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Ben

neh

,JacobS

ongsore,Joh

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Nabila,

A.T

.A

mu

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vonY

angyuoruU

niversityof

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Benneh,Jacob

Songsore,Jo

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S.N

abila,A

.T.

Am

uzu,K

.A.

Tutu

and

Yvon

Yangyuoru

University

ofG

hana-Legon

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bythe

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nvironment

InstituteN

op

an

ofthis

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aybe

reproducedin

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,or

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ISB

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andS

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itLatrine

bottledgas

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United

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thetim

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fthe

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Household

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aluesand

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xvii

IIN

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copeand

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11.1.1

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11.1.2

Research

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21.1.3

Sam

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rocedurefor

Household

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21.1.4

Physical

Tests

51.1.5

Focus

Group

Discussions

51.2

Overview

ofthe

Urban

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thD

ynamics

ofGA

MA

.5

1.2.1P

opulationG

rowth

andP

hysicalD

evelopments

within

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61.2.2

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81.3

The

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ofG

AM

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Local

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9

2H

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112.2

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2.3C

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eliabilityo

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152.5

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172.6

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acteriologicalExam

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Water

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202.7.1

Bacteriological

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ouseholdW

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2.7.2In-H

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washing

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323.5

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andS

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acilitiesand

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37

III

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4.2.2C

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445.1

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445.1.2

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445.1.3

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455.1.4

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485.1.5

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,49

5.2Insecticide

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617.1.1

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627.1.2

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637.1.3

Exposure

toR

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articulatesW

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xposureto

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While

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677.1.5

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758.2

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778.3

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Illness82

8.3.1A

cuteR

espiratoryInfection

among

Children

Under

Six

Years

Old

828.3.2

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Problem

Sym

ptoms

among

PrincipalH

omem

akers85

Box

8.1H

ouseholdE

nvironmental

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andH

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919.2

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10010.1

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10.2T

heG

overnment's

InstitutionalS

tructure100

10.2.1C

entralG

overnmentInstitutions

10010.2.2

Health

Education

10210.2.3

The

DistrictA

ssemblies

10210.2.4

The

Environm

entalProtection

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(EPC

)103

10.2.5E

nvironmental

Sub-C

onunittees103

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eliveryA

gencies103

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oliticalO

rganisations:T

heC

onunitteesfor

theD

efenceo

ftheR

evolution(C

DR

s)104

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eighbourhoodG

roups105

10.6S

pontaneousN

eighbourhoodO

rganisations106

10.6.1N

ima

441W

elfareA

ssociation106

10.6.2L

aM

ansaamo

Kpee,L

aT

own

(Labadi)

10610.7

Households'E

nvironmental

Role

10710.8

Sum

mary

andC

onclusions108

11S

UM

MA

RY

OF

PO

LIC

YIM

PL

ICA

TIO

NS

11011.1

Introduction110

11.2W

ater110

11.3S

anitationand

Hygiene

11111.4

Solid

Waste

11211.5

Pests

andP

esticides113

11.6F

oodC

ontamination

11411.7

Household

Air

Pollution

11411.8

An

IntegratedE

nvironmental

Strategy

115

RE

FE

RE

NC

ES

117

AP

PE

ND

IX1

,120·

Sam

plingP

rocedurefor

Questionnaire

Survey

120A

PP

EN

DIX

2122

Methodology

forA

ssessmento

fWater

Quality

1221

Material

andm

ethods122

2W

aterS

ampling

Procedure

1222.1

Bacteriological

Exam

ination122

AP

PE

ND

IX3

123M

ethodologyfor

Air

Test..

1231

Field

Operations

123·1.1

Field

Exposure

Measurem

entsM

ethods123·

AP

PE

ND

IX4

125O

peningA

ddresso

ftheR

ightHonorable

Dr.C

hristineA

moako-N

uamah,

Minister

forthe

Environm

ent,Ghana.

Benneh

etai.v

FO

RE

WO

RD

For

many

lowincom

eurban

dwellers,

thereis

noneed

topredict

life-threateningenvironm

entaldegradation:

itis

alreadya

facto

flife.

Indeed,m

anyo

fthe

worst

featureso

furban

povertyin

theT

hirdW

orldare

environmental:

pooraccess

tosafe

water,

unsanitaryconditions,

smoky

kitchens,contam

inatedfood,

uncollectedsolid

waste,

insectinfestation.L

ikem

ostenvironm

entalproblem

s,these

areclosely

interrelated.T

heneed

fora

multisectoral

strategyto

addressthese

problems

isgenerally

recognised.M

ostresearch,

however,

continuesto

proceedalong

disciplinarylines.

An

environmental

perspective,w

ithits

inherentlytransdisciplinary

nature,is

theappropriate

approach.M

oreover,it

isim

portantthat

thelocal

environmental

problems

which

currentlyplague

thepoor

beaddressed

with

dueregard

forthe

broaderenvironm

entalcontext.

As

theexperience

of

many

middle-incom

em

egacitiesindicates,

economic

expansionand

rapidurbanization

cancreate

ahost

of

newenvironm

entalproblem

s,w

ithoutnecessarily

resolvingthose

typicallyassociated

with

poverty.In

1991,S

EI,

working

incollaboration

with

localresearch

institutions,initiated

ascoping

studyo

fhousehold

environmental

problems

inA

ccra,Jakarta

andS

aoP

aulo.D

rawing

uponboth

localand

internationalexpertise,

acom

parableapproach

was

developedand

appliedin

eacho

fthese

cities.S

urveyso

f1,000

householdsw

ereundertaken

ineach

city,along

with

physicaltesting

insubsam

pleso

fabout

200.T

hestudy

isboth

trans-disciplinaryand

action-oriented.T

heem

piricalresultsrange

fromindicators

offaecal

contamination

indrinking

water,

topeople's

perceptionso

fw

hatshould

bedone

byw

homto

improve

thesituation..

The

analysisexam

inesthe

physicalseverity

of

theproblem

s,and

alsothe

institutionalcontextfrom

which

practicalsolutions

mustem

erge.T

hisreport

summ

arizesthe

resultso

ftheA

ccracase

study.It

ishoped

thatthe

reportw

illb

eo

finterest

notonly

within

Accra,

butalso

toother

researchersand

policy-makers

concernedw

ithurban

environmental

issues.S

aoP

auloand

Jakartaare

bothm

egacities,renow

nedas

thesites

of

severeenvironm

entaldistress.

Accra

doesnot

yetface

them

egacityproblem

s.Y

etthe

localenvironm

entalproblem

sdescribed

inthis

reporton

Accra

areprobably

afar

greaterburden

forlocal

inhabitantsthan,

forexam

ple,the

widely

publicisedam

bientair

pollutionin

Sao

Paulo.

Moreover,

Accra

isprobably

typicalo

fhundreds

of

otherm

edium-sized

citiesin

thisregard.

This

reportaim

sto

demonstrate

notonly

thatsom

ethingneeds

tobe

done,but

that,w

ithbetter

information,

something

canbe

done.P

reliminary

resultsw

erepresented

atthe

SE

IlIIED

/SID

Aw

orkshopon

Urban

Environm

entsand

Hum

anW

elfarein

SouthernC

ities:L

essonsfrom

fivecase

studies(S

EI,

Stockholm

,F

ebruary,1993).

The

casestudies

includednot

onlyA

ccra,Jakarta

andS

aoP

aulo,but

alsolIE

Dco-ordinated

studieso

fN

airobiand

Lagos.

Papers

onhealth

andenvironm

entalaspects

inall

fivecities

areappearing

inthe

journalE

nvironment

andU

rbanization(for

Accra

andJakarta,

seeV

ol.5,

No.2).

Further

publicationsare

anticipated.D

etailson

thepublications

arisingfrom

thestudies

of

Accra,

Jakartaand

Sao

Paulo

will

beavailable

fromS

EI.

For

furtherdetails

onthe

studieso

fN

airobiand

Lagos,

pleasecontact

David

Satterthw

aiteor

Diana

Mitlin,

Hum

anS

ettlements,

lIED

,3

Endsleigh

Street,

London

WC

IHO

DD

,U

.K.

Gord

onM

cGran

ahan

Urban

Environm

ent,S

tockholmE

nvironmentInstitute

viE

nvironmental

Problem

sand

theU

rbanH

ouseholdin

theG

AM

A-G

hana

AC

KN

OW

LE

DG

EM

EN

TS

Research

work

isa

collectiveenterprise,

thesuccess

of

which

dependson

theco­

operationo

fm

anyactors.

While

theresponsibility

forthe

contentso

fthis

reportis

theauthors',

much

of

thecredit

must

goto

thosew

hom

aynot

havew

rittenthe

text,butw

ithoutwhom

thisstudy

would

nothavebeen

successful.T

hanksare

dueto

thestudents

of

theU

niversityo

fG

hanaw

hoserved

as.research

assistantsand

supervisorsfor

them

ainsurvey.

Am

ongthis

group,P

atienceD

jietror,B

enjamin

KB

.A

moyaw

,G

odwin

A.

Djietror,

Ernest

Y.

Asante

andS

.A.

Tetteh

needspecial

mention

forthe

continuedsupport

theyshow

edfor

thestudy

beyondthe

fieldresearch

stage.T

hephysical

testso

fw

aterand

airquality

were

carriedout

bytw

oseparate

teams

basedat

theW

aterR

esourcesR

esearchInstitute

of

theC

SIR

.S

pecialm

entionis

made

of

E.K

Bosque-H

amilton

andW

.D

oudufor

thew

atersam

pling;and

E.

Nana-A

mankw

ahand

Ms.

P.D

.A

tsakpofor

theair

monitoring.

We

arealso

gratefulto

thecom

puterprogram

mer

Mr.

KK

Etsibah

who

didthe

dataprocessing

atthe

University

of

Ghana-L

egon,and

Mr.

S.A

.O

tcherew

hohandled

allthe

secretarialwork,especially

thetyping

ofthe

draftreportC

hristerP

erssoncreated

thedata

baseat

SE

I,upon

which

thestatistical

analysiso

fhealth

andenvironm

entis

based.S

olveig'N

ilssonprovided

criticalsupport

duringthe

revisionprocess.

Anna

Bratt

conductedthe

statisticalanalysis

of

thephysical

testresults,

andhelped

innum

erousw

aysto

getthe

[mal

document

intoshape.

All

deservethanks.

Carolyn

Stephens,

of

theL

ondonS

choolo

fH

ygieneand

Tropical

Medicine,

reviewed

thedraftreport,providing

many

perceptivecom

ments

andsuggestions.

Am

ongthe

policym

akers,w

eare

especiallygrateful

forthe

supporto

fthe

Mayor

of

theA

ccraM

etropolitanA

uthority,and

theH

eadso

fD

epartment

of

theW

asteM

anagement,

Environm

entalH

ealth,and

Tow

nand

Country

Planning

Departm

ents.T

hesam

ealso

goesfor

theA

reaM

anager,G

hanaW

aterand

Sew

erageC

orporationA

TM

Aand

theH

eadso

fthe

variousD

epartments

within

theorganisation.A

llo

fthe

participantsat

thew

orkshopheld

inpreparation

forthe

three-citystudy

(SE

I,S

tockholm,

June17-21,

1991)contributed

substantiallyto

developingthe

approachtaken.

Special

thanksgo

to:A

ndersE

llegard,w

honot

onlyprovided:

.guidelines

forthe

airquality

monitoring,

buthelped

supervisethe

field-testing;.

JosefL

eitmann,

whose

help,especially

atthe

criticalearly

stageso

fthe

study,w

asinvaluable;

andY

vonneA

nderssono

fthe

Sw

edishS

tateB

acteriologicalL

aboratory,w

hosecontinuing

interestand

supporthasbeen

greatlyappreciated.

The

discussionsheld

atthe

SE

IJIIED

/SID

Aw

orkshopon

Urban

Environm

entsand

Hum

anW

elfarein

SouthernC

ities:L

essonsfrom

fivecase

studies(S

EI,

Stockholm

,F

ebruary,1993)

were

alsoextrem

elyhelpful.

David

Satterthw

aiteand

Goran

Tannerfeldt

deservethanks

forhelping

createthis

opportunity.A

Sem

inaron

Environm

entalP

roblems

andthe

Urban

Household

inthe..

Greater

Accra

Metropolitan

Area

was

organisedin

Accra

onthe

9thand

10th0

[­

Decem

ber1993

topresent

theresults.

We

were

honouredto

havethe

Minister

forthe

Environm

ent,D

r.(M

rs.)C

hristineA

moako-N

uamah

providean

introduction,clearly

placingthe

studyin

context.P

rofessorE

.A

.B

oatengdeserves

thanksfor

expertlychairing

thesessions,

asw

ellas

making

anum

bero

fcritical

interventions.T

hesem

inarw

asattended

bynum

erousrepresentatives

of

governmental

andnon-

Benneh

etal.vii

governmental

organisationsinvolved

inenvironm

entalim

provement,

whose

contributionsto

thediscussions

were

invaluable.S

AR

EC

andS

IDA

providedfinancial

supportatcriticaljunctures.A

ndo

fcourse,

avery

specialthanks

goesto

thethousand

or

sorespondents

who

answered

atrying

questionnaire.W

ecan

onlyhope

thatthe

resultso

fthe

studyw

illcontribute

toa

betterenvironmentfor

themand

theirneighbours.

GH

AN

AS

HO

WIN

GG

RE

AT

ER

AC

CR

AR

EG

ION

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2"

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5"-

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9"-

7"-

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t ~'<O'

viiiE

nvironmentaL

ProbL

ems

an

dthe

Urban

HousehoLd

inthe

GA

MA

-Ghana

EX

EC

UT

IVE

SU

MM

AR

YT

hisreport

summ

arisesthe

resultsof

astudy

ofhousehold

environmental

problems

inthe

Greater

Accra

Metropolitan

Area

(GA

MA

),undertaken

jointlyby

theD

epartment

of

Geography

andR

esourceD

evelopment

of

theU

niversityo

fG

hanaand

theS

tockholmE

nvironment

Institute.T

hestudy

isaction

oriented,and

isintended

toenhance

theunderstanding

of

householdenvironm

entalproblem

sw

itha

viewtow

ardsim

provingthem

.P

astenvironm

entalassessm

entso

fA

ccrahave

emphasised

thelarger

scaleproblem

s,w

hichrange

fromm

arinepollution

to·am

bientair

pollution.In

time,

theselarge

scaleproblem

sm

ayindeed

become

critical,as

theycontinue

tounderm

inethe

sustainabilityo

fthe

city.C

urrently,how

ever,it

isthe

problems

which

GA

MA

dwellers

facein

theirhom

esand

neighbourhoodsw

hichare

ofprim

aryconcern.

Acom

binationof

poverty,dem

ographicgrow

th,econom

icfluctuations,

andfiscal

austerityis

placinga

considerablestrain

onhousehold

environments

inG

AM

A.

GA

MA

isboth

thenational

capitaland

them

ajorindustrial

centreo

fG

hana.In

1990it

hadan

estimated

populationo

f1.7

million,

andby

2010its

populationis

projectedto

reachthe

4m

illionm

ark.B

yinternational

standards,the-·

majority

of

thepopulation

livesin

poverty.W

ith10%

of

thecountry's

population,­G

AM

Aaccounts

forbetw

een15%

and20%

of

thegross

domestic

product.T

hesepercentages

areexpected

toincrease

inthe

coming

years.T

heeconom

icenvironm

entis

veryuncertain,

however.

Following

asevere

economic

recessionin

Ghana

duringthe

1970sand

early1980s,

aneconom

icrecovery

programm

ew

asintroduced

in1983.

While

therehas

beena

strongtum

-aroundin

theeconom

yin

recentyears,

government

financesrem

ainseverely

constrained.T

hism

akesit

allthe

more

criticalthat

environmental

effortstarget

priorityproblem

sand

areas,and

arew

elldesigned.

Given

theprevious

lacko

finform

ationon

householdenvironm

entalproblem

s,this

reportconcentrates

onproviding

asum

mary

of

existingconditions.

The

problemareas

coveredinclude

water,

sanitation,solid

waste,

pestsand

pesticides,food

contamination

andhousehold

airpollution.

Specialattention

isgiven

toissues

of

environment

andhealth.

Inaddition,

thereport

providesinform

ationon

thehouseholds'

own

views

onw

hatneeds

tobe

doneand

byw

hom,

andsum

marises

theinstitutional

contextw

ithinw

hichhousehold

environmental

managem

enttakes

place.Finally,som

eofthe

policyim

plicationsare

discussedbriefly.

The

empirical

basisfor

thisstudy

includesa

questionnairesurvey

of

1,000representative

households,physicaltests

ofw

aterand

airquality

among

sub-setso

fabout

200,focus

groupdiscussion

inselected

low-incom

eneighbourhoods,

andunstructured

interviews

with

policym

akersand

implem

entors.

Household

Water

Supplies-

Conditions:

The

vastm

ajorityo

fhouseholds

surveyedin

GA

MA

depend,either

directlyo

rindirectly,

onpiped

water

supplies.A

ccessto

drinkingw

atervaries

considerably,how

ever.R

oughlyone

thirdo

fhouseholds

surveyedhad

indoorpiping,

anotherthird

gottheir

water

fromprivate

orpublic

standpipes,and

thebulk

of

the,,·rem

aininghouseholds

boughtw

aterfrom

vendors.O

nlyabout

3%o

fhouseholds"

reliedon

thelargely

pollutedw

ellsand

waterw

ays.N

otsurprisingly,

itw

asthe­

wealthy

householdsw

hotended

tohave

indoorpiping,

andpoor

householdsw

horelied

most

heavilyon

water

vendors.W

ellsand

waterw

aysw

erelargely

restrictedto

poorperi-urban

households.

Benneh

etal.IX

The

physicaltests

indicatedsom

efaecal

contamination

of

thetap

water,

particularlyfrom

tapsin

poorareas

of

thecity.

Overall,

10%of

the(136)

samples

of

tapw

aterhad

positivecounts

of

faecalcolifonn.

The

qualityo

fthe

water

inhousehold

storagecontainers

was

considerablyw

orse,how

ever:87%

of

the(149)

testshad

positivecounts.

Faecalcontam

inationis

likelyto

bea

greaterhealth

riskw

henit

originatesoutside

of

theim

mediate

household.N

evertheless,the

levelsencountered

instorage

containersw

eredisturbingly

high,especially

inlight

of

thefact

thatless

than10%

· of

householdsboiled

orfiltered

theirw

aterprior

todrinking.

Also,

thisin-hom

econtam

inationreflects

am

oregeneral

fmding

thatthe

householdw

aterproblem

so

fG

AM

Alie

more

inaccess

andits

effectson

hygienethan

inw

aterquality

problems

atthe

tap.C

ompared

toother

areaso

fGhana,

water

accessis

relativelygood.

About

halfo

fthe

householdshad

aw

atersource

intheir

housecom

pound,and

95%o

fhouseholds

hada

drinkingw

atersource

within

100m

etreso

ftheir

home.

The

resultssuggest,

however,

thateven

thedifference

between

havingw

aterin

thehouse

compound

andhaving

tofetch

itfrom

ashort

distanceaw

aybears

arelation

tohealth.

Am

onghouseholds

with

small

children,the

prevalenceo

fchildhood

diarrhoeaw

as7%

when

therew

asa

water

sourcein

thehouse

compound,

ascom

paredto

20%w

henthere

was

not.T

hesam

ehouseholds

who

hadno

water

sourcein

thehouse

compound

may

alsoface

otherrisk

factors,but

thereis

goodreason

tobelieve

thatdifficulties

inobtaining

water

area

contributingfactor.

Having

tofetch

water

reducesw

aterconsum

ption,thereby

creatingvarious

hygieneproblem

s.W

atersupply

interruptionsare

comm

onthroughout

GA

MA

,and

areless

dependenton

wealth

thanis

thelocation

ofthew

atersource.

As

aresult,

almost

allhouseholds

hadsom

efonn

of

water

storagein

theirhom

e.T

heoverhead

tankw

asthe

most

comm

oncontainer

among

wealthy

households,w

hilethe

barrelw

asthe

most

comm

onam

ongpoor

andm

edium-w

ealthhouseholds.

Buckets

were

alsopopular

among

thepoor,

andpots

areused

bysom

e6%

.B

yincreasing

theneed

tostore

water,

water

irregularitiesare

contributingto

water

contamination

problems.

Moreover,

bycreating

periodicw

atershortages,

water

interruptionscan

leadto

hygieneproblem

s.T

hism

ayexplain

why,

inthe

healthresults

describedbelow

,households

facingregular

water

interruptionsw

erealso

foundto

havea

higherprevalence

ofchildhood

diarrhoea.F

orthe

poor,access

tow

ateris

furthercom

promised

bythe

pricingsystem

.T

heofficial

water

tariff isintended

tobe

progressive,w

ithhigher

pricescharged

tohigh-volum

econsum

ers.T

hisintention

isunderm

inedby

thefact

thatpoor

householdsare

more

likelyto

sharew

aterconnections,

therebyincreasing

thew

ateruse

perconnection.

More

significant,them

ostcomm

onw

atersource

among

poorhouseholds

was

water

vendors,w

hocharge

significantlym

orethan

thehighest

tarifflevel,

althoughthe

purchaserstypically

collectedthe

water

themselves.

Vendors

servean

important

rolein

thew

aterdistribution

system,

butin

conditionso

fgeneralw

aterscarcity,those

who

purchasefrom

vendorslose

out.

Sanitationa

nd

Hygiene

-C

onditions:G

AM

Ahas

two

of

thethree

publicw

ater-bornesew

eragesystem

sin

thecountry,

butexceptin

theplanned

township

ofT

ema,

onlya

verysm

allshare

of

householdsare

served.T

hisis

reflectedin

thetypes

of

toiletsused:

36%used

flushtoilets,

31%

conventionalpit

latrines(broadly

defined),10%

Kum

asiV

entilatedIm

provedP

it(KV

IP)

latrines,20%pan

latrines,and

about3%

hadno

accessto

atoilet

atall.

xE

nvironmental

Problem

sand

theU

rbanH

ouseholdin

theG

AM

A-G

hana

Flush

toiletsw

ereused

byalm

ostall

of

thew

ealthyhouseholds

andm

osto

fthe

medium

-wealth

households,m

anyo

fw

hichhave

septictanks.

Pitlatrines

orpan

latrinesw

ereused

bym

ostpoor

households.·Households

with

flushtoilets

hada

considerablylow

erprevalence

of

childhooddiarrhoea

thanthose

usingother

typeso

ffacilities,

thoughthis

may

bea

reflectiono

fthe

crowding

of

theseother

facilities.W

hilethe

sanitationtechnology

profilem

aybe

superficiallysuperior

tothat

of

therest

of

Ghana,

crowding

hascreated

aserious

sanitationproblem

fora

largeshare

of

GA

MA

'spopulation.

Alm

ostthree

outo

ffour

householdsshared

theirtoilet,

andabout

41%

reliedon

comm

unalfacilities

opento

thew

holeneighbourhood.

The

comm

unalfacilities

areso

overcrowded

thatalm

osttw

oout

of

threeusers

claimed

thatthere

were

times

when

thesetoilets

were,

ineffect,

unusable(e.g.

theyw

ereout-of-order

orthe

queuesw

eretoo

long).R

esidentso

fG

a,the

peri-urbandistrict,

reliedm

oreheavily

onconventional

pitlatrines

thanresidents

of

Accra

orT

ema

Districts,

butless

oftencom

plainedthat

theirtoilets

were

unusable.T

hisprobably

reflectsa

more

generalphenom

enon.T

oiletsin

GA

MA

may

betechnologically

superiorto

thosein

otherparts

ofG

hana.F

ora

small

elitew

ithprivate

flushtoilets

conditionsare

indeedbetter.

But

forthe

poor.m

ajority,crowding

more

thanelim

inatesany

technologicaladvantage.

Crow

dingo

fsanitary

facilitiescreates

problems

onat

leasttw

ofronts.

On

theone

handthe

conditionso

fthe

toiletsdeteriorate.

This

was

evidentin

thehigher

prevalenceo

fdirty

floors,flies

andother

indicatorsof

unhygienicconditions

inthe

more

widely

sharedtoilets.

On

theother

hand,crow

dingcan

leadto

opendefecation,

which

isitself

agreater

publichealth

riskin

more

denselypopulated

areas.A

bouthalf

of

theadults,

onfinding

theirusual

toiletunusable,

saythat

theyused

anothertoilet.

Athird,

however,

usedopen

landor

abeach

undersuch

circumstances.

One

would

expectm

oreopen

defecationam

ongchildren,

astheir

knowledge

of

personalhygiene

andneed

forprivacy

islow

er.Y

etchildren

arem

orevulnerable,

andtheir

faecesa

greaterhealth

risk.O

verall,36%

of

householdssaid

childrenin

theirneighbourhood

sometim

espractised

opendefecation,

with

thehighest

percentagesin

poorareas.

Both

crowding

of

sanitaryfacilities

andopen

defecationby

neighbourhoodchildren

were

associatedw

ithhigher

prevalenceso

fchildhood

diarrhoea.T

hecosts

of

usingsanitary

facilitiesplace

asignificant

burdenon

po

or

households,despite

theinadequacy

of

theirfacilities.

Atypical

chargefor

acom

munal

latrinew

as5

cedisper

use,and

anadditional

5for

toiletpaper

(anda

penaltyon

theorder

of20

cedisfor

thosew

hobring

excretain

pans).M

ost(82%

)o

fhouseholds

payinguser

feesincurred

costso

fbetw

een10

and60

cedisper

day.R

elativelyfew

householdscited

costas

areason

fornot

always

beingable

touse

theirusual

toilet.N

evertheless,one

canassum

ethat

thesecosts,

which

aresom

etimes

intendedto

covernot

onlym

aintenanceo

fthe

facilitiesbut

alsoother

environmental

maintenance,

arecontributing

tothe

opendefecation

problems.

More

generally,hygiene

inG

AM

Ais

notsim

plya

matter

of

householdhabits:

itisintim

atelylinked

tothe

water

andsanitation

conditions.O

pendefecation

isjust

oneexam

ple.M

uchthe

same

appliesto

handw

ashingpractices,

thoughin

thiscase

thelin

kis

with

water

ratherthan

sanitaryfacilities.

The

resultsindicate

thatw

hilefactors

likeeducation

may

beassociated

with

betterhand

washing

practices,the

typeofw

atersupply

hasan

independentandprobably

more

significanteffect.

Benneh

etai.xi

SolidW

aste-

Conditions:

Solid

waste

disposalis

notas

important

tohealth

asw

aterand

sanitation,but

hasbecom

eone

of

them

oreintractable

environmental

managem

entproblem

s.D

espiterecent

upgrading,the

Waste

Managem

entD

epartment

isstill

onlycapable

of

collectingsom

e60%

of

refuse.O

nlyabout

10%o

fthe

surveyedhouseholds

hadhom

ecollection,

thoughthe

sharerose

to39%

among

wealthy

households.M

ostdum

pedtheir

waste

locally,about

70%at

collectionpoints

orofficial

dumps,

and13%

onem

ptyland

orother

unofficialsites.

The

firstpoint

atw

hichsolid

waste

canbecom

ea

problemis

within

thehom

e.O

penstorage

of

solidw

astew

aspractised

bysom

e42%

ofhouseholds,

andw

asassociated

with

ahigher

prevalenceo

fflies

androdents.

Outdoor

storageo

fw

astein

thehouse

compound

was

relativelyrare,

reflectingin

partthe

lowlevel

of

home

collection.A

ccumulations

of

waste

within

theneighbourhood

arethe

most

visibleproblem

inthis

sector.E

vencollection

pointsand

officialdum

pscan

become

environmental

hazards,especially

giventhe

veryinterm

ittentcollection,

andthe

tendencyfor

faecalm

aterialto

become

intermixed

with

householdrefuse.

Alm

osthalf

of

thehouseholds

perceivedlocal

accumulations

of

solidw

asteto

bea

problem,

andm

orethan

onethird

mentioned

opendum

psites

intheir

neighbourhoodw

herew

astew

entuncollected

fora

week

orm

ore.In

additionto

beingunsightly

andgenerally

unpleasant,such

sitesare

ahealth

riskfor

children,exacerbating

flyand

rodentproblems,and

when

washed

away

canblock

thedrains.

Finalw

astedisposal

isalso

aproblem

.T

hem

ostcom

mon

method

isdum

pingin

pits,designated

aslandfIlls

butactually

littlem

orethan

opendum

ps.M

ostexisting

siteshave

alreadybeen

usedup

to,or

beyond,capacity,

andthere

isan

urgentneed

fornew

sites.U

nlikew

ateror

sanitation,the

wealthy

payconsiderably

more

forw

astedisposal

thanthe

poorerhouseholds.

This

isnot

onlybecause

thecharge

forhom

ecollection

isconsiderably

higherthan

thatfor

usinga

collectionsite,

butalso

becausem

osthouseholds

who

donot

havehom

ecollection

donot

actuallypay

thefee

forusing

officialsites.

Pests

an

dP

esticides-

Conditions:

Malarial

mosquitoes

remain

am

ajorhealth

hazardin

GA

MA

.W

hilepast

urbanizationhas

lowered

theincidence

of

malaria

inG

AM

A,

thereis

noreason

toassum

ethis

trendw

illcontinue

unaided.P

aststudies

suggestthat

some

malarial

mosquitoes

areadapting

toG

AM

A's

urbanenvironm

ent,w

ith,for

example,

increasedbreeding

inhousehold

water

containers.W

hileonly

arelatively

small

shareo

fthe

mosquitoes

arem

alarialspecies,

malaria

remains

byfar

them

ostfrequently

reportedhealth

problematout-patientfacilities.

Moreover,continual

urbanw

ateruse

combined

with

poordrainage

hascreated

asituation

where

mosquitoes

arecom

mon

throughoutthe

year.A

lmost

allhouseholds

surveyedsaid

theyw

ereat

leastoccasionally

bittenby

mosquitoes

indoorsat

nightthroughout

theyear,

with

aboutthree

outo

ffour

beingbitten

regularlyin

bothw

etand

dryseasons.

Excluding

householdsw

ithfull

screening,the

responsesw

erequite

similar

indifferent

areaso

fthe

cityand

among

poorand

wealthy

households.B

arringexplicit

effortsto

controlm

osquitoes,the

onlyinfluential

factorw

asindoor

water

storage,w

hichw

asassociated

with

more

mosquito

biting.W

hilethis

shouldnot

betaken

tosuggest

thatthe

risko

fm

alariais

similar

throughoutthe

city(the

prevalenceo

fm

alarialm

osquitoesis

likelyto

be

Xli

Environm

entalProblem

sa

nd

theU

rbanH

ouseholdin

theG

AM

A-G

hana

more

variedthan

thato

fm

osquitoesin

general),it

doeshelp

explainthe

widespread

concern.A

lso,if

thepresence

of

malarial

mosquitoes

breedingin

householdw

atercontainers

isincreasing,

these[m

dingsalso

indicatethat

indoorw

aterstorage

may

be

increasingm

alariaprevalence.

House

fliesare

alsoknow

nto

bea

healthrisk,

especiallygiven

generallyunsanitary

conditions.T

heresults

of

thesurvey

indicatethat

thisrisk

shouldbe

takenseriously:

childhooddiarrhoea

prevalencew

asconsiderably

higherin

householdsw

ithm

oreflies

intheir

kitchenso

rtoilets.

House

fliesw

erecom

mon

inall

neighbourhoods,iIiboth

kitchensand

toilets.T

heprevalence

of

houseflies

was

considerablyhigher

among

po

or

householdsthan

wealthy

households,how

ever.T

hus,for

example,

more

thanfour

outo

ffive

wealthy

householdssaid

theyalm

ostnever

hadflies

intheir

toilets,com

paredto

aboutone

poorhousehold

inseven.

Environm

entalm

anagement

tocontrol

insectsis

notgenerally

practisedin

GA

MA

.H

owever,

about90%

of

thehouseholds

usedsom

eform

of

insectcontrol,

principallyfor

mosquitoes.

The

most

popularm

ethodsinclude

screening,m

osquitocoils,

andaerosol

andpum

pinsecticides.

Mosquito

coilsare

them

ostcom

mon

means

of

controlam

ongp

oo

rhouseholds,

while

screeningand

sprayinsecticides

arem

orecom

mon

among

wealthy

households.T

heuse

of

chemicals

tocontrol

insectscreates

itso

wn

healthrisks.

The

childhoodprevalence

of

acuterespiratory

infection(o

rat

leastreported

symptom

sthereof)

was

significantlyhigher

when

mosquito

.coilsw

ereused.

Am

ongthe

principalw

omen

of

thehouseholds,

who

were

likelyto

bethe

onesapplying

thepesticides,

theprevalence

of

respiratoryproblem

symptom

sw

ashigher

where

pump-spray

insecticidesw

ereused.

Food

Contam

ination-

Conditions:

Fo

od

canb

echem

icallyo

rm

icrobiallycontam

inated.T

hisreport

isonly

concernedw

iththe

latter.M

ost

householdsin

GA

MA

obtaintheir

foodfrom

openm

arkets,w

herethe

riskso

fcontam

inationare

significant.P

reparedvendor

foodis

likelyto

posethe

highestrisks,

however.

Most

householdspatronised

vendorso

fprepared

foodregularly,

bu

tthe

percentagew

aslow

eram

ongw

ealthyhouseholds.

Also,

thefoods

purchasedby

po

or

householdsw

erem

orelikely

tofall

intopotentially

highrisk

categories.O

verall,the

prevalenceo

fchildhood

diarrhoeaw

asroughly

twice

ashigh

among

householdsw

hopatronised

foodvendors.

Fo

od

contamination

anddeterioration

inthe

home

isalso

aconcern.

As

indicatedabove,

fliesin

thekitchen

posea

healthrisk,

principallydue

tothe

dangerso

ffood

contamination.

Serving

coldleftovers

isalso

apotential

risk,b

ut

well

under10%

of

thehouseholds

saidthey

didso

regularly,and

therew

asno

associationw

ithdiarrhoea

prevalence.F

oo

dstorage

practicesvaried

widely.

Fo

rexam

ple,w

hilevirtually

allw

ealthyhouseholds

storedm

eatin

refrigerators,alm

osthalf

of

thep

oo

rhouseholds

who

hadm

eatto

storesim

plyused

coveredbow

ls.A

gain,how

ever,there

was

noclear

associationw

ithdiarrhoea

prevalence.Q

uitepossibly,

theprincipal

effectis

thatp

oo

rhouseholds

storefoods

lesslong:

aconsiderably

highershare

of

po

or

householdssaid

thatleftover

foodw

ouldspoil

inless

thantw

elvehours

thandid

wealthy

households.H

ouseholdsw

ithsick

childrenw

erem

oreinclined

toblam

efood

eatenoutside·

thehouse

thanfood

preparedat

home.

Indeed,28

of

the72

householdsw

hosechildren

hadrecently

haddiarrhoea

identifiedfood

eatenout

asthe

probablecause.

While

thisis

likelyto

bea

farhigher

sharethan

thosew

hoactually

contracteddiarrhoea

fromsuch

food,it

doesindicate

considerableaw

arenesso

fthe

dangerso

ffood

contamination.

Benneh

etal.xiii

Household

Smoke

(andC

rowding)

-C

onditions:C

ookingfuels

arethe

most

significantsource

of

householdair

pollutionin

GA

MA

.H

ouseholdsnot

onlyuse

arange

of

fuels,but

individualhouseholds

typicallyuse

more

thanone.

Charcoal

was

theprincipal

cookingfuel

for69%

of

thehouseholds

surveyed,follow

edby

bottledgas

orL

PG

(14%),

fuelwood

(8%),

kerosene(6%

),and

electricity(3%

).G

enerally,the

wealthier

householdsused

cleanerfuels.

Past

studiessuggest

thatrespirable

particulateconcentrations

arelikely

tobe

highestam

ongfuelw

oodusers,

followed

bycharcoal,

kerosene,L

PG

andelectricity.

These

areprecisely

thehousehold

preferencessuggested

bythe

relationshipbetw

eenfuel

choiceand

wealth,

with

charcoaland

wood

thetw

oprincipal

fuelso

fp

oo

rhouseholds,

charcoaland

LP

Gthe

principalfuels

of

medium

wealth

households,and

LP

Gand

electricitythe

principalfuels

of

thew

ealthy.H

owever,

evenL

PG

andelectricity

usersoften

alsouse

charcoal,w

hichw

asused

atleast

intermittently

by81

%o

fthe

households.P

articulateexposure

measurem

entsundertaken

forthis

studyindicate

thatw

oodusers

areindeed

them

ostexposed,

followed

bycharcoal

usersand

[mally

kerosene,L

PG

andelectricity

users(these

lastthree

fuelsw

erecom

bineddue

tosm

allsub-sam

ples).T

helevels

encounteredam

ongw

oodand

charcoalusers

were

significantlyhigh

soas

toraise

concernabout

healtheffects.

Carbon

monoxide

exposurew

ashighest

among

charcoalusers,

followed

byw

oodusers.

Again,

levelsw

eresufficiently

highto

raiseconcern,

butw

erenot

ashigh

assom

estudies

inother

locationshave

encountered.In

additionto

cookingfuels,

exposuredepends

uponcooking

practices.A

mong

po

or

householdsseparate

kitchensare

rare,though

inthe

ruralfringe

cookinghuts

arecom

mon.

How

ever,m

ostw

oodand

charcoalusers

cookoutdoors,

atleast

when

itis

notraining.

Children's

exposurealso

dependson

whether

theyare

presentduring

cooking.A

mong

householdsw

ithsm

allchildren,

25%usually

hadchildren

presentduring

cooking,and

most

hadchildren

presentat

leastoccasionally._

While

therelationship

between

respiratoryproblem

sand

cookingfuel

choicew

asnot

statisticallysignificant,

perhapsdue

tothe

predominance

of

charcoal,use

patternsdid

displaysignificant

associations.A

mong

wom

en(principal

homem

akers)the

prevalenceo

frespiratory

problemsym

ptoms

was

higheram

ongthose

usinga

cookinghut.

Itw

asalso

higheram

ongthose

who

nevercooked

out­of-doors.

Am

ongchildren,

symptom

so

facute

respiratoryinfection

were

more

comm

onw

henchildren

were

usuallypresentduring

cooking.

Health

an

dE

nvironmentalR

iskF

actorsB

etween

1987and

1990,m

alaria,upper

respiratorytract

infections,and

diarrhoeaw

ereconsistently

thethree

most

comm

onlyreported

healthproblem

sat

out-patientfacilities

inthe

Greater

Accra

Region.

All

threeare

alsoclosely

relatedto

avariety

of

environmental

factors.A

sustainedanalysis

of

malaria

andits

associationw

ithenvironm

entalconditions

isbeyond

thescope

of

thisstudy:

selfdiagnosis

of

malaria

isnotoriously

inaccurate,households

cannotidentify

malarial

mosquito

species,and

neitherblood

testsnor

mosquito

countsw

ereundertaken

duringthe

survey.B

othrespiratory

problems

anddiarrhoea

arethe

outcome

of

complex

combinations

of

interrelatedfactors,

buttheresults

ofthis

studyclearly

indicatethe

importance

ofenvironm

entalinadequacies.

xivE

nvironmental

Problem

sand

theU

rbanH

ouseholdin

theG

AM

A-G

hana

The

prevalenceo

fdiarrhoea

among

childrenunder

sixw

as,not

surprisingly,associated

with

wealth

andtype

ofresidential

area:w

ealthyhouseholds

andhouseholds

inhigh

classareas

hadconsiderably

lesschildhood

diarrhoea.T

heresults

suggestthat

most

of

thesedifferences

arerelated

tothe

environmental

conditionshouseholds

face.In

am

ultifactorialstatistical

analysiso

fchildhood

diarrhoeaprevalence,

allof

thefollow

ingw

erefound

tobe

significantlyassociated

with

higherdiarrhoea

prevalence:

1.Sharing

toiletw

ithm

orethan

5other

households.2.

Using

potforstoring

water.

3.Storing

water

inan

opencontainer.

4.O

utdoordefecation

byneighbourhood

children5.T

hepresence

ofm

anyflies

inthe

cookingarea.

6.N

otalways

washing

handbefore

preparingfood.

7.E

xperiencingw

aterinterruptions

atcertaintim

eso

fday.8.B

uyingprepared

foodfrom

vendors.

Once

theserisk

factorsw

ereincluded

inthe

analysis,social

andeconom

icfactors

were

nolonger

significant.O

fthe

69households

with

small

childrenw

hofaced

atm

ostone

of

theserisk

factors,there

were

norecent

caseso

fdiarrhoea.

Of

the102

householdsfacing

more

thanfour

riskfactors,

37had

childreriw

hohad

haddiarrhoea

inthe

pasttwo

weeks.

Sym

ptoms

of

acuterespiratory

infectionin

youngchildren

were

alsom

oreprevalent

among

poorhouseholds

andin

lowclass

areas,though

thedifferences

were

notas

striking.A

gainthe

resultssuggest

thatthese

differencescould

bedue

toenvironm

entalconditions.

Inthis

case,the

following

riskfactors

were

foundto

besignificantin

them

ultivariateanalysis:

1.Children

oftenpresent

duringcooking.

2.P

resenceo

fmany

fliesin

thecooking

area.3.L

essthan

foursquare

meters

perperson

inthe

most

crowded

sleepingroom

.4.

Experiencing

water

interruptionsatcertain

times

ofday.5.U

singm

osquitocoils

6.N

evercooking

outdoors7.

Leaky

roof.

Again,

socialand

economic

factorsw

ereno

longersignificant

oncethese

riskfactors

were

included.A

mong

the51

householdsfacing

atm

ostone

riskfactor,

therew

eretw

oin

which

youngchildren

hadhad

acuterespiratory

infectionsym

ptoms

inthe

pasttw

ow

eeks.A

mong

the107

householdsfacing

fiveor

more,

therew

ere29.

Respiratory

problemsym

ptoms

inthe

principalw

omen

of

thehouseholds

boreno

clearassociation

with

eitherthe

wealth

ofthehousehold

orthe

typeo

farea

they.lived

in.V

ariousenvironm

entalrisk

factorsw

eresignificant,

however,

andseveral

of

thesefactors

were

notso

prevalentam

ongpoor

households(it

isalso

possible,as

otherstudies

of

Accra

havesuggested

inthe

past,that

wealthy

respondentsare

more

likelyto

reportm

inorhealth

problems).

More

specifically,the

following

riskfactors

were

foundto

besignificant:

Benneh

etal.

1.S

moking

cigarettes2.

Using

pump-spray

insecticides3.E

xperiencingw

aterinterruptions

atcertaintim

eso

fday.

4.N

ever

cookingoutdoors

5.L

eakyroof.

xv

While

fewer

significantfactors

were

identifiedthan

inthe

previoustw

oexam

ples,the

healthdifferences

remain

striking.O

fthe

79w

omen

notexposed

toany

riskfactors,

sixhad

respiratoryproblem

symptom

s,ascom

paredw

ith56

of

the178

wom

enw

hofaced

threeor

more

riskfactors.

Itis

important

notto

overinterpret

individualfactors.

Som

ecould

reflectother,

unmeasured,

factors.T

hepresence

of

flies,for

example,

couldbe

anindicator

of

generallypoor

sanitaryconditions.

Som

efactors

couldbe

statisticallysignificant

just

bychance

(thoughvirtually

bydefinition

theprobability

of

thisoccurring

arerelatively

small).

How

ever,taken

togetherthe

resultsclearly

illustratethe

importance

of

environmental

improvem

entto

thehealth

of

theresidents

of

Accra,

andparticularly

thechildren.

Environm

entalValues

an

dH

ouseholdE

conomics

Th

evalues

therespondents

placedon

environmental

improvem

ents(ascertained

throughcontingent

valuationquestions)

were

atleast

roughlyconsistent

with

existingknow

ledgeo

fthe

healthburdens

imposed.

Malaria

isthe

most

evidenthealth

problem,

andinsect

controlw

asthe

most

valuedim

provement.

Diarrhoea

isalso

am

ajorhealth

problem,

andw

aterim

provements

were

alsohighly

valued.(S

anitationim

provements

were

notincluded

inthe

survey,but

thereis

everyindication

thatthey

toow

ouldhave

beenhighly

valued.)A

irquality

improvem

entsw

ereless

highlyvalued,

despitethe

importance

of

respiratoryinfection.

How

ever,the

linkbetw

eenair

pollutionand

respiratoryproblem

sm

ayw

ellbe

lesssignificant

thanthat

between

water

anddiarrhoea.

Solid

waste

collectionw

asquite

highlyvalued,

despitehaving

avery

uncertainlink

tohealth.

Inthis

case,it

isprobably

bestto

assume

thathealthw

asnotthe

principalm

otivation.T

heresults

supportthe

notionthat

peopleplace

considerablevalue

onenvironm

entalim

provements,

andare

willing

tom

akesignificant

economic

concessionsin

orderto

achievethem

.T

heeconom

icburden

of

payingfor

existingenvironm

entalservices

isconsiderable.

Inseveral

cases(e.g.

water)

po

or

householdsare

alreadypaying

highprices

foran

inadequateam

enity.U

ndersuch

circumstances,

itis

anindication

of

theim

portancepeople

attachto

thehousehold

environment

thatm

ostare

willing

topay

stillm

orefor

improvem

ents.H

owever,

itis

unrealisticto

expectto

achieveadequate

home

andneighbourhood

environments

without

significantim

provements

inthe

economic

statuso

fthe

majority

of

households.A

bilityto

payis

clearlya

major

constraint,especiallyin

poorareas.

On

theother

hand,even

ifhouseholds

valueenvironm

entalbenefits,

individuallythey

oftenhave

relativelylittle

controlover

theenvironm

entthey

face.Indeed,

theim

mediate

economic

incentivem

aybe

todegrade

theenvironm

ent,despite

thecosts

thisincurs

onothers.

Such

problems

arisein

po

or

asw

ellas

wealthy

areas.O

utdoordefecation

inan

urbansetting,

forexam

ple,is

inpart

asym

ptomo

fsevere

poverty.B

ut

itis

alsoan

indicationthat

individualand

collectiveinterests

arenot

inharm

ony.S

imilarly,

inadequatew

ateraccess

may

besym

ptomatic

of

poverty,but

povertydoes

notdictate

thatw

aterprices

shouldbe

XV

IE

nvironmental

Problem

sand

theU

rbanH

ouseholdin

theG

AM

A-G

hana

especiallyhigh.

Econom

icssuggests

thatsom

eform

of

collectiveaction

may

berequired

when

publicbenefits

areinvolved.

Justas

householdsseem

edto

placea

higherpriority

onim

provements

which

would

havea

major

healthim

pact,so

alsohouseholds

tendedto

identifya

needfor

more

collectiveaction

them

orepublic

thebenefits.

Respondents

were

askedw

hetherthey

feltaction

was

requiredin

eachofthe

majorproblem

areascovered

inthe

survey,and

ifso

whether

theythought

individualaction,

neighbourhoodaction

orgovernm

entaction

was

mostim

portant.Indoor

airim

provement,

which

benefitslargely

thehousehold

making

theim

provement,

was

seenprincipally

asa

householdaffair.

For

otherproblem

s,the

respondentsm

ostoften

identifieda

needfor

government

action,though

neighbourhoodaction

receivedconsiderable

supportforgarbage,

insectandespecially

sanitationproblem

s.

InstitutionalAspects

ofU

rbanE

nvironmentalM

anagement

Environm

entalm

anagement

institutionsrange

fromgovernm

entagencies

andutilities

tothe

householdsthem

selves,and

includea

number

ofcritical

intermediate

institutions.E

venconventional

environmental

services,such

asw

ater,sanitation

andsolid

waste

disposal,are

more

oftenprovided

togroups

ofhouseholds

thanto

individualhomes.

Especially

inpoor

areas,thisis

likelyto

remain

thecase

forsom

etim

eto

come.

This

hascreated

asituation

inw

hichco-ordination

among

institutionsis

ascriticalto

environmental

managem

entastheir

individualefficiency.T

hegovernm

entalready

hasa

keyrole

inenvironm

entalm

anagement,

andits

rolein

environmental

managem

entislikely

toincrease

relativeto

many

of

itsother

more

traditionalroles.

More

thanhalf

of

thegovernm

entm

inistriesare

directlyinvolved

inone

way

oranother

inurban

environmental

managem

ent.T

heM

inistryo

fF

inanceand

Econom

icPlanning

hasthe

overalltask

of

allocatingfunds

forresearch

intoenvironm

ent-relatedissues

andfor

theexecution

of

environmental

actionplans.

The

Ministry

of

Works

andH

ousinghas

atleast

asupervisory

rolein

almost

allpublic

constructionactivities,

andthe

Ghana

Water

andS

ewerage

Corporation

isa

serviceagency

within

thism

inistry.W

ithinthe

Ministry

ofL

ocalG

overnment,the

Tow

nand

Country

Planning

Departm

enthasthe

responsibilityfor

ensuringthe

planneddevelopm

ento

fthe

metropolis,

while

theE

nvironmental

Protection

Council

isresponsible

forensuring

thatdevelopm

entprojects

takeproper

measures

toavoid

environmental

destruction.T

heD

istrictA

ssemblies

ofA

ccra,T

ema

andG

ahave,

among

theirresponsibilities,

thato

fgeneral

managem

ento

fw

asteand

sanitation.C

o-ordinatingthe

activitieso

fthe

numerous

ministries

anddifferent

levelso

fgovernm

entis

aform

idabletask.

The

currentclim

ateo

ffm

ancialausterity

makes

efficientco-ordination

allthe

more

important.

How

ever,just

asim

portant,these

numerous

governmental

institutionsm

ustinteract

with

thefar

more

numerous

andever

changingnon-governm

entalinstitutions.

The

localinstitutionsinvolved

inenvironm

entalm

anagement

varyconsiderably

inim

portancefrom

neighbourhoodto

neighbourhood,but

tendto

bem

oresignificant

inlow

-wealth

areas.In

anum

berof

areas,political

groups(C

omm

ittees.for

theD

efenceo

fthe

Revolution

orC

.D.R

.s)took

theinitiative

inthe

early1980s,

organisingnot

onlythe

provisiono

fsanitary

facilities,but

aw

iderange

of

environmental

improvem

entactivities.Som

ehave

beennotably

successful,notonly

inorganising

improvem

entefforts,

butalso

ingenerating

localsupport

forenvironm

entalm

anagement.

C.D

.R.s

areby

nom

eansthe

onlylocal

groupsinvolved

inenvironm

entalm

anagement,

however,

andgiven

currentpolitical

and

Benneh

etal.xvii

economic

trends,they

arelikely

tocontinue

todecline

inim

portance.In

some

areas,official

neighbourhoodgroups

aregrow

ingin

importance,

while

inothers

spontaneousneighbourhood

organisationshave

made

considerableheadw

ay.T

heneed

forsuch

localgroups

isheightened

bythe

lacko

fcom

prehensiveservices.

Their

strengthslie

intheir

abilityto

responddirectly

tolocal

concerns.A

lmost

allo

fthe

more

successfulexam

ples,how

ever,have

obtainedoutside

supportat

criticaltimes

intheir

development.

Inm

ucho

fG

AM

A,

thecom

poundhousing

unitis

alsocentral

tohousehold

environmental

managem

ent.A

snoted

above,individual

householdw

atertaps,

sanitaryfacilities,

andw

astecollection

arelargely

restrictedto

wealthy

areas.M

anycom

poundhousing

unitseven

lackshared

facilities.H

owever,

within

compound

housingunits,

many

environment

relatedtasks

aretypically

shared,and

theinfonnal

institutionalarrangem

entsw

hichdevelop

arean

important

locusof

activity.Indeed,

toview

theinfonnal

relationsam

ongm

embers

of

differenthouseholds

livingat

suchclose

quartersas

simply

inter-householdco-ordination

isto

underestimate

theirim

portance.H

ouseholdsthem

selvesare

made

upo

fm

embers

with

differentpriorities

andperceptions.

The

genderbased

divisiono

flabour

within

groupso

fhouseholds

canbe

ascentral

tolocal

environmental

managem

entasindividualhousehold

environmental

managem

entstrategies.

Policy

Implications

The

principalpurpose

of

thisreport

isto

presentaction-relevant

results,not

todraw

specificpolicy

conclusions.T

heanalysis

ofhealth

andenvironm

entclearly

demonstrates

thathousehold

environmental

improvem

entis

am

ajorconcern.

The

analysiso

fparticular

problemareas

indicatesw

hatsom

eof

thepriorities

are.T

heanalysis

of

environmental

valuationand

householdeconom

icssuggests

thatpeople

want

action,and

thattheir

prioritiesand

perceptionso

fw

hatneeds

tobe

doneshould

betaken.

seriously.T

heinstitutional

analysisindicates

many

ofthe

opportunitiesand

obstaclesto

improved

environmental

managem

entat

thehousehold

level.C

oncreteproposals

andeffective

strategiescannot

beread

offthe

resultso

fa

study,how

ever.A

tthis

point,it

isonly

appropriateto

indicatesom

egeneral

policyim

plications.E

speciallyin

relativelypoor

areas,integrated

improvem

entefforts

arem

orelikely

tobe

effective.T

heproblem

sare

interrelated.O

nlyan

integratedapproach

canbe

expectedto

respondeffectively

tolocal

concerns.F

orthe

purposesof

exposition,however,itis

simpler

toexam

ineeach

problemarea

separately.

Water

There

areserious

deficienciesin

thew

atersupply

systemin

GA

MA

,but

probablyless

seriousthan

inm

osto

fthe

country.A

ccessto

water

iscurrently

am

oreserious

deficiencythat

qualityo

fthe

water

atthe

tap.H

owever,

extendingthe

water

supplysystem

andincreasing

throughputis

costly.G

ivenprevailing

economic

conditions,providing

allhouseholdsw

ithin-house

pipingm

ustrem

aina

longtenn

goal.In

them

ediumterm

,the

resultssuggest

thatproviding

standpipesin

housecom

poundsm

aybring

significanthealth

benefitsat

considerablylow

ercost.

Increasingw

atersupply

within

theexisting

system,

andreducing

interruptions,could

alsohave

healthbenefits.

Increasedw

atersupply

inlow

­incom

eareas

couldhave

theadded

benefito

fdecreasing

vendorw

aterprices.

Overall,

while

thehealth

benefitso

fw

atersupply

systemim

provements

would

likelybe

considerable,econom

icconsiderations

will

necessarilyguide

which

xviiiE

nvironmentalP

roblems

andthe

Urban

Household

inthe

GA

MA

-Ghana

measures

oughtto

betaken.

Even

disregardingcostly

improvem

entefforts,

theresults

clearlydem

onstratethat

theexisting

systemplaces

thegreatest

healthburden

onthe

poorhouseholds,

who

alsoend

uppaying

thehighest

pricefor

theirw

ater.T

hisis

verym

uchcounter

tothe

govemm

ent'sintentions,

anddeserves

specialattention.

To

addressthis

problemeffectively

islikely

torequire

institutionalinnovation

cateringto

theparticular

needso

flow

income

householdsliving

predominantly

incom

poundhousing

units.

SanitationO

verall,alleviating

thesanitation

problems

ofG

AM

Ais

clearlya

major

priority.T

hem

ostserious

problemis

theovercrow

dingof

thefacilities.

Ifthe

healtho

fthe

populationis

theprincipal

concem,

increasingthe

quantityo

ftoilet

facilitiesavailable

isprobably

more

criticalthan

introducingim

provedtechnologies.

Improved

maintenance

isalso

important,

butextrem

elydifficult

giventhe

severeovercrow

ding.O

wing

tothe

comm

unalcharacter

of

alarge

shareo

fthe

facilities,the

government

andlocal

comm

unitygroups

arealready

directinvolved

indeterm

iningthe

quantityo

ffacilities

available.M

oresupport

tocom

munity

groupsinvolved

inim

provingsanitary

conditionsw

ouldbe

verybeneficial.

Measures

toincrease

theincentives

forprivate

provisioncould

alsobe

important.

While

sanitaryfacilities

requireboth

landand

investment,

giventhe

healthrisks

of

inadequateprovision,

itseem

slikely

thatthe

benefitsw

ouldbe

substantiallygreater

thanthe

costs.

Hygiene

Hygiene

problems

aresevere,

butare

closlylinked

tow

ater,sanitation

andeven

solidw

asteproblem

s.It

isoften

notedthat

water

andsanitation

improvem

entscan

failw

henhygiene

practicesrem

ainthe

same.

The

resultssuggest

thatthe

reverseis

probablyequally

true.In

anycase,

itis

difficultto

prescribehousehold

hygienehabits.

Education

andaw

arenessprogram

mes

arepotentially

important,

butare

likelyto

befar

more

convincingifaccom

paniedby

improved

conditions.

SolidW

asteW

hilesolid

waste

problems

arenot

apriority

healthconcern,

thecapacity

forsolid

waste

collectionand

disposalrem

ainsw

eak,and

thecosts

ofallow

ingrefuse

toaccum

ulatelocally

areconsiderable.

Effective

arrangements

forhandling

waste

problems

atthe

locallevel

couldhelp

redressat

leastsom

eo

fthe

capacitydeficiencies.

As

with

sanitation,m

anylocal

groupsare

alreadyinvolved

insolid

waste

managem

ent,and

probablydeserve

more

support.H

owever,

itis

difficultto

envisagem

ajorim

provements

inthe

solidw

astesituation

without

increasingthe

collectionand

disposalcapacity.

There

areindications

thatm

osthouseholds

arew

illingto

payfor

improved

solidw

astem

anagement,even

iftheyare

notw

illingto

payfor

poorservice.

Pests

an

dP

esticidesInsects,

andespecially

malarial

mosquitoes,

accountfor

alarge

shareo

fillness

inG

AM

A.

