When Nature’s Call Becomes a Health Hazard – Public Toilets in Ghana

By: Felicity Boachie-Danquah, Daily Dispatch and Sophie Nicholls, JHR

For Rita Adjetey using a public bathroom daily isn’t a choice, it is nature’s call.

The mother of two, who lives in a Labadi neighbourhood near Accra’s Trade Centre, wished she had a private toilet and shower inside her home but her family cannot afford the installation costs.

“We are making do with this until we have the money to build our own,” she says. “We wish the government would come to our aid, but they are not coming.”

Mrs. Adjetey is just one of thousands of Ghanaians, living in both urban and rural areas, who rely upon public toilets that are far too often seeping, spilling and smelling. According to a June 2006 study, Behavioral Indicators of Household Decision-Making and Demand for Sanitation and Potential Gains from Sanitation Marketing in Ghana, 58 per cent of adults across the country are queuing up daily to use these facilities, while 65 per cent of are dissatisfied with where they have to defecate.

Luckily for Mrs. Adjetey the facility she uses, which is open 4:30am to 9pm, is fairly well maintained. The 10 toilets are cleaned once a day and five showers once a week. Entrance costs are standard at about 10 cents to use the toilet or shower, about 5 cents to empty chamber pots, while a wad of toilet paper or piece of newspaper are free. Queues are only experienced during morning and evening rush hour, as people head off or return from work.

Despite this, Mrs. Adjetey feels a dent in her wallet after paying about 12 GHC a month to use this facility. She is even charged to empty her children's potties.

“It’s very costly,” she admits.

But what choice does Mrs. Adejtey have?

According to Mr. Demedeme Naah, Director of Environment and Sanitation with the Ministry of Local Government, although public toilets are meant for the floating population, it is actually illegal to erect such structures in neighbourhoods due to the health implications. He feels people are now relying upon them instead of focussing on ways to implement domestic toilets into their homes.

“People say they can’t afford it but I don’t want to accept that,” he says. “I think having a toilet in the house is not a priority because they have access to public toilets. They think, why worry ourselves?”

Public Washroom owner, Mr. Samuel Amant Tetteh, however, believes that if it was not for his facility, which was erected a year ago for about Cdn$200, Labadi residents would still be defecating openly in a park across the street.

“I was trying to help the community. People used the park and it’s unfair,” he explains, adding that some residents even defecated on the streets. “Some people used to come and spoil the place. Human beings can be difficult. If you say you are going to help the community you have to have patience.”

The problem gets deeper when looking at legal facilities located in local markets and public transport terminals, such as Kaneshie and Makola. According to Mr. Demedeme these are so poorly maintained that some patrons remove all their clothing before entering.

“(Public washrooms) are an eyesore and a public health hazard,” explains Mr. Demedeme, who recommends they be washed down twice a day, morning and evening. “The problem is keeping them well-cleaned. People go in and some end up contracting diseases.”

Children using public toilets or defecating outdoors are at even greater risk. According to a March 2005 study, Journal of Health & Population in Developing Countries, conducted in the Accra Metropolitan area, children who were sharing a toilet with more than 10 families had a higher incidence of diahrrea (30.4 per cent) and dysentery (53.6 per cent). Just over 24 per cent of diarrhea cases were reported from children whose families participated in outdoor defecation.

So, whose responsibility is it to make sure the public washroom facilities are legal and adhere to proper health standards?

According to Mr. Demedeme, the private sector took the mantle in 1999 when a National Environmental Sanitation Policy was established by the Ministry of Local Government and Rural Development. This sector is now responsible for 80 per cent of waste management services, while the assemblies and municipalities are left to make sure all runs smoothly and according to policy.

“It was the responsibility of the Metropolitan, Municipal, and District Assemblies to take care of public toilets and bathrooms in the country, but they seemed to be non-performing,” he explains. "So, in early 2000, the private sectors were encouraged to put up such structures and pay franchise fees."

Owners like Mr. Tetteh, who pays about Cdn$15 in taxes a month to the Accra Metropolitan Assembly (AMA), are now responsible for collecting monies, cleaning, recruiting labour and paying the franchise fee. According to Mr. Tetteh, it’s all about the cash.

“AMA did not help me,” says Mr. Tetteh. “They just collect the money.”

Mr. Demedeme agrees that financial gains have become the main focus. He says owners are more interested in the profits from patrons than maintenance, while assemblies are busy collecting their fees and failing to monitor facilities through inspections and assessments.

“The biggest problem we have is enforcement of laws,” admits Mr. Demedeme, adding that it is actually law for every property to have a domestic toilet and illegal for people to openly defecate.

“People won’t do it (break the law) if they know they can’t get off scot free.”

On the Ministry’s side, Mr. Demedeme admits his office plays a key role in ensuring policies are implemented and assemblies, the private sector, even citizens are living up to their responsibilities.

“We are also not doing our part well,” he admits. “But it is all because of the constraints we have in the system ... time, logistics and personnel.”

Despite all these constraints, the government still hopes to have domestic toilets installed in 90 per cent of Ghanaian households, with the remaining 10 per cent of the population using hygienic public washrooms, by 2020. Pan (bucket) Latrines and open trench latrines are also to be phased out and replaced with flush toilets by 2010.

If these aspirations, inspired from the Millennium Development Goals (MDGs), are to be met, then efforts will have to be doubled, according to Mr. Demedeme. “Doubling means a lot more than education and enforcement,” he says. “But we are getting a lot of support from our developing partners to try and push us to do so. “

In the meantime, citizens will keep queuing up, paying out and stripping down when nature calls.