Can open-defecation free (ODF) communities be sustained? A cross-sectional study in rural Ghana

Community-led total sanitation (CLTS) is a widely used approach to reduce open defecation in rural areas of low-income countries. Following CLTS programs, communities are designated as open defecation free (ODF) when household-level toilet coverage reaches the threshold specified by national guidelines (e.g., 80% in Ghana). However, because sanitation conditions are rarely monitored after communities are declared ODF, the ability of CLTS to generate lasting reductions in open defecation is poorly understood. In this study, we examined the extent to which levels of toilet ownership and use were sustained in 109 communities in rural Northern Ghana up to two and a half years after they had obtained ODF status. We found that the majority of communities (75%) did not meet Ghana’s ODF requirements. Over a third of households had either never owned (16%) or no longer owned (24%) a functional toilet, and 25% reported practicing open defecation regularly. Toilet pit and superstructure collapse were the primary causes of reversion to open defecation. Multivariate regression analysis indicated that communities had higher toilet coverage when they were located further from major roads, were not located on rocky soil, reported having a system of fines to punish open defecation, and when less time had elapsed since ODF status achievement. Households were more likely to own a functional toilet if they were larger, wealthier, had a male household head who had not completed primary education, had no children under the age of five, and benefitted from the national Livelihood Empowerment Against Poverty (LEAP) program. Wealthier households were also more likely to use a toilet for defecation and to rebuild their toilet when it collapsed. Our findings suggest that interventions that address toilet collapse and the difficulty of rebuilding, particularly among the poorest and most vulnerable households, will improve the longevity of CLTS-driven sanitation improvements in rural Ghana.

Does financial literacy inevitably lead to access to finance services? Evidence from rural Ghana

ABSTRACT: This study examined the determinants of financial literacy (FL) and its impact on access to financial services (AFS), using data collected from rural Ghana. A two-stage residual inclusion model is utilized to address the selection bias issue. The results showed that FL is affected by household heads’ age, gender, education, asset ownership, homeownership, and economics education. The results revealed that FL is significant and positively related to AFS, but its square shows an inverse relation with saving mobilization. This indicated a non-linear relationship between FL and AFS. Moreover, we find that FL has a larger AFS impact for households with high-income and male household heads relative to their counterparts. The study recommended that the government can initiate the creation of a rural committee to educate rural residents on financial issues through radio broadcasting and meetings. Our findings highlighted the importance of FL on AFS in enhancing the welfare of rural households.

Women Empowerment and Skilled Birth Attendants among Women in Rural Ghana

Background. A critical public health issue is maternal mortality. Around 810 women die per day from pregnancy and childbirth, with approximately 99 percent of these deaths recorded in low-and middle-income countries (LMICs). In sub-Saharan Africa (SSA), more than half of these mortalities are registered. The situation is remarkably similar in Ghana, with maternal mortality standing at 319 deaths per 100,000 live births in 2015. Methods. Using data from 2014 Demographic and Health Surveys, the study examined the association between women empowerment and skilled birth attendance among women in rural Ghana. Results. Women with medium decision-making ( OR = 0.75 , CI = 0.61 , 0.93), low knowledge level ( OR = 0.55 , CI = 0.40 , 0.76), high acceptance of wife beating ( OR = 0.68 , CI = 0.51 , 0.90), with less than 4 ANC visits ( OR = 0.25 , CI = 0.19 , 0.32), whose partner had higher education ( OR = 1.96 , CI = 1.05 , 3.64), and who had a big problem with the distance getting to the health facility ( OR = 0.63 , CI = 0.50 , 0.78) had a significant association with skilled birth attendants. Decision-making power, women’s knowledge level, acceptance of wife beating, antenatal care visit, partner’s education, getting medical help for self, and distance to health facility were seen to have a significant association with skilled birth attendants among women in Ghana. Conclusion. Efforts to increase the current SBA should concentrate on the empowerment of women, male involvement in maternal health problems, women’s education, and participation in the ANC. There is a need to review current policies, strategies, and services to improve maternal health conditions.

Minding the Design Reality Gap

This paper focuses on evaluating an information and communication technology (ICT) intervention promoted as a pro-poor telecentre initiative in rural Ghana. Our evaluative tool is the Design Reality Gap (DRG) framework used to analyse the Community Information Centre (CIC) initiative in Ghana. Data were collected through a qualitative multi-site case study. By tracing the linkages between the investment and outcomes, we found a worrying trend of failed implementations and sustainability, although implementers did sustain efforts at planning new initiatives. Based on the findings, we argue that the CIC initiative in Ghana is a failing ICT intervention. We also found that the tailored DRG approach allowed us to tease out the nuances that account for the CICs' status. We conclude by proposing gap closure measures for the failing intervention. This paper contributes to ICT evaluations by demonstrating the utility of the DRG framework in evaluating one of the most significant pro-poor ICT initiatives in lower-to-middle-income communities: telecentres. This research also contributes to the current ICT literature by enhancing our current knowledge about publicly accessible ICT facilities in an under-investigated setting, and further offers an approach to telecentre evaluations in similar contexts inspired by the DRG model.