Water and health in Ghana

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Water and health in Ghana


Ghana formed from the merger of the British colony of the Gold Coast and the Togo land trust territory in 1957 became the first sub-Saharan country in colonial Africa to gain its independence. It, is the closest landmark to the centre of the world, and is located on the west coast of Africa, about 750 km north of the equator on the Gulf of Guinea, between the latitudes of 4-11.5o north and longitude 3.11 West and 1.11 East. Tema, the industrial city, which is adjunct to Accra, the capital city of Ghana, is on the Greenwich Meridian (zero line of longitude). Ghana is bounded on the north by Burkina Faso, on the west by La Cote D’lvoire, on the east by Togo and on the south by the Gulf of Guinea (Yvette, 2004).The country has a total land coverage of 238,537 km2 (92,100 sq. miles) with a total stretches of 672 km north-south and 536 km east-west. Its coastal area consists of plains and numerous lagoons near the estuaries of rivers. The land is relatively flat and the altitude is generally below 500m, with more than half of the country below 200m. The Volta River basin dominates the country’s river system and it is 8,480km long which consist of Lake Volta, (the largest artificial lake in the world), formed behind the Akosombo hydro-electric dam (Yvette, 2004).


Ghana has a tropical climate. The temperature is generally 21-32°C (70-90°F).while the humidity is 50 to 80%. In most areas, temperatures are highest in March and lowest in August after the rains. Variation between day and night temperatures is relatively small, but the northern section of Ghana has hotter temperatures and some seasonal temperature variations because it is farthest from the moderating influence of the ocean in the south, and closest to the Sahara Desert. There are two rainy seasons, the major one from March to July and a minor from September to October, separated by a short cool dry season in August and a relatively long dry season in the south from mid-October to March. The rainfall is influences mainly by the rain bearing monsoon wind in the south, the southing coastal areas together with the middle belt receives a fair share of rain while the northern regions have little rain. Annual rainfall in the south averages 2,030 mm but varies greatly throughout the country, with the heaviest rainfall in the south western part. Mean rainfall in the southern regions is around 1800mm but this decreases to less than 1000mm in the northern fringes (Benneh, 1990).

Administrative divisions, Population and demographic characteristics of the Economy

The country practices a decentralized system of government where the central government administration has been fostered at local government level. There are 10 Regional Co-coordinating Councils with 110 Metropolitan, Municipal and District Assemblies, which serve to involve grassroots participation in the formulation and implementation of government policies and the general development of their areas of jurisdiction.
Ghana’s population of 20,922,000 (2003 est) with a growth rate of 1.6% and the density of 88 per sq km is one of the most populous countries in Western Africa, second only to Nigeria. The population has gradually triple since achieving political independence in 1957, from about 6 million to nearly 18 million in 1996, and is expected to increase to 27 million by 2020. The fast rapid growth of its population has seen urban density rocketing mainly as a result of migration from the rural communities. Out of the total population, 43% of it is under 15 years as a result of a combination of high fertility and declining mortality, however this seems to be changing mainly because of falling fertility (Arjun Adlakha, 1996).
Well endowed with natural resources, Ghana has roughly twice the per capita output of the poorer countries in West Africa. Even so, Ghana remains heavily dependent on international financial and technical assistance. Gold, timber, and cocoa production are major sources of foreign exchange. The domestic economy continues to revolve around subsistence agriculture, which accounts for 36% of GDP and employs 60% of the work force of mainly small landholders. Ghana opted for debt relief under the Heavily Indebted Poor Country (HIPC) program in 2002. Policy priorities include tighter monetary and fiscal policies, accelerated privatization, and improvement of social services (Sarpong. 2002)).
Ghana has a diverse and rich resource base. The main stay of the country is mainly primarily agricultural. Nevertheless, most people now engaged in other the secondary sector such as trading the country depends so much on cocoa and cocoa products, which typically provide about two-thirds of export revenues, timber products and other non traditional products such as coconuts and palm products, she nuts, coffee, pineapple, cashew, pepper, cassava, yams, plantain, maize, rice, peanut, millet. Although Ghana is a poor country, its industrial base is relatively advanced compared to many other African countries. There are many Import-substitution industries which includes textiles, steel, tires, oil refining, flour milling, beverages, tobacco as well as car, truck, and bus assembly. Also, tourism has become one of Ghana’s largest foreign income earners (ranking third in 1997), and the Ghanaian Government has placed great emphasis upon further tourism support and development (Naylor, 2000).

