CLTS concept, an effective tool for curbing Open Defecation in Northern Ghana

Feature by Samuel Adadi Akapule

One major problem confronting the three northern Regions is Open Defecation (OD), also known as “free range”.

Why would one identify this as a problem? In fact, it is a problem because of the health implications associated with the practice.

Not only are people affected by diseases such as typhoid, diarrhea, cholera, and other infectious diseases as a result of indiscriminate faecal deposits, It is equally important to note that the aforementioned regions are not only plagued with the practice of OD but in terms of sanitation in general these regions are not living up to expectation. If the trend is not checked and changed now, it may affect Ghana’s efforts at achieving the Millennium Development Goals (MDGs) on Sanitation. For instance, in the Upper East Region, available statistics shows that only 10 per cent of the population has access to improved sanitation. This means that a large number of the population practice open defecation. Data available further reveal that in the Upper East Region 90 per cent of the population are practicing open defecation whilst 72 per cent of the population in Upper West Region is also into the practice. This trend, experts have described as an unhealthy situation.

Although data collected reveal that portable water is satisfactory in these areas, its safety is eroded by the non-availability of latrines or non latrine coverage in households and communities.

This is even made worse by the fact that soap for hand washing is only available in 46 per cent of households. Since it has serious bearing on the health of the population, it is worth mentioning that at least 78.3 per cent of the population use improved water. However the population that has access to both improved water and improved sanitation is 2.7 per cent. It is not surprising that in 2012 the Upper East Region topped the national figures in open defecation, otherwise known as “free range”, with a score of about 82 per cent; a situation International Non-governmental Organizations expressed worry about. In addition, data on improved sanitation coverage also in 2012 put the Region close to the bottom, scoring it at 18 per cent and putting the Upper West Region at the bottom with a 17 per cent score.

The Country Director of the United Nations Children’s Fund (UNICEF) at the time, Dr Iyabo Olusanmi disclosed this when she paid a courtesy call on the then Upper East Regional Minister, Mr. Mark Woyongo in Bolgatanga. At that time she called on the district assemblies in the region to be proactive and to ensure that all hands were on deck to encourage the people to make sanitation their priority.

The above scenario about the Upper East Region is not all that different from the remaining two regions; the Upper West and Northern Regions. It is in line with this that Government through some development partners have initiated a number of interventions including building toilets for communities to be used or supporting them with subsidy to build latrines in the households. All these interventions one way or the other failed to achieve the purpose.

Many people refuse putting into good use public toilets built for them to use. Others for reasons best known to them collected subsidies from government to put up latrines in the households but never did so and monies have not been recouped by these assemblies. In 2010 the Government of Ghana in collaboration with UNICEF revised the strategy by adopting what is called “Community Led Total Sanitation” (CLTS ) which was piloted in five districts including the Bongo, Bawku, Garu , Kassena-Nankana West and Builsa Districts .

Under the CLTS, communities were and are still trained and equipped with technology to use local materials at the community level to build household latrines. They are also triggered to understand thoroughly the health hazards of bad sanitation practices and to help them initiate their own methodology which is convenient in the management of good sanitation practices.

Since the inception of the CLTS concept in the Upper East Region, 332 communities have been triggered, with a total number of 8,206 houses. Out of the 332 communities, 212 of them had stopped open defecation. This is because, out of the 8,206 houses, 2,396 of them have latrines. There are also 534 soak away pits and 930 hand washing facilities attached to these latrines. Even though most of these communities were triggered in late 2012 and early 2013, they have made significant impact with regards to sanitation. Diseases such as typhoid, cholera, diarrhea, and other diseases associated with sanitation have reduced drastically in the piloted communities.

