that same stream – ready for consumption. These activities seem unrelated but for the common denominator – the stream. Similar stories can be told of other suburbs in the Greater Accra Region. It is no surprise that Bortianor recorded numerous cases during the massive cholera outbreak in 2014. The Greater Accra Region was the hardest hit with cholera, recording about 5,000 cases and 45 deaths as at August that year.

Cholera, a bacterial disease caused by Vibrio Cholerae, is commonly transmitted to individuals through contaminated water. It is fatal, especially to women and children within hours, as a result of dehydration caused by diarrhoea and vomiting. Though curable, preventive measures such as clean environments, water purification for drinking and cooking, and proper handwashing (after visiting the toilet, before and after eating etc) are preferable and sustainable options for preventing the spread of the disease.

The 2014 outbreak was brought under control by the collaborative intervention of Global Communities, the Ghana Health Service, Ministry of Sanitation and Water Resources, Environmental Health Directorate and the Red Cross Society. WASH interventions were intensified in 2016 and are still underway. Since September 2016, there have been no recorded case of cholera in the region, largely due to the efforts of actors in the Water, Sanitation and Hygiene (WASH) sector, such the USAID funded WASH for Health project implemented by Global Communities.

     Night fumigation at Agbogbloshie market

USAID has funded various projects in the WASH sector; including WASH for Urban Poor (WASH-UP) and WASH for Health projects. These projects support preventive measures such as house-to-house education on cholera, distribution of Aquatabs (a brand of chlorine tablets for purifying 20 liters of water per tablet in 30 minutes), disinfection of cholera-prone communities, distribution of Social and Behavior Change Communication (BCC) materials, as well as radio and television spots. Currently, cholera prevention activities are being carried out under the WASH for Health project initiated in 2015 and implemented across communities in 30 districts in five regions of Ghana (Greater Accra, Central, Western, Northern and Volta).

Almost two years after the intervention, residents in the cholera prone areas continue to adopt hygienic practices. The fact that Accra has been cholera-free for two years in a row is testament to the hard work of community members in sustaining the practice of these effective WASH interventions. Madam Bebli, a fishmonger at Tsokomey sums this up by saying, “It’s been long since I last noticed a cholera outbreak in Tsokomey. I personally ensure that our working area is thoroughly cleaned after the fishes are smoked. I also ensure that my family, especially the children, wash their hands regularly.”


 

The Pro-poor guideline policy is to deliver basic sanitation for the poor and vulnerable in the Country. The document was developed by the Ministry of Sanitation and Water Resources with support from Stakeholders in the sanitation sector.

Sanitation being one of the biggest challenges in the Country was one of the contributing factors which was considered in developing the document. The guidelines is to ensure inclusion, equality and sustainability in providing directions for stakeholders to adequately reach the poor and the vulnerable without undermining community and cohesion in building their own latrines.

The document will also serve a working document and provide direction and guidance for all stakeholders in the Sanitation and hygiene in Ghana. The guidelines is available for download here

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