By Ewurabena YANYI-AKOFUR

Dear Mr. President,

The issue with Ghana’s sanitation goes beyond households lacking access to restrooms. It is deeply embedded within our key public structures—hospitals, educational institutions, marketplaces, and administrative buildings—areas where people anticipate security, respect, and fundamental amenities.

Currently, numerous such areas do not have the fundamental WASH (Water, Sanitation, and Hygiene) facilities required to meet those standards.

Throughout the nation, many women continue to deliver babies in locations lacking access to toilets or potable water. In remote regions, healthcare providers or community members offer clean birthing spaces devoid of sanitizers, gloves, or even basic soap. When restrooms do exist, they are frequently damaged, unclean, and neglected.

Numerous schools face challenges due to inadequate and unsafe restroom infrastructure, leading students to avoid using toilets and instead resort to defecating openly. In government buildings and marketplaces—areas crucial for administration and trade—their restrooms are often non-functional or nonexistent, with even fundamental handwashing supplies being considered extravagant. This issue represents a critical nationwide crisis rather than a gradual problem.

As per the 2023 WHO/UNICEF Joint Monitoring Programme (JMP):

Healthcare facilities:

• Almost 40% (39.54%) of medical centers face restricted availability of hygienic conditions, with 3.32% completely lacking access to hygiene resources — presenting significant dangers concerning the prevention and management of infections.
• Approximately one out of every three (32.58%) medical centers face restricted water availability, which complicates maintaining hygiene during childbirth, treating injuries, or performing simple sanitation tasks.

Primary Schools in Ghana:

• More than one in four (25.22%) elementary schools lack access to clean drinking water, endangering students’ health and increasing their chances of becoming dehydrated or sick.
• Almost one out of four (24.69%) do not have access to proper sanitation facilities, as toilets are either missing or not functioning.
• Over one-third of schools (35%) lack proper sanitation facilities, preventing students from maintaining fundamental cleanliness by washing their hands after using the restroom.

These figures go beyond mere digits. They symbolize:

• Female students skipping classes because of inadequate sanitary facilities.
• Mothers delivering in indignity.
• Nursing staff required to clean delivery tables using only their bare hands.
• Government employees and street sellers facing humiliation in open areas.

According to a WaterAid study employing the World Bank methodology, healthcare-associated infections are estimated to cost Ghana $1,570 million annually, resulting in numerous avoidable fatalities. Today, WaterAid reveals through fresh research that up to half of these infections might be avoided with better water, sanitation, and hygiene (WASH) conditions within such facilities. Additional findings show that reducing healthcare-related infections by half would save approximately 31,300 lives yearly throughout Ghana and free up around $72 million for the country’s finances.

However, the true expense lies in human deaths, damaged confidence, reduced efficiency, and an uncertain tomorrow.

“Out of Toilets, Out of Permits,” the president’s strong pledge needs to move past empty promises. It should be implemented, supported with resources, and extended throughout every public organization, not merely limited to residential areas.

Yet today:

• Medical institutions rely on insufficient NHIA payments and IGF funding, making it difficult to support essential WASH programs.
• Rural medical facilities lack cleaning personnel, forcing overburdened healthcare workers or untrained volunteers to handle hygiene tasks.
• School water, sanitation, and hygiene funding is scattered and not given sufficient attention.
• No single nationwide regulation or method of implementation exists for WASH facilities within public organizations.

We call upon you to take firm action and:

1. Ensure complete implementation of “No toilet, no permit” for all public facilities.
2. Make sure that NHIA and public funding provide assistance for the functioning and upkeep of WASH infrastructure within healthcare facilities.
3. Create and finance a nationwide initiative focused on Water, Sanitation, and Hygiene within schools, implementing required benchmarks for restrooms, clean water access, and health practices—with particular attention to the needs of female students.
4. Give precedence to WASH facilities within the designs for revitalizing public markets.
5. Appoint specific sanitation workers at healthcare centers across the country, including those in remote areas and districts.

Let us also not overlook:

• Many mother-related fatalities take place in remote healthcare centers, where access to clean water, sanitation, and hygiene services is most limited.
• Female students leave school because they do not have access to secure, gender-aware restroom facilities.
• Institutions supported by taxpayer money frequently fail to provide even basic facilities like a functional restroom.

This is far from an insignificant matter—it lies at the heart of our obligations regarding health, education, gender equality, efficiency, and public confidence. Ghana cannot establish modern institutions with outdated sanitary systems.

Address the Emergency. Mr. President, the moment to take action has arrived. Stop with partial solutions. Cease waiting for crises to escalate into public incidents. Tackling the Crisis should be a nationwide priority—centered around strong leadership, financial support, and responsibility.

No woman ought to deliver a child without access to water,

Every nurse must have access to soap while working.

Every child deserves respect and honor,

No Ghanaian person should endure hardship behind faulty doors or without water flowing from taps.

Flush the crisis.

The author serves as the Country Director for WaterAid Ghana.

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