SOCIAL INCLUSION IN WATER SNAPSHOTS Ghana | GREATER ACCRA METROPOLITAN AREA SANITATION AND WATER PROJECT Provision of Inclusive WSS Services Photo credit: GAMA Context Ghana has experienced strong and sustained economic growth over the last several years, translating into substantial socioeconomic improvements. This economic growth has been accompanied by rapid urbanization, particularly in the Greater Accra Metropolitan Area (GAMA). Ghana was one of the first Sub-Saharan African countries to achieve the Millennium Development Goals of halving poverty and reducing hunger by 2015. However, because these achievements have been accompanied by rapid urban growth, the provision of basic health and sanitation services has not been able to keep up, which has particularly adverse effects on people living in low-income areas. A lack of basic sanitation and water services and inadequate facilities is particularly evident among the urban poor. As a result, they must rely on commercial water vendors and public toilets, which negatively affects both their household expenditures and quality of life. Since 2014, the GAMA Sanitation and Water Project has been working to address this gap in water supply and sanitation services by expanding water distribution networks, conducting sanitation and hygiene awareness training in schools and communities, and by providing technical assistance to municipal, metropolitan, and national institutions. Notably, the project has paid particular attention to reaching low-income urban communities and persons with disabilities, and to addressing the specific sanitation and hygiene needs of young girls. Focusing on Low-Income Urban Communities The GAMA Sanitation and Water Project prioritizes households in low-income urban communities in its efforts to improve water supply and sanitation services. Overcrowding is used as a key proxy for “low income” status, as well as lack of access to improved sanitation. The Project introduced a mobile money platform, The GAMA Tigo Cash Platform, that households can use to save towards the cost of a toilet. This allows people who are unable to access the traditional banking sector to participate in a flexible payment arrangement. The Project has also funded new technologies, such as different types of household-level sanitation containment and treatment solutions, which are available on the market and are now subsidized by the Project for low-income households. Disability-Inclusive Water Supply, Sanitation, and Hygiene Facilities As of September 2019, 299 school sanitation facilities have been completed, and a total of 406 facilities will be renovated or newly constructed by 2020, which is the end of the Project. All of the participating schools now have separate sanitation facilities for boys and girls, as well as disability-inclusive toilets with access ramps and handrails, both inside and outside the units. Access to safe and hygienic water and sanitation facilities in schools is essential for the uninterrupted education of children and young adults, and contributes to a reduction in absenteeism and dropout rates. GAMA also provides accessible toilets to households with persons with disabilities at an affordable price. Many of the low-income people who rely on public toilets must pay a fee per use, walk a considerable distance, and often wait in a long queue. Such constraints are even more acute for people with disabilities. Since it is difficult for many persons with disabilities to access a toilet by themselves, they need Photo credit: GAMA support by a caregiver. This can contribute to a loss of self-esteem, and a need for a caregiver—normally a family member—to provide such assistance. Now, beneficiaries with accessible toilets on their premises can use them with minimal support from family members, thereby saving the household both time and money. For example, one caregiver reported that she had previously missed several lectures at school because she needed to accompany her father to a public toilet. He has now access to a toilet at home, so she is able to attend class regularly. Menstrual Hygiene Management For school-going girls, a lack of adequate facilities for managing their menstrual hygiene can lead to absenteeism, or to dropping out of school entirely. 1 All GAMA-supplied WASH facilities in schools include handwashing facilities, separate toilets for boys and girls, changing rooms for girls, and disposal bins for used sanitary pads. GAMA has also provided education about menstrual hygiene management at upper primary and middle schools by integrating it into existing Photo credit: GAMA public health programs. School-based health coordinators and teachers have received training, and over 141,000 students in 189 schools have participated in menstrual hygiene education activities. In 2018, to mark Menstrual Hygiene Day, GAMA held awareness program for boys, girls, and local communities on the benefits of menstrual hygiene management. Because talking about menstruation in public has traditionally been taboo, the program created a space to break the silence, provide accurate information, and build awareness to enable women and girls to reach their full human capital potential. In 2019, a similar event was held at the school for the blind in Ashaiman, with 1,000 students participating. 1 In India, for instance, a meta-analysis found that 25 percent of girls did not attend school during menstruation because of a lack of adequate toilets in the school. Van Eijk, A., M. Sivakami, M. Thakkar, A. Bauman, K. Laserson, S. Coates, and P. Phillips-Howard. 2016. “Menstrual Hygiene Management among Adolescent Girls in India: A Systematic Review and Meta- Analysis.” BMJ Open 6 (3). Sources and additional information: _________________________________ • Project Appraisal Document Project Snapshot #6. October 2019 • GAMA-SWP Newsletter, March 2018 Water Global Practice in collaboration with • GAMA Project Brief http://www.worldbank.org/water • GAMA Sanitation and Water Project – NEWS, November 2018 • GAMA website http://www.mswrpcu.com/ For more information about this snapshot, Note prepared based on support and inputs from Yitbarek Tessema, George contact: Yitbarek Tessema: ytessema@worldbank.org Asiedu, Quaranchie Tettey, Sanyu Lutalo, Claire Chase, and Ayumi Koyama