Sources of water in the Nkoranza South  include pipe-borne water, dam, streams rivers, ponds and wells. These sources of water are very often polluted. Most people drink the water untreated, Sanitation in general is very poor. Only few houses have private toilet facilities. About 80% of the people  use public latrines which are very untidy and inadequate. K.V.I.P system has been introduced but only few towns have either 12 seater or 16 seater KVIP.The hospital, which are operated by the Ministry of Health, and their distribution among settlements.
 
The is served by one hospital located in Nkoranza town. The hospitalcontains four wards - the male, female, maternity and pediatric wards with a totalnumber of 62 beds and an estimated bed-patient ratio of 1:1100

Poor physical access to health facilities.

The baseline survey revealed that a largenumber of the sampled households traveled less than 6km to enjoy the lower order health facilities as health posts, traditional healers, while 64 per cent travel more than 9 kilometers to obtain health services in Nkoranza hospital and the health centre.

Poor waste disposal methods.

The baseline survey revealed that 82 per cent of the sampled households dump their dry waste at site, 13 per cent burn it and 5 per cent dispose of them by dumping in the vicinity of the home. Furthermore, 89 per cent use the free flow method to get rid of their waste water, 11 per cent use drains and 0.8 per cent use septic tanks. This insanitary methods of waste disposal are largely responsible for the frequent occurrence of diseases such as cholera, malaria and other intestinal infections.

This problem is compounded by the fact that 73 per cent of the sampled household fetch their drinking water from streams, 22 per cent from boreholes, 4.4 per cent from springs and 0.6 per cent from ponds and wells.

Poor Housing Conditions.

The study indicated an average occupancy rate of 2.5. This is a relatively favourable rate. However the coupled with the often poorly
ventilated rooms facilitates to the spread of airborne diseases’.

Inadequate Medical Personnel.

The average ratio of physician to population and patients are as follows:1 physician per 43,000 population as against a recommended figure of 1 per 10,000.

Drug Supply.

The procurement and distribution of drugs and pharmaceutical are other major problems of the health service delivery system in the district. The socio-economic survey revealed that 44 per cent of the people have problems of obtaining drugs because it is very expensive while 32 per cent indicated the nearest source is very far. Another 15 per cent, and 9 per cent mentioned the unavailability of drugs and "lack of money" as the reasons for difficulty for obtaining drugs. Malaria is the commonest disease followed by stomach disorders in the District.

In general there is the need to mobilize resources to improve the health delivryn system. Health education should constitute an important aspect of development in the district. There are about ninety-two (92) existing functioning facilities in the Nkoranza South distributed as follows:

Other sources of water  include dams, rivers, streams and ponds which are often polluted.  These other sources are accessed by about 44.5% of the population which is not covered by the three main potable sources listed above.  About 54.5% of the total population in the district has access to potable water provided by Nkoranza Assembly, Central Government, CWSA, ADRA, Catholic Relief Services and other donor agencies.  Out of the boreholes available, about 8 of them are not functioning.  The four existing hand-dug wells are also in use.

Opportunities of the Water Sector

Opportunities which are the enabling factors for development identified in the district in the water sector include the following:

• Capital inflow from Central Government and Donors, e.g. DACF, AFD Water and Sanitation project, World Bank, DFID, Catholic Relief Services and so on.
• Existence of policy guidelines on water and sanitation
• Existence of rivers and streams for surface water treatment and supply
• Availability of trained community and Area Mechanics
• Assembly water and sanitation training and support from CWSA in place
• Willingness of Communities to pay matching funds
• Existence of two small town water systems for extension to new areas

Challenges of Water Sector Development

The opportunities available are constrained by the under-mentioned factors.  The effects of these constraints must be minimized to harness opportunities in the district for effective provision of water facilities.
The constraints include:

• Low ground water potential
• Inadequate funds/budget for the provision of water and sanitation facilities
• Difficulty in getting spare parts
• Inadequate supervision and monitoring by CWSA staff
• Belief systems which negatively impact on the adoption of new water technology and user facilities
• Poor road conditions making remote communities inaccessible
• High poverty levels among the population

Sanitation Situation

This session of the plan provides baseline information on sanitation in the area of excreta disposal and management in the district to inform assessment of needs, strategies and actions needed to correct the undesired situation.

Access to Toilet Facilities

Access to toilet facilities in the district is generally poor.  This fact is depicted by the 2000 population and Housing Census of Ghana and field data.  The data from the two sources indicate that water closet (WC), the most preferred facility, is not common with majority of households in the district and in the region.  Just about 7.4% of households in the district have access to water.  The few existing WCs are mainly located in the district capital and other communities with access to piped water, such as Donkro-Nkwanta.

Majority of the households in the district frequently use public toilets which could be WC, KVIP or Pit latrine.  Again, about 31.4% of the people adopt the use of the traditional pit latrine, popularly known in local parlance as “hwii-tim”).  The water closet facility is not common with households in the district possibly because of the need for piped water for its use which does not exist in the communities.

About 17.2% of the people do not use any facility but rather adopt crude method, popularly known as “free range” disposal.  Defecating anywhere, anyhow poses health hazards to the people.  This is because the faucal substances are washed away into streams and rivers which also serve as source of drinking water to a section of the population.

Data generated from the field revealed similar situation indicated by the 2000 population and Housing Census Report.  The field data however seem to show levels of improvement over the cast decade, the situation however is still gloomy.

Access to Water Closet improved from 1% in 2000 to 7.4% in 2009.  This may be due to availability and extension of piped water schemes in Nkoranza and Donkro-Nkwanta.  Table 1.60 Shows access to toilet facilities in 2009.

