TELLING OUR STORY

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

  Night fumigation at Agbogbloshie market

At the same time, of of the girls amongst them hid behind a tree, partly rooted in the river, relieving herself with the urine trickling into the same river. In that very river they washed their sugarcane to eat.

Similar stories can be told of other suburbs in the Greater Accra region. It is no surprise the region was hardest hit with cholera in 2014, recording about five thousand cases and 45 deaths as at August that year.

Fortunately, since September 2016, the Region has not recorded any cholera case and no chance is being taken, thanks to the collaborative effort of Global Communities and sector players, with funding from USAID.

Owing to the partnership of Global Communities, Ghana Health Service, Environmental Health and Sanitation Directorate and the Red Cross Society, the 2014 outbreak was managed and ameliorated nationwide. Interventions were intensified through to 2016 and still underway.

The preventive measures adopted with support from the American people, USAID, as part of the WASH for Urban Poor (WASH-UP) WASH for Health Projects are: House-to-house education on cholera, distribution of Aquatabs (a brand of chlorine tablets for purifying 20 liters of water per tablet within 30 minutes of application), disinfection of cholera-prone communities, distribution of Behaviour Change Communication (BCC) materials, as well as radio and television spots.

Almost two years down the lane these interventions have proven sustainable since residents in the cholera prone areas are gradually adopting hygienic lifestyles. Global Communities is looking forward to a cholera-free Accra for two years in a row!

Currently, cholera prevention activities are carried out under the WASH for Health project initiated in 2015 and being implemented varied communities in 30 districts in five (Greater Accra, Central, Western, Northern and Volta) regions of Ghana.

Cholera is a bacterial disease caused by Vibrio Cholerae commonly transmitted through contaminated water to victims. Cholera can be fatal, snuffing lives out of victims, especially women and children, within hours as a result of dehydration caused by diarrhoea and vomiting. Though curable, preventive measures such as cleanliness of environment, purification of water for drinking and cooking, and proper hand washing at critical times of the day (after visiting the toilet, before and after eating) are preferable and sustainable options for nipping cholera in the bud.  

Community-Led Total Sanitation (CLTS) has drastically improved sanitation and hygiene in Ghana’s Zangu-Vuga community.  Prior to the USAID-funded WASH for Health Project, basic sanitation was a formidable challenge, as there were no household or communal latrines in the area. Community members typically practiced open defecation and disposed of refuse indiscriminately. Stagnant waste water created ‘mini ponds’ behind bath houses, which served as breeding grounds for mosquitos and flies.  This produced a terrible stench and limited community members’ ability to sell food outside their homes.

Azindoo Tongo Yidana, commonly called Chief Tidoro, is a 34-year-old man with five children in a polygamous family of 16 people. He and his two wives were born and raised in Zangu-Vuga. Like other families in the community, Chief Tidoro and his family are peasant farmers and cultivate maize around their house, but he admits that “we are not able to eat roasted maize (Kawan sheira), and harvesting becomes difficult as a result of feces.” Open defecation has also caused significant other problems for his family; as he explained: “The bad smell and awful sights surrounding the house made us feel lazy to harvest or even roast the maize. Health challenges such as cholera, stomach pains, diarrhea and others were common in the family. The elders in the house used to expose themselves to people by defecating in bushes and [other] open places.”

Then, in June 2017, through the WASH for Health Project, Global Communities sent a five- member team of interns from Ghana’s University for Development Studies to the Zangu-Vuga Community. For two weeks, the interns worked with the community to update action plans and develop community maps to help visually identify places where members cook, relax, eat, and practice open defecation. Action plans reinforced efforts for households to construct their own latrines, and taught the importance of Tippy Taps (simple, cost-effective handwashing stations), Soak Away Pits (large pits that accumulate waste water and keep the community clean) and healthy hygiene behaviors.

