Is sanitation finally beginning to receive the importance it deserves?

Certain developments seem to suggest this. At the beginning of March, President John Mahama was in Tamale and took part in National Sanitation Day activities there. A Daily Graphic article on 10 March 2015, "Bye-laws are to be enforced –President," reported that President Mahama stated publicly in a meeting with Northern Regional chapter of the Ghana Journalist Association that the performance appraisal of all Chief Executives will be partly determined by how they deliver on sanitation within their various metropolitan, municipal, and district assemblies.

In the Wednesday, 1st April edition of the Daily Graphic there was an article "bye-law on sanitation soon." In the article, Naa Lamiley Bentil informed us that a draft sanitation bye-law is being developed and the idea is that it will form the basis of legislation for all district assemblies. According to the article, this legislation will make participation of the national sanitation exercises mandatory for all citizens. Hopefully, making it mandatory will also come with making necessary logistical arrangements for garbage/debris to be collected right after they are gathered/heaped.

There is a lot about the recent higher profile being given to sanitation that is commendable. There seems to be a growing recognition that sanitation is important and must be appropriately addressed. On one hand, we have our president giving political prioritization to sanitation. On the other hand, we have attempts to craft legislation making participation in clean up exercises on sanitation day mandatory. What is to be made of all of this?

It is good to hear that the performance appraisal of Chief Executives and their mandates as leaders will be apprised on the basis, partly, of their enforcement of sanitation bye-laws. But what exactly does this mean? What will we see happening to know that DCEs are being held accountable? Will there be budget tracking activities that ensure funds allocated for proper sanitation issues (not just fuel allocation charged to that line item) is spent as planned? And if not, what will be the consequences? Will there be random visits and spot inspections of MMDAs to ensure that they have fully functioning water, sanitation, and hygiene facilities at all time, including toilets? It would be interesting for journalist to investigate how many Metropolitan, Municipal, District Assemblies (MMDAs) have safe bathrooms for the use of their staff and the general public and whether there is consistently adequate water and soap for hand washing. It would be equally important to learn if every public health facility in Ghana provides safe bathrooms for the use of their staff and the general public, had appropriate systems in place for the disposal of medical waste, and ensured good personal hygiene was promoted and enabled by the provision of adequate water and soap for hand washing. Then corrective actions taken at the presidential level to address failure in providing these basics in any MMDAs would be a concrete demonstration of leadership enforcing accountability.

Is it making citizens more accountable for helping make Ghana clean that is the basis for the emerging attempts to mandate the participation is sanitation day clean up exercises? Or is this mainly an attempt of government to shift responsibilities to the population? Certainly, every individual has a responsibility to help creating and maintaining a sanitary environment. It is widely known that good sanitation, including appropriate hygiene, is a key determinant of child health especially, and public health, more generally. It is possible that both assumptions above are true. However, from our WaterAid Ghana perspective, mandating participation in national sanitation day activities can have absolutely no legitimacy before leadership at every level of government ensured that sanitation (and hygiene) budgets were appropriately costed, disbursed in a timely manner and incorporated into national health plans. These funds should also be appropriately accounted for after they have been spent. Indeed, let us mandate that health planning comprehensively addresses newborn and child health with a focus on preventative health through the promotion of sanitation and hygiene.

Evidently, stronger leadership is emerging to champion sanitation. There is widespread recognition that sanitation is a fundamental pillar for national development. Yet there remains a serious disconnect. Recognition of a problem is NOT being met with the provision of adequate funding to address it. Journalists are encouraged to closely review the allocation to sanitation in the 2015 budget. They should also evaluate whether it meets the commitment made by the Government of Ghana when they signed the Sanitation and Water for All (SWA) in April 2014. Strong leadership is necessary to fulfil financial promises that have been made to address sanitation.

We also need strong leadership on hygiene. There is still inadequate attention to culturally appropriate hygiene promotion. Perhaps journalist and engaged citizens can ascertain just how much money in their respective MMDAs has been allocated for hygiene promotion.

After all it is widely known that sanitation and hygiene promotion are the most cost effective way to improve public health. Further, increased coverage of improved sanitation and culturally appropriate hygiene promotion is an important pre-requisite for poverty reduction; Indeed, extending coverage of improved sanitation and culturally appropriate hygiene promotion when done with equity and social inclusion as the guiding principles of design and implementation can also support reducing inequalities, including health outcome inequalities.

So let's support President Mahama's call for sanitation bye-laws to be enforced by MMDAs. As a nation we urgently need to ensure safe collection, transport, treatment and disposal or reuse of human excreta, domestic wastewater and solid waste and culturally appropriate hygiene promotion. Enforcing bye-laws requiring that everyone everywhere including children have access to safe sanitation and culturally appropriate hygiene promotion will have vast positive public health implications for our nation.

And as President Mahama uses the office of the president to increase momentum on improving sanitation coverage, we are sure he will have overwhelming national support when he holds the Ministry of Finance and all relevant bodies accountable for ensuring that the central government fulfils its obligations to ensure that MMDAs receive Common Funds allocations that are adequate to the task, predictable in the amounts to be released and timely in their actual disbursement, but most importantly, accounted for.

This is what it means to get really serious about sanitation!

Article written by : Mr. Ibrahim Musa and Dr. Chaka Uzondu

Mr. Ibrahim Musa is the Head of Policy at WaterAid Ghana and Dr. Chaka Uzondu is the WASH and Health focal person at WaterAid Ghana.