Water resources

The main sources of water supply in Ghana include surface water, ground water and rain water. According to FAO (2005), Rainfall although not reliable, has a mean ranging from 2150mm in the south-western part to 800 mm on the south- eastern. Rain harvest is not so popular among urban settlers. Nevertheless, it provides a significant amount of domestic water in the southern rural areas particularly in during the humid months of May, June, July and August. Sarpong, (2005), estimated total annual run-off as 56.4 percent. The main surface waters is made up of the Volta river system which covers about 70 percent of the entire country and it consist of rivers Oti, Daka, White and Black Volta, Pru, Sene and the Afram rivers. Rivers Bia, Tano, Ankobra, Pra which drains the south-western regions also covers about 22 percent of the country, while the coastal zone is drain by rivers Ochi- Nakwa, Ayensu, Densu and the Tordzie takes charge of about 8 percent of the country (FAO,2005). Greater part of the rural Ghana relies on ground water which is often extracted from boreholes while urban Ghana gets about 95 percent of its waters from surface water. The main rock formation is the sedimentary and the non sedimentary which provides quality ground water but for few instances where there is localized pollution (Sarpong, 2005).

Water management in Ghana

According to Turney (2007), Water Resources Management is seen by many institutions as the integrating concept for a number of water sub-sectors such as hydropower, water supply and sanitation, irrigation and drainage, and environment and this ensures that an integrated water resources will incorporate social, economic, environmental and technical dimensions which enhances accountability in the management and development of water resources. However, in Ghana, there are different institutions managing these related sectors. The main body managing and providing drinking water is the Ghana Water Company.

Ghana Water Company

Since independence, the state owned company (Ghana Water Company Limited) has been managing water supply systems in almost all urban areas especially administrative cities with the state providing the finances for both technical and human resources. The company’s task was mainly to supply water however, it relayed on professionals outside the organisation for technical studies and other detailed engineering designers. The company could not cope with rapid population growth and urbanization. It was unfortunate that the company had no hand and could not integrate with water sub-sectors such as hydropower, sanitation, irrigation and drainage, and environment which could have ensures that social, economic, environmental and technical dimensions are taken into account in pursuance of proper management and development of water resources. The other sub sectors were under different institutions and this contributed to create poor sanitation and poor hygiene in most urban areas. A paper by Well (2005), reveals that since 2000, the company have been experiencing considerable deterioration to the extent that about 40 percent out of the total 70 percent taps had water running through them and this was also irregular and the urban population has to some extent wait for days before any water runs in their taps. The company had to deal with lack of autonomy with weak management which also resulted in debt. In 2002, it was estimated the company was indebted to the tune of $ 400 million and about 50 percent of all waters produced were not able to be accounted for. It came to light that in the year 2003 alone, losses in operation were cost about $ 34 million – almost 100 percent of the total revenue and the urban population have since been suffering to get water and therefore had to relay on other source of getting water ( Well Factsheet,2005). Apart from the Ghana Water Company, there is some Non-governmental organization (NGO) and some few local based private companies who are involved in managing and provision of water particularly in the urban areas.

Water and health in Ghana

All major cities in Ghana are faced with numerous health problems which normally originate from its environment. It is often believed that there is a general higher standard of living in urban areas as compared to the rural areas nevertheless a visit to Ghana reveals that greater portion of urban Ghana lacks basic necessities including the supply of adequate safe drinking water and poor sanitation. While areas of residential for high income settlements have constant supply of safe drinking water, shanty, peripheral urban as well as low income settlements have little and to some extent no access at all and often venerable to water contaminations and poor hygiene. The poor living in informal urban areas are generally vulnerable to water borne diseases because of uneven coverage of projects providing clean drinking water, with this situation, most of these people therefore relays on water from unprotected water sources. And it is this reason why Ghana is said to be among African counties that suffers by far the highest infant mortality and water-related disease in all world, (WHO, 2003).
Waterborne diseases, such as diarrhoea, cholera, typhoid, hepatitis A, dysentery and vector-borne diseases, such as malaria, yellow fever, and sleeping sickness are still rampant in Ghana causing severe human suffering and responsible for many deaths. Also, the presences of toxic substances, such as pesticides or heavy metals, due to excessive or deficient amounts of natural substances such as fluoride or iodine have serious health implications.
A researched conducted by Water Aid (2005) in Ghana shows that out of the total population of about 20.2 million 20.2 (11.8/8.4) million in 2003 (rural/urban), it was detected that only 44%/61% of the people have access to safe drinking water and there was a corresponding record of 11% and 40% rural and urban respectively of access to good sanitation. This shows that more than 60% of the total population in Ghana lack basic sanitation. It is therefore not surprising that the country recorded 3678 reported cases of guinea worm in the year 2000 and diarrhoeal diseases rose to the third most commonly reported cases in health centres across the country (Water Aid, 2002).
Water is seen as the conveyance medium of pathogens (disease-causing organisms), and water also provides the habitat for vectors and intermediate hosts of pathogens Water plays a conveyance role for micro-organisms and chemical pollutants. The issue for urban Africa relates more to drinking water, however also we can connect water to food crops and livestock. It is already known fact that Poor sanitation is the most critical determinant of contamination of drinking water with micro-organisms. Pollution from urban and industrial and runoff of agrochemicals is mainly responsible for chemical contamination in almost all the ten regional capitals in Ghana. Talk about diarrhoea, trachoma, cholera, hepatitis, typhoid, hookworm, round worm etc and every Ghanaian will tell you “I had this or that attack on this day or that year”.

