Sometimes the first step in improving sanitation is changing people’s attitudes about what standard of sanitation they should be willing to accept. If you lived in the U.S. in the 70’s you will no doubt remember the commercial about the Indian Crying because of pollution. (I love it that it took me all of 2 seconds to find that, and share it with you!) In Ghana both government authorities and local NGOs are engaged in a big push to clean up the city and change citizen’s expectations and behavior.
Yes, it is once again largely about toilets. Living in the post industrial west, I have grown up taking toilets for granted. My brief stint in Nicaragua, though, gave me an appreciation for life without them. In the 80’s dysentery killed thousands of young children there every year. In Ghana it is cholera and dysentery. The problem in Ghana, and other developing countries, also includes the mess, the degradation of public beaches, and issues you might not think about, such as young women not going to school when they are menstruating because there are no private toilets there.
It isn’t all about lack of toilets, of course. It is also about the trash that clogs waterways, causing flooding when it rains… which, again, is an issue when those waterways are used as toilets.
The great ideas here are public education campaigns. The practical steps are cleaning up the cities, and working to improve those toilets so they would work, and be practical, in cities like Accra.