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Enoch Asuman is a physically-challenged sanitation champion spearheading the eradication of open defecation in his community, Kwaku Ninsin, located in the Asikuma Odoben Brakwa District in the Central region of Ghana. Like many other open defecation free (ODF) communities, Kwaku Ninsin practiced open defecation until the USAID-funded WASH for Health project team initiated the ODF implementation process. Since the initiation of the process, Enoch has personally rallied his community behind the Community Led Total Sanitation (CLTS) team to ensure the community adopt safer sanitation practices.

 

Enoch Asuman by his household latrine

 

The 50-year-old man was made the chairman of the Natural Leaders in his community due to his unquestionable commitment to ending the practice of open defecation. Despite his physical disabilities, he leads the CLTS team to remote areas in the community to initiate the ODF process. His influence has translated into majority of the 592 community members, including the local leaders, accepting and adopting proper sanitation practices such as building household latrines, cleaning of the environment, and safely disposing of refuse.

 

Enoch with some residents on a concrete slab he constructed

This altruistic family man of four children, constructs the concrete slabs for the latrines at no cost, provided the construction materials are available. Agya Kwaku, a beneficiary of a latrine constructed with the assistance of Enoch, is awed by his commitment to improving sanitation in their community. “But for his assistance, my family and I did not have this facility. We feel more comfortable attending nature’s call a few steps away from our house, especially at night. Previously, it we had to risk attending nature’s call at night in the bush,” Agya Kwaku said.

As a small-scale farmer, Enoch must spend long hours planting and weeding his fields, but he does not let these time constraints deter him from championing the sanitation agenda. He personally visits individual homes to encourage them to build latrines in order to attain an ODF status. According to Enoch, “My sole aim for championing this course is two-fold: to make the community clean leading to the prevention of diseases, and to enable us attain and ODF status by the end of December, 2018.”

Enoch cleaning his compound

 

Within two months of initiation, the community has attained an ODF basic status. This means feces are disposed of appropriately, so there are no visible signs of human or animal feces. To attain full ODF status by Enoch’s timeline, all households must have access to and use latrines. Additionally, 80% of households must have their own latrine and residents must increase handwashing practices at critical times of the day.

 

Enoch taking the lead

Word of his activities has spread to neighboring communities, motivating them to practice improved hygiene behaviors. Based on the example set by Enoch’s community, a couple of households in the neighboring town have begun constructing household latrines as well. Enoch has started advising other communities still practicing open defecation to improve their sanitation practices as well encouraging every family to construct a their own household latrine.

 

 

 “Exactly ten years ago since the Global Handwashing Day was launched, Ghana has realized a 30% increase in handwashing practices,” according to Ing. Worlanyo Siabi, Chief Executive of the Community Water and Sanitation Agency. He went on to explain that despite these gains in increased handwashing, communities in Ghana still have a long way to go. According to UNICEF, more than 10,000 children in Ghana die each year from preventable diseases like diarrhea and pneumonia. Handwashing could reduce these diseases up to 50%, yet less than 15% of Ghanaian households have handwashing facilities.

That is why this year’s theme for Global Handwashing Day—Clean Hands, a Recipe for Health—is so important. Global Handwashing Day is dedicated to increasing awareness and understanding about the importance of handwashing with soap as an effective and affordable way to prevent diseases and save lives.

With support from USAID and Global Communities, the Ministry of Sanitation and Water Resources commemorated the day at Agbogloshie market. Located in the heart of Accra, the market is one of the city’s major trading centers and notorious for its unsanitary conditions. Madam Cecilia Dapaah, the Minister for Sanitation and Water Resources, and other speakers took the opportunity to drum home the importance of handwashing to market vendors, the majority of whom are food handlers. 

Students taking turns to demonstrate effective handwashing

 

Other speakers included Mr. Mohammed Adjei Sowah, the Chief Executive of Accra Metropolitan Assembly, as well as representatives from USAID and Global Communities. The Minister stressed on the need to “adopt the habit of automatic hand washing at critical times.” 

Kitchen staff and pupils at the Tema event

At the same time, a similar event was taking place at the Manhean Anglican Primary in Tema.  Dr. Nana A. Konadu Darko, the Senior Medical Officer of Manhean Health Center, reminded the school kitchen staff about the importance of hygiene in reducing the spread of infections.

Skit by Agbogbloshie market vendors

Both events featured skits and plays extolling the importance of handwashing and hygiene performed by vendors and students. In Agbogbloshie, Global Communities was recognized for its consistent supporter of handwashing promotion. In Tema the day culminated with a chorus of students singing a song about handwashing.

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.

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.

 

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.”


 

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