Five million Ghanaians among global 1.1b people who defecate openly

Accra, the capital of  of Ghana, is a city widely known for its very modern infrastructure, which includes beautiful architecture, a very good road network and flyovers, including the recent but famed George Walker Bush Motorway, which stretches from the Tetteh Quarshie Roundabout to Mallam junction.

The city also boasts of a very modern international airport, the Kotoka International Airport which handles an average of about 4,888 passengers on a daily basis, if the total of 1.784 million passengers who went through the airport in 2011 is anything to go by (By 2013 it is expected that expansion works will increase the annual passenger population to 5.2 million).

Adding to the city’s attractions are plush residential areas such as Trasaaco estates, Manet estates, East and West Legon, Roman Ridge, Ridge, Dzorwulu, Cantonments and Labone, just to mention a few.

Indeed, it is not only the infrastructure of Accra that visitors to the capital and first timers to Ghana admire, but the country’s warm people and tasty and spicy cuisine. Many nationals experience a ‘love at first taste’ relationship with most Ghanaian dishes.

Open defecation practiced with careless abandon

However, what may shock many visitors to Ghana, especially those from the Diaspora, is the awful sight of able-bodied men and women as well as children busily defecating along some of the country’s beautiful beaches, inside big drains and at dump sites, especially in the mornings and at dusk, mostly in the capital cities of the 10 regions, including the administrative and commercial capital – Accra.

Rural folks also indulge in open defecation, albeit in bushes at the outskirts of their communities and along footpaths for those afraid to venture deep into the bush for fear of being bitten by a reptile or attacked by wild animals or fellow humans.

In fact, during a recent encounter with an indigene of a community in the Northern Region of Ghana where open defecation is rife – Tindang Peliga, Madam Ayishetu Kofi, the women’s leader, said “Whenever we go to the bush we are exposed to danger from both snakes and men.”

Current statistics from a 2008 assessment by the Water and Sanitation Monitoring Platform (WSMP), Ghana, indicates that about five million Ghanaians defecate openly daily, with the Upper East Region topping with 81.9%, followed by Upper West with 78.7%.

That is what happens on a daily basis in Ghana according to available statistics and the country will need to build a million toilets to curb the practice.

The Northern Region of the country is listed as having the third highest open defecation rate in Ghana at 72.9%, meaning about 73 out of every 100 persons openly ease themselves on a daily basis.

The Central Region is the fourth highest on the table with 18.1% and Volta Region fifth with 13.8%.

Placing sixth is the Western Region with 12.8%; Greater Accra, seventh with 8.1%; Brong Ahafo, eighth with 6.4%; Eastern Region, ninth with 5.5%, and Ashanti Region, tenth and the lowest, with 3.4%.

Confirming the number of Ghanaians who defecate daily, is a desk study released by the World Bank’s Water and Sanitation Programme (WSP) on April 17, 2012.

According to the study, 4.8 million Ghanaians have no latrine at all and defecate in the open, and that the poorest quintile (20% of the population) is 22 times more likely to practice open defection than the richest.

This figure however represents just a fraction of a total of 1.1 billion people worldwide who defecate daily because they do not have access to any form of toilet facility.

Top 12 countries that practice open defecation

India leads the pack of top 12 countries of the world that account for almost three-quarters of the people who practice open defecation.

Also referred to as the world’s headquarters for open defecation, 626 million of the Asian populous state has more than twice the number of the next 18 countries combined; accounts for 90 per cent of the 692 million people in South Asia who practice open defecation and accounts for 59 per cent of the 1.1 billion people in the world who practice open defecation.

They are followed by Indonesia with 63 million doing open defecation, Pakistan  with 40 million, Ethiopia  with 38 million and Nigeria with 34 million engaging in open defecation.

Sudan is sixth on the chart with 19 million having no access to toilets, followed by Nepal with 15 million of its people without access to toilets,

then China in eighth position with 14 million, Niger at ninth place with 12 million, Burkina Faso at 10th with 9.7 million, Mozambique at 11th with 9.5 million without access to any form of toilets and Cambodia 12th with 8.6 million without toilet access.

Interestingly however, although according to the World Health Organisation (WHO) 23 countries practicing open defecation have shown a marked improvement from 1990 to 2006 with Nepal leading, having moved from 84 percent to 50 percent over the period and hence a 34 percent decrease, Ghana is nowhere on the table.

