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Opinions of Friday, 15 May 2020

Columnist: D. C. Kwame Kwakye, Contributor

One toilet, one cedi: Assessing the open defecation situation in Ghana

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Excretion is part and parcel of human existence. Once anything enters the alimentary canal through the mouth, the remnants must be excreted through the anus or better still through unrination.

Thus, ever since mankind came into existence, the excretion of faecal matter is a natural occurrence and has been part of us. According to Britannica.com, defecation, also called bowel movement, is the act of eliminating solid or semisolid waste materials (faeces) from the digestive tract.

In human beings, wastes are usually removed once or twice daily, but the frequency can vary from several times daily to three times weekly and remain within normal limits. Muscular contractions (peristaltic waves) in the walls of the colon move faecal material through the digestive tract to the rectum. Where to do it and how it affects society has been managed by societies and has evolved as societies evolve.

For example, in a typical Ghanaian Akan society, a place for defecation is normally built at the outskirt of the community because of the stench that normally emanates from such places, and are generally divided into male and female portions. This act has been done ever since mankind came into existence and hasn't posed a threat to society until a social aberration set in where some sizeable members of society begun to defecate in the open with reckless abandon. The number of people who practice open defecation has gone up as the population of societies also increases and this is posing a health challenge and has a lot of negative effects on society.

The practice of defecating outside has possibly been part of human existence but the term "open defecation" became widely used in the water, sanitation, and hygiene (WASH) sector from about 2008 onward. This was due to the publications by the Joint Monitoring Programme for Water Supply and Sanitation (JMP) and the UN International Year of Sanitation (JMP, 2008). Indeed, with the advent of modern building architecture, with its socio-cultural practice, some people even built houses without incorporating a place of convenience in it.

Open defecation as explained by washdata.org "refers to the practise of defecating in fields, forests, bushes, bodies of water or other open spaces". Defecating in the open is an affront to dignity and risk to childrens nutrition and to community health. They do so because either they do not have a toilet at home or due to socio-cultural practices or is behavioural. Another definition according Prof. Mariwah is that "open defecation is the situation where people chose to ease themselves either along the beaches, in the bush, in gutters or behind their houses which is a consistent habit" (Kwakye, 2020).

From Prof. Mariwah's view, the consistency of the behaviour is what makes the social canker problematic. As to where it is done, either on the fields, in bushes, forests, ditches, streets, canals or other open space depends on the community and the available space that the inhabitants may find appropriate for this awkward practice.

I can vividly recollect when growing up and assisting my parents to do some peasant farming; any time one had the urge to attend to nature's call, you're reminded to dig a hole, ease yourself into and cover it up. This is what we were taught as children growing up in a forest community. To ease yourself in the open bushes without covering it up or urinate or defecate close to a water body was an abnormality and no one dares to do that. All this happened because there were no public toilets close the farm. We were made to understand that, uncovered or not properly disposed off toilet could find its way into streams and rivers that served as a source of drinking water in the community and for others downstream and the consequence of drinking water mixed with faecal matter wasn't pleasant. Everyone tried to act right, knowing very well that his/her actions and inactions impacted on the whole community.

As societies evolved, the communal living gave way for individualism and as such the toilet facilities provided for by the society gave way for household toilets. Modernity and individualistic thinking bred selfish house owners who either refused to provide toilet facilities in their homes or have converted those facilities into rental accommodation. This has degenerated and compounded open defecation situation which has now become a social canker even in urbanised communities like Accra, the nation's capital, Takoradi, Cape Coast, Kumasi etc.