The

resultsindicate

thatim

provements

ininsect

controlare

apriority

forthe

householdsthem

selves.C

urrently,households

arespending

considerablesum

so

fm

oneyon

chemical

insectcontrol.There

issom

edoubt

asto

theeffectiveness

of

.these

measures

inreducing

malaria

prevalence,how

ever.M

oreover,the

useof

thesechem

icalsis

notonly

environmentally

hazardous,but

may

behaving

Benneh

etat.xix

detrimental

effectson

healthtoo.

There

isa

needto

investigatethe

dangerso

fexisting

methods

of

insectcontrol

further.F

urthermore,

newapproaches

toinsect

controlshould

beconsidered.

Environm

entalm

anagement

asa

means

of

controllingm

osquitoescould

proveto

befar

more

costeffective

thanexisting

measures.

As

anurban

area,G

AM

Aalready

standsat

aconsiderable

advantagein

comparison

with

mosto

fGhana:

mostm

alarialm

osquitospecies

arebetter

adaptedto

ruralconditions.E

xploitingthis

advantagecould

yieldm

ajorbenefits.

Food

Contam

inationT

herelative

importance

of

foodcontam

inationto

healthis

difficultto

discern,but

couldbe

considerable.W

omen

with

sickchildren

oftenblam

edfood

eatenoutside

thehom

e,and

therew

ereother

indicationsthat

foodprepared

byvendors

may

becontributing

significantlyto

healthproblem

s.U

nfortunately,governm

entpoliciesto

reducefood

contamination

aredifficult

todevise.

Improved

hygieneeducation

ispossible,

butacting

tocontrol

thepractices

of

foodvendors

isdifficult.

On

theother

hand,som

elocal

groupsare

alreadyacting

toim

provethe

hygieneo

ffood

vendors.P

rovidingsupport

forthese

localactivities

couldw

ellbe

them

osteffective

means

of

improving

foodquality,

especiallyif

combined

with

more

attentionto

foodhygiene

within

educationalactivities.

Household

Air

Pollution

Both

charcoaland

fuelwood,

butespecially

fuelwood,

giverise

topotentially

damaging

levelso

fpollution

exposurefor

wom

enand

childrenin

GA

MA

.H

owever,

conditionsare

probablyw

orsein

otherparts

of

thecountry

where

wood

isthe

predominant

fu~l.P

romoting

theincreased

useof

LP

Gor

electricityfor

cookingw

ouldreduce

exposurefor

thosehouseholds

who

switch

fuels.H

owever,

subsidieslarge

enoughto

influencefuel

choiceare

likelyto

bevery

costly,and

will

benefitprincipally

therelatively

well

offw

hocan

affordthe

necessaryequipm

ent.A

tleast

inthe

shortrun,

improved

cookingpractices,

possiblyin

conjunctionw

ithim

provedstoves,

areo

fmore

relevanceto

thepoor

majority.

Benneh

etat.

CH

AP

TE

RO

NE

1IN

TR

OD

UC

TIO

NT

hisstudy

of

householdenvironm

entalproblem

sin

theG

reaterA

ccraM

etropolitanA

rea(G

AM

A)

isa

component

of

aresearch

projectco-ordinated

bythe

Stockholm

Environm

entInstitute,

andalso

coveringJakarta

(Indonesia)and

Sao

Paulo

(Brazil).

Of

thethree

cities,G

AM

Astands

outas

beingan

ordero

fm

agnitudesm

allerin

population.T

hatdoes

notm

akeits

environmental

problems

anym

oretractable,

however.

Despite

vastdifferences,

notonly

insize,

butalso

ineconom

y,clim

ateand

culture,households

inall

threecities

faceat

leastsuperficially

similar

typeso

fenvironm

entalproblem

s.In

allthree

cities,these

problems

areparticularly

severein

low-incom

eareas.

Inorder

toallow

theresults

tobe

compared

acrossthe

threecities,a

similar

approachw

asadopted

ineach

city.T

hefollow

ingsection

summ

arisesthe

scopeo

fthe

GA

MA

studyand

them

ethodsem

ployed.W

hilethe

kindsofenvironm

entalproblems

householdsin.G

AM

Aface

may

notbe

untypical,their

severity,incidence

andsocio-econom

icbasis

areradically

differentfrom

thosein

theother

citiesstudied.

Following

thediscussion

of

thescope

andm

ethods,this

introductorychapter

continuesw

ithan

overviewo

fthe

urbangrow

thdynam

icso

fG

AM

A,

andthe

localcontext

within

which

householdand

neighbourhoodlevel

environmental

problems

arise.G

hana'srecent

economic

anddem

ographichistory

iscritical

tounderstanding

notonly

thecurrent

situationin

GA

MA

,but,

more

important,

theconstraints

onand

possibilitiesfor

improvem

ent.

1.1Scope

an

dA

pproachT

hisstudy

was

designedto

providea

coherentassessm

ento

fhousehold

environmental

problems

inA

ccra,with

anem

phasison

thoseproblem

sfaced

bythe

poor.T

hestudy

isaction-oriented;

theresearch

isintended

toim

proveunderstanding

Ofhousehold

environmental

problems

andhelp

developstrategies

toalleviate

them.

Various

assessments

of

Accra's

environmental

problems

havebeen

conductedin

thepast

(e.g.E

nvironmental

Managem

entA

ssociates,1989;

Am

uzuand

Leitm

ann,1991).

For

them

ostpart,

suchassessm

entshave

concentratedon

largerscale

environmental

problems,

inpart

becauseo

fa

lacko

finform

ationon

householdand

neighbourhoodlevel.

Yet,

asthe

resultso

fthis

studyclearly

demonstrate,

small

scaleenvironm

entalproblem

scan

havelarge

effects.W

hileperhaps

lesscritical

tothe

environmental

sustainabilityo

fthe

city,these

problems

arecentralto

thehealth

andw

ell-beingo

ftheinhabitants.

1.1.1Scope

The

problemareas

coveredinclude:

water

(Chapter

Tw

o),sanitation

(Chapter

Three);

solidw

aste(C

hapterF

our);pests

andpesticides

(Chapter

Five);food

contamination

(Chapter

Six);and

airpollution

andhousing

conditions(C

hapterS

even).T

hestudy

setsout

toexam

inethe

physicalseverity

of

theseproblem

sam

onghouseholds

with

differingsocio-econom

icbackgrounds

andliving

conditions.W

herepossible,

theanalysis

attempts

todraw

outthe

interconnections,both

among

theenvironm

entalproblem

sand

more

generallyw

ithother

physical,social

andeconom

icconditions.

Som

eo

fthe

healthrisks

associatedw

itheach

ofthe

problemareas

arealso

assessed.

2E

nvironmental

Problem

sand

theU

rbanH

ouseholdin

theG

AM

A-G

hana

Am

oreintegrated

analysiso

fthe

relationbetw

eenenvironm

entalconditions

anddiarrhoea

andrespiratory

problems

was

alsoconducted

(Chapter

Eight).

These

healthproblem

sare

notonly

extremely

serious,particularly

forchildren,

butrelate

toa

varietyo

fenvironm

entalproblem

s.O

nlyby

analysingthe

environmentai

riskssim

ultaneouslyis

itpossible

toaddress

thecom

plexo

fenvironm

entaland

socialfactors

involved.In

orderto

betterunderstand

some

of

thecritical

constraintsand

possibilitiesfor

environmental

improvem

ent,an

assessment

of

theeconom

icso

fhousehold

environmental

managem

entw

asundertaken

(Chapter

Nine).

Due

tothe

publicnature

of

many

environmental

problems,

pricescan

rarelybe

usedto

ascertainhouseholds'

concernfor

environmental

improvem

ent.C

ontingentvaluation

methods

were

employed

toascertain

thevalue

householdsw

ouldplace

onim

provements.

An

attempt

was

alsom

adeto

identifyhouseholders'perceptions

of

what

needsto

bedone

byw

hom.

Any

attempt

toim

proveenvironm

entalm

anagement

inG

AM

Am

ust,o

fcourse,

buildon

existinginstitutional

capacities.A

nassessm

ento

fthe

institutionalaspects

of

urbanenvironm

entalm

anagementw

asundertaken

(Chapter

Ten),

with

aview

towards

identifyingsom

eo

fthe

keyactors,

andthe

rolethey

couldplay

inim

provingenvironm

entalm

anagementatthe

locallevel.M

akingspecific

strategicrecom

mendations

isbeyond

thescope

of

thisstudy.

The

information

presenteddoes

haveim

portantim

plicationsfor

strategydevelopm

ent,how

ever.T

he[m

altask

of

thestudy

was,

therefore,to

highlightsom

eo

fthese

implications,

anddem

onstratethat

theresults

areindeed

action­oriented.

Given

thepaucity

of

pre-existinginform

ationon

householdenvironm

entalproblem

s,a

largepart

of

theeffort

undertakenfor

thisstudy

was

devotedto

collectingand

analysingnew

data.The

methods

employed

aresum

marised

below.

1.1.2R

esearchD

esignT

hefield

work

involvedthe

useo

fthefollow

inginstrum

ents:

(a)A

detailedand

structuredquestionnaire

surveyof

householdstogether

with

physicaltests

ofw

aterquality

andexposure

toair

pollutionfor

asub-set o

fthehouseholds

coveredin

thequestionnaire

survey.(b)

Afew

selectedfocus

groupdiscussions

ongrassroots

environmental

concernsand

actionw

ithrank

andfile

mem

bersand

some

executivesof

wom

en'sgroups,

ethnicassociations,

neighbourhoodw

elfareassociations,

andother

comm

unitybased

organisations.(c)

Unstructured

discussionsor

interviews

with

policym

akersand

implem

entors.

1.1.3Sam

plingP

rocedurefo

rH

ouseholdSurvey

Asurvey

of

1,000households

inG

AM

Aprovides

thecore

empirical

baseo

fthe

study.The

surveyw

asadm

inisteredto

theprincipal

homem

akero

feachhousehold,

generallya

wom

an.T

heprincipaltopics

coveredare

summ

arisedin

Table

1.1.

Benneh

etal.

Table

1.1:S

electedT

op

icsC

overedin

Household

En

viron

me

ntS

urveyso

fAccra

Jakartaand

Sao

Paulo.

Ba

ckgro

un

dIn

form

atio

nH

ou

seh

old

Size

andage

structure

Indicatorso

fincome/w

ealth

Ge

nd

er

ofhousehold

head

Education

(principalm

ale&

female)

Mig

rato

rystatus

(principalhom

emaker)

Typ

eand

qualityof

residence

Size

ofresidence

andplot

Te

nu

reo

fresidence

Tim

ehouseholders

spendat

home

Water:

Typ

eof

wa

ter

sup

ply

byuse

Ease

ofaccess

todrinking

water

supply

Wa

ter

storagepractices

Wa

ter

filtrationo

rboiling

practices

Wa

ter

sup

ply

disruptions

Sa

nita

tion

&H

ygiene:T

ype

oftoilet

To

ilet

sharing

To

ilet

usepractices(e.g.

useof

toiletsb

ychildren)

Ind

icatio

ns

ofu

nh

ygie

nic

toilets

Ha

nd

cleansingpractices

ofprincipal

ho

me

ma

ker

Pests:

Pre

sen

ceo

ffliesin

kitchensand

toilets

Mo

squ

itobiting

An

ima

lskept

at

home

Ro

de

nt

problems

Co

ckroa

chproblem

s

Ho

usin

gP

rob

lem

s:C

rowding

Da

mp

problems

Building

materials

"Ind

oo

r"A

irP

ol/u

tion

:F

uelsused

forcooking

andheating

Locationof

cookingplace

Co

okin

gpractices

Pesticide

use

Sm

okin

gpractices

Fo

od

Co

nta

min

atio

n:

Fo

od

storagepractices

andfacilities

Food

preparationpractices

Indicationsof

po

or

foodhygiene

Use

offood

ven

do

rs

So

lidW

aste:W

aste

stora

ge

andcollection

Wa

stepicking

andselling­

Locationof

waste

problems

Va

lua

tion

ofim

pro

ved

wa

stecollection

service

Health:

Ch

ildre

n's

diarrhoeaproblem

s

Ch

ildre

n's

respiratoryproblem

s

Re

spira

tory

problems

ofprincipal

ho

me

ma

ker

3

The

sampling

procedurew

asdesigned

toprovide

arepresentative

sample

ofhouseholds.

The

firststep

ofthe

sampling

procedureinvolved

proportional

4E

nvironmental

Problem

sand

theU

rbanH

ouseholdin

theG

AM

A-G

hana

stratificationaccording

tothe

residentialcategories

outlinedin

Table

1.2;an

adaptationof

thestrata

employed

inthe

recentH

ousingN

eedsA

ssessment

Study(H

ousingand

Urban

Developm

entA

ssociates,1990)

of

theA

ccraM

etropolitanA

rea(A

MA

).T

hesam

plew

asapportioned

acrossthe

firstseven

categoriesaccording

tothe

relativeshare

ofhouseholds

estimated

tobe

residingin

eachstratum

.T

heapportioning

was

basedon

theresults

ofthe1984

Census,adjusted

toallow

fora

more

rapidrate

ofgrow

thsince

1984in

the"L

owD

ensityN

ewly

Developing

Sector".The

shareofhouseholds

inthe

lastcategory,

"RuralFringe"

isnot

known

accurately,but

hasbecom

esignificantdue

tothe

recentinclusionofthe

Ga

districtw

ithinG

AM

A.

Itw

asapportioned

5%of

thesam

pleas

arough

estimate

of

itsshare

ofhouseholds.

The

resultingsam

plesize

ineach

stratumis

givenin

Table

1.2(w

ithsom

erounding).

For

detailso

fsam

plingprocedure,

seeA

ppendix1.1.

Ta

ble

1.2:S

tratifica

tion

by

Re

side

ntia

lCa

teg

ory.

Stratum

High

Density

IndigenousS

ector(H

DIS

)

Lo

wD

en

sityH

ighC

lassS

ecto

r(LD

HC

S)

Middle

Density

Middle

Class

Sector

(MD

MC

S)

Lo

wD

ensityM

iddleC

lassS

ector(LD

MC

S)

Lo

wD

ensityN

ewly

Developing

Sector

(LDN

DS

)

Middle

Density

IndigenousS

ector(M

DIS

)

High

Density

Lo

wC

lassS

ector(H

DLC

S)

Rural

Fringe

(RF

)

Total

Sam

pleshare

17%

2%5%

11%3%

12%

46

%5%

100%

Sam

pleS

ize

170

2050

11030115

45550

1000

As

theirnam

essuggest,

thestrata

were

designedto

distinguishareas

ofthe

cityprincipally

onthe

basisof

populationdensity

andam

enityvalues.

The

indigenoussectors

(HD

ISand

MD

IS)consist

of

settlement

nucleialong

thecoast.

They

areterm

edindigenous

becausethey

were

fqundedby

theG

aethnic

groupw

hooccupied

theA

ccraplains

beforethe

earlyperiod

ofE

uropeancoastal

trade.A

number

ofresidentsare

stillengagedin

coastalcanoe

fishing.T

hesesettlem

ents,and

especiallythe

HD

IS,

sharecom

mon

traitsw

ithother

lowclass

areas.T

helow

densitynew

lydeveloping

sector(L

DN

DS),

onthe

otherhand,includes

areaslikely

tobecom

ehigh

class,but

asyet

havinga

poorlydefined

comm

unitycharacter

andin

some

caseshaving

publicam

enitiesw

hichlag

behindthe

privatedevelopm

ent.T

herural

fringe(R

F)consists

ofrural

settlement

nucleiw

hichhave

nowbeen

incorporatedinto

them

etropolisthrough

anextension

ofthe

metropolitan

boundary.L

argeopen

spacesstill

exist,allow

ingfor

peri-urbanagriculture.

These

Ga

villages,likem

ostrurallocalities,are

generallybereftofservice

provisions.F

orthe

purposesof

presentation,tw

oform

so

fpost-stratification

were·

applied.L

ow,

middle

andhigh

wealth

householdshave

beengrouped

accordingto

aw

ealthindex

constructedfrom

thefollow

ingindicators

(weights

appliedare

inbrackets):

lamps

(1);iron

(5);fan

(5);black

andw

hitetelevision

(10);colour

television(20);

video(20);

refrigerator(30);

airconditioner

(50);bicycle

(10);m

otorcycle(40);

automobile

(100).H

ouseholdsscoring

lessthan

96have

been

Benneh

etal.5

designatedL

owW

ealth,those

scoringbetw

een96

and190

havebeen

designatedM

ediumW

ealth,and

thosescoring

over190

havebeen

designatedH

ighW

ealth.O

fthe

1,000households

surveyed,818

areL

owW

ealth,131

areM

ediumW

ealthand

51are

High

Wealth.

While

imperfect,

theow

nershipofconsum

erdurables

was

deemed

abetter

indicatoro

fw

ealththan

theinaccurate

estimates

of

income

andexpenditure

which

couldbe

obtainedrapidly

ina

householdsurvey.

Reapplying

thehousehold

wealth

indexto

thestrata

confmned

thew

ealthclassification

ofthe

stratathem

selves:T

hehigh

densityindigenous

sector,the

highdensity

lowclass

sector,the

middle

densityindigenous

sectorand

therural

fringeallhave

averagescores

significantlybelow

thelow

andm

iddledensity

middle

classsectors,

which

inturn

scoredlow

erthan

thelow

densityhigh

classsector

andthe

lowdensity

newly

developingsector.

This

trichotomy

providesthe

basisfor

thedistinction

between

low,

middle

andhigh

classareas

appliedin

some

of

thechapters

which

follow.

1.1.4P

hysicalTests

As

anothercom

ponento

fthe

study,physical

testsfor

water

andair

qualityw

erecarried

outin

asubset

of

200o

fthe1000

householdscovered

bythe

questionnairesurvey.

One

of

thefive

householdssurveyed

ineach

blockw

asselected

forthe

physicaltests,

allowing

maxim

umspread.

The

water

testsw

erefor

faecalcoliform

,both

atsource

andin

storagecontainers

when

possible.T

heair

testsw

eredesigned

toassess

wom

en'sexposure

toparticulates

andcarbon

monoxide

duringthe

cookingperiod.

Details

of

them

ethodsem

ployedfor

thephysical

testsare

presentedin

Appendix

1.2and

1.3.

1.1.5F

ocusG

roupD

iscussionsF

ocusgroup

discussionsw

ereundertaken

in14

lowincom

eneighbourhoods

where

environmental

qualityw

aspoor,

therebyindicating

aneed

forcom

munity

action.T

heneighbourhoods

includeA

shiaman,

Tem

aN

ewT

own

andO

ldA

shaleB

otwe

inT

ema

District;

Labadi

(La),

Darkum

an,Sabon

Zongo,

Maam

obi,A

ccraN

ewT

own,

Nim

a,Mam

probi,Jam

estown

andM

atahekoin

Accra

District;

andO

fankorand

Madina

forG

aD

istrict.T

hisfield

work,

includingthe

survey,the

physicaltests

andthe

focusgroup

discussions,provides

a"snap

shot"o

fA

ccraat

onepoint

intim

e.In

orderto

appreciatethe

contextfrom

which

this"snap

shot"w

astaken,

thefollow

ingsections

of

thischapter

reviewthe

urbangrow

thdynam

icso

fG

AM

A,

anddraw

outsom

eo

ftheim

plicationsfor

localenvironmental

managem

ent.

1.2O

verviewo

ftheU

rbanG

rowth

Dynam

icso

fGA

MA

An

estimated

1.5billion

peoplecurrently

livein

thecities

andtow

nso

fthe

Third

World.

Already

much

largerthan

thecom

binedpopulations

of

Europe,

North

Am

ericaand

Japan,this

figureis

stillgrow

ingby

some

70m

illionper

year(H

ardoy,M

itlinand

Satterthw

aite,1992,

p.29).

While

sub-Saharan

Africa

isthe

leasturbanized

of

allregions,

itsrate

of

urbanizationis

thehighest.

The

largestcities

havebeen

growing

particularlyrapidly

(White,

1989,p.2).T

heglobal

economic

problems

of

recentdecades

havehelped

drivesub­

Saharan

Africa

intoa

graveeconom

iccrisis.

Most

countriesin

theregion

havehad

toadopt

Structural

Adjustm

entProgram

mes

underthe

auspicesof

theW

orldB

ankand

theIM

P.

Proponents

arguethat

structuraladjustm

entis

thebest

means

of

corningto

terms

with

hardeconom

icrealities.

Detractors

arguethat

itcom

pounds

6E

nvironmentalP

roblems

an

dthe

Urban

Household

inthe

GA

MA

-Ghana

theeconom

iccrisis

forthe

poor,and

helpscreate

the"hard"

economic

conditions.R

egardless,m

ostgovernm

entsare

clearlyfacing

aperiod

of

severefm

ancialausterity.

These

demographic

andeconom

icconditions

havecom

binedto

placesevere

pressureson

governments

attempting

tom

aintainpublic

facilitiesand

services,let

aloneim

proveand

expandcoverage

(Stren,

1989).P

erhapsnow

hereis

thism

oretrue

thanin

theG

reaterA

ccraM

etropolitanA

rea(G

AM

A),

which

servesas

boththe

capitalo

fGhana

andthe

major

industrialgrow

thpole

(Songsore,

1992,p.1).

1.2.1P

opulationG

rowth

andP

hysicalDevelopm

entsw

ithinG

AM

AF

oundedin

the16th

centuryas

asm

allcoastal

fishingvillage

closeto

theeastern

shoreo

fthe

Korle

Lagoon,

Accra

soonbecam

ea

pre-eminent

centrein

Ghana.

Inthe

17thcentury

itbecam

eone

of

them

ostim

portantE

uropeantrading

centresalong

theG

oldC

oast(as

Ghana

was

thenknow

n).A

sm

anyas

threetrading

fortsor

castlesw

erebuilt

inA

ccra:the

Dutch

builtU

ssherF

ort(1650),

theS

wedish

Christiansborg

Castle

(1657),and

theB

ritishJam

esF

ort(1673).

In1877,

havingestablished

themselves

asthe

solecolonial

power

inthe

country,the

British

decidedto

transferthe

seato

fB

ritishA

dministration

fromC

apeC

oastto

Accra..

This

eventwas

ofsem

inalim

portancein

thedevelopm

entofA

ccra(D

ickson,1969,

p.259).

Accra

grewrapidly

butin

agenerally

unplannedm

anner.T

hepopulation

of

thesettlem

entincreased

from16,000

in1891

toaround

42,000in

1921and

in1948

(atthe

lastcensus

beforepolitical

independencein

1957)recorded

apopulation

of

136,000(Plan

Consult

1989,p.ii).A

newindustrial

satellitetow

nshipof

Tem

aw

asdeveloped

inthe

wake

ofindependence,a

periodw

hena

largeshare

of

publicinvestm

entw

asbeing

divertedtow

ardslarge

citiesand

towns.

Plannedby

Doxiades

andA

ssociates,this

industrialsatellite

grewfrom

apopulation

of

only23,000

in1960

to181,000

in1984.

Tem

ais

thesite

of

am

odemdeep

seaharbour

anda

major

industrialestate.

Accra

andT

ema

were

plannedto

growinto

onebig

metropolitan

area.T

heG

reaterA

ccraM

etropolitanA

rea(G

AM

A),

asdefined

here,includes

theA

ccraM

etropolitanA

rea(narrow

lydefm

edas

theA

ccraD

istrict)in

additionto

Tem

aand

Ga

Districts

(Fig.1.1

andF

ig.l.2).T

hesethree

districtshave

become

physicallyand

functionallyone

singleurbanized

area.T

heG

AM

Ahad

acom

binedpopulation

of

450,000in

1960,w

hichalm

ostdoubled

by1970,

andstood

at1,300,000

aso

fthe

1984census.

The

estimated

populationfor

them

etropolitanarea

was

putat

1.7m

illionin

1990.It

isexpected

toreach

the4

million

mark

by2010,

accountingfor

about15%

of

estimated

nationalpopulation

atthat

time

(Accra

Planning

Developm

entProgram

me

(Draft)

1992,p.35).T

heaverage

annualintercensal

growth

rates(6%

between

1960and

1970and

3.5%betw

een1970-84)

were

bothw

ellabove

thenational

growth

rate(T

able1.3).

The

much

highergrow

thrate

between

1960and

1970coincides

with

theeconom

icboom

periodfor

them

etropolitanarea

consequentto

thecreation

ofthe

industrialtow

nshipo

fT

ema

andthe

generalrapid

expansionof

administrative,

comm

ercial,business

andindustrial

activitiesin

Accra

township

itself.

Benneh

etal.

Ta

ble

1.3:P

op

ula

tion

Tre

nd

sw

ithin

GA

MA

,1960,1970,

1984.

Population

Totals

AnnualG

rowth

Rate

District

19

60

19

70

19841960-70

1970-84

Accra

388,396636,667

969,1955.1

3.1

Te

ma

27,127102,431

190,91714.2

4.5

Ga

33,90766,336

136,3586.9

5.3

TotalG

AM

A449,430

805,4341

29

6,4

70

6.03.5

Data

source:G

ha

na

Population

Census,

1984.

7

Although

about75%

of

thetotal

populationis

locatedin

Accra

District,

them

orerapid

growth

ratesare

foundin

theindustrial

districto

fT

ema

andthe

peri­urban

District

of

Ga,

which

havebeen

accomm

odatingm

ucho

fthe

over-spillo

furban

development

fromA

ccraD

istrict.G

iventhese

differentialgrow

thrates

itis

anticipatedthat

Tem

aand

Ga

districtsw

illaccount

foran

increasingshare

of

thetotal

population,as

shown

inT

able1.4

below.

By

2010,A

ccra'srelative

shareo

fthe

totalpopulation

of

GA

MA

isexpected

tohave

droppedto

66%,

from75%

in1984.

The

relativeshare

of

thesetw

odistricts

couldeven

behigher

thanthese

otherfigures

suggest,given

thesaturation

of

thebuilt

residentialenvironm

entw

ithinA

ccraD

istrict.

Ta

ble

1.4:P

op

ula

tion

Pro

jectio

ns

for

Districts

inG

AM

A1990-2000

('OO

Os).

District

19

90

19952000

20052010

Accra

1,2431,514

1,8432,231

2,686

Te

ma

268351

459547

772

Ga

197262

348461

607

Total

GA

MA

1,7082,126

2,6503,239

4,065

Data

source:A

ccraP

lanningand

Developm

entP

rogramm

e,1991.

GA

MA

'srapid

populationgrow

thhas

ledto

urbanspraw

land

uncontrolledphysical

expansionfrom

them

unicipalboundary

of

Accra

intoG

aD

istrict,w

hichuntil

1960·was

largelyrural

incharacter.

Som

eo

fthe

more

notableresidential

satellitesthat

havesprung

upinclude

Madina,.A

denta,H

aatcho,M

cCarthy

Hill,

Kw

ashieman,

New

Achim

ota,Dom

eand

Ofankor.

Inaddition

toexpansion,

therehas

alsobeen

increasedcrow

dingin

existingresidential

areas.T

hishas

resultedin

higheroccupancy

ratiosin

existinghousing

unitsand

theinfilling

of

vacantplots

inthe

existingresidential

areas(B

enneh,et

al,1990,

pp.17-19).

The

overcrowding

hasbeen

particularlysevere

inthe

numerous

unservicedand

unplannedslum

areasw

ithinthe

Accra

District

andA

shiaman

inT

ema

District.

8E

nvironmentalP

roblems

andthe

Urban

Household

inthe

GA

MA

-Ghana

InA

ccraD

istrict,except

forthe

fewhigh

andm

ediumclass

residentialareas,

thebulk

of

thepopulation

livesin

largelyunplanned

residential·developments.

This

dualstructure

reflectsthe

charactero

fall

Ghanaian

citieso

fcolonial

origin:w

hilstthe

European

sectorw

asplanned,

theA

fricanor

indigenouscity

was

oftenleft

onits

own,

exceptfor

afew

regulationsto

controlthe

frequentoutbreak

of

epidemics

(Songsore,

inpress).

Tem

aindustrial

township

hadthe

singularprivilege

of

havinga

planned­sew

eragesystem

andother

municipal

facilities.A

shiaman,

however,

which

developedas

asquatter

settlement

nextto

Tem

a,lacks

anym

eaningfulservice

infrastructure,w

hilstT

ema

New

Tow

n,w

herethe

originalG

afisherm

enw

ereresettled,

is-inadequately

serviced.T

heG

aD

istrict,w

hichurbanized.during

thecrisis

decadeso

fthe

70sand

80s,is

characterisedby

uncontrolledphysical

development

anda

poorcoverage

ofmunicipal

services.O

necannot

fullyunderstand

thefailures

inservice

deliveryexcept

throughan

analysiso

fthe

trendsin

urbaneconom

icperform

ance.B

oththe

ambitious

planningo

fT

ema

andthe

laissezfaire

charactero

frecent

developments

inG

areflect

.changesin

theeconom

icas

well

aspolitical

climates.

1.2.2U

rbanE

conomic

Grow

thT

rendsH

avingbeen

chosenas

thenational

capital,a

chaino

fagglom

erativeprocesses

were

soonset

inm

otion,further

consolidatingA

ccra'spre-em

inentposition

inthe

nationaleconom

y.C

ompounding

theover-centralisation

of

governmental

decision­m

akingpow

erand

controlin

Accra,

many

headoffices

of

businessfum

sw

ereestablished

inA

ccrato

benext

tothe

seato

fgovernment.

The

metropolis

was

alsohost

tothe

most

dynamic

fums

andindustries

inthe

country.W

ithjust

over10%

of

thetotal

population,it

hasthe

most

diversifiedeconom

yin

thecountry,

andcontributes

between

15and

20%o

fG

DP

(Accra

PlanningD

evelopment

Program

me

(Draft)

1992, p.17).

About

32%o

fthe

country'sm

anufacturirigindustries

arelocated

inthe

metropolis.

Itis

thecom

mercial,

business,educational

andcultural

centreo

fthe

country.It

liesat

thehub

ofinternal

andinternational

comm

unicationsnetw

orksw

iththe

most

modem

deep-seaport

atT

ema

andthe

onlyinternational

airport.M

oreover,the

metropolis

isw

ellserved

byroad

linksto

otherparts

of

thecountry,

andis

them

ostimportantcoastal

terminus

ofthe

railway

network

inG

hana.H

owever,

theeconom

yo

fthe

metropolitan

areais

alsocharacterised

bystructural

imbalances.

Itis

estimated

thatservices

aloneaccount

for26%

oftotal

employm

entfollow

edclosely

byw

holesaleand

retailtrade

with

24%.

Manufacturing

activityaccounts

foronly

19%o

fthe

totallabour

employed

(Am

uzuand

Leitm

an,1991, p.i).

During

the1970s

andearly

1980s,G

hana'sG

rossD

omestic

Product

persistentlydeclined.

Output

shrunkin

almost

allsectors,

inflationw

ashigh,

andthere

were

acuteshortages

of

consumer

goods.T

hisled

todeclining

percapita

incomes

anda

generaldeterioration

inthe

welfare

of

thepopulation.

The

metropolitan

economy

was

particularlyaffected

bythe

economic

crisis,given

its.dependence

onim

ports.Industrial

productionw

asat

anall

time

loww

ithcapacity­

utilisationfor

most

establishments

generallybelow

25%(Plan

Consult,

1989,p.

104).In1983,

Ghana

initiatedan

Econom

icR

ecovery/Structural

Adjustm

entP

rogramm

e(E

RP

/SA

P),

with

theobject

of

arrestingthe

declinein

theeconom

icand

socialconditions

inG

hana.T

able1.5

indicatesthe

extento

fthe

recoveryin

Benneh

etal.9

GD

P.

For

theyears

1984-1987,G

DP

recordedan

averageannual

growth

rateo

f6%

,w

ithindustry

growing

at12%

,servicesat

8%,and

agricultureat

3%.

Table

1.5:G

row

tho

fG

ha

na

'sG

OP

by

kind

ofe

con

om

ica

ctivityin

con

stan

t1975

price

s(p

er

cen

tpe

ra

nn

um

).

19

80

19811982

19831984

19851986

1987

Agriculture

2.17-2.56

-3.25-9.11

9.710.65

3.310.04

Ind

ustry

-1.85-14.46

-16.67-6.77

11.9417.60

7.5611.34

Se

rvices

-2.792.73

-4.65-4.54

6.637.52

6.509.38

Total

GD

P-0.23

-3.18-5.85

-4.348.96

5.095.20

4.80

Data

source:Je

bu

niet

aI.,1991,

p.8.

Since

GA

MA

hasa

highconcentration

of

industryand

service.activities,these

figuresw

ouldseem

tosuggest

thatits

recoveryhas

beenstrong.

This

impression

shouldbe

qualifiedby

thefact

thatm

iningaccounts

form

ucho

fthe

growth

inthe

industrialsector,

andis

insignificantin

GA

MA

.T

hem

anufacturingindustry

facesstiff

competition

fromim

portedgoods

underthe

liberalisationprogram

me.

The

balanceo

fpaym

entsposition

hasrem

ainedprecarious

throughoutthe

period,and

thereare

doubtsabout

thelong

termsustainability

of

recentgrow

thtrends

(Jebuniet

al.,1991).

Moreover,

evenif

growth

inproduction

canbe

maintained,

theeconom

icprospects

forthe

majority

ofthe

populationare

uncertain.T

heincreasing

economic

activityis

generatinggreater

industrial,com

mercial

andm

unicipalw

astes.Y

etthe

government

islikely

tocontinue

toface

severebudget

constraints.C

ombined

with

thepressing

needso

fhouseholds

inthe

burgeoningresidential

areas,theenvironm

entalchallenge

isim

mense.

1.3T

heC

hallengeo

fGA

MA

'sG

rowth

attheL

ocalLevel

The

rapidgrow

tho

fGA

MA

inan

unfavourableeconom

icenvironm

enthas

ledto

arapid

increasein

thenum

bero

fits

inhabitantsliving

insubstandard

housingand

overcrowded

conditions,w

ithoutthe

resourcesfor

decentshelter.

Our

surveyresults

indicatethat

about67%

of

householdslive

inthe

singlestorey

traditionalhouse

compounds,

occupiedby

severalhouseholds,

andoften

sharingsanitary

andkitchen

facilities.A

bout35%

of

householdslive

crowded

intoone

roomand

another33%

intotw

oroom

s.T

hegeneral

shortageo

fhousing

hasforced

some

peopleto

resortto

otherm

eanso

fshelter

includingthe

occupationo

fbuildings

underconstruction,

kiosks,garages

andverandas.

Itis

estimated

thatabout

3%o

fthe

populationo

fG

AM

Ais

homeless

(Accra

Planning

Developm

entP

rogramm

e,1992,

p.7).E

venaqlong

thehouseholds

surveyed,there

was

evidencethatin

them

orecrow

dedhouses

itis

notuncom

mon

forsom

ehouseholders

tosleep

away

fromhom

e.T

heH

ousingN

eedsA

ssessment

studyindicates

thaton

averagethere

are4.2

householdso

r23.3

personsper

dwelling.

There

areon

average1.8

rooms

perhousehold

and8.1

rooms

perdw

ellingw

ithan

averageo

f2.9

personsper

room.

The

mean

occupancyrate

of

2.9per

roomis

abovethe

United

Nations

recomm

endedstandard

of

2.5.(H

ousingand

Urban

Developm

entA

ssociates,1990,V

ol.1,p.103).

10E

nvironmental

Problem

sand

theU

rbanH

ouseholdin

theG

AM

A-G

hana

About20%

ofthe

householdheads

andprincipal

homem

akersfrom

oursurvey

were

illiterate,whilst

them

ajority(65%

)had

nothad

educationbeyond

elementary

schoollevel.

Most

peoplew

ithvery

lowskills

canbe

assumed

tow

orkin

theinform

alsector

which

accountsfor

about57%

of

thetotal

employm

entof

GA

MA

.W

omen

dominate

inthis

sector,often

working

closeto

home.

About

40%o

fthe

populationcovered

inour

surveyw

asbelow

15,m

ostlyyoung

childrenw

hospend

thebulk

of

theirtim

eat

home.

Overall,

thesurvey

resultsindicate

thatabout

30%o

fhouseholdm

embers

spend4

hoursor

lessaw

ayfrom

home,

50%spend

between

5-8hours

away

fromhom

e,andonly

4%o

fthe·populationspend

12hours

or

more

away

fromhom

e.T

heseresults

underscorethe

potentialim

portanceo

fthe

householdenvironm

enttothe

welfare

ofAccra's

inhabitants.R

eflectingthe

prevailinggender

divisiono

flabour,

itw

asfound

tobe

mainly

wom

enand

female

childrenw

hocook

andm

anagethe

householdenvironm

ent,and

arem

ostat

risk.M

oreover,as

would

beexpected,

thew

omen

were

generallyless

educated.A

sregards

poverty,the

evidencefor

Accra

would

seemto

suggestthat

thehigh

economic

growth

ratesrecorded

sincethe

inceptiono

fG

hana'sS

tructuralA

djustment

Program

me

havebrought

minim

alrelief

tothe

averageurban

household.F

orexam

ple,the

averageurban

worker

isstill

much

poorerthan

in1970.

Although

povertyis

stillm

oreprevalent

inrural

areas,w

iththe

metropolis

havingthe

highestm

eanper

capitahousehold

expenditurein

Ghana,

ina

recentstudy

about95%

of

thosesurveyed

earnedbelow

thepoverty

lineo

f$4.00per

dayas

stipulatedby

theInternational

Labour

Organisation

(Housing

andU

rbanD

evelopmentA

ssociates,1990).Indeed,given

thepressures

ofday

today

survival,the

capacityo

fpoor

householdsto

manage

theirlocal

environment

may

well

havecontinued

todecline

understructural

adjustment.

Benneh

etal.

CH

AP

TE

RT

WO

11

2H

OU

SE

HO

LD

WA

TE

RS

UP

PL

Y2.1

IntroductionT

hischapter

providesa

physicaloverview

of

water

accessand

useam

ongG

AM

Ahouseholds.

Itcovers

thetypes

andlocation

of

water

sources,w

aterstorage

andhandling,

water

payments

anduse

patterns,and

theassociation

between

water

sourceand

diarrhoeaprevalence

among

children.F

inally,the

physicalquality

of

thew

ater,both

atthe

households'w

atersources

andin

theirstorage

containers,are

examined.

Intra-urbandifferences

inaccess

tofacilities

arediscussed

interm

so

fboth

geographicalareas

andhousehold

wealth.

Both

of

thesedim

ensionsare

relevantto

policysince

itis

important

toknow

theareas

of

intervention.and

thetarget

groupsinvolved.

2.2W

aterSupply

Systems

An

adequatesupply

of

easilyaccessible,

potablew

ateris

centralto

households'w

elfare,and

aprerequisite

togood

hygieneand

sanitation(S

ongsore,1992,

p.5).M

anyhealth

problems

arelinked

tow

aterquality,

availability,ease

of

accessand

provisionsfor

disposal(see

Hardoy,

Mitlin

andS

atterthwaite,

1992;C

airncross,1990).

GA

MA

hasa

more

comprehensive

pipedw

atersystem

thanother

urbancentres

inG

hana.It

accountsfor

90x

10 6m

3(m

illioncubic

metres)

outo

fthe

totalannual

water

productionby

pipedsystem

so

fabout130

x10 6

m3

.

Ta

ble

2.1

:D

istrib

utio

no

fH

ou

se

ho

lds

inG

AM

Ab

yS

ou

rce

of

Drin

kin

gW

ate

r.

So

urce

Accra

Tem

aG

aG

AM

A

No.

0/0N

o.%

No.

%N

o.0/0

IndoorP

iping248

34.765

40.639

31.2352

35.2P

rivateS

tandpipe221

30.910

6.312

9.6243

24.3W

aterV

endor167

23.472

45.041

32.8280

28.0O

therP

rivateS

ource9

1.32

1.34

3.215

1.5C

omm

unalStandpipe

689.5

116.9

32.4

828.2

Well

20.3

75.6

90.9

Rainw

aterC

ollector4

3.24

0.4O

penW

aterway

1512.0

151.5

Total

715100.0

160100.0

125100.0

1000100.0

Data

source:Q

uestionnaireS

urveyof

GA

MA

.1991.

Table

2.1show

sthe

differentsources

of

water

supplyfor

them

etropolisas

aw

hole,w

ithindoor

pipingaccounting

for35%

whilst

privatestandpipes

andw

atervending

accountfor

24%and

28%respectively

of

thesam

pleo

fhouseholds

interviewed.

Virtually

allo

fthe

householdsin

Accra

andT

ema

dependon

thepiped

water

system,

eitherdirectly

or

indirectly.T

ema

District

hasthe

highestshare

with

indoorpiping

asthis

isthe

normin

allthe

plannedresidential

areaso

fT

ema

Tow

nship.In

Ga,

however,

more

than20%

of

thehouseholds

obtaintheir

drinkingw

aterfrom

rainwater

collectiono

ropen

waterw

aysand

wells.

12E

nvironmentaL

ProbLem

sa

nd

theU

rbanH

ousehoLdin

theG

AM

A-G

hana

Access

topiped

water

isclosely

relatedto

thedegree

of

planning,but

alsoto

householdw

ealth.A

sdescribed

inC

hapterI,

householdsw

eredivided

intothree

wealth

categories:low

wealth

(poor),m

ediumw

ealthand

highw

ealth(w

ealthy).T

able2.2

indicatesthe

importance

of

householdw

ealthin

determining

accessto

thebest

water

supplysystem

.W

hereas98%

of

wealthy

householdsand

70%o

fm

edium-w

ealthhouseholds

respectivelyhave

accessto

indoorpiping,

only26%

ofall

poorhouseholds

havesuch

afacility.

About33%

ofpoorhouseholds

relyon

thew

atervendor

asthe

principaldrinking

water

source.

Ta

ble

2.2:R

ela

tion

ship

Betw

eenP

rincip

alS

ou

rceo

fD

rinkin

gW

ate

rand

Ho

use

ho

ldW

ea

lth(%

).Wealth

IndexofH

ouseholdS

ourceLow

Medium

Ind

oo

rP

iping25.7

70.2

Sta

nd

pip

e(P

rivate)27.1

15.3

Wa

ter

Ve

nd

or

32.98.4

Co

mm

un

al

Sta

nd

pip

e9.2

5.3

Oth

ers

5.10.8

To

tal

10

0100

(N)

(818)(131)

High

98.0

2.0

100

(51)

All

35.2

24

.3

28

.0

8.2

4.3

100

(1000)

Da

taso

urce

:Q

ue

stion

na

ireS

urve

yof

GA

MA

,1991.

2.3C

onvenienceo

fAccess

an

dR

eliabilityo

fSupplyA

bout83%

of

allhouseholds

inG

AM

Adepend

onshared

water

supplysources

(includingvendors),w

hichnotonly

canlead

tothe

problemo

fqueues,but

insom

ecases

may

causecontam

inationproblem

s.S

ome

20%o

fthe

householdsget

theirdrinking

water

fromsources

theyshare

with

atleast

tenother

households;usually

sourcesopen

tothe

whole

neighbourhood.T

hevendors,

who

serveanother

28%o

fthe

households,also

typicallyhave

alarge

number

of

customers.

Reflecting

theoverall

availabilityo

fpiped

water,

householdsin

Ga

District

were

them

ostlikely;.,

tohave

toshare

aw

atersource

with

largenum

berso

fotherhouseholds,

while

high·levels

ofsharing

were

relativelyuncom

mon

inT

ema.

Benneh

etai.

Ta

ble

2.3

:R

ela

tion

sh

ipb

etw

ee

nH

ou

se

ho

ldS

ha

ring

Sa

me

Wa

ter

Su

pp

lya

nd

We

alth

of

Ho

use

ho

ldin

GA

MA

(%).

We

alth

Ind

ex

of

Ho

use

ho

ld

No

.of

Ho

use

ho

lds

Lo

wM

ed

ium

Hig

hA

ll

No

Sharing

(0)9

.039.9

76.616.2

1-

26.6

15.623.4

8.6

3-4

13.913.3

4.95

-78.5

7.78.0

8-

10

6.13.1

13.6

Above

10

-22.5

11.620.0

From

Ve

nd

or

33.58.6

28.6

Total

100.0100.0

100.0100.0

(N)

(803)(128)

(47)(978)

Data

source:Q

ue

stion

na

ireS

urveyo

fGA

MA

,1991.

N.B

.T

his

tab

lee

xclud

es

22

householdsw

ho

didnotrespond

toquestion

onsharing.

13

Table

2.3show

sthat

whereas

77%o

fall

wealthy

householdshave

exclusiveuse

of

theirw

atersupply,

most

poorhouseholds

eithershare

theirsource

of

water

with

atleastten

otherhouseholds

orbuy

fromvendors.

Ifone

isto

regardhouseholds

within

100m

etresof

water

sourceas

havingadequate

supplyo

fpotable

water

thenthe

bulkof

thepopulation

within

GA

MA

isadequately

servedw

ithw

ater,as

Table

2.4illustrates.

As

many

as54%

of

allhouseholds

haveaccess

tow

atersupply

within

theirhouse

compound,

andonly

5%have

supplysources

beyond100

metres

distancefrom

home.

Again,

thebest

serveddistrictis

Tem

aand

thew

orstisG

a.

Ta

ble

2.4

:A

ve

rag

eD

ista

nce

of

Ho

use

ho

lds

from

Wa

ter

So

urc

e.

Dista

nce

from

District

Ho

me

(me

tres)

Accra

Te

ma

Ga

To

tal

GA

MA

No.

0/0N

o.%

No.

%N

o.%

InH

om

e(0)

40857.1

7546.9

5241.6

53553.5

1-

50

23833.3

7546.9

3427.2

34734.7

51-

10

05

57

.75

3.113

10.473

7.3

10

1-2

00

50

.72

1.316

12.823

2.3

Above

2009

1.33

1.910

8.0

222.2

To

tal

715100.0

160100.0

125100.0

1000100.0

Data

source:Q

ue

stion

na

ireS

urveyof

GA

MA

,1991.

Whilst

allbut

2households

within

thehigh

classresidential

areas(for

definitionsee

section1.1.3)

havein-house

water

suppliesand

onlya

small

proportionw

ithinthe

medium

classresidential

areaslack

in-housesupplies,

allhouseholds

whose

water

supplysources

were

beyond50

metres

fromthe

house

14E

nvironmental

Problem

sand

theU

rbanH

ouseholdin

theG

AM

A-G

hana

were

foundin

thelow

classresidential

areas.E

venhere,

however,

about5%

of

allhouseholds

hadw

atersources

beyond100

metres

fromthe

house.T

hisgives

theim

pressiono

fadequate

overallcoverage.

How

ever,even

shortdistances

canlead

tow

atersupply

deficiencies.M

oreover,w

atersupply

inG

AM

Ais

oftendisrupted

bythe

breakdown

of

obsoleteequipm

entin

treatment

plantsat

theW

eijaand

Kpong

water

works,

which

supplythe

bulkof

potablew

aterto

them

etropolis.T

hepresent

estimated

water

demand

forA

ccraand

Tem

a,excluding,

thefast

growing

Ga

District,

is76

million

gallonsper

day(M

GD

)as

againstthe

actualestimated

productionof60

MG

D(T

able2.5).

According

tothe

managem

ento

fthe

Ghana

Water

andS

ewerage

Corporation

(GW

SC

),an

additional30%

of

totalproduction

islost

throughleakages.

Supplyis

particularlyerratic

andprecarious

forthe

lowpressure

zonein

thew

esternparts

of

Accra

servedby

theold

Weija

Water

Works.

Ta

ble

2.5:W

ate

rP

rod

uctio

na

tthe

Weija

an

dK

po

ng

Tre

atm

en

tP

lants.

Insta

lled

Tre

atm

en

tP

lan

tC

ap

acity

MG

D

A.W

eija

Ne

wW

orks15.00

Bam

ag4.00

Candy

8.00

Weija

Sub-total

27.00

B.K

po

ng

Ne

wW

orks

40.0

Old

Works

10.5

Kpong

Sub-total

50.5

Grand

Total

77.5

Actu

alP

rod

uctio

n

MG

D15.00

3.000.00

18.00

35.6

6.75

42.35

60.35

Re

ma

rks

Candy

Plant

brokendow

nsince

1986.

1.2MG

Dis

supplieddaily

to

Akw

apimR

idge.

Data

source:D

atacom

piledfor

studyby

GW

SC

,A

ccra,1992.

The

worst

affectedareas

includeD

ansoman

Housing

Estates,

South

Odorkor;

Bubuashie,and

Darkom

anto

theW

est,and

Teshie-N

unguaH

ousingE

statesto

theE

ast.In

additionm

ostnew

housingestates

andhigh

densitylow

classareas

inG

adistrict,

suchas

Madina,

alsosuffer

acutew

atershortages.

This

isaggravated

inthe

dryseason

when

theonly

availablesource

ofw

aterfor

householduse,

gardening,w

ashingo

fcars,etc.,isthe

GW

SCsystem

.D

atafrom

thequestionnaire

surveytend

tosupport

theobservation

thatthe

water

supplyfrom

theG

WS

Csystem

isunreliable

andirregular.

About

66%o

fhouseholds

indicateda

regulardaily

interruptiono

ftheir

principaldrinking

water

supply.T

hesereported

interruptionsw

erew

idespreadin

them

etropolis,affecting

neighbourhoodsin

low,

medium

andhigh

classresidential

areasalike.

They

alsoarise

throughoutthe

year:m

osto

fthe

households(91

%)

who

reportedinterruptions

indicatedthat

theyoccurred

inboth

thew

etand

dryseasons.

The

problemis

particularlysevere

inthe

dryseason,

however,

especiallyfor

residentsw

ithinthe

Ga

District

where

some

comm

unitiesrely

onnatural

sourcessuch

asstream

s,rainwater

harvestingand

shalloww

ells.

Benneh

etal.15

Ow

ingto

theunreliability

of

water

supply,the

practiceo

fw

aterstorage

isw

idespreadeven

among

householdsw

hohave

indoorpiping.

Inaddition

tothe

inconvenience,thiscreates

adanger

ofcontamination.

The

sourceo

fw

atersupply,

thenum

berof

householdssharing

water,

thedistance

tosource

andsupply

interruptionsare

alldim

ensionso

fw

ateravailability

andease

of

access.M

osto

fthese

factorsare

alsorelated

tow

aterquality.

Evidence

fromthe

bacteriologicalquality

of

drinkingw

ater(see

below)

suggeststhat

althoughw

aterquality

fromthe

pipedsystem

isgenerally

good,it

isoften

contaminated

dueto

poorstorage

andhandling

practicesby

households.

2.4W

aterStorage

an

dH

andlingP

racticesM

ostlandlords

andhousing

agenciesw

hobuild

inhigh

andm

ediumclass

residentialareas

provideoverhead

tanksor

otherrelatively

efficientstorage

facilitiesin

thehouses

theyconstruct.

Especially

inthe

lowclass

residentialareas

with

inadequateservice

facilities,individual

householdshave

devisedcoping

strategiesby

providingtheir

own

small

storagecontainers

suchas

barrels,pigfeet

containers,jerrycans,

potsand

bucketso

fvarious

sizes.T

hehigh

incidenceof

water

storageis

confirmed

bythe

surveydata;

about96%

of

allhouseholds

within

GA

MA

storedw

ater(T

able2.6).

Ta

ble

2.6

:P

ractic

eo

fW

ate

rS

tora

ge

inth

eM

etro

po

lis.

Response

District

No

Yes

To

taI

No.

0/0N

o.%

No.

%

Accra

324.5

68395.5

715100.0

Tem

a2

1.3158

98.8160

100.0G

a9

7.2116

92.8125

100.0

TotalG

AM

A43

4.3957

95.71000

100.0

Data

source:Q

uestionnaireS

urveyofG

AM

A,1991.

The

most

comm

onstorage

containeris

theengine

oildrum

orbarrel,

followed

bythe

bucket,the

pigfeetcontainer,

thejerry

can,the

overheadw

atertank

andthe

potin

descendingorder

of

importance.

Table

2.7show

sthat

whereas

theoverhead

tanktends

tobe

thepredom

inantm

eanso

fw

aterstorage

among

thew

ealthyhouseholds,the

barrelis

popularam

ongpoor

andm

ediumincom

egroups.

16E

nvironmental

Problem

sand

theU

rbanH

ouseholdin

theG

AM

A-G

hana

Ta

ble

2.7

:R

ela

tion

sh

ipB

etw

ee

nT

ype

of

Sto

rag

eC

on

tain

er

Use

da

nd

Ho

use

ho

ldW

ea

lthin

pe

rcen

tag

es.

Wealth

Ind

ex

of

Ho

use

ho

ldC

on

tain

er

(typica

lsize)L

ow

Medium

High

All

Overhead

Tank

(2,250)2.6

16.348.9

6.6B

arrel(225

litres)48.6

48.025.5

47.4P

igF

eetContainer

(45H

tres)15.0

15.412.8

15.0Jerrycan

(22.5H

tres)8.4

9.88.5

8.5P

ot(13.5-100

litres)6.3

3.35.6

Bucket

(13.5-18litres)

19.27.3

4.316.9

Total

100.0100.0

100.0100

(N)

(778)(123)

(47)(948)

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

About

43%o

fall

householdshad

tocarry

water

totheir

homes,

usingsuch

rudimentary

methods

ashead

portageand

handcarriage.

The

hygienepractices

surroundingw

aterportage

ispoor

asm

ostpeople

useopen

bucketsand

containersto

conveythe

water.

Although

83%o

fhouseholds

inthe

metropolis

hadtheir

water

storedin

closedcontainers,

asignificant

number

of

these(i.e.

28%)

keptthese

containersoutside.

Only

17%o

fhouseholds

storingw

aterused

opencontainers.

The

useo

fclosed

water

containersw

asrelated

tothe

educationalstatus

ofthe

principalhom

emakers.

For

example,w

hereasonly

76%o

fprincipalhom

emakers

with

noform

aleducation

storedw

aterin

closedcontainers,

83%o

fthose

with

onlysom

eelem

entaryschool

education,88%

of

thosew

ithsom

esecondary

education,and

94%o

fthose

with

post-secondaryeducation

storedw

aterin

closedcontainers.

Given

thehigh

incidenceo

fw

aterstorage

discussedabove,

andirregular

washing

of

storagecontainers

(Table

2.8),one

would

anticipatesignificant

in­house

water

contamination.

How

ever,the

practiceo

fboiling

water

orfiltering

beforedrinking

isnegligible.

About

90%o

fall

householdsinterview

eddrank

theirw

aterw

ithoutboiling

orfiltering

it(T

able2.9).

The

onlyneighbourhoods

where

am

ajorityo

fthe

respondentsboiled

orfiltered

theirw

aterw

erethe

highclass

residentialareas

of

Airport

andR

ingway

Estate,

which

havea

highconcentration

of

foreignem

bassystaff

andtop

businessexecutives.

Even

among

the24

householdsusing

wells

oropen

waterw

ays,only

5boiled

orfiltered

thew

aterprior

todrinking

(indeed,alm

osthalfo

fthe

householdsboiling

orfiltering

water

hadin­

housepiping).

Benneh

etaL.17

Ta

ble

2.8

:F

req

ue

ncy

of

Cle

an

ing

of

Sto

rag

eC

on

tain

ers

by

Ho

use

ho

lds.

District

GA

MA

Cle

an

sing

Fre

qu

en

cyA

ccraT

ernaG

aT

otal

No.

%N

o.%

No.

%N

o.%

Daily

29743.5

6440.5

3227.8

39341.0

Weekly

27840.8

5434.2

6455.7

39641.5

Monthly

608.8

148.9

97.8

838.7

Rarely

orN

ever47

6.926

16.510

8.783

8.7

Total

682100.0

158100.0

115100.0

955100.0

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

Ta

ble

2.9

:G

en

era

lP

ractice

of

Wa

ter

Bo

iling

or

Filte

ring

Be

fore

Drin

kin

gb

yH

ou

se

ho

lds.

Response

District

No

Yes

To

taI

No.

%N

o.%

No.

%A

ccra635

88.880

11.2715

100.0T

erna154

96.36

3.8160

100.0G

a113

90.412

9.6125

100.0

TotalG

AM

A902

90.298

9.81000

100.0

Data

source:Q

uestionnaireS

urveyof

GA

MA

,1991.

Most

householdsfailed

toboil

theirw

aterbecause

of

thepopular

perceptionthat

overallw

aterquality

was

good.E

venw

henthey

perceivedan

inadequacyin

thew

aterquality,

theygenerally

didnot

care,perhaps

implying

alack

of

understandingo

fthe

healthrisks

involved.F

ewpeople

indicatedtim

eor

fuelcost/scarcity

asbeing

theconstraint

forthe

lowpractice

of

water

boilingor

filtering.D

rinkingw

aterdirectly

fromrivers,

streams

andother

waterw

aysw

as,on

theother

hand,relatively

rare,even

among

children.O

nlythree

percent

of

therespondents

saidtheir

childrendrank

regularlyfrom

suchsources,

whilst

aboutfive

percent

saidthey

didoccasionally.

These

childrenw

erem

ainlyfound

indeprived

comm

unitiesin

theperi-urban

andrural

fringeareas

inG

aand

Tem

aD

istricts.T

hew

orstaffected

comm

unitiesare

Danfa

andA

masam

anin

Ga

District.

InA

ccradistrict,

itw

asm

ainlychildren

of

poorlyeducated

slumdw

ellersw

hooccasionally

drankw

aterfrom

suchsources.

2.5W

aterU

tilisationP

atternsU

nlikesom

ecities

with

well-planned

neighbourhoodutility

services,such

asbath

houses,the

metropolitan

areain

generallacks

suchpublic

bathingfacilities,

andthe

fewthat

existedin

thepast

havefallen

intodisrepair.

