2 Four-part Summary of the Literature Review 1
COVID-19 transmission pathways
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Risks of environmental contamination and fecal-oral transmission of SARS-CoV-2 points to the need to eliminate uncontained sanitation technologies that pollute water bodies and the poor performance of waste treatment plants
Human-to-human transmission occurs via airborne virus-carrying particles attacking the respiratory system. More recent research discovered extended viability of SARS-CoV-2 (the virus causing COVID-19) in human excreta, thus raising concern of transmission via feces and the environment connected to water bodies.
Women, children and the elderly are discouraged from using shared toilets due to poor hygiene and safety, or lack of dedicated facilities. Shared toilets are unpleasant also due to unmaintained cleaning duties and gender bias in their upkeep.
Toilets are high-risk sites of transmission, especially when shareed between households and large groups of people.
The lack of effective handwash solutions, the financial burden of pay-per-use toilets, and the lack of constant water supply in informal settlement, are some of the vulnerabilities revealed by Ghana's free water directive during the pandemic.
In dense, unplanned peri-urban settlements, overcrowded households, poor sanitation infrastructure, certain cultural practices and public health awareness may pose risks of cross-contamination
Shared sanitation in less-developed areas of Accra have not been included in new investments in response to COVID-19. This also brings into quesiton to the exclusion of shared toilets as improved sanitation by the UN Sustainable Development Goals.
Improvements on shared toilet design requires looking into links to user behaviour and broader infrastructure and planning.
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Vulnerabilities of shared sanitation in peri-urban Accra during COVID-19
Overview of shared sanitation in Accra, Ghana
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Access • Within the Greater Accra Metropolitan Area (GAMA), 41% of the population rely on pay-per-use public toilets, and only 33% have private sanitation facilities (data from 2017). Only 15% of Accra is connected to the sewer network (data from 2019). The Kumasi Ventilated Pit Latrine (KVIP) is a significant onsite containment sanitation technology used by the peri-urban population.
Recommendations for postCOVID shared sanitation design Effective handwashing solutions must be provided in all facilities. Water sources protected from contamination should be prioritized for handwashing. Appliances should limit cross-contamination.
Availability • Micro-context studies reveal the severely low coverage of sanitation facilities in lowincome informal settlements. Poor maintenance of these facilities lead to alternative defecation methods.
The design should accommodate the needs of women, children, vulnerable groups and caregivers. Effort is needed to eiliminate gender bias in the management of shared toilets.
Standards • Government bodies and policies implemented to systematically improve sanitaiton in Ghana are relatively recent. Although the government failed to meet its targeted provision of sanitation service in 2019, ongoing efforts are still being made.
Setting a clear monitoring framework may allow shared toilets to be recognized by monitoring protocals and the UN Sustainable Development Goal. This may also encourage more investments for informal peri-urban settlements.
Norms & Perception • Poor perception of shared toilets, esp. by women and vulnerable groups, is affected by overcrowding and low public health awareness.
Ensure sustainable operation of desludging services and centralized fecal waste treatment plants by linking them to business opportunities for recycling fecal waste into useful resources and products.
Maintenance • Public toilets are managed by lower government levels and private companies. Costly desludging services often lead to their failure and unsafe disposal of fecal waste.
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