One in every five people still practise open defecation in rural Ghana. According to the Ghana Multiple Indicator Cluster Survey (MICS 2017/18), rural access to basic sanitation is a low 17%. An exception to low coverage rates is Nandom District – currently with a total coverage of 96%.
Nandom raises the sanitation progress bar
Through its Sustainable Sanitation and Hygiene for All Results Programme (SSH4A RP), SNV has been working in Nandom since 2014. Back then, rural ODF coverage was at 47%.
During the initial engagement meeting at district level, the Paramount chief Naa Dr Puore Puobe Chiir VII welcomed SSH4A, and pledged that the district will become a model for others to follow. Strong political will in Nandom, and sanitation improvements paved the way for a second SNV project: the Voice for Change Partnership (V4CP). Launched in 2016, V4CP involves country-based CSOs intent in strengthening sector or issue-based coordination and engaging in evidence-based advocacy to influence government-led development budget allocation, policy reviews, and enforcement.
In December 2017 , results from an SSH4A RP household sample survey found that OD was no longer practised across the sampled households (compared to 79% at the start of the project). Access to improved sanitation levels (JMP standards) increased by almost 57% (compare baseline and endline results).
Nandom district endline results: access to sanitation - 2014-2018
The December 2017 SSH4A RP household survey found low coverage of household toilet facilities amongst potentially disadvantaged households (elderly, female-headed and people with disabilities): 8.5% of sampled households in Nandom district have a member living with disability. Across all SSH4A RP districts, 63.42% households have members 50 years and over. During the Sixth CLTS Stock Taking Forum in June 2018, the Ministry of Sanitation and Water Resources launched the Pro-Poor Policy Guideline, which highlighted the various forms of support for potentially disadvantaged households.
A step in the right direction – the guideline’s launch manifests clearly the government’s commitment to achieve SDG 6.2, based on a policy of inclusivity.
"I was visited a couple of times by the Environmental Health Officer, and sensitised on the negative effects of practising OD. But as an elderly person with not enough funds to support myself I often used to ask “how can I afford to build a good latrine”? Communities are celebrated for achieving ODF, and there are times I feel that I’m holding back my community from achieving ODF status. I want my daughter and mother to enjoy good health, as the EHO said that defecating in the open causes cholera. I’m glad for this support, and I gladly supported by digging the pits for the latrines (with the support of my neighbours)." Catherine Humbade, 69 year elderly woman in Niima, Nandom.
Catherine, from Nandom, poses in front of her toilet
Catherine and her 89-year old mother standing next to their handwashing facility
Reaching the last mile
But how do we reach potentially disadvantaged households (and identities) when they often fall in the periphery of mainstream development planning, including WASH? Unless we belong to an organisation specialised on disability for example, mainstream development knows very little about their lives and needs. For governments, an emphasis on the last mile certainly adds extra pressure in managing already-limited resources.
Identifying the potentially disadvantaged was led by the Traditional Authority and Environmental Unit to manage community members’ expectations on “who gets sanitation support, and what type of support this would entail.” This support varied from providing materials for construction to payment of artisans’ services. Because the allocation of resources is a highly political exercise, village chiefs known for their neutrality were requested to lead in the process. A neutral leader/ champion to implement guidelines based on equity and inclusivity is highly recommended to mitigate demands for all-out subsidy, which we all know, is unsustainable.
In Nandom, local government seems to be on the right track in making the Nandom Paramount Chief’s dream of living in the first ODF-district a reality. SNV is committed to continuing its regional and national-level contributions to this vision; through advocacy that rests on evidence-based data.
 Nandom, home to approximately 52,589 people (DMTDP 2018 – 2021, June 2018), is one of the 13 districts in the Upper West Region of Ghana.
 SSH4A-RP Project End-line Report, available upon request. Contact the author.
 SSH4A RP was implemented across eight districts: Nandom, Lawra, Nanumba South, East Gonja, KEEA, Saboba, Chereponi and Jasikan
About the Author: Theresa Swanzy is WASH Advisor in Ghana and member of the Voice for Change Partnership (V4CP) - a multi-country advocacy programme. She is coordinating the 'final push' to make Nandom the first-ever district to eradicate open defecation in Ghana. Theresa is passionate about social change that impacts on the lives of children and vulnerable groups.