Afew

comm

ercialshow

erunits

havestarted

developing:som

ew

erenoted

inthe

lowclass

residentialarea

ofS

abonZ

ongoin

Accra

andT

ema

New

Tow

nin

Tem

a.O

verall,for

thelow

class

18E

nvironmental

Problem

sa

nd

theU

rbanH

ouseholdin

theG

AM

A-G

hana

residentialzones

which

lackindoor

piping,the

practiceof

water

utilisationat

sitew

hetherfor

drinking,bathing,cooking,washing

orotheruses

was

negligible.A

lthoughthe

practiceof

drinkingice

water

andice-kenkey

fromunhygienic

ice-water

sellersis

popularin

comm

ercial,industrial

andother

workplaces,

veryfew

ofthose

without

regularin-house

water

supplydrank

water

atthe

pointof

water

collection.B

athingand

washing

atthe

water

sourcew

aslim

itedto

therural

fringezone

inG

aD

istrictespeciallyin

them

ostdeprived

andisolated

comm

unitiessuch

asO

yarifa,Danfa

andO

ldO

fankor.

2.6W

aterP

ayments

Sincethe

inceptionof

Ghana's

Econom

icR

ecovery/StructuralA

djustment

Program

me,

theprevailing

ethoshas

beenthe

removal

ofsubsidies

fromall

servicesincluding

water.

The

costrecovery

measures

forw

ateruse

havem

eantthe

veryregular

revisionof

water

tariffsupw

ards.A

tthe

time

ofthe

survey,for

metered

premises

therates

varyfrom

741for

thefirst

3,000gallons

perm

onth(equivalent

to247

cedisper

thousandgallons

ifthe

full3,000

was

consumed)

to814

cedisper

thousandgallons

consumed

inexcess

of

10thousand

gallonsper

month.

Unm

eteredprem

isesw

erecharged

aflat

rateo

f741

cedisper

houseper

month.

Those

who

relyon

publicstand

pipesw

erecharged

aflat

rateof

247cedis

perhouse

perm

onth.F

orresidents

who

relyon

boreholes,w

ellsand

handpum

psa

flatm

onthlycharge

of146

cedisw

aslevied

perhouse.

More

recently,these

rateshave

increasedby

between

27and

161%

.A

bout90%

of

householdsin

them

etropolishad

topay

forw

ater.T

hebulk

ofG

AM

A's

population,how

ever,w

asunm

eteredand

hadto

payby

thebucket

tow

atervendors

ora

fixedm

onthlyrate

toG

WS

c.F

orthe

metropolis

asa

whole

only38%

ofhouseholds

who

paidfor

water

uselived

inm

eteredprem

ises(T

able2.10).

Ta

ble

2.1

0:

Mo

de

of

Wa

ter

Pa

yme

nt

am

on

gH

ou

seh

old

sP

ayin

gfo

rW

ate

r.

Mode

of

Paym

entA

ccraT

ema

Ga

TotalG

AM

A

No.

0/0N

o.%

No.

%N

o.%

Fixed

Monthly

Rate

11718.9

4831.4

1920.0

18421.2

.,.M

etered254

41.139

25.53

738.9

33038.1

Bucket

23938.7

6441.8

3941.1

34239.5

Other

Container

40.6

40.5

Pay

forE

achU

se4

0.62

1.36

0.7

Total

618100.0

153100.0

95100.0

866100.0

Source:

Questionnaire

Survey

ofGA

MA

,1991.

As

aresult

ofthe

widespread

practiceof

water

vendingin

lowincom

eareas,

about40%

of

allhouseholds

who

paidfor

water

usedid

soon

adaily

basis.E

achbuyer

paysfive

orten

cedisper

bucket,indicating

anaverage

costof

roughlyone

cediper

gallon.T

hisis

well

abovethe

pricefor

householdspurchasing

water

directlyfrom

theutility.

Am

eteredor

unmetered

householdusing

3,000gallons

perm

onth,or

ahousehold

collectinga

1,000from

apublic

standpipe,paid

aquarter

of

thisrate.

The

costofpurchasing

water

froma

vendorcould

easilycom

e

Benneh

etal.19

to10%

of

them

onthlyincom

eo

fa

lowincom

ehousehold.

This

almost

certainlyserves

asa

constraintonthe

amounto

fdailyw

ateruse.

Also,

while

thegraduated

tariffm

ayserve

todissuade

some

wealthy

householdsfrom

usingw

atercarelessly,it

canalso

bea

burdenon

householdsw

hoshare

water

meters.

The

surveyresults

indicatethat

more

thanthree

outo

ffour

metered

connectionsused

bypoor

householdsare

shared,w

hilesharing

isan

exceptionam

ongw

ealthyhouseholds.

Thus

wealthy

householdscan

consume

considerablym

orew

aterbefore

fallinginto

thehigh

tariffblocks.T

able2.11

illustratesthe

closerelationship

between

thew

ealtho

fhouseholds

andthe

mode

of

payment

forw

ater,establishing

thecase

thatthe

poorestgroups

arehaving

topay

bythe

buckettow

atervendors.

.

Tab

le2.11:

Relatio

nsh

ipB

etween

Wealth

Statu

so

fH

ou

seho

ldan

dM

od

eo

fW

aterP

aymen

ts(%

).

Wealth

Ind

exo

fH

ou

seho

ld

Mo

de

of

Paym

ent

Lo

wM

ediu

mH

igh

All

Fixe

dM

on

thly

Ra

te2

2.4

16

.21

5.2

21

.2

Me

tere

d2

9.2

74

.88

4.8

38.1

Bu

cket

47

.08.1

39

.5

Oth

er

Co

nta

ine

r0

.70

.5

Pa

yfo

re

ach

Use

0.7

0.9

0.7

To

tal

10

0.0

10

0.0

10

0.0

10

0.0

(N)

(708)(108)

(46)(866)

Da

taso

urce

:Q

ue

stion

na

ireS

urve

yof

GA

MA

,1

99

1.

Households

with

asew

erageconnection

haveto

paya

35%surcharge.

From

January1992,a

surchargeo

f3%has

beenadded

forthe

publicuse

ofw

aterfor

fIrefIghting

andfor

theprom

otiono

frural

water

development.

Only

about10%

of

totalhouseholds

who

paidfor

water

indicatedthat

they~ere

aware

of

anadditional

servicecharge

forsew

erageconnection.

These

areprincipally

inthe

plannedm

aintow

nshipo

fT

ema

andthe

highto

medium

classresidential

areasin

Accra

District.

According

tothe

GW

SC

,m

ostresidents

inthe

metropolis

donot

want

topay

forw

aterservices.

Am

ongthe

reasonsare

thefollow

ing:

Consum

erssubject

tosupply

interruptionsm

ayfeel

theyshould

nothave

topay.

Residents

donot

seemto

appreciatethat

with

inadequatefunds

foroperational

expenses,it

isdiffIcult

forthe

GW

SC

toprovide

areliable

service.C

onsumers

canfall

backon

neighboursor

evena

tankerservice

inthe

evento

fadisconnection

fornon-paym

entofwaterbills.

Consum

ersin

thehigh

classresidential

areas,living

infenced

inbungalow

sw

ithguard

dogs,m

ayfeel

thatno

oneshould

dareto

enterand

demand

payment,letalone

attemptdisconnection,

and;In

ruralareas

inparticular,

peoplem

ayhave

become

accustomed

tothe

notionthatw

ateris

free,and

hencebe

unwilling

topay.

20

Environm

entalP

roblems

andthe

Urban

Household

inthe

GA

MA

-Ghana

Also,

asthe

GW

SC

putsit,

"sightshould

notbe

losto

fsom

econsum

ers'inability

topay

evenat

beloweconom

icrates.

The

percentageo

fpaym

entto

theearnings

of

theaverage

income

earnersignificantly

affectshis

decisionto

payfor

water

consumed

asw

ellas

tom

eetother

pressingcom

mitm

ents.F

acedw

iththis

dilemm

a,the

consumer

becomes

apatheticto

theneed

topay.

All

thesefactors

hamper

theflow

of

revenueto

theproducer

andconsequently

thecost

recoveryas

well."

(GW

SC

Materials

providedfor

study,1992).

Given

thew

idespreadpractice

of

unhygienicstorage

andhandling

of

water,

thevirtual

absenceo

fw

aterboiling

or

fIlteringand

theuse

of

dubiousw

atersources

bysom

ehouseholds,

itis

notenough

tofocus

onbringing

"water

tothe

tap"w

hatis

happening"betw

eentap

andm

outh"m

ayalso

becritical

(Lindskog

andL

undqvist,1989,

p.16).

The

evidencefrom

thephysical

testso

fw

aterquality

describedbelow

tendsto

supportthis

view.

Table

2.12illustrates

thestrong

associationbetw

eenprincipal

sourceo

fdrinking

water

andself-reported

prevalenceo

fchildhood

diarrhoeaam

onghouseholds

with

childrenunder

six.T

helocation

of

thew

atersource

alsodisplays

.aclose

association:the

two-w

eekprevalence

of

childhooddiarrhoea

among

householdsw

ithchildren

was

only7%

ifthew

atersource

was

within

thehouse,

incontrast

toa

prevalenceo

f20%

among

householdsw

hohad

theirw

atersource

locatedoutside

thehouse

compound.

Even

among

poorhouseholds

with

water

inthe

housecom

pound,the

diarrhoeaprevalence

was

low(7%

).T

hishas

potentiallyim

portantim

plicationsfor

healthpolicy,

asit

indicatesthat

theprovision

of

standpipesw

ithincom

poundhousing

units,w

hichis

lesscostly

thanin-house

piping,may

havesim

ilarhealth

benefits.

Ta

ble

2.12:R

ela

tion

ship

Be

twe

en

Drin

king

Wa

ter

So

urce

an

dP

reva

len

ceo

fD

iarrh

oe

ain

Ch

ildre

nU

nd

er

Six.

Water

Source

Ind

oo

rP

iping

Private

Standpipe

Wa

ter

Ve

nd

or

Com

munal

Standpipe

Oth

ers

Total

Num

berofhouseholds

with

children<6

yrs

162

139

165

5021

537

%tw

o-week

prevalenceo

fdiarrhoea

6.8

14.0

10.1

42.0

14.3

13.8

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

2.7

BacteriologicalE

xamination

ofD

rinkingW

aterSupply

Tests

were

conductedto

determine

thelevels

of

bothfaecal

coliformand

faecalstreptococci

inthe

water

householdsdrink.

Where

possible,sam

plesw

eretaken

fromboth

thehouseholds'w

atersources

andtheir

storagecontainers.

All

together,sam

plesw

eretaken

from199

households.T

hedetection

of

faecalcoliform

s(F

.e.)in

water

isconfirm

atoryevidence

of

faecalpollution

of

human

or

animal

origin.It

isam

ongthe

most

reliableindicators

of

excretalcontam

inationo

fw

ater.A

partfrom

contamination

fromexcretal

material,

F.e.

arerarely

foundnaturally

insoil,

vegetationor

water.

High

.countsindicate

heavyand

recentpollution,

lowcounts

slightor

relativelyrem

ote

Benneh

etal.21

pollution.T

heabsence

of

F.e.,

however,

isnot

anabsolute

indicationthat

thesupply

isfree

fromF

.e.,as

thecoliform

sdie

outratherrapidly

inw

ater.C

hlorinateddrinking

water

suppliesshould

ideallycontain

nofaecal

coliform(W

HO

,1984).

How

ever,it

issom

etimes

arguedthat

suchstandards

canbe

toorigorous

andim

practicalto

follow,

andlead

toan

overemphasis

onw

aterquality

incircum

stancesw

hereit

isthe

lacko

fw

aterw

hichis

more

detrimental

topublic

health(C

aimcross,

1990).In

unchlorinatedsupplies

suchas

boreholesand

hand­dug

wells,

F.e.

shouldnot

exceed3

organismsllO

Om

lo

fsam

ple,according

toW

HO

guidelines.F

aecalstreptococci

(F.S

.)are

unlikelyto

multiply

inw

ater,but

may

alsodie

ou

tless

rapidlythan

F.e.

They

may

thereforebe

usedto

confmn

remote

pollutiono

ffaecal

origin(K

enner,1978).

They

tendto

persistin

water

evenafter

chlorination(W

HO

1984).T

heresults

of

thehousehold

water

testsare

summ

arisedin

Table

2.13-2.15.T

hefollow

ingdiscussion

examines

fIrstthe

contamination

atthe

households'water

sources(principally

tapw

ater),and

thenthe

contamination

of

thew

aterin

householdcontainers.

Table

2.13:C

ou

nts

of

Faecalco

liform

sa

nd

Faecalstre

pto

cocci

pe

r100

mlw

ate

r(H

ou

seh

old

sg

rou

pe

da

ccord

ing

toC

lasso

fA

rea).

1.Lo

wC

lass

Areas

Tap

Faecalcoliform

sF

aecalstreptococci

n~

~

mean

2.628.4

standarddeviation

16.383.4

minim

um0

0m

aximum

150620

%contam

inated13

76

Co

nta

ine

rF

aecalcoliforms

Faecalstreptococci

129129

32.6338.2

34.0297.5

o1

1601480

88100

2.M

idd

lea

nd

Hig

hC

lass

Areas

n38

mean

0.02standard

deviation0.2

minim

um0

maxim

um1

%contam

inated3

3827.848.3o

16039

2014.817.1o5375

20144.9152.512

430100

22

Environm

entalP

roblems

andthe

Urban

Household

inthe

GA

MA

-Ghana

Ta

ble

2.1

4:

Ba

cte

riolo

gic

al

Re

sults

(Dis

trict

Le

vel).

1.Accra

District

Tap

Co

nta

ine

rF

aecalcoliforms

Faecalstreptococci

Faecalcoliforms

Faecalstreptococci

n110

110113

113m

ean2.3

26.730.9

261.5standard

deviation15.4

82.435.2

241.8m

inimum

00

01

maxim

um150

620160

1280%

contaminated

1266

85100

2.Tem

aD

istrictn

1818

1818

mean

0.0629.5

27.1604.3

standarddeviation

0.227.4

22.5452.9"

minim

um0

00

70m

aximum

182

661480

%contam

inated6

948

3100

3.G

aR

uralD

istrictn

88

1818

mean

047.8

28.6339.2

standarddeviation

29.325.6

177.9m

inimum

05

154

maxim

um0

9084

580%

contaminated

0100

100100

Ta

ble

2.1

5:

Ba

cte

riolo

gic

al

Re

sults

(GA

MA

).

4.To

talG

AM

A

nmean

standarddeviation

minim

umm

aximum

%contam

inated

Tap

Faecalcoliform

sF

aecalstreptococci136

136

1.928.3

13.975.1

o0

150620

1071

Container

Faecalcoliforms

Faecalstreptococci

149149

30.2312.3

32.8289.6

o1

1601480

87100

Data

source:T

estsundertaken

forthis

stUdy.

2.7.1B

acteriologicalQ

ualityo

fHousehold

Water

SourcesN

early56%

of

thetaps

sampled

inthe

GA

MA

duringthe

surveyw

erein

housecom

pounds.T

heothers

were

typicallyoutdoor

standpipes,eitherprivate

orpublic.

Households

which

hadno

in-housesupplies

andhad

nofree

accessto

standpipes,purchased

water

fromprivate

standpipes(w

atervendors).

Water

suppliesfrom

theG

WS

Ctreatm

entplants

areregularly

testedand

generallyfound

tobe

ofgood

qualityand

bacterial-free.T

herefore,the

presenceo

ffaecal

bacteriain

thew

atersource

suggestscontam

inationw

ithinthe

distributionsystem

.A

sindicated

inT

able2.13,

about13%

of

the98

tapssam

pledin

Low

Class

Areas

exceededthe

WH

Oguideline

of

O/lO

Om

lfor

F.e.O

nlyone

of

the38

samples

inthe

Middle-and-H

ighC

lassareas

exceededthis

guideline.C

hi-squarevalues

indicatethat

iftheextent

of

contamination

were

thesam

ein

Low

Class

and

Benneh

etal.23

Medium

-and-High

Class

Areas,

suchdifferences

would

beunlikely

(pr.<

07)to

arisein

thesam

ples.M

oreover,there

aregood

reasonsto

expectthe

water

qualityto

below

erin

poorareas

of

GA

MA

.illegal

andim

properlyfitted

connections,breakages

andloose

jointso

fpipes

which

runthrough

cesspoolsand

gutterscause

localcontam

inationo

fw

atersupply.

These

arenorm

allyfound

inthe

lowincom

eand

economically

depressedareas.

F.e.

countsranged

from0

to150/100m

lin

tapsam

plesfor

suppliesin

theL

owC

lassA

reas(T

able2.13).

Specifically,som

etaps

inA

ccraN

ewT

own,

Nim

aand

Maam

obineighbourhoods

hadF

.C.

countsgreater

thanthe

recomm

endedlevels.

F.e.

countsin

13sam

plesfrom

Accra

New

Tow

nranged

from0

to6/100m

lw

itha

mean

counto

f2.

Nim

ahad

thew

orstw

aterquality,

with

arange

of

0to

150,and

am

eano

f37

countsam

ongthe

10sam

ples.In

Accra

District

asa

whole,

12%o

ftap

water

samples

exceededthe

guidelinefor

F.e.

levels,as

compared

to6%

inthe

Tem

aD

istrict.F

aecalstreptococci

countsw

ereconsiderably

higherthan

thefaecal

coliformlevels.S

amples

fromS

abonZ

ongo,N

ima

andM

aamobi

containedparticularly

highcounts

of

F.S

.T

hem

eanF.S.

levelsw

ereo

fthe

same

ordero

fm

agnitudein

theA

ccraand

Tem

aD

istrict.T

hem

eancount

of

48in

theG

aD

istrictw

asconsiderably

higherthan

thato

fthe

otherD

istricts.T

hesupplies

inthe

Ga

districtare

however

unchlorinated.T

hehighest

counto

f620/100m

lw

asobtained

fora

supplyin

theA

ccraD

istrict,as

compared

tom

aximum

countso

f82

and90

inthe

Tem

aand

Ga

Districts

respectively(T

able2.14).

Overall,

10%o

fthe

tapw

atersam

plesin

GA

MA

exceededthe

WH

Ofaecal

coliformguideline

and71

%exceeded

theguidelines

onfaecal

streptococci(T

able2.15).

Groundw

aterand

Pond

(Ga

Rural

District)

Ahand-dug

well

anda

pondw

eresam

pledat

Oyarifa

andD

anfarespectively,both

inthe

Ga

district.T

hew

ellhad

aF

.e.value

of

1I100ml

anda

F.S.count

of470/100m

l.F

.e.count

forthe

pondw

as16/100m

lw

hilethe

F.S.level

was

480/l00ml.

'Ice-water'vendors

Tw

osurveys

were

specificallycarried

outonthe

qualityo

f'ice-w

ater'which

issold

allover

them

etropolis.In

most

market

placesand

busstations,

'ice-water'vendors

sellcold

drinkingw

aterduring

theday.

Blocks

of

iceare

putin

water

containedin

ice-boxesor

potsfor

cooling.T

hechilled

water

isdispensed

with

aluminium

orplastic

cupsfrom

thepots

orpackagedin

thincellophane

bagsfor

sale.In

thefirst

survey,faecal

coliformand

faecalstreptococci

numbers

were

detennined.In

thesecond

surveytotal

coliform,

F.C.

andF.S.

countsw

erecarried

out.N

oF

.e.w

eredetected

oneither

occasion.T

herew

erehow

eversignificantly

largecounts

of

totalcoliform

sand

F.S

.,as

indicatedin

Table

2.16.Indeed,

thelevels

of

F.S.w

ereso

highas

tow

arrantfurtherinvestigation.

24

Environm

entalP

roblems

andthe

Urban

Household

inthe

GA

MA

-Ghana

Table

2.16:B

acterialcon

cen

tratio

no

fdrin

king

water

from

'Ice-w

ater'vendors.

To

talco

liform

Faecalco

liform

Faecalstre

pto

cocci

cou

nts!

10

0m

lN

o.%

No.

%N

o.%

00

042

1000

01

-1

05

220

00

011

-100

1878

00

1433

101-

10000

00

028

67

Total

23100

42100

42100

Data

source:T

estsundertaken

forthis

study.

When

organisms

ofthe

coliformgroup

otherthan

faecalcoliform

sare

detectedin

aw

atersam

ple,the

presenceo

ffaecal

streptococciis

sufficientconfirm

atoryevidence

of

faecalcontam

ination.A

lsothe

presenceo

fcoliform

organisms

ina

water

sample

may

indicatepast

faecalcontam

inationat

atim

elong

enoughago

toallow

Ee.

todie

out.T

hefaecal

contamination

of

'ice-water'clearly

originatesfrom

sourcesoutside

theconsum

ers'households,

andis

thereforelikely

tobe

agreater

healthrisk.

Assum

ingthe

tapw

aterused

bythe

ice-water

vendorsis

ofa

qualitycom

parableto

thatused

bym

osthouseholds,

thedeterioration

probablyarises

duringthe

fillingand

dispensingo

fthecontainers.

2.7.2In-H

ouseW

aterC

ontamination

Ina

studyo

fw

atercontam

inationand

infantilediarrhoeal

diseasesin

thePhilippines,

VanD

ersliceet

al.(1991)

stressedthe

needto

improve

thequality

of

water

atthe

household'sw

atersource,

ratherthan

eliminating

in-housecontam

ination.A

mong

householdersalready

inclose

contactwith

eachother,

thereare

avariety

of

non-water-bom

eroutes.

Exposure

topathogens

harbouredby

otherhousehold

mem

bersthrough

in-housew

atercontam

inationis,

therefore,less

likelyto

becritical.

Such

considerationsm

ayapply

inA

ccra.A

higherlevel

of

in-:.house

thanat-tap

contamination

doesnot

necessarilyim

plythat

in-house·contam

inationplays

agreater

rolein

thespread

of

diarrhoealdisease.

In-housecontam

inationshould

notbe

entirelydiscounted,

however.

Indeed,in

areasw

herechildren

arelikely

todrink

fromother

households'w

atersources,

eventhe

distinctionis

questionable.G

enerally,as

indicatedin

Table

2.15,w

atersam

plesfrom

storagecontainers

were

foundto

bem

orecontam

inatedw

ithfaecal

bacteriathan

runningw

aterfrom

taps.In-house

contamination

was

estimated

byfm

dingthe

differencebetw

een83

pairedsam

pleso

fsource

water

andstored

water.

The

levelo

fin-house

contamination

was

approximated

tobe

thedifference

between

faecalbacteria

instored

water

andsource

water.

The

cumulative

effecto

fin-house

orintra-fam

ilycontam

inationo

fstored

water

ism

ostlikely

tobe

reflectedby

theincrease

inbacterial

counts.B

acterialregrow

thduring

water

storagew

asassum

edto

benegligible

atthe

time

of

sampling.

Levels

of

in-housecontam

inationare

shown

inT

able2.17.

Fivehouseholds

inG

AM

Ashow

eda

decreasein

bacterialconcentrations,

which

may

indicatebacterial

die-offor

changesin

thequality

of

the

Benneh

etal.25

fapw

aterbetw

eenthe

time

of

collectionfor

storageand

thetim

eo

fsam

pling.A

bout78%o

fstored

water

samples

hadnetincreases.

Table

2.17:Levels

of

in-h

ou

sew

aterco

nta

min

atio

nin

GA

MA

.

Ch

an

ge

inF

.co

liform

N%

Ne

tD

ecre

ase

-100to

·10

22.4

·10

to-1

33.6

Total

netdecrease5

5.8

No

cha

ng

e12

14.5

Ne

tIncre

ase

1to

1013

15.7

10to

10049

59.0

100to

10004

4.8

Totalnet

increase67

78

Total

Observation

86100.0

Data

source:T

estsundertaken

for

thisstudy.

There

area

number

of

possiblesources

of

contamination.

The

resultso

fa

small

questionnairesurvey

(199households)

indicatethat

them

ajorityo

fhouseholds

(91.6%)

usedipping

cups.(T

heuse

of

ladlesaccounts

for3%

.)T

hehigh

incidenceo

fthe

multiple

useo

fdipping

cupsw

ithinhouseholds

couldexplain

thehigh

in-housebacterial

contamination

andpossible

cross-contamination

acrossfam

ilym

embers.

Furtherm

ore,to

theextent

thatpeople,

andperhaps

childrenin

particular,visit

anddrink

water

inother

homes,

thecontam

inationcould

spreaddisease

among

householdsin

theneighbourhood.

Dirty

surroundingsand

poorpersonal

hygienecould

itselfcontribute

tocontam

inationo

fdipping

cups.A

bout75%

of

the199

householdssurveyed

inG

AM

Akept

theirdipping

cupsin

theirroom

s.A

sdescribed

below,

about5%

of

theprincipal

homem

akersin

GA

MA

neverw

ashtheir

handsw

ithsoap

andabout

50%only

washed

theirhands

with

soapone

tothree

times

aday.

The

surveyrevealed

poorhygiene

practicesin

thelow

income

neighbourhoodsw

hereall

thehouseholds

which

didnot

wash

theirhands

with

soapeven

oncea

dayw

ereidentified.

Buckets

arem

ostlyused

forcollection

of

water

eitherfrom

publicstandpipes

or

fromw

atervendors.

The

risko

fcontam

inationis

highbecause

bucketsare

usedfor

bathingand

otherhousehold

chores.

26

Environm

entalP

roblems

andthe

Urban

Household

inthe

GA

MA

-Ghana

Bo

x2.1:

Water

and

Wealth

Figure

2.3:Faecalco

liform

con

tam

ina

tion

levelsa

ttap

an

din

stora

ge

by

we

alth

gro

up

s

Code:

1•Tap

inm

edium-high

wealth

area2

-Tapin

loww

ealtharea

3·S

toragecontainerin

medium

-highw

ealtharea

4• S

toragecontainerin

loww

ealtharea

N-S

ubsample

size

Metered

Notpurchased

N=

subsample

size

.'-'0

Poor

householdsin

GA

MA

gettheleastw

ater,w

iththe

mosteffort,atthe

highestprice,anditis

more

likelyto

becontam

inatedtoo.

This

phenomenon,

probablyall

toocom

mon

incities

where

everyonedepends

onpiped

wa-

terbut

onlythe

relativelyw

ealthycan

•O

the

rafford

home

connections,is

clearlyil-

•V

endorlustrated

inthese

diagrams.

Figure

2.1portrays

theshifts

inD

Com

munalstandpipe

drinkingw

atersources

asone

moves

IIP

rivatestandpipe

fromthe

poorest20%o

fhouseholdson

•In-house

pipingthe

left,throughthe

intermediate

wealth

N=

subsample

sizequintiles,

tothe

wealthiest

20%on

theright.

The

poorerhouseholds

usesources

which

arein­

herentlyless

convenient,andtypically

involvefetching

waterto

thehom

e.There

arestrong

indicationsthatthese

householdsare

notgettingenough

waterto

practicegood

hygiene,and

thatit

isaffecting

theirhealth.

There

aresignificant

differenceseven

among

thepoorest

80%o

fthe

households,all

of

which

arepoor

byinternational

standards.A

sillustrated

inF

igure2.2,these

shiftsalso

involvechanges

inthe

way

wateris

paidfor,

with

By

containero

ruse

poorerhouseholdspaying

bycontaineror

byuse,

andw

ealthierhouseholds

payingm

onthlybills

form

eteredw

ater.P

oorF

ixedm

onthlyrate

householdsfind

itdifficulttopay

relativelylarge

lump

sums

oncea

month,

andare

betterableto

make

thesm

allpayments

in­volved

inpurchasing

bycontaineroruse.

Butthe

priceperlitre

form

eteredw

aterisoften

lessthan

halfthatforvendor

water.

Com

poundingthese

problems,

water

fromtaps

inthe

low-w

ealthareas

were

more

oftenfound

tobe

con­tam

inatedthan

inm

ediumto

highw

ealthareas,as

illus­trated

inF

igure2.3.

This

couldbe

dueto

theinadequate

11

'00

-1000

adhoc

pipingw

hichlocal

residentssom

etimes

lay.In

01

0-1

00

allareas

thesam

plesfrom

storagecontainers

were

con-siderably

worse

thanfrom

thetap,indicating

theim

por­tance

ofhousehold

hygiene.

•DII

..., 198200

200198

210

187210

187

L-MM

iddleU

-MU

pper

L-MM

iddleU

·MU

pper

Low

Low

N=

205

Fig

ure

2.1:Prin

cipa

ldrin

king

wa

ter

sou

rces

inA

ccrab

yw

ea

lthg

rou

p

Fig

ure

2.2:Distrib

utio

no

fho

use

ho

lds

by

mode

of

wa

ter

pa

yme

nt

inA

ccrab

yw

ealthg

rou

p

0%10

60%

20%

80%

40%

N=

205100°1.

100%

Data

source:Q

uestionnairesurvey

andphysicaltests,

Accra,1991.

Note:

The

wealth

groupsem

ployedin

thesediagram

sare

basedon

thesam

ew

ealthindex

employed

inthe

resto

fthe

report.H

owever,

ratherthan

threeunequal

groups(the

poorm

ajority,a

small

wealthy

elite,and

asom

ewhat

largerm

edium-w

ealthgroup),

fivegroups

of

roughlyequal

sizehave

beencreated

forthe

graphicalpresentation.

Benneh

etal.

CH

AP

TE

RT

HR

EE

27

3S

AN

ITA

TIO

NF

AC

ILIT

IES

3.1Introduction

Sanitation

managem

entis

closelylinked

topotable

water

supply,and

isalso

anim

portantfacet

of

thehousehold

environment,

with

important

healthim

plications(E

sreyand

Habicht,

1986).T

hischapter

addressesaccess

tosanitation

facilities,prevalence

of

outdoordefecation

andhygiene

behaviour.The

disposalo

fsullage

orgrey

water

isalso

brieflydiscussed.

3.2A

ccessto

SanitationF

acilitiesO

fthe

threecom

munity

water-borne

sewerage

systems

inthe

country,tw

oare

inT

ema

andA

ccraD

istricts,w

ithinthe

Metropolitan

Area.

InA

ccraD

istrictthere

isa

centralsew

eragesystem

which

was

designedin

·1971and

intendedfor

theA

ccraand

Tem

atow

nshipsand

theirfuture

extensions.D

ueto

lackof

funds,only

thefirst

phasew

asconstructed

andthis

isknow

nas

theC

entralA

ccraS

ewerage

System

andis

underthe

managem

ento

fthe

Ghana

Water

andS

ewerage

Corporation

(GW

SC

).A

so

fthe

endo

fthe

firstquarter

of1992,

therehave

been482

connectionsconsisting

ofthe

following:

187com

mercial

properties,166

domestic

properties,15

industrialproperties,and

114institutional

andpublic

services.

Since

theC

entralA

ccraS

ewerage

Systemfalls

within

theC

entralB

usinessD

istricto

fAccra,together

with

some

denselypopulated

innercity

residentialareas,

thelayout

hasbeen

deliberatelym

adeto

pickup

flows

fromabout

40public

toiletsin

thearea.

Due

tolack

of

awareness

of

theexistence

of

sucha

facility,coupled

with

highconnection

fees,there

arenot

asm

anyconnections

asanticipated

inthe

design.P

rospectiveconnectors

tothe

systemare

furtherdissuaded

bythe

surchargeo

f35%

of

them

onthlyw

aterbillfor

sewerage

services.T

hiscreates

lowflow

sand

subsequentsew

erm

aintenanceproblem

s(G

WS

C,

documents

compiled

forcurrent

study,1992).

Other

para-statalorganisations

provideeven

more

limited

sewer

systems

andtreatm

entplants

invarious

partso

fA

ccra.T

heseare

restrictedto

Teshie-N

ungua,L

aboneand

Dansom

anE

states,m

ilitarybarracks,

hospitals,m

inistriesand

theU

niversityo

fGhana.

These

systems

togetherserve

onlya

privilegedfew

inthe

highand

medium

classresidential

areas.B

ycontrast,

theplanned

township

ofT

ema

within

Tem

aD

istricthasa

modem

sewerage

systemw

hichhas

continuedto

expandto

newhousing

developments.

This

however,excludes

Tem

aN

ewT

own,the

squattersettlem

ento

fAshiam

anand

otheroutlying

settlements

within

thedistrict.

Ga

District

hasno

sewerage

system.

Consequently

therange

of

sanitationfacilities

isquite

diverse,depending

onthe

comm

unityor

neighbourhoodcharacter.

Table

3.1below

shows

theproportions

ofhouseholds

servedby

differenttypes

of

toiletfacility.

Inthe

metropolis

asa

whole,

about35%

areserved

byflush

toiletfacilities.

(Flush-sew

eredand

flushseptic

tanksare

classedtogether

becauseo

fthe

confusionrespondents

sometim

esm

adebetw

eenthe

two.)

The

more

comm

onfacilities

arethe

pitlatrines,

which

togetherserve

about40%

of

thepopulation.

28E

nvironmentalP

roblems

andthe

Urban

Household

inthe

GA

MA

-Ghana

Aboutone

infour

pitlatrineusers

reportedthat

theyw

ereusing

Kum

asiV

entilatedIm

provedP

it(K

VIP

)latrines,

which

arepit

latrinesw

ithan

improved

designbeing

promoted

asan

alternativeto

thepan

latrines.A

lmost

20%o

fthe

householdsstill

usedpan

orbucket

latrines,w

hichm

ustbe

emptied

frequently,typically

througha

hatchin

theouter

wall

of

thetoilet.

Three

percent

ofthe

respondentsclaim

edto

haveno

accessto

anytoiletfacility.

Ta

ble

3.1

:D

istrib

utio

no

fH

ou

seh

old

sb

yT

ype

of

To

ilet

Fa

cility.

District

Total

Type

ofT

oile

tA

ccraT

ema

Ga

GA

MA

No.

%N

o.%

No.

%N

o.%

No

Toilet

111.5

63.8

1310.4

30

3.0F

lushT

oilet240

33.691

56.924

19.2355

35.5P

itLatrine232

32.426

16.352

41.6310

31.0K

VIP

Latrine5

98.3

3320.6

129.6

10410.4

Pan

Latrine170

23.84

2.521

16.8195

19.5O

ther3

0.43

2.46

0.6

Total

715100.0

160100.0

125100.0

1000100.0

Data

source:Q

uestionnaireS

urveyof

GA

MA

,1991.

Whereas

98%

of

allw

ealthyhouseholds

hadaccess

toflush

toiletfacilities,

68%and

26%o

fm

ediumincom

eand

poorhouseholds

respectivelybenefited

fromsuch

facilities.T

hem

ostpopular

singlefacility

forthe

pooris

thestandard

pitlatrine,

as36%

of

thepoor

dependedon

it(T

able3.2).

About

22%o

fthe

poorw

ereusing

panlatrines,

which

arenot

onlyconsidered

tobe

sub-standardfor

thehouseholds

themselves,butdegrading

forthe

collectors.

Ta

ble

3.2:R

ela

tion

sh

ipB

etw

ee

nT

ype

of

To

ilet

Fa

cilitya

nd

Ho

use

ho

ldW

ea

lth(%

).

Wealth

Indexo

fHousehold

Typ

eo

fTo

ilet

LowM

edium

Flush-sew

ered12.3

35.9F

lush-septic14.1

32.1

PitLatrine

35.812.2

KV

IP12.1

3.8

Pan

Latrine22.1

10.7

Other

0.7

No

Toilet

2.85.3

Total

100.0100.0

(N)

(818)(131)

High

49.049.0

2.0

100.0(51)

-----------------------------_

---.:

•.~\D

atasource:

Questionnaire

Survey

ofGA

MA

,1991.

Benneh

etal.29

Table

3.3show

sthe

relationshipbetw

eenthe

typeoftoiletfacility

andthe

self­reported

prevalenceo

fchildhood

diarrhoea(tw

ow

eekrecall)

among

householdsw

ithchildren

undersix.

Ta

ble

3.3

:T

yp

eo

fT

oile

tF

acility

an

dP

reva

len

ceo

fD

iarrh

oe

ain

Ch

ildre

nU

nd

er

6(%

).

Type

ofT

oile

t

Flush

Toilet

Pit

latrin

eK

VIP

latrin

eP

anla

trine

No

Toilet

Total

Num

bero

fHouseholds

with

Children

<6yrs

1641756611317

535

%prevalence

ofd

iarrh

oe

a

6.715.421.216.011.8

14.0

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

The

low-cost

facilities,including

thepotentially

more

hygienicK

VIP

latrines,are

associatedw

itha

considerablyhigher

diarrhoealprevalence.

Ithas

beenfound

thatthe

KV

IPtechnology,

when

usedas

acom

munal

facility,often

doesnot

operatew

ell,and

many

ofthose

builtfor

comm

unaluse

havenot

beenconstructed

accordingto

standard.M

oregenerally,

theseresults

areat

leastas

likelyto

reflectproblem

so

fm

aintenanceand

crowding

asthey

areto

reflectdeficiencies

inherentto

thetechnologies

themselves.

There

isa

highincidence

oftoiletsharing.T

able3.4

indicatesthat

only28%

ofhouseholds

didnot

sharetheir

toiletfacilities.

By

contrast,about

41%

of

thepopulation

within

them

etropolisrelied

oncom

munal

facilitiesopen

tothe

whole

neighbourhood.A

lthoughm

ostpeople

usingpan

latrinesalso

sharedfacilities,

thisw

asnorm

allyrestricted

totenants

within

thehousing

unit.

Ta

ble

3.4

:N

um

be

ro

fH

ou

se

ho

lds

Sh

arin

gT

oile

tF

acility.

Nu

mb

er

ofH

ou

se-

District

Total

ho

lds

Sh

arin

gA

ccraT

ema

Ga

GA

MA

No.

%N

o.%

No.

0/0N

o.0/0

No

Sharing

19227.5

4831.2

2623.2

26627.6

1-

5119

17.118

11.731

27.7168

17.4

6-

1065

9.38

5.212

10.785

8.8A

bove10

456.5

63.9

43.6

555.7

Whole

Neighbourhood

27639.6

7448.1

3934.8

38940.5

Total

697100.0

154100.0

112100.0

963100.0

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

About

33%o

fthe

householdssurveyed

reportedthat

theydid

notm

akeregular

payments

forthe

useo

fthe

toilet,w

iththe

highestpercentage

inG

aD

istrict,w

herethe

enforcement

of

usercharges

isnot

asstrict

asfor

Accra

andT

ema

Districts.

InA

ccraand

Tem

a,the

householdsindicating

freeaccess

totoilet

30

Environm

entalP

roblems

andthe

Urban

Household

inthe

GA

MA

-Ghana

facilitiesw

eregenerally

thosew

ithin-house

flushtoilet

facilities.M

anyo

fthese

householdshave

topay

forthe

removal

of

sewage

fromtheir

septictanks

atthe

rateo

fabout

7,000cedis

pertrip

made

bythe

cesspoolem

ptiers.S

ome

82%of

householdspaying

dailyuser

chargesspentbetw

een10

to60

cedisper

day.T

hisis

thecom

mon

practicein

lowclass

residentialareas

with

publicpit

latrinesand

KV

IPs.T

hem

ostcom

mon

chargeis

fivecedis

peruse

andanother

fivecedis

forpaper

tobe

usedas

analcleansing

material

forthose

without

theirow

npaper.

Households

bringinghum

anexcreta

inbow

lsm

aybe

chargeda

20cedis

penalty.

3.3P

revalenceo

fOutdoor

Defecation

Insufficientcom

munal

facilitiescan

leadto

opendefecation

alongbeaches,

drainsand

openspaces.

Indeed,the

resultsindicate

thatopen

defecationis

closelyrelated

tothe

percentageo

fthe

populationw

horely

onthe

pitlatrine

andthe

publicK

VIPs.

Itw

ouldseem

thatoutdoor

defecationis

anoutcom

eo

flong

queuesat

comm

unaltoilet

facilitiesas

well

aspoor

maintenance.

These

factorsdo

notonly

poseinconvenience

forusers

butalsocreate

am

ajorpublic

hazard.A

bout35%

of

thepopulation

inthe

metropolis

reportedthat

therew

eretim

esw

henhousehold

mem

bersfound

itinconveriienttouse

theirregular

toilets,and

hadto

usean

alternativesite.

Not

surprisingly,such

problems

arem

oreprevalent

among

thepoor.

For

example,

about96%

ofall

householdsw

hofelt

inconveniencedin

theuse

of

toiletfacilities

were

poor.H

owever,

theG

aD

istrict,w

hichlies

inthe

peri-urbanzone,

hada

valuew

ellbelow

theaverage

forG

AM

A,

althoughis

hasthe

highestproportiono

fpoorhouseholds

(Table

3.5).

Ta

ble

3.5:H

ou

seh

old

sH

avin

gh

ad

toF

ind

Alte

rna

tiveS

iteD

ueto

Pro

ble

ms

Acce

ssing

or

Usin

gR

eg

ula

rT

oile

tb

yD

istrict.

District

No

Yes

Ta

taI

No.

%N

o.%

No.

%

Accra

46466.0

23934.0

703100.0

Te

ma

8253.2

7246.8

154100.0

Ga

8576.6

2623.4

111100.0

To

talG

AM

A631

65.1337

34.9968

100.0

Da

taso

urce

:Q

uestionnaireS

urveyof

GA

MA

,1991.

Of

thehouseholds

affected,a

disproportionatenum

berw

erehouseholds

sharingtoilets

with

more

thanfive

otherhouseholds

(Table

3.6).Indeed,

more

thanthree

quarterso

fthe

householdssharing

comm

unaltoilets

encounteredsuch

problems,

compared

toless

thanone

inten

householdsw

iththeir

own,

unshared,toilet.

Benneh

etai.

Ta

ble

3.6

:H

ou

se

ho

lds

En

co

un

terin

gP

rob

lem

sA

cce

ssin

go

rU

sin

gb

yL

eve

lo

fS

ha

ring

.

Sh

arin

gN

um

be

rP

ercentage

No

Sharing

164.8

1-

532

9.66

-10

4112.2

Above

10

298.7

Whole

Neighbourhood

21764.8

Total

335100.0

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

Note:

This

tableonly

includeshouseholds

which

encounteredproblem

s.

31

The

most

comm

onreasons

householdsgave

forhaving

tofm

danother

locationto

defecatew

eredirectly

relatedto

accessibility:o

fthose

affected,56%

mentioned

thatthe

toiletw

assom

etimes

outo

forder

orlocked-up,

47%that

thequeues

were

sometim

estoo

long,and

45%that

thetoilet

was

sometim

eslocked

(more

thanone

responsew

asallow

edfor).

No

otherreasons

were

citedby

more

thana

quartero

fthose

householdsaffected,

with

costonly

mentioned

byabout

12%.

Abreakdow

no

fthe

frequencyo

fdifferent

responsesin

eachdistrict

isprovided

inT

able3.7.

InA

ccra,long

queuesw

erethe

most

comm

onlycited

reason,w

hilein

bothT

ema

andG

athe

toiletsbeing

outof

orderw

ascited

more

thantw

iceas

oftenas

longqueues.

Ta

ble

3.7

:R

ea

so

ns

Giv

en

for

Se

ekin

gA

ltern

ativ

eL

oca

tion

for

De

feca

tion

.

District

To

tal

Circu

msta

nce

sA

ccraT

ema

Ga

GA

MA

No.

%N

o.%

No.

%N

o.%

Children

Don't

Alw

aysU

seT

oilet39

7.914

8.57

16.360

8.5O

utofOrder

10721.6

6237.8

1637.2

18526.3

Nighttim

e15

3.012

7.33

7.030

4.3

Cost

357.0

42.4

12.3

405.7

Early

Morning

6913.9

63.7

613.9

8111.5

Queue

toolong

13126.4

1811.0

716.3

15622.2

Lockedup

10020.2

4829.3

37.0

15121.5

Num

berof

Responses

496164

43703

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

Note:

As

some

householdsgave

more

thanone

response,the

percentagesare

notequalto

thepercentage

ofrespondinghouseholds.

Only

householdssaying

theyhad

hadto

seekalternative

locationsare

included.

These

problems

quiteclearly

leadto

opendefecation,

notonly

onthe

partof

children,but

alsoadults.

Table

3.8pertains

onlyto

those30%

of

allhouseholds

where

adultsare

affected.A

bouthalf

reportusing

othertoilets,

while

most

of

therem

ainderadm

itto

defecatingin

theopen.

(Of

thehouseholds

who

indicated"other

place",m

ostw

ouldhave

usedthe

bushor

the"w

rapperm

ethod"in

which

peopledefecate

inpolythene

bagsor

paperw

hichis

thenthrow

nin

guttersor

into

32

Environm

entalP

roblems

andthe

Urban

Hou$ehold

inthe

GA

MA

-Ghana

comm

unalw

astecontainers.)

This

may

underestimate

theextent

of

theproblem

,as

under-reportingis

comm

onw

henpeople

arequestioned

onpractices

known

tobe

frowned

upon.

Ta

ble

3.8

:P

lace

for

Ou

tdo

or

De

feca

tion

for

Ad

ults

.

District

Total

Pla

ceA

ccraT

ema

Ga

GA

MA

No.

%N

o.%

No.

%N

o.%

On

Land19

9.727

36.512

34.358

19.0R

iveror

Stream

21.0

12.9

31.2

Beach

4523.1

79.5

5217.1

OtherT

oilet126

64.618

24.410

28.6154

50.6O

therP

lace3

1.522

29.712

34.337

12.1

Total

195100.0

74100.0

35100.0

304100.0

Data

source:Q

uestionnaireS

urveyofG

AM

A.

1991.N

ote:O

nlyincludes

householdsw

hoseadults

hadencountered

problems

usingregular

toilet.

One

would

expectm

oreopen

defecationam

ongchildren,

astheir

knowledge

of

personalhygiene

andthe

needfor

privacyis

lower.

Yet

itis

preciselychildren

who

arem

ostat

riskbecause

of

theirgreater

vulnerability.M

oreover,children's

faecestend

tocreate

ahigher

healthrisk,

dueto

ahigher

concentrationo

fdangerous

pathogens.F

orthe

metropolis

asa

whole,

about100

respondents(10%

)reported

thatchildren

intheir

neighbourhoodfrequently

defecatedoutdoors

and263

respondents(26%

)indicated

thatchildren

sometim

espractised

opendefecation

(Table

3.9).In

them

ajorityo

fcases,

thisinvolved

defecatingon

land(58%

)o

rat

abeach

(13%).

Low

classresidential

areasw

erethe

most

severelyaffected.

Ta

ble

3.9

:In

cid

en

ce

of

Ou

tdo

or

De

feca

tion

by

Ch

ildre

nw

ithin

the

Ne

igh

bo

urh

oo

d.

Response

District

Never

Som

etimes

Re

gu

larly

Total

No.

%N

o.%

No.

%N

o.%

Accra

50270.2

19126.7

223.1

715100.0

Tem

a72

45.036

22.552

32.5160

100.0G

a63

50.436

28.826

20.8125

100.0

TotalG

AM

A637

63.7263

26.3100

10.01000

100.0

Data

source:Q

uestionnaireS

urveyofG

AM

A.

1991.

The

two-w

eekprevalence

of

childhooddiarrhoea

among

the(145)

householdssaying

neighbourhoodchildren

atleast

sometim

esdefecate

out-of-doorsat

thebeach

or

onopen

landis

26%;

more

thanthree

times

theprevalence

among

householdssaying

thatchildrennever

defecateoutdoors.

Benneh

etal.33

3.4H

ygienea

nd

Hand

washing

Practices

Given

thelow

amenity

valueo

fm

ostneighbourhood

environments,

characterisedby

inadequatesanitary

andsolid

waste

disposalfacilities,

goodhygiene

isnecessary

ifhouseholds

(more

especiallyw

omen

andchildren)

areto

reducethe

environmental

risksthey

areexposed

to.A

ndyet,

asalready

indicated,access

tow

ater,w

hichis

vitalfor

householdhygiene,

isfar

fromsatisfactory.

Hand

washing

practiceso

fthe

principalhom

emaker

areused

hereas

anindicator

of

hygiene.If

onecan

expectopen

defecationto

beunder-reported,

theopposite

istrue

of

handwashing~

Respondents

may

sometim

esdescribe

thehand

washing

practicesthey

believethey

shouldfollow

,rather

thanthose

theyactually

do.T

heresponses

aretherefore

likelyto

fallsom

ewhere

between

actualand

desiredpractice

onthe

parto

fthe

respondents.V

irtuallyall

principalhom

emakers

reportedw

ashingtheir

handsw

ithat

leastw

aterat

leastonce

aday,

andabout

63%claim

edto

wash

theirhands

more

thanseven

times.

Asm

allpercentage(5%

)did

notreport

washing

theirhands

with

soapeven

oncea

day,w

iththe

majority

(63%)

usingsoap

between

oneand

4tim

esa

day.T

able3.10

shows

thatlow

levelso

fhand

washing

were

reportedm

orefrequently

inG

aD

istrict,w

hilehigh

levelsw

erem

ostoften

reportedin

Accra

District.

The

differencesbetw

eentypes

of

neighbourhoodare

more

striking.O

nlyone

of

thefIfty

principalhom

emakers

livingin

highclass

areasreported

washing

herhands

lessthan

fIvetim

esa

day,as

compared

to14%

inthe

lowclass

areas.M

oreover,all

principalhomem

akersliving

inhigh

classareas

wash

theirhands

with

soapatleasttw

ice,w

hereas13%

ofthose

inlow

classareas

donot.

Ta

ble

3.10:F

req

ue

ncy

of

Hand

Wa

shin

gb

yP

rincip

alH

om

em

ake

rb

yD

istrict.

Tim

es!

District

To

tal

Da

yA

ccraT

ema

Ga

GA

MA

No.

%N

o.%

No.

%N

o.%

·0to

483

11.616

10.328

22

.8'

12712.8

-5

to8

15021.0

5736.5

3629.3

24324.5

·8+

48067.3

8353.2

5948.0

62262.7

Total

713100.0

156100.0

123100.0

992100.0

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

Tw

oo

fthe

times

when

handw

ashingis

criticalare

afterdefecation

andprior

topreparing

food.T

heprincipal

homem

akersw

ereasked

atw

hichtim

esthey

always

wash

theirhands.

About

91%

saidthey

always

washed

theirhands

afterusing

thetoilet,

while

only74%

saidthey

didbefore

preparingfood.

Moreover,

among

thosew

hodid

wash

theirhands,

itw

asm

orecom

mon

touse

soapafter

usingthe

toiletthanbefore

preparingfood.

There

isquite

aclose

relationbetw

eendiarrhoea

prevalenceand

handw

ashing,particularlyhand

washing

priorto

foodpreparation.

As

indicatedin

Table

3.11,am

onghouseholds

where

handsw

erenot

washed

beforefood

preparation,the

prevalenceo

fdiarrhoeaw

asseveraltim

eshigher

thanam

onghouseholds

where

handsare

regularlyw

ashedw

ithsoap

andw

ater.Hand

washing,

andindeed

theuse

of

soap,is

lessdiffIcult

when

water

iseasily

accessible,how

ever.T

hus,like

many

34

·E

nvironmental

Problem

sand

theU

rbanH

ouseholdin

theG

AM

A-G

hana

hygienepractices,

handw

ashingis

likelyto

involvea

combination

of

householdnorm

sand

facilities.

Ta

ble

3.11:H

andw

ash

ing

Be

fore

Preparing

Fo

od

an

dthe

Prevalence

of

Diarrhoea

inC

hild

ren

Un

de

r6.

Re

spo

nse

Doesn'tM

ention

Wa

ter

Water

or

Soap

Soap

andW

ater

Total

Nu

mb

er o

fH

ou

seh

old

s

with

Ch

ildre

n<

6

132

223

10560

520

Tw

ow

ee

kD

iarrh

oe

aP

reva

len

ce(%

)

22.1

12.1

12.4

3.0

13.7

Data

source:Q

uestionnaireS

urveyof

GA

MA

,1991.

As

indicatedin

Table

3.12,the

useo

fstandpipes,

especiallypublic

ones,w

asassociated

with

lowlevels

of

handw

ashingw

hethero

rnot

theprincipal

homem

akerhad

receivedany

formal

education.Indeed,

thedifferences

inhand

washing

arem

oreevident

acrosshouseholds

usingdifferent

water

sourcesthan

acrosseducation

levels.It

isoften

arguedthat

water

improvem

entsshould

beaccom

paniedby

hygieneprogram

mes

toensure

thebenefits

of

thew

aterare

fullyutilised.

These

resultssuggest

analternative

message

may

beequally

valid:w

ithoutbetter

water

supplies,improved

hygieneaw

arenessm

ayprove

ineffective.

Ta

ble

3.12:P

ercentageo

fP

rincip

alH

om

em

ake

rsW

ash

ing

Hands

Prio

rtoF

oo

dP

rep

ara

tion

by

Ed

uca

tion

an

dW

aterS

ou

rce.

Le

velo

fE

du

catio

n

Drin

king

No

Ed

uca

tion

Som

eE

du

catio

n

Wa

ter

Nu

mb

er

of

Per

cen

tN

um

be

ro

fP

erce

nt

So

urce

Re

spo

nd

en

tsN

otW

ash

ing

Re

spo

nd

en

tsN

otW

ash

ing

Ha

nd

sH

ands

Indoorpiping

5721.1

29117.2

Vendors

10221.6

17122.2

Private

standpipe54

38.9183

38.9

Public

standpipe27

55.654

40.7

Oth

er

1833.3

2422.3

Total

25829.5

72324.9

Data

source:Q

uestionnaireS

urveyof

GA

MA

,1991.

While

soapis

nota

largeitem

inhousehold

budgets,its

priceis

sufficientlyhigh

toinfluence

some

households.A

lso,toilets

andkitchens

inw

ealthyhouseholds

arem

orelikely

tobe

designedto

make

handw

ashingeasy.

The

resultsindicate

thatnot

onlyw

ashand

washing

lesscom

mon

among

poorhom

emakers,

bu

tw

henthey

didw

ashtheir

handsthey

were

lesslikely

touse

soap.F

or

example,

among

homem

akersw

how

ashedhands

priorto

foodpreparation,

only41

%from

po

or

householdsat

leastsom

etimes

usedsoap,

ascom

paredto

54%and

74%from

Benneh

etal.35

medium

-wealth

andw

ealthyhouseholds

respectively.T

able3.13

illustratesthe

relationbetw

eenw

ealthand

hygieneeven

more

clearly,using

theexam

pleo

fhand

washing

afterusing

thetoilet.

About

94%o

fprincipal

homem

akersfrom

wealthy

householdsw

ashedtheir

handsand

atleast

sometim

esused

soap.O

nly57%

of

poorhouseholds

practisedthis

goodhygiene

behaviour,although

overallthese

valuesare

higherfor

toiletusethan

forfood

preparation.

Ta

ble

3.1

3:

Re

latio

nsh

ipB

etw

ee

nH

ou

se

ho

ldW

ea

lthS

tatu

sa

nd

Ha

nd

Wa

shin

gA

fter

To

ilet(%

).

Wealth

Ind

ex

ofH

ou

seh

old

Response

Lo

wM

ediumH

igh

Doesn't

always

wash

9.510.2

Water

only32.1

15.05.9

Wateror

Soap

andW

ater29.4

40.239.2

Alw

aysS

oapand

Water

29.134.6

54.9

Total

100.0100.0

100.0(N

)(814)

(127)(51)

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

3.5Sullage

an

dStorm

Water

Drainage

"Sullage

orgrey

water

isthe

liquidw

astew

aterdischarged

fromdom

esticprem

isesand

consistso

feffluents

fromkitchens,

bathrooms

andlaundries.

Sullage

isnorm

allydischarged

intostreet

drainsor

intosoak-aw

ays.T

hebulk

of

householdw

ateruse

becomes

sullage.E

venin

thosehouseholds

with

flushtoilets

itis

estimated

thatsullage

amounts

to60%

of

totalw

ateruse"

(Tahal,

1981,p.

C.2­

12).Table

3.14illustrates

thepatterns

ofsullage

disposalw

ithinthe

metropolis.

Ta

ble

3.1

4:

Me

tho

ds

of

Ho

use

ho

ldS

ulla

ge

(Gre

yW

ate

r)D

ispo

sal.

Disp

osa

lD

istrictT

otalP

ractice

Accra

Tem

aG

aG

AM

A

No.

0/0N

o.%

No.

%N

o.%

Sam

eas

Sew

erage11

1.520

12.511

8.842

4.2

Closed

Separate

drains43

6.019

11.97

5.669

6.9O

penS

eparatedrains

38353.6

6540.6

129.6

46046.0

Nearby

Waterw

ay44

6.26

4.850

5.0D

umped

inS

treet8

712.2

53.1

3528.0

12712.7

Dum

pedin

Yard

14520.3

5031.3

5241.6

24724.7

Other

20.3

10.6

21.6

50.5

Total

715100.0

160100.0

125100.0

1000100.0

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

Open

separatedrains

were

theprincipal

means

of

sullagedisposal

among

46%o

fthe

householdssurveyed.

The

betterm

ethods,including

closedseparate

drains

36E

nvironmentalP

roblems

andthe

Urban

Household

inthe

GA

MA

-Ghana

andsew

erageor

septictanks,

were

hardlyused.

The

leastsatisfactory

methods

ofstreet

andyard

dumping

accounttogether

forover

37%of

householdsullage

disposalm

ethods.T

able3.15

shows

therelationship

between

householdw

ealthstatus

andthe

means

of

sullagedisposalavailable.

Yard

andstreet

dumpirig

were

more

comm

onlypractised

among

poorand

medium

wealth

households.T

om

akem

attersw

orse,in

lowclass

residentialareas

andthe

slums,

some

ofthe

openseparate

drainsm

entionedare

nothingm

orethan

mere

naturalchannels

alongw

hichsullage

flows

fromholes

made

throughw

allso

fbuildings.