The interns organized an initial community meeting at the chief palace, where many people, including the Chief Tidoro, elders and other community members were present. Participants were divided into two groups: people who owned a household latrine and people who did not. Though Chief Tidoro was a highly esteemed community member, he was grouped among people who did not own a latrine. He felt ashamed that he advocated against open defecation practices, but did not own a latrine himself. Chief Tidoro was receptive to the sanitation messaged relayed by Global Communities, and was so inspired and motivated that he completed digging a pit for his own household latrine the very next day. And, within one week, he had a beautifully painted improved latrine with a functional Tippy Tap attached.

The Chief happily reported, “My wives no longer complain of flies when selling food outside the house. We now harvest and eat roasted maize without worrying about feces. We don’t deal with bad sanitation and hygiene-related illness in the family anymore. Our image and dignity is now intact as we no longer have to expose ourselves in bushes and open places.”

Chief Tidoro has truly proven that ‘leadership by example’ can change lives. By practicing healthy sanitation behaviors and properly disposing of refuse, Chief Tidoro and his family have served as a positive example for the Zangu-Vuga community. 

Dorcas proudly stands outside her constructed toilet

“When we were using public toilets, our community members suffered many health issues. Strong chemicals were used inside the toilet facility to try to keep it clean and free of infection. These chemicals were often dangerous to women’s health,” said Iliasu, a recipient of a Biofill toilet under the Water, Sanitation and Hygiene (WASH) for Health project in Ghana. “I am so grateful for these toilets; we just don’t know how to thank you.”

With support from USAID under the WASH for Health Project, and thanks to Global Communities’ partnership with Coca-Cola’s Water and Development Alliance (WADA), the construction of close to 100 water closet and Biofil toilets was successful in two peri-urban Ghanaian communities: Anyaa, just outside of Ghana’s capital Accra, and Apowa, outside of Takoradi. The project focuses on peri-urban and urban communities which were selected in partnership with the Metropolitan, Municipal and District Assemblies (MMDAs)—criteria for household participation include their access to land and their ability and evidence to pay a contribution of the toilet construction costs. Additionally, female-headed households and those with widows/ widowers are prioritized, as are landlord/landladies with water-related small businesses. Households registered by Global Communities were introduced to financial institutions as a support mechanism.

To reinforce a household’s investment in the construction of their toilet, families are required to contribute 60 percent of the cost (the amount ranges between $350 and $720) of the toilet of their choice to the process, while WASH for Health contributes the remaining balance of 40 percent ($285 - $480). It can take time to mobilize households and explain the benefits of owning a household toilet, let alone the time it takes to collect enough funds for construction. But through Global Communities’ continued financial support and effective behavioural change communication (BCC) campaign, progress has been made steadily and since the beginning of the project in March 2017, 95 toilets have already been constructed in both Anyaa and Apowa.

“We are happy and feeling very good!” Iliasu says. Before the WADA/Global Communities toilet intervention, his compound, housing 20 people, had to pay GHC 0.50 per person to use a public toilet 3-4 times a day. According to Iliasu, if someone had an upset stomach then they were out of luck– they would have to wait in a long queue for their turn. Iliasu and his friend, Issaka, happily report that with their new household toilet, “Using the toilet now is free. It doesn’t smell. It took less than one hour to construct. And best of all, we save water and money!”

Global Communities’ contribution towards the construction of water closets and Biofil toilets has greatly improved the sanitation and wellbeing of 750 people in Anyaa. Lila, a beneficiary who runs a primary school in Anyaa, learned of the project and pushed for the construction of two new toilets at her school. Before the project, Lila had actively but unsuccessfully sought ways to construct toilets for her 95 students – but the cost of the project was simply too expensive. A previous budget Lila was given for constructing one toilet would cost her more than GHC 10,000 (approximately $2,000) - an offer she said was “simply not an option.” With the support of Global Communities, Lila was able to construct two toilets for only GHC 4,000 (approximately $900), which to her was a shock, and it took under four hours to build. ‘‘I thought it would take days,” she said.

To further promote healthy sanitary practices throughout the country, Global Communities’ fundamental message to these communities is to practice good hygiene behaviours. These include the importance of hand-washing with soap under running water before eating and after defecating, and the appropriate care and maintenance of the facilities. Communities in Accra and Takoradi have successfully adopted these behaviours and are actively implementing and promoting them. “We use a portable sink to wash our hands with water we fetch from the well. Every two weeks, Rosina, the Project Lead, checks in with us. She teaches us how to wash our hands correctly, how to maintain and flush our toilet, how to keep it neat and clean, and it leaves us feeling very good,” reports Iliasu.

