Ill health unleashed? Cities and municipal services in Ghana

Abstract

Increasing urbanisation, wealth and ill health in cities necessitate careful study, especially in African cities whose development is widely regarded as rapid and chaotic. Using Ghanaian cities as a case study, this article analyses some of the important sources of ill health, identifies why they persist, and assesses how they impinge on economic growth, redistribution, and poverty reduction. It argues that, although there is considerable evidence that policy change is urgently needed, the tensions and contradictions between economic and social efficiency, intermeshed with vested political interests, are likely to impede significant changes to the status quo.

Keywords:

• Ghana
• Africa
• cities
• water
• sanitation
• health

Acknowledgements

I am most grateful to Professor F.J.B. Stilwell, Dr Abraham Oduro, Lewis Eldridge, and the reviewers and Editorial Working Group of ROAPE, whose comments have helped to strengthen this article. Any disparity between their intentions and realisation in this article is solely my responsibility.

Notes

Anna Tibaijuka, Under-Secretary-General and Executive Director of UN-HABITAT, has consistently used the term ‘homo urbanus’, for example in a recent lecture at the University of Sydney, Australia.

Note that, because of lack of more recent data, the period of comparison in Ghana is from 1990 to 2005.

This result has been achieved by persistently denying communities adequate municipal services and extolling the idea of ‘community’ self-help and ‘do it yourself’.

The institutions involved in the management of water in Ghana include the Ministry of Works and Housing (MWH), Ghana Water Company Limited (GWCL), Community Water and Sanitation Agency (CWSA), Ministry of Local Government and Rural Development (MLGRD), Public Utility Regulatory Commission (PURC), District Assemblies, donor agencies, NGOs and communities; see Laryea-Adjei 2006, pp. 74–75 for a discussion of the roles of each of these organisations.

This broad picture hides differences between cities. In Accra, for example, more than 50% of the population do not have access to house or yard connection (Beyene et al. 2008).

Such a provision gives incentives to AVRL to pad costs, engage in transfer pricing, and generally to ‘take it easy’ with economising on costs. As a profit-driven company, AVRL could increase its profit by targeting ‘non-revenue water’ decomposed into water not paid for as a result of illegal connection and leakage. Between the two, AVRL prefers to work on consumers to get their money, rather than work on the leakage (Weissman 2002).

Note, however, that official declaration of private involvement in waste management started in the first half of 1990. In Accra, it started in 1995 (Addo-Yobo and Ali 2003). So, prior to the official declaration, there was already private-sector involvement in the management of waste.