This

water

oftenends

ina

roadsideditch.

Consequently,stagnantpools

ofw

aterare

comm

onin

theseneighbourhoods.

Ta

ble

3.1

5:

Re

latio

nsh

ipB

etw

ee

nH

ou

se

ho

ldW

ea

ltha

nd

Me

tho

do

fS

ulla

ge

Dis

po

sa

l.

Lo

wM

ediumH

ighA

llD

ispo

salP

ractice

%%

%%

Sam

eas

Sew

age/Septic

Tank

2.89.2

13.73.2

Closed

Separate

Drain

4.316.0

23.56.9

Open

Separate

Drain

46.042.7

54.946.0

Nearby

Waterw

ay5.9

2.35.0

Dum

pedin

Street

14.27.6

2.012.7

Dum

pedin

Yard

26.421.4

5.924.7

Other

0.50.8

0.5

Total

100.0100.0

100.0100.0

(N)

(818)(131

(51)(1000)

Data

source:Q

uestionnaireS

urveyof

GA

MA

,1991.

As

aresult

of

theoverall

poorw

astew

aterdisposal

system,

togetherw

iththe

factthat

largeareas

liein

floodprone

areasless

than20

metres

abovesea

level,flooding

hasbecom

ecom

mon.

As

illustratedin

Table

3.16,som

eo

fthe

more

severefloods

havecaused

seriousdam

ageand

evenloss

oflife.

Ta

ble

3.1

6:

Ma

jor

Flo

od

Eve

nts

inth

eM

etro

po

litan

Are

a.

Ye

ar

Accra

District

1963floods

july

1973floods

May

1986floods

Te

ma

District

1.1988

floods

Dam

ageca

use

d

5deaths

anddam

ageto

property.

Extensive

floodsw

ith3

deathsand

lossof

property.

Lossof3

lives,dam

ageof

property&

telephonesw

itchingequipm

entworth

US

$10m

illionand

loss

ofpropertyof

residents.

InundationofpartofT

ema

Sew

age.

System

anddam

ageofproperty

incom

munities.

Data

source:E

nvironmentalM

anagementA

ssociatesLtd.,

1989,p.

114.

Benneh

etaL.37

Bo

x3.1:

San

itation

Facilities

and

Wealth

N=

205187

210200

198

Fig

ure

3.1:Distrib

utio

no

fho

use

ho

lds

by

type

of

toile

tfacility

inA

ccrab

yw

ealthg

rou

p

GA

MA

'soverallprofile

ofsanitation

technologiesis

superiorto

thatfor

mosto

fGhana,w

ithm

orethan

athird

ofhouseholds

havingflush

toilets.But

asillustrated

inF

igure3.1,sanitation

technologyis

closelylinked

tow

ealth,and

forG

AM

A's

poorm

ajoritythe

flushtoilets

arelargely

irrelevantandcom

munal

pitlatrines

arethe

most

comm

onfacility.

Pit

latrineso

fim

­proved

design(K

VIP

)are

becoming

increasinglycom

mon,butexisting

fa­cilities

areso

overusedthatany

tech­nologicaladvantage

islost.

As

illustratedin

Figure

3.2,most

poorhouseholdsshared

latrinesw

ithm

orethan

tenother

households.A

l­m

osttwo

outofthree

householdsus­

ingcom

munal

facilitiescom

plainedthatthere

were

times

when

thelatrines

were

unusablebecause,for

example,

thequeues

were

toolong

inthe

morn­

ingsorthe

latrinesw

eresim

plyouto

forder.

Inneighbourhoods

with

over­crow

dedsanitary

facilities,children

oftenpractised

opendefecation.

Not

surprisingly,recentcaseso

fdiarrhoeaw

erecom

mon

amo

ng

childrenin

householdsusing

heavilyshared

toi­lets.

•O

the

r/no

ne

oP

anLatrine

•P

itLatrine

•F

lush

N=

Su

bsa

mp

lesize

IN

oresponse

DS

harew

ith>10

hh

•S

harew

ith5.10

hh

IN

otshared

N=

Subsam

plesize

200198

LowL-M

Middle

U-M

Upper

0%

60%

40%

N=

205187

210

80%

20%0%

60%

40%

20%

80%

100%

LowL·M

Middle

U·M

Upper

Fig

ure

3.2:Distrib

utio

no

fho

use

ho

lds

by

nu

mb

ersh

arin

gto

iletfa

cilityin

Accra

by

we

alth

gro

up

(hh

=h

ou

seh

old

s)

Data

source:Questionnaire

surveyofA

ccra,1991.

Note:

The

wealth

groupsem

ployedin

thesediagram

sare

basedon

thesam

ew

ealthindex

employed

inthe

resto

fthe

report.H

owever,rather

thanthree

unequalgroups

(thepoor

majority,a

small

wealthy

elite,anda

somew

hatlargerm

edium-w

ealthgroup),

fivegroups

of

roughlyequal

sizehave

beencreated

forthe

graphicalpresentation.

38

Environm

entalP

roblems

andthe

Urban

Household

inthe

GA

MA

-Ghana

CH

AP

TE

RF

OU

R

4S

OL

IDW

AS

TE

DISPO

SAL

SYST

EM

SA

ND

PR

AC

TIC

ES

4.11ntroductionT

hischapter

isprim

arilyconcerned

with

refuserather

thannight

soil.H

owever,

owing

tothe

sanitationproblem

so

fG

AM

A,

nightsoil

oftenfinds

itsw

ayinto

therefuse.F

urthermore,nightsoil

collection,likerefuse

collection,isthe

responsibilityo

fthe

Waste

Managem

entDepartm

ent.The

collectionand

disposalo

fsolid

wastes

andnight

soildeteriorated

progressivelyfrom

1976,reaching

acrisis

in1985.

As

aresult,

theentire

cityw

as"engulfed

with

refuseheaps,

drainsand

gutterschoked

andpublic

septictank

latrinesover-flow

ing.In

thehom

es,a

similar

situationalso

couldbe

foundw

ithseptic

tankso

fWater

Closets

dischargingeffluents

freelyinto

drainsand

compounds."

(Chief

Mechanical

Engineer,

Waste

Managem

entD

epartment,

1992).T

heproblem

of

solidw

astedisposal,

excludingnight

soil,m

aynot

haveas

serioushealth

implications

asthe

water

andsanitation

problems

describedin

theprevious

two

chapters,but

hasbecom

e·one

of

them

oreintractable

waste

managem

entproblem

s.T

hisproblem

developedw

iththe

economic

crisiso

fthe

mid

'70sand

early'80s,

asthe

publiccollection

servicedeclined

dueto:

lacko

ffunds

forthe

acquisitionof

capitalequipm

entand

theoperation

of

theservices,

regularbreakdow

no

fvehicles,plantand

equipment,

lacko

fadequate,trainedand

motivated

personnelinappropriate

managem

entorganisation.

With

theestablishm

ento

fthe

Waste

Managem

entD

epartment

in1985,

equippedand

fundedw

ithG

erman

assistance,the

problemstarted

tobe

tackled.H

owever,

theD

epartment

"isstill

capableof

collectingonly

60%o

fthe

900tons

perdiem

of

refuseand

about300

tonsof

nightsoil."

(Chief

Mechanical

Engineer,

Waste

Managem

entDepartm

ent,1992).

4.2H

andlingo

fSolidW

astes4.2.1

Household-L

evelStorage

andD

isposalPractices

Residential

domestic

waste

forms

thebulk

ofall

sourceso

fsolid

waste

producedin

Ghanaian

urbanareas.

These

householdsolid

wastes

areknow

nto

havehigh

densitiesw

itha

highm

oisturecontent.

The

organiccom

ponento

fsolid

waste

which

isputrescible

probablyaccounts

forbetw

een70-90%

of

thetotal

refuseproduced.

Tins,

cansand

paperare

probablyresponsible

forabout

5to

10%of

totalw

asteproduced

(Songsore,

1992,p.13).T

hefust

pointat

which

solidw

astecan

createproblem

sis

within

thehouses

themselves.

Table

4.1below

shows

household-levelw

astestorage

practices.A

bout21

%o

fall

householdsw

ithinthe

metropolis

didnot

storesolid

waste

within

the:hom

e,42%stored

inopen

containersand

only36%

storedin

closedcontainers.

Benneh

etai.39

Ta

ble

4.1

:W

aste

Sto

rag

eP

ractice

sw

ithin

the

Ho

me

.

District

Do

n'tS

toreO

penC

ontainerC

losedC

ontainerT

otal

No.

%N

o.%

No.

%N

o.A

ccra136

19.0304

42.5275

38.5715

Tema

4025.0

5735.6

6339.4

160

Ga

3729.6

6350.4

2520.0

125

TotalG

AM

A213

21.3424

42.4363

36.31000

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

The

Ga

District

hadthe

highestincidence

of

bothnon-storage

andstorage

inopen

containers,increasingthe

risko

fattracting

diseasecausing

pestssuch

asflies,

cockroachesand

rats.A

mong

thew

ealthgroups,

itw

asthe

wealthy

householdsw

how

erem

ostlikely

touse

closedcon~ainers.

Whereas

65%o

fall

wealthy

householdsstored

theirw

astein

closedcontainers,

about50%

of

medium

income

householdsand

only32%

of

poorhouseholds

storedin

closedcontainers.

Non­

storage,on

theother

hand,issim

ilarin

thedifferent

wealth

groups.T

herisks

of

increasingpest

infestationthrough

openw

astestorage

aregenerally

confmned

bythe

surveyresults.

The

enumerators

observedm

oreflies

inthe

kitchens(or

foodpreparation

areas)o

fhouses

where

solidw

astew

asbeing

storedindoors

inopen

containers.T

hus,m

any(>

10)flies

were

observedin

38%

of

thesuch

kitchens,but

where

waste

was

notstored

orw

asstored

inclosed

containersthis

percentagefell

to16%

and19%

respectively.Sim

ilarly,households

with

opencontainers

were

significantlym

orelikely

tocom

plaino

fratsor

mice.

Incontrast

toindoor

storageo

frefuse,

outdoorstorage

isrelatively

rare,as

house-to-housegarbage

collectionis

low.

Only

about32%

of

allhouseholdsstored

wastes

outsidethe

home.

Wealth

was

notsignificantly

relatedto

whether

ornot

householdsstored

waste

outside,but

againpoor

householdsgenerally

usedopen

containersw

hilethe

richm

oreoften

usedclosed

containers.C

losingw

astecontainers

isnot

generallyexpensive.

Inw

ealthyneighbourhoods

therem

aybe

strongersocial

sanctionspreventing

openw

astestorage

outside,and

door-to-doorrefuse

collectionim

posescertain

standards.H

owever,

thefact

thatw

ealthyhouseholds

alsoused

more

closedcontainers

indoorsalso

suggestsa

betterunderstanding

of

safew

astestorage

practice.T

hebulk

of

domestic

waste

fmds

itsw

ayto

eitherunauthorised

or

authorisedneighbourhood

disposalsites

where

itis

eithercollected

or

abandoned.O

nlya

fewhouseholds

inthe

metropolis

undertookfm

aldisposal

of

waste

throughburning

or

composting

aroundthe

house.Just

about18%

of

householdsin

GA

MA

burnttheir

refuse,8%

practisedsom

ecom

posting,anda

mere

5%buried

theirrefuse.

4.2.2C

omm

unityL

evelWaste

Managem

entT

hecapacity

tohandle

allo

fthe

householdw

astegenerated

isstill

weak.

About

83%o

fthe

populationdum

pstheir

refusein

eitherauthorised

or

unauthorisedsites

intheir

neighbourhood(T

able4.2).

Waste

dumping

ism

ostcom

mon

inA

ccraD

istrict.T

hispractice

was

notexclusive

tothe

most

run-down

poorslum

neighbourhoods,but

was

alsofound

inm

ediumand

highclass

areasbecause

of

theoverall

poorcoverage

ofw

astecollection

service.

40

Environm

entalP

roblems

andthe

Urban

Household

inthe

GA

MA

-Ghana

Ta

ble

4.2

:H

ou

se

ho

lds

Du

mp

ing

So

lidW

aste

inth

eN

eig

hb

ou

rho

od

.

Response

District

No

Yes

To

taI

No.

0/0N

o.%

No.

0/0

Accra

9613.4

61986.6

715100.0

Tem

a43

26.9117

73.1160

100.0G

a29

23.296

76.8125

100.0

TotalG

AM

A168

16.8832

83.21000

100.0

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

The

waste

was

typicallydum

pedat

aneighbourhood

collectionpoint

or

officialdum

p,w

ithonly

15%o

fall

householdsdum

pingrefuse

onem

ptyland,

.waterw

ay,gutters

andsuch

places(T

able4.3).

How

ever,som

eo

fthe

so-calledofficial

dumps

may

simply

beunauthorised

sitesw

hichhave

developedinto

accepteddum

psin

theabsence

of

alternatives.O

nestudy

identifiedsom

e100

unauthoriseddum

pingsites

inthe

metropolis

(Tahal,

1981,pp.C

.2-14).

Ta

ble

4.3

:N

eig

hb

ou

rho

od

Du

mp

ing

Site

so

fH

ou

seh

old

s.

District

To

taI

Site

Accra

Tem

aG

aG

AM

A

No.

%N

o.%

No.

%N

o.0/0

Collection

Point

29245.8

3025.6

1616.2

33839.6

OfficialD

ump

28044.0

7967.5

2929.3

38845.5

Em

ptyLand

568.8

76.0

5050.5

11313.2

Waterw

ay4

0.63

3.07

0.8

Other

50.8

0.91

1.07

0.8

Total

637100.0

117100.0

99100.0

853100.0

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.N

ote:O

nlyhouseholds

dumping

theirw

asteare

includedin

thistable.

Given

thew

idespreadinadequacies

inw

astem

anagement,

itis

notsurprising

thatabout

45%o

fthe

populationin

them

etropolisconsider

waste

mism

anagement

tobe

aproblem

intheir

neighbourhood(T

able4.4).

The

responsesdid

notvary

appreciablybetw

eendistricts.

The

concernw

ithopen

dumping

sitesw

asclearly

relatedto

theoverall

amenity

levelofthe

area,however.W

hereasonly

12%in

highclass

areasand

31%

inm

iddleclass

areasperceived

aproblem

,the

sharerose

tohalf

inthe

lowclass

areas.T

hem

ostaffected

sitesw

ereopen

land,streets,

waterw

ayso

rgutters

andprivate

land,in

descendingorder

of

importance.

This

would

tendto

confmn

theview

thatsom

eo

fthe

dumps,

atleast

inthe

lowclass

areas,are

unauthorisedsites.

,-,

Benneh

etat.

Ta

ble

4.4

:H

ou

se

ho

lds

Pe

rceivin

gL

oca

lA

ccu

mu

latio

ns

of

So

lidW

aste

tob

ea

Pro

ble

m.

District

Response

No

Yes

To

taI

No.

%N

o.%

No.

%A

ccra382

53.4333

46.6715

100.0T

ema

9861.3

6238.8

160100.0

Ga

6854.4

5745.6

125100.0

TotalG

AM

A548

54.8452

45.21000

100.0

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

41

The

riskto

healthfrom

theexistence

of

thesesites

ispotentially

high,as

thew

astesom

etimes

remains

uncollectedfor

more

thana

week

(fable

4.5).T

hem

ostaffected

areasare

within

theG

aD

istrict.O

new

ouldexpect

theproblem

sto

bem

orethreatening

incrow

dedareas,

andindeed

thisw

ouldseem

tobe

theperception

of

theresidents.

While

inG

aD

istrict,w

itha

relativelylow

populationdensity,

twice

aslarge

ashare

ofrespondents

reporteduncollected

waste

sites,they

were

nom

orelikely

thanA

ccraresidents

tocom

plaino

fasolid

waste

problem.

Ta

ble

4.5

:E

xis

ten

ce

of

Op

en

Du

mp

Site

so

fU

nco

llecte

dW

aste

for

aW

ee

ko

rM

ore

.

Response

District

No

Yes

To

taI

No.

%N

o.%

No.

0/0

Accra

51471.9

20128.1

715100.0

Tem

a78

48.882

51.3160

100.0

Ga

4737.6

7862.4

125100.0

TotalG

AM

A639

63.9361

36.11000

100.0

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

Within

Tem

aD

istrict,it

ism

ainlyareas

outsidethe

plannedindustrial

township,

suchas

thesquatter

settlemento

fAshiam

an,Tem

aN

ewT

own

andother

outlyingcentres,

thatare

poorlyserved.

Large

areaso

fthe

Accra

District

arenow

benefitingfrom

more

regularservicing

interm

so

fw

asterem

ovalfrom

comm

unalcollection

points.A

mong

residentialareas

which

donot

asyet

benefitfrom

regularservice

arethose

inthe

fringeareas

of

thecity

includingN

orthT

eshieE

state,A

chimota,

Labadi,

Rom

anR

idgeand

Cantonm

ents.M

osto

fthese

arefar

frombeing

among

thepoorestcom

munities

which,

with

theexception

of

Jamestow

nand

Mam

probiare

nowbetter

servicedthan

before.T

heposition

ininner

cityareas

of

Accra

District

hasim

provedbecause

of

theprovision

of

comm

unalcontainers

toprevent

theindiscrim

inatedum

pingo

frefuseand

nightsoil.W

hilstsolid

waste

managem

entfor

them

ajorityis

generallyunsatisfactory,

thereare

aprivileged

feww

hoselevel

of

servicedelivery

isexceptional.

Table

4.6indicates

that11

%o

fthe

householdshave

home

collection.A

bout7%

of

poorhouseholds,

20%o

fm

edium-w

ealthhouseholds

and39%

of

wealthy

households

42

Environm

entalP

roblems

andthe

Urban

Household

inthe

GA

MA

-Ghana

benefited,leaving

medium

wealth

householdsm

arginallyless

likelyto

havehom

ecollection

thanthe

averageT

ema

resident.

Ta

ble

4.6

:H

om

eC

olle

ctio

nS

ervice

for

Ho

use

ho

ldS

olid

Wa

ste.

Response

District

No

Yes

To

taI

No.

%N

o.%

No.

%A

ccra640

90.766

9.3706

100.0T

ema

122n.7

3522.2

157100.0

Ga

11595.0

65.0

121100.0

TotalG

AM

A877

89.1107

10.9984

100.0

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

4.2.3H

ouseholdL

evelServiceC

hargesfo

rG

arbageR

emoval

Currently,

two

main

waste

collectionsystem

sare

inuse

inthe

metropolis:

houseto

housecollection

servicecom

munity

refusedum

pservice

ortransfer

stationsw

ithcom

munal

containers.

At

thetim

eo

fthe

survey,house

tohouse

collectiononce

aw

eekattracted

acharge

of

1,000cedis

am

onthfor

a100

litrecontainer

and3,500

cedisa

month

fora

240litre

container.O

nthe

otherhand,

thecharge

fora

householdusing

acom

munity

refusedum

po

rcontainer

was

2,500cedis

peryear,

or

abouttw

ohundred

andeightcedis

perm

onth.In

Tem

aD

istrict,the

waste

collectioncharge

is500

cedisper

month.

Out

of

about82%

of

thepopulation

of

them

etropolisthat

reliedon

comm

unalsolid

waste

disposalsites,

am

ere31

%claim

edto

payany

levyat

all.T

heproportions

who

paidw

erehighest

inthe

plannedtow

nshipo

fT

ema,

andthe

innercity

slums

suchas

Nim

aand

Maarnobi,

where

over90%

of

respondentspaid

alevy.T

hem

ajority,who

paidnothing,

may

well

havebeen

usingunauthorised

sites,o

rauthorised

sitesfrom

which

waste

was

notbeing

evacuated.T

hecollection

ratefor

thelevy

islow

inindigenous

areas(about

10%),

probablybecause

inthe

pastthese

areasw

ereprovided

with

afree

"generalservice,"

with

payments

onlybeing

made

forhom

ecollection.

Inthe

compound

housingunits

with

numerous

households,there

isalso

aproblem

of

detenniningw

hoshould

pay,especially

when

thelandlord

isnot

residentin

thecom

pound.In

theseneighbourhoods

thereis

noenforceable

penalty,as

residentscan

always

gainaccess

tothe

openrefuse

collectioncontainers

todum

ptheir

householdgarbage,

whether

ornot

theypaid

theservice

charge..'

4.3F

inalDisposalSystem

sS

olidw

astethatis

collectedfrom

householdso

rfrom

theneighbourhood

collectionpoints

isgenerally

transportedto

[mal

disposalsites.

The

Waste

Managem

entD

epartment

operatescom

postplants

andland

fIlls.Incineration

of

refuseis

rare.T

hem

ostcom

mon

method

of

[mal

disposalis

opendum

pingin

pits,euphem

isticallycalled

landfIlls,

principallynear

Korle

Lagoon,

Korle

Gonno

Benneh

etal.43

beach,L

abadi,R

idgeand

atA

penkwa

nearC

FChousing

estate.M

osto

fthese

havealready

beenused

to,or

beyond,capacity,

exceptfor

thoseat

Apenkw

aand

Korle

Lagoon.

The

Departm

entis

badlyin

needo

fnew

sites,as

residentsare

becoming

more

environmentally

conscious.A

newlandfill

hasbeen

openedat

Mallam

.H

ere,the

Environm

entalP

rotectionC

ouncilC

EPC)

hasstarted

monitoring

groundwater

aspart

of

ailattempt

toprevent

pollution.In

additionthe

Departm

enthas

acom

postplant

atT

eshie-Nungua

anda

number

of

high-techoxidation

pondsat

Achim

ota,both

ofw

hichproduce

compostm

anure.

44

Environm

entalP

roblems

andthe

Urban

Household

inthe

GA

MA

-Ghana

CH

AP

TE

RF

IVE

5U

RB

AN

PEST

SA

ND

PE

ST

CO

NT

RO

L5.1

Urban

InsectV

ectorsa

nd

Rodents

5.1.1Introduction

Certain

human

diseasesare

transmitted

fromone

hostto

anotherthrough

theagency

of

aninsect

intermediary

or

vector.In

Accra,

inadequatedrainage

and

sanitation,the

generalenvironm

entalconditions,

andthe

behaviourpatterns

of

thepeople

inthe

variousresidential

areas,all

combine

toprovide

favourableconditions

forsom

eo

fthem

oresevere

vector-bornediseases.

Many

insectvectors

existin

theG

reaterA

ccraM

etropolitanA

rea(G

AM

A).

This

studyfocuses

primarily

onm

osquitoes,flies,

andcockroaches.

The

incidenceo

frodents-

mice

andrats

-is

alsosum

marised

briefly.

5.1.2M

osquitoesP

oorsullage

disposal,blocked

drains,and

thegenerally

poordrainage

system,

facilitatem

osquitobreeding.

As

emphasised

duringm

anyo

fthe

focusgroup

discussions,w

hileone

mightexpect

mosquitoes

tobe

prevalentlargely

inthe

rainyseason,

over-crowding

coupledw

iththe

poordrainage

systemhas

meant

thatsom

egutters,

streams,

stormcanals,

etc.contain

water

throughoutthe

year.M

anyindustrial

andcom

mercial

establishments,

especiallychop-bars,

restaurants,hospitals,

andhotels,

continuouslyuse

largeam

ountso

fw

ater.P

erhapsas

aresult,

while

them

osquitopopulation

undoubtedlyincreases

duringthe

rainyseason,

itis

highthroughout

theyear.

Low

lyingareas

with

streams

andchoked

uplagoons

(theK

orle,C

hemu

andK

peshilagoons

inA

ccraD

istrict,for

example)

offerexcellentbreeding

grounds.It

hasbeen

estimated

thatover

90%o

fthe

mosquitoes

inA

ccracity

areC

ulexand

Aedes

species(C

hinery,1969).

Anopheles

mosquitoes,

thevectors

of

malaria,

generallyprefer

unpolluted,naturalbreeding

sites.N

evertheless,betw

een1987

and1990,

malaria

accountedfor

between

41%

and53%

of

thecases

reportedat

outpatientfacilities

inthe

Greater

Accra

Region

(seeT

able8.1).

While

suchstatistics

may

exaggeratethe

relativeim

portanceo

fm

alaria,there

islittle

doubtthat

itrem

ainsan

important

causeo

fillhealth.

Thus,

while

Anopheles

mosquitoes

onlyaccount

fora

small

shareo

fm

osquitoes,there

aresufficient

numbers

tohelp·

createlarge

scalehealth

problems.

Moreover,

Anopheles

mosquitoes

canadapt

tourban

breedingsites

overtim

e.In

India,the

A.

Stephensi"has

developedinto

anurban

speciesand

isfound

inm

uchhigher

numbers

inm

anycities

inIndia

thanin

thesurrounding

countryside"(W

HO

,1988a,

p.17).T

hereis

evidencethat

Anopheles

mosquitoes

arelikew

isebecom

ingbetter

adaptedto

thebreeding

siteso

fAccra.A

soutlined

byC

hinery(1984),

thechanging

ecologyo

fA

ccrahas

ledto

significantshifts

inthe

composition

of

them

osquitopopulation.

On

theone

hand,"T

healm

ostcom

pleteelim

inationo

fA

n.funestus

anddecrease

inbreading

intensityo

fAn

gambiae

s.l.over

theyears

havecontributed

todim

inishingm

alaria..

parasiterates

between

1912and

1964and

may

alsoaccount

forlow

incidence.of·

W.

bancroftiinfection

inA

ccrain

recentyears"

(Chinery,

1984,p.

75).O

nthe

otherhand,

"An.

gambiae

s.l.has

adaptedto

breedingappreciably

inw

ater-filleddom

esticcontainers

inrecent

times"

and"breeding

hasalso

increasedin

the

Benneh

etai.45

numerous

pollutedw

aterhabitats

createdas

aresult

of

urbanizationII

(Chinery,

1984,p.75).

Thus,

while

pasturbanization

haslow

eredthe

incidenceo

fm

alariain

Accra,

thereis

noreason

toassum

ethat

continuingurbanization

will

automatically

eliminate

itas

am

ajorhealth

problem.

Indeed,further

adaptationcould

actuallylead

toan

increasingpresence

of

Anopheles

mosquitoes.

Moreover,

theshift

todom

esticw

atercontainers

suggeststhat

malaria

isnot

onlylinked

top

oo

rdrainage,

butincreasingly

tohousehold

water

managem

ent,and

more

generallythe

reliabilityo

fwater

supply(as

outlinedin

Chapter

2,the

unreliabilityo

fw

ateris

oneo

fthe

main

reasonsfor

thehigh

levelo

fhousehold

water

storage).T

heA

edesspecies

alsocom

monly

breedin

householdw

atercontainers,

andcan

bevectors

of

yellowfever

anddengue

haemorrhagic

fever.T

herisks

of

urbanyellow

feverand

outbreakso

fdengue

haemorrhagic

fevershould

notbe

neglected,even

ifthey

arenot

currentlya

major

healthconcern.

The

surveyundertaken

forthis

studydoes

notprovide

information

onm

osquitospecies,

andas

such·provideslim

itedinsight

intothe

relativerisks

differenthouseholdsare

facingfrom

mosquitoes.

The

surveyresults

indicatethat

inalm

ostall

thesam

pledresidential

areasm

osquitobiting

was

prevalentduring

bothdry

andw

etseasons,especially

indoorsatnightw

henA

nopheles,but

alsothe

more

comm

onC

ulex,m

osquitoesare

biting.O

nly2%

of

therespondents

saidthat

theyw

erenot

botheredby

mosquitoes

bitingindoors

atnight

duringthe

wet

season,w

iththe

percentagerising

to4%

inthe

dryseason.

Som

e17%

inthe

dryseason

and21

%in

thew

etseason

saidthatthere

were.only

occasionallym

osquitoesbiting

indoorsat

night.B

ut

them

ajorityin

bothseasons

oftenhad

bitingm

osquitoes.M

oreover,excluding

householdsw

ithfull

window

screening,the

responsesw

erequite

similar

inthe

differentareas

of

thecity

andam

ongp

oo

rand

wealthy

households.O

nerelationship

which

didem

ergew

asa

significantassociation

between

thelocation

of

storedw

aterand

thelevel

of

mosquito

bitingin

thedry

season.W

hereas4

4%

of

the(621)

householdsstoring

water

insidew

ereoften

botheredby

many

bitingm

osquitoesat

nightduring

thedry

season,this

appliedto

only31

%o

fthose

(334)households

who

storedtheir

water

outside.A

lternatively,only

3.2%o

fthose

storingw

aterindoors

were

notbothered

bybiting

mosquitoes

atall,

asopposed

to6.6%

of

thosestoring

water

outdoors.If

thereis

indeeda

growing

presenceo

fA

nophelesm

osquitoesin

householdw

atercontainers,

indoorw

aterstorage

may

be

increasinglyrisky.

Except

when

mosquitoes

arebreeding

inhousehold

water

containers,there

isrelatively

littlean

individualhousehold

cando

tocontrol

breeding.O

nthe

otherhand,

thereare

anum

bero

fm

easuresw

hichcan

betaken

tokill

adultm

osquitoeso

rinhibit

theirentry

intothe

home.

As

illustratedin

Section

5.2.1,about

90%o

fhouseholds

inA

ccraattem

ptsom

eform

of

insectcontrol,

typicallytargeting

mosquitoes.

Very

few,

however,

achieveanything

likecom

pleteprotection.

5.1.3H

ouseF

liesM

anyinsects

otherthan

mosquitoes

serveas

diseasecarriers

inurban

areas.T

heseinclude

houseflies,

sandflies,

tricklingfIlter

flies,fleas,

bedbugs,

cockroaches,lice,

mites

andtriatom

inebugs

(Table

5.1).A

lmost

allthe

listeddisease

vectorsare

presentat

variouslevels

throughoutthe

studyarea.

How

ever,only

houseflies

andcockroaches

will

bediscussed.

46

Environm

entalP

roblems

andthe

Urban

Household

inthe

GA

MA

-Ghana

Table

5.1:H

abitatso

furbandisease

vecto

rso

the

rthanm

osquitoes.

House

Sand

Trickin

gF

leasB

ed

bu

gs

Flies

Flies

filter

flies

+++++

+++

++

++

+++

Co

ckroa

chL

iceM

itesT

riato

min

eb

ug

s

+++++

++

++

++

Refuse

Sites

Slaughter

houses

Food

Stores

Deficienthouses

Dirty

garments

Sew

eragefilters

An

ima

lshelters

Excre

me

nt

Unsanitary

latrines

Rodent

burrows

Refuse

Sites

Slaughter

houses

Food

Stores

Deficient

houses

Dirty

ga

rme

nts

Sew

eragefilters

Anim

alshelters

Excrem

ent

Un

san

itary

latrines

Rodent

burrows

WH

O,1

98

8a

The

housefly

isboth

afJlth

feederand

breeder.Flies

arem

echanicalcarriers,

andcan

contaminate

human

foodor

drinkthrough

directcontact

orby

defecatingor

regurgitatingstom

achcontents.

Unsanitary

conditionslead

tom

oreflies,

anda

higherrisk

thattheflies

will

spreaddisease.

House

fliesw

erecom

mon

inall

neighbourhoods,in

bothfood

preparationareas

andtoilets.

The

presenceo

ffliesin

toiletsvaried

more

thanin

kitchens.M

ore"than

twice

asm

anyhouseholds

claimed

neverto

haveflies

intheir

toiletsas

claimed

thesam

efor

theirfood

preparationareas

(23%as

opposedto

11%

).O

nthe

otherhand,

about50%

more

householdssaid

therew

erealm

ostalw

aysflies

intheir

toiletsthan

thatthere

were

almost

always

fliesin

theirfood

preparationareas

(38%as

opposedto

24%).

Similarly,

thedifferences

between

poorand

wealthy

householdsw

erem

orestriking

with

respectto

fliesin

thetoilet

thanw

ithrespect

toflies

inthe

kitchen(S

eeT

ables5.2

and5.3).

More

thanfour

outo

ffive

wealthy

householdssaid

theyalm

ostnever

hadflies

intheir

toilets,com

paredto

aboutone

poorhousehold

inseven.

Indeed,about

44%o

fpoor

householdsalm

ostalw

ayshad

fliesin

theirtoilets.

'"

Benneh

etal.47

Ta

ble

5.2

:P

rese

nce

of

Flie

sin

Fo

od

Pre

pa

ratio

nA

rea

by

Ho

use

ho

ldW

ea

lth(%

).

We

alth

Presence

ofF

liesIn

de

xo

fA

lmo

stO

cca-U

suallyA

lmo

stN

oT

ota

IH

ou

seh

old

Never

sion

ally

Alw

aysC

oo

king

%N

Low6.4

24.041.2

28.00.4

100.0818

Medium

30.529.0

29.89.9

0.8100.0

131H

igh39.3

43.113.7

3.9100.0

51

Total

11.225.6

38.324.4

0.4100.0

1000

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

Ta

ble

5.3

:P

rese

nce

of

Flie

sin

To

ilets

by

Ho

use

ho

ldW

ea

lth(%

).

Presence

ofF

liesW

ealthIn

de

xo

fA

lmo

stO

cea-U

suallyA

lmo

stF

reeT

ota

IH

ou

seh

old

Never

sion

ally

Alw

ays

Range

%N

Low14.3

16.323.8

44.41.2

100.0818

Medium

54.217.6

16.710.7

0.8100.0

131H

igh82.4

9.85.8

2.0100.0

51

Total

23.016.1

22.037.8

0.1100.0

1000

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

Inthe

discussiono

fsolid

waste

(Chapter

4),it

was

shown

thathouseholds

storingw

asteinside

theirhom

ew

erem

orelikely

tohave

fliesin

theirkitchen.

The

relationbetw

eenthe

sanitarycondition

of

thetoilet

andthe

presenceo

fflies

was,

asone

would

expect,far

stronger.T

he32%

of

householdsusing

toiletsw

herefaecal

material

was

visibleoutside

of

the"bow

l",accounted

form

orethan

halfo

fthe

householdsw

ithm

anyflies

inthe

toilet,and

only6%

ofthe

toiletsw

ithoutflies.S

imilar

associationsexist

with

otherindicators

of

unsanitarytoilets.

Furtherm

ore,unsanitary

toiletsare

associated,though

lessstrongly,

with

havingm

oreflies

inthe

kitchens.Indeed,

them

ultiplicityo

finterconnections

isso

strongthat

itis

more

reasonableto

portrayflies

asa

dangerousvector

within

acom

plexsystem

of

sanitaryproblem

s,than

toattem

ptto

singleout

particularreasons

forfly

prevalence.T

ables5

Aand

5.5illustrate

clearlythat

childhooddiarrhoea

ism

oreprevalent

inhouseholds

where

respondentssay

thereare

more

flies.In

lighto

fthe

multiplicity

of

interconnectionsnoted

above,this

associatiOll

shouldbe

takento

reflectnot

onlythe

roleo

fflies

ascarriers,

butalso

thefact

thatthe

presenceo

fflies

isan

indicationo

fotherhigh

riskconditions.

48

Environm

entalP

roblems

andthe

Urban

Household

inthe

GA

MA

-Ghana

Ta

ble

5.4

:P

rese

nce

of

Flie

sin

Kitch

en

an

dth

eT

wo

We

ek

Pre

vale

nce

of

Ch

ildh

oo

dD

iarrh

oe

aa

mo

ng

Ho

use

ho

lds

with

Ch

ildre

nU

nd

er

Six.

Presence

of

Ch

ild«

6)

with

Diarrhoea

Ho

use

flies

inL

astT

wo

Weeks

To

taI

%N

o%

Ves

%N

Alm

ostN

ever92.7

7.3100.0

41O

ccasionally93.4

6.6100.0

136~

Usually

87.612.4

100.0209

Alm

ostA

lways

77.322.7

100.0150

Total

86.613.4

100.0536

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

Ta

ble

5.5

:P

rese

nce

of

Flie

sin

To

ilet

an

dth

eT

wo

We

ek

Pre

vale

nce

ofC

hild

ho

od

Dia

rrho

ea

am

on

gH

ou

seh

old

sw

ithC

hild

ren

Un

de

rS

ix.

Ch

ild«

6)

with

Diarrhoea

Presence

of

inL

astT

wo

Weeks

To

taI

Ho

use

flies

%N

o%

Ves

%N

Alm

ostN

ever94.1

5.9100.0

101O

ccasionally90.8

9.2100.0

87U

sually86.2

13.8100.0

138A

lmost

Alw

ays81.2

18.8100.0

207

Total

86.513.5

100.0533

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

5.1.4C

ockroachesU

ndersom

econditions,

cockroaches,like

flies,can

bem

echanicalcarriers

of

disease.W

hilenot

inherentlyattracted

tohum

anfaeces,

theysom

etimes

livein

habitatsw

herecontactis

likely.P

athogenicbacteria

may

thenbe

depositedon

foodas

thecockroaches

foragein

akitchen

or

foodarea.

Astudy

of

cockroachesin·

Accra

(Agbodaze

andO

wusu,

1989)found

evidenceleading

theauthors

tosuggest

thatcockroaches

couldbe

playinga

rolein

thetransm

issionbacterial

diarrhoea.(O

uto

f208

cockroachescollected

fromkitchens,

64harboured

coliforms,

13harboured

proteusspecies,

sixharboured

Salmonella,

two

harbouredP

seudomonas

species,and

oneharboured

Shigelladysentariae.)

Inaddition

tothe

potentialhealth

risk,cockroaches

aregenerally

considereda

nuisance,and

canproduce

anunpleasantodour.

Only

8%

of

thehouseholds

surveyedfor

thisstudy

saidthey

neversaw

cockroachesin

theirhom

es,and

44%claim

edoften

tosee

largenum

bers.C

ockroachesw

ereassociated

with

many

of

thesam

eenvironm

entalindicators

asflies,

thoughthe

associationsw

eresom

ewhat

lessstrong.

As

aresult,

while

only'13%

of

(112)households

with

noflies

intheir

kitchenoften

sawm

anycockroaches,this

percentageclim

bedto

69%in

the(244)

householdsw

hichalm

ostalw

ayshad

fliesin

theirkitchen.

Again

thisindicates

thecom

plexcom

binationo

fsanitary

andinsect-related

conditionsw

hichm

anyhouseholds

face.N

ot

Benneh

etal.49

surprisingly,cockroaches,

likeflies,

arem

oreprevalent

inpoor

households(see

Table

5.6).

Ta

ble

5.6

:P

rese

nce

of

Co

ckroa

che

sin

Ho

me

sb

yH

ou

seh

old

We

alth

(%).

Prevalence

Wealth

To

taI

Indexo

fN

everO

ccasionallyO

ftenin

Often

in%

NH

ouseholdS

mallN

os.Large

Nos.

Low7.7

15.430.1

46.8100.0

818M

edium4.6

32.131.9

32.1100.0

131H

igh21.6

35.321.6

21.6100.0

51

Total

8.018.6

29.943.6

100.01000

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

5.1.5R

odentsS

everalspecies

of

ratsand

mice

arew

elladapted

tourban

environments.

They

consume

storedfood,

damage

property,and

cancontam

inatehum

anfood

with

theirfaeces

andurine,

sometim

estransm

ittingdiseases

inthe

process(W

HO

,1988a).

Historically,rats

areinfam

ousfor

theirrole

inspreading

theplague.

While

therodents

of

Accra

may

notbe

am

ajorhealth

problem,

theyare

apersistent

nuisance,and

atleasta

minor

healthproblem

.R

odentstend

tobe

comm

onin

certainneighbourhoods

asa

resulto

fthe

qualityo

fhousing

andthe

environmentas

aw

hole.H

ousesin

thelow

income

areasare

notonly

closelybuilt,

butare

typicallyin

avery

poorstate

of

repair,both

favourableconditions

forthese

pests.T

helack

of

adequatefacilities

tohandle

domestic

waste

inm

ostlow

income

householdshas

compounded

theproblem

.F

urthermore,

while

ratsand

mice

canadapt

tourban

conditions,they

arem

oreprevalent

inthe

ruralfringe.

Tables

5.7illustrates

theextent

tow

hichthese

factorscom

bineto

placea

largepart

of

theburden

onpoorer

households.H

owever,

likeseveral

otherpest

relatedproblem

s,it

isnotew

orthythat

eventhe

wealthy

areaffected.

Indeed,about

16%o

fthew

ealthyhouseholds

claimed

thattherew

ererats

orm

icein

theirhom

esevery

day.

Ta

ble

5.7

:P

rese

nce

of

Ra

tso

rM

icein

Ho

me

sb

yH

ou

seh

old

We

alth

(%).

Prevalence

Wealth

To

taI

Indexo

fN

everO

ccasionallyO

ftenE

veryN

igh

tl%

NH

ouseholdD

ay

Low18.8

24.418.0

38.8100.0

818M

edium32.1

37.414.5

16.0100.0

131H

igh62.8

17.63.9

15.7100.0

51

Total

22.825.8

16.834.6

100.01000

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

50

Environm

entalP

roblems

andthe

Urban

Household

inthe

GA

MA

-Ghana

5.2Insecticide

Usage

an

dO

therP

reventiveM

easuresT

hepeople

of

Accra

arevery

concernedabout

theirpest

problems.

There

is,how

ever,relatively

littleenvironm

entalm

anagement

designedto

reducethe

levelo

fpest

infestationthrough,

forexam

ple,controlling

man-m

adebreeding

sites.Instead,

householdstake

anum

bero

fprotective

measures,

many

of

which

involvethe

useo

fpotentially

hazardouschem

icals.D

espitethe

economic

burdenthey

impose,

theseprotective

measures

havethe

attractionso

fbeing

relativelysim

pleto

applyand

of

concentratingtheir

protectionon

theusers

themselves.

Controlling

breedingsites

requiresa

more

sophisticatedunderstanding

of

thebehaviour

of

thepests,

and,since

thebeneficiaries

arem

oredispersed,

ittypically

requiressom

eform

of

publico

rcollective

action.M

osquitoesare

perceivedto

bea

major

healthrisk,

andare

thetarget

of

most

of

theprotective

measures

householdstake.

Sim

ilarly,m

ostgovernm

entefforts

targetm

osquitoes.T

hefollow

ingsections

summ

arisethe

extentto

which

differentm

ethodsare

employed,

andsom

ehealth

associationsw

hich,w

hilefar

fromdefinitive,

do

indicatethat

thepotential

dangerso

fusing

insecticidesdeserve

more

.consideration.

5.2.1H

ouseholdInsect

Control

About

nineout

of

tenhouseholds

takesom

em

easuresto

controlm

osquitoes.A

sindicated

inT

able5.8,

them

ostcom

mon

measure

isscreening.

Even

ina

well

constructedhouse,

screeningdoes

notprovide

fullprotection,

andin

many

itis

relativelyineffective.

Indeed,households

with

fullscreening

arem

orelikely

touse

otherm

ethodso

finsect

controlthan

thosew

ithout.T

heother

threem

easurestaken

bym

orethan

10%o

fthe

respondentsare

allchem

ical:m

osquitocoils,

aerosolinsecticides

andpum

p-sprayinsecticides.

Table

5.8:U

seo

fInse

ctCo

ntro

lMethods.

Use

of

Me

tho

dT

ota

lR

esp

on

de

nts

No

nY

esn

n

Me

tho

d(%

)(%

)

Full

Screening

47.4474

52.6526

1000

Mo

squ

itocoils

54.7547

45.3453

1000

Ae

roso

linsecticides

59.5594

40.5405

999

Pu

mp

insecticides89.2

88910.8

108997

Bed

nets92.2

9227.8

781000

Traditional

method

96.5961

3.535

996

Private

service96.7

9633.3

33996

Go

vt.service

99.3989

0.77

996

Oth

er

97.9973

2.121

994

At

lea

stoneo

fabove10.2

10189.8

893994

Data

source:Q

uestionnaireS

urveyofG

AM

A,.1991.

Mosquito

coils,the

most

comm

onchem

icalm

eanso

finsect

control,are

usedm

orecom

monly

among

poorhouseholds,

asillustrated

inT

able5.9.

Their

useundoubtedly

leadsto

increasedexposure

toair

pollution.W

hilethe

healthhazards

of

suchpollution

arenot

well

documented,

among

thehouseholds

surveyedw

ho

Benneh

etaf.51

hadchildren

undersix

therew

asa

highershare

with

oneo

fthese

childrenhaving

respiratoryinfection

symptom

sw

henm

osquitocoils

were

used.Indeed,about

15%(of

260)using

mosquito

coilshad

atleastone

childunder

sixw

ithsuch

symptom

s,com

paredto

9%(of

284)am

ongthose

notusing

mosquito

coils.T

heassociation

between

mosquito

coilsand

healthis

exploredfurther

inC

hapter8.

Table

5.9:U

seo

fMo

squ

itoC

oils

by

Household

Wealth

(Ofo).

We

alth

Ind

ex

Use

ofC

oliT

ota

I

of

Ho

use

ho

ldN

o.

Yes

%N

Low50.5

49.5100.0

818

Medium

69.530.5

100.0131

High

84.315.7

100.051

Total

54.745.3

100.01000

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

Aerosol

insecticides,on

theother

hand,are

usedm

oreoften

among

wealthy

households,as

illustratedin

Table

5.10.A

erosolsalso

increasepersonal

exposureto

airbornepollution,

especiallyfor

theperson

applyingthe

insecticide.N

osignificant

associationbetw

eenchildren's

healthand

theuse

of

aerosolpesticides

was

found.R

espiratoryproblem

symptom

sw

ereactually

lessprevalent

among

personalhom

emakers

usingaerosol

insecticides.H

owever,

aerosolsand

pump

spraypesticides

arerelatively

closesubstitutes,

andthis

couldbe

confoundingthe

results.In

Chapter

8,a

briefattem

ptis

made

toexam

inethis

associationm

oreclosely,

controllingfor

factorssuch

assm

oking,gender

of

theprincipal

homem

aker,andother

potentiallysignificantvariables.

Table

5.10:U

seo

fAe

roso

lInse

cticide

sb

yH

ouseholdW

ealth(Ofo).

We

alth

Ind

ex

Use

of

Ae

roso

lT

ota

I

of

Ho

use

ho

ldN

oY

es%

N

Low65.2

34.8100.0

817M

edium38.8

61.2100.0

129

High

20.879.2

100.053

Total

61.038.9

100.0999

Like

aerosols,pum

pinsecticides

arem

oreoften

usedby

wealthy

households(see

Table

5.11).G

enerally,it

ism

oredifficult

tocontrol

thechem

icalsused

ininsecticide

pumps,

andpum

pusers

arelikely

touse

largerquantities

ofinsecticide.

As

inthe

caseo

faerosols,

nostatistically

significantassociation

couldbe

foundbetw

eenthe

useo

fpum

psprays

andchildren's

health.H

owever,

about40%

of

the(l08)

principalhom

emakers

usingpum

pinsecticides

hadrespiratory

problemsym

ptoms,as

compared

to17%

ofthe(889)

principalhom

emakers

notusing

pump

pesticides.

52

Environm

entalP

roblems

andthe

Urban

Household

inthe

GA

MA

-Ghana

Tab

le5.11:

Use

of

Pu

mp

Insecticid

esby

Ho

useh

old

Wealth

(%).

Wealth

Ind

exU

seo

fP

um

pP

esticide

To

taI

ofH

ou

seh

old

No

Yes

%N

Low90.2

9.8100.0

815.

Medium

84.515.5

100.0129

High

84.915.1

100.053

Total

89.210.8

100.0997

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

Benneh

etai.53

Bo

x5.1:

Flies,

Mo

squ

itoes

and

Wealth

Lo

wL-M

Middle

U-M

Up

pe

r

Flies

areboth

filthfeeders

andfilth

breeders,andtheir

presencein

thecooking

areais

particularlyhazar­

dousw

hensanitation

isgenerally

poor,and

theyare

likelyto

trans­fer

faecalm

aterialtothe

food.A

sillustrated

inF

igure5.1,

thepres­

ence

of

fliesfollow

sm

uch

the

.same

patternas

mostother

house­hold

environmentalhazards

-they

arem

oreprevalent

among

poorerhouseholds.

Mosquitoes

were

comm

onboth

indoorsand

outinalm

ostallneigh­bourhoods.

How

ever,asillustrated

inF

igure5.2,the

measures

house­holds

taketo

protectthemselves

arevery

much

wealth

dependent.M

os­q

uito

coils

arem

ore

com

mo

nam

ongpoor

households,aerosol

spraysam

on

gw

ealthier

house­holds,and

pump

sprayssom

ewhat

more

comm

onam

ongw

ealthierhouseholds.

Malaria

isa

majo

rhealth

hazardin

GA

MA

,butusinginsecticides

canalso

beharm

ful,es­pecially

ifcareis

nottakenin

theirchoice

andapplication.

As

de­scribed

inC

hapterE

ight,the

useo

fm

osquitocoils

was

associatedw

ithrespiratory

problems

inchil­

dren,w

hilethe

useo

fpump

sprayinsecticides

was

associatedw

ithrespiratory

problems

inthe

princi­palw

omen

ofthe

household.

•U

-M

oU

pper

•Low

oL-M

IlilM

iddle

Wealth

group

presenceofflies

oalm

ostalw

ays

•usually

IIIoccasionally

oalm

ostn

eve

r

N=

Subsam

plesize

198200

18

72

10

20

5N

=

o 5040 60 7010

Figure

5.1:P

resenceo

fflies

inco

okin

garea

by

we

alth

gro

up

20

100%

90%

80%

70

%

60%

50

%

40%

30

%

20%

10

%

0%--jL==:""-L---"~-'----"~-'---""-,--'---'L(

%30

mo

squ

itocoils

ae

roso

lspum

p

Inse

ctcon

trolm

ethod

Figure

5.2:U

seo

finse

ctcon

trolm

eth

od

sb

yw

ealthg

rou

p

Data

source:Questionnaire

surveyofA

ccra,1991.

Note:

The

wealth

groupsem

ployedin

thesediagram

sare

basedon

thesam

ew

ealthindex

employed

inthe

resto

fthe

report.H

owever,rather

thanthree

unequalgroups(the

poorm

ajority,asm

allwealthy

elite,anda

somew

hatlargerm

edium-w

ealthgroup),

fivegroups

of

roughlyequal

sizehave

beencreated

forthe

graphicalpresentation.

54

Environm

entalP

roblems

andthe

Urban

Household

inthe

GA

MA

-Ghana

CH

AP

TE

RS

IX

6F

OO

DC

ON

TA

MIN

AT

ION

6.1Introduction

This

chapteris

concernedw

ithm

icrobialfood

contamination,

andespecially

therole

offood

inthe

transmission

offaecal-oraldisease.

Bacterialagents

canm

ultiplyin

food,w

hilefor

viruses,protozoa

andhelm

inths,food

canbe

acarrier.

Food

contamination

canoccur

atany

number

ofpoints

between

productionand

consumption,

while

cookingfood

canreduce

contamination.

The

following

sectionsexam

ine,in

tum,

thepotential

sourcesof

contamination:

1)prior

topreparation;

2)during

preparation;and

3)during

storagein

thehom

e.

6.2F

oodSupplies

Mosthouseholds

inthe

studyarea

obtaintheir

foodfrom

openm

arkets.V

eryoften

thefood

isdisplayed

openlyon

tablesand

onthe

bareground

invery

poorsanitary

environments.

The

prevalenceof

diseasevectors

suchas

housefliesat

thesem

arkets,as

well

asthe

presenceof

pestssuch

ascockroaches

androdents

inthe

storagelocations,

suggestsa

potentiallyhigh

levelof

contamination.

Such

contamination

posesparticular

risksfor

meat,

fishand

forfruit

andvegetables

eatenraw

.A

significantshareofthe

vegetablessold

areproduced

insm

allmarketgardens

inthe

studyarea.

Vegetables

suchas

lettuce,carrots,

greenpepper,

cucumber

andIndian

spinachare

cultivatedalong

some

major

drainsin

thestudy

area,and

microbiological

examination

hasuncovered

highlevels

offaecal

contamination

bothin

thew

aterand

inlettuce

andcabbage

leavestaken

fromsuch

sites(E

nvironmentalM

anagementA

ssociatesL

td.,1989,p.154).

Fruits

areavailable

inalm

ostallthe

localm

arketsand

afew

wayside

groceriesin

thestudy

area,having

arrivedfrom

hinterlandareas

afew

kilometres

away.

Alm

ostall

fruitsare

eatenraw

.T

herisk

ofcontam

inationis

thushigh,

especiallyw

henthe

fruitsare

notw

ashedproperly

beforebeing

eaten.S

uchfruits

may

includem

angoes,sugar-caneand

berrieso

fallsorts.The

manner

inw

hichthese

arehandled

anddisplayed

forsale

exposesthem

todust

andhouseflies.

Sugar-cane

isunloaded

fromtrucks

andpacked

onthe

bareground

priorto

cuttingit

upin

bitsfor

sale.F

ortunately,fruits

suchas

coconut,groundnut

(inshell),

avocadopears

andbananas

arenotso

easilycontam

inated,dueto

theirprotective

outercoat.

Meat

ism

ostlysold

rawin

thestudy

area.H

owever,

ina

fewcases,

particularlyw

ithgam

e(popularly

referredto

asbush

meat),

itm

aybe

smoked

anddisplayed

ontables

onthe

openm

arketfor

sale.In

spiteof

theS

laughterH

ouseand

Saleo

fM

eatB

yeL

awof

1962,w

hichstates

thatno

animal

shouldbe

slaughteredfor

consumption

outsidethe

slaughterhouse,

theslaughter

andtransport

of

rawm

eatfrom

theexisting

slaughterhouses

inthe

studyarea

tothe

marketing

pointsis

~uch

thatthe

riskof

contamination

isvery

high.T

heslaughter

housesare

inpoor

conditionand

attim

espoorly

located.T

heJam

esT

own

slaughterhouse,

forexam

ple,is

locatedabout

20m

etresfrom

apublic

toilet.C

arcassesare

transportedin

opentrucks

andthen

head-loadedbare

tothe

sellingpoints

which

arethem

selvesoverw

helmed

byscores

ofbuzzing

houseflies.A

llthese

arepossible

sourcesofcontam

ination.B

othraw

andsm

okedfish

aredisplayed

bareon

wooden

traysin

theopen

market,

exposingthem

tocontam

inationby

houseflies.T

hesm

okingis

notalw

ays

Benneh

etal.55

properlydone,

andthe

fishis

oftenin

veryp

oo

rcondition

bythe

time

itis

boughtand

consumed.

Furtherm

ore,viruses

arepresent

inthe

shellfish,w

hichare

popularprotein

foodsin

most

indigenousG

acom

munities,

where

po

or

householdspredom

inate.

6.3F

oodP

reparationA

llbut

afew

(8)households

surveyedregularly

preparedat

leastone

meal

aday.

Inthe

majority

of

cases,tw

oo

rthree

meals

aday

areprepared.

How

ever,as

illustratedin

Table

6.1,a

higherproportion

of

thelow

income

householdsthan

highincom

ehouseholds

prepareonly

onem

eala

day.

Ta

ble

6.1:N

um

be

ro

fM

ealsP

reparedP

erD

ayb

yH

ou

seh

old

Wealth

(%).

We

alth

Ind

ex

Nu

mb

ero

fM

ealsT

ota

I

of

Ho

use

ho

ldO

ne

Tw

oT

hree%

N

Low16.8

42.840.3

100.0808

Medium

3.139.1

57.8100.0

128

High

2.031.4

66.7100.0

51

Total

14.241.7

43.9100.0

982

So

urce

:Q

ue

stion

na

ireS

urve

yo

fG

AM

A,

19

91

.

While

po

or

householdsconsum

eless

food,the

tendencyto

prepare.fewer

meals

athom

ealso

reflectstheir

greaterreliance

onvendors

sellingprepared

food,illustrated

inT

able6.2.

Most

operatorsin

theprepared

foodand

ready-to-eatfood

businessin

thestudy

areaoperate

underrather

unhygienicconditions.

Prepared

foodssuch

ascooked

rice,kenkey,

andgari

andbeans

aredished

outto

buyersin

leaves,cem

entpapers

andold

newspapers.

Besides,

some

of

thesem

aybe

uncoveredand

soare

exposedto

dustand

houseflies.R

eady-to-eatfoods

suchas

doughnuts,bread,

roastedplantain

andgroundnuts,

andpastry

arealso

inm

anycases

similarly

packagedo

rexposed.

Inthe

chopbars

thepresence

of

buzzinghouseflies

isnot

theonly

sourceo

ffood

contamination;

them

assuse

of

facilitiessuch

aseating

platesand

bowls

(which

may

notalw

aysbe

properlyw

ashedbefore

thenext

buyeris

served),drinking

cupsand

napkins/towels

forcleaning

thehands,

asw

ellas

thep

oo

rpersonal

hygieneo

fm

anyoperators

andstaff

of

thesechop

bars,m

ayw

ellbepossible

sourceso

ffoodcontam

inationtoo.

56

Environm

entalP

roblems

andthe

Urban

Household

inthe

GA

MA

-Ghana

Table

6.2:P

atronageo

fP

reparedF

oodF

romV

endorsb

yH

ouseholds(%

).

Pa

tron

ag

eT

ota

l of

We

alth

Ind

ex

Ho

use

ho

ldo

fH

ou

seh

old

No

Yes

%N

Low22.9

n.l

100.0818

Medium

46.653.4

100.0131

High

47.152.9

100.051

Total

27.272.8

100.01000

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

Prepared

foodpurchased

bypoor

householdsis

alsosom

ewhat

more

likelyto

fallinto

thehigh

riskgroups.

Thus,

forexam

ple,about

30%o

fpoor

householdspurchasing

preparedfood

fromvendors

includedpurchases

of

openstreet

food,as

compared

to14%

and11%

form

edium-w

ealthand

wealthy

householdsrespectively.

Food

eatenout,

which

includesfood

purchasedfrom

vendors,is

clearlyperceived

asa

healthrisk

bythe

householdsthem

selves,and

especiallyby

thepoor.

