Water supply and the persistent prevalence of guinea worm cases in the Savelugu-Nantong District

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Globally, over one billion people have no access to potable water, and an estimated 2.7 billion people will face major water shortages by 2025 (International Institute for Sustainable Development, 2006). Majority of those without potable water are in the developing world, especially in Sub-Saharan African countries. This gloomy state of inadequacy of potable water has translated into high incidence of water and sanitation related diseases such as guinea worm. Naturally, since guinea worm is a water borne disease and associated with the use of contaminated water, with the provision of potable water, the expectation is that societies should be free from the worm, but it resurfaced. With the global launch of the Guinea Worm Eradication Programme in 1989, several and varied interventions have been implemented in all endemic countries. Chief among these interventions in Ghana is the provision of potable water by central government and development partners. Others include educational campaigns on appropriate hygiene practices regarding the treatment and use of water, provision of filters, extensive surveillance and case containment. The Savelugu-Nantong District of the Northern Region is the leading endemic districts in Ghana and this study sought to investigate why in spite of the huge investment in the provision of water and sanitation facilities, as well as education campaigns, the disease is stilt persistent. A blend of quantitative and qualitative techniques were employed to collect both primary and secondary data from households and relevant stakeholders in the water and sanitation sector as well as those engaged in the guinea worm eradication efforts. With the purposive sampling technique, 10 questionnaires each were administered in 10 communities across the District. Even though the spread of cases of guinea worm does not correlate with the distribution of water facilities, it is more preponderant in communities in the south-eastern corridor and in the major communities along the main Tamale-Bolgatanga trunk road. Many communities have more than enough potable water facilities and yet they are grappling with guinea worm cases, and others do not have any potable water source at all and have no cases of guinea worm. Several factors such as finance, geography, conflicts, waiting time, beliefs, practices among others militate against the people's access and use of potable water, thus compelling them to use contaminated, which exposes them to the risk of contracting guinea worm. Some WATSAN Committees and Water Boards do not have adequate capacity to administer hygiene education campaigns and ensure sustained potable water supply as breakdown of water facilities take over a week to fix. Ineffective collaboration among stakeholders in the delivery of water and sanitation has resulted in the duplication of efforts. Educational campaigns and social mobilization on behaviour change regarding water treatment has not caught up with the people, as some do not treat unwholesome water before use. Wholesale hygiene education programmes have been packaged and delivered with water and sanitation projects by different service providers Regardless of the unique characteristics of the different communities. The practice of 'one jacket fits all' by service providers perhaps partly accounts for the apathy, adamancy and lack of commitment on the part of the people to change their behaviour. Recommendations made inter alia are placing priority on the provision of potable water to the unserved 47% of the district population and equal attention should be given to water, sanitation and hygiene education. Periodic capacity building programmes should be organized to strengthen Watsan Committees and Water Boards for sustained potable water supply. For those communities where borehole construction is not feasible, studies should be conducted to identify alternative sources of potable water. Studies should also be conducted to unravel why hygiene education is not translating into behaviour change. To eradicate guinea worm, an all hands on deck approach is required to reduce the suffering, deprivation and poverty levels of the people.
A Thesis Submitted to the School of Graduate Studies, Kwame Nkrumah University of Science and Technology in partial fulfillment of the Requirements for a Degree of Master of Science (Development Planning and Management), 2008