Referencing the World Health Organization (WHO), report on June 14, 2019, 2 billion people did not have basic sanitation, and out of that number, 673 million still defecate in the open for example into open bodies of water, into drains, gutters etc. Also WHO/UNICEFs Joint Monitoring Programme report 2016/17, looking at the percentage of the population defecating in the open, ranked countries as follows:

Rank Value year
1. Niger 67.85 2017
2. Eritrea 67.0 2016
3. Chad 66.99 2017
4. Benin 53.83 2017
5. Solomon
Islands 53.69 2017
6. Namidia 48.71 2017
7. Togo 47.69 2017
8. Sao Tome
and Principe 47.43 2017
9. Burkina
Faso 46.67 2017
10. Madagascar 44.58 2017

From the above, more than half of the population of the first five countries ranked practice open defecation. Out of the first ten countries ranked, only two (Solomon Islands and Sao Tome and Principe) are outside the African continent. Almost all the countries affected by this canker are developing countries.

Ghana is ranked 33rd with 18.06 percent of the population as at 2017 practicing open defecation which is our lowest figure with our highest being 21.86 as at 2000. With this rank by WHO/UNICEF's Joint Monitoring Programme (JMP) for Water Supply and Sanitation, Ghana has an estimated 5.4 million people practicing open defecation based on an estimated population of about 30 million people, which is quite a substantial number.

More specifically, the 2018 Multiple Indicator Cluster Survey by the Ghana Statistical Service revealed that open defecation varies widely across the 10 regions, with the Upper East (67%), Northern (57%) and Upper West (52%) reporting the highest proportions, while the Eastern (7%), Greater Accra (8%), and Ashanti (11%) had the least (GSS, 2018).

Meanwhile, on the 19th of November, 2019 during the World Toilet Day, it was reported that inadequate sanitation is estimated to cause 432,000 diarrhoea deaths yearly. Additionally, the UN estimates that some 294,000 children under five years die each year from diarrhoea as a result of poor access to water, sanitation and hygiene. Open defecation is unhygienic and contaminates our water bodies and foods and no wonder our health bill is high. According to Prof. Mariwah "between 70-80% of all out-patient cases in all hospitals across our country are related to water, sanitation and hygiene". He said illnesses such as diarrhoea, dysentery, cholera and typhoid are all associated with open defecation and added that, "once you get cholera or typhoid it simply means you have eaten faeces (Kwakye, 2020).

Moreover, the Education Management Information System report 2018 further indicates that 30% and 49% of all basic public and private schools in Ghana lack access basic sanitation and water facilities. Between 2013 and 2018, the proportion of public basic schools with access to improved toilets increased by a paltry 5% from 60% to 65%. Within that same period, the figure for the private schools declined from 84% to 82%. This implies that, within the five-year period access to improved sanitation went up by just a percentage point from 69% to 70% (Hlordzi, 2019).

It is also important to note that 2 out of 5 basic schools do not have toilets and 3,600 Ghanaian children die every year from diarrhoea as a result of this situation". A household latrine or toilet gives children an opportunity to grow up in a healthy environment, to go to school and to live with the dignity they deserve, said by UNICEF Ghana Representative, Susan Namondo Ngongi.

It is therefore sad to noted that, after sixty-one (61) years of independence as at 2018, only 17% and 25% of rural and urban dwellers have access to basic sanitation including toilets respectively.

On the 24th January, 2017, from 3news.com and as published by Ghanaweb.com, the Chief Director of the Northern Regional Coordinating Council is reported to have said that Ghana has been ranked second in open defecation and that costs the country about $79 million dollars annually.

Buttressing the Northern Regional Coordinating Council Chief Director's points, a recent story titled "Sanitation issues cost Ghana over $290 million annually" and published on Ghanaweb.com, modernghana.com, radiocentralonline etc, Professor Simon Mariwah who is the Director of the Institute for Oil and Gas Studies at the University of Cape Coast as well as a Health and Development Geographer with research interests in Sanitation, Waste Management, Health Behaviours and Livelihoods is reported to have underscored that "sanitation issues cost Ghana over $290 million cedis annually and over 18% of the Ghanaian population defecate outside which equates to about 5.4 million of the Ghanaian population, estimated at 30 million" (Kwakye, 2020).