Indeed,28

of

the72

householdsw

hosechildren

hadrecently

haddiarrhoea

identifiedfood

eatenout

asa

probable(or

definite)cause,

andallbut

oneo

fthese

householdsw

aspoor.

By

way

of

contrast,only

sevenidentified

home

preparedfood.It

isunlikely

thatprepared

vendorfoods,

or

more

generallyfood

eatenoutside

thehom

e,is

toblam

efor

am

ajorshare

of

diarrhoeam

orbidity.T

hereis,

however,

asignificant

associationbetw

eeneating

suchfood

anddiarrhoeal

morbidity.

In16%

of

the(400)

householdsw

ithchildren

undersix

who

regularlypurchase

preparedfood

fromvendors,

oneo

fthe

childrenhad

haddiarrhoea

within

thelast

two

weeks,

asopposed

to6%

among

those(137)

who

didnot

regularlypurchase

suchfood.

Purchasing

preparedfood

fromvendors

isalso

statisticallyassociated

with

otherrisk

factors.H

owever,

evencontrolling

forthese

otherfactors,

thestatistical

associationbetw

eendiarrhoea

andsuch

foodpurchases

isstatistically

significant(seeC

hapter8).

Even

ifhouseholds

areless

inclinedto

blame

foodprepared

athom

e,the

potentialfor

in-housecontam

inationshould

notbe

neglected.F

oodcontam

inationin

thehom

eis

intimately

linkedto

thehousehold

sanitation,hygiene

andinsect

problems

discussedin

previouschapters.

Both

thepresence

of

fliesin

kitchensand

notw

ashinghands

priorto

foodpreparation

were

shown

tobe

closelyassociated

with

ahigh

diarrhoeaprevalence

among

childrenunder

six.M

oreover,both

of

thesefactors

remain

significant,even

controllingfor

otherrisks.

This

couldreflect

highlevels

ofin-hom

efood

contamination

inG

AM

A.

Generally,

onew

ouldalso

expectfreshly

cookedfood

tobe

lessprone

tocontam

inationthan

leftovers.T

ables6.3

and6.4

showthe

extentto

which

freshfood,

heatedleftovers

andcold

leftoversw

ereregularly

includedin

differentm

eals.A

mong

allw

ealthgroups,

theevening

meal

typicallyincluded

freshfood.

The

midday

meal

was

theone

leastlikely

toinclude

freshfood,

especiallyam

ongpoor

householdsw

hereabout40%

ofthe

householdsdid

notinclude

it.P

oorhouseholds

were

alsosom

ewhatless

likelyto

includefreshly

cookedfood

inthe

morning

meal,

Benneh

etal.57

thougheven

among

thepoor

more

thanfour

householdsin

fivedid

includefresW

ycooked

food.

Ta

ble

6.3:R

eg

ula

rIn

clusio

no

fF

resh

lyC

ookedF

oodin

Hom

eP

reparedM

ealsb

yH

ou

seh

old

Wealth.

Mo

rnin

gM

ealM

idd

ay

Meal

Eve

nin

gM

eal

We

alth

Ind

ex

No

Ye

sn

No

Ye

sn

No

Ye

sn

of

Ho

use

ho

ld(%

)(%

)(%

)(%

)(%

)(%

)

Lo

w17

83707

40

60530

397

785

Me

diu

m5

95121

1189

89

298

126

High

0100

4813

87

45

496

53

To

tal

14.485.6

87634.3

65.7664

3.097.0

964

Da

taso

urce

:Q

ue

stion

na

ireS

urve

yof

GA

MA

,1991.

Serving

reheatedleftovers

was

alsorelatively

comm

on,especially

forthe

midday

meal.

Except

forthe

morning

meal,

when

poorhouseholds

more

oftenincluded

reheatedleftovers,

itw

asthe

wealthier

householdsthat

were

more

inclinedto

servereheated

leftovers.T

hism

ayreflect

betterstorage

facilitieso

rthat

poorhouseholds

were

lesslikely

tohave

foodleftover.

Ta

ble

6.4:R

eg

ula

rIn

clusio

no

fR

eheatedL

efto

vers

inH

ome

Prepared

Meals

by

Ho

use

ho

ldW

ealth.

Mo

rnin

gM

ealM

idd

ay

Me

al

Eve

nin

gM

ea

l

We

alth

Ind

ex

No

Yes

nN

oY

esn

No

Ye

sn

of

Ho

use

ho

ld(%

)(%

)(%

)(%

)(%

)(%

)

Lo

w57

43703

6040

52871

29778

Me

diu

m64

36118

5149

8862

38125

High

7822

5042

5845

6238

53

To

tal

59.240.8

87157.6

42.4661

69.430.6

956

Da

taso

urce

:Q

ue

stion

na

ireS

urveyof

GA

MA

,1991.

As

illustratedin

Table

6.5,cold

leftoversw

ererarely

served,and

were

includedby

lessthan

10%o

fthehouseholds

inevery

category.

58

Environm

entalP

roblems

andthe

Urban

Household

inthe

GA

MA

-Ghana

Ta

ble

6.5

:R

eg

ula

rIn

clu

sio

no

fC

old

Le

ftove

rsin

Ho

me

Pre

pa

red

Me

als

by

Ho

use

ho

ldW

ea

lth.

We

alth

Mo

rnin

gM

ealM

idd

ay

Meal

Eve

nin

gM

ealIn

de

xo

fN

oY

esn

No

Yes

nN

oY

esn

Ho

use

ho

ld(%

)(%

)(%

)(%

)(%

)(%

)

Low97

3699

946

52398

2774

Medium

929

11894

688

982

125H

igh100

050

982

45100

053

Total

973

83794

6656

982

952

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

6.4F

oodStorage

inthe

Hom

eD

uringthe

surveythe

facilitiesfor

thehousehold

storageof

rawvegetables,

rawm

eat,and

leftoversw

ereinvestigated.

The

surveyrevealed

thatw

hilethe

refrigeratorw

asthe

most

popularstorage

facilityfor

theabove-m

entionedcategories

offood

among

them

ediumand

highincom

ehouseholds,

farfew

erhouseholds

inthe

lowincom

ebracket

usedthis

facility.M

anyo

fthe

poorhouseholds

eitherused

cupboardsor

thecovered

dishes(both

ofw

hichare

ineffectivestorage

facilities)for

thestorage

ofthese

categoriesof

food(see

Tables

6.6,6.7

and6.8).

There

were

alsoquite

anum

berof

poorhouseholds

who

eitherdid

notuse

anyo

fthe

storagefacilities

identifiedor

donot

haveany

of

thefood

categoriessurveyed

tostore.

Ta

ble

6.6

:S

tora

ge

Fa

cilitie

sN

orm

ally

Use

dfo

rR

aw

Ve

ge

tab

les

by

Ho

use

ho

ldW

ea

lth.

We

alth

To

taI

Ind

ex

of

Re

fri-C

up

-O

pe

nC

ove

red

Fo

od

Ho

use

ho

ldg

era

tor

bo

ard

Air

Dish

Ne

tN

lA%

n

Low30.1

15.610.5

27.62.1

14.1100.0

818M

edium81.7

5.33.8

5.30.8

3.1100.0

131

High

96.13.9

100.051

Total

40.213.5

9.123.5

1.811.9

100.01000

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

Benneh

etai.59

Ta

ble

6.7

:F

acilitie

sU

sed

for

Sto

ring

Ra

wM

ea

tb

yH

ou

seh

old

We

alth

(%).

Wealth

Ind

ex

of

Refri-

Cup-

Open

Covered

Food

To

tal

Household

ge

rato

rboard

Air

Dish

Net

NlA

%N

Low32.9

7.92.0

28.51.0

27.9100.0

818M

edium87.8

1.50.8

4.65.3

100.0131

High

98.02.0

100.051

Total

43.36.7

1.724.0

0.823.4

100.01000

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

Ta

ble

6.8

:F

acilitie

sU

sed

for

Sto

ring

Le

ftove

rsb

yH

ou

seh

old

We

alth

(%).

Wealth

Ind

ex

of

Refri-

Cup-

Open

Covered

Food

To

taI

Ho

use

ho

ldg

era

tor

boardA

irD

ishN

etN

lA%

N

Low27.5

10.93.3

46.62.0

9.7100.0

818

Medium

79.44.6

8.42.3

5.3100.0

131

High

94.02.0

2.02.0

100.051

Total

37.79.5

2.839.3

1.98.8

100.01000

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

The

generalpattern

thatem

ergesfrom

theabove

tablesis

thatit

isthe

poorerhouseholds

thatuse

theless

effectivestorage

facilitiesto

storethe

threecategories

offood.

They

thereforestand

thegreatest

riskof

losingtheir

freshfoods

andleftovers

throughspoilage.

This

problemis

highlightedin

theansw

ersto

questionsregarding

thetim

eit

takesfor

leftoversto

spoil.T

hereis

alarger

proportiono

flow

income

householdsfor

whom

leftoversspoil

rapidly(see

Table

6.9).T

hisis

obviouslydue

tothe

inefficientstorage

facilitiesused.

The

tablealso

shows

thatthere

isa

largerproportion

of

highincom

ehouseholds

forw

homthe

questionof

spoilageof

leftoversdoes

notapply,

most

probablybecause

ofthe

useof

refrigeratorsand

deepfreezing

facilities.

Ta

ble

6.9

:T

ime

Ta

ken

by

Le

ftove

rsto

Sp

oil

by

Ho

use

ho

ldW

ea

lth(%

).

Num

berof

Hours

Wealth

Ind

ex

of

To

tal

Ho

use

ho

ld1

-12

13-

2424

andA

boveN

lA%

N

Low33.0

31.58.1

27.4100.0

818

Medium

22.118.3

10.748.9

100.0131

High

15.717.6

11.854.9

100.051

Total

30.729.1

8.631.6

100.01000

Data

source:Q

uestionnaireS

urveyof G

AM

A,

1991.

60

Environm

entalP

roblems

andthe

Urban

Household

inthe

GA

MA

-Ghana

Bo

x6.1:

Fo

od

Ven

din

gan

dW

ealth

Figure

6.1:Purchase

ofuncovered

streetfoo

ds

from

ven

do

rsb

yw

ealthg

rou

p

30N

=205

en"

25o.EGil!!__

20

-;;~

1lf!

Qi.g15

~;

g>

~~

10G

l­enca.s:u

5...:::Jn.

oL

ow

L·MM

iddle

We

elth

gro

up

s

M·H

High

InG

AM

A,

buyingprepared

foodfrom

vendorsis

nota

luxurycon­

finedto

thew

ealthy.N

otonlyare

poorhouseholdsm

orelikely

topa­

tronizevendors,butthey

arem

orelikely

topurchase

uncoveredstreet

foods,as

illustratedin

Figure

6.1.R

espondentsw

ithsick

childrenof­

tenblam

edfood

preparedaw

ayfrom

home,

anda

statisticalasso­

ciationbetw

eendiarrhoea

preva­lence

andfrequenting

foodvendors

was

found.W

hilethese

vendorsprovide

anim

portantservice,

im­

provinghygiene

practicesam

ongthese

vendorsis

oneo

fthe

more

importantfood-related

issues.

Data

source:Qu

estio

nn

aire

surve

yo

fAccra,

1991.

Note:

The

wealth

groupsem

ployedin

thesediagram

sare

basedon

thesam

ew

ealthindex

employed

inthe

restof

thereport.

How

ever,ratherthan

threeunequalgroups

(thepoor

majority,a

small

wealthy

elite,anda

somew

hatlargermedium

-wealth

group),five

groupso

froughlyequal

sizehave

beencreated

forthe

graphicalpresentation.

Benneh

etat.

CH

AP

TE

RSE

VE

N

61

7A

IRP

OL

LU

TIO

NA

ND

HO

USIN

G7.1

Household

Air

Pollution

Air

pollutionis

among

them

ostdiscussed

urbanenvironm

entalproblem

sin

internationalcircles,

andstatistics

onoutdoor

concentrationso

fparticulates

andS

02

areavailable

fora

wide

number

of

citiesacross

thew

orld(U

NE

PIW

HO

,1988).

How

ever,concentrations

inam

bientair

arepoor

indicatorso

fthe

healthburden

of

airpollutants.

High

levelso

fexposure

canresult

frompollution

which

onlyaccounts

fora

small

shareo

fthe

overallurban

airpollution

load.Pollution

fromcooking

fIiesis

acase

inpoint:

exposurecan

behazardous

dueto

highconcentrations

inthe

vicinityo

fthe

stove,even

ifthe

contributionto

monitored

ambient

airconcentrationsis

insignifIcant.A

listingo

fsome

ofthe

major

airpollutants

andtheir

potentialhealth

effectsis

providedin

Table

7.1,along

with

WH

Oguidelines.

Table

7.2sum

marises

therecom

mendations

of

theE

nvironmental

Protection

Council

of

Ghana

(seeC

hapter10).

Weekly

airquality

monitoring

hasbeen

establishedat

two

sitesin

Tem

a(A

muzu

andL

eitmann,

1991).Paststudies

havefound

particulateconcentrations

inam

bientair

inresidential

areasto

bebelow

suggestedlim

its.Sim

ilarly,results

froma

small

number

of

samples

indicatecom

parativelylow

sulphurdioxide

concentrations.G

enerally,w

hileoutdoor

airpollution

may

well

come

tobe

acritical

issuein

GA

MA

asindustrialisation

andm

otorizationproceed,

thereis

noevidence

thatitiscurrently

am

ajorhealth

problem.

Table

7.1:E

ffects

andg

uid

elin

es

for

ma

jor

air

po

lluta

nts.

Po

lluta

nt

Kn

ow

nD

an

ae

rW

HO

Gu

ide

line

sIJglm3

SU

lphurdioxide

respiratoryproblem

sannual

mean:

40-60

98th%

tile:100-150

TS

PIJglm

3

Particulates

respiratoryproblem

sannual

mean:

40

-60

98th%

tile:150-230

mg/m

2

Carbon

Monoxide

reducedability

toabsorb

oxygenand

15m

inutes:100

attendantdam

age3

0m

inutes:6

0

1h

ou

r:3

0

8h

ou

rs:1

0

LeadP

roblems

ofthecirculatory

andIJglm

3

nervoussyste

ms

annualm

ean:0.5-1.0

Nitrogen

dioxideviral

infections,·silo

-fillers·disease

IJglm3

andlung

disorders1

ho

ur:

40

0

24hours:

150

Po

lycyclica

rom

atic

cancer

hydrocarbons

Data

source:U

NE

P-W

HO

,1988;

Wellburn,

1988.

62

Environm

entalP

roblems

andthe

Urban

Household

inthe

GA

MA

-Ghana

ab

le7

.2:

Re

co

mm

en

de

dA

mb

ien

tA

irQ

ua

litvS

tan

da

rds

for

Se

lecte

dP

ollu

tan

ts-

Gh

an

a.

Po

lluta

nt

Effe

ctiveA

reaM

ax.P

erm

issible

LevelA

vera

ain

aT

ime

1.Pa

rticula

tes

Du

sta)

TotalS

uspendedR

esidential260

IJg/m3

24hours

Particulates

Industrial290

IJg/m3

24hours

b)R

espirablenon-

toxicdust

Residential

150IJg/m

324

hoursIndustrial

260IJg/m

324

hours

c)D

ustF

allR

esidential8

Ukm

2/month

1m

onthIndustrial

10U

km2/m

onth1

month

2.T

oxic

Pa

rticula

tes

a)A

sbestosA

llAreas

1fibre/m

324

hours

b)F

luorides(Total)

AllA

reas10

IJglm3

24hours

c)Lead

AllA

reas15IJglm

324

hours

d)A

rsenicA

llAreas

10ualm

324

hours

3.G

asesS

ulphurdioxide

AllA

reas200

ua/m3

24hours

TData

source:E

nvironmental

Protection

Council,

1977.

The

potentialdangers

of

exposureto

smoke

fromcooking

fIreshas

onlyrecently

begunto

receivew

idespreadattention.

Recent

estimates

suggest,how

ever,that

pollutionconcentrations

encounteredin

thevicinity

of

cookingfIres

accountfor

afar

largershare

ofglobal

human

exposureto

airborneparticulates

thandoes

ambient

airpollution

(Smith,

1993).F

oran

individualhousehold,

exposuredepends

onsuch

factorsas

thecooking

fuel,the

stove,ventilation,

cookingpractices,

andthe

locationo

fboth

thepeople

cDoking

andother

householdm

embers.

Even

within

GA

MA

thereis

sufficientvariation

inthese

factorsto

leadto

verydifferenthealth

burdensam

ongdifferentgroups.

7.1.1C

ookingF

uelsT

heresults

of

thequestionnaire

surveyindicate

afuel

transitionas

onem

ovesfrom

poorto

wealthy

households.A

sillustrated

inT

able7.3,

charcoalw

asthe

principalcooking

fuelo

fm

orethan

three-quartersof

thepoor

households,follow

edby

fuelwood

(usedprincipally

inthe

ruralfringe).

Am

ongm

ediumw

ealthhouseholds,

charcoalw

asalso

them

ostcom

mon

principalfuel,

butbottled

gas(L

PG)

was

almost

asprevalent.

For

abouttw

othirds

of

thew

ealthyhouseholds

LP

Gw

asthe

principalfuel,

followed

byelectricity.

This

shiftfrom

biofuelsto

LP

Gand

electricity,often

describedas

an"energy

ladder",is

comm

onto

many

urbanareas

acrossthe

world

(McG

ranahanand

Kaijser,

1993).D

espitethe

variationsam

ongw

ealthgroups,

charcoalstands

outas

thedom

inantfuel,

afInding

consistentw

iththe

Ghana

Living

Standards

Survey

(Ghana

Governm

ent,1989),

which

estimated

that81

%o

fhouseholds

inA

ccraused

charcoalas

cookingfuel.

Moreover,

theresults

of

oursurvey

indicaterelatively

highstability

infuel

usepatterns:

85%ofhouseholds

hadbeen

usingtheir

principalcookingfuels

form

orethan

fIveyears,

with

somew

hathigher

percentagesam

ongw

oodand

charcoalusers.

Benneh

etai.63

Ta

ble

7.3

:P

rincip

al

Co

okin

gF

ue

lb

yH

ou

seh

old

We

alth

(%).

Wealth

Do

no

tF

uel-C

har-K

ero-G

asE

lec-T

ota

IIn

de

xo

fco

ok

wo

od

or

coalsene

(LPG

)tricity

%N

Ho

use

ho

ldsim

ilar

Low1.0

8.875.6

6.16.1

2.4100.0

818M

edium1.5

3.143.5

6.941.2

3.8100.0

131H

igh2.0

9.868.6

19.6100.0

51

Total

1.07.7

68.06.0

13.83.5

100.01000

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

Fuelchoice

ism

orecom

plicatedthan

thesestatistics

might

seemto

suggest,how

ever:A

lmost

halfo

fthe

householdsused

more

thanone

fuel(see

Table

7.4),w

ithm

ultiplefuel

usem

ostcom

mon

among

wealthy

households.B

eingable

touse

more

thanone

fuelprovides

security,in

caseo

fsupply

interruptions.A

lso,som

ew

ealthyhouseholds

haveservants

cookingw

ithone

fuel,w

hilethey

themselves

cookw

ithanother.

Taking

accounto

fm

ultipleuse,

afull

88%o

fhouseholds

usecharcoal

atleastintermittently,including

60%ofthe

wealthy

households.

Ta

ble

7.4

:S

eco

nd

Co

okin

gF

ue

lsb

yH

ou

seh

old

We

alth

(%).

Wealth

No

seco

nd

Fuel-

Char-

Kero-

Gas

Elec-

To

taI

Ind

ex

of

fue

lw

oo

do

rcoal

sene(LP

G)

tricity%

NH

ou

seh

old

simila

r

Low54.4

9.616.1

15.91.6

2.3100.0

818M

edium37.2

3.935.7

13.25.4

4.7100.0

131H

igh19.6

7.847.1

2.09.8

13.7100.0

51

Total

50.78.8

20.114.7

2.53.1

100.01000

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

7.1.2C

ookingL

ocationsT

hecooking

locationsem

ployedw

erealso

verydiverse,

asindicated

inT

able7.5.

As

with

cookingfuels,

cookinglocations

beara

closerelation

tow

ealth.A

lmost

allw

ealthyhouseholds

hadseparate

kitchens,com

paredw

ithtw

othirds

of

medium

­w

ealthhouseholds,

andonly

aboutone

infour

poorhouseholds.

Every

othercooking

location,from

multi-purpose

rooms,

tocooking

huts,to

openair,

were

more

frequentlyused

bypoor

households.

64

Environm

entalP

roblems

andthe

Urban

Household

inthe

GA

MA

-Ghana

Ta

ble

7.5

:C

oo

kin

gL

oca

tion

sb

yH

ou

se

ho

ldW

ea

lth(0/0).

Wealth

Separate

Oth

er

Co

mm

un

al

Co

okin

gV

erandaO

penT

ota

lIn

de

xo

fK

itche

nP

rivateR

oomH

ut

Air

NH

ou

seh

old

Ro

om

Low26.1

10.43.3

11.526.8

52.3817

Medium

66.75.4

1.66.2

17.133.3

129H

igh96.2

1.91.9

1.913.2

15.153

Total

35.09.3

3.010.3

24.847.8

999

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

Note:

The

figuresin

thetable

arepercentages

ofhouseholds.

Since

some

householdsused

more

thanone

location,the

percentagessum

tom

orethan

100.

The

locationalpatterns

aredisplayed

ina

somew

hatdifferentform

inT

able7.6

About

onethird

of

thehouseholds

always

cookedindoors,

onequarter

sometim

escooked

indoorsand

sometim

esoutdoors,

with

therem

aining40%

always

cookingoutdoors

(outdoorsis

defmed

hereto

includeverandas

andother

coveredopen-air

locations).T

heshift

towards

indoorlocations

with

increasingw

ealthis

clear.P

arto

fthis

shiftis

presumably

dueto

thegreater

indoorspace

availableto

wealthier

households.Indeed

poorhouseholds

livingin

theR

uralFringe

arem

orelikely

tohave

anindoor

cookinglocation

thanpoor

householdsin

them

orecrow

dedsectors.

Another

parto

fthe

shiftis

anoutcom

eo

fthe

fuelsused:

generallythe

more

smoky

fuelsare

more

likelyto

beused

outdoors.

Ta

ble

7.6

:O

utd

oo

ra

nd

Ind

oo

rC

oo

kin

gL

oca

tion

by

Ho

use

ho

ldW

ea

lth(0/0).

We

alth

Ind

ex

of

Alw

ays

Bo

thIn

do

ors

Alw

ays

To

taI

Ho

use

ho

ldO

utd

oo

rsand

Ou

tdo

ors

Ind

oo

rs%

N

Low49.7

22.927.4

100.0807

Medium

20.526.0

53.5100.0

127

High

25.574.5

100.051

Total

43.423.5

33.2100.0

985

Date

Source:

Questionnaire

Survey

ofGA

MA

,1991

Note:

Households

notcookingathom

eare

excludedfrom

thistable.

About

aquarter

of

thehouseholds

usingeither

fuelwood

orcharcoal

always

cookedindoors.

Ifhouseholdsw

ithcooking

hutsare

excluded,the

percentagefalls

to18.

Outdoor

cookingraises

avariety

of

hygieneand

sanitationproblem

s,but

onem

ightexpect

reducedsm

okeexposure.

How

ever,sm

okefrom

openfIres

canbe

blown

intothe

faceso

fthose

cooking.M

oreover,all

buta

fewpoor

andm

ediumw

ealthhouseholds

cookingindoors

saidthat

theircooking

rooms

were

ventilated.

Benneh

etaL.65

For

children,exposure

will

of

coursedepend

onw

hetherthey

arepresent

while

thecooking

isgoing

on.T

able7.7

indicatesthat

childrenin

poorhouseholds

areconsiderably

more

likelyto

bepresent.

Ta

ble

7.7:P

rese

nce

of

Ch

ildre

nU

nd

er

Six

Du

ring

Co

okin

gb

yH

ou

seh

old

We

alth

(%).

Wealth

Indexo

fN

everS

ometim

esU

suallyT

ota

IH

ouseholdP

resentP

resentP

resent%

N

Low32.8

40.426.9

100.0458

Medium

39.741.4

18.9100.0

58H

igh60.9

26.113.0

100.023

Total

34.739.9

25.4100.0

539

Data

source:Q

uestionnaireS

urveyof

GA

MA

,1991.

Note:

This

tab

leonly

includeshouseholds

with

childrenunder

six.

7.1.3E

xposureto

Respirable

Particulates

While

Cooking

Exposure

torespirable

particulates(R

SP)is

generallytaken

tobe

theprinciple

riskassociated

with

highconcentrations

ofair

pollutionfrom

cookingfires.

The

particulatesem

ittedcontain

avariety

ofcarcinogens.

But

more

important

toG

AM

Adw

ellers,particulates

canincrease

susceptibilityto

respiratoryinfection

among

childrenand

chronicrespiratory

problems

inadults.

Anum

berof

studiesundertaken

inother

countries,including

some

inA

frica,suggest

thatexposure

tow

ood-fuelsm

okecontributes

toacute

respiratoryinfections

inchildren

andchronic

obstructivelung

diseasein

wom

en(see

Chen

etaI.,

1990or

Smith,

1993).H

owever,

sincethe

evidencealso

indicatesconsiderable

variationin

exposureacross

differentlocations,itisim

portanttobe

ableto

assessexposures

locally.In

orderto

determine

more

preciselythe

levelso

fexposurew

omen

inG

AM

Aface

while

cooking,199

wom

enw

erem

onitoredfor

bothrespirable

particulates(R

SP

)and

carbonm

onoxide(C

O).

Inthis

section,the

resultsof

theR

SPm

easurements

aresum

marised.

Adescription

ofthe

measurem

entprocedures

areprovided

inA

ppendix3.

Briefly,

thew

omen

were

requestedto

wear

portablepum

psw

ithfIlters

forabout

threehours,

spanningthe

time

spentcooking

am

eal.T

heparticulates

collectedduring

thisperiod

were

measured,

andthen

employed

tocalculate

theaverage

concentrationof

respirableparticulates

inthe

vicinityof

thew

oman's

faceduring

theperiod.

As

illustratedin

Table

7.8,the

resultsconform

tothe

anticipatedfuel

hierarchy.W

oodusers

were

subjectto

thehighest

averageconcentrations,

followed

bycharcoal

usersand

fmally

kerosene,L

PG

andelectricity

users(grouped

togetherdue

tothe

small

sample

size).T

hedifferences

inthe

estimated

means

areappreciable.

At

587/lg/m

3,the

estimated

mean

concentrationfaced

byw

oodusers

isover

twice

theestim

ateof

195/lg/m

3for

kerosene,L

PG

andelectricity

users.W

hilethere

was

considerablevariation

inthe

averageconcentrations

evenw

ithinthe

fueluser

groups,fuel

choiceis

quiteclearly

an

66

Environm

entalP

roblems

andthe

Urban

Household

inthe

GA

MA

-Ghana

important

factorin

determining

exposure 1.T

hefrequency

distributionin

Figure

7.1-3illustrates

theextentto

which

wood

usersare

exposedto

largerquantities

ofrespirable

suspendedparticles

compared

tocharcoal

orkerosene,

LP

Gand

electricityusers.

Ta

ble

7.8:A

vera

ge

con

cen

tratio

ns

ofR

SP

(J1g/m3)

inthree

gro

up

so

ffue

lusers.

Wood

Mean

SE

n

587.1194.0

21

Charcoal

Mean

SE

n

341.234.4

122

Ke

rose

ne

,LP

G,e

lectr.

Mean

SE

n

195.255.0

24

Data

source:P

ersonalmonitoring

undertakenin

GA

MA

forthisstudy.

AS

P-

Wo

od

n=21605

0

40

%302

010o

00

00

00

00

0IJ'l

0IJ'l

0IJ'l

0IJ'l

08

NIJ'l

...~

~~

~0N

00

0N

c::iIJ'l

00

00

00

NIJ'l

IJ'l0

IJ'l0

'"...

~~

~~

IJg/m

3

Fig

ure

7.1:F

req

ue

ncy

distrib

utio

no

fR

SP

con

cen

tratio

ns

am

on

gw

oo

du

sers.

RS

P-

Ch

arc

oa

l

n=

11

9605

0

40

%3

0

2010O-l-l"'...:.::L~-"4~o.l.+'';';;;;''J..+..I.:''''''-I.~--'-4----+,~,,+--+l'''~

0~

80

80

80

§IJ'l

IJ'lIJ'l

§N

IJ'l...

~~

~~

.;N

8N

c::iIJ'l

0:5

0:5

0N

IJ'lIJ'l

IJ'lIJ'l

"~

~~

~

IJg/m

3

Fig

ure

7.2:F

req

ue

ncy

distrib

utio

no

fR

SP

con

cen

tratio

ns

am

on

gch

arco

alu

sers.

IAN

OV

Aanalysis

indicatedstatistically

significantdifferences

inexposure

toR

SPam

ongthe

threefuel-user

groups(p=O

.002).F

urtheranalysis,

applyingt-tests,

showed

astatistically

significantdifference

inR

SPexposure

between

wood

andcharcoal

users(p=O

.022)and

am

arginallysignificant

differencebetw

eencharcoal

usersand

kerosine,L

PG

andelectricity

users(p=

O.075).

Benneh

etal.

RS

P•

LPG

etc.n=

24

67

605040

%3

02010o0

00

00

00

00

0II)

0II)

0II)

0II)

00

NII)

.....0

NII)

.....0

00

00

......

......

N0

...0

00

00

00

C\l

ciII)

00

00

00

NII)

II)0

II)0

II).....

0N

II).....

......

......

~m3

Fig

ure

7.3:F

req

ue

ncy

distrib

utio

no

fRS

Pco

nce

ntra

tion

sa

mo

ng

kerosene,

LPG

an

de

lectricity

use

rs.

There

areno

directlyapplicable

internationalstandards

orguidelines

with

which

tocom

parethese

concentrationlevels.

How

ever,for

outdoorair,

WH

Orecom

mends

thatthe

mean

dailyconcentration

oftotal

suspendedparticulates

(TS

P)

shouldnotexceed

150-230Jlg/rn 3

more

thanseven

daysper

year(see

Table

7.1).T

heU

nitedS

tatesG

overnment

hasset

a24-hour

standardo

f150Jlg/m

3that

shouldnot

beexceeded

more

thanonce

ayear.

Also,

asnoted

inT

able7.2

above,the

maxim

umperm

issiblelevel

of

TS

Pin

residentialareas

inG

hanais

150Jlg/m3

(averagedover

24hours).

Inview

of

thesefigures

thelevels

measured

aredisturbingly

high.In

acom

parablestudy

fromZ

ambia,

wood

usersw

ereexposed

toa

mean

concentrationo

frespirable

particleso

f890

Jlg/m3,

charcoal.users

to380

Jlg/m3

andelectricity

usersto

240Jlg/m

3(E

llegardand

Egneus,

1992).T

hesefigures

arenot

verydifferent,

andcould

easilybe

accountedfor

bysom

ewhat

different.cooking

locationsand

practices.W

ithinG

AM

A,

nosignificant

differencesin

exposurecould

bedetected

among

thedistricts,

orbetw

eenhigh,

medium

andlow

classresidential

areas.H

owever,

asnoted

above,poor

householdsare

more

likelyto

usew

oodor

charcoalas

theirprincipal

fuel,w

hilehouseholds

inthe

ruralfringe

arethe

most

likelyto

usew

ood.It

issafe

toassum

e,therefore,

thatthe

poor,and

particularlythe

more

ruralpoor,face

thehighestexposure

torespirable

particulates.

7.1.4E

xposureto

Carbon

Monoxide

While

Cooking

Carbon

monoxide

(CO

)is

alsoem

ittedfrom

cookingfires,

andcan

behazardous

tothe

health.F

actorsthat

governthe

toxicityo

fC

Oinclude

theconcentration

of

thegas

inthe

inhaledair,

theduration

of

exposure,the

respiratoryvolum

e,the

cardiacoutput,

theoxygen

demand

of

thetissues

andthe

concentrationo

fhaem

oglobinin

theblood.

Table

7.9indicates

thephysiological

effectsdifferent

CO

levelshave

in

68E

nvironmental

Problem

sand

theU

rbanH

ouseholdin

theG

AM

A-G

hana

humans.

CO

exposureis

ofparticular

concernfor

pregnantw

omen,

andtheir

unbornchildren.

Ta

ble

7.9

:E

ffects

of

carb

on

mo

no

xide

an

dth

eir

likely

acco

mp

an

ying

carb

oxyh

ae

mo

glo

bin

blo

od

(CO

Hb

)co

nte

nt

inh

um

an

s.

Exp

osu

rera

ng

e·

Effe

cta

nd

symp

tom

sC

OH

b··

(pp

m)

blo

od

con

c.%

0-1

0N

odiscom

forto

reffect

0-21

0-5

0G

eneraltiredness,im

pairedvigilance

2-10and

reductionin

manual

dexterity5

0-1

00

Slight

headache,pronounced

tiredness10-20

andirritability

10

0-2

00

Headache

20-302

00

-40

0S

evereheadache,

visualim

pairment,

30-40nausea,

generalweakness

andvom

iting4

00

-60

0A

sabove,

butw

ithg

rea

ter

possibility40-50

ofcollapse

60

0-8

00

Fainting,

increasedpulse

rateand

50-60convulsions

80

0-1

60

0C

oma,

we

ak

pulseand

possibilityofdeath

60-701600-

Death

within

ash

ort

period7

0-

*2

hoursexposure

**Likely

equilibriumcarboxyhaem

oglobin/oxyhaemoglobin

ratiosin

theblood

aftersom

etim

ew

hilstresting

(althoughthey

may

beachieved

threetim

esas

fastduringheavy

work

andgenerally

byheatand

humidity).

Data

source:W

ellburn,1988.

p274.

WH

Oguidelines

forC

Oexposure

areas

follows:

maxim

umexposure

of

100m

glm

3(87

ppm)

fora

time

durationof

notm

orethan

15m

inutes,and

30m

glm

3

(approximately

25ppm

)for

atim

eduration

ofnot

more

than1

hour(U

NE

P­

WH

O,

1988).E

PC

ofG

hanahas

norecom

mended

standardsin

regardo

fC

Oexposure

levels.H

encethe

WH

Oguideline

valueo

f25

ppmfor

1hour

isused

inthe

following

discussionresults.

The

averageexposures

ofthe

fivefuel-user

groupsare

presentedin

Table

7.10,along

with

thetim

e-weighted

averageconcentrations.

The

datashow

sthat

charcoalusers

were

thegroup

most

exposedto

CO

,follow

edby

wood

usersand,

[mally,

kerosene,L

PG

andelectricity

users.T

hegraphical

presentationin

Figure

7.4-6o

fthe

frequencydistribution

ofC

Oam

ongthe

threefuel

usergroups

inG

AM

Adem

onstratethat

more

charcoalusers

were

exposedto

higherconcentrations

thanusers

ofw

oodor

kerosene,L

PGand

electricity.A

llC

Oconcentrations

forw

oodusers

fallunder

20ppm

andunder

10ppm

forkerosene,

LPG

andelectricity

users.

Benneh

etal.

Table

7.10:A

vera

ge

con

cen

tratio

no

fCO

measured

asd

ose

un

its(p

pm

h)

andca

lcula

ted

Tim

e-W

eig

hte

dA

vera

ge

sin

thre

efu

el-u

ser

gro

up

so

ffue

luse

rs.

69

Wood

Mean

SE

nC

harcoalM

eanS

En

Kerosene,LP

G,electr.

Mean

SE

n

Exposure

(ppmh)

Concentration

(ppm)

24.17.5

9.124

3.024

33.111.0

2.9137

1.0137

3.81.2

1.10.4

3232

Data

source:P

ersonalm

onitoringundertaken

inG

AM

Afor

thisstudy.

CO

-Wo

od

n=228060

II

%4

020oo

0.1-1

010.1

-50

ppmC

O(TW

A)

50-

Fig

ure

7.4:F

req

ue

ncy

distrib

utio

no

fcarb

on

mo

no

xide

con

cen

tratio

ns

am

on

gw

oo

du

sers.

co-

Charcoal

n=l228060

%4

02000

0.1-

101

0.1

-50

50

-

pp

mC

O(T

WA

)

Fig

ure

7.5:F

req

ue

ncy

distrib

utio

no

fcarb

on

mo

no

xide

con

cen

tratio

ns

am

on

gch

arco

alusers.

70

Environm

entalP

roblems

andthe

Urban

Household

inthe

GA

MA

-Ghana

co-LP

Getc.

n=26

80706050

%4

0302010oo

0.1

-10

10

.1-5

0

ppmC

O(TW

A)

50

-

Fig

ure

7.6:F

req

ue

ncy

distrib

utio

no

fcarb

on

mo

no

xide

con

cen

tratio

ns

am

on

gkerosene,

LPG

an

de

lectricity

use

rs.

About

6%o

fthecharcoal

usersw

ereexposed

toan

averageC

Oconcentration

greaterthan

25ppm,

theU

NE

P-W

HO

guidelinefor

1hour

of

exposure.T

hem

easuringtim

eranged

between

1.6-

4.5hours,

with

am

eanm

easuringtim

eo

f3.0

hours,suggesting

that25ppm

isvery

conservative.A

lso,table

7.9indicates

thateven

lowexposure

levelso

f10-50

ppmv

havea

negativeeffectin

humans,w

hichis

accentuatedw

henexposure

time

isprolonged.

Itis

bestto

assume

thatC

Oexposure,

likeexposure

toparticulates,

isa

healthburden

fora

significantshareof

thew

omen

inG

AM

A.

Inthe

Zam

biastudy

referredto

above(E

llegardand

Egneus,

1992),the

mean

CO

exposuresw

erefound

tobe

43ppm

hfor

fuelwood

usersand

65ppm

hfor

charcoalusers,

which

areabout

doublethe

dosesm

easuredin

thepresent

studyand

coverperiods

of

similar

duration.W

hencom

paredto

arecent

studyfrom

Maputo

which

againused

similar

measurem

enttechniques

anddurations,

theC

Odose

measured

inA

ccrafor

wood,

24ppmh,

isalso

considerablylow

erthan

theM

aputodose

of

49ppm

h,w

hilecharcoal

levelsare

of

thesam

em

agnitude,33

ppmh

inA

ccraversus

37ppm

hin

Maputo

(Ellegard,

1993.).Ina

tablecom

piledby

Sm

ith(1987),

two

studiesfrom

Nepal

reported14

-295

ppmC

Oduring

1-

2hour

cookingperiods.

One

would

expectexposures

inN

epalto

beconsiderably

higherthan

Accra,

however,

ascooking

isoften

performed

indoorsw

ithvery

littleventilation.

7.1.5C

ookingP

atternsand

Respiratory

Problem

sT

heresults

describedabove

suggestthat

exposureto

pollutionfrom

cookingfires

isindeed

ahealth

risk,even

ifthe

situationis

likelyto

bew

orsein

otherparts

ofG

hanaw

herew

ooduse

ism

oreprevalent.

This

sectionlooks

brieflyat

therelationship

between

cookingpatterns

andsym

ptoms

of

respiratoryproblem

sin

female

principalhom

emakers

andchildren

undersix.

Am

orecom

prehensiveanalysis

of

respiratoryproblem

s,w

hichattem

ptsto

takeinto

accountfactors

otherthan

airpollution,

ispresented

inC

hapter8.

Even

inthis

section,how

ever,the

41principal

homem

akersw

hosm

okehave

beenexcluded

toavoid

distortingthe

results.M

orethan

halfo

fthe

smokers

complained

of

respiratoryproblem

symptom

s(e.g.

sorethroat,

cough,and

difficultiesbreathing),

ascom

paredto

18%for

non-smoking

principalhomem

akers.

Benneh

etal.71

Table

7.11presents

thetw

o-week

prevalenceo

frespiratory

problemsym

ptoms

forprincipal

homem

akersgrouped

accordingto

cookingpractices.

Only

thosecategories

foundto

bestatistically

significantare

included.P

erhapssurprisingly,

therelationship

between

fuelchoice

andrespiratory

problemprevalence

was

notstatistically

significant.A

sdescribed

inC

hapter8,

thism

aybe

dueto

otherrisk

factorsthe

wom

enusing

cleanfuels

face.A

lso,m

ultiplefuel

useand

therelatively

small

shareo

fhouseholds

usingthe

cleanerfuel

make

itinherently

more

difficultto

detectassociations.

Alonger

cookingtim

e,cooking

ina

cookinghut,

andnot

cookingin

theopen

air,are

allassociated

with

higherprevalences,

which

couldw

ellreflecthigher

exposuresto

airpollution.

Ta

ble

7.1

1:

Co

okin

gP

atte

rns

an

dth

eP

reva

len

ceo

fR

esp

irato

ryP

rob

lem

Sym

pto

ms

inF

em

ale

Prin

cipa

lH

om

em

ake

rs.

Category

Households

inC

ategoryT

wo-w

eekP

revalence(%

)

a.S

ometim

esco

ok

inopen

air

Yes

No

b.S

ometim

esco

ok

inco

okin

gh

ut

Yes

No

c.H

ou

rssto

veis

litper

da

y0~3

hours3+

hours

43413.8

47622.1

9425.6

81617.3

50615.4

40321.3

Data

source:Q

uestionnairesurvey

ofGA

MA

,1991.

Note:

Households

withoutfem

aleprincipalhom

emakers

andm

issingvalues

areexcluded.

The

wom

enm

onitoredfor

exposurew

erealso

testedfor

peakexpiratory

flow(see

Appendix

1.3).T

hepeak

expiratoryflow

(PE

F)

isproportional

tothe

diameter

of

theupper

andcentral

airways

andtherefore

lowvalues

canindicate

theexistence

of

areduction

inthe

airways

dueto

inflamm

atoryreactions

orblockage

byphlegm

.S

uchreaction

couldbe

dueto

theeffect

of

prolongedexposure

toparticulates

andirritating

gases(E

llegardand

Egneus,

1992).H

owever,

neitherthe

differencesin

PE

Fbefore

andafter

cooking,nor

thedifferences

between

fuels,are

appreciable(see

Table

7.12).

Ta

ble

7.1

2:

Pe

ak

Exp

irato

ryF

low

IImin

be

fore

an

da

fter

co

okin

gp

erio

db

yfu

el-u

ser

gro

up

.

Co

okin

gfuel

Wood

Charcoal

Kerosene,LP

G,E

lectr.m

eanS

En

mean

SE

nm

eanS

En

FinalPE

F344.4

20.824

361.67.2

1393

n.0

20.532

InitialPE

F373.4

17.424

353.77.0

139365.5

19.732

Difference

-29.07.9

11.6

Data

source:P

ersonalmonitoring

undertakenin

GA

MA

forthisstudy.

72

Environm

entalP

roblems

andthe

Urban

Household

inthe

GA

MA

-Ghana

As

illustratedin

Table

7.13,children

undersix

were

more

likelyto

havehad

symptom

so

facute

respiratoryinfection

inthe

lasttw

ow

eeksif

theyw

eregenerally

presentduring

cookingo

rif

cookingw

asdone

ina

cookinghut.

Again,

thiscould

well

reflectdifferences

inair

pollutionexposure.

Table

7.13:C

oo

king

Pa

ttern

sand

theP

revalenceo

fAcu

teR

espiratoryIn

fectio

nS

ymp

tom

sin

Ch

ildre

nU

nderS

ix.

Ca

teg

ory

Ho

use

ho

lds

inC

ate

go

ryT

wo-w

eekP

revalence(%

)

a.S

om

etim

es

coo

kin

coo

king

hu

tY

es63

20.6N

o481

10.6

b.C

hild

ren

pre

sen

t du

ring

coo

king

Usually

13720.4

Rarely

4029.0

Data

Source:

Questionnaire

surveyofG

AM

A.

1991.N

ote:H

ouseholdsw

ithoutchildrenunder

sixand

missing

valuesare

excluded.

7.2H

ousingT

hesize

andquality

of

thedw

ellingare,

ofcourse,critical

aspectso

fthe

householdenvironm

ent.M

anyprevious

sectionso

fthis

reporthave

dealt,either

directlyo

rindirectly,

with

housingproblem

s.T

herecent

Housing

Needs

Assessm

entS

tudy(H

ousingand

Urban

Developm

entA

ssociates,1990)

examines

GA

MA

'shousing

situationin

some

depth.T

hissection

providesa

briefassessm

ento

fselected

housingproblem

s,drawing

onthe

resultso

fthe

questionnairesurvey.

Excessive

crowding

clearlyaffects

thew

ellbeing

of

ahousehold,

andm

anystudies

indicateit

canalso

affecthealth

(Bradley

etal.,

1991).N

eighbourhoodcrow

dingis

atleast

partiallycaptured

inthe

strataupon

which

thequestionnaire

surveyw

asbased.

Crow

dingw

ithinthe

home

canbe

equallyim

portant.A

sindicated

inT

able7.14,

abouta

thirdo

fthe

householdssurveyed

residedin

oneroom

,another

thirdin

two

rooms,

andthe

finalthird

inthree

orm

oreroom

s.W

hileabout

41%

of

thepoor

householdslived

inone

room,

noneo

fthe

wealthy

householdsdid

so.Indeed,

94%lived

inthree

or

more

rooms,

indicatingthe

extentto

which

overcrowding

isassociated

with

poverty.

Table

7.14:N

um

be

ro

fR

ooms

Household

Occupies

by

Ho

use

ho

ldW

ealth.

We

alth

Nu

mb

ero

fRo

om

sO

ccup

ied

Ind

ex

of

One

Tw

oT

hree+T

ota

IH

ou

seh

old

Room

Room

sR

oo

ms

%N

Low40.9

35.423.7

100.0816

Medium

11.529.2

59.2100.0

130

High

5.994.1

100.051

Total

35.033.1

31.9100.0

997

Data

source:Q

uestionnairesurvey

ofGA

MA

.1991.

Note:

Missing

valuesare

excludedfrom

table.

Benneh

etal.73

Itis

possible,how

ever,for

crowding

toresult

evenin

homes

with

severalroom

s,especially

ifthe

useof

most

rooms

isrestricted

toone

ortw

ohouseholds

mem

bers.F

orthis

reason,the

spaceavailable

perperson

inthe

most

crowded

sleepingroom

canbe

abetter

indicatoro

fcrow

dingfor

most

householdm

embers

thanthe

overallnum

berofroom

sor

theirfloor

space.As

indicatedin

Table

7.15,in

about60%

ofhouseholds

thereis

lessthan

4square

meters

perperson

inthe

most

crowded

sleepingroom

,though

among

wealthy

householdsthe

percentagefalls

to16.W

hileall

buta

fewofthese

rooms

areventilated,

thislevel

of

crowding

isa

causefor

concern.Principal

homem

akersin

householdsw

ithless

than4

squarem

etersper

personhave

asom

ewhat

higherprevalence

of

respiratoryproblem

s(21

%instead

of

18%),

butthere

isa

more

obviousdifference

among

householdsw

ithsm

allchildren:

among

the(388)

householdsw

ithless

than4

squarem

eters,14%

hadhad

achild

with

symptom

sof

acuterespiratory

infectionin

thepast

two

weeks,

ascom

paredto

6%am

ongthe

(139)households

with

more

space.

Ta

ble

7.15:S

pa

cep

er

Pe

rson

inM

ostC

row

de

dS

lee

pin

gR

oo

m.

We

alth

Sq

ua

reM

ete

rsP

er

Pe

rson

Ind

ex

of

To

taI

Ho

use

ho

ld<2

2-44-8

8+%

N

Low11.4

53.328.6

6.7100.0

796

Medium

7.938.6

43.310.2

100.0127

High

2.014.3

57.126.5

100.049

Total

10.549.4

32.08.1

100.0972

Data

source:Q

uestionnairesurvey

ofG

AM

A,

1991.

Note:

Missing

valuesare

excludedfrom

table.

Dam

pconditions

canalso

affectboth

well

beingand

health.O

verall,40%

ofthe

householdsreported

thattheir

roofsleaked,

18%

complained

of

damp

conditions,and

14%reported

mildew

orm

ouldproblem

s.A

gainthe

problems

were

farm

oreprevalent

among

poorhouseholds

thanam

ongthe

wealthy.

Thus,

forexam

ple,43%

ofpoor

householdshad

leakyroofs,

compared

with

23%of

thew

ealthyhouseholds,

20%o

fpoor

householdscom

plainedof

damp

conditions,com

paredw

ith6%

ofw

ealthyhouseholds,

and15%

ofpoor

householdsreported

mildew

orm

ouldproblem

sw

hileno

wealthy

householdsreported

suchproblem

s.

74

Environm

entalProblem

sand

theU

rbanH

ouseholdin

theG

AM

A-G

hana

Bo

x7.1:

Co

okin

gF

uels

and

Wealth

N=

205187

210200

198

Fig

ure

7.1:D

istribu

tion

ofh

ou

seh

old

sb

ytyp

eo

fprin

cipa

lco

okin

gfu

elin

Accra

by

wealth

gro

up

100%

80%

60%

40%

20%0%Low

L-MM

iddleU

-MU

pper

•E

lectricity

•LP

G•

Kerosene

DC

harcoal

IIIW

oodfuel

•D

onotcook

N=

Subsam

plesize

Cooking

firesare

almost

cer­tainly

them

ainsource

ofpersonal

exposureto

airpollution

forw

omen

inG

AM

A.

Charcoal

isthe

dominant

cookingfuel,

andis

likelyto

remain

sofor

many

yearsto

come.

As

illustratedin

Figure

7.1,how

ever,there

isa

fuelhierarchy,

with

asm

allbut

significantshare

of

thepoorest

householdsusing

wood,

andL

PG

andelectricity

becoming

significantin

thew

ealthiest

groups.E

xposurem

onitoringundertaken

forthis

studyindi­

catedthat

wood

usersare

them

ostexposedto

particulates,fol­low

edby

charcoalusersand

fi­nally

kerosene,LPG

andelectric­

ityusers.

Data

source:Questionnaire

surveyofA

ccra,1991.

Note:

The

wealth

groupsem

ployedin

thesediagram

sare

basedon

thesam

ew

ealthindex

employed

inthe

resto

fthe

report.H

owever,rather

thanthree

unequalgroups(the

poorm

ajority,asm

allwealthy

elite,anda

somew

hatlargerm

edium-w

ealthgroup),

fivegroups

of

roughlyequal

sizehave

beencreated

forthe

graphicalpresentation.

Benneh

etal.

CH

AP

TE

RE

IGH

T

75

8H

OU

SE

HO

LD

EN

VIR

ON

ME

NT

AN

DH

EA

LT

H8.1

IntroductionM

anyo

fthe

environmental

problems

describedabove

posehealth

risks.In

individualchapters,

some

of

thesehealth

risksw

erediscussed,

andem

piricalassociations

between

particularenvironm

entalhazards

andill

healthw

erepresented.

Tw

oo

fthe

most

important

environment-related

healthproblem

sare

diarrhoeaand

respiratoryillness.N

eithero

fthese

healthproblem

sare

simple

effectso

findividualenvironm

entalfactors.

There

area

number

of

interrelatedenvironm

entalrisk

factors,w

hichare

relatedin

tumto

non-environmental

factorssuch

asage,

malnutrition

andso

on.O

neo

fthe

reasonsfor

bringingthe

healthissues

togetherin

thischapter

isto

broachsom

eof

thesecom

plexities.M

oregenerally,

byconsidering

thehealth

issuestogether,

itis

possibleto

demonstrate

more

forcefullythe

criticalim

portanceo

fhousehold

andneighbourhood

environments

tothe

well-being

ofthe

population.A

mong

theten

top"diseases"

reporte~

atoutpatient

facilitiesin

theG

reaterA

ccraR

egion(T

able8.1),

environment-related

healthproblem

sfeature

veryprom

inently.(G

AM

Aaccounts

forover

90%o

fthepopulation

ofthe

region.).F

orthe

period1987

to1990,

thetop

threeon

thelist

were

malaria,

diarrhoea,and

upperrespiratory

tractinfection.

Outpatient

visitsare

abiased

sourceof

information

onm

orbidity,and

will

tendto

exaggeratethe

importance

of

thebetter

known

treatableconditions.

On

theone

hand,people

arem

orelikely

tobecom

eoutpatients

ifthey

believethere

isa

treatment

fortheir

condition.O

nthe

otherhand,

thediagnostics

arerelatively

superficial.M

alaria,forexam

ple,is

likelyto

beover-reported,

sincethere

isa

treatment

known

tom

ostpotem

ialpatients,

anda

tendencyto

labelam

biguouscases

asm

alariaso

asto

justifytreatm

ent.E

venaccepting

thedata

deficiencies,how

ever,the

highprevalence

of

environment

relatedhealth

problems

isclear.

Table

8.1

:T

enM

ost

Fre

qu

en

tlyR

eportedH

ealthP

roblems

atO

utp

atie

nt

Fa

cilities

(Greater

Accra

Region

-19

87

-90

).

19

87

%1988

%1989

%1

99

0%

ma

laria

53.0m

alaria45.7

malaria

44.3m

alaria41.0

diarrhoea10.9

diarrhoea7.0

respiratoryinf.

10.9respiratory

info9.1

resp

irato

ryinf.

8.0

respiratoryinfo

10.3diarrhoea

5.8diarrhoea

5.9skin

dise

ase

s7

.3skin

dise

ase

s4.9

skindiseases

4.5skin

diseases5

.3a

ccide

nts

5.3

accidents3.2

pregnancyrelated

3.4pregnancy

related4.1

acu

teeye

info4

.3acute

eyeinfo

2.1accidents

3.2accidents

3.9

intestinalwo

rms

3.4intestinalw

orms

2.6intestinalw

orms

1.8hypertension

2.4

pre

gn

an

cyrelated

3.0

anaemia

2.1rheum

atism2.8

intestinalwo

rms

2.1

hypertension2

.3hypertension

2.4hypertension

2.0anaem

ia2

.02

feve

r2.1

pre

gn

an

cyrelated

1.9anaem

ia1.7

feve

r2.0

Data

source:G

ha

na

Governm

ent,1991.

2P

yrexia(fever)

of

unknown

origin.

76

Environm

entalP

roblems

andthe

Urban

Household

inthe

GA

MA

-Ghana

The

following

statement

fromthe

1991H

ealthA

nnualR

eportfor

GA

MA

clearlyem

phasisesthe

twin

roleo

fpoor

environmental

conditionsand

povertyin

causingdisease

inthe

metropolis:

"Ma

laria,

skinconditions,

respiratoryconditions,

measles,

whooping

cough,tuberculosis

andgastro-intestinal

infections-featuredprom

inentlyin

thelist

of

diseasescom

mon

inthe

Metropolis.

Poor

hygienicstandards

dueto

lacko

fhealth

knowledge

coupledw

ithlow

eredresistance

dueto

malnutrition

havebeen

some

ofthe

predisposingcauses

ofa

number

ofcases"

(Ghana

Governm

ent,1991,

p.2).

Over

time,

ifeconom

icconditions

improve,

thedisease

profileis

likelyto

change.A

lready,there

aresom

eindications

thatdiseases

more

typicallyassociated

with

wealthy

lifestyles,such

ascancer

andheart

disease,m

aybe

becoming

increasinglyim

portantcauses

of

deathin

GA

MA

.C

urrently,how

ever,the

most

evidenthealth

problems

arenot

theresult

of

lifestylechoices,

buto

fthe

lacko

fchoice.

Inthe

courseo

fthe

householdsurvey,

questionsw

ereasked

regardingdiarrhoea,

respiratoryillness

andm

alariaam

ongchildren

undersix,

andrespiratory

problems

among

principalhom

emakers,

most

of

whom

arew

omen.

The

principalsections

of

thischapter

coverdiarrhoea

andrespiratory

problems

inturn.

Num

erousother

healthproblem

sare

environment-related,

butare

noteasily

addressedusing

theapproach

adoptedin

thisstudy.

Malaria

isone

of

them

ostim

portantdiseases

inA

ccra.T

heprevalence

of

Anopheles

mosquitoes

dependson

anum

bero

fenvironm

entalfactors,

some

of

which

havebeen

discussedin

Chapter

5.O

ftenthe

linksare

complex.

Inadequatew

atersupplies,

forexam

ple,lead

tow

aterstorage

inthe

home,

creatinga

potentialbreeding

sitefor

malaria

vectors(see

page48

above).T

hesurvey

datado

notallow

fordetailed

analysis,how

ever.W

hileabout

19%o

fthe

householdsw

ithchildren

undersix

saidthat

atleast

oneo

fthe

childrenhad

hadm

alariaw

ithinthe

lasttw

ow

eeks,self

reportingo

fm

alariais

inaccurate.M

oreover,since

Anopheles

mosquitoes

make

uponly

asm

allshare

of

them

osquitopopulation,

reportso

fm

osquitobiting

arenot

agood

indicatoro

frisk

(some

of

them

orecom

mon

mosquitoes

can,how

ever,be

vectorso

fother

diseases,such

asdengue

andyellow

fever).F

inally,factors

suchas

proximity

tonatural

breedingsites

arelikely

tobe

critical,b

ut

were

notidentified

duringthe

survey.F

orthese

reasons,no

attempt

ism

adehere

togo

beyondthe

discussiono

fC

hapter5.

Sim

ilarly,epidem

icsare

notam

enableto

analysisusing

thehousehold

surveydata.

Inm

anycases,

however,

theconditions

which

sustainendem

icdiseases

arealso

thosew

hichgive

riseto

epidemics.

Evidence

inG

AM

Ao

fcholera

morbidity

in1991

suggeststhat

theurban

poorliving

indegraded

slumenvironm

entsw

ithp

oo

rw

aterand

sanitationfacilities

arem

oreat

riskfrom

choleraattack.

