“We used to defecate just anywhere in the bushes around us and we saw nothing wrong with that practice,” explained Kujo Bekui Agboza, a resident of Bekuikope, a small farming community in the Adaklu district of the Volta region in eastern Ghana. Like many communities in the region, the residents used to practice open defecation. According to the UN, 19 percent of the population still practices open defecation—a major health risk in Ghana, especially among children and other vulnerable groups.

For the residents of Bekuikope, it was a long, hard journey of consistent practice and behavioral change, but they are now proud to be deemed a ‘Sanitized Community.’ The residents of Bekuikope were assisted along their journey by Global Communities, who began working with the community as part of the USAID WASH for Health project. Global Communities worked with residents to implement a process called Community Led Total Sanitation (CLTS), an approach which has been used to educate communities and help eliminate open defecation around the world.

It takes a lot of communal effort and resolve to achieve the status of a Sanitized Community. A community must first attain what is known as Open Defecation Free (ODF)-Basic status. Then progress to ODF status and then to a Sanitized Community. Ultimately, a community can be certified as a Sustainable Sanitized Community.

A community practicing open defecation is declared ODF-Basic, when there is no visible fecal matter in the entire community for a period of two months. After four months of being ODF-Basic, the community can be declared ODF if at least 80 percent of households can show they have latrines and handwashing facilities. After six months of being ODF, if all households have access to improved latrines with hand washing facilities and all residents are demonstrating proper management of refuse and waste water and good hygiene practices, a community is declared sanitized by a regional verification body. Finally, a community is declared a Sustainable Sanitized Community when it has sustained its sanitized status for three successive years.

The residents acknowledged that it was very difficult during the initial stages because they were not used to the proper sanitation and hygiene behaviors. They also did realize the health implications of open defecation until it was explained to them in a way that demonstrated the path of contamination between open feces and food. Once they understood the fecal-oral transmission of disease, the residents agreed to collectively end the practice of open defecation. This is a process called ‘triggering’—a participatory approach of outlining the negative effects of open defecation with the aim of influencing communities to stop the practice. Kujo was so motivated the process that he enlisted to become a ‘Natural Leader’ in Bekuikope. Natural Leaders are volunteers from the community who are trained in CLTS to help drive the process forward. Kujo recalls how the residents of Bekuikope came together to make their success possible. “We did not hesitate to collectively construct household latrines. We worked together, moving from one house to another, to construct these latrines and rid ourselves of improper hygiene and sanitation practices. But it was fun and interesting,” he explained.

The community has also witnessed health benefits since they started practicing proper hygiene and sanitation behaviors. Nana Dorgah, a mother of six, noted that the incidence of diarrhea, especially among children, has significantly gone down since the start of the USAID WASH for Health project. “Personally, I have not utilized my health insurance for close to two years,” she said.

As a result of the health benefits and the community prestige and pride that comes with ODF status, the residents of Bekuikope were motivated to go the extra mile. “During the celebration of our ODF status, we were told we could progress further if we desired to. At that time there wasn’t much work to be done, so we consulted the CLTS team on how to safely keep our animals and manage their fecal matter. We were also taught how to treat, store and retrieve the dug-out water for drinking in the dry season,” explains Favor Abbey, a Natural Leader and mother of five.

The community, with technical support from the Global Communities, crafted pens for their domestic animals. They also constructed barriers around their community water source to protect it from run-off and other contaminants. Maintenance of latrines and handwashing stations by all households remains a daily activity and the community has also begun digging new holding pits for new latrines since the current ones are becoming full.

Kujo, on behalf of the community firmly resolves that “We will continue using our facilities well and continue to project our community in the district. Knowing we are one of the few communities in the entire region to achieve this feat. We the people of Bekuikope, will not relent in our effort to attain the Sustainable Sanitized status!”

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.

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. 

“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!”