Ghana’s economic loses

The WSP study states further, that Ghana’s economy loses GH¢ 420 million ($290 million, 1.6 percent of GDP) each year, due to poor sanitation.

Titled “Economic Impacts of Poor Sanitation in Africa – Ghana”, the desk study found that the majority (74 percent) of the costs come from the annual premature death of 19,000 Ghanaians from diarrhoea, including 5,100 children under the age of five, nearly 90 percent of which is directly attributable to poor water, sanitation, and hygiene.

Health-related costs accounted for nearly 19 percent of the total economic costs, while access time and productivity losses accounted for about seven  percent.

In his reaction to the figures, Yolande Coombes, Senior Water and Sanitation Specialist with WSP, stated “We’ve known for some time about the impact of poor sanitation on health, but this is one of the first studies to quantify the annual costs incurred because of poor sanitation,” adding “Ghana will not be able to grow sustainably without addressing these costs”.

Quoting from the Rural Sanitation Model and Strategy (R-SMS) of Ghana, the Coalition of NGOs in Water and Sanitation (CONIWAS), says the strategy estimates that open defecation alone costs Ghana $79 million annually, and that $215 million is lost each year to premature deaths emanating from diarrheal diseases – a direct consequence of the poor WASH situation.

Other scary figures attributable to poor WASH, according to the R-SMS, are that $1.5 million is lost due to productivity losses while sick or accessing healthcare and $54 million spent each year on health care.

Economic impacts of poor sanitation in Africa

But Ghana is not alone in economic loses. In its key messages, the World Bank study shows that open defecation alone accounts for almost $2 billion in annual losses in 18 African countries which will require a total of 23,305,000 (23.3 million) toilets to curb the practice.

The countries analysed are Benin, Burkina Faso, Chad, Central African Republic, Democratic Republic of Congo, Ghana, Kenya, Republic of Congo, Liberia, Madagascar, Mauritania, Mozambique, Niger, Nigeria, Rwanda, Tanzania, Uganda, and Zambia.

“More than 114 million people still defecate in the open in the 18 countries analysed; this is about half the number of people on the continent who have no latrine at all and defecate in the open and almost 24% of the total population in the countries surveyed.”
“Eliminating the practice of open defecation in these countries would require about 23 million toilets to be built and used,” the report states.

Adding that open defecation costs more per person than any other type of unimproved sanitation, the report indicates further: “Each person without access to a toilet can spend up to 2.5 days a year finding a private location to defecate, resulting in losses totalling almost US$ 500 million in access time annually due to open defecation for the 18 countries surveyed.

The study also points out that “Women shoulder a huge proportion of this cost, as they spend additional time accompanying young children or sick or elderly relatives to relieve themselves, as well as time spent finding a safe place for urination.

The burden of poor sanitation falls disproportionately on the poor. “In all countries, the poorest people are more likely to practice open defecation than the wealthiest people”,
“The poorest people have to pay disproportionately more for the negative effects of poor sanitation,” the study says.

Open defecation in Mumbai India

The study further discloses that the 18 African countries investigated, annually lose about $5.5 billion due to poor sanitation.

“These countries account for 448 million people, which is almost half of Africa’s population; “The annual economic losses due to poor sanitation are equivalent to between 1% and 2.5% of GDP,” according to the study.

It however states that “The true cost could be much higher: these analyses only deal with losses due to premature deaths, healthcare costs, losses in productivity, and time lost through the practice of open defecation.”

“Other impacts of inadequate sanitation likely to be significant, but difficult and expensive to estimate and therefore not included, include the costs of epidemic outbreaks; losses in trade and tourism revenue; impact of unsafe excreta disposal on water resources; and the long-term effects of poor sanitation on early childhood development,” says the study.

Lack of investments in sanitation

Meanwhile, in most countries, current investments in sanitation are less than 0.1% of GDP, according to available figures.

Additionally, “According to the 2011 eThekwini commitments monitoring carried out by countries, currently only five of the 18 countries analysed invest more than 0.1% of GDP in sanitation, while most countries invest less than 0.1% of GDP,” the report indicates.

It says “Although African countries committed to increase their budgetary allocations for sanitation to at least 0.5% of GDP (eThekwini Declaration, 2008), none of the 18 countries surveyed has reached that target yet.