The enthusiasm and excitement regarding household toilets has generated so much interest in their communities that 25 more households in Anyaa have committed to constructing toilets in the next three months. One avid supporter is Lila who has been promoting the toilets around town - “The obvious economical and sanitary benefits speak for itself,” she explained. “Friends and strangers who heard about the project have called me from regions outside of Accra inquiring about the process of acquiring a toilet.” Lila’s eloquence and enthusiasm in advocating for toilets is truly motivational: “Everyone should have one. Let’s spread the word!”

ABOUT CLTS: Community Led Total Sanitation (CLTS) is a basic sanitation approach that has been adopted to help combat open  defecation in Ghana.

How it works: the approach is used to mobilise communities to completely eliminate open defecation. Communities are then facilitated to conduct their own assessment and analysis of open defecation (OD) and take their own action to become ODF (open defecation free).

Since its introduction 2010 in the Country, the number of organisations implementing CLTS has increased, these organisations include Global Communities, Plan Ghana SNV, RING, WaterAid, Catholic Relief Services, Care International, World Vision etc. Reports indicates that the implementation had moved from 300 communities in 3 regions to 5,000 communities in 9 regions in 2015.

While the approach has successfully been implemented in some districts there still remains some challenges that need to be addressed.

Pupil uses a tippy-tap in Asikuma Bremang

Imagine saving 5,000 lives. This is one of many things that the Government of Ghana and its non-profit and private-sector partners hope to accomplish by promoting improved water, sanitation and hygiene behaviors, like handwashing. According to UNICEF, more than 10,000 children in Ghana die each year from preventable diseases like diarrhea and pneumonia.

To address these challenges, Global Communities encourages the construction of tippy taps or other handwashing stations. The United States Agency for International Development Water, Sanitation and Hygiene program (USAID WASH for Health) has worked with communities to construct 5,331 tippy taps throughout Ghana, and provided over 200 Veronica Buckets (or mini handwashing stations) to institutions last year alone.  Tippy taps and Veronica Buckets are a simple and effective solution to handwashing in areas where there is no running water. These efforts reinforce healthy handwashing behaviors after using the latrine and at other critical times in the day.

Demonstating handwashing using facilities donated
by USAID WASH for Health Project

The simple act of hand washing can reduce preventable diseases by up to 50 percent. The challenge is that less than 15 percent of Ghanaian households have hand washing facilities. At the same time, only 20 percent of Ghanaians have access to a toilet, meaning that the majority of the population is forced to practice open defecation resulting in the further spread of hygiene-related diseases.

These are dual challenges. One is the lack of physical equipment and materials needed for adequate sanitation facilities. The other is instilling the knowledge and behaviors that encourage people to adopt improved hygiene practices.

For two years, Global Communities worked with government officials and WASH sector stakeholders to research, analyze and design a comprehensive behavior change communication (BCC) package that contains a broad range of materials from instruction manuals to games and radio dramas that educate people on the importance of safer hygiene behaviors. Since introducing the package, in June 2017 at the Innovation at Work: Sustainable Sanitation Hygiene Technologies and Resources event in Accra, over 599 people have been trained on how to utilize the materials. The key messages include the importance of washing hands with soap under running water before eating and after defecating; the proper treatment, storage and retrieval of drinking water; and installing, using, and maintaining latrine. The roll-out of the new BCC materials is being combined with the promotion of the Digni-Loo.

The comprehensive education package, combined with affordable and easy-to-install handwashing stations aim to reinforce key healthy behaviors, improve health and sanitation outcomes throughout the country, and ultimately reduce preventable deaths and illness.

These efforts are being undertaken as part of the USAID WASH for Health program, a five-year initiative which aims to expand water and sanitation access and improve key hygiene behaviors in 30 districts in five regions of Ghana.

 

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