Research Paper Accelerating rural sanitation coverage in Ghana: what are the speed bumps impeding progress? Isaac Monney, Amos Baffoe-Kyeremeh and Papa Kofi Amissah-Reynolds ABSTRACT Progress towards the Millennium Development Goal (MDG) sanitation target has generally been slow- paced in Ghana. This is particularly the case in rural areas where access to improved sanitation has increased by just 4% within two decades. This paper examines defecation practices as well as constraints and existing opportunities at both household and institutional levels in promoting in- house toilet construction. The study was conducted in three rural communities in the Tain district and drew on key informant interviews, focus group discussions, field observations and face-to-face interviews of 400 residents selected from 249 houses. The results showed the scarcity of in-house toilets, which means consequently open defecation and use of communal toilets are common practices. The need for in-house toilet facilities is high among property owners without them, mainly driven by the desire for comfort and safety. Barriers at the household level constraining latrine installation include ignorance of low-cost technologies, the perceived high cost of latrines and the low priority given to their ownership. Analysis of expenditure patterns at the local assembly shows low priority afforded to sanitation promotion, which is constrained by low donor support, lack of requisite logistics and poor human resource capacity. Existing opportunities for accelerating sanitation coverage in these study communities are examined both at the household and institutional levels, and best practices discussed. Isaac Monney (corresponding author) Department of Environmental Health and Sanitation Education, University of Education, Winneba, P.O. Box M40, Mampong, Ashanti, Ghana E-mail: monney.isaac@gmail.com Amos Baffoe-Kyeremeh Jaman North District Health Directorate, P.O. Box 66, Sampa, Brong Ahafo, Ghana Papa Kofi Amissah-Reynolds Department of Science Education, University of Education, Winneba, P.O. Box M40, Mampong, Ashanti, Ghana Key words | community-led total sanitation, household toilet, MDG sanitation targets, rural sanitation in Ghana, sanitation coverage INTRODUCTION The impacts of inadequate access to safe water and sanitation services, coupled with poor hygiene practices, remain an unseen emergency situation beyond the focus of the general public. This is due to the insidious way in which the lack of these facilities claims thousands of lives, not as an explosive which claims thousands of lives within a short period, but very gradually. This is more rampant than other mortality fac- tors in the developing world. According to the UN-Water Global Analysis and Assessment of Sanitation and Drinking- Water (GLAAS 2014), inadequate access to water and sani- tation is a major driving force behind the spread of diseases in households, schools, communities and health centres and is also responsible for hundreds of thousands of diarrhoea deaths among children (WHO ). This is corroborated by empirical studies conducted over the years, which provide fac- tual evidence of the impacts of unsafe water and poor sanitation on public health (Esrey et al. ; Varley et al. ; Bartlett ; Fewtrell & Colford ; Prüss-Üstun et al. ; Cronin et al. ) and socio-economic development (Lenton et al. ; Hutton et al. ; Hutton & Bartram ). Figures provided by Prüss-Üstun et al. () based on data from 145 countries suggest that close to 800,000 lives 531 Research Paper © IWA Publishing 2015 Journal of Water, Sanitation and Hygiene for Development | 05.4 | 2015 doi: 10.2166/washdev.2015.005 Downloaded from https://iwaponline.com/washdev/article-pdf/5/4/531/385494/washdev0050531.pdf by guest on 20 July 2020