Appropriateness of Existing Technologies
The poor water supply situation in the community makes the greater reliance on dry sanitation systems appropriate. For private latrines, the preference for the VIP by many (47 %) households with private latrines could be attributed to their improved ventilation, hence, their potential to minimise the emission of odour and heat (Ryan and Mara 1983). This preference is consistent with the identification of odour and heat control by the focus groups as a factor that influences latrine usage in the community. Even though the adoption of dry sanitation systems is appropriate, their construction in some cases was not done in line with relevant technical guidelines. For instance, the lengths of vent pipes on some VIP latrines were found to be less than the recommended 500 mm above flat and sloppy roofs, or up to the highest point on conical roofs (Mara 1984). Inadequate vent height leads to a reduced chimney effect which is the main mechanism for reducing odour and heat in VIP latrines (Ryan and Mara 1983; Mara 1984). Besides, it was observed that some relevant operational guidelines were not followed. For instance, some twin-pit VIP latrines were observed to have both squat holes opened and in use simultaneously. This practice defeats the purpose of pit rotation that allows such latrines to be used continuously (Mara 1984).
For communal latrines, the known poor performance of VIPs under high faecal loading rates makes their use at the communal level inappropriate (MLGRD 2010b). Under high faecal loading rate, the practice of pit rotation (Mara 1984) is not possible since cycle duration becomes too short to allow complete decomposition of excreta for manual removal. Desludging by a cesspit emptier is often not feasible because by the time the pit becomes full, the initial sludge deposits would have partially decomposed and hardened, making it difficult to dislodge by a cesspit emptier. On the other hand, the management of the water closet technology as a communal facility in a water-scarce community could be inefficient and expensive as observed in the study area. In such a case, the pour-flush technology would be most appropriate. Compared to the water closet, the pour-flush uses minimal water, i.e., 1.5-2 litres per flush (Roy et al. 1984; Mara 1985) as compared to nine litres per flush for a standard water closet. Also, unlike a VIP, sludge removal by a cesspit emptier can be easily done since regular flushing prevents the hardening of sludge.
Analysis of Latrine Usage Trend
A comparison of the usage of facilities under different ownership regimes (household, shared and communal latrines) provides some basis for pondering over the JMP’s definition of ‘improved sanitation’ that recognises only facilities that are exclusively used by a single household. According to the JMP, only improved facilities (used by single households) are likely to be used consistently because those who do not have access to improved sanitation facilities are “obliged to defecate in the open or use unsanitary facilities” (JMP 2006; p. 16). However, as shown in Table 2, the default rate among users of household (3.3 %) and shared (3.1 %) latrines was not statistically significant (odds ratio = 1.05; p-value = 1). This implies that having access to shared facilities at home could achieve as much impact on open defecation as exclusive access by a single household. This finding supports the JMP’s emphasis on having access to latrines at home in the formulation of the post-2015 MDG targets on sanitation that prioritises the elimination of open defecation (JMP 2014). Even though the average number of users of shared latrines was higher (9.7) as compared to household latrines (3.6), and could make them more likely to be unhygienic, this risk could be compensated for by the sharing of maintenance costs and cleaning responsibilities among the multiple households. It must, however, be noted that the sharing of latrines by too many households could lead to quarrels among users. It is seen in Table 4 that quarrels among users accounted for 7 % of defaults among users of private latrines.
On the contrary, there was a significantly higher default rate among expected users of communal latrines (75 %) as compared to users of shared latrines (odds ratio = 3.09; p-value < 0.0001). This confirms the observation that the availability of communal latrines does not necessarily lead to regular latrine usage (Biran et al. 2011). The implication of this finding is that the JMP’s definition of improved sanitation is appropriate for excluding communal latrines. For latrines shared at home, it may be more appropriate to consider a limited number of households or a maximum user population per squat hole rather than classifying any level of sharing as unimproved. Another implication of this finding is that the pooling of resources among households for construction of a privately shared facility should be recognised as a potential tool for preventing open defecation and included in latrine promotion messages.