In seeking the reasons underlying open defecation, Prof. Mariwah explained that, the causes of open defecation have cultural, social, spiritual and some economic dimensions to it. He said "culturally within the Akan system toilets were normally built on the outskirts of town and as such people built houses without incorporating toilet facilities into them". He also added that in some jurisdictions people would defecate outside even if you provide them with toilet facilities.

Economically, he revealed that "some members of society are poor and cannot afford public toilets but was quick to add that those ones are very few and, in the minority, and most persons who practise open defecation do so because it is an attitudinal problem". On the spiritual angle, he said research has shown that in some parts of Northern Ghana, some people think that defecating in an "enclosed area will strip them of their magical powers and that such individuals would never use toilets no matter the public education that they receive’ (Kwakye, 2020).

With the above reasons why people defecate openly, officials in some District Assemblies have expressed worry over the trend and are warning and taking steps to address the problem. In a presentation to launch the Basic Sanitation Fund in Ashiaman on Tuesday, the Municipal Environmental Officer, Mr Patrick Tsigbey indicated that, from 2014 to 2017, the rate of open defecation in urban areas had increased from 8 per cent to 11 percent adding that many people were engaged in open defecation (businessghana.com, 2018).

This, in the writer's view, is as a result of the kind of charges that one would have to pay at the various public toilet facilities in most urban areas of Ghana. A cursory research conducted on how much is charged when one visits public toilet in Ghana ranges from ¢20 pesewas, to ¢1.00 depending on the location of toilet facilities available. For example at Akyem Oda old town, public toilet providers charge ¢20 pesewas whiles ¢1.00 is charged at the new town main lorry station.

In Cape Coast, Tantri lorry station public toilet charges ¢50 pesewas while a private toilet facility behind the defunct Shell Filling station at Tantri also charges ¢50 pesewas for water closet and ¢20 pesewas for KVIP. But interestingly, one of the areas where open defecation is endemic in the Cape Coast Metropolitan Area is along the coast and Brofoyedur is one of such communities and the charge for public toilet is ¢30 pesewas per head as of 2020. Thus, between 2018-2020 the charge for public toilet has been between 20 pesewas and one cedi.

Assuming without admitting that open defecation has a cultural element, how come it's still a problem in the 21st century across the world and in Ghana? Taking into consideration the prices quoted above, how do we expect poor households to be able to finance just attending to nature’s call? Assuming one has a family of five, it means such a family would have to spend a minimum of ¢1.00 and ¢5.00 on toilet fees if it's ¢20 pesewas and ¢1.00 per head respectively.

The social good that these public toilets must offer is being eroded possibly for two main reasons: One, the inability or unwillingness of people to pay and two, the perceived enjoyment of fresh air should they decide to do it in an open space.

What I propose can be done to help curb this socially deviant behaviour are the following:

1. The provision of clean and adequate public toilets that are affordable.

2. Governments must initiate policy that compels house owners to provide toilet facilities for houses that don't have and persecute same if they fail.

3. Education and sanctions can be applied to recalcitrant members of society.

With reference to the second point, government through the District assemblies is implementing such measures. An example is reported by 3news.com with the caption "Court jails 11 people 30 days each for open defecation, public urination". The story went on to state that, eleven persons in Accra have been sentenced to 30 days each in prison for engaging in open defecation, urinating in public and indiscriminate dumping of refuse.

The 11, who were arrested by the Accra Metropolitan Assembly on Wednesday, May 30, were convicted on their own guilty plea at the Adjaben Magistrate Court and were accordingly sentenced by the magistrate, Isaac Addo the same day (Ghanaweb, 2018).

Until such drastic actions are taken by government and sustained, winning the war against open defecation would be very daunting and debar governments from attaining some of the Sustainable Development Goals (SDGs), such as those one "Good health and well-being” as well as water, sanitation and hygiene.

Whether open defecation is a cultural, spiritual or attitudinal issue or not, we must either eradicate or reduce its occurrence to the barest minimum. The earlier something is done the better for our country, continent and the world at large.