2021•01•18

The Global Health Reflections series brings together opinion pieces, commentaries, and summaries of major issues related to global health. It is informed by the research and activities of UNU-IIGH fellows and our partners.

by Ayak Wel (Institute on Globalization and the Human Condition, McMaster University), Kayla J. Lucier (Department of Health Research Methods, Evidence, and Impact, McMaster University), and Samson O. Abioye (W. Booth School of Engineering Practice and Technology, McMaster University)

Introduction

Access to improved water sources and hygiene facilities is central to achieving the United Nations Sustainable Development Goals (SDGs) – a set of 17 goals that aim to improve lives and protect the environment by 2030. More than ever, there is an urgent need for improved water sources to prevent water-borne illnesses and for hygiene purposes in the face of biological outbreaks, such as the ongoing COVID-19 pandemic. Current evidence suggests that social distancing and regular hand washing with soap under running water – for at least 20 seconds – are amongst the most effective ways of controlling the spread of COVID-19. This emphasizes that providing improved access to water is needed to save lives.

A community water kiosk in a Accra suburb | photo credit: Maria Ximena Ruiz Caldas.

“Current evidence suggests that social distancing and regular hand washing with soap under running water – for at least 20 seconds – are amongst the most effective ways of controlling the spread of COVID-19. This emphasizes that providing improved access to water is needed to save lives.”

Despite advancements made to ensure communities have access to safe drinking water in Ghana, data reveals that at least three million people struggle to meet their daily water requirements. Like many other low and middle-income countries, Ghana also faces challenges in ensuring improved sanitation and hygiene, making public health crises more difficult to manage. Since the start of the pandemic, the Ghana Health Service has reported 50,874 confirmed cases of COVID-19, with the Greater Accra Region being affected the most, having reported 54% of the cases. In recent weeks, Ghana has reported 1,146 active cases of the virus, raising concerns about a possible second wave.

In this article, we share our perspectives generated from a 2018 field trip to the Greater Accra Region of Ghana, where we investigated barriers to water access and quality, and evaluated efforts to ensure the availability and sustainable management of water and sanitation for all. This experience provided us with on-the-ground exposure to issues related to the global water crisis and expanded our understanding of the health risks associated with unimproved water, sanitation, and hygiene (WASH) infrastructures. In the context of the current COVID-19 pandemic, we have been reflecting on how water accessibility challenges magnify the public health consequences of disease outbreaks. Discussions in this article will focus on the barriers related to water accessibility in Ghana and the possibilities, both real and imagined, for containing the spread of COVID-19 with improved access to water.

WASH in Ghana: Current Challenges

In Ghana, conflict exists between being physically and financially able to access quality water sources. According to the United Nations Children’s Fund, one out of every ten people have to travel at least 30 minutes to reach a water source. There is also a correlation between socioeconomic status and water access, as household wealth is a significant contributor in determining access to improved sources of water. Those living in poverty spend more time collecting water than their wealthier counterparts.

Our visit to a densely populated informal settlement within Ghana’s capital city, Accra, confirms this reality. This particular informal settlement is home to various ethnic groups predominantly from the northern parts of the country. Access to water is difficult to provide here, as taps often flow briefly at midnight when individuals are asleep. When taps are operating in good condition, they are opened only once per week and individuals are forced to store water in jerry cans in the hopes that it will last for the next seven days. Similarly, tap water sometimes ceases to flow for as long as two to six months due to operational challenges. In these conditions, the most vulnerable, such as women and children, spend a maximum of four hours per day searching for water.

Currently, available data from the Ghana Demographic and Health Survey indicates that while more than half of Ghanaian households have a designated place for washing hands, only one out of every five households have water or hand washing agents available at home. The same report also reveals that about 44% of the 5,332 rural households surveyed lack access to soap and water for hand washing. Moreover, based on personal observations in Ghana, the impact of unstable power supply in ensuring running water limits the capacity for proper hygiene. Households with private water wells and boreholes are limited by erratic power supply for pumping water into overhead storage tanks for subsequent use.

During our time in Ghana, we visited a water source located in a suburb within Accra, which is equipped with a water kiosk – constructed in the heart of the community – to provide potable water for a large number of individuals at a token fee. These kiosks provide an opportunity for communities to alleviate water challenges. However, fetching water in buckets and jerry cans makes it difficult to comply with public health messages of washing hands under running water. Lack of access to water for domestic use could also weaken current efforts made to contain the spread of COVID-19 in Ghana through physical distancing. For instance, with lack of access to piped water, people resolve to public water kiosks to provide solutions to their daily water needs. Gatherings at water kiosks make it difficult to social distance as individuals are likely to queue to access water.

While everyone is affected by the COVID-19 pandemic, based on our experiences, we expect that vulnerable communities in Ghana’s rural and urban informal settlements will be most affected. The lack of water security in informal settlements threatens the management of COVID-19 and would undoubtedly interfere with public health initiatives that aim to reduce the spread of infectious disease through hygiene promotion and education. Additionally, space restrictions and overcrowding make physical distancing and self-isolation unfeasible, and the proliferation of infection highly probable. This could potentially undermine Ghana’s progress towards controlling the spread of COVID-19 and future outbreaks, as well as achieving the SDGs by 2030.