These findings make a strong case for increased investments in sanitation, increased attention to the bottlenecks constraining delivery of sanitation services, specific pro-poor policies, and the elimination of open defecation, the World Bank desk study recommends.

Why people openly defecate

In a bid to find out why people openly defecate despite the shame associated with exposure during the act, the Ghana Watsan Journalists Network (GWJN) in 2010 embarked on a year-long campaign dubbed “Drop it in a hole”, during which some notorious sites noted for open defecation were visited and interviews conducted.

60-year-old Harisu Mohammed explained that there is no toilet facility where he lives and the nearest public facility is about 30 minutes walk from the compound house he shares with many other tenants, hence his resort to the open storm drain every day on his way to work.

For his part, 31-year-old Kweku Nyarko an apprentice driver who had also just finished emptying his bowels inside the same open storm drain just behind a very popular hotel, said his main reason was the lack of access to a facility in his rented residence.

He said he lives in Kokomlemle, a suburb of Accra with about 40 tenants but with no toilet facility with the nearest public toilet about seven minutes walk from where he lives.

“It is more convenient to do it in the gutter and a large number of my colleagues do the same and when we have stomach upset we defecate into black polythene backs and throw them into the drain,” he said.

Any hope in sight?

In an exclusive interview with a Programmes Officer of the Environmental Health and Sanitation Directorate (EHSD), Mr. Kweku Quansah at the fringes of the recently held national durbar in Accra to commemorate Global Handwashing Day,  he said in order to tackle the issue of open defecation in Ghana, the media must be used to educate the populace.

“For me the way forward is to critically look at mass media campaigns and one-on-one campaigns, adding it to what we call community-led total sanitation.”

“Within the embodiment of community led total sanitation we have behaviour change, where we lead people to appreciate that there is the need to stop open defecation, and I can assure you, open defecation is so dangerous that 5,100 Ghanaian children die every year as a result of people eating faeces and getting diarrhoea etc,” he added.

Mr. Kweku Quansah, who was so full of praise for the people of the Upper West Region of Ghana where open defecation is rife, for taking the initiative to build household latrines through community-led total sanitation, urged the media to join in the crusade against open defecation, since it is one sure way of curbing the menace.

For urban areas though, he urged city authorities to enforce the sanitation by-laws, especially that which makes it mandatory for house owners and landlords to include toilets in their buildings.

“In the bigger cities, our building regulations tell us that if you build a house you should provide latrine, therefore there is the need for us to enforce those regulations,” he stressed.

Sanitation is a human right

The United Nations for instance, maintains that the majority of the world’s 1.1 billion people who practice open defecation are living in rural areas, and because they have no private place to defecate and urinate; they use fields and bushes, ditches or railway tracks, or simply a plastic bag.

For them, sanitation is about dignity and ultimately human rights, the UN body states.

In 2010, the UN General Assembly recognised sanitation and water as a human right, essential to the full enjoyment of life and all other human rights. This breakthrough decision not only provides a major argument to all those sanitation advocates; it constitutes an important step towards turning these rights into a reality for everyone.

The human rights approach is particularly concerned with the people who do not have access to safe sanitation. It looks at the reasons why, and tries to find ways to overcome those barriers. It seeks to address inequalities by targeting the most vulnerable, such as women, children, people with disabilities, the chronically ill or the poorest of the poor.

Governments that have recognised the right to sanitation have, by doing so, signed up to establishing a plan of action and agreed to take concrete steps to ensure that, over time, all people gain access to sanitation – this is known as “progressive realisation”, says the UN.

If the world is really serious about turning this right into a reality, though, more, and concerted action is needed. Not only politicians, but also businesses, donors, development agencies, NGOs, media and communities will need to redouble their commitments and efforts, the world body maintains.

The way forward

Perhaps a statement by Catarina de Albuquerque, UN Special Rapporteur on the right to safe drinking water and sanitation in 2011 that “ Ensuring access to sanitation for all, which is safe, affordable, acceptable and sufficient, requires multiple interventions from different stakeholders, leadership, an enabling environment, and an engaged population willing and able to claim their rights,” needs to be considered, if the canker of open defecation in Ghana, Africa and the world is to be dealt a severe blow.

For after all, as great Indian Leader Mahatma Gandhi said in 1925, “ Sanitation is more important than independence.”

By Edmund Smith-Asante on special assignment for

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