A Ghana News Agency feature by Dzifa Azumah

Do landlords know that it is an offence not to provide toilet facilities in their houses before renting them out? Well, a lot of them do not know and that is why they continue to put up houses without toilet facilities and expect their tenants to use the public toilets.

So the reminder of the Director of Environmental Health and Sanitation, Mr Demedeme Naa Lenason, to landlords that it is an offence not to provide toilet facilities in their houses or to convert their toilets and bathrooms into living rooms is timely.

Quoting from the 2000 Population and Housing Census, he said more than 20 per cent of Ghanaians did not have any form of latrines and therefore resorted to open defecation.

Mr Lenason said the 2000 census revealed that 31.45 per cent households in Ghana used public latrines as compared to 8.5 per cent using water closet; 22 per cent used pit latrine, 6.9 per cent used KVIP, four per cent used bucket or pan latrine and 6.9 per cent attend to nature's call in other people's houses.

He said the Ministry's Environmental Sanitation Policy of 1999 was unequivocal on households and public toilets and the policy states that at least 90 per cent of the population should have access to acceptable domestic toilet, while the remaining 10 per cent should have access to hygienic public toilets.

As we observe World Toilet Day on November 19, a day to celebrate the humble, yet vitally important toilet and to raise awareness of the global sanitation crisis, we need to learn from other countries, such as the United Kingdom, how toilets became a vital part of any building. As far back as in 1891, there were legislations for the construction of water closets in houses by the British under the London Householder's chart. There were nuisances, which could be dealt with summarily under the Public Health (London) Act 189.

There were strict regulations regarding erected or re-built houses, with the provision of proper water closets. Penalty was 20 pounds then. Additionally, the British found it necessary to support this Law having had very bad experiences in waste management and becoming sufferers of epidemics such as typhoid and cholera in the 1840s. There is no way a building can be erected in the UK now without the provision of at least a toilet.

But in Ghana people still build houses without making provision for toilet facilities.

Dr John Snow's work in tracing the source of a cholera outbreak in Soho, England, in 1954, is described now as "a major event in the history of public health and can be regarded as the founding event of the science of Epidemiology".

The discovery of what causes cholera was followed by the crisis, which was termed, "The Great Stink or the Big Stink." In the summer of 1858, the smell of untreated sewage almost overwhelmed people in Central London. Within 18 days a bill was passed and the task of building the city's sewers began and those sewers still serve London.

Sadly, there are still outbreaks of cholera in Ghana almost every year, but no serious focus has been given to building hygienic toilets across the country to check this outbreak.

Across Africa, about 62 per cent of the people do not have access to an improved toilet, the WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation said in its March 2008 report.

Though having a clean accessible toilet is also central to the human rights and personal dignity of every woman, man and child, 2.6 billion people - half the developing world - lack a simple "improved" latrine. The WHO and UNICEF estimate that 1.2 billion people worldwide gained access to improved sanitation between 1990 and 2004, while about 980 million children had no toilets at home.

If current trends continue, there will still be 2.4 billion people without basic sanitation in 2015, which is the target year for halving the number of people without access to sanitation and safe drinking water. The main problem will be that the children among them will continue to pay the price in lost lives, missed schooling, in disease, malnutrition and poverty.

As for Sub-Saharan Africa, it has been predicted that not until 2076 can the MDG be met, which is, about 61 years later than the target. So, this means a child somewhere today may have to wait for at least 68 years before being able to use a proper toilet.

Over population and overcrowding issues, lack of basic funds and infrastructure required to build an effective sanitation model are inhibiting access to sanitation or the use of a proper toilet. Improving access to sanitation is a critical step towards reducing the impact of diseases. It also helps create physical environments that enhance safety, dignity and self-esteem. Safety issues are particularly important for women and children, who otherwise risk sexual harassment and assault when defecating at night and in secluded areas.

In some parts of Africa, including rural communities in Ghana, women and children are forced to wake up around 0300 hours or wait till it is very dark to go into the bush to defecate, exposing themselves to dangers such as snake and scorpion bites.

People become infected with intestinal parasitic worms through contact with soil that has been contaminated with human faeces from an infected person, or by eating contaminated food.

