ACCRA, Ghana -- It's 7:30 a.m. and the sun is rising fast over Ashaiman. Open gutters steam at the side of the road and the air is alive with the sounds of the crowded Accra suburb waking. Women fry meat over wood fires while the clatter of their cooking cuts through the morning. Patrick Apoya, former executive secretary of the Coalition of NGOs in Water and Sanitation, drives to meet a colleague. His white Toyota pickup truck crawls through the crush of workers on their morning commutes. He loosens the collar on his pressed cream shirt and leans a broad forearm out the window, drumming his fingers on the car's warm metal. He has been driving for 30 minutes and is dressed for an air-conditioned office. Frowning, Apoya wipes a bead of sweat from his brow. Five minutes from his destination, Apoya sees a crowd gathered around a neatly dressed young man. They are standing at the concrete entrance to a shabby public toilet. A fight is about to break out.
Apoya pulls over, steps out of his car and approaches. The young man is trying to speak, but the group drowns him out. "What's going on?" Apoya asks a bystander. "This man takes us for fools because he dresses better than us," the bystander says. Someone pushes the young man, and Apoya turns to another member of the mob, still looking for an explanation. "This man wanted to jump the queue to use the toilet, pretending he was late for office and feared his supervisor would be angry," someone explains. "If he knew his supervisor would be angry, he should have been here at 4 a.m."
The young man, clothes tussled, sheepishly retreats to his original place in line. He anxiously looks at his watch and turns to Apoya. He's usually at the public toilet no later than 5 a.m., he explains, but felt unwell last night and overslept. "Thank God I'm not suffering from a bout of diarrhea," he says, "or else I would have been in big trouble."
A scuffle over a place in line at a public bathroom may seem strange, but so many houses in this country of 23 million lack proper facilities that queuing to use a public toilet is routine, particularly in urban Ghana. Waiting for 20 minutes or more is standard, even for the most basic facilities. And most public bathrooms are unsanitary, poorly maintained, gender-insensitive and quite smelly. Beyond the personal humiliation, the toilet queues are a sign that something is terribly wrong in one of Africa's most vibrant nations.
A River of Filth
Politically stable, rich in natural resources and endowed with twice the per capita output of its poorer neighbors, Ghana is, in many ways, an African success story. Corruption is relatively low, and the business sector is strong. In the World Bank Group's 2010 "Ease of Doing Business Index," which rates countries based on their citizens' access to entrepreneurial opportunities, Ghana comes in 92nd in the world--above Russia, Kenya, Greece and India. On Barack Obama's 2009 presidential visit to the country, he praised the nation as an example of African democracy and opportunity. It is, in part, because of its successes and rapid development that Ghana is mired, quite literally, in a sanitation crisis.
According to a report by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF), Ghana ranks as Africa's fourth-dirtiest--the official term is "least sanitary"--nation, and the second-worst of the 15 countries that make up the West African region. This means that Ghana has a severe shortage of what the WHO defines as "improved sanitation"--waste disposal systems that separate human excrement from human contact. Approximately 20 percent of Ghanaians are forced to relieve themselves in open spaces, and 80 percent of residential toilets are shared between more than one household. Of those facilities that are available, most have not been improved in accordance with WHO standards, which means that the proportion of the population with access to safe sanitation facilities is only 10 percent. Anything approaching modern, Western bathroom facilities can only be found in Ghana's four-and five-star hotels and the country's wealthiest homes. But even "wealthy" sewage makes its way, untreated, into the country's rivers, where it infects the populace. Diseases related to poor sanitation take eight lives an hour and account for 80 percent of all ailments reported...