1. Proposed Study to Assess the Environmental Sanitation Needs of Ghanaian Communities Yela Awunyo-Akaba Department of Social and Behavioural Sciences Sch. of Public Health, Univ. of Ghana

2. Background  As a research institution, mandate to conduct studies to improve the health of our people  Environmental Sanitation- critical problem in spite of prior and ongoing interventions  What accounts for lack of behaviour change?  Focus: Solid Waste Management  Waste Management involves the collection, transportation, processing and recycling of waste materials produced through human activity

3. Government Environmental Structures  The government’s structures for managing our waste well defined The Ministry of Local Government and Rural Development’s National Sanitation Policy supports the Environmental Sanitation Service Delivery and enforces compliance of sanitation rules The Ministry of Local Government and Rural Development’s National Sanitation Policy supports the Environmental Sanitation Service Delivery and enforces compliance of sanitation rules The programme components are: effective environmental health inspections (Sanitary Inspections), dissemination of sanitation information (Hygiene Education), pests/vector control and law enforcement The programme components are: effective environmental health inspections (Sanitary Inspections), dissemination of sanitation information (Hygiene Education), pests/vector control and law enforcement

4. continued  Regulatory Authority is vested in the Environmental Protection Agency (EPA)  The Ministries of Health, Education and Industry are also stakeholders

5. continued  The Metropolitan, Municipal and District Assemblies are responsible for the collection and final disposal of solid waste through their Waste Management Departments and their Environmental Health and Sanitation Departments  but there are inefficiencies due to insufficient resources, ineffective management and the lack of well trained and motivated personnel.

6. Conclusions-Government Agencies DAs are semi-autonomous and can decide % of budget to allocate to sanitation projects DAs are semi-autonomous and can decide % of budget to allocate to sanitation projects Revenue generated cannot support effective waste collection and disposal Revenue generated cannot support effective waste collection and disposal Public unaware of need to pay for waste collection Public unaware of need to pay for waste collection Improper tax system for urban dwellers Improper tax system for urban dwellers The laws and regulations are not a sufficient deterrent to bad hygiene behaviour and not consistently enforced The laws and regulations are not a sufficient deterrent to bad hygiene behaviour and not consistently enforced Poor institutional cooperation and collaboration Poor institutional cooperation and collaboration

7. Interventions to Manage Sanitation and Hygiene  The Urban Environmental Sanitation Project (UESP), 1997 Ministry of Local Government and Rural Development project in 7 settlements within 3 cities Ministry of Local Government and Rural Development project in 7 settlements within 3 cities to support primary drainage, citywide sanitation and solid waste management to support primary drainage, citywide sanitation and solid waste management Aspects of the project included the rehabilitation of existing public toilet facilities and the provision of communal solid waste containers Aspects of the project included the rehabilitation of existing public toilet facilities and the provision of communal solid waste containers government subsidized thus raises the issue of sustainability government subsidized thus raises the issue of sustainability

8. Interventions to Manage Sanitation and Hygiene (cont.)  School Health Education Program (SHEP) This initiative though commendable has not resulted in the wide spread reduction in poor sanitary practices due to This initiative though commendable has not resulted in the wide spread reduction in poor sanitary practices due to Poor maintenance of the school latrines such that the school still remains an unsafe place for the child with respect to sanitary diseasesPoor maintenance of the school latrines such that the school still remains an unsafe place for the child with respect to sanitary diseases Poor sanitation and hygiene practices learned at home are also introduced into schoolsPoor sanitation and hygiene practices learned at home are also introduced into schools

9. Interventions to Manage Sanitation and Hygiene (cont.) The increase in knowledge is not reflected in sustained behaviour change partly because of mismatch of facilities for practiceThe increase in knowledge is not reflected in sustained behaviour change partly because of mismatch of facilities for practice Beneficiary Schools channel resources under the capitation grant to other priority projectsBeneficiary Schools channel resources under the capitation grant to other priority projects Schools cannot afford to make minor maintenance repairs on the facilitiesSchools cannot afford to make minor maintenance repairs on the facilities Poor community support-vandalism etcPoor community support-vandalism etc

10. From NGOs  Donor funded projects-not sustainable  Lack of proper documentation and sharing of knowledge  Duplication of interventions  Ineffective evaluation component  Researcher initiated projects  Work independently of Government Structures  Lack of community ownership

11. Problem Statement Waste management is still a major problem in our urban and peri-urban communities in spite of previous initiatives to address sanitation and hygiene needs in Ghana Waste management is still a major problem in our urban and peri-urban communities in spite of previous initiatives to address sanitation and hygiene needs in Ghana

12. Rationale  Children still suffer disproportionately from Health Effects of Poor Hygiene and Sanitation  School Health Initiatives have ignored the Community Sanitation Needs Limiting Effectiveness of these Projects  Need to Bridge the Gap between School Health and Community Sanitation

13. Broad Objectives  Main aim to diagnose the environmental sanitation needs of communities to ensure that planned public health programs are based on the outcome measures of assessment  Action plan will focus on advocacy, education, communication and practical interventions but the exact components will depend on our assessment within the capacity of the communities

14. The Way Forward  Critically assess the waste management practices in urban and peri-urban communities Investigate the gaps in policy implementation Investigate the gaps in policy implementation Determine the knowledge, attitudes and practices in hygiene and sanitation behaviour in two communities in the Greater Accra region (pilot) Determine the knowledge, attitudes and practices in hygiene and sanitation behaviour in two communities in the Greater Accra region (pilot)

15. To Do This  Community members active participants in all aspects of the decision making process  The health researcher will serve as a facilitator to help communities manage their own waste problems  Increasingly the practice of public health seeks to move away from researcher initiated interventions to encourage complete community ownership of all planned health programs

16. Assessment Components  Needs identification  Analyzing the causes and variations of problems  Collecting and interpreting data  Monitoring and forecasting trends  Researching the outcomes  Evaluating the outcomes

17. Possible Questions to Explore  What do community members consider unsanitary or unhygienic practices?  What are the initiatives the community itself has embarked upon to improve their sanitation?  What are the local resources available within the community to improve sanitation?

18. Study Population  Community Members  Relevant Government Agencies  Opinion Leaders  Members of Households  School Children  School Authorities  NGOs  etc.

19. Long Term Goals  Study communities would have a well managed waste collection system in place  School Children would have access to good sanitation at home as well as in school

20. Thank You