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‘Improving’ versus ‘improved’ sanitation: the case of shared toilets in Ghana

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Ms. Tettey wakes her children up at 3.30 am every morning to be able to make it to the front of the line at the nearest public toilet block, located about 150 meters from her house in Accra’s La Dade Kotopon Municipal Assembly.  Like many residents of low-income informal settlements in Greater Accra, the Tettey family rents a single room in a compound house with about ten other families.  The 2008 Ghana Living Standards Survey reports that 79% of Ghanaians live in compound houses consisting of several households built around a common open area or yard that share basic utilities like water, electricity and sanitation, where available.  The use of shared toilets was the only alternative the Tetteh family had to open defecation when at home.  During the day, the adults tried to take advantage of the public toilets near the market where Mrs. Tettey works, and the children were encouraged to use the toilets at their school before coming home.  The Tetteys are among the 80 percent of Ghana’s population that lack access to ‘improved’ or safely managed sanitation.

An improved sanitation facility is defined as one that hygienically separates human excreta from human contact.  The Sustainable Development Goals (SDGs) currently exclude shared toilets from their definition of safely managed sanitation.  Likewise, to meet the WHO/UNICEF Joint Monitoring Program (JMP)’s definition of improved sanitation, toilets must be used by only one household, and they should meet certain design standards that prevent human contact with faeces.  These definitions are driven by concerns that an increased number of users, among other factors, reduces the overall levels of hygiene and cleanliness of facilities and decreases their safety, thereby limiting access for women, children, and the elderly, and precluding achievement of the health, social and environmental benefits of having adequate sanitation.


The WHO/UNICEF JMP 2015 report noted that a mere 14 percent of urban Ghanaians had access to improved sanitation, making it among the ten countries with the lowest access levels in the world.  Yet, the number of Ghanaians with access to toilets shoots to about 72 percent when the use of shared or public toilets is considered.  In fact, public toilets represent the single largest form of sanitation service for Ghanaians.  According to the WHO Perspectives Bulletin, 2015, this is more than twice the level of shared toilet usage in urban Sub-Saharan Africa (33%), yet trends in seventeen sub-Saharan countries indicate that the rates of people using shared sanitation is on the increase.

The quality of public toilets in Ghana varies considerably when factors such as technology, management of operation and maintenance functions, safety and overall hygienic practices, including access to handwashing and cleansing materials are considered.  While some facilities are properly run and could technically meet all the criteria for improved sanitation except for being shared by one or more households, some are poorly run and fail to meet most of the criteria.  The majority fall somewhere along the continuum between the two extremes.

We can envisage a ‘sanitation ladder’ which presents sanitation coverage as including a series of steps that move from: people practicing open defecation to use of unimproved sanitation facilities, to use of shared or private improved facilities, and at the top of the ladder are households using an improved facility that includes safely managed service delivery.  Typical shared toilets in Accra fall somewhere between stages two and three of this sanitation ladder, depending mainly on the effectiveness of operation and management arrangements.

© Ghana Together 
Moving from open defecation to the use of public and shared toilets, and ultimately to individual toilets, calls for tremendous effort involving many stakeholders. This effort is not just in terms of making physical investments but, more importantly, in effecting behavior change to maintain the momentum to move towards the top of the ladder and, once there, to ensure that facilities are properly operated and maintained.  

The Government of Ghana is determined to transform its sanitation landscape by increasing the number of people with access to improved sanitation and, ultimately, by increasing the likelihood of achieving universal access in line with the SDGs.  The Government has mobilized support from various partners, including the World Bank, the Global Partnership on Output based Aid and others to improve access to individual household toilets.  However, as progress is made towards the goal of universal coverage, a step by step approach up the sanitation ladder will remain part of the modus operandi for informal settlements in the short- to medium-term.  

The Tettey family are among the fortunate people that have recently benefitted from the ongoing IDA financed Greater Accra Sanitation and Water Project. Their landlord, with support from the project, provided a small toilet block where the Tetteys and two other families now share one stall.  The families ensure that the toilet is kept clean and hygienic at all times, thanks to Mrs. Tetteh’s diligence.  While the facility is still considered ‘unimproved’ by the JMP standards, it is an ‘improvement’ for the Tetteys, who now have the dignity of a clean toilet with water and soap, conveniently located behind their house, where they feel safe.  They have moved up the ladder in more ways than one.

Given the inevitable reality of shared facilities for many informal settlements, isn’t it time we focused on how to ensure access to clean, safe toilets regardless of the number of people using them? Instead we should focus on achieving progress up the ladder, to prevent the perfect from becoming the enemy of progress.

To learn more about Shared Sanitation, check out the World Bank’s recent publication:
Shared and Public Toilets: Championing Delivery Models That Work 
This blog is part of a series on shared sanitation. To read about other experiences, check out:
An Introduction to Shared Sanitation: How many people can share a toilet?


Sanyu Lutalo

Senior Water Supply and Sanitation Specialist, the World Bank Water Global Practice

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