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The wind of privatisation

With the growing concern of providing adequate safe drinking for the people, the World Bank, together with other international organizations suggested and kept pressure on developing countries to privatise urban water. The World Bank thus provided Ghana with the initial interest free loan of $150 million for the first phase of the proposed plan. The study found out that out of the initial five companies who bid and were selected for water services in the capital Accra such as the Suez, Veolia, Saur and Biwater had annual sales larger than the GDP of Ghana. The World Bank believes that with this and higher payment from consumers, these companies will have both revenue and the incentives to supply and extend pipes to those relying on unsafe sources. But there are a lot of critics from all parts of the country. A lot fear that higher prices will rather limit the poor for consuming safer water. In Accra for example, a report of the international fact – finding mission on water sector reform in Ghana (August 2002) reveals that price increases have already forced the poor to cut down drastically on their use of water. Some have resorted rather to walk distance to fetch free water or for a token fee as they could not bear with the 95 percent increases fees charged in this post-privatization period. Many interest groups including civil societies such as the women’s groups, teachers, trade unions, public health workers, environmental groups, disabled organizations and students under the name “Ghana National Coalition Against Privatization of Water to oppose the World Bank led-backed proposal to privatize the urban water supply under the grounds that :
That water is a fundamental human right, essential to human life to which every person, rich or poor, man or woman, child or adult is entitled.
That water is not and should not be a common commodity to be bought and sold in the market place as an economic good.
Water is a natural resource that is part of our common heritage to be used judiciously and preserved for the common good of our societies and the natural environment today and in the future.
Water is an increasingly scarce natural resource, and as a result crucial to the securities of our societies and sovereignty of our country. For this reason alone, its ownership, control, delivery and management belong in the public domain today and tomorrow.
The public sector is legally and constitutionally mandated and designed to represent the public interest. The essential purpose of the private sector on the other hand is to make profit not to promote the public good. Any public benefits arising from the private sector’s activities are incidental not designed. As a result, the private sector cannot be trusted with the public interest.
Citizens have the right to effectively participate (as distinguished from being informed) in the shaping of public policies which fundamentally affect their lives such as the control of water, and that government has a responsibility to enforce this right.
Community participation in the management of water systems is valid/legitimate, essential and beneficial to the overall effectiveness in affordable and sustainable water delivery.
Water management policies should be designed to ensure social equity such as gender equity, public health and environmental equity.
There are many examples around the world which shows that this could lead to a disaster. For example, the Kwazulu- Natal (South Africa) situation in 2001 cholera outbreak which killed many people was traced to the imposition of high water charges which forced the poor to rely on polluted river supplies for their water.(The World Traveller, 2001).


The bill is in its final stage. From whatever views one holds either in support or criticize water privatisation in Ghana, there is no denying fact that Ghana needs to substantially increase the outputs from its water sector with the provision of water not only to formal areas but informal areas as well. This should be linked with sanitation and hygiene of the environment if only the nation aims at reduction of the health risk of its citizens. Nevertheless, this requires good management and finances which could easily be provided if the communities are allow to participate fully in managing and financing projects and this will further enhance monitoring and capacity building to the benefit of all including the poor living in shanty and informal urban areas.

Location and size

Kumasi, the capital of the Ashanti Region is the second-largest city in Ghana with a very rich history behind it. The garden city, as it is popularly called because of its richness in flowers and beautiful trees and various species is located on (6 35’ – 6 40’N) 30’ W and longitude 1 30’ 135’ W 6 40’ N. Almost in the heart of Ghana, about 300 miles north of the equator, 100 miles north of the Atlantic Ocean (gulf of Guinea) and 100 miles north of the Prime Meridian with relatively flat land. Greater part of its vegetation is made up of forest (tropical vegetation) (Benneh, 1996).With a population of more than 2.5 million, the rate of it expansion and growth is so alarming that apart from non recognize settlements in its peripheral as well as slum and shanty settlement, the city has more than 33 suburbs made up of Abuaohia, Adeibra, Adiebaba, Ahinsan, Akrom, Ampabami, Anumanye, Asokori, Asuabua, Ayeduasi, Ayija, Bantama, Bomso, Bremang, Brunkum, Buokrom, Duasi, Esen, Ewhemasi, Hemng, Kantinkronu, Kanyasi. Central Kumasi, Kuronum, Kwadaso, Kwapra, Tafo, Nyanchrenniasi, Owabi, Pankronu, Suame, Tanoso, etc. (Sarpong, 2002).