Most rural homes in Ghana and urban slum areas truly lack toilets and where there is a community toilet, the people prefer not to use it because of the fees that are normally charged for maintaining them. This can also be related to the high level of illiteracy and poverty among them. Community members do not understand why they have to pay for the use of facilities such as a toilet, when people cannot get money for a square meal.

What is worse is that children are prevented from using the toilet facilities, because parents do not see why they should spend money on children to use a proper toilet. They have to use what is open defecation. What the parents do not know is that lack of proper sanitation causes death. They do not know that about four billion cases of diarrhoea per year cause 1.8 million deaths, over 90 per cent of them (1.6 million) among children under five. Repeated episodes of diarrhoea make children more vulnerable to other diseases and malnutrition.

Diarrhoea is the most important public health problem directly related to water and sanitation. The simple act of washing hands with soap and water can cut diarrhoeal disease by one-third.

Next to providing adequate sanitation facilities, it is the key to preventing waterborne diseases. Improving sanitation facilities and promoting hygiene in schools has, however, benefited both learning and the health of some school going children.

Child-friendly schools that offer private and separate toilets for boys and girls, as well as facilities for hand washing with soap, are better equipped to attract and retain students, especially girls, and where such facilities are not available, the girls often withdraw from school when they reach puberty.

To help girls remain in school especially during their puberty years, non-governmental organisations (NGOs) in Ghana, for instance, are taking up the challenge to provide schools with toilets.

One of these NGOs is Plan International. This has helped to improve school enrolment. Plan International has constructed about 10 girl-friendly toilets in rural schools to promote sanitation.

The latrines have to be secure from dangerous animals and rapists or sexual abusers.

The design was developed following group consultations with the girls. The latrines help girls in several ways:

* There is a washroom that girls can use to change or clean themselves in privacy.

* The squat holes are slightly bigger to cater for girls' physiological urge to urinate while defecating.

* Rainwater is collected from the roof of the sanitary unit, which makes it completely self-sufficient.

* Water and soap are provided.

Better sanitation would in fact have a multiplier effect on all the Millennium Development Goals.

The MDG target on sanitation is seriously lagging behind schedule. The entire UN System has a shared responsibility in mobilizing concrete actions towards its achievement and investments must increase immediately. To focus attention on what it has deemed a global crisis, the United Nations declared 2008 the International Year of Sanitation.

According to Sha Zukang, UN Under-Secretary General for Economic and Social Affairs, "Sanitation is not a dirty word; it is a critical factor in human welfare and sustainable development. We need to put the spotlight on this silent crisis."

The International Year of Sanitation 2008 is aimed to raise the profile of sanitation issues on the international agenda and to accelerate progress towards meeting the Millennium Development Goal target of reducing by half the proportion of people living without access to improved sanitation by 2015.

In spite of these interventions, the age-old practice of carrying human excreta in pans continued in Ghana until the Supreme Court ruled last year to outlaw it in Accra effective from July 8, 2008. The Supreme Court ruling banned the use of pan latrines and ordered the Accra Metropolitan Assembly to phase out its use completely by 2010 and arrest and prosecute people who engage the use of "night carriers" in their homes. In a ruling described as a landmark, one of the presiding judges, Justice Sophia Akuffo could not help but shower praises unto the plaintiff, Nana Ampofo Adjei, a private legal practitioner, saying, "history shall be grateful to you".

The ruling further ordered the defendant, the AMA, to build 500 KVIPS across the capital for public use, and financially assist people with latrines to convert them into water closets.

The ruling came as a relief to many. Nana Ampofo Adjei said the ruling was a result of hard work started from 1992, when he found the practice as an assault on human dignity and made all efforts to stop it, but was unsuccessful.

He has won one battle, but the pressure on public toilets has increased. There are no alternatives and people have to queue for hours to access a facility which about 20 to 30 more people need around the same time.

There are occasions when people quarrel or are injured because someone jumps the queue.

To avoid the problem of queues, some unscrupulous people also defecate in plastic bags and dump them in drains with the hope that rainwater would carry them away.

Choked drains are a major cause of floods in sprawling cities such as Accra.

The answer is for individuals to be socially responsible and not rely on the government for every amenity.

Whenever you construct a building for the use of humans, be it a house, an office, a bank, restaurant, market, school or fuel filling station, make sure there are toilet facilities for both residents and visitors. One day, very soon, building owners would be prosecuted if they fail to do so. So do it now for humanity's sake.