Understanding the Barriers and Opportunities for Effective Management of Shared Sanitation in Low-Income Settlements—The Case of Kumasi, Ghana

Abstract

Improved sanitation for all is a daunting task for low-income countries, and shared toilets often provide an alternative to private household sanitation for most urban residents. This study sought to provide better understanding of the existing barriers and opportunities for improved management of shared sanitation. The study used focus group discussions and in-depth interviews with 70 users (landlords and tenants) of shared sanitation in Kumasi, Ghana to assess barriers and opportunities of “high-quality” shared sanitation. The commonly used toilet facilities were dry toilets—Kumasi Ventilated Improved Pit latrine and Ventilated Improved Pit latrines; and flush systems—water closet and pour flush connected to septic tanks. Between 2 and 21 households, or 4 and 84 people, shared one facility. Participants’ description of “high-quality” (Ideal) shared sanitation was centred on cleanliness, user behaviour, smell, and user crowding. They also identified challenges of shared sanitation as overcrowded users, poor user behaviours, conflicts among users, and high cost associated with frequent desludging. However, opportunities for improvement included users’ preference for shared toilets due to enjoyed benefits, existing facility management practices, and mutual understanding among users (tenants and landlords). Interventions and policy guidelines to influence behaviour change of shared sanitation users are proposed and are intended to be delivered by local government and users.

Barriers and opportunities for cleanliness of shared sanitation facilities in low-income settlements in Kenya

“…An additional two FGDs were then held with landlords and tenants as participants in the same group to verify that all information from the previous discussions had been captured. The interview and group discussion guides developed for this study have been published elsewhere [ 34 ].…”

Exploring barriers to the adoption and utilization of improved latrine facilities in rural Ethiopia: An Integrated Behavioral Model for Water, Sanitation and Hygiene (IBM-WASH) approach

“…In many of the prior studies conducted in Ethiopia and other African nations having a larger family, an advanced education, and being male were associated with the increased adoption and utilization of latrines [16][17][18][19]. Also, Qualitative studies on sanitation have identified the un-affordability of building materials [20] and the lack of awareness of the health risks associated with open defecation as a hindrance to the adoption of sanitation facilities [21]. Nevertheless, the majority of the studies focused on a single-level analysis [22][23][24].…”

Pit latrines may be a potential risk in rural China and low-income countries when dealing with COVID-19

“…Similarly, the most common type of toilet facilities was shared pit latrine with a slab (67%) with no hand-washing facilities in Kampala, Uganda ( Ssemugabo et al, 2020 ). In Ghana, 40% of commonly used toilet facilities were dry toilets (pit latrines), and between 2 and 21 households, or 4 and 84 people shared one facility, ( Antwi-Agyei et al, 2020 ), and more than 25% of households engaged in open defecation ( Adzawla et al, 2020 ). In short, toilet facilities in low-income countries are critical and need to be improved.…”

“…Ultimately, it might increase the risk of COVID-19 transmission. Given that plentiful households shared toilet facilities (most of them were pit latrines) with poor ancillary facilities (such as hand-washing facilities) were common in low-income countries ( Antwi-Agyei et al, 2020 ; Ssemugabo et al, 2020 ), we believed that the use of pit latrines in rural China and low-income countries would increase the contact between human, thus increasing the risk of COVID-19 transmission to a certain extent.

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