WASH in Ghana: Progress and Opportunities

Our trip to Ghana revealed the various challenges related to water accessibility in the country. However, what was also evident is that Ghanaians are using innovative, community-based technologies to help navigate these challenges, and have continued to do so during this pandemic. Ghana has proven to be one of the leading African countries with epidemiological excellence and has exhibited increased capacity to undertake serious measures in response to COVID-19. This includes an improved capacity to administer tests, aggressive tracing of infected persons, and the expansion of treatment and isolation centers. At the onset of the outbreak, the government implemented a three-week lockdown and subsidised water and electricity bills to middle-income households for three months. Water tanks were also made available to those living in poverty and all vulnerable communities. Ghanaian youth have found equally innovative ways to engage in combating COVID-19, by designing solar-powered hand washing basins to encourage regular hand hygiene in their communities.

“…Ghanaians are using innovative, community-based technologies to help navigate these challenges, and have continued to do so during this pandemic. Ghana has proven to be one of the leading African countries with epidemiological excellence and has exhibited increased capacity to undertake serious measures in response to COVID-19.”

Although Ghana has shown progress in its response to COVID-19, much more could be done to address the existing barriers in providing water to the three million Ghanaians that do not have access to it at all. In fact, current research shows that only four percent of the 1,443 households surveyed in the Greater Accra Region benefited from the water tanks that were distributed by the government at the initial stage of the outbreak. Furthermore, 80 percent reported that they could not use the water provided by the tanks because it was not made available in their community.

Lockdowns may seem great in theory, but based on our experiences, it could be difficult to implement. Without even considering the difficulties brought on by COVID-19, it was already challenging for many Ghanaians to access water. In a lockdown situation, accessing water from public kiosks is also not feasible, yet it is the sole water source for many people. Ghanaians that lack water and sanitation facilities at home are more likely to breach lockdown directives and venture out of their homes in search of these necessities. This highlights the ways in which vulnerability to COVID-19 is magnified by inequalities and the absence of in-house access to these basic amenities.

Water access is an important determinant for infectious disease control and prevention. The simple act of washing your hands with soap and water could save countless lives from COVID-19. Ghana may consider the ongoing pandemic as an opportunity to fast track and strengthen its water sector, by ensuring that no one, regardless of socioeconomic status, will be left without water in their homes. In their intervention, Ghana may consider more proactive measures rather than mitigative ones in relation to WASH, as a way of ensuring universal water accessibility.

Short-term efforts must address WASH access issues among poor communities, particularly those in urban settings. Long-term approaches ought to focus on building infrastructure for ensuring that every household is given access to piped water so as to minimise the reliance on public water stations. In-house water access will permit compliance with public health measures and reduce the risk of exposure and a second wave of COVID-19.

“Policy implications that adopt more inclusive approaches to water security are thus needed to help minimize COVID-19 transmission and reduce healthcare and other societal costs…”

To achieve this, intervention strategies should include strengthening water policies and governance, with a strong focus on those living in precarious conditions. There is a pressing need to increase the efficiency of water use in informal settlements in Accra, by adopting approaches for its preservation. For instance, sustainable or nature-based solutions may improve water storage and supply, therefore increasing availability. Policy implications that adopt more inclusive approaches to water security are thus needed to help minimise COVID-19 transmission and reduce healthcare and other societal costs in Ghana. The financial and administrative resources required for these interventions are likely to be overwhelming. Timely cooperation between state and private sectors will therefore be crucial for the successful implementation of WASH interventions during this pandemic, and afterwards.

Conclusion

COVID-19 presents new challenges and highlights the existing inequalities in Ghana’s WASH service delivery. The country ought to intensify its efforts in the water sector, to combat this unrelenting pandemic and its long-term effects. Doing so will stabilise Ghana’s WASH sector so it can better navigate future outbreaks. Ghana could increase investments towards maintaining water provisions, improve technical assistance, and extend the scope of water facilities to communities at risk.

This necessary investment is attainable in Ghana, especially when weighing in the costs of unimproved WASH amenities during outbreaks. Despite ongoing challenges, we believe that Ghana is a country that is full of potential and opportunities for new technological innovations that can improve its hygiene and sanitation needs, especially during outbreaks. Our interactions with individuals in communities and those working in the WASH field to alleviate their country’s daily difficulties were a testament to the unwavering determination of Ghanaians and their allies that can, and should, be harnessed during this unprecedented time.

Acknowledgements

We would like to thank the United Nations University – Institute for Water, Environment, and Health and McMaster University for supervising and facilitating our field trip to Ghana.

(The authors were participants in Water Without Borders collaborative graduate program in water, environment and health between the United Nations University, Institute for Water, Environment and Health (UNU-INWEH) and McMaster University.)