Abstract
Abstract There are few affordable and acceptable sanitation solutions for dense, low-income urban settlements. Though container-based toilets are a safely managed sanitation solution, little is known about user experiences to inform how such a solution should be viewed by governments. We conducted a before and after enrolment study of objective and subjective measures of sanitation quality due to the Clean Team Ghana (CTG) container-based toilet service in Kumasi, Ghana from June to December 2019. We collected data immediately prior to installation and 10 weeks afterwards for 292 customers. Most of them initially used public toilets with good structural quality, but sometimes these toilets had poor hygiene, lacked handwashing facilities, and required a 14.3-min mean time to use. We found that CTG delivered a high-quality service that positively impacted the quality of life of customers, saved them money, reduced gender gaps in the quality of life, and addressed the needs of those with physical disabilities. Problems with the CTG service, such as leaking, filling, smelling, or not being replaced as scheduled, were reported by fewer than 10% of customers. This evaluation supports the growing body of evidence that container-based sanitation provides a service valued by users in dense urban settlements.
Highlights
About 4.2 billion people lack access to safely managed sanitation globally (World Health Organization 2019) with more than half residing in urban areas where shared sanitation is more common than in rural areas
The overall attrition rate of 28% consisted of customer dropout from Clean Team Ghana (CTG) service subscription (17%), unavailability of active customers for the survey (2%), and potential customers subsequently declining to install the toilet (9%)
We suggest the following areas of future research on Container-based sanitation (CBS) based on the results of this study:
Summary
About 4.2 billion people lack access to safely managed sanitation globally (World Health Organization 2019) with more than half residing in urban areas where shared sanitation is more common than in rural areas. On-site sanitation systems such as improved pit latrines and septic tanks become less appropriate as population density increases due to the safe management requirements of pit leachate, septage effluent, and the safe removal of solids (Amin et al 2020), structurally, providing networked sanitation to all areas of the city is problematic. There are many reasons for this, but pertinent for this paper is the mosaic of land, housing, and tenure arrangements in.
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