There

were

more

thantw

othousand

reportedcases

of

choleraw

ith35

reporteddeaths

inA

ccraD

istrictalone

(AM

A,

1991,T

able6).

The

residentialareas

where

thediseases

were

prevalentw

erem

ainlyfound

inthe

poorsectors.

The

poorneighbourhoods

inw

hichthe

epidemic

occurredinclude

Nirna,

Accra,

New

Tow

n,M

aamobi,

Zongo,

Sukura

andA

beka.O

thersare

Bukom

,Jam

esT

own,

Korle

Wokon,

Korle

Gonno,

Chorkor,

Labadi

andT

eshie.N

oneo

fthe

remaining

areascited,

includingA

sylumD

own,

Adabraka,

Kaneshie

andT

eshie,w

erehigh

classresidential

areaso

fthecity.

Benneh

etal.77

Overall,

theanalysis

which

follows

depictsa

complex

system,w

hereinpoverty,

relatedsocial

riskfactors,

andenvironm

entaldeprivation

allcom

bineto

contributeto

ill-health.Ithas

beenargued

elsewhere

thathealth

outcomes

inthe

urbanm

ilieuderive

ultimately

fromthe

socio-economic

contexto

fa

household'sexistence,

with

povertyas

them

ostsignificantpredictor

of

urbanm

orbidityand

mortality

(Bradley

etal.,

1991,p.ii).

The

importance

of

povertyis

indeedevident

inthe

following

results.H

owever,

thisshould

notbe

takento

imply

thatdirect

actiontargeting

environmental

improvem

entis

notw

arranted.E

nvironmental

factorsm

akean

appreciabledifference

tothe

healtho

fthe

poor.Indeed,

theim

portanceo

fpoverty

would

seemto

bein

largepart

areflection

of

thedifficulties

poorhouseholds

faceachieving

adequateenvironm

entalconditions.

These

difficultiescannot

allbe

reducedto

householdfm

ancialcapacities,

butoften

involvenon-econom

icdisadvantages.

8.2D

iarrhoea"D

iarrhealdiseases

arew

idelyrecognized

asa

major

causeo

fm

orbidityand

mortality

inS

ub-Saharan

Africa"

(Kirkw

ood,1991).

The

situationin

GA

MA

isnot

exceptionalin

thisregard.

Children

areespecially

atrisk,

anddespite

effortsto

improve

treatment,

diarrhoealdiseases

continueto

inflicta

heavytoll.

Most

diarrhoealdiseases

aretransm

ittedthrough

faecal-oralroutes

which

areparticularly

pervasivein

conditionso

fpoverty.T

able8.3

displaysthe

relationshipbetw

eenpoverty

andthe

prevalenceo

fdiarrhoea

among

childrenunder

six.T

heestim

atesare

basedon

theprincipal

homem

akers'reports

of

caseso

fdiarrhoea

within

thepast

two

weeks

among

anychildren

inthe

householdunder

six.H

ouseholdsw

ithoutchildren

undersix

areexcluded.

Th

eresults

clearlyindicate

thatchildren

livingin

poorhouseholds

aresignificantly

more

atrisk

thanthose

livingin

wealthier

households.G

ivenm

alnutritionand/or

inadequatetreatm

ent,diarrhoea

ism

oreoften

lethal.P

oorchildren

areless

likelyto

bew

ellnourished

orreceive

adequatetreatm

ent.A

ssuch,

thedifferentials

indiarrhoea

morbidity

acrossw

ealthgroups

arelikely

tobe

lessthan

thosefor

diarrhoeam

ortality.

Ta

ble

8.3:R

ela

tion

ship

Betw

eenW

ea

lthand

Ch

ildh

oo

dD

iarrh

oe

aP

revalence.

We

alth

Group

Lo

w

Medium

High

Total

Nu

mb

er

of

Ho

use

ho

lds

with

child

ren

un

de

r6

4575921

537

Tw

oW

ee

kP

reva

len

ceo

fD

iarrh

oe

a(%

)

14.78.50.0

13.6

Data

source:Q

ue

stion

na

ireS

urveyo

fGA

MA

,1991.

The

relationshipbetw

eenarea

of

thecity

anddiarrhoea

prevalence,displayed

inT

able8.4,

isequally

clear.P

oorareas

of

thecity

arealso

thosew

iththe

greatestdiarrhoeal

prevalence,although

thereare

significantvariations

within

thegroup.

The

highdensity

indigenoussector

andthe

ruralfringe

hadthe

worst

scores.T

hehigh

densitylow

classsector

ranksthird

eventhough

them

eanw

ealthindex

was

78E

nvironmental

Problem

sand

theU

rbanH

ouseholdin

theG

AM

A-G

hana

higherfor

thehigh

densityindigenous

sectorthan

thehigh

densitylow

classsector.

By"

contrast,the

diarrhoealprevalence

was

quitelow

forthe

middle

densityindigenous

sector,the

middle

tolow

densitym

iddleclass

sectorand

thelow

densityhigh

classsector

(incorporatingthe

newly

developinglow

densityareas).

Table

8.4:R

ela

tion

ship

between

Re

side

ntia

lSe

ctor

andC

hild

ho

od

Diarrhoea

Prevalence.

Are

a

RF

HD

LCS

HD

IS

MD

ISM

-LDM

CS

LDH

CS

Total

Nu

mb

ero

fH

ou

seh

old

sw

ithch

ildre

nu

nd

er

6

29

27481617022

537

Tw

oW

eekP

reva

len

ceo

fD

iarrh

oe

a(%

)

24.1

14.0

26.05.0

4.34.6

13.6

Key:

RF

=Rural

Fringe;

HD

LCS

=High

Density

LowC

lassS

ector;H

DIS

=High

Density

IndigenousS

ector;

MD

IS=

Middle

Density

IndigenousS

ector;M

-LDM

CS

=Middle

toLow

Density

Middle

Class

Sector;

LDH

CS

=Low

Density

High

Class

Sector

(includingN

ewly

Developing

Sector).

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

There

area

number

of

additionalsocial

factorsw

hichcould

beexpected

toaffect

diarrhoeaprevalence.

As

notedin

Chapter

One,

asignificant

shareo

fthe

householdsin

Accra

areheaded

byfem

ales.S

uchhouseholds

tendto

bepoorer

thanm

aleheaded

households.A

bout79%

ofall

male

headedhouseholds

fellinto

thepoor

groupw

ith15%

and7%

inthe

medium

income

andw

ealthygroups

respectively.B

ycontrast,

89%o

fall

female

headedhouseholds

were

poor,w

ith7%

and4%

lyingin

them

ediumincom

eand

wealth

groupsrespectively.

Nevertheless,

theprevalence

of

diarrhoeain

childrenunder

6w

asonly

marginally

higherfor

female

headedhouseholds

thanm

aleheaded

ones.A

bout13%

of

all(415)

male

headedhouseholds

with

childrenunder

6had

diarrhoea,as

compared

to15%

forall

(122)fem

aleheaded

householdsw

ithchildren

under6.

This

may

bedue

tothe

factthat

wom

entend

tochannel

more

of

theirincom

eand

time

totheir

childrenthan

men.

The

importance

of

wom

enis

alsohighlighted

bythe

factthat

when

theprincipal

homem

aker(generally

aw

oman)

spendsm

oretim

eat

home,

thechildren

areless

likelyto

havehad

diarrhoea.T

hus,for

example,

inthe

(174)households

where

theprincipal

homem

akertypically

spendsalm

ostall

hertim

eat

home,

diarrhoeaprevalence

fallto

about9%.

The

environmental

factorsm

ostoften

linkedto

diarrhoealm

ortalityand

morbidity

arew

aterand

sanitation.S

tudiesindicate

that"children

fromhouseholds

usingpublic

standpipesand

cesspoolsare

severaltim

esm

orelikely

todie

fromdiarrhoea

thanthose

with

in-housepiped

water

andsew

erage"(B

radleyet

al.,1991,

p.ii).T

herehave

beensim

ilarfindings

with

respectto

diarrhoealm

orbidity:"C

omparing

theresults

of

studieso

fdiarrhoeal

morbidity,

Esrey,

Feacham

andH

ughes(1985)

founda

median

percentagereduction

indiarrhoeal

morbidity

of16%

inthe

9cases

involvingim

provedw

aterquality,

25%

inthe

17cases

involvingim

provedw

ateravailability,

37%in

the8

casesinvolving

improvem

ents

Benneh

etal.79

inboth

water

qualityand

availability,and

22%in

the10

casesinvolving

improvem

entsin

excretadisposal"

(McG

ranahan,1991,p.14).

The

resultso

four

own

analysiscited

inthe

chapterson

water

andsanitation

tendto

conformto

suchobservations.

For

example,

theprevalence

of

childhooddiarrhoea

among

householdsusing

comm

unalstandpipes

was

severaltim

eshigher

thanam

ongthose

with

indoorpiped

water

supply.D

ifferenceso

fa

similar

magnitude

were

observedbetw

eenhouseholds

usingnon-flush

toilettechnologies

(i.e.pit,

KV

IP,

andpan

latrines)and

thosew

ithflush

systems.

As

Lindskog

andL

undqvisthave

indicated,im

provements

insanitation

andhygiene

may

havea

greaterim

pactupon

diarrhoealdiseases

thanim

provements

inw

aterquality

atsource

alone."T

hism

aybe

sobecause

improvem

entsin

water-quality

atthe

water­

sourceonly

influencethe

diseaseload

inone

way,w

hileim

provements

insanitation

andpersonal

hygieneinfluence

thedisease

loadin

threedifferent

ways.

Firstly,better

personalhygiene

reducesfaecal-oral

transmission

viasolid

bodies.Secondly,

betterhygiene

reducesfaecal-oral

transmission

viaw

ater.Finally,

betterhygiene

reducesfaecal-oral

transmission

viafood.

Improvem

entsin

sanitation,i.e.

properlyconstructed

pit-latrinesw

hichare

correctly.used,prevent

transmission

viaw

ater,w

hilelack

of

goodpersonal

hygienem

aystill

resultin

transmission

viathe

otherroutes"

(Lindskog

andL

undqvist,1989,p.21).

Itis

thereforeim

portantto

takeaccount

of

hygienepractices

of

householdsto

achievea

betterunderstanding

of

thespread

ofdiarrhoeal

diseases.O

therfactors

which

were

identifiedin

previouschapters

aspotential

causeso

fhigh

diarrhoeaprevalence

includepurchasing

preparedfood

fromvendors

andthe

presenceof

fliesin

foodpreparation

areasand

toilets.In

acity

likeA

ccra,household

hygieneis

notindependent

of

water

andsanitation

facilities,how

ever.W

ithouta

reliablew

atersource,

goodhygiene

habitsare

difficulttom

aintain.As

indicatedin

Chapter

3,handw

ashingw

ouldseem

tobe

more

closelyassociated

with

thetype

of

water

sourcea

householdhas

thanthe

educationlevel

of

theprincipal

homem

aker.Sim

ilarly,hygiene

habitscan

beaffected

byinadequate

sanitation.T

heresults

summ

arisedin

Chapter

3clearly

demonstrate

thatoutdoordefecation

isrelated

toovercrow

dedsanitary

facilities.U

nderthese

circumstances,

itcanbe

unreasonableto

isolatespecific

causesof

highdiarrhoeal

morbidity,

andtarget

policiesaccordingly.

Socio-econom

icconditions

helpdeterm

ineaccess

toenvironm

entalam

enitiesw

hichin

turnhelp

determine

hygienepractices.

Even

incases

where

hygienepractices

arethe

proximate

cause,it

may

bem

oreappropriate

toachieve

betterhealth

throughim

provedfacilities

orim

provedeconom

icopportunities,

ratherthan

admonishing

peopleto

adoptbetterhygiene

practices.T

hesecom

plexinterrelationships

alsom

akeit

difficultto

analysethe

associationsbetw

eenenvironm

entand

diarrhoeam

orbiditystatistically

One

of

them

orecom

mon

techniquesem

ployedby

epidemiologists

islogistic

regression(A

rmitage

andB

erry,1987).

This

techniqueallow

ssim

ultaneousanalysis

ofdiarrhoea

prevalenceand

anum

bero

fpossible

explanatoryfactors.

Itis

generallypreferable

totechniques

which

examine

associationsbetw

eendiarrhoea

morbidity

andenvironm

entalconditions

oneby

one,in

thatit

avoidsfully

ascribingthe

same

diarrhoeacases

toa

number

of

differentfactors.

On

theother

hand,logistic

regressioncannot

capturethe

hierarchyo

finterrelationships

describedabove:

itcannot

model,

forexam

ple,the

way

inw

hichsocio-econom

icconditions

relateto

diarrhoeam

orbiditythrough

accessto

environmental

amenities.

80

Environm

entalP

roblems

andthe

Urban

Household

inthe

GA

MA

-Ghana

Table

8.5displays

thechildhood

diarrhoeaprevalence

among

8high

riskgroups

identifiedthrough

logisticregression.

Only

householdsw

ithchildren

undersix,

andhaving

information

onall

ofthe

relevantvariables,

areincluded

inthe

table.A

sindicated,

thedifference

between

thediarrhoea

prevalencein

any

on

eof

thesegroups

andthe

diarrhoeaprevalence

forthe

restof

thesub-sam

pleis

highlysignificantstatistically

(p<

.01).

Ta

ble

8.5:C

hild

ren

'sD

iarrh

oe

aP

reva

len

cein

Hig

hR

iskH

ou

seh

old

Gro

up

sId

en

tified

for

Lo

gistic

Re

gre

ssion

-Accra

.E

nvironmentalF

eatureH

ouseholdsin

Subsam

pleT

wo

Week

Diarrhoea

Prevalence

(%)

18.832.427.828.025.223.2

3033490132151125

Sh

are

toile

twith

>5

households

Use

Po

t for

Storing

Wa

ter

Op

en

Wa

ter

Sto

rag

eC

on

tain

er

Ou

tdo

or

De

feca

tion

·N

eighb.C

hildren

Ma

ny

Flies

inK

itchen

Do

no

tW

ash

Ha

nd

s-

be

fore

Food

Prep.

Wa

ter

Su

pp

lyIn

terru

ptio

ns

(time

of

day)329

17.9

Bu

yP

rep

are

dF

oo

dfrom

Ve

nd

ors

37416.6

Total

50013.8

Diffe

ren

ceb

etw

ee

nhigh

riskg

rou

pand

resto

fsam

ple

isstatistically

sign

ifican

t(p

<.01)

inall

cases.

Da

taS

ource:Q

ue

stion

na

ireS

urveyof G

AM

A-

1991

InT

able8.6

thediarrhoea

prevalenceis

presentedfor

householdsgrouped

accordingto

thenum

berof

highrisk

conditionsthe

householdsface.

The

associationvery

close.N

oneof

thehouseholds

facingless

thantw

oof

therisks

identifiedhad

children(under

six)w

ithdiarrhoea,

while

most

of

thehouseholds

facingm

orethan

fiverisks

hadat

leastone

childw

ithdiarrhoea.

One

would

notexpect

allthe

riskfactors

tobe

equallyclosely

associatedw

ithhigher

diarrhoeam

orbidity,how

ever.

Ta

ble

8.6:C

hild

ho

od

Dia

rrho

ea

Pre

vale

nce

by

Nu

mb

er

of

Hig

hR

iskC

on

ditio

ns

Ho

use

ho

ldF

aces.

Num

ber ofH

ighR

iskC

onditionsS

izeofS

ubsample

Tw

o-Week

Diarrhoea

Prevalence

(%)

No

ne

On

e

Tw

o

Th

ree

Fo

ur

Five

Six

Se

ven

195013311977682113

0.00.03.0

14.314.3

23.5

57.169.2

Da

taS

ource:Q

ue

stion

na

ireS

urveyofG

AM

A,

1991.

Benneh

etal.81

The

resultso

fthe

logisticregression

aresum

marised

inT

able8.7.

Even

enteredsim

ultaneously(and

alongw

ithvariables

forw

ealthquintile,

educationo

fthe

principalhom

emaker

andthe

number

of

childrenunder

six)all

of

therisk

factorsdisplay

statisticallysignificant

associationsw

ithdiarrhoea

morbidity

(p<.05).

The

oddsratio,

alsosom

etimes

referredto

asthe

approximate

relativerisk,

isan

estimate

of

theodds

of

havinghad

achild

(undersix)

with

diarrhoeaif

thefactor

ispresentover

theodds

of

havinghad

achild

with

diarrhoeaifthe

factoris

absent.F

or

allo

fthe

riskfactors,

itis

estimated

thatthe

oddso

fhaving

hada

childw

ithdiarrhoea

areat

leasttw

iceas

highif

thefactor

ispresent

thanif

itis

absent.

Table

8.7:S

um

ma

ryR

esu

ltso

fL

og

isticR

egressionR

elatingC

hild

ren

'sD

iarrhoeaP

reva

len

cew

ithE

nviro

nm

en

tal

Fa

ctors

inH

ou

seh

old

sw

ithC

hild

ren

Un

de

rS

ix.V

aria

ble

Use

po

tfor

storingw

ate

r

Wa

tersu

pp

lyinterruptions

Share

toiletwith

>5

households

Purchase

ven

do

rprepared

food

Open

wa

ter

storageco

nta

ine

r

Ou

tdo

ordefecation

Ma

ny

fliesin

kitchen

Don't

always

wa

shhands

before

preparingfood

Co

efficie

nt

1.47

1.12

.98

0.950.79

0.73

0.720.71

Sta

nd

ard

Erro

r

.48

.39A

O.45

.34.31

.32

.31

Sig

nifica

nce

.002

.004.015

.034

.022

.020.025

.023

Od

ds

Ratio4.34

3.06

2.66

2.582.19

2.082.05

2.03

Note:

Other

variablesincluded

inlogistic

regressionw

ereeducation

levelof

principalhom

emaker,

wealth

quintile,andnum

bero

fchildrenunder

six.N

oneof

thesevariables

were

statisticallysignificant

atthe

95%

confidencelevel,

however.

Environm

entalvariables

which

were

notincluded

dueto

alack

of

statistical

significancew

ere:w

atersource,

typeof

toiletfacility,

locationof

water

source,dirty

toiletfloor,

open

storageof

leftoverfood

observed,m

anyflies

inthe

toilet,and

crowding.

Data

Source:

Questionnaire

Survey

ofGA

MA

,1991.

These

resultsclearly

indicatethat

householdenvironm

entalfactors

playa

major

rolein

diarrhoeaprevalence,

andthereby

overallchild

morbidity

inA

ccra.A

llo

fthe

factorsidentified

throughthe

statisticalanalysis

aresuspected

contributorsto

thespread

of

faecal-oraldisease.

They

reflecta

number

of

differentpossible

routes,including

foodcontam

inationand

insects.Individual

coefficientsshould

notbe

givenundue

attention,how

ever.F

orexam

ple,the

highodds

ratioassociated

with

theuse

of

apot

forstoring

water

isbased

ona

verysm

allsubsam

pleo

fp

ot

users,and

inany

caseneed

notreflect

problems

with

potstorage

per

se.W

aterand

sanitaryconditions

areheavily

implicated,

butthe

most

comm

onindicators

of

accessto

water

andsanitation

(typeo

fw

atersource

andsanitary

facility)did

notem

ergeas

statisticallysignificant

inthe

multi-factor

analysis.T

heresults

conformto

theview

thataccess

tow

ater,rather

thanthe

qualityo

fthe

water

atsource,

iscritical

tohealth.

With

easyaccess

toa

goodw

atersupply,

therew

ouldbe

now

aterinterruptions,

noneed

tostore

water,

andas

notedabove

many

of

thehygiene

practicesidentified

would

befacilitated.

Similarly,

theresults

would

seemto

corroboratethe

viewthat

itisthe

quantityrather

thanquality

of

sanitationfacilities

which

iscritical.

Both

thelevel

of

sharingo

ftoilet

facilitiesand

theprevalence

of

outdoordefecation

bychildren

areclosely

linkedto

alack

of

toiletfacilities.

82E

nvironmentalP

roblems

andthe

Urban

Household

inthe

GA

MA

-Ghana

Three

of

thefactors

identifiedm

ayreflect

foodcontam

ination:w

ashinghands

beforepreparing

food,purchasing

preparedfood

fromvendors,

andthe

presenceo

fm

anyflies

inthe

kitchenor

foodpreparation

area.

8.3R

espiratoryIllness

Globally,

thelevel

ofm

orbidityand

mortality

causedby

respiratoryinfections

rivalsthat

fromdiarrhoeal

diseases.A

cuterespiratory

infection(A

Rl)

isparticularly

hazardousfor

children,especially

infants,and

theelderly

(Graham

,1990).

Viral

agentsaccount

forthe

majority

of

AR

Icases,

butbacterial

agentstend

tocause

more

severeinfections,

andaccount

fora

greatershare

of

fatalities(B

erman,

1991).A

lternatively,infections

affectingthe

lower

respiratorytract

tendto

bem

oresevere

thanupper

respiratorytract

infections.L

ikediarrhoeal

diseases,A

RI

isbelieved

tobe

aggravatedby

malnutrition

andspread

more

easilyunder

conditionstypically

associatedw

ithpoverty,

suchas

po

or

hygieneand

crowding

(Kirkw

ood,1991).T

heincidence

of

respiratorydiseases

hasalso

beenlinked

toair

pollution.T

hesurvey

undertakenfor

thisstudy

collectedinform

ationfrom

theprincipal

homem

akeron

respiratoryproblem

sam

ongchildren

undersix

andfor

therespondent

herself.F

or

thechildren,

thequestions

were

designedto

identifyA

Rl,

thoughthe

interviewers

were

nottrained

bym

edicalpersonnel.

For

theprincipal

homem

akers,a

serieso

ftracer

symptom

sw

ereem

ployed,w

hichw

ouldbe

expectedto

identifya

broaderrange

of

respiratoryproblem

s,including

chronicconditions.

As

with

diarrhoea,a

two

week

periodw

asem

ployed,and

theresults

forchildhood

prevalencerefer

tothe

shareo

fhouseholds

with

childrenunder

sixw

hereinat

leastone

casew

asidentified.

8.3.1A

cuteR

espiratoryInfection

among

Children

Under

SixY

earsO

ldO

verall,the

estimated

prevalenceo

fchildhood

AR

Iw

as11.8%

,roughly

comparable

with

thediarrhoea

prevalence.Indeed,

therew

asconsiderable

overlap:in

aboutone

thirdo

fthe

householdsreporting

diarrhoeao

rA

RI,

bothw

erereported.

Children

inp

oo

rhouseholds

or

poorareas

againseem

tobe

more

atrisk,

asindicated

inT

ables8.8

and8.9.

The

differencesare

lessstriking

thanin

thecase

of

diarrhoea,and

vergeon

beingstatistically

insignificant.O

nthe

otherhand,

mortality

differencesare

likelyto

bem

oreappreciable

thanm

orbiditydifferences.

Ta

ble

8.8:R

ela

tion

ship

Be

twe

en

We

alth

an

dC

hild

ho

od

AR

IP

reva

len

ce.

Wealth

Group

Lo

w

Me

diu

m

High

Total

Num

bero

fHouseholds

with

childrenunder6

4606023

543

Tw

oW

eekP

revalenceo

fAR

I(%

)

13.0

5.04.4

11.8

Da

tasource:

Qu

estio

nn

aire

Survey

ofG

AM

A,

1991.

Benneh

etaL.

Ta

ble

8.9:R

ela

tion

ship

between

ResidentialS

ecto

randC

hild

ho

od

AR

IP

revalence.

83

Area

RF

HD

LCS

HD

ISM

DIS

M-LD

MC

SLD

HC

S

Num

ber ofHo

use

ho

lds

with

child

ren

un

de

r6

2927982627022

Tw

oW

eekP

revalenceofA

RI

('Yo)

13.812.512.212.98.64.5

Key:

RF

=Rural

Fringe;

HD

LCS

=High

Density

LowC

lassS

ector;H

DIS

=High

Density

IndigenousS

ector;M

DIS

=Middle

Density

IndigenousS

ector;M

-LDM

CS

=Middle

toLow

Density

Middle

Class

Sector;

LDH

CS

=Low

Density

High

Class

Sector

(includingN

ewly

Developing

Sector).

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

Several

aSSOC

iatIOns

between

childhoodA

RI

prevalenceand

environmental

factorsw

eredescribed

brieflyin

previouschapters.T

able8.10

summ

arisesthe

AR

Iprevalence

inhigh

riskgroups

identifiedthrough

logisticregression.

Most

of

thevariables

previouslym

entionedare

included.Fuel

choiceis

not,how

ever,although

asindicated

inC

hapter7,

fuelchoice

issignificantly

associatedw

ithA

RI

prevalencew

henone-w

ayanalysis

isperform

ed(i.e.

novariables

otherthan

fuelchoice

areincluded).

Once

theother

explanatoryvariables

areincluded,

fuelchoice

doesnot

addsignificantly

tothe

explanatorypow

ero

fthe

equation.H

owever,

most

of

thehouseholds

usem

orethan

onefuel,

anda

largem

ajorityuse

charcoal,m

akingit

inherentlydifficult

todiscern

theinfluence

offuel

choice.M

oreover,tw

oo

fthe

variablesw

hichare

includedm

ayreflect

theeffects

of

airpollution:

whether

achild

isusually

presentduring

cooking,and

whether

cookingalw

aystakes

placeindoors.

Table

8.10:C

hild

ho

od

AR

IS

ymp

tom

Prevalence

inH

ighR

iskH

ou

seh

old

Gro

up

sId

en

tified

thro

ug

hL

og

isticR

egression.E

nviro

nm

en

talF

eatureH

ouseholdsin

Subsam

pleC

hildoften

presentduringcooking

137M

anyflies

inkitchen

161Less

than4

m2/ person

insleeping

room388

Water

supplyinterruptions

(time

ofday)348

Use

mosqU

itocoils

253N

evercook

outdoors258

Roof

leaksduring

rains224

To

tal

527

Tw

oW

eekA

RI

Prevalence

('Yo)

20.4"""18.6"""13.9""14.9"""15.4""13.61

5.2

"'11.8

Note:

Statisticalsignificance

ofdifferencebetw

eenhigh

riskgroup

andrest

ofsample:

C"forp

<.1)

CO"forp<.05)

COO"forp<.01).

Data

Source:

Questionnaire

Survey

ofGA

MA

-1991

Table

8.11sum

marises

thechildhood

AR

Iprevalence

accordingto

thenum

bero

frisk

factorshouseholds

face.A

gain,the

relationshipis

fairlyclear.

Overall,

theprevalence

among

the274

householdsfacing

threeor

fewer

highrisk

conditionsw

as4.4%

,while

thatam

ongthe

253households

facingfour

orm

orew

as19.8%

.

84

Environm

entalProblem

sand

theU

rbanH

ouseholdin

theG

AM

A-G

hana

Ta

ble

8.11:C

hild

ho

od

AR

IS

ymp

tom

Pre

vale

nce

by

Nu

mb

ero

fH

igh

Risk

Co

nd

ition

sH

ou

seh

old

Faces

Num

berofH

ighR

iskC

onditions

One

orfe

we

r

Two

Three

Four

Five

Six

or

mo

re

Num

berofH

ouseholdsw

ithC

hildrenU

nder6

51

106

117

1467433

Two-W

eekP

revalanceo

fAR

I

2.0

6.63.4

14.4

20.342.4

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

The

resultso

fthe

logisticregression

aresum

marised

inT

able8.12.

By

andlarge,

theresults

corroborateprevailing

wisdom

regardingrespiratory

infection.W

hilethere

isconsiderable

uncertaintyin

theodds-ratios

associatedw

ithparticular

variables,overall

theresults

indicatethat

environmental

factorsare

associatedw

ithappreciable

differencesin

AR

Im

orbidity.T

hestrong

associationbetw

eenA

RI

andchildren

beingpresent

duringcooking

shouldbe

interpretedw

ithcare.

Children

presentduring

cookingm

aybe

exposedto

hazardsother

thansm

oke.A

lso,w

omen

who

arem

oreoften

with

theirchildren

arem

orelikely

tobe

aware

of

theirhealth

problems.

The

prevalenceo

fdiarrhoea

(without

respiratoryproblem

symptom

s)is

alsohigher

among

householdsw

herechildren

arepresentduring

cooking,though

thisis

unlikelyto

berelated

tosm

okeexposure.

Thus,the

relationshipbetw

eenA

RI

andthe

presenceo

fchildren

duringcooking

shouldnot

betaken

asa

definitiveindication

of

thehazards

of

smoke.

On

theother

hand,outdoor

cookingis

alsostatistically

significant,and

theresults

dosuggest

thatthe

riskso

fsm

okeexposure

shouldbe

takenseriously.

Fliesin

thekitchen

andw

aterinterruptions

areboth

likelyto

indicatepoor

hygiene.W

hilem

oretypically

associatedw

ithdiarrhoeal

diseases,poor

hygieneis

alsoim

plicatedin

respiratoryinfection.

Inthis

context,it

isw

orthnoting

thatboth

of

thesevariables

remain

significanteven

ifcases

where

diarrhoeaw

asalso'

reportedare

excluded.C

rowding,

anotheroften

citedrisk

factorin

respiratoryinfection,

isalso

represented.H

avinga

leakyroof

may

reflectdam

pconditions,

which

canfacilitate

thespread

of

respiratoryinfections,

butcould

alsobe

takento

indicategenerally

lowquality

housing.T

heuse

of

mosquito

coilsis

nota

well

known

riskfactor

inA

RI,butdoes

ofcourse

contributeto

airpollution.

Benneh

etal.

Table

8.12:S

um

ma

ryR

esultso

fLo

gistic

Regression

Relating

Ch

ildre

n's

AR

IP

revalencew

ithE

nviro

nm

en

talF

actorsin

Household

with

Ch

ildre

nU

nderS

ix.

85

Variable

Co

efficie

nt

Standard

Erro

rS

ign

ifican

ceO

dd

sR

atio

Child

oftenp

rese

ntd

urin

gcooking

0.960.29

.0012.62

Ma

ny

fliesin

kitchen0.87

0.33.008

2.39L

ess

than4

m2/

pe

rson

insleeping

room0.83

0.42.049

2.29W

ate

rsupplyinterruptions

0.770.38

.0402.16

Use

mosquito

coils

0.600.30

.0481.83

Ne

ver

coo

ko

utd

oo

rs0.60

0.30.0

44

1.82R

oo

fleaks

duringrains

0.530.30

.0791.69

Note:

Other

variablesincluded

inlogistic

regressionw

ereeducation

levelof

principalhom

emaker,

wealth

qUintile,and

number

ofchildren

undersix.

Only

thenum

berof

childrenunder

sixw

asstatistically

significant atthe90%

confidencelevel.

Environm

entalvariablesw

hichw

erenotincluded

dueto

alack

ofstatistical

significancew

ere:use

ofcooking

hut,use

ofpum

p-sprayinsecticide,

principalcooking

fuel,observed

evidenceofdam

pnessand

selectedw

aterand

sanitationvariables.

Data

Source:

Questionnaire

Survey

ofGA

MA

,1991.

8.3.2R

espiratoryP

roblemSym

ptoms

among

PrincipalH

omem

akersA

full19.5%

of

the(956)

female

principalhom

emakers

reportedat

leastone

respiratoryproblem

symptom

,them

ostcomm

onbeing

drycoughs

(9.3%)

andsore

throats(8.8%

).A

sindicated

inT

ables8.13

and8.14,

theprevalence

of

respiratoryproblem

symptom

s(R

PS

)and

wealth

or

zoneo

fthe

cityare

somew

hatam

biguous.T

hehighest

prevalencesare

inthe

medium

wealth

groupand

them

iddleclass

zone.T

hisis

largelythe

resulto

fa

veryhigh

prevalencein

oneneighbourhood

within

them

iddleclass

zone,w

here13

of

the15

principalhom

emakers

interviewed

reportedat

leastone

respiratorysym

ptom.

Such

anextrem

eresult

isalm

ostcertainly

theresult

of

asingle

cause,and

shouldnot

betaken

asrepresentative.

The

neighbourhoodhas

beenexcluded

inthe

analysisw

hichfollow

s.A

lso,how

ever,the

riskfactors

forrespiratory

problemsym

ptoms

inprincipal

homem

akersare

notas

wealth-dependent

asthose

forchildhood

diarrhoeaand

AR

I.

Table

8.13:R

ela

tion

ship

Betw

eenW

ealthand

Principal

Hom

emaker

RP

SP

revalence.

Wealth

Gro

up

LowM

ediumH

igh

Total

Num

bero

fHo

use

ho

lds

with

female

PH

7811255

0

956

Tw

oW

eekP

revalenceo

fR

PS

('Yo)

18.228.816.0

19.5

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

86

Environm

entalP

roblems

andthe

Urban

Household

inthe

GA

MA

-Ghana

Table

8.14:R

ela

tion

ship

between

ResidentialS

ectorand

PrincipalH

omem

akerR

PS

Prevalence.

Area

RF

HD

LCS

HD

ISM

DIS

M-LD

MC

SLD

HC

S

Num

bero

fHo

use

ho

lds

with

Fem

aleP

H

4943716210815545

Tw

oW

eekP

revalenceo

fRP

S(%

)

14.318.514.816.731.615.6

Key:

RF

=Rural

Fringe;

HD

LCS

=High

Density

LowC

lassS

ector;H

DIS

=High

Density

IndigenousS

ector;M

DIS

=Middle

Density

IndigenousS

ector;M

-LDM

CS

=Middle

toLow

Density

Middle

Class

Sector;

LDH

CS

=Low

Density

High

Class

Sector

(includingN

ewly

Developing

Sector)

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

The

RPS

prevalenceam

ongprincipal

homem

akersin

highrisk

groupsidentified

throughlogistic

regressionis

presentedin

Table

8.15.A

gain,several

ofthe

variableshave

alreadybeen

mentioned

inprevious

sections,includingthe

useo

fpum

pspray

insecticides,w

hichis

associatedw

itha

surprisinglyhigh

prevalence.S

moking

isincluded

forobvious

reasons.It

istreated

hereas

adichotom

ousvariable

(eitherone

smokes

orone

doesnot),

althoughin

theregression

thenum

bero

fcigarettes

smoked

was

employed.

Generally,

smoking

among

females

isnotonly

relativelyrare,butthe

numbers

ofcigarettes

smoked

islow

:about

halfthesm

okersconsum

efive

orless

cigarettesa

day.T

heoverall

prevalencenoted

inT

able8.15

issom

ewhat

lower

thanthe

19.5%cited

abovedue

tothe

exclusiono

fthe

excessivelyhigh

prevalenceneighbourhood.

Table

8.15:F

emale

Principal

Hom

emakers'R

espiratoryP

roblemS

ymptom

Prevalence

inH

ighR

iskH

ouseholdG

rou

ps

Ide

ntifie

dth

rou

gh

Lo

gistic

Regression.

En

viron

me

nta

lFeature

Ho

use

ho

lds

inT

wo

Week

Subsam

pleR

PS

Prevalence

(%)

Sm

okescigarettes

3534.3**

Uses

pump-spray

insecticide101

39

.6"*

Water

Supply

Interruptions(lim

eofday)

61719.8

NeverC

ookO

utdoors482

21.2**R

oofLeaks

During

Rains

37421.7**

To

tal

93918.3

Note:

Statistical

significanceof

differencebetw

eenhigh

riskgroup

andrest

ofsam

ple:(*

forp

<.1)

(**for

p<.05)(***

forp<.01).

Note:

Households

with

missing

valuesfor

anyvariable,

or

without

female

principalhom

emakers,

are

excluded.D

ataS

ource:Q

uestionnaireS

urveyofG

AM

A,

1991.

As

indicatedin

Table

8.16,the

prevalencein

those(79)

householdsnot

inany

of

therisk

categoriesidentified

isonly

7.6%,

risingto

31.5%in

the(178)

householdsin

threeor

more

riskcategories

(only16

householdsw

erein

more

thanthree

categories).

Benneh

etal.87

Table

8.16:F

emale

RP

SP

revalenceb

yN

umbero

fHigh

Risk

Co

nd

ition

sH

ouseholdF

aces.

Nu

mb

ero

fHig

hR

iskC

on

ditio

ns

Size

ofS

Ubsam

pleT

wo-W

eekR

PS

Prevalence

(%)

None

One

Tw

oT

hreeor

more

79307

375178

7.611.719.731.5

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991

Table

8.17sum

marises

theresults

of

thelogistic

regression.T

heonly

higWy

significantvariable

(p<

.01)relates

tothe

useo

fpum

p-sprayinsecticides

(aerosolinsecticides

arenot

includedin

thiscategory).

This

fmding

clearlydeserves

furtherinvestigation.

Breathing

inthe

insecticidecould

bethe

causeo

frespiratory

'problemsym

ptoms,

andthe

useo

fpum

p-sprayinsecticides

would

notappear

tobe

restrictedto

anyparticular

parto

fthe

city,o

rassociated

with

otherknow

nrisk

factorsnotincluded

inthe

regression.Itw

ouldbe

premature

toassum

ethat

theuse

of

spraypesticides

isa

major

healthrisk.

But

acareful

assessment

of

theinsecticides

beingused,

them

ethodso

fapplication,

andthe

healthproblem

susers

faceis

clearlyw

arranted.S

houldpum

p-sprayinsecticides

bea

problem,

thereare

anum

bero

fmeasures

which

couldbe

taken.

Use

pu

mp

·spra

yinsecticide

Wa

ter

Interruptionsco

mm

on

atcertaintim

esof

da

y0.46

0.20.019

1.58R

oo

fleaks

duringrains

0.420.18

.0231.52

Ne

ver

cookin

opena

ir0.36

0.18.050

1.43C

iga

relle

ssm

oke

dp

er

da

y0.10

0.05.025

1.11

Table

8.17:S

um

ma

ryR

esultso

fL

og

isticR

egressionR

elatingP

HR

PS

Prevalence

with

En

viron

me

nta

lF

actors.-v-ar-ia-b-'-e--==..:...::.:.:='-'C:.;o:.;e:..:.ff:..:.ic::,:i.:;en:..:.;t=---_

_I....;s:.;t:=a:..:.;nd::a:.:.r.:.d.=E:.:.;rr:..:o:..:..r---Jl....-....::S:..:.i...gn:..:.;i""'fi.:;ca:.:n.:.,:c:..:e'--_

_.=O:..:d:..:d:=s....:.R.:,:a:..:.:ti:=o_

1.250.24

<.0013.49

Note:

Other

variablesincluded

inlogistic

regressionw

ereage

ofprincipal

homem

akerand

wealth

qUintile,

thoughneither

were

statisticallysignificant.

Environm

entalvariablesw

hichw

erenot

includeddue

toa

lackof

statisticalsignificance

were:

crOW

ding,use

ofcooking

hut,principal

cookingfuel,

observedevidence

ofdam

pnessand

selectedw

aterand

sanitationvariables.

88E

nvironmentalP

roblems

andthe

Urban

Household

inthe

GA

MA

-Ghana

Water

interruptions,leaky

roofsand

nevercooking

out-of-doorsare

allvariables

which

arosein

theanalysis

of

children'sA

RI.

RougW

y,they

canbe

takento

reflectpoor

sanitation,dam

pconditions,

andsm

okeexposure

respectively.In

interpretingthe

resultsfor

cigarettesm

oking,it

isim

portantto

bearin

mind

that,given

thesm

allnum

bero

frelatively

moderate

smokers,

onew

ouldnot

expecta

highstatistical

significance.F

urthermore

theodds

ratioapplies

tosm

okingone

additionalcigarette:

theequivalent

oddsratio

forsm

okingten

cigarettesw

ouldbe

closeto

three.

Benneh

etal.89

Bo

x8.1:

Ho

useh

old

En

viron

men

talC

on

ditio

ns

and

Health

N=34

0·12·3

4-56·7

nu

mb

ero

fhig

hrisk

con

ditio

ns

Fig

ure

8.1:Ch

ildh

oo

dd

iarrh

oe

ap

reva

len

ceb

yn

um

be

rofh

igh

riskco

nd

ition

s

The

figuresin

thisbox

graphicallyillustrate

theim

portanceo

fenviron­m

entalriskfactors

toG

AM

Adw

ell­ers.

Diarrhoea

andrespiratory

in­fection

aretw

oo

fthem

ajorhealth

problems

inG

AM

A,and

areespe­

ciallycriticalam

ongyoung

childrenand

infants.F

igures8.1

and8.2

arebased

onthose

householdsw

ithchildren

undersix,andillustrate

theclose

as­sociation

between

theprevalence

of

thesehealth

problems

inthe

pasttwo

weeks

among

childrenunder

six,and

thenum

bero

fenvironm

entalrisk

factorshouseholds

face.F

or

diarrhoea,the

conditionsidentified

(throughstatisticalanaly­

sis)are

dominated

byw

ater,sanita­tion

andhygiene

problems,

which

aresuspected

riskfactors,

andare

clearlyassociated

with

poverty.H

owever,

while

thefactors

identi­fied

arenot

surprising,the

differ­ences

indiarrhoea

prevalenceare

striking.T

heconditions

associatedw

ithsym

ptoms

of

acuterespiratory

in­fection

among

small

childrenare

alsoall

susp

ectedrisk

factors.

Along

with

crowding,

andindica­

torso

fpoorhygiene,thereare

sev­eral

factorsrelated

toexposure

toairpollution,including

smoke

fromm

osquitocoils.

Again,m

ostofthese

conditionsare

povertyrelated.

Respiratory

problemsym

ptoms

inw

omen

areshow

nto

berelated

with

aless

wealth-dependentseto

frisk

factors,see

Figure

8.3.S

mok­

ingcigarettes

andusing

pump

sprayinsecticides,tw

oo

fthem

ostsignifi­cantfactors,are

actuallym

orecom

­m

onam

ongw

ealthierhouseholds.

>6

N=33

N=223

2t0

34

t05

number

ofh

igh

riskconditions

Oto

1

N=51

oL-~~J---+-

~60

fl50

c:Ql

~4

0eD

o30

~~2

0~c..

10

70

Fig

ure

8.2:Ch

ildh

oo

da

ccute

resp

irato

ryin

fectio

np

reva

len

ceb

yn

um

be

rofh

igh

riskco

nd

ition

s

N=

subsample

size

Listo

fhig

hrisk

con

ditio

ns

-childoften

presentduringcooking

-presence

of many

fliesin

kitchenattim

eofinterview

•less

than4

m'/person

insleeping

room•

experiencingw

aterInterruptionsatcertain

times

ofday-

useofm

osquitocoils

-nevercooking

outdoors•

leakingroofduring

rains

_6

0~Q

l

g50

..~e4

0D

oIII..o

30

'EIII

'S2

0

!10o

-l-----+

__

N=

69

70

N=subsam

plesize

Listo

fhig

hrisk

con

ditio

ns

-sharing

toilet with

>5otherhouseholds

-using

potforstoringw

ater-storing

water in

anopen

container•outdoordefecation

byneighbourhood

children•presence

ofmany

filesin

kitchenattim

eofinterview

-notwashing

handsbefore

preparingm

eals-experiencing

waterinterruptions

atcertaintim

esofday

-buyingprepared

foodsfrom

vendors

Data

source:Questionnaire

surveyo

fAccra,

1991.

90

Environm

entalProblem

sand

theU

rbanH

ouseholdin

theG

AM

A-G

hana

Box

8.1co

nt'd

70160

1~

I~

IG

l50

+uCG

l

J4

0l!!c.1Il

30

Q.

It:

!2

010oo

12

number

ofh

igh

riskco

nd

ition

s.

N=

178

>3

Figure

8.3:Fem

alere

spira

tory

pro

ble

msym

tom

sprevalence

by

nu

mb

ero

fhig

hrisk

con

ditio

ns

N=

subsample

size

Listo

fh

igh

riskco

nd

ition

s-

smo

kes

ciga

rette

s-

use

sp

um

p-sp

ray

inse

cticide

-e

xpe

rien

cing

wa

ter

inte

rrup

tion

sa

tce

rtain

time

s01

da

y-

ne

verco

okin

go

utd

oo

rs-le

akin

gro

old

urin

grains

Benneh

etal.

CH

AP

TE

RN

INE

91

9T

HE

EC

ON

OM

ICS

OF

HO

US

EH

OL

DE

NV

IRO

NM

EN

TA

LM

AN

AG

EM

EN

T9.11ntroductionT

hew

ayenvironm

entassets

arem

anagedhas

important

consequencesfor

theeconom

y,and

more

generallyhum

anw

elfare.E

quallyim

portant,econom

icconstraints

andincentives

helpdeterm

inehow

theenvironm

entis

managed.

This

holdsfor

boththe

largescale

problems

likeoutdoor

airpollution

andthe

more

localisedproblem

saffecting

urbandw

ellersin

ornear

therrhom

es,w

ithw

hichthis

studyis

primarily

concerned.It

hasbeen

demonstrated

thatnot

onlyare

many

of

theenvironm

entalconditions

verypoor,

butthe

healthrisks

aresubstantial.

This

chapterfocuses

onthe

concernso

ftheprincipal

homem

akers,and

inparticular

thevalue

theyplace

onenvironm

entalim

provement.

Ideally,such

concernsshould

providea

drivingforce

forenvironm

entalim

provement.

Unfortunately,

deficientinform

ation,structural

obstaclesand

inadequatepolicies

oftenprevent

suchconcerns

frombeing

formulated

appropriatelyor

actedupon,

eitherby

thehouseholds

ortheir

government.

Environm

entalrisks

andprocesses

canbe

difficultto

understand.A

sdem

onstratedin

thepreceding

chapter,the

healthim

plicationsof

environmental

degradationare

extremely

complex.

Households

may

practicepoor

hygieneor

governments

may

takeinappropriate

actionsbecause

theyare

poorlyinform

ed.It

ishoped

thatsom

eo

fthe

information

gatheredin

thecourse

of

thisstudy

will

providefor

betterdecisions.

How

ever,households

havean

intimate

knowledge

oftheir

surroundingsw

hichno

studycan

hopeto

capture.M

oreover,their

opinionsand

preferencesm

atter,even

ifthey

arenot

always

well

informed.

Even

inareas

where

householdsdo

notparticipatedirectly

indecision-m

aking,it

isim

portantnot

torely

on"expert"

judgementalone,butto

considerthe

prioritiesand

valuationso

fthose

most

affected.F

orsom

eeconom

icgoods,

people'spreferences

arerelatively

easyto

ascertain.If

someone

buysfood

for400

cedis,it

seems

reasonableto

assume

thatthey

areplacing

avalue

of

atleast

400cedis

onthat

food.O

nem

ayquestion

whether

400cedis

isw

orththe

same

todifferent

people,but

byand

largepeople

canbe

saidto

berevealing

theirow

npreferences

throughtheir

purchases.F

orenvironm

entalam

enities,the

situationis

typicallym

orecom

plicated.M

ostenvironm

entalam

enitieshave

publicbenefits,and

hencecan

bedifficult

tosell

evenw

henthe

benefitsoutw

eighcosts.

Itis

notpossible,

forexam

ple,to

provideindividuals

with

cleanerstreets

inproportion

totheir

voluntarypaym

ents.O

ncethe

streetis

clean,it

isclean

foreveryone

who

usesit.

Ifstreet

sweeping

were

putup

forsale,

therew

ouldbe

astrong

incentiveto

free-ride,and

hopeothers

paythe

costs.M

uchthe

same

appliesto

safew

astedisposal,

drainage,clean

outdoorair

andenvironm

entalinsect

control.O

neresult

isthat

many

environmental

amenities

arenot

soldin

theprivate

sector:their

provisionis

often,at

leastin

part,the

government's

responsibility.E

venenvironm

entalservices

which

aresold,

suchas

pipedw

ater,sanitation

andhousehold

waste

collection,have

publicbenefits.

For

thesequasi-public

goods,m

arketprices

may

exist,but

areunlikely

toreflect

thepublic

benefitso

fbettersanitation,w

astedisposal

andhealth.

As

partofthe

householdsurvey

undertaken,a

serieso

fquestionw

ereasked

inorder

toprovide

anindication

of

howm

uchpeople

valueenvironm

entalam

enities.

92

Environm

entalP

roblems

andthe

Urban

Household

inthe

GA

MA

-Ghana

There

areseveral

possibleapproaches

which

canbe

employed

forsuch

purposes.O

necan

attempt

toim

putevalues

fromthe

expensespeople

incurprotecting

themselves.

Rents

may

behigher

inareas

with

betterenvironm

entalquality,

andin

some

circumstances

itmay

bepossible

touse

rentdifferentialsto

estimate

thevalue

peopleplace

onenvironm

entalam

enities.People

may

boiltheir

water

beforedrinking,

andcost

incurredcould

betaken

toreflect,

roughly,the

valuethey

placeon

cleanerw

ater.U

nfortunately,the

scopefor

suchestim

atesis

verylim

ited,and

would

notprovide

comparable

resultsfor

differentenvironmentalam

enities.T

heapproach

employed

forthis

studyis

more

direct:the

principalhom

emakers

were

askeddirectly

what

theyw

ouldbe

willing

topay

forparticular

environmental

improvem

entsif

theyw

erefor

sale.T

histechnique

iscalled

contingentvaluation,

aspeople

areasked

toprovide

valuescontingent

ontheir

beinga

market

forthe

benefitsin

question.T

hetechnique

hasbeen

appliedextensively

inrecent

years,and

thereis

agrow

ingbody

ofliterature

onits

strengthsand

weaknesses

(seeM

itchelland

Carson,

1989).A

number

ofstudies

haveundertaken

contingentvaluation

ofw

aterand

sanitationtechnologies

indeveloping

countries(e.g.W

hittingtonet

al.,1990;

Altafetal.,

1992).The

purposehere,

however,

isnot

toevaluate

anyparticular

technologies,but

toascertain

howm

uchvalue

peopleattach

toenvironm

entalim

provements.

The

improvem

entsevaluated

cover:w

aterquality,

water

availability,solid

waste,

outdoorair,

indoorair,

andinsects.

Inorder

toprovide

abasis

forcom

parison,theim

provements

were

takento

berelatively

comprehensive,

andincluded

theelim

inationo

fhealth

risksw

henrelevant.

Sanitationim

provement

was

notincluded

dueto

difficultiesform

ulatingappropriate

questions(i.e.

notbecause

sanitationw

asconsidered

lessim

portant).R

atherthan

askingrespondents

open-endedquestions,

estimates

were

elicitedthrough

biddinggam

es.A

monthly

payment

of400

cedisw

asproposed.

Ifthe

respondentsw

ere"w

illingto

pay",the

bidw

asincreased.

Ifnot,

itw

asreduced.

This

processw

asrepeated

upto

fivetim

es,after

which

therespondent

was

askedto

estimate

them

aximum

theyw

erew

illingto

pay.R

espondentsnot

interestedin

theim

provementin

question,orunw

illingto

payanything,w

ereasked

why.

The

estimates

arisingfrom

thecontingent

valuationare

onlyintended

asa

roughguide

tohousehold

priorities.T

heyare

toouncertain

toprovide

asound

basisfor

cost-benefitanalysis

orthe

pricingof

environmental

services.H

ouseholdscannot

beexpected

tohave

aprecise

ideaof

what

anenvironm

entalim

provement

would

bew

orthto

them,

orto

beoverly

concernedw

iththe

accuracyo

ftheir

responses.Som

em

ayeven

beinclined

tooverestim

atein

thehope

ofprom

otingthe

improvem

ent,w

hileothers

may

underestimate

inthe

hopeof

avoidingfees.

Moreover,

differentm

embers

of

thehousehold

may

haveopposing

priorities.T

herespondents

were

theprincipal

homem

akers(96%

wom

en),w

hoare

likelyto

berelatively

knowledgeable

abouthousehold

conditions,but

may

nothave

comm

ensurateinfluence

overthe

householdbudget.

Inshort,

theestim

atesprovide

afirst

approximation

of

howthe

principalhom

emakers

valueenvironm

entalim

provement,

ratherthan

anaccurate

predictiono

fhow

much

householdsw

ouldactually

bew

illingto

allocateto

theim

provements

inquestion.

Econom

ics,as

well

ascom

mon

sense,suggests

thatw

ealthierhouseholds

arelikely

toplace

ahigher

monetary

valueon

environmental

amenities.

To

theextent

thatenvironm

entalam

enitiescan

alreadybe

purchased,this

isalready

reflectedin

thesuperior

environmental

conditionsin

wealthy

homes.

For

publicbenefits,

averagingvaluations

acrosshouseholds

will

tendto

placem

orew

eighton

the

Benneh

etal.93

prIOrItIes

of

thew

ealthy.T

hism

irrorsthe

realityof

goodsprovided

throughcom

petitivem

arkets.It

doesnot

necessarilyreflect

thepriorities

thegovernm

entw

ouldlike

torespond

to,how

ever.F

orthis

andother

reasons,in

most

of

thefollow

inganalysis

householdsare

stratifiedinto

low,

medium

andhigh

wealth

groups.In

additionto

havingopinions

aboutthe

valueo

fim

provement,

peoplehave

opinionsaboutw

ho,ifanyone,

needsto

act.C

rudely,one

canthink

ofthreelevels:

householdaction,

neighbourhoodaction

andgovernm

entaction.

Econom

ictheory

suggeststhat

theappropriate

levelof

actionis

relatedto

theextent

tow

hichthe

improvem

entsprovide

publicbenefits.

Reducing

indoorair

pollutionbenefits

principallythe

pollutinghousehold,

anddoes

notraise

theproblem

offree-riding.

Many

ofthe

benefitso

fbetter

solidw

astecollection

accrueto

thew

holeneighbourhood.

Reducing

outdoorair

pollutionsim

ultaneouslybenefits

aw

iderange

of

householdsliving

indifferent

partsof

thecity.

From

apublic-goods

perspective,this

suggests,again

verycrudely,

thatw

hilehousehold

actionm

aybe

adequatefor

indoorair

improvem

ents,neighbourhood

actionand

city-wide

actionare

more

likelyto

beappropriate

forsolid

\yasteand

outdoorair.

There

areother

relevantconsiderations,

however,

many

ofw

hichare

beyondthe

purviewof

economics,

narrowly

defined(e.g.

moral

responsibilitiesand

thecom

petenciesof

theinstitutions

involved).A

sin

thecase

ofvaluing

environmental

improvem

ent,household

perceptionsm

atter,not

onlybecause

theyinfluence

theoutcom

e,but

alsobecause

theyreflectopinions

which

shouldbe

takenseriously.

The

following

sectionsaddress

thefollow

ingissues

inturn:

1.In

which

areasdid

respondentsfeel

actionw

asneeded

andby

whom

?;2.

Inw

hichareas

were

respondentsw

illingto

payfor

improvem

ents,and

ifnot,

why

not?;3.

How

much

were

respondentsw

illingto

payfor

theseim

provements?

9.2W

hereis

actionneeded

byw

hom?

Inall

of

theproblem

areascovered,

more

thanthree

outof

fourhouseholds

perceiveda

needfor

action.A

sindicated

inT

able9.1,

however,

therew

eredifferences

among

theproblem

areas,not

onlyregarding

whether

actionw

asnecessary,buteven

more

asto

who

needsto

act.

Ta

ble

:9

.1:

Op

inio

ns

on

Wh

oN

ee

ds

toA

ct

by

En

viron

me

nta

lP

rob

lem

Are

a-

All

Ho

use

ho

lds.

Problem

No

Ind

ividu

al

Neighbourhood

Go

v'tN

oN

umbero

f

Area

Actio

nO

pinionH

ouseholds

(%)

(%)

(%)

(%)

(%)

#

Water

134

378

21000

Outdoor

Air

202

1656

61000

IndoorA

ir24

562

153

1000

Insects7

2721

441

1000

Garbage

116

2161

11000

Sanitation

913

3442

21000

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

94

Environm

entalP

roblems

andthe

Urban

Household

inthe

GA

MA

-Ghana

Inthe

two

areasw

herethe

largestshare

of

respondentsfelt

actionw

asnecessary,

insectsand

sanitation,there

was

alsothe

most

disagreement

overw

hoshould

takeaction.

Inboth

cases,the

largestshare

favouredgovernm

entaction,

butm

orethan

halfo

fthe

respondentsidentified

eitherindividuals

or

neighbourhoodsfor

insectcontrol,

andm

orethan

athird

feltthat

neighbourhoodsshould

takeaction

toim

provesanitation.

The

responsibilityfor

providingand

maintaining

sanitationfacilities

doesvary

considerably,w

ithneighbourhood

groupsoften

playingan

important

rolein

managing

comm

unaltoilets.

One

might

expectthat

householdsusing

comm

unaltoilets

opento

theneighbourhood

would

bethe

most

inclinedto

Identifythe

neighbourhoodas

theappropriate

locusfor

action.A

ctually,alm

osthalf

(49%)

of

these(389)

householdsreferred

togovernm

entaction;

theshare

referringto

neighbourhoodaction

(36%)

was

littledifferent

fromother

households.W

ithinthis

group,how

ever,there

was

asignificant

divergenceo

fopinion

between

thosew

ithcom

munal

KV

IPlatrines

andthose

stillusing

unimproved

pitlatrines.

The

(70)households

with

KV

IPlatrines

referredto

neighbourhoodaction

abouttw

iceas

oftenas

government

action,w

hilethe

reversew

astrue

of

the(243)

householdsw

ithunim

provedpit

latrines.It

would

seemthat

thosehouseholds

with

unimproved

pitlatrines

believeit

isup

tothe

government

toprovide

bettersanitation

facilities,and

quitepossibly

feelthey

havem

issedout

onrecent

improvem

entprogramm

es.Indoor

andoutdoor

airpollution

attractedthe

largestshares

of

respondentsfeeling

noaction

was

necessary,reflecting

arelatively

lowlevel

of

concern.T

hosew

hodid

want

some

actionw

erelikely

torefer

tothe

government

with

respectto

outdoorair

andindividuals

with

respecttoindoor

air.F

orindoor

air,there

were

noappreciable

differencesbetw

eenhouseholds

usingdifferent

cookingfuels

or

cookingin

differentlocations.