Asante (Kumasi) kingdom rich in gold, dominated the states in modern Ghana from the late 17th through the late 19th century where one of the greatest kings, Osei Tutu founded Kumasi after a victory over the British with the help of his mystic friend and sage, Okomfo Anokye. It grew and became the largest and most powerful of a series of states formed in the forest region of southern Ghana by people known a as the Akan. The Kingdom presently ranks among the few monarchical states in the world, with a long and sustained system of governance. At present, a descendant of King Osei Tutu, Nana Osei Tutu the second is the king, receiving allegiance from the people within the democracy of Ghana, and it is believed to be the richest king on Africa’s West Coast. The king resides in Kumasi, Manhyia Palace, and it is one of the city’s most spectacular sights with people travelling weekly to pay homage to him. Legend has it that a golden stool in the palace descended from heaven, and that near the palace grounds, a copper sword was said to have been driven into the ground by an ancient priest, which no one has been able to remove by any means. The people have protected this legend and this has made the seat very important among historians, tourists and even politicians (Clark, 2003).


Trade and commerce has played an important role in the economy of Ashanti kingdom since early times. As early as 300 CE, camel caravans and human carried salt gold, food products from this part of Ghana to the northern territories including countries outside the borders of Ghana. The largest market, Kumasi Central Market is located at the heart of the city within a forest zone. As a result there are many forest products and related industries that account for the prosperity of commercial activities in Kumasi. Gold-mining, teak harvesting, breweries and agro-processing also dominate the economy of this largest Millennium City, in addition its region boasts of a rich cultural heritage particularly evident in smaller surrounding towns. Other riches abound, wealth derived from substantial gold deposits and agricultural products. Cocoa and high-quality hardwood product made up carving form the major exports. Another striking fact of this city’s culture is the liveliness of the street trade sector: majority of the dropped out school children and many men and women finds labour in selling products on the street. This is made up of hawkers, service providers and petty shop operators etc. As a result of lack of space, roads and drainage systems are blocked and are been used as shopping sites for many unregistered traders where anything from foodstuff, jewellery, livestock and herbal medicine can be purchased through lively bargaining and the most unfortunate situation is that all wastes are seen been dumped in streams and other water ways including gutters. Above this, much of the city’s population lives and farms in peri-urban settings, having been forced off the farms by crop failure and lack of market access by taking advantage of streams around (Dinye, 2005).

Table of contents :

1.1 Introduction and background
1.2 Research question
1.3 Research aims
1.4 Objectives
1.5 Methodology
1.5.1 Interviews
1.5.2 Observation
1.5.3 Literature
1.5.4 Pre- test
1.5.5 Research assistants
1.5.6 Data analysis
1.5.7 Assumptions
1.5.8 Limitations
1.6 Organization of the thesis
2.1 Country profile
2.1.2 Climate
2.1.3. Administrative divisions
2.2 Water resources
2.3 Water management in Ghana
2.3.1 Ghana Water Company
2.4 Water and health in Ghana
2.5 The wind of privatisation
2.6 Challenges
3.1 Location and size of the study area
3.2 History
3.3 Economy
3.4 Administrative
3.5 Land / property ownership
3.6 Housing
3.7 Informal settlement
3.8 Migration and urbanization
3.9 Activities of Peri- urban and its influence on the city.
3.10 Income and poverty levels
3.11 Education levels
4.1 The concept of safe adequate drinking water in the study area.
4.2 Water quality
4.3 Water supply and sources of water
4.3.1 Ghana Water Company- Kumasi
4.3.2 Bore holes and wells
4.3.3 Rain harvest
4.3.4 Streams
4.3.5 Water vending
4.5 Sanitation
4.6 Water, sanitation and health in the study area
5. Results and responses
5.1 Socio-Demographic information
5.2 Responses on the various sources of water
5.3 Attitudes about existing drinking water sources
5.4 Rating of the water managers in the city
5.5 What are the possible reasons why water is not being managed to fully serve the city
5.6 Knowledge of community participation in water management
5.7 Preference and willingness of the community to participate in water management
6. State of the art
6.1 Community participation
6.2 The concept of community participation
6.3 The concept of community participation and sanitation programme in rural Ghana
6.3.1 Institutional structures
6.4 Selected cases of community participation on water management
7.1 Water and health
7.2 Knowledge of community participation in water management
7.3 Willingness of the community to participation in managing water
7.4 Hygienic living condition
7.5 Community participation verses privatization
7.6 Challenges
7.7 The way forward
7.7.1 Identification of stakeholders
7.7.2 Fiscal backing
7.7.3 Clearly defined roles of the community
7.7.4 Private sector
7.7.5 Municipal government
7.7.6 Traditional leaders
7.7.7 Possible roles of the community
7.8 Nongovernmental organizations
7.9 Conclusions


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