Motivated by the success story of the CLTS in the piloted communities, UNICEF and the MLGRD brought the originator of the concept, Dr Kamal Kar from India to facilitate a five-day training workshop on the CLTS at Bolgatanga, the Upper East Regional capital. About 160 stakeholders drawn from the Upper East and Upper West Regions attended the five-day training programme aimed at empowering the regions to tackle the issues of sanitation particularly that of OD. The training programme which was under the theme” Scaling –Up CLTS –Making Upper East Region and Upper West Region Open Defecation Free (ODF), organised by the Ministry of Local Government and Rural Development(MLGRD) and sponsored by UNICEF with technical assistance from CLTS Foundation Global, Kolkata , Indian attracted the participants from the Ghana Education Service , Community Development, Water and Sanitation Agency, Ghana Health Service, NGOs among others. At the close of the five day training workshop, all the 13 Districts from the Upper East and 11Districts in the Upper West Regions pledged to work harder to declare their Districts Open Defecation Free (ODF) by the close of 2014. The Stakeholders including some political heads such as Municipal and District Chief Executives made a political commitment to that effect.

Speaking to this writer in an interview, the Deputy Upper East Regional Environmental Health Officer, Mr Cletus Asamani explained that the concept where Government built toilets for communities and gave them support to build were no longer working, hence the introduction of the CLTS .

He disclosed that the programme which was piloted in five Districts in the Upper East Region including the Bongo, Bawku, Garu , Kassena-Nankana West and Builsa Districts in the region in 2010 with support from UNICEF had yielded positive impact in terms of health needs. Mr Asamanni said out of the 333 communities that were selected from the five Districts for piloting, 212 had stopped practicing OD and had constructed their own toilets using local materials hence reducing diseases such as typhoid, and diarrhea among others. UNICEF and the MLGRD, he noted, were motivated by this effort and that led to the bringing of the originator of the concept, Dr Kamal Kar from India to facilitate the workshop and to equip the participants with the necessary knowledge, skills and technologies to help confront sanitation problems in the country. The Deputy Regional Environmental Health Officer explained that after the training, the Participants were expected to form District Integrated Agency Coordinating Committees on Sanitation to address sanitation issues using CLTS at the community levels.

He stated that it was anticipated that by June 2014, the three Northern Regions including the Central and Volta regions which are also benefiting from the training, would have fixed their sanitation related problems to reduce their impact. He impressed upon the participants to ensure that they put into practice the knowledge and skills acquired from the training programme to better their communities and to reduce the higher expenditure often incurred by government in the treatment of health problems related to sanitation issues. There is no doubt that this effort by the MLGRD and UNICEF would help curb some of the diseases that are associated with sanitation issues that push government to spend huge sums of money in the treatment of diseases and battling the continuous loss of productivity man hours.

If the trainers take their assignments seriously by replicating what they learnt from their respective communities half of the problems would have been surmounted even before the close of the project.

It is advised that the trainees show keen interest in the formation of the District Integrated Agency Coordinating Committees on Sanitation to address sanitation issues using CLTS at the community levels as they have been directed. Contact should be made to other field staff of the Ministry of Food and Agriculture (MOFA) and the Community Health Nursing colleges to join the facilitation team as well as enterprising Community members should be encouraged and made to be roped into the facilitation process. There is also the need for Municipal and District Assemblies to support the CLTS Teams including the Environmental Health and Sanitation Units with logistics such as fuel and means of transportation to embark on sanitation exercise. It should be pointed out that the key drawbacks to sanitation is funding. Consequently, for the agenda to move on successfully, it is required that funds be made available by the various MMDAs for sanitation programmes. Sanitation officers should be empowered to carry out frequent follow-ups to communities to ensure that they are kept clean.

Officers should also be made to work in areas and communities within walking distances to make them more efficient in performing their duties.

The Political authorities and chiefs should prioritize sanitation issues in their dealings with the communities. Parents including schools should also prioritize sanitation issues by inculcating in children the need to embrace good sanitation practices.

Government through other partners should institute national sanitation awards. This could start from the District, to Regional and National levels and could be spearheaded by the Regional Coordinating Councils, MMDAs and the MLGRD. Corporate bodies including NGOs could be encouraged to sponsor such programmes.

Let all of us take sanitation issues very seriously. It is only through this that we can all contribute to reducing diseases and saving money for other developmental projects for the betterment of our lives as well as help Ghana to fast track her achievement of the MDGs on sanitation..