For

outdoorair,

residentso

fT

ema

were

substantiallym

orelikely

toperceive

aneed

foraction

(only6%

feltthere

~as

noneed

foraction),

presumably

becauseo

fconcern

aboutindustrial

emissions.

InG

a,on

theother

hand,w

heresolid

waste

burningis

comm

on,a

largershare

of

respondents(36%

)favoured

neighbourhoodaction.

Water

andgarbage

problems

hadthe

largestshares

of

respondentsreferring

togovernm

entaction,

thoughabout

onein

fivehouseholds

identifiedthe

neighbourhoodas

them

ostim

portantlevel

fordealing

with

garbageproblem

s.A

mong

vendorusers,

afull

97%w

antedaction

onw

aterproblem

s,though

unlikeother

groupsa

significantshare

of

vendorusers

(l0%)

referredto

neighbourhoodaction,perhaps

with

aview

towards

curbingvendor

profits.T

ables9.2

to9.4

summ

arisethe

responsesfor

householdsin

differentw

ealthgroups.

Generally,the

differencesare

notvery

substantial.H

owever,

inallproblem

areas,the

ratioo

fhouseholds

favouringgovernm

entaction

tohouseholds

favouringneighbourhood

actionis

highestam

ongw

ealthyhouseholds.

This

resumably

reflectsthe

factthatneighbourhood

actionis

consideredinappropriate

inw

ealthyareas,

andexpected

torem

ainso.

More

generally,m

osto

fthe

difficultiescan

beexplained

interm

so

ftheconditions

householdsatthe

differentw

ealthlevels

face.

Benneh

etal.

Ta

ble

:9

.2:

Op

inio

ns

on

Wh

oN

ee

ds

toA

ct

by

En

viron

me

nta

lP

rob

lem

Are

a-

Lo

w-W

ea

lthH

ou

seh

old

s.

95

Pro

ble

mN

oIn

divid

ua

lN

eighbourhoodG

ov't

No

Num

ber of

Area

Actio

nO

pinionH

ouseholds

(%)

(%)

(%)

(%)

(%)

#

Water

144

377

2818

Outdoor

Air

202

1755

6818

IndoorA

ir23

583

133

818Insects

727

2044

2818

Garbage

105

2064

1818

Sanitation

712

3544

2818

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

Ta

ble

:9.3:

Op

inio

ns

on

Wh

oN

ee

ds

toA

ct

by

En

viron

me

nta

lP

rob

lem

Are

a-

Me

diu

mW

ea

lthH

ou

seh

old

s.

Pro

ble

mN

oIndividual

Neighbourhood

Gov't

No

Num

bero

fA

reaA

ction

Opinion

Households

(%)

(%)

(%)

(%)

(%)

#

OutdoorA

ir23

115

565

131

IndoorA

ir30

510

181

131

Insects5

2926

391

131

Garbage

1610

2647

1131

Water

115

281

1131

Sanitation

1524

2634

1131

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

Ta

ble

:9.4:

Op

inio

ns

on

Wh

oN

ee

ds

toA

ct

by

En

viron

me

nta

lP

rob

lem

Are

a-

Hig

h-W

ea

lthH

ou

seh

old

s.

Problem

No

IndividualN

eighbourhoodG

ov'tN

oN

umbero

f

Area

Actio

nO

pinionH

ouseholds

(%)

(%)

(%)

(%)

(%)

#

Water

152

077

651

Outdoor

Air

196

665

451

IndoorA

ir28

430

290

51Insects

1025

2045

051

Garbage

238

1257

051

Sanitation

2810

2537

051

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

9.3W

illingnessa

nd

Ability

ToP

ayT

heim

provements

respondentsw

ereasked

toevaluate

included,briefly:w

atero

fa

qualityperfectly

safeto

drink(sam

esource

asat

present);w

ateravailable

inthe

home

without

interruption;outdoor

airclean

enoughto

poseno

healthrisk;

similarly

cleanindoor

air,elim

inationo

finsect

bornedisease;

comprehensive

solidw

astecollection

with

safedisposal.

Insom

ecases,

distinctionsw

erealso

made

in

96

Environm

entalP

roblems

andthe

Urban

Household

inthe

GA

MA

-Ghana

thescale

of

theim

provement

(e.g.just

forthe

household,for

thew

holeneighbourhood,

or

forthe

whoie

city).B

yand

large,how

ever,the

responsesw

eresim

ilarregardless

of

scale,so

onlythe

resultsfor

them

oreextensive

improvem

entsare

presentedhere.

Despite

thecom

prehensivenature

of

theim

provements,

some

respondentssaid

theyw

ereuninterested

inthe

improvem

entscited.

Am

ongthose

interested,som

ew

ereunw

illingto

payanything.

Table

9.5provides

abreakdow

no

fhouseholds

ineach

wealth

group,according

tow

hetherthey

were

willing

topay

anythingfor

theim

provements

andif

notw

hynot.

Overall,

fewer

householdsw

erew

illingto

paythan

advocatedaction.

Indeed,som

ehouseholds

who

advocatedaction

claimed

thatthe

situationw

asalready

adequatew

henasked

inthe

contexto

fm

akingpaym

ents.O

nthe

otherhand,

thedifferences

acrossthe

problemareas

aresim

ilar.Insects

standout

asthe

problemthe

largestshare

was

willing

topay

toim

proveupon,

while

bothindoor

andoutdoor

airattracted

onlyslightly

more

thanhalf

of

therespondents.

Also,

insectsw

asthe

onlyproblem

areaw

herealm

osthalf

of

thoseunw

illingto

paysaid

thatthey

couldnot

affordany

payment.

Inall

otherareas,

byfar

them

ostcom

mon

reasonfor

beingunw

illingto

payw

asthat

qualityw

asalready

sufficient.O

nlyfor

outdoorair

dida

significantshare

(13%)

of

therespondents

claimthat

theyw

ouldbe

unwilling

topay

becauseit

was

nottheir

responsibility.

Ta

ble

9.5:R

easonsfo

rU

n-W

illing

ne

ssto

Pay

for

Imp

rove

me

nts

by

Imp

rove

me

nt

Ca

teg

ory.W

ate

rW

ate

rO

utd

oo

rIn

do

or

Inse

ctsG

arb

ag

eQ

ua

lityQ

ua

ntity

Air

Air

Willing

toP

ay

for

Improvem

ent(%)

7273

5157

8775

Quality

already

sufficient(%)

1514

2331

514

Any

payment

is

toocostly(%

)8

912

106

5

Not

household'sR

esponsibility(%)

33

132

3

Unw

illingfo

r

Other

Reason(%

)2

22

TO

TA

L%

100100

100100

100100

(N)

10001000

10001000

10001000

Data

source:Q

uestionnaireS

urveyofG

AM

A,

1991.

Th

eshare

of

householdsw

illingto

payfor

improvem

entsdoes

notshow

aclear

associationw

ithw

ealth.A

sindicated

inT

able9.6,

theshare

willing

topay

declinesw

ithincreasing

wealth

forindoor

airand,

thoughless

significantly,for

garbagecollection.

Fo

rall

theother

areasthe

lowest

shareis

inthe

middle

wealth

Benneh

etal.97

group,w

iththe

highestshare

inm

ostcases

beingin

thehighest

wealth

group.T

hisis

perhapsnot

allthat

surprising.It

isquite

possiblethat

with

fewer

aspirationsthan

thew

ealthy,and

betterconditions

thanthe

poor,m

iddlew

ealthhouseholds

arethe

most

likelyto

besatisfied

with,

forexam

ple,the

existingw

atersupply.

What

ism

orestriking

thanthe

wealth-related

differencesis

thatam

ongall

thegroups

thehighest

sharew

asw

illingto

payto

alleviateinsect

problems

andthe

lowest

sharesw

erew

illingto

payto

improve

airquality.

Ta

ble

9.6:S

ha

res

of

Ho

us

eh

old

sW

illing

toP

ay

for

Imp

rov

em

en

tsb

yW

ealthG

rou

pan

dIm

pro

ve

me

nts

by

Categ

ory.

Water

Water

Ou

tdo

or

Ind

oo

rInsects

Garb

age

Qu

alityQ

uantityA

irA

ir

LowW

ealth

('YoW

illingto

Pay)

7274

5259

8876

Middle

Wealth

('YoW

illingto

Pay)

6864

4550

8173

High

Wealth

('YoW

illingto

Pay)

8579

4940

8972

All

Households

('YoW

illingto

Pay)

7273

5157

8775

Data

source:Q

uestionnaireS

urveyof

GA

MA

,1991.

Before

examining

theadditional

payments

householdsw

erew

illingto

payfor

improvem

ents,it

isw

orthreconsidering

howm

uchthey

were

alreadypaying

forsom

eo

fthe

existingservices.

As

indicatedin

Chapter

2,w

aterprices

were

regressive,w

ithp

oo

rhouseholds

generallypaying

more

pergallon

thanthe

wealthy.

Moreover,

pricesw

ereinversely

relatedto

thequality

of

theservice.

Fo

ra

householdusing

1,000gallons

perm

onth,the

costsranged

fromroughly

1,000cedis

perm

onthif

purchasedby

thebucket

toabout

250cedis

ifa

privateconnection

were

sharedbetw

eenthree

households.F

or

garbagecollection,

while

82%o

fthe

sample

saidthey

dumped

theirw

asteat

comm

unitycollection

pointso

rdum

ps,only

31%

of

theseclaim

edto

paya

levy.T

heofficial

chargefor

theuse

of

comm

unityrefuse

dumps

is2500

cedisa

year,o

rroughly

200cedis

perm

onth,in

Accra

and500

cedisa

month

inT

ema.

Only

about10%

of

householdsw

ereserved

bya

home

collectionservice.

The

chargesfor

home

collectionranged

from1000

cedisa

month

fora

100litre

containerto

3500cedis

am

onthfor

a240

litrecontainer.

How

ever,m

orethan

halfo

fthe

householdsw

ithhom

ecollection

saidthey

paidless

than1000

cedisa

month.

Table

9.7show

sthe

averageso

fthe

maxim

umm

onthlyw

illingnessto

payfor

improved

servicesfor

eachw

ealthgroup

(householdsunw

illingto

payanything

havebeen

ascribedzero).

Fo

rall

householdscom

binedthe

means

rangefrom

240cedis

perm

onthfor

indoorair

to446

cedisper

month

forinsect

control.T

hesefigures

areo

fcom

parablem

agnitudeto

monthly

payments

forw

aterand

solidw

asteservices.Individually

theym

ayseem

small,

butthey

would

representsignificant

sacrificeson

thepart

of

thehouseholds,

andsum

med

acrossthe

more

98

Environm

entalP

roblems

andthe

Urban

Household

inthe

GA

MA

-Ghana

than200,000

householdsin

GA

MA

,the

totalsare

appreciable(sum

ming

acrossim

provement

categoriesw

ouldyield

stilllarger

figures,but

would

probablyoverestim

atethe

combined

willingness

topay).

The

446cedis

perm

onthper

householdfor

insectcontrol,

forexam

ple,w

ouldtranslate

intom

orethan

onebillion

cedisper

annum(roughly

2.5m

illiondollars).

Inshort,

theresults

suggesta

considerabledem

andfor

improvem

ents,anda

willingness

tom

akereal

sacrificesto

achievethem

.In

most

cases,the

averagew

illingnessto

payfor

improvem

entincreases

substantiallyw

ithw

ealth.For

everyim

provementexceptindoor

air,the

richare,

onaverage,

willing

topay

them

ostand

thepoor

theleast.

Indeed,in.every

caseexcept

indoorair

thew

ealthyare

willing

topay

more

thantw

icew

hatthe

poorare

willing

topay,

despitethe

factthat

inseveral

categoriesthey

arealready

farcloser

tothe

improved

situation.T

hus,for

example,

thew

ealthyare

willing

topay

onaverage

anadditional

954cedis

perm

onthto

obtaina

reliableindoor

pipedw

atersupply,

despitethe

factthat

virtuallyall

of

themalready

haveindoor

pipedw

ater.T

helow

-wealth

householdsare

onlyw

illingto

payan

additional361

cedisper

month,

despitethe

factthat

most

nowhave

tofetch

water

byhand.

On

theother

hand,given

theprevailing

income

distributionin

GA

MA

,as

ashare

of

income,

them

eanw

illingnessto

payfor

thelow

-wealth

householdsis

almost

certainlyhigher

thanfor

wealthy

households.

Ta

ble

9.7:W

illing

ne

ssto

Pay

for

En

viron

me

nta

lIm

pro

vem

en

tsb

yW

ealthG

rou

pin

Ce

disIM

on

th.Low

Medium

Hig

hA

ll

Wa

ter

Qu

ality

332418

746365

(619)(670)

(1123)(668)

Wa

ter

Ava

ilab

ility361

441954

404

(594)(825)

(1357)(701)

Ou

tdo

or

Air

228298

466250

(638)(695)

(764)(654)

Ind

oo

rA

ir235

270245

240

(571)(573)

(554)(570)

Inse

ct417

462849

446

(597)(414)

(941)(608)

Solid

Wa

ste343

450809

382

(607)(518)

(1018)(634)

#H

ou

seh

old

s796

12453

973

Note:

nu

mb

ers

inbrackets

arestandard

deviations.

Data

sou

rce:

Questionnaire

Survey

ofG

AM

A,

1991.

Incontrast

tothe

differentoverall

levelso

fpaym

ent,the

relativevalue

attachedto

differentim

provements

remains

similar

acrossthe

wealth

groups.F

orall

householdscom

bined,the

highestw

illingnessto

payis

forinsects,

followed

byw

ateravailability,

solidw

astedisposal,

water

quality,outdoor

airquality

and

Benneh

etat.99

indoorair

quality,w

ithboth

of

theair

qualityfigures

considerablylow

erthan

anyo

fthe

othercategories.

With

theexception

of

afew

minor

reversals,this

same

orderapplies

toevery

wealth

group.P

oorhouseholds

placem

oreconcern

onindoor

thanoutdoor

airpollution,

presumably

becausethey

arethe

householdsusing

them

orepolluting

fuels.W

ealthyhouseholds'

willingness

topay

forw

ateravailability

ism

arginallyhigher

thanfor

insectcontrol,

possiblybecause

of

water

supplyinterruptions.

9.4Sum

mary

The

previouschapter

demonstrated

theclose

associationbetw

eenenvironm

entalinadequacies

andhealth

problems.

The

valuationso

fenvironm

entalunprovem

entpresented

inthis

chapterare,

byand

large,consistent

with

existingknow

ledgeo

fthe

healthburdens

imposed.

Malaria

isthe

most

evidenthealth

problem,

andinsect

controlw

asthe

most

valuedim

provement.

Diarrhoea

isalso

am

ajorhealth

if

problem,

andw

aterim

provements

were

alsohighly

valued.(S

anitationim

provements

were

notincluded

inthe

survey,but

thereis

everyindication

thatthey

toow

ouldhave

beenhighly

valued.)A

irquality

improvem

entsw

ereless

highlyvalued,

despitethe

importance

of

respiratoryinfection.

How

ever,the

linkbetw

eenair

pollutionand

respiratoryproblem

sis

probablyless

significantthanthat

between

water

anddiarrhoea.

Solid

waste

collectionw

asquite

highlyvalued,

despitehaving

avery

uncertainlink

tohealth.

Inthis

case,it

isprobably

bestto

assume

thathealthw

asnot

theprincipal

motivation.

Inthe

[mal

analysism

ajorenvironm

entalim

provements

atthe

householdlevel

requirepoverty

alleviation.T

heresults

supportthe

notionthat

peopleplace

considerablevalue

onenvironm

entalim

provements,

andare

willing

tom

akesignificant

economic

concessionsin

orderto

achievethem

.T

heeconom

icburden

of

payingfor

existingenvironm

entalservices

isconsiderable.

Inseveral

cases(e.g.

water)

po

or

householdsare

alreadypaying

highprices

foran

inadequateam

enity.U

ndersuch

circumstances,itis

anindication

ofthe

importance

peopleattach

tothe

householdenvironm

entthat

theyare

willing

topay

stillm

orefor

improvem

ents.H

owever,

itis

unrealisticto

expectto

achieveadequate

home

andneighbourhood

environments

without

significantim

provements

inthe

economic

statuso

fthe

majority

of

households.O

nthe

otherhand,

asnoted

atthe

starto

fthis

chapter,even

ifhouseholds

valueenvironm

entalbenefits,

individuallythey

oftenhave

relativelylittle

controlover

theenvironm

entthey

face.Indeed,

theim

mediate

economic

incentivem

aybe

todegrade

theenvironm

ent,despite

thecosts

thisincurs

onothers.

Such

problems

arisein

po

or

asw

ellas

wealthy

areas.O

utdoordefecation

inan

urbansetting,

forexam

ple,is

inpart

asym

ptomo

fsevere

poverty.B

utit

isalso

anindication

thatindividual

andcollective

interestsare

notin

harmony.

Similarly,

inadequatew

ateraccess

may

besym

ptomatic

of

poverty,but

povertydoes

notdictate

thatw

aterprices

shouldbe

especiallyhigh.

Econom

icssuggests

thatsom

eform

of

collectiveaction

may

berequired

when

publicbenefits

areinvolved.

Justas

householdsseem

edto

placea

higherpriority

onim

provements

which

would

havea

major

healthim

pact,so

alsohouseholds

tendedto

identifya

needfor

more

collectiveaction

them

orepublic

thebenefits.

.Indoorair

improvem

ent,w

hichbenefits

principallythe

householdm

akingthe

improvem

ent,w

asseen

principallyas

ahousehold

affair.F

or

otherproblem

s,the

respondentsm

ostoften

identifieda

needfor

government

action,though

neighbourhoodaction

receivedconsiderable

supportforgarbage,insectand

especiallysanitation

problems.

100E

nvironmentalP

roblems

andthe

Urban

Household

inthe

GA

MA

-Ghana

CH

AP

TE

RT

EN

10T

HE

INS

TIT

UT

ION

AL

ASPE

CT

SO

FU

RB

AN

EN

VIR

ON

ME

NT

AL

MA

NA

GE

ME

NT

10.1Introduction

As

indicatedin

theprevious

chapter,good

environmental

managem

entcan

onlybe

achievedthrough

appropriateinstitutions.

Itis

notenoughto

identifyproblem

sand

priorities.S

ocietyresponds

toproblem

sthrough

institutionsranging

fromm

arketsto

centralgovernments,

fromprivate

enterpriseto

non-governmental

organisations,from

kinshipnetw

orksto

politicalparties,

andso

on.A

llsuch

institutionscan

bepart

of

theproblem

orpart

of

thesolution.

Hence,

therole

of

existingsocial

institutionsin

environmental

managem

entneeds

carefulexam

ination.T

hepresent

chapterw

illexam

inew

hetherand

tow

hatextent

identifiablegovernm

ental,political,

non-governmental

andneighbourhood

organisationscan

make

significantcontributions

tothe

cruciallyim

portantenterprise

of

improving

environmental

managem

entatthe

householdand

comm

unitylevels.

10.2T

heG

overnment's

InstitutionalStructureW

ithinthe

metropolis,

acom

plexset

of

institutionsis

involvedin

thedecision­

making

andpolicy-execution

processesw

hichhelp

determine

howthe

environment

ism

anaged.Each

hasan

importantrole

toplay

inprom

otinga

healthycity.

Butitis

throughthe

functionalinteraction

of

theseagencies

andorganisations

thathousehold

environmental

problems

canbe

effectivelym

anaged.E

nvironmental

problems

rarelyem

ergew

ithinthe

confineso

fanyoneinstitution:

theirvery

naturetypically

precludesa

simple

assignment o

finstitutionalresponsibilities.

10.2.1C

entralG

overnmentInstitutions

Clearly

thelarger,m

oreform

al,state

institutionshave

anim

portantroleto

play.A

sindicated

inthe

precedingchapter,

most

householdssee

thestate

asthe

most

important

actorfor

achievingenvironm

entalim

provement.

Already,

stateinstitutions

providethe

corestructure

forenvironm

entalservices,

tow

hichother

institutions,including

households,m

ustadapt.

The

roleo

fthe

statein

protectingthe

environment

isexpected

toincrease

relativeto

many

of

itsother,

more

traditionalroles.

How

ever,environm

entalresponsibilities

within

thestate

remain

dividedam

onga

largenum

bero

fm

inistries.T

herem

aybe

advantagesto

thisdivision

ofresponsibilities,butitcreates

anum

berofco-ordination

problems.

Atthe

governmentallevel,atleasteight ofthe

fifteenm

inistriesare

involvedin

onew

ayo

ran

otherin

environmental

managem

ent.A

tthis

macro-institutional

level,relevant

policiesare

adoptedand

decisionstaken

concerningthe

implem

entationo

fenvironm

entrelated

policies.T

hecritical

actorsin

theenvironm

entalarena

includethe

ministries

discussedbelow

.T

heM

inistryo

fFinance

andE

conomic

Planninghas

theoverall

tasko

fresource

allocationfor

researchinto

environment-related

issuesand

forthe

executiono

fenvironm

entalaction

plans.Financing,

personnelrecruitm

entand,

indeed,all

material

andhum

anresources

haveultim

atelyto

beaddressed

bythis

ministry.

The

effectivenesso

fenvironm

entalm

anagement

agenciesand

practitionersis,therefore,largely

dependentonthis

ministry.

The

Ministry

of

Works

andH

ousingnot

onlyengages

inconstruction

andm

aintenance,but

alsohas

asupervisory

rolein

almost

allpublic

construction

Benneh

etal.101

activities.T

heG

hanaW

aterand

Sew

erageC

orporation,a

serviceagency

within

thism

inistry,will

bediscussed

ingreaterdetailin

10.2.2.T

heM

inistryo

fL

ocalG

overnment

performs

basicco-ordinating

andharm

onisingroles.

Itstask

isto

ensurethat

what

ishappening

onthe

groundis

inline

with

regionaland

nationalpolicies

andguidelines

onenvironm

entalas

well

asother

issues.T

wo

keydepartm

entsw

ithinthis

ministry

arethe

Tow

nand

Country

Planning

Departm

entand

theE

nvironmental

Protection

Council.

The

former

isresponsible

forensuring

theplanned

development

of

them

etropolis,and

thelatter

forensuring

thatdevelopm

entprojects

takeproper

measures

tosafeguard

thequality

of

theenvironm

ent(A

muzu

andL

eitmann,

1991,p.

41).Indeed

anew

Ministry

of

theE

nvironment

hasbeen

createdw

iththe

inaugurationo

fthe

Fourth

Republic

onthe

7tho

fJanuary,1993.

The

Ministry

of

Industries,S

cienceand

Technology

hasan

organisingand

controllingrole.

This

ministry,besides

itsconcerns

forscientific

research,oversees

andcontrols

thesiting

of

newindustries

toensure

environmental

safety.A

mong

theinstitutes

directlyinvolved

inenvironm

entalm

attersare

theInstitute

of

Aquatic

Biology,

theW

aterR

esourcesR

esearchInstitute,

theF

oodR

esearchInstitute,

andthe

Building

andR

oadsR

esearchInstitute

(Am

uzuand

Leitm

ann,1991,p.38).

The

Ministry

ofM

ineraland

Natural

Resources

isresponsible

forensuring

thatthe

useo

fnatural

resourcesdoes

notlead

toundue

environmental

degradation.W

hilenot

centrallyconcerned

with

householdenvironm

entissues,

itis

acritical

actorin

theenvironm

entalarena.

The

Ministry

of

Agriculture

isnot

onlyconcerned

with

agriculturalproduction

butalso

with

thehealth

of

citizensand

safetyo

fthe

environment.

The

IrrigationD

evelopment

Authority

within

thism

inistry,for

example,

hasas

anobjective

ensuringthe

healtho

fpeople

livingin

targetareas.

The

Ministry

of

Transport

andC

omm

unicationhas

specificresponsibility

forcontrolling

andcontaining

airpollution.

Policieson

emissions

fromvehicles

areform

ulatedand

executed.T

heM

inistryo

fT

radeand

Tourism

,besides

regulatingtrade,

isconcerned

with

thedevelopm

ento

fthe

tourismindustry.

Developm

ento

ftourist

siteshas

totake

intoactive

considerationthe

possiblenoxious

environmental

consequences.G

iventhe

wide

rangeo

fm

inistriesw

ithdifferent,

andin

some

casesoverlapping,

responsibilitiesfor

environmental

managem

ent,problem

so

finter

institutionalco-operation

andco-ordination

caneasily

emerge.

Success

dependsas

much

onthe

harmonious

interactiono

fthese

differentm

inistriesas

onthe

qualityo

fany

on

em

inistry'sactions.

At

alow

erlevel

of

thisorganisational

structureare

theregional

anddistrict

administrations.

The

regionaladm

inistrationis

areplica,

atthe

Greater

Accra

Regional

level,o

fthe

institutionalstructure

outlinedabove.

Similarly,

thedistrict

administration

replicatesthe

regionaladm

inistrativestructure.

These

interconnectedinstitutional

structuresare

intendedto

ensurean

efficientflow

of

information

andinfluence,

andthe

effectiveform

ulationand

executiono

fenvironm

entalpolicies.

102E

nvironmental

Problem

sand

theU

rbanH

ouseholdin

theG

AM

A-G

hana

10.2.2H

ealthE

ducationT

heinstitutional

arrangements

thatare

inplace

inthe

studyarea

forhealth

educationand

managem

entare

discussedhere

with

respectto

thethree

health­related

issues:food

contamination,

airpollution

andinsect

vectorincidence.

Three

distinctgroups

ofactors

areassociated

with

thehealth

educationendeavour:

theM

inistryo

fH

ealth(M

OH

)and

itsvarious

preventivehealth

deliveryunits,

thedistrict

assemblies

ofthe

threedistricts

inthe

studyarea,

andprivate

organisations.including

NG

Os

andother

voluntaryassociations.

Inthe

studyarea,

healthcare

deliveryis

underthe

auspicesofthe

Ministry

ofHealth.

The

Ministry

of

Health

hasestablished

aH

ealthE

ducationD

ivisionw

hichis

chargedw

iththe

dissemination

ofinform

ationon

healthand

health-relatedissues

tothe

generalpublic.

Itsfunctions

arecarried

outthrough

seminars,

workshops,

talks,publiccam

paignsand

thelike.

The

Ministry's

Primary

Health

Care

Programm

eis

directedat

deliveringpreventive

healthcare,

andprom

otes,am

ongother

things,good

personalhygiene

andthe

implem

entationof

theE

xpandedProgram

me

ofIm

munisation

(EP

I)against

thesix

childhoodkiller

diseases(i.e.m

easles,tuberculosis,

poliomyelitis,

tetanus,diphtheria,

andyellow

fever).Public

educationto

helppeople

understandand

respondto

thepotential

dangersof

foodcontam

inationand

theuse

ofdangerous

chemicals

andsoaps

ispart

ofthis

preventivehealth

deliverysystem

.In

theA

ccraD

istrict,for

instance,prim

aryhealth

careand

outreachservices

froma

number

of

healthinstitutions

havebeen

established,to

ensurethat

healthprom

oting,preventive

andcurative

measures,

includinghealth

education,reach

residentsin

almostallneighbourhoods.

10.2.3T

heD

istrictAssem

bliesT

hethree

districtassem

bliesin

theStudy

areaare

theA

ccraM

etropolitanA

ssembly

(AM

A)

forthe

Accra

District,

theT

ema

District

Assem

blyfor

theT

ema

District,and

theA

masam

anA

ssembly

forthe

Ga

District.

General

Managem

entof

waste

andsanitation

isthe

responsibilityo

fD

istrictand

Municipal

Councils,

accordingto

Section7,

Sub-sectionI

ofthe

Local

Adm

inistrationA

ct.C

onsequently,in

thereform

edlocal

government

system,

theA

ccraM

etropolitanA

uthorityin

theA

ccraD

istrict,the

Tem

aD

evelopment

Corporation

andD

istrictA

uthorityin

Tem

aD

istrict,and

Am

asaman

Assem

blyin

Ga

District

areresponsible

forw

astem

anagement

intheir

respectiveareas

ofjurisdiction.

Inthe

caseof

Accra

District,

thethen

Accra

City

Council

setup

theW

asteM

anagement

Departm

entin

1985to

addressthe

acuteproblem

ofw

astem

anagement

causedby

run-down

facilitiesand

equipment.

This

was

supportedw

ithequipm

entand

fundingfrom

Germ

any(form

erlyFR

G).

This

institutionalstrengthening

hasgone

along

way

tostabilise

thedeteriorating

sanitationsituation

inthe

country,although

alotrem

ainsto

bedone

(Songsore,1992,p.11).

The

Accra

Metropolitan

Assem

bly,how

ever,encounters

anum

berof

difficultiesin

itshealth

educationm

anagement

efforts.D

espiteallof

them

easuresm

entionedabove,

lackof

supervisionand

enforcement

ofbye-law

soften

resultsin

verypoor

foodhygiene

practicesby

thenum

erouschop-bars

andrestaurants,

asw

ellas

foodand

water

vendors.B

ye-laws

regulatingm

eathygiene

arealso

notalw

aysenforced.

Benneh

etai.103

10.2.4T

heE

nvironmentalP

rotectionC

ouncil(E

PC

)T

heonly

regulatorystandards

forair

pollutionare

thoseset

bythe

EP

Cfor

ambient

airquality

inresidential,

comm

ercialand

industrialareas.

These

standards,sum

marised

inC

hapter7,

coverboth

indoorand

outdoorair

pollution.T

oensure

thesuccessful

achievement

ofsuch

standards,there

must

beadequate

information

onpresent

emissions

andconcentrations,

asw

ellas

futuretrends.

The

highrisk

sourcesand

locationsm

ustbe

identified.T

hegeneral

public,as

well

asthe

government,

must

knoww

henhigh

levelso

fair

pollutionoccur

andw

here.Public

educationis

allthe

more

criticalgiven

therelative

importance

of

exposureto

smoke

fromcooking

fires,w

hichaffects

mainly

wom

enand

children,and

isparticularly

severew

henw

oodand

charcoalare

usedw

ithpoor

ventilation.It

isdifficult

tocontrol

suchpollution

without

theactive

involvement

of

well

informed

users.Unfortunately:

"sinceits

establishment

in1974,

theE

PC

hasnot

createdany

formal

mechanism

forinvolving

thepublic

inenvironm

entalm

anagement,

exceptfor

theannual

observanceo

fthe

World

Environm

entalD

ay.O

nthis

day,institutions,

politiciansand

othersenior

officialsare

invitedto

participatein

lecturesand

discussionson

selectedthem

es.Form

alparticipation

islim

itedlargely

tothose

who

haveprofessional

andother

interestsin

environmental

matters.

The

media

isheavily

involvedin

theseevents

butthis

isnot

usuallysustained"

(Am

uzuand

Leitm

ann,1991,

p.44).H

owever,

Am

uzuand

Leitm

annalso

notethat

"...the

EP

C's

pastad-hoc

approachto

environmental

educationis

beingchanged

toone

ofpositive

actionthrough

theform

ulationo

ftheE

nvironmental

Action

Plan".

10.2.5E

nvironmentalSub-C

omm

itteesT

hereare

moves

toestablish

environmental

sub-comm

itteesw

ithinthe

District

Assem

blies,to

functionunder

thetechnical

guidanceo

fthe

EP

e.It

isanticipated

thatthese

sub-comm

itteesw

illtranslate

theobjectives

of

broadpublic

healtheducation

programm

eson

environmental

pollutionand

qualityinto

practicalactivities

atthegrassroots

level.

10.3D

eliveryA

genciesIt

isthe

responsibilityo

fthe

Ghana

Water

andS

ewerage

Corporation

(GW

SC

)to

make

potablew

ateravailable

tothe

citizenry.A

sindicated

inthe

chapteron

water

supply,actual

productiono

fpotable

water

islow

erthan

estimated

demand,

resultingin

widespread

water

supplyproblem

sin

largeareas

of

them

etropolis.A

neffort

torehabilitate

water

supplyinfrastructure

andexpand

productionis

anticipated.G

WS

Cfaces

am

ajorproblem

,how

ever,generating

revenue.Q

uiteapart

fromthe

problems

of

costrecovery

throughuser

fees,there

isthe

addedproblem

of

diversiono

frevenue

generatedin

GA

MA

tothe

Head

Office

ofG

WS

C,

which

re-allocatesa

shareo

fthe

fundselsew

here.T

hiscreates

furtherproblem

so

fmaintaining

supplysystem

sand

expandingcoverage.

The

GW

SC

isalso

involvedin

human

waste

disposal.In

Accra,

thelevel

ofsew

erageservice

providedranges

fromhouse

connectionsto

water-borne

systems,

septictanks,

KV

IPs,

pitlatrines

andirregular

nightsoil

collection.O

therparastatal

organisationsprovide

sewer

systems

andtreatm

entplantsin

variousparts

of

Accra,

e.g.S

tateH

ousingC

orporation,M

inistryo

fH

ealth,the

Military

establishment,

hospitals,etc.

As

describedin

previouschapters,

however,

thesanitation

systemrem

ainsinadequate,

especiallyin

lowincom

eareas

within

GA

MA

.A

gain,how

ever,revenueproblem

sm

akeitdifficultto

respondeffectively.

104E

nvironmental

Problem

sand

theU

rbanH

ouseholdin

theG

AM

A-G

hana

10.4P

oliticalOrganisations:

The

Com

mittees

for

theD

efenceo

ftheR

evolution(C

DR

s)T

heC

omm

itteesfor

theD

efenceof

theR

evolution(C

DR

s)w

ereform

edin

theearly

80s,w

iththe

adventof

theProvisional

National

Defence

Council

(PND

C).

They

areovertly

politicalorganisations.

Their

officialobjective

isto

involvethe

peopleatthe

grassrootslevel

inpoliticaldecision-m

aking,and

tobring

government

tothe

doorstepso

fthe

ordinarycitizen.B

ut,likeany

organisation,the

CD

Rs

haveadapted

totheir

physicaland

socialcontext.

Apart

fromtheir

more

overtlypolitical

activities,C

DR

salso

serveother

functions.T

ypically,they

areenvironm

entallyconscious,

andinstrum

entalboth

inenvironm

entaleducation

andin

planningcollective

localresponses

toexisting

environmental

conditions.T

heM

atehekoC

DR

isa

casein

point.

Box

10.1:E

nvironmentalM

anagementand

aN

eighbourhoodP

oliticalInstitution:

theM

atehekoC

DR

.

Although

theM

atehekoC

DR

isnotofficially

involvedin

protectingor

improving

theenvironm

ent,it

occasionallytakes

responsibilityin

ensuringa

safeenvironm

entfor

thecom

munity.

Itorganises

am

onthlyclean-up

tounblock

chokedgutters

anddrains.

The

surroundingsare

clearedo

fw

eedsand

allfilth

isrem

ovedto

preventoutbreak

of

epidemics.

Itensures

thatfood

sellerscover

theirfood

properlyand

adoptgood

hygienicpractices,

which

hasreportedly

broughtthe

incidenceo

ffood

poisoningto

verylow

levels.It

isin

chargeo

fthe

onlypublic

toiletw

ithinthe

comm

unity,and

ensuresa

veryhigh

levelof

cleanliness.It

alsoensures

thatthe

inhabitantsdispose

ofsolid

waste

inthe

collectioncan

provided.

Data

sou

rce:

Focus

Group

Discussion,

1992.

While

thisis

typicalof

anum

berof

theC

DR

sencountered

(e.g.those

inJam

estown,

Madina

andM

amprobi),

theC

DR

inD

arkuman

would

seemto

havegone

further.T

heD

arkuman

CD

Rhas

beenvisibly

comm

ittedto

ahealthy

environment,

akey

concernof

thegroup.

To

realisethis

objective,the

grouphas

establisheda

projectscom

mittee,

whose

primary

taskis

tom

obilise[m

andalresources

tom

eetoperational

costs.A

sanitationcom

mittee

hasbeen

setup

with

theresponsibility

oforganisingcom

munity

mem

bersto

become

activelyinvolved

inthe

managem

entof

theirenvironm

ent.R

egularclean-up

campaigns

havebeen

organised,along

with

publiceducation

initiativesto

createaw

arenessof

environmental

sanitation.T

henet

resultof

allthese

effortshas

beenpositive.

Residents

havenot

onlycom

eto

valuekeeping

theirsurroundings

clean,but

theyhave

alsoorganised

themselves

intosm

allw

orkgroups.

Regular

activitiesinclude

sweeping

thestreets

andcleaning

chokedgutters.

The

CD

Rhas

alsoem

barkedon

campaigns

educatingvendors

onthe

dangerso

ffood

contamination

andthe

importance

of

keepingtheir

surroundingsclean

andsafe.

Stubbornfood

sellersare

made

topay

fines.T

heeffects

areencouraging.

InD

arkuman,

environmental

consciousnessis

nowhigh,

atleast

inpart

asa

resulto

fthe

CD

Rpublic

educationefforts.

The

unitC

DR

isin

closecontact

with

theE

nvironmental

Protection

Council

(EPC

)and

assiststhe

Council

by,for

example,

puttingup

postersto

make

peoplebecom

em

orevigilant

aboutthe

Benneh

etal.105

environment.

(One

of

theposters

reads:K

eepyour

surroundingsclean

forgood

health.)activities

of

theC

DR

reinforcethe

message.

As

insom

eother

areasvisited,

theD

arkuman

CD

Rinteracts

positivelyw

ithother

neighbourhoodorganisations.

Such

interactionyields

gooddividends

interm

so

fenvironm

entalm

anagement.

Overall,

thecase

of

Darkum

anw

ouldappear

tobe

somew

hatexceptional.

Inno

othercom

munity

havethe

activitieso

ftheC

DR

sbeen

soeffective

increating

asustained

comm

itmentto

aclean

environment.

Indeed,the

unsanitaryconditions

inm

ostneighbourhoods

suggestthat

clean-upcam

paignsare

notbearing

thedesired

results.F

urthermore,

therew

ereindications

of

seriousinternal

difficultiesand

conflictsw

ithin·som

eC

DR

s,no

doubtlim

itingtheir

effectiveness.A

sfar

asenvironm

entalm

anagement

isconcerned,

itappears

thatm

osto

fthe

CD

Rs

haverun

outo

fsteam

inrecent

years.A

lso,their

futureis

uncertainin

thelight

of

theongoing

democratisation

process.A

lternativesocial

arrangements

toprom

otea

cleanenvironm

entare

thereforerequired.

Fortunately,

some

suchsocial

mechanism

salready

existw

ithinthe

studyarea,

eitheras

spontaneousneighbourhood

organisationsor

officialneighbourhood

socialstructures.

10.5O

fficialNeighbourhood

Groups

Acharacteristic

featureo

ftheG

hanaiansocial

structureis

theem

ergenceo

fgroups

respondingto

specificcom

munity

needs.S

ome

of

thesegroups

haveevolved

with

supportand

encouragement

of

thestate.

Such

organisationsare

referredto

asofficial

neighbourhoodgroups.

They

aresm

allscale

government

agencies.S

ome

of

thesegroups

haveenvironm

entalm

anagement

astheir

primary

objective.F

orinstance,

theA

shaiman

Waste

Managem

entC

omm

itteew

asinaugurated

inM

arch,1991,and

hasbeen

primarily

concernedw

ithenvironm

entalsanitation.

Specifically,the

main

objectivesare

toadm

inisterthe

sanitaryfacilities:

maintain

them,

desludgethem

when

theyare

full,and

generallym

akethem

accessibleto

thecom

munity.

This

grouphas

beeneffective

interm

so

fits

main

objectives.T

heachievem

entsof

thecom

mittee

duringthe

firstseven

months

of

itsoperation

includethe

effectivem

anagement

of

publictoilets,

theorganisation

of

clean-upcam

paigns,and

activeinvolvem

entin

thegovernm

entsponsored

face-liftproject

forA

shaiman.

Phase

1o

fthis

projecthas

alreadybeen

completed.

The

projectsunder

thisphase

includedrainage,

rehabilitationo

fexistingtoilets

aridthe

constructiono

fnew

ones,as

well

asthe

extensiono

fpipedw

atersupply

tosom

ehitherto

deprivedareas.

Similarly,the

Bogyia

ServicesL

imited

of

Accra

New

Tow

nis

agood

example

of

inter-organisationalinteraction.

Established

inD

ecember,

1987,through

theco­

ordinatedefforts

of

theM

inistryo

fH

ealth,A

MA

,and

theG

erman

Governm

ent,the

grouphas

beenactively

involvedin

theplanned

disposalo

fliquid

andsolid

waste

within

theneighbourhood.

Such

technicaland

material

supportis

apositive

stimulant

forgroups

onthe

ground.T

heO

ldA

shaleB

otwe

Developm

entC

omm

itteeis

anothercase

inpoint.

With

thenecessary

assistancefrom

theD

epartment

of

Rural

Developm

ent,the

comm

unity,through

theleadership

of

theT

own

Developm

entC

omm

ittee,has

beenable

tobuild

fourK

VIPs.

This

hasim

provedsanitary

conditionsconsiderably.

Dynam

icgroups

of

thisnature

constitutecritical

socialstructural

variablesfor

effectiveenvironm

entalm

anagement.

106E

nvironmental

Problem

sand

theU

rbanH

ouseholdin

theG

AM

A-G

hana

10.6Spontaneous

Neighbourhood

Organisations

During

thecourse

of

thefield

work,

anum

bero

fspontaneous

neighbourhoodgroups

orclubs

were

identifiedw

ithinthe

studyarea.

These

include:Jerusalem

FunC

lub,T

ema

New

Tow

n;K

ungiyarN

asara(N

asaraC

lub),S

abonZ

ongo;M

aamobi

Islamic

Youth

Association,

Nim

a441

Muslim

Youth

Association,

theL

aM

ansaamo

Kpee

of

La

Tow

n(L

abadi),and

theN

ima

441W

elfareA

ssociation.T

heseclubs

emerged

spontaneouslyin

responseto

certainperceived

needsw

ithinthe

comm

unities.T

heyare

fonnalbut

voluntaryorganisations.

They

havespecific

goalsem

bodiedin

theirconstitutions,butm

embership

isoptional.

The

goalspursued

bythese

clubsvary.

How

ever,they

typicallyincorporate

comm

unity-wide

concerns.T

heJerusalem

FunC

lub,though

am

anifestlysocialising

neighbourhoodgroup,fosters

environmental

awareness

within

theT

ema

New

Tow

narea.

Furthennore,

inco-operation

with

otherclubs

inthe

area,it

activelyprom

otesenvironm

entalsanitation.The

Nim

a441

Muslim

Association,the

Maam

obiIslamic

Youth

Association

andthe

Kungiyar

Nasara

(Nasara

Club)

transcendtheir

imm

ediatereligious

concernsto

tackleenvironm

entalissues.

Indeed,concern

forthe

environment

isone

of

thefew

comm

onalitiesextending

acrossall

of

theseclubs.

Unfortunately,

theirdifferences

canm

askthis

comm

onconcern,

making

co-operationand

co-ordinationproblem

atic.T

wo

relativelysuccessful

neighbourhoodorganisations,

theN

ima

441W

elfareA

ssociationand

La

Mansaam

oK

peeo

fL

abadi(L

a),are

describedin

more

detailbelow

.

10.6.1N

ima

441W

elfareA

ssociationT

heN

ima

441W

elfareA

ssociationw

asestablished

inJuly,

1980.N

ima

isa

highdensity,

lowincom

eresidential

neighbourhood.S

anitationhas

beenan

endemic

problem.

The

objectiveso

fthe

Welfare

Association

includethe

promotion

andim

provement o

fsanitation

andthe

trainingo

funskilled

andunem

ployedpersons

soas

toenable

themto

become

gainfullyem

ployed.T

heassociation

hasachieved

considerablesuccess

inboth

regards.T

heassociation

hasbeen

ableto

trainthe

unskilledand

unemployed

invarious

skillslike

carpentry,dressm

aking,and

welding.

Group

mem

bershave

builta

clinicto

caterfor

thesick

inand

aroundthe

neighbourhood;they

havebeen

dealingw

ithenvironm

entalissuessuch

assolid

waste

disposal,desiltingo

fguttersand

sweeping

of

surroundings,and

organisingpublic

educationon

sanitationand

environmental

issues.A

24-seaterK

VIP

hasbeen

builtw

iththe

helpo

fa

Canadian

benevolentorganisation

(St.John).T

heassociation

derivesits

financesfrom

monthly

dues,special

contributions,revenue

fromthe

operationo

fthe

association'scom

-mill,

anddonations

fromthe

Netherlands

Em

bassy.G

iventhe

properenvironm

entand

thecom

mitm

ento

forganisational

mem

bers,there

isno

reasonthat

theeffectiveness

of

thegroup

shouldnot

besustained,

oreven

enhanced,to

thebenefit

ofsocial

andhum

andevelopm

entinthe

targetarea.

10.6.2L

aM

ansaamo

Kpee,

La

Tow

n(L

abadi)T

heL

aM

ansaamo

Kpee

(LM

K)

was

establishedin

1979by

eminentcitizens

of

thecom

munity.

The

objectiveso

fL

MK

includethe

provisiono

fa

forumfor

freediscussion

ofallthe

matters

thatw

illprom

otean

orderlyyet

vigorousdevelopm

ento

fthe

La

traditionalarea,

raisingthe

standardof

livingand

qualityo

flife

of

theinhabitants

of

La

byim

provingpublic

health,sanitation,

education,and

recreation

Benneh

etal.107

throughself-help

andvoluntary

serviceand

undertakingand

sponsoringdevelopm

entprojectsin

theL

aT

raditionalA

rea.

Box

10.2:E

nvironmentalM

anagementand

aS

pontaneousN

eighbourhoodA

ssociation:L

aM

ansaamo

Kpee

(LM

K).

The

effortso

fL

MK

tohelp

indeveloping

theL

atow

nby

way

ofim

provingpublic

sanitationhas

yieldedfour

publicw

atercloset

toilets(W

Cs),

onepublic

bathroom,

andthree

KV

IPtoilets

forsom

eschools

inthe

neighbourhood.A

lsothe

grouphas

beenable

tosetup

acom

munity

bank,which

isoperating

successfully.A

grantfrom

theA

fricanD

evelopmentFoundation

basedin

theU

.S.A

.,enabled

LM

Kto

establisha

revolvingfund

throughw

hichindividualhouseholds

areassisted

inbuilding

KV

IPsor

WC

sin

theirow

ncom

pounds.L

MK

bearsthe

fullconstructional

costw

hilethe

landlordor

owner

of

thehouse

isexpected

torepay

theloan

within

30m

onthsat

aninterest

of

11%

.C

reditadvanced

toeach

householdis

limited

to300,000.00

cedisper

project.A

tthe

mom

ent25

householdshave

benefitedfrom

thefund

andare

providingthem

selvesw

ithelectricity,w

aterandtoiletfacilities.

Da

taS

ource:F

ocusG

rou

pD

iscussionsand

Reports.

1992.

Th

eassociation

derivesfunds

fromm

anysources.T

heseinclude

monthly

dues,clan

houselevies,

grantsand

donationsfrom

organisationsabroad,

proceedsfrom

thehiring

outo

fa

cesspitemptier"a

tractorand

atipper

truck,and

profitsfrom

thecom

munity

bankw

hichare

investedinto

otherventures.

Th

eL

aM

asaamo

Kpee

iscertainly

asuccess

story.T

hissuccess

canbe

attributedto

severalfactors.

These

includethe

abilityto

generatefunds

fromm

embers

andresource

supportfrom

othersources,

theinteraction

of

theorganisation

with

otherlocal

andeven

internationalgroups,

and,o

fcourse,

them

embers'active

participation.S

pontaneousneighbourhood

groups,given

material

resourcesand

effectiveleadership,

canclearly

bevery

effective.E

nvironmental

managem

entis

anatural

focusfor

suchgroups.

As

such,there

alreadyexist

within

theA

ccram

etropolissocial

mechanism

so

rarrangem

entsthat

canhelp

promote

effectiveenvironm

entalm

anagement.

This

isan

opportunityw

hichenvironm

entalm

anagement

agenciesand

practitionersshould

capitaliseon

inthe

pursuito

ftheir

keyobjective:

ahealthy

city.

10.7H

ouseholds'Environm

entalRole

The

householdis

abasic

socialinstitution,

andcritical

toenvironm

entalm

anagement.

On

theone

hand,households

themselves

manage

ashared

space,and

oftenpeople's

most

criticaldecisions

regardingw

ater,sanitation,

cookingand

soon,

arevery

much

influencedby

thehousehold

context.O

nthe

otherhand,

householdsare

byno

means

always

harmonious

decision-making

units.H

ouseholdsare

theterm

inalfocus

of

many

of

thepolicies

andgovernm

entinterventions,

andm

anyenvironm

entalservices

takehouseholds

tobe

theirnatural

customers.

Needless

tosay,

householdperceptions

of,and

attitudestow

ardsenvironm

entalproblem

sare

vitalto

thesuccess

ofenvironm

entalprogram

mes.

108E

nvironmental

Problem

sa

nd

theU

rbanH

ouseholdin

theG

AM

A-G

hana

Inthe

Accra

context,it

isim

portantto

distinguishbetw

eensingle

householdunits

andm

ultiplehousehold

units.S

inglehousehold

unitsare

typicalo

fm

iddleand

highclass

areassuch

asA

irportR

esidentialA

rea,C

antonments,

East

Legon,

etc.Ironically,

inthese

singlefam

ilyhom

es,the

householdplays

arelatively

minor

rolein

environment

managem

ent.S

tateand

privateorganisations

playm

ajorroles

inthis

regard.T

herole

of

families

consistsin

depositingsolid

waste

inthe

appropriatecontainers

foreventual

disposalby

otheragencies

and,o

fcourse~.

ensuringthe

cleanlinesso

ftheim

mediate

surroundings-

atask

frequentlyexecuted

byhouse

maids.

The

situationw

ithinthe

lowincom

e,highdensity

residentialareas

isdrastically

different.S

uchareas

arecharacterised

byseveral

householdsliving

within

thesam

eresidential

unit,frequently

acom

poundhouse.

Residents

within

theseareas

typicallyexperience

them

oreacute

environmental

problems.

As

aresult

thehousehold

playsa

keyrole

inthe

maintenance

ofthe

environment.

Keeping

thesurroundings

cleanis

adaily

taskof

thehousehold.

Inm

ultiplehousehold

residentialarrangem

entsa

genderbased

divisionof

labourobtains

with

regardto

environmentaJ.

managem

ent.E

achhousehold

unitassum

esresponsibility

forits

imm

ediatesurroundings

-room

s,verandas.

Beyond

this,there

isshared

responsibilityfor

thelarger

compound

with

eachfam

ilytaking

turnsat

regularperiods

of

time

toensure

cleansurroundings.

Characteristically,

female

householdm

embers

of

variousages

performthis

vitallyim

portantrole.

The

more

conscioushouseholds

areo

fenvironm

entalissues,

thegreater

isthe

comm

itment

to,and

participationin,

environmental

managem

entat

thisbasically

micro-institutional

level.

10.8Sum

mary

an

dC

onclusionsA

lmost

everyinstitutional

levelhas

itsstrengths

andw

eaknesses.M

oreovernone

canoperate

effectivelyalone.

Success

dependsnot

onlyon

theefficiency

ofindividual

institutions,but

onhow

well

adaptedthey

areto

theinstitutions

which

surroundthem

.T

hisapplies

togovernm

entalas

well

asnon-governm

entalinstitutions.

The

government

clearlyhas

acritical

roleto

play.It

isalready

centralto

aw

iderange

of

environmental

services,and

most

respondentsfelt

thatthe

government

needsto

actto

addressa

rangeof

environmental

problems.

Within

thegovernm

entitself,

co-ordinationproblem

sarise,

giventhe

wide

rangeo

fm

inistriesresponsible

fordifferent

aspectso

fenvironm

entalm

anagement.

An

efficientsystemo

fco-ordination

andco-operation

would

certainlyenhance

theeffectiveness

ofenvironm

entalm

anagement

effortsat

thelevel

ofgovernm

entm

inistries,district

administration,

andthe

comm

unity.T

hereare,

however,

otherproblem

sw

hichm

akeitdifficultfor

thegovernm

enttorespond.

Given

thecurrent

financialcircum

stances,and

theim

perativeso

fstructural

adjustment,

financingenvironm

entalim

provement

isdifficult.

As

thew

ealthiestarea

inG

hana,it

isim

portantthat

GA

MA

doesnot

drainthe

nationaleconom

yto

solveits

localenvironm

entalproblem

s.U

nfortunately,local

taxesare

unlikelyto

providesignificant

amounts

of

additionalresources

inthe

nearterm

.O

nthe

otherhand,

giventhe

publicnature

of

most

environmental

amenities,

andthe

economic

statuso

fthe

householdsthem

selves,there

islim

itedscope

forcost

recoverythrough

userfees.

These

circumstances

make

itdifficultfor

thegovernm

enttotake

anythingnear

fullresponsibility

forproviding

environmental

servicesto

households,and

more

generallyensuring

thatenvironm

entalconditions

are

Benneh

etaI.109

adequate.D

evisingnew

andequitable

means

of

fmancing

improved

environmental

managem

entis

important.

Equally

critical,governm

entagencies

must

beable

tow

orkeffectively

with

non-governmental

institutions,w

how

illalso

continueto

playa

major

role.T

hereis

atendency

toportray

householdsas

direct"consum

ers"o

fenvironm

entalservices,

suchas

water,

garbagecollection,

sanitationprovision,

andso

on.In

GA

MA

,this

isnot

thecase,

particularlyin

poorareas.

Household

water

connections,hom

ew

astecollection,

andindividual

toiletsare

theexception,

notthe

rule.V

ariousinstitutions,

rangingfrom

informal

householdgroupings

toC

.D.R

.sm

ediatebetw

eenthe

householdsand

theservice

utilities.Im

provingthe

technicalefficiency

of

servicedelivery

andextending

theircoverage,

areclearly

important.

Providing

am

oreflexible

service,adapted

tothe

particularneeds

andinstitutional

contextoflow

-income

neighbourhoodscould

beequally

important.

Non-governm

entalinstitutions

arealso

important

inother

aspectso

fenvironm

entalm

anagement.

The

focusgroup

discussionsindicated

thatneighbourhood

organisationsare

dynamic

socialstructures,

takinga

wide

varietyo

fchangingform

s.E

nvironmental

managem

entagenciesand

practitionersw

illhave

totake

activeaccount

of

thesegroups.

They

arealready

involvedin

environmental

managem

ent,and,

giventhe

rightsupport,

coulddo

evenm

ore.L

ocalparticipation

inenvironm

entalm

anagement

istim

econsum

ingand

canbe

aburden.

But

itcan

alsoincrease

comm

itment

andappropriate

socialnorm

s,as

well

ashelping

ensurethatthe

prioritieso

flocalresidents

aretaken

intoaccount.

Fortunately,

theW

astesM

anagement

Departm

ento

fthe

Accra

Metropolitan

Assem

blyrecognises

theim

portanceo

fthe

complex

of

factorsin

environmental

managem

ent.T

heobjectives

ofthe

departmentinclude

thefollow

ing:

To

involvethe

comm

unityin

variousaspects

of

waste

managem

ent,particularly

inthe

areao

fparticipation,

clean-upcam

paigns/healthday

activities,maintenance

ofresidential

drainsand

paymento

ffees.'Involvem

ento

fthe

privatesector

andN

on-Governm

entalA

genciesin

thew

astem

anagementdelivery

sector.P

ubliceducation

of

thecom

munity

soas

toim

proveuser

habitso

fthe

facilities,thatis,containers,public

drainsand

toilets(A

MA

Docum

ent).

The

realisationo

fthese

statedobjectives

would

certainlyprom

otethe

effectivenesso

fenvironm

entalm

anagement

andcreate

therequisite

conditionsfor

ahealthy

Accra

City.

The

challengew

illbe

totum

themfrom

goalsinto

operatingprinciples.

With

regardto

environmental

educationthere

alsoappears

tobe

groundat

leastforqualified

optimism

aboutthe

future.P

upilsatthe

JuniorS

econdaryS

choollevel

areexposed

tocourses

onenvironm

entalstudies.

These

seminal

programm

eshave

thepotential

of

drawing

outthe

pupils'concern

forthe

environment,

andm

akingit

more

effective.T

ogetherw

ithother

neweducational

initiatives,such

effortscan

besignificantin

furtheringthe

causeo

fenvironmentalm

anagement.

110E

nvironmental

Problem

sand

theU

rbanH

ouseholdin

theG

AM

A-G

hana

CH

AP

TE

RE

LE

VE

N

11SU

MM

AR

YO

FP

OL

ICY

IMP

LIC

An

ON

S11.1

IntroductionT

heprincipal

purposeo

fthis

reportis

topresent

action-relevantfm

dings,not

tom

akespecific

policyrecom

mendations.

Effective

policiesem

ergefrom

politicalprocesses,

andcannot

bededuced

fromthe

resultso

fa

study.In

anycase,

identifyingand

evaluatingthe

rangeo

foptions

available,and

examining

acoherent

strategy,is

beyondthe

scopeo

fthis

study.E

venat

thisearly

stage,how

ever,it

ispossible

todraw

·some

conclusionsabout

thefonn

anappropriate

strategyw

ouldprobably

take,and

thepriority

problems

which

needto

beaddressed.

Household

environmental

improvem

entis

notsim

plyanother

concernto

beadded

tothe

longw

ish-listo

fany

urbancentre

suchas

GA

MA

.It

iscentral

toim

provingthe

well-being

of

thepopulation.