Identification of Factors Affecting Latrine Usage
The factors identified by the focus groups as influencing latrine usage were generally consistent with those identified by other studies such as Appiah and Oduro-Kwarteng (2011), Biran et al. (2011) and Keraita et al. (2013). The frequent mentioning of factors relating to odour and heat emission could be associated with the fact that members of this coastal community have an age-old practice of open defecation on the beaches where they experience unlimited natural ventilation. Therefore, they could be easily irritated by the slightest level of odour and heat encountered in a latrine. This finding implies that technological innovation should pay much attention to increasing the level of ventilation in latrines. However, the high importance attached to privacy implies that efforts to improve ventilation should not lead to provision of wide openings in the superstructure that may compromise the privacy of the user.
A comparison of the findings of the focus group discussions and the household surveys indicate that the most important factors recognised by focus groups as influencing their decision to use or avoid a latrine (safety, privacy and provision of seats for the aged, children and the physically challenged) were adequately catered for by existing latrines in the community. This is seen in the fact that none of the reasons cited by survey respondents for failing to use their latrines related to these important factors. On the other hand, intense odour, desludging challenges and unhygienic conditions which were cited by many defaulters were actually observed in latrines.
Potential Interventions to Address Barriers to Latrine Usage
The barriers to latrine usage in Prampram may be addressed by a combination of technical and non-technical interventions.
Potential Technical Interventions
Figure 1 shows potential technical interventions for overcoming the identified barriers based on literature recommendations and good practices observed in the study area. They are aimed at addressing the fundamental technical challenges that create barriers to latrine usage. For instance, intense odour and heat from pits are often the result of poor ventilation in latrines and may primarily arise from poor design of vent pipes or incorrect positioning of superstructure openings in relation to the direction of wind. These defects were observed in some of the latrines in the community. Ventilation in VIPs as well as fly control may be improved by installing a vent pipe of appropriate dimensions and painting it black to enhance the chimney effect (Ryan and Mara 1983; Mara 1984).
Adoption of wet technologies is particularly recommended for public toilets. Their advantages were attested to by users and managers of a pour-flush public toilet recently constructed in the study area. In addition to their capacity in handling high sludge loads, wet systems with a water-seal have a potential for controlling odour and heat emission as well as minimising fly nuisance. They also eliminate the challenge of hardened sludge which is associated with dry systems. Under the current circumstance where piped water is supplied to the community only once or twice per week, the development of sewerage systems is not feasible. Nevertheless, the pour-flush technology has a high chance of success if a moderate water storage capacity could be maintained.
Feelings of insecurity among toilet users were associated with the presence of reptiles or rodents in the toilet room and the fear of falling into the pit. Safety could thus be improved by designing the superstructure to prevent entry of rodents and reptiles. For instance, nets or other insect or reptile screens may be fitted on openings in the superstructure, though such openings would need to be enlarged to account for reduced air flow through the nets while maintaining privacy. Another safety measure is providing a squat hole of a maximum width not exceeding 200 mm (Mara 1984) and providing smaller ones for children in selected cubicles in communal toilets. Safety could also be improved, especially for night users, by installation of a lighting system.
Potential Non-Technical Interventions
The large number of private and communal latrine users who cited unhygienic practices by other users as their reason for defaulting the use of their latrines calls for measures to compel owners of private and communal latrines to ensure their hygienic maintenance. In this regard, special attention needs to be given to sanitary inspection in premises, which is one of the key tools for public health regulation emphasised in Ghana’s sanitation policy (MLGRD 2010a). In particular, poor management practices of communal toilets such as inadequate cleaning and failure to desludge on time could be improved by public sector regulation and regular monitoring. Furthermore, the establishment of a sanitation information desk at the offices of the local government (District Assembly) to guide households in technology selection and proper construction could lead to the construction of technically appropriate toilets to minimise the technical barriers discussed above. Nevertheless, such an intervention will need to be complimented with initiatives to deal with other socio-economic barriers such as financing, rights over land and the capacity of local artisans. The District Assembly could provide training on proper latrine construction to local artisans and issue them with licenses to operate in the District. A complaint system could then be instituted for feedback and monitoring of performance of artisans.