Previous

chaptershave

describedin

some

detail:

1.T

heserious

deficienciesin

households'environmentalconditions.

2.T

heclose

associationbetw

eena

number

ofthese

deficienciesand

ill-health.

3.T

hedisproportionate

shareo

fthe

environmental

healthburden

borneby

thepoor.

4.T

hehigh

valuepeople

placeon

improvem

ents,despite

severeeconom

icconstraints.

5.T

hecom

mon

perceptionthat

thegovernm

entshould

takethe

leadin

introducingim

provements

ina

number

of

areas.T

akentogether,

theresults

demonstrate

theim

portanceo

fdeveloping

anenvironm

ental-healthstrategy

forA

ccra.B

utperhapsm

oreim

portant,theyindicate

where

them

ostpressing

concernslie,

andcan

helpidentify

opportunitiesand

obstaclesw

hichan

effectivestrategy

mustconfront.

The

following

subsectionsreview

some

of

thepolicy

implications

ineach

problemarea.

The

Chapter

thenconcludes

with

abrief

discussiono

fthe

needto

developan

integratedstrategy

tohousehold

environmental

improvem

ent,and

some

ofthe

ways

inw

hichresearch

couldcom

plementsuch

developments.

11.2W

aterT

hedeficiencies

inthe

water

supplysystem

servinghouseholds

inG

AM

Aare

serious,but

probablyless

seriousthan

inm

osto

fthe

country.O

nlya

minority

of

householdshave

indoorpiping,

butm

ostlive

within

arelatively

shortdistance

of

aw

atertap.

The

qualityo

fthew

ateratthe

tapw

ouldgenerally

seemto

beadequate,

exceptperhaps

inpoor

neighbourhoods.G

AM

Ahouseholds

aredependent

onthe

pipedw

atersystem

,and

cansuffer

considerablyw

henthat

systemfails.

How

ever,such

failuresare

lesso

fa

burdenfor

GA

MA

residentsthan

thechronic

water

qualityand

quantityproblem

salm

ostcertainly

experiencedm

oreseverely

inother

partso

fG

hana.W

ithinG

AM

A,

accessto

water

iscurrently

am

oreserious

problemthan

water

qualityat

thetap.

The

resultsindicate

asignificantim

provement in

healthw

henthe

tapsare

locatedw

ithinthe

housecom

pounds,probably

dueto

thebetter

hygienepractices

easyaccess

tow

aterallow

s.A

lternatively,w

atersupply

interruptionsw

erevery

stronglyassociated

with

healthproblem

s.H

owever,

extendingthe

water

Benneh

etal.111

systemand

increasingthroughput

iscostly.

Given

prevailingeconom

icconditions,

providingall

householdsw

ithin-house

pipingm

ustremain

along

termgoal.

Inthe

medium

term,

providingstandpipes

tocom

poundhousing

unitsm

aybring

almost

equivalenthealth

benefitsat

considerablylow

ercost.

Even

inthe

shortterm

,efforts

toincrease

thew

atersupply

tolow

-income

areasare

warranted:

inaddition

tohealth

improvem

ents,a

greaterw

atersupply

shouldlead

tolow

ervendor

prices.T

heresults

clearlydem

onstratethat

theexisting

systemplaces

thegreatest

healthburden

onpoor

households,w

hoalso

oftenrely

onw

atervendors

andend

uppaying

thehighest

pricesfor

theirw

ater.T

hisis

verym

uchcounter

tothe

government's

intentions,and

deservesspecial

attention.W

hilem

anyvendors

..

chargehigh

pricesfor

water,

effortsto

controlvendors

directlyare

likelyto

becounter-productive.

Ifsanctions

decreasevendor

sales,for

example,

supplyproblem

sw

illbe

exacerbatedand

unofficialw

aterprices

may

actuallyrise.

Itshould

bepossible,

however,

touse

vendorprices

asan

indicatoro

fw

hichlow

­incom

eareas

deservespecial

effortsto

increasew

atersupply.

Alternatively,

theexisting

water

tariff,w

hileintending

tobe

progressive,discrim

inatesagainst

householdsw

hichshare

water

connections.H

ighprices

arecharged

tolarge

consumers,

bothin

orderto

preventprofligate

water

use,and

becauselarge

consumers

areconsidered

wealthy.

When

severalhouseholds

sharea

meter,

however,

theycan

easilyhave

highm

eterreadings

despitea

lowper-household

consumption.

There

area

number

of

possiblem

eanso

fredressing

thisproblem

,ranging

fromarea-based

pricingto

formal

recognitiono

fsharedm

eters.A

largeshare

of

thew

atersam

plestaken

fromw

aterstorage

containersshow

edevidence

of

faecalcontam

ination.T

hisreflects

boththe

water

supplyproblem

sw

hichnecessitate

considerablein-house

storage,and

hygieneproblem

s(see

sub-sectionon

hygienebelow

).Households

usingpots

tostore

theirw

aterhad

asignificantly

higherlevel

of

childhooddiarrhoea.

While

itshould

notbe

assumed

thatstorage

inpots

isthe

causeo

fthis

ill-health,further

investigationis

clearlyw

arranted.S

houldpots

proveto

beleading

tow

atercontam

ination,there

area

number

ofrelatively

low-costpolicy

measures

which

couldbe

taken.

11.3Sanitation

an

dH

ygieneA

lleviatingthe

householdsanitation

problems

of

GA

MA

isclearly

apriority.

The

technologyprofile

may

lookrelatively

favourable,w

itha

comparatively

highshare

of

households(36%

)using

flushtoilets

andfew

(3%)

without

accessto

anytoilet

facilitiesat

all.H

owever,

fora

largesegm

ento

fthe

population,the

extreme

levelo

fcrow

dingnegates

anytechnological

advantageover

lessurbanised

settings.A

lmost

halfo

fthe

householdsshared

toiletfacilities

with

atleast

tenother

households.M

anycom

plainedthat

thequeues

fortheir

toiletsw

eresom

etimes

solong

asto

renderthem

unusable.In

additionto

causingunhygenic

conditionsin

thetoilets

themselves,

over-crowding

of

existingfacilities

leadsto

opendefecation,

which

isitselfan

importantpublic

healthhazard

inG

AM

A.

Indeedboth

thesharing

of

toiletsand

opendefecation

byneighbourhood

childrenw

erefound

tobe

closelyassociated

with

higherdiarrhoeal

prevalenceam

ongchildren.

Given

theseconditions,

increasingthe

quantityo

ftoilet

facilitiesavailable

isprobably

more

criticalto

publichealth

thanintroducing

improved

technologies.O

wing

tothe

comm

unalcharacter

of

alarge

shareo

fthe

facilities,the

government

andcom

munity

groupsare

alreadyinvolved

indeterm

iningthe

quantityo

ffacilities

available.M

osthouseholds

interviewed

feltthat

thegovernm

entneeds

totake

thelead

insanitation

improvem

ents,though

asignificant

sharefelt

actionat

the

112E

nvironmental

Problem

sand

theU

rbanH

ouseholdin

theG

AM

A-G

hana

neighbourhoodlevel

was

more

critical.U

ltimately,

thesuccessful

provisionand

operationo

fcom

munal

toiletsdepends

oneffective

collaborationo

fgovernm

ent(e.g.

theW

asteM

anagementD

epartment)

andlocal

groups.Identifying

additionalsources

of

fundsfor

expandingsanitation

provisionis

itselfa-priority.

The

pricingo

fcom

munity

toiletsis

relativelyhigh,

giventhe

lowincom

eso

fm

ostusers.

Insom

ecom

munities

chargeson

usingthe

toiletsare

employed

tohelp

financeother

environmental

clean-upactivities.

There

islittle

evidencethat

thesehigh

chargesare

anim

portantfactorin

dissuadingpeople

fromusing

toilets(people

were

more

likelyto

citethe

lengtho

fthe

queuesor

toiletsbeing

outo

forder

orclosed).

How

ever,given

theinsufficient

supplyo

fsanitary

facilities,the

diversiono

ffunds

which

couldbe

usedto

expandsupplies

isa

matter

of

concern.It

amounts

toa

taxon

aservice

which

providespublic

benefits,and

economics

suggestsshould

bepartially

fmanced

throughother

taxesor

publicrevenues.

More

generally,the

difficultiesencountered

atthe

locallevel

infunding

sanitationim

provementreflect

anunderlying

obstacleto

comm

unityenvironm

entalm

anagement.

User

chargesalone

cannotprovide

anefficient

means

of

fmancing

allenvironm

entalservices,letalone

environmental

improvem

entsnot

linkedto

servicedelivery.

Yet

fewcom

munities

havethe

capacityto

raisesubstantial

fundsthrough

otherm

eans.T

heresults

alsoindicate

thatgood

hygienebehaviour

isassociated

with

appreciablybetter

health.H

owever,

while

thegovernm

entis

directlyinvolved

inproviding

water

andsanitation

facilities,it

cannotprescribe

hygienebehaviour.

Moreover,

theresults

suggestthat

hygienebehaviour

isclosely

linkedto

theprovision

of

water

andsanitation

facilities,and

more

generallyeconom

icconstraints.T

hem

ostobviousdifference

between

thesituation

inpoor

andw

ealthyhouseholds

isnot

thatw

ealthyhouseholds

arem

oreaw

areo

fgood

hygienepractices,

butthat

theyhave

facilitiesw

hichm

akegood

hygienepractice

comparatively

simple.

Itis

oftennoted

thatw

aterand

sanitationim

provements

canfail

when

hygienepractices

remain

thesam

e.T

hereverse

isequally

true:education

andaw

arenessprograinm

esare

farm

orelikely

tobe

effectiveif

accompanied

byim

provedenvironm

entalservices.

11.4Solid

Waste

Accum

ulationso

fsolid

waste

createproblem

sat

thefm

aldisposal

sites,at

neighbourhooddum

pingsites,

andeven

within

people'shom

es.Financially

precariouscities

typicallyhave

difficultiesm

aintainingan

efficientw

astedisposal

system,

andA

ccrais

noexception.

With

Ghana's

economic

difficultiesin

thelate

70sand

early80s,

thew

astem

anagement

systemfell

intocrisis.

More

recently,som

eo

fthe

deficiencieshave

beenredressed,

butthe

Waste

Managem

entD

epartment

canstill

onlycollect

abouttw

othirds

of

thew

astegenerated,

andexisting

disposalsites

arealready

overused.O

nlyabout

10%o

fhouseholds

havehom

e-collection,andincom

pletecollection

typicallyleads

tolocal

accumulations

of

waste,

especiallyin

relativelypoor

neighbourhoods.Problem

sw

ithw

astestorage

within

peopleshom

esare

relativelyindependento

fthew

astecollection

system,but

canaffect

theindoor

environment.

The

surveyresults

indicate,for

example,

thatopen

storageo

fw

astew

ithinthe

homes

isassociated

with

ahigher

prevalenceof

insectsand

rodents.W

hilesolid

waste

problems

arenot

apriority

healthconcern,

therespondents

clearlyfelt

improvem

entsw

ereneeded,

andw

ereinclined

toidentify

thegovernm

entas

thekey

actor.A

lso,there

were

indicationsthat

while

peoplem

ay

Benneh

etai.113

notw

antto

payfor

apoor

service,they

arew

illingto

paysignificant

sums

forgood

service.A

sw

ithsanitation,

many

localgroups

arealready

somew

hatinvolved

insolid

waste

managem

ent,and

probablydeserve

more

support.S

uccessfullocal

managem

entcan

easilybe

inhibitedby

institutionalobstacles.

Unlike

comm

unaltoilets,

itis

difficultto

chargefor

comm

unalsolid

waste

managem

ent.Y

etlocal

groupsm

usthave

areliable

means

of

raisingfunds

iftheyare

toplay

anim

portantrole

overthe

longterm

.E

quallyim

portantis

areliable

municipal

waste

collectionservice,

anda

goodinterface

between

thecollection

serviceand

thelocal

managem

entsystem

.It

isdifficult

toenvisage

major

improvem

entsin

thesolid

waste

situationw

ithoutincreasing

thecollection

anddisposal

(and/orrecycling)

capacity.

11.5P

estsan

dP

esticidesInsects,

andespecially

malarial

mosquitoes,

areundoubtedly

am

ajorhealth

riskfor

GA

MA

residents.M

alariais

theprincipal

healthproblem

reportedby

out-patientclinics.

Fliesare

aknow

nhealth

risk,especially

when

sanitaryconditions

arepoor,

andstrong

associationsw

erefound

between

thepresence

of

fliesin

thekitchen

andhealth

problems

among

children.F

urthermore

,the

resultsindicate

thatim

provedinsectcontrol

isa

priorityam

ongthe

householdsthem

selves.U

rbanareas

generallyhave

acom

parativeadvantage

inm

alariacontrol,

asm

alarialspecies

arerelatively

poorlysuited

tourban

conditions.H

owever,

while

householdsspend

considerablesum

son

chemical

mosquito

control,relatively

littlehas

beendone

toexploit

GA

MA

'surban

advantagethrough

environmental

managem

ent.F

roma

householdperspective,

anem

phasison

chemical

controlis

understandable.It

isdifficult

forindividual

householdsto

identify,let

aloneelim

inate,breeding

sites.F

urthermore,

insecticidesand

insectrepellents

clearlytarget

themo~quitoes

threateningthe

householditself,

while

environmental

managem

entdoes

not.A

sa

result,effective

environmental

managem

entfor

mosquito

controlalm

ostinevitablyrequires

publicsector

support.C

hemical

insectcontrol

canitself

createenvironm

entalproblem

sand

healthrisks.

Associations

were

foundbetw

eenthe

useo

fm

osquitocoils

andthe

prevalenceo

frespiratory

illnessam

ongchildren,

andbetw

eenthe

useo

fpum

p­spray

insecticidesand

theprevalence

of

respiratoryproblem

symptom

sam

ongfem

aleprincipal

homem

akers.W

hilethese

fmdings

shouldbe

interpretedw

ithcare,

thepossibility

thatcurrent

methods

of

insectcontrolare

contributingto

respiratoryproblem

sdoes

indicateanother

advantageo

fenvironm

entalm

anagement.

While

mosquito

controlthrough

improved

environmental

managem

entoften

hasbenefits

overand

abovea

declinein

malaria

prevalence,chem

icalcontrol

islikely

tohave

damaging

side-effects.T

hisis

notto

say,how

ever,that

chemical

controlshould

beuniversally

condemned.

Indeed,it

iscritical

todistinguish

between

differenttypes

of

chemical

control,and

differentiatebetw

eenthose

which

yieldan

acceptablerisk

andthose

which

donot.

An

effectiveprogram

me

of

mosquito

controlthrough

environmental

managem

entw

illrequire

farm

oreinform

ationthan

couldbe

collectedor

reviewed

inthe

courseo

fthis

study.The

newinsights

thatcan

bederived

fromthis

studyare

limited

byinherent

inaccuraciesin

self-reportedm

alariaprevalence,

andthe

lacko

finform

ationon

differentm

osquitospecies.

Past

studiesindicate

thatsom

em

alarialspecies

arebecom

ingbetter

adaptedto

breedingin,for

example,A

ccra'shousehold

water

storagecontainers.

The

resultso

fthis

studyindicated

asom

ewhat

higher

114E

nvironmental

Problem

sand

theU

rbanH

ouseholdin

theG

AM

A-G

hana

levelo

fm

osquitobiting

inhouseholds

storingtheir

water

indoors.T

heseresults

indicatethe

potentialim

portanceo

fcollecting

information

onm

osquitobreeding

andbiting

inA

ccra,but

onlybegin

toansw

era

number

ofcritical

questionsrelevant

toenvironm

entalm

anagement.

Fliesm

aynot

posea

healthhazard

comparable

tom

alaria,but

areim

portantdisease

vectorsnonetheless.

Fliesare

bothfilth-feeders

andfilth-breeders.

They

arem

echanicalcarriers

of

disease,and

posea

particularrisk

when

regularlyin

contactw

ithboth

human

faecalm

aterialand

food.T

hepresence

of

many

fliesin

thekitchen

was

foundto

beassociated

with

ahigher

prevalenceo

fchildhood

diarrhoea.H

owever,

them

ostobvious

means

todecrease

therisk

of

foodcontam

inationfrom

fliesare

improvem

entsin

sanitation,solid

waste

disposaland

foodhandling.

People

shouldbe

made

aware

of

thedangers

fliespose,

butthere

islittle

pointindesigning

policiestargeting

fliesin

particular.

11.6F

oodC

ontamination

The

contributiono

fmicrobial

foodcontam

inationto

ill-healthis

difficulttodiscern,

butcould

beconsiderable.

Three

of

thevariables

foundto

beassociated

with

ahigher

diarrhoeaprevalence

may

reflectfoodcontam

inationproblem

s:the

presenceo

fflies

inkitchens;

notalw

aysw

ashinghands

priorto

foodpreparation;

frequentingprepared-food

vendors.P

opularperceptions

clearlylin

kfood

toillness,

andalm

osthalf o

fthe

questionnairerespondents

whose

childrenhad

haddiarrhoea

identifiedbad

foodas

aprobable

cause.(F

oodeaten

out,rather

thanfood

preparedat

home,

was

typicallyblam

ed,how

ever).W

hileit

isunlikely

thatanything

likehalf

of

thediarrhoea

casesare

theresult

of

eatingcontam

inatedfood,

theresults

areconsistent

with

thenotion

thatfood

isone

ofthe

more

comm

onroutes

throughw

hich"w

aterdiseases"

arecontracted.

Unfortunately,

itis

difficultto

designpolicies

toim

provefood

handlingpractices.

Better

water,

sanitationand

solidw

astedisposal

arelikely

tohelp.Im

provedhygiene

educationis

possible.G

overnment

regulationo

fsm

allfood

vendors,however,is

likelyto

beineffective

andpossibly

counterproductive.O

nthe

otherhand,

some

localgroups

arealready

actingto

improve

thehygiene

of

foodvendors

intheir

neighbourhoods.Providing

supportfor

theselocal

activitiescould

wellbe

oneo

fthem

osteffectivem

eansofim

provingfood

qualitydirectly.

11.7H

ouseholdA

irP

ollutionC

ookingw

ithcharcoal

orfirew

ood,and

especiallythe

latter,gives

riseto

potentiallydam

aginglevels

of

pollutionexposure.

How

ever,conditions

areprobably

worse

inother

partso

fthe

country,w

herew

oodis

thepredom

inantcooking

fuel.W

ithinG

AM

Am

ostofthehouseholds

relyingprim

arilyon

wood

livein

therural

fringe,and

itisthere

thatexposureto

particulatesfrom

cookingfires

islikely

tobe

highest.In

some

circumstances,

however,

urbancrow

dingm

aylead

tocooking

indoorsin

small

poorlyventilated

rooms.

Inhouseholds

where

cookingw

asalw

aysdone

indoors,both

wom

en'sand

children'srespiratory

problems

were

more

comm

on,and

children'srespiratory

problems

were

alsom

orecom

mon

when

theyw

ereoften

presentduringcooking.

Prom

otingthe

increaseduse

of

LP

Gor

electricityfor

cookingw

ouldreduce

exposuream

onghouseholds

which

switched

tothese

fuels.H

owever,

subsidieslarge

enoughto

influencefuel

choiceare

likelyto

bevery

costly.M

oreover,the

healthbenefits

will

almost

inevitablyaccrue

primarily

tothe

relativelyw

ell-off.E

venif

theshare

of

householdsusing

LP

Gor

electricityas

theirprincipal

fuel

Benneh

etal.115

couldbe

trebledthrough

subsidiesm

ostpoorhouseholds

would

stillbeusing

wood

andcharcoal.A

tleastin

theshort

term,

improved

cookingpractices,

possiblyin

conjunctionw

ithim

provedstoves,

areo

fm

orerelevance

tothe

poorm

ajority.H

owever,

theresults

suggestthan

many

wom

enare

notconcerned

aboutexposure

tosm

okefrom

cookingfIres.

There

islittle

pointin

advocatingm

easuresto

reducesm

okeexposure

topeople

who

donot

perceivesm

oketo

bea

signifIcantproblem

.M

orethan

with

thehousehold

environmental

problems

examined,

educationshould

becentral

toany

seriousefforts

tocurb

smoke

exposure.S

uchinform

ationcould

beintegrated

intocam

paignsagainstsm

okingcigarettes.

11.8A

nIntegrated

Environm

entalStrategyA

successfulenvironm

entalstrategy

forG

AM

Am

ustcom

eto

terms

with

boththe

verysevere

environmental

problems

peopleface

intheir

homes

andneighbourhoods

andalso

city-wide

environmental

degradationand

theregional

impact

of

developments

inG

AM

A.

Itw

ouldbe

economically

inappropriateand

fmancially

infeasibleto

implem

enta

traditionalinfrastructure

programfor

GA

MA

onthe

scaleneeded

toaddress

allhousehold-level

problems,

evendisregarding

thebroader

environmentalim

plicationso

fsuch

anapproach.

On

theother

hand,partial

measures,

slowly

extendingthe

coverageo

fgood

qualityenvironm

entalservices,

riskfavouring

therelatively

well-off.

Itis

thereforecritical

toidentify

means

toassist

thepoor

majority,

who

will

nothave

indoorpiping,

individualtoilets,

or

householdw

astecollection

inthe

nearfuture.

.E

conomic

austeritym

akesit

allthe

more

important

thatpolicy

actionrespond

tolocal

prioritiesand

bebased

onthe

bestinform

ationavailable.

Under

existingconditions,

itis

notenough

forpolicy

analyststo

identifyserious

problems

andrecom

mend

actions.T

hegovernm

entcannotaffordto

takeon

allserious

problems.

DiffIcult

choiceshave

tobe

made.

The

perceptionsand

prioritieso

flocal

residentscan

helpguide

policydevelopm

ent.Inform

ationon

existingconditions

andhealth

riskscan

alsohelp

ensurethatim

provementefforts

arew

elltargeted.

With

tightconstraints

ongovernm

entexpenditures,

itis

alsoim

portantthat

environmental

strategiestake

fullaccount

of

non-governmental

institutions,and

theirpotential

rolein

environmentalm

anagement.

As

indicatedin

Chapter

10,thereare

aw

iderange

of

localinstitutions

working

with

varyingdegrees

of

successin

GA

MA

.T

hem

oresuccessful

examples

receivedat

leastsom

edegree

of

externalsupport.

Assisting

theseinterm

ediateinstitutions,

bothinstitutionally

andfm

ancially,is

oftenlikely

tobe

more

cost-effectivethan

simply

expendingresources

oninfrastructure

development.

Itshould

alsobe

keptin

mind,

however,

thatespecially

inrelatively

poorareas,

integratedim

provement

effortsare

more

likelyto

beeffective

thana

serieso

findependent

interventions.Physically,

theproblem

sare

closelyinterrelated.

Sanitation,w

ater,hygiene

andfood

contamination

problems

areso

intertwined

thattheir

bordersare

difficultto

defIne,and

most

problemareas

haveat

leastsom

einterconnections.

Refuse

canbe

abreeding

groundfor

flies,w

hichthen

leadto

foodcontam

ination.W

ater,including

householdw

aterstorage

containers,can

bea

breedingsite

form

alarialm

osquitoes.C

hangesin

cookinghabits

may

notonly

affectfood

contamination,

butalso

smoke

exposure.G

iventhese

closeinterrelations,

itiscritical

thatimprovem

entsbe

complem

entary.T

akentogether,

allo

fthese

considerationspoint

tothe

needfor

anintegrated

strategyfor

environmental

managem

entinG

AM

A.

The

problems

aretoo

severeto

116E

nvironmental

Problem

sand

theU

rbanH

ouseholdin

theG

AM

A-G

hana

beignored.

Econom

icand

fmancial

conditionspreclude

administratively

simple,

high-costsolutions.

Th

einstitutional

contextprovides

arange

of

opportunities,but

anum

bero

fco-ordination

andco-operation

problems.

Th

ephysical

interrelationspose

adifferent

seto

fco-ordination

problems

andopportunities.

Only

acoherent

strategycan

holdout

thehope

of

weaving

togetherthe

threadsin

thisw

eb.T

hisreport

hasonly

begunto

tapthe

policyrelevant

information

which

hasbeen

collectedin

thecourse

of

thisstudy.

There

areim

portantpolicy-related

issuesregarding

environmental

serviceprovision,

housetenure,

settlement

planning,gender

andepidem

iology,m

anyo

fw

hichcould

beexplored

with

thehelp

of

thedata

baseem

ployedhere.

Ina

fewareas,

thestatistical

associationspresented

needto

befollow

edup

with

more

detailedphysical

evaluations.The

associationbetw

eenpum

p-spraypesticides

andrespiratory

problems

isa

casein

point:there

isnot

enoughevidence

tocondem

nthese

insecticidesoutright,

thoughthere

ism

orethan

enoughto

justifya

carefulinvestigation

of

thechem

icalsand

practicesinvolved.

Perhaps

more

important

thanthese

extensions,how

ever,the

resultscould

beem

ployedin

thepolicy

development

processitself. It

would

bepossible

todevelop

aset

of

environmental

healthindicators

\yhichcould

beused

tohelp

monitor

endemic

environmental

healthhazards,

andsupport

targetedpolicies

designedto

improve

conditionsin

criticalareas.

Alternatively,

theresults

couldprovide

criticalinput

toevaluations

of

particularoptions,

suchas

investments

inim

provedsanitation

facilitieso

renvironm

entalcontrol

of

malarial

mosquitoes.

Inshort,

thisreport

neednot

beseen

asthe

end-producto

fa

researchproject

-it

couldalso

bethe

startingpoint

forrenew

edefforts

toim

provethe

environmental

conditionsfor

thepeople

of

GA

MA

.

RE

FE

RE

NC

ES

Benneh

etal.117

AM

A1991.D

epartmento

fHealth

AnnualR

eport.Accra

Metropolitan

Assem

bly,A

ccra.A

ccraP

lanningD

evelopmentP

rogramm

e,UN

DP

,HA

BIT

AT

.1992.

StrategicP

lan

for

theG

reaterA

ccraM

etropolitanA

rea.Volum

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.and

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.O

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1989.Cockroaches

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ayfo

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aterin

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anitationR

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aseStudy.

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ftheU

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orldB

anklUN

CH

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rbanM

anagementP

rogramm

e.A

PH

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ethodsfo

rthe

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inationo

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an

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astewater.

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ssociation,Washington,D

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Arm

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Berry.

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ethodsin

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lackwellS

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Songsore,

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.KY

anksonand

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ographicstudies

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rojectionsfor

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AB

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me,

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Bennan,S.

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iologyo

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evelopingC

ountries.R

eviewo

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iseases13

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454­462.

Bradley,

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Cairncross,T

.H

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eviewo

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nvironmentalH

ealthIm

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aper.U

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ank,U

ND

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airncross,S.

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heP

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ieY

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.R.

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R.

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Chinery,W

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hanaM

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hinery,W.A

1984.Effects

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hana.JournalofT

ropicalMedicine

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Dickson,K

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eographyo

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td.1989.E

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evelopmentP

rogramm

e.A

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118E

nvironmentalP

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Esrey,S

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G.

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.H

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improving

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ulletino

ftheW

orldH

ealthO

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srey,S.A

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abicht.1986.E

pidemiological

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hanaG

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ealthA

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90

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heepidem

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pidemiologic

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itlinand

D.

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aite.1992.

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ousingN

eedsA

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ol.I,II

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abitatandA

ccraP

lanningand

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ER

CR

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.E.

1978.F

aecalS

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Berg,G

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atera

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Arbor,M

ichigan,USA

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irkwood,

B.

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cuteR

espiratoryInfections.In

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.F

eachamand

D.T

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iseasea

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xfordU

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.D.

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indskog,P.

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Lundquist.

1990.W

hyP

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eopleStay

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elfarein

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candinavianInstitute

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McG

ranahan,G.

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roblems

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cGranahan,

G.

andA

.K

aiser.1993.H

ouseholdE

nergy:P

roblems,

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an

dP

rospects.S

tockholmE

nvironmentInstitute,S

tockholm.

Mitchell,R

C.

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T.

Carson.

1989.U

singSurveys

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alueP

ublicG

oods:The

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Valuation

Method.

Resources

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ashington,D

C.

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1989.E

mploym

entandE

conomic

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ccraM

etropolitanA

rea).F

inalReport.

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Sm

ith,K

R1987.

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ealth:A

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eview.P

lenumP

ress,New

York.

Sm

ith,K

1993.Fuel

Com

bustion,Air

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andH

ealth:T

heS

ituationin

Developing

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InA

nnualReview

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nergyand

Environm

ent18:529-66.

Songsore,

J.1992.

Review

ofH

ouseholdE

nvironmentalproblem

sin

theA

MA

,G

hana.Working

Paper.

Stockholm

Environm

entInstitute,Stockholm

.S

ongsore,J.

(Inpress).T

heU

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ousingC

risisin

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apital,theS

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eople.G

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Stren,

RE

.1989.

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overnmentin

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RW

hite(eds.).

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apidU

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rowth.

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rchitectural&

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Services

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1981.Accra-T

ema

Water

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nd

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eviewo

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2.Accra.

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IWH

O.

1988.Assessm

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irQ

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oni­toring

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,World

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anDerslice,J.

andJ.

Briscoe.

1993.All

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Acom

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fthe

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atercontam

inationon

infantilediarrheal

disease.W

aterR

esourcesR

esearch.29:1965-1974.

Wellburn,A

.1988.A

irP

ollutiona

nd

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ongman,H

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.W

hiteR

R1989.T

heInfluence

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nvironmental

andE

conomic

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inthe

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Crisis.In

RS

trenand

RW

hite(eds).

African

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inC

risis:M

anagingR

apidU

rbanG

rowth.

Westview

Press,B

oulder.W

hittingtonD

, J.B

riscoe,Mu

Xinm

ingand

W.

Banon.

1990.Estim

atingT

heW

illingnessto

Pay

forW

aterS

ervicesin

Developing

Countries:

Acase

studyo

fthe

useo

fcontingentvaluationsurveys

insouthern

Haiti.

Econom

icD

evelqpmenta

nd

Cultural

Change

38:293-312.W

HO

.1984.

Gu

idelin

esfor

Drinking

Water

Quality.

World

Health

Organization,

Geneva.

WH

O.

1988a.U

rbanV

ectorP

estC

ontrol,Technical

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eriesN

o.767,

WH

O,

Geneva.

120E

nvironmentalP

roblems

andthe

Urban

Household

inthe

GA

MA

-Ghana

AP

PE

ND

IX1

Sam

plin

gP

rocedurefor

Questionnaire

SurveyT

hefIrst

orderstratifIcation

isdescribed

inthe

introductorychapter

of

thisreport.

The

selectiono

fneighbourhoods

tobe

sampled

fromeach

strataw

asa

modifIcation

ofthe

listemployed

inthe

Housing

Needs

Assessm

entStudy(H

ousingand

Urban

Developm

entAssociates,

1990).T

headditions

arestarred

inT

able1.6.

andare

intendedto

reflectthe

recentextensiono

ftheboundary

of

GA

MA

,and

theaddition

of

therural

peripherycategory.

For

Accra,

25o

fthe

52neighbourhoods

arerepresented,

forT

ema

8o

fthe

22neighbourhoods

arerepresented,

andfor

Ga

7o

fthe20

neighbourhoodsare

represented..

The

sample

was

apportionedam

ongA

ccra,T

ema,

andG

adistricts

soas

toreflect

theapproxim

aterelative

populationshares

ofthese

districts,·asestim

atedfor

1992(B

ennehet

al,1990).

Within

thestrata

of

eachdistrict,

thesam

plew

asapportioned

among

neighbourhoodsin

thesam

eproportions

asin

theH

ousingN

eedsA

ssessment

Study,except

forthe

newly

addedneighbourhoods

(i.e.those

starredin

Table

1.6).T

hesam

plesize

inthe

newly

addedneighbourhoods

reflectsthe

relativeshare

of

GA

MA

'spopulation

inG

aand

Tem

adistricts,

andthe

estimated

5%o

fG

AM

A's

populationliving

inthe

Rural

Periphery.T

heresulting

sample

sizein

eachneighbourhood

isgiven

inT

able1.6.

Within

theneighbourhoods,

clustersaveraging

fivehouseholds

were

selected.T

ocreate

theseclusters,

blockso

fan

estimated

onehundred

householdsfor

highdensity

areasand

fIftyhouseholds

forlow

densityareas

were

selectedw

ithinthe

neighbourhoods,the

number

of

blocksin

eachneighbourhood

beingindicated

inT

able1.6.

The

selectiono

fblocks

was

basedon

areconnaissance

of

thesupervisors.

(Ideally,the

blocksw

ouldbe

basedon

arandom

orstratifIed

sample

of

enumeration

areasfrom

theG

hanaStatistical

Office.

Sucha

procedurew

ouldpose

seriouslogistical

problems,

however).

During

theirreconnaissance

thesupervisors

identifIedthe

principaltypes

of

residentialareas

inthe

neighbourhood,estim

atedroughly

theshare

of

householdsliving

inthe

differentresidential

types,and

apportionedthe

blocksto

reflectthese

shares,and

alsoto

ensurethat

areasoff

them

ainroads

ando

fhighdensity

areadequately

represented.H

avingbeen

shown

theblocks,

theinterview

ersselected

householdsto

interviewby

systematically

walking

throughthe

blockand

interviewing

everytw

entieth(or

tenth)household.

The

interviews

were

doneat

times

when

peoplew

erenot

generallyw

orking,so

asto

avoida

biasagainst

householdsw

hereinthe

principalw

oman

works.

Ifthe

principalhom

emaker

was

nothom

e,the

surveyorcontinued

with

thenext

household,returning

laterto

attempt

aninterview

again.O

nlyafter

therest

of

thehousehold

interviews

inthe

blockhave

beencom

pleteddid

theinterview

erlook

fora

replacement

household(a

neighbouringhousehold).

Households

which

refusedto

beinterview

edw

erereplaced

imm

ediately.A

codew

asincluded

inthe

surveyto

ensurethatreplacem

enthouseholdscan

beidentifIed.

Benneh

etal.

Ta

ble

1:L

isting

ofN

eig

hb

ou

rho

od

sS

urveyed.

121

Ne

igh

bo

urh

oo

d

11O

su(A

)

12Jam

esT

own

(A)

13Labadi(A

)

Su

b-to

tal

HO

IS

21A

irportR

esidential(A)

22R

oman

Ridge

(A)

23R

ingway

Estate

(A)

24N

.Labone

Estate(A

)

Su

b-to

tal

LO

HC

S

31A

chimota

(A)

32T

esano(A

)33

Asylum

Dow

n(A

)34

Cantonm

ents(A

)

Su

b-to

tal

MO

MC

S

41D

ansoman

Estate

(A)

42K

aneshieE

state(A

)43

S.

Odorkor

(A)

44N

.T

eshieE

state(A

)45

Tem

aC

.4

&9

(T)

Su

b-to

tal

LO

MC

S

51S

portsC

.A

rea(A

)52

E.

LegonE

xtension(A

)53

Adenta

(T)

54H

aatcho(G

)

Su

b-to

tal

LO

NO

S

61M

ataheko(A

)62

Mam

probi(A

)63

Darkum

an(A

)64

Abeka

(A)

65*A

masam

an(G

)

66*K

po

ne

(nS

ub

-tota

lM

OIS

71S

abonZ

ongo(A

)72

Accra

New

Tow

n(A

)73

Nim

a(A

)74

Maam

obi(A

)75

Madina

(G)

76T

ema

New

Tow

n(T)

nA

shiaman

(T)

78*T

ema

C.

2(T

)

Su

b-to

tal

HO

LC

S

81*O

ldA

shalebotwe

(T)

82*D

anfa(G

)83

*Oyarifa

(G)

84*A

fienya(T)

85*O

ldO

fankor(G

)

Su

b-to

tal

RF

TO

TA

L

Sa

mp

leS

ize

70703017055552015151010502515202525110155553

0202035201010115806550808035353045510101010105

0

1000

No

.o

fB

locks

141463411114332210534552231116447422231613101616776912222210

200

NB

:A

=A

ccraD

istrict;T

=T

ema

District;

G=

Ga

District.

122E

nvironmental

Problem

sa

nd

theU

rbanH

ouseholdin

theG

AM

A-G

hana

AP

PE

ND

IX2

Methodology

forA

ssessmento

fWater

Quality

1M

aterialan

dm

ethodsH

ouseholdlocation

andw

atersam

plingusually

startedin

them

orningat

about0900hrs

andsom

etimes

endedatabout

1800hrs. An

averageo

fabout

7-10sam

ples.w

erecollected

aday.

Inthe

varioushouseholds,

thedrinking

water

sourcew

asfIrst

identifIedand

thequestionnaire

was

laterrun.

Paired

samples

ofw

atersource

andstored

water

were

taken.H

owever,

ifnorunning

water

sourcew

asavailable,

thensingle

storedw

atersam

plesw

eretaken.

Som

ehouseholds

didnot

havestored

water

andw

eretherefore

notcovered.A

llthe

samples

were

transportedin

anice-box

ata

temperature

rangeo

f0

­4

0Cto

minim

isechanges

inbacterial

countsbetw

eensam

plingand

testing.

2W

aterSam

plingP

rocedureSam

plingo

fthe

pipedsupplies

andoverhead

tanksw

ascarried

outusing

asepticm

ethods(A

PH

A,

1985).F

orthe

collectiono

fw

aterfrom

householdstorage

containers,an

aluminium

cupw

asused

forsam

pling.'Ice-w

ater'dispensed

froma

cupw

aspoured

directlyinto

asterilised

bottleand

storedin

anice-box

at0-4

0C.

The

cellophane-packaged

"ice-water"

was

placeddirectly

inthe

icebox.

2.1B

acteriologicalExam

inationF.

coliand

faecalstreptococci

were

quantifIedusing

them

embrane

fIltrationm

ethod.T

heS

lanetzand

Bartley

agarm

ethodw

asused

forthe

examination

of

faecalstreptococci.

The

sample

was

fIrstfIltered

througha

mem

branefIlter,

afteradding

3.0­

3.5m!

of

steriledistilled

water

tothe

petri-dishcontaining

thenutrient

pad.T

hem

embrane

fIlterw

asthen

placedon

thenutrient

padw

ithoutentrappingair

bubblesand

incubated.F

orthe

detectiono

fF.coli,

theM

FC

(Mem

braneFaecal

Coliform

)m

ediumw

asused

with

theincubation

temperatures

rangingbetw

een44

to44.5

0Cfor

22to

24hours.B

luecolonies

with

diameters

of

1-2m

mw

erecounted.

The

Azide

medium

was

usedfor

thedetection

of

faecalstreptococci,

with

incubationconditions

at37

0Cfor

24to

48hours.

Faecalstreptococci

formsm

all(approxim

ately1

mm

indiam

eter)red

toreddish

brown

coloniesw

hichhave

smooth

peripheries.

AP

PE

ND

IX3

Benneh

etat.123

Meth

odology

forA

irT

est1

Field

Operations

The

fieldoperation

beganafter

thefield

assistantsw

erecarefully

introducedto

thebackground

andthe

purposeo

ftheair

pollutionsurvey.T

heyw

erealso

introducedto

thepractical

aspectsof

thesurvey

with

aseries

ofinitial

test-runs

with

theequipm

entandtrial-testw

iththe

questionnairebefore

moving

intothe

field.T

herew

ere12

fieldand

2laboratory

assistants.T

hefield

equipment

was

packedin

nylonshopping

bags.Each

bagcontained:

********

aG

il-Air

S-C

Air

pump

chargedw

ithfIlter

cassettecontaining

filterw

itha

cyclone,carbon

monoxide

tubesw

ithclips,

screw-driver,

tapem

easure,beltfor

mounting

theair

pump,

Peak

Expiratory

Flowm

eter,P

eakE

xpiratoryFlow

cylindersand

aquestionnaire.

1.1F

ieldE

xposureM

easurements

Methods

The

method

ofcollecting

physicalinform

ationduring

thisinvestigation

was

byexposure

measurem

entusing

theperson-carried

equipment.

The

person-carriedequipm

enthas

theadvantage

ofensuring

thatthe

sampling

ofparticulates

andcarbon

monoxide

reflectthe

actualexposure

situations.It

alsodoes

nothinder

therespondents

intheir

normal

work

duringthe

monitoring

perioddue

toits

lightw

eightandportability.

The

equipmentused

forthe

investigationsam

plesthe

ambient

airw

hereverthe

respondentis.

Itgives

information

aboutthe

quantityo

fa

pollutanta

personhas

beenexposed

toduring

them

onitoringtim

es,and

henceaverage

concentrationsencountered,butno

information

aboutthepeak

concentrations.T

heexposure

was

monitored

fora

3hour

period,covering

thetim

eduring

which

therespondentcooked

theprincipal

meal.

a)P

articulateM

atterT

heG

il-Air

S-C

Air

pumps

were

fittedw

itha

cyclonew

hichcontained

afilter

tocollect

respirabledust

andparticulates.

Sinceit

hasbeen

establishedthat

most

emissions

frombiom

assfires

are0-51lffi

insize

(Klaassen,c.n.

1985),am

bientsettling

particlesof

otherorigin,

forexam

pleroad

dust,w

hichare

oftenlarger,

were

excluded.T

hesebattery

powered

Gil-A

irpum

psused

with

built-intim

ersdrew

airat

afixed

rateo

f1.9

litres/minute.

The

built-intim

ersw

ereused

tom

onitorthe

exacttime

thepum

psw

erein

operation.A

llpum

psw

erecharged

duringthe

nightand

theair

floww

asadjusted

with

arotam

eterbefore

use.B

eforethe

pumps

were

senttothe

field,the

filters(the

filtertype

isa

37m

mC

elluloseacetate

filterw

itha

porosityof

8J.1m

,M

illiporeSW

CP

03700)w

ereconditioned

atroom

temperature

andhum

idity24

hoursprior

tofield

useand

for24

hoursafter

fielduse.

After

conditioning,they

were

weighed

onan

electronicdigital

balance.T

oaccount

forthe

possiblevariation

ofthe

humidity

inthe

laboratory,blank

filtersw

erew

eighedtogether

with

thesam

plefilters.

The

124E

nvironmental

Problem

sand

theU

rbanH

ouseholdin

theG

AM

A-G

hana

monitoring

of

humidity

inthe

laboratoryw

ascarried

outusing

am

echanictherm

ohydrograph(Fischer).

No

monitoring

of

humidity

inthe

fieldw

ascarried

out.After

instructingthe

recipientas

tothe

useand

operationo

fthe

pump,

theequipm

entw

asattached

tothe

waist

andthe

fIltercontraption

was

fittedto

thedress

of

therecipient

asclose

tothe

breathingzone

aspossble.

After

monitoring

thetim

erso

fthe

pumps

were

recheckedand

theinform

ationnoted

inthe

questionnairein

thefield.

The

pump

airflow

was

re-checkedas

soonas

thepum

psw

erereturned

fromthe

fieldin

orderto

obtainthe

averageair

flowduring

them

onitoringperiod.

b)C

arbonM

onoxideT

hem

onitoringo

fcarbonm

onoxidew

ascarried

outw

ithdiffusion

tubes.A

fterthe

tipw

asbroken,

thediffusion

tube(D

rager6733191)

was

placedclose

tothe

breathingzone

ofthe

recipient.The

colourchange

ofa

reactivesalt

inthe

tubew

ascom

paredw

itha

printedscale

onthe

tubeto

determine

theextent

ofthe

recipient'sexposure

tocarbon

monoxide

gas.T

hescale

readingon

thetube

isin

ppmh.

Readings

were

donein

thefield

andcross-checked

inthe

laboratory,30

minutes

afterthe

completion

ofthe

monitoring.

c)P

eakE

xpiratoryF

lowW

hena

personis

exposedfor

along

time

toparticulate

andirritable

gases,obstruction

of

theairw

ayscan

occurand

may

causeinflam

mation

andphlegm

production.In

thisstudy

theim

pairment

of

airways

ofthe

respiratorysystem

was

measured

bythe

useo

ftheportable

Wright's

MiniP

eakF

lowM

eterto

measure

theP

eakE

xpiratoryF

low(PE

F).T

heP

eakE

xpiratoryF

lowis

proportionalto

thediam

etero

fthe

upperand

centralairw

ayso

fthe

respiratorysystem

andtherefore

indicatesthe

presenceo

fa

reductionin

theairw

aysdue

toinflam

mation

orblockage

byphlegm

(Klaassen,C

.D.

1985).T

heW

right'sm

iniPeak

Flow

Meter

hasa

directreading

of

them

aximum

flowin

litresper

minutes.

Anew

papercylinder

forblow

ingw

asfitted

tothe

flowm

eterfor

everyrespondent.

The

respondentw

asthen

taughthowto

exhaleinto

them

eterand

allowed

oneor

two

trainingexhalations.

After

this,three

exhalationsw

ereperform

edsequentially

bythe

respondentw

hilecatching

enoughbreath

between

theexhalations.

The

highestvalue

of

thethree

exhalationsw

asthen

takenas

theP

EF

value.

d)O

therM

easurements

The

heightofthe

respondentwas

alsom

easured.

1.2The

Questionnaire

An

additionalquestionnaire

was

appliedalong

with

theair

tests,designed

togive

information

on:

*Residential

areaand

conditions*fueltype

usedand

cookinghabits

*thehealth

statuso

ftherespondent

All

respondentsinterview

edusing

thequestionnaire

were

alsom

onitored.

Benneh

etai.

AP

PE

ND

IX4

Opening

addressT

hursdayD

ecember

9,1993

byHon.D

r.C

hristineA

moako-N

uamah

Minister

forthe

Environm

ent

125

At

theopening

cermony

ofthesem

inaron"E

nvironmentalProblem

sand

theU

rbanH

ouseholdin

theG

reaterA

ccraM

etropolitanA

rea"(G

AM

A)

heldat

The

Auditorium

,School

ofAdm

inistrationU

niversityo

fGhana

Mr.

Chairm

an,Y

ourExcellencies,

Distinguished

Ladies

andG

entlemen,

Itis

agreatpleasure

form

eto

addressthis

gatheringo

facademics

fromG

hanaand

theS

tockholmE

nvironmentInstitute,

representativesof

internationalorganizations

inG

hana,planners,

government

officials,environm

entalN

GO

'sand

comm

unitygroups

asyou

prepareto

deliberateon

theresults

of

am

ajorstudy

on"E

nvironmental

Problem

sand

theU

rbanH

ousehold"in

theG

reaterA

ccraM

etropolitanA

rea(G

AM

A).

The

slums

andshantytow

nso

fcities

inthe

developingw

orldare

growing

attw

icethe

rateo

fcities

inother

partso

fthe

world.

The

World

Bank

estimates

thatthe

bottomquarter

of

urbanpopulations

inm

ostA

fricanand

low-incom

eA

siancities

cannotafforda

minim

allevel ofperm

anenthousing.L

argesections

of

major

citiesin

developingcountries

arew

ithoutadequate

treatedw

ater,m

unicipalsew

erageor

solidw

astedisposal

systems.

According

tothe

World

Com

mission

onE

nvironment

andD

evelopment,betw

een1985

and2000

developingcountries

will

requirea

65percent

increasein

theircapacity

tobuild

andm

anageurban

infrastructure,including

transportationand

sanitationsystem

s,utilities,

schoolsand

hospitals.It

istherefore

imperative

thatdevelopm

entstrategies

bedeveloped

todeal

with

thecom

binationo

fpopulation

growth,

healtho

fthe

fragileecosystem

s,

126E

nvironmental

Problem

sand

theU

rbanH

ouseholdin

theG

AM

A-G

hana

appropriatetechnologies

andaccess

toadequate

human

andm

aterialresources.

The

primary

goalo

fanydevelopm

entstrategyin

thisregard

shouldinclude

povertyalleviation,

foodsecurity

andeducation

asw

ellas

goodhealth

andquality

of

life.T

heseissues

areo

fm

ajorconcern

tothe

urbanhousehold.

Consequently,

atthe

recentR

ioE

arthS

umm

it(U

NC

ED

),there

was

abroad

agreement

thata

"brown

agenda",w

hichfocuses

onenvironm

entalissues

andpoverty,

would

bevital

forurban

populationsif

citiesare

todevelop

ina

sustainablem

anner.It

isthis

concernfor

thesustainable

managem

ento

four

human

settlements,

thatled

theG

overnment

of

Ghana

tosupport

thedesign

of

theS

trategicP

lanfor

theG

reaterA

ccraM

etropolitanA

rea(G

AM

A)

which

was

thesubject

of

asem

inarheld

afew

weeks

ago.G

AM

Ahas

alsobeen

selectedfor

participationin

boththe

sub-regionaland

globalnetw

orkso

fsustainable

orhealthy

cities.T

oem

phasizethe

importance

of

thisconcern,

anothersem

inarheld

lastw

eekon

"Planning

andM

anagement

of

theU

rbanE

nvironment",

highlightedsom

egeneral

problems

associatedw

ithurbanization

andalso

proposedsom

estrategies

andoperational

arrangements

fortheir

solution.It

ishoped

thatresults

of

thisstudy,

empasizing

intra-urbandifferentials

inaccess

toenvironm

entalam

enities,thelinks

between

environmentalrisk

factorsand

healthoutcom

es,the

economics

of

householdenvironm

entalm

anagement

andfinally

institutionalissues

will

bethorougW

ydiscussed

atthat

seminar.

Itis

furtherhoped

thatout

of

thediscussions

concreteproposals

forinnovative

policiesfor

improving

urbanm

anagementshallbe

senttothe

Ministry

forconsideration.

Mr.

Chairm

an,ladies

andgentlem

en,as

youm

ayall

befully

aware,

thecom

mitm

ento

fthe

Governm

ento

fG

hanato

sustainabledevelopm

entis

unquestionable.T

heestablishm

ento

fthe

Environm

entalP

rotectionC

ouncilin

1974after

theS

tockholmC

onferenceon

theH

uman

Environm

entand

thecreation

of

theM

inistryfor

theE

nvironment

inthe

Fourth

Republic

underscoresthis

comm

itment.

On

thepart

of

theM

inistryit

might

pleaseyou

toknow

thatim

provement

tothe

urbanm

anagement

isa

major

priority.It

isfor

thisreason

thatthe

Ministry

issupporting

two

newprojects

aimed

atalleviating

livingconditions

inurban

centres.T

heseare

theS

ustainableC

itiesP

roject(S

CP

)and

theC

omm

unityB

asedE

nvironmentalM

anagementInform

ationS

ystem(C

EM

IS).

Many

more

of

suchprojects

aregoing

tobe

soughtby

theM

inistryin

asm

uchas

theM

inistryforesees

thaturban

centresin

Ghana

would

otherwise

beoverw

helmed

bysanitation

problems

bythe

tumo

fthecentury.

As

am

easureo

fassuring

sustainabilityo

fthe

improvem

entaim

edat

urbanm

anagement,

theM

inistryis

consideringpolicies

thatw

illlead

toprotection

anddevelopm

ento

fthe

ruralenvironm

entthrough

vastlyim

provedplanning

andm

anagement

of

over-allhum

ansettlem

entsand

otherland

usein

pursuito

fsustainable

nationaldevelopm

ent.O

nbehalf

of

theG

overnment

andpeople

of

Ghana,

asw

ellas

onm

yow

nbehalf,

Iform

allyw

elcome

youall

tothis

Sem

inar.I

extenda

specialw

elcome

t.oD

r.G

ordonM

cGranahan

of

theU

rbanE

nvironmental

Managem

entP

rogramm

eo

fthe

Stockholm

Environm

entInstitute.M

r.C

hairman,

Your

Excellencies,

Distinguished

Guests,

Ladies

andG

entlemen,I

nowhave

thepleasure

todeclare

theS

eminar

open.

SE

IB

oard

Ch

airman

:

Karin

Soder

Sw

eden

Prof

Um

bertoC

olombo

Italy

Dr

Peggy

Dulany

USA

ProfG

ordonT.

Goodm

anU

K

Mrs

Fatim

aA

hmed

IbrahimS

udan

ProfT

homas

B.Johansson

Sw

eden

Ms

Kerstin

Niblaeus

Sw

eden

Sir

Shridath

Ram

phalG

uyana

Dr

Katsuo

SeikiJap

an

Dr

Alvaro

Um

anaC

ostaR

ica

Dr

Alexi

V.

Yablokov

Russia

ST

OC

KH

OL

ME

NV

IRO

NM

EN

TIN

ST

ITU

TE

Telephone:

Telex:

Telefax:

Telephone:

Telex:

Telefax:

Director:

ProfM

ichaelJ.Chadw

ickV

iceD

irector:D

rL

arsK

ristofersonH

eado

fAdm

inistration:A

nn-Charlotte

Bradley

Information

Manager:

Dr

Arno

Rosem

arinL

ibrarian:K

risterS

vard

Sto

ckh

olm

En

viro

nm

ent

Institu

teA

ddress:Jarntorget

84,B

ox2142

S-10314

Stockholm

,S

wed

enInt

+468

72

30

26

019580

SEI

SInt

+468

72303

48

DirectorS

EI-B

oston:D

rP

aulR

askinD

irectorSE

I-Tallinn:

Dr

Tanis

Kaasik

SE

Iat

York

Address:

University

ofY

ork,H

eslingtonY

orkY

015D

D,

UK

Int+44

904432897

57933Y

OR

KU

LG

Int+44

90443

2898

SE

I-Boston

Address:

Telephone:

Telex:

Telefax:

11A

rlingtonS

treetB

oston,M

A02116-3411

US

AInt

+16172668090

279926E

SRG

BSN

DR

Int+1

6172668303

SE

I-Tallinn

Address:

Box

160E

E-0090

Tallinn

Estonia

Telephone:

Int+

3722

601844

Telefax:

Int+

3722

44

09

82

Stock

holm

En

vironm

entInstitute

The

Stockholm

Environm

entInstitute

(SE

I)w

asestablished

bythe

Sw

edishP

arliament

in1989

asan

independentfoundationforthe

purposeo

fcarryingoutglobalenvironm

entanddevelopm

entresearch.The

Instituteis

governedby

aninternationalB

oardw

hosem

embers

aredraw

nfrom

developingand

industrial­ized

countriesw

orldwide.

Central

tothe

Institute'sw

orkhave

beenactivities

surroundingthe

Rio

UN

CE

Dconference,

andprevious

tothis,

theB

randtand

Palm

eC

omm

issionsand

thew

orko

fthe

World

Com

mission

forE

nvironmentand

Developm

ent.Apartfrom

itsw

orkinglinkages

with

therelevantspecialized

agencieso

fthe

UN

system,a

particularfeatureo

fSE

I'sw

orkprogram

me

isthe

roleithas

playedin

thedevelopm

entand

applicationo

fA

genda21,the

actionplan

forthe

nextcentury.A

major

aimo

fS

EI's

work

isto

bringtogether

scientificresearch

andpolicy

development.

The

Instituteapplies

scientificand

technicalanalysesin

environmentaland

developmentissues

ofregionaland

globalim

portance.The

impacts

ofdifferentpolicies

areassessed,providing

insightsinto

strategyoptions

forsocially

responsibleenvironm

entalmanagem

entandeconom

icand

socialdevelopment.

The

resultso

fthe

researchare

made

availablethrough

publications,the

organizationo

fand

participationin

conferences,seminars

anduniversity

courses,andalso

throughthe

developmento

fsoftware

packagesforuse

inthe

explorationo

fscientificproblem

s.SE

Ihasalso

developeda

specializedlibrary

which

functionsas

acentral

catalystin

theshort-term

andlong-term

work

ofthe

institute.

Research

Program

me

Am

ultidisciplinaryrolling

programm

eo

fresearchactivities

hasbeen

designedaround

thefollow

ingm

ainthem

es,w

hichare

beingexecuted

viainternationally

collaborativeactivjties

with

similar

institutionsand

agenciesw

orldwide:

oE

nviro

nm

en

talR

esources,including

energyefficiency

andglobaltrends,

energy,e

nviro

nm

en

tanddevelopm

ent,and

world

wa

ter

resources;

oE

nviro

nm

en

talT

echnology,including

cleanproduction

andlow

waste,

energytechnology,

envi­ronm

entaltechnology

transfer,and

agriculturalbiotechnology;

oE

nviro

nm

en

talIm

pacts,including

environmentally

soundm

anagementoflow

-gradefuels,

climate

cha

ng

eand

sustainabledevelopm

ent,and

coordinatedabatem

entstrategiesfo

racid

depositions;

oE

nviro

nm

en

talP

olicya

nd

Managem

ent,including

urbanenvironm

entalproblem

s,sustainable

en

viron

me

nts

andcom

mon

propertym

anagement;

and

oP

OLE

ST

AR

,a

comprehensive

modelling

andscenario-based

activity,investigating

thed

yna

mics

ofa

world

with

10billion

peopleby

them

iddleof

thenext

century.

SE

l'sN

etwork

SE

Ihas

chosena

globalnetw

orkapproach

ratherthan

am

oretraditional

institutionalset-up.

The

work

programm

eis

carriedout

bya

worldw

idenetw

orko

fabout60full-

andpart-tim

eand

affiliatedstaffand

consultants,who

arelinked

with

theS

EIH

eadO

fficein

Stockholm

ortothe

SE

IOffices

inB

oston(U

SA

),Y

ork(U

K)and

Tallinn

(Estonia).S

EIhasdeveloped

alarge

mailing

registertocom

municate

tokey

mem

berso

fsocietyin

government,

industry,university,NG

Os

andthe

media

aroundthe

world.

~SE

I~:~~:~~~~NTIN

ST

ITU

TE

InternationalInstitute

forE

nvironmentalTechnology

andM

anagement

_

Postaladdress:

Telephone:

Telex:

Telefax:

E-m

ail:

Box

2142,S-103

14S

tockholm,

Sw

eden+

46-8-7230260

19580sei

s+

46-8-7230348

cdp!gn!pns!seihq