In the Nkoranza South, public toilets are constructed by the  Assembly and managed by private individuals for and on behalf of the Assembly.  Household toilets are managed by private individuals for and on behalf of the Assembly.  Household toilets are managed by the individual households and landlords.  Patrons of public toilets pay facility user fees to the caretakers or private manager.  About one-third (1/3) of the money realized is used to maintain the facility, a third is paid to the Assembly and the remaining one-third is retained by the caretaker as his wage or remuneration.

The private households operate their facilities on their own.  However, they engage the services of the Assembly Environmental Health Unit, DWST and Works Unit for dislodgement services and technical support.  Their level of management has seen the sustainable use of facilities.  The private operations of the public facilities have a better edge over the  Assembly managing the facilities directly.  To maximize profit and to maintain business, the private care-taker tries to avoid revenue leakages and also good standard of cleanliness of the facility to attract patrons.  The challenges of management of toilet facilities in the district include:

• High pressure on the limited number of facilities
• Dumping of foreign substances into toilets do not facilitate smooth dislodgement
• Low user feeds fixed by the Assembly for the private operators
• Failure of private estate developers to construct household toilets as part of housing development is putting excess pressure on the few existing public facilities.

a) Opportunities in the Sanitation Sector

• Capital inflow from Central Government and donors
• Existence of sanitation policy and strategic plan
• Sanitation training and support from CWSA in place
• Willingness of communities to pay matching contribution in kind or in cash

b) Challenges to the Sanitation Sector

• Inadequate sanitation facilities and services
• High illiteracy levels
• Low hygiene and health education
• Poor environment sanitation practices
• High poverty levels limiting the ability of households to pay for sanitation investment and services

Waste management
Liquid Waste

Liquid waste comprises sullage – from household washing and cooking and that from the toilet facilities.  Sullage generated is proportional to the water consumption, ranging from 70 to 90 percent of water used.

The 2000 Population and Housing Census report (Analysis of  Data and Implications, 2005) indicates that majority of households in the (63.9) dispose off liquid waste on the street or outside the house (See Table 1.61).  The trend holds similarly for the region as a whole.  The next adopted method of disposing liquid waste is in the compound, accounting for 31.2%.  These practices accumulate stagnant water and as breeding grounds for mosquitoes and other household pests who transmit diseases, such as Malaria, Cholera and Sleeping Sickness.  The practice is probably due to lack of or inadequate drains and gutters.  This is because the few open drains and gutters normally harder roads constructed in few urban towns in the district.  Estates developers do not realize the need to construct proper drains and gutters for such purposes.

Number of Latrines in the District

According to data generated from the field, the total number of toilet facilities in the district is 2,642.  This figure comprises private, public, institutional and industrial.  The distribution is shown in Table 1.62 below.

About 90% of the total stock of toilet facilities are private and are used by households.  The public toilet facilities in the district are dotted within and around the suburbs of the capital, Nkoranza.  The problem of management, dislodgement and ability to pay toilet tolls may form part of reasons for concentration of public toilets in the capital.

Industrial centres and institutions (schools and health facilities) do not have adequate number of toilets.  The patrons of these institutions and the industrial centres may be compelled to use the ‘free range’ method.

Sullage

The main sources of sullage generation  identified as that from cooking, washing and bathing activities.  Sullage generation was determined as a percentage of water consumption. Waste water from residential houses is solely managed by residents.  This is done in various ways such as free spillage into streets or neghbourhood, catch pits, well constructed soakage pits and drainage system to join storm water drain.  The general practice of disposing residential wastewater is free pour on the street.  Whilst some residents saw the need for technical support in soakage pit design and construction to prevent breeding of mosquitoes and odour associated with existing systems, others felt satisfied with the unconventional existing practice.  Yet a lot more simply do not know of any improved methods of waste water disposal.  Wastewater from washing and cooking activities is mainly disposed off on available ground spaces in the house and outside the house or on the street.

Bathhouse Sullage

The field report indicates that the number of bathhouses in the district is 10,202 (See Table 10) and about 48.1% of this number is located outside the house, spilling wastewater around the environs.  This practice mainly account for the high incidence of malaria, which is the main cause of morbidity . The type and number of bathhouses and their distribution among the Area Councils.

The bathhouses located inside the houses (39.7%) are quite manageable.  Some have proper drainage systems constructed to direct wastewater to main drains.  In the absence of a sewage system, some residents use soakage pits for disposal of sullage generated from bathrooms, but their maintenance has left much to be desired.

Maintaining soakage pits involves removing filled stones, washing off slimy formations on the stones, drying and re-filling.  This maintenance procedure is quite cumbersome and has thus deterred a lot of resident from attending to their soakage pits when they get full for the first time.  The result has been overflowing pits behind bathrooms promoting aglae growth and very unsightly conditions.
    
Catch pits are also sometimes seen to be overflowing, since scooping wastewater out after bathing has not been in good taste for yet those who prefer catch pits to soakage pits.  Evaders of the above two forms of bathroom casing unsightly stagnation of sullage behind their bathrooms. 

Management of Procedures of Liquid Waste Collection, Transportation and Disposal
Human Waste

Review of specific liquid waste management systems of the district revealed that management of liquid waste in the residential areas presently involves both DA and residents playing specific and/or combined roles at various stages in the management of waste generated.

Collection and disposal of excreta stored in homes is done through private arrangement with some conservancy labourers in the case of bucket latrine which is phasing out.  Dislodging of pit type latrines is done through the DA with the use of its cesspool emptier.  The cesspool emptier collects the residue and transport it to the final disposal site at a fee fixed by the Assembly from time to time.

There were indications at the DA level, of provision of home toilets being a pre requisite for putting up new buildings.  This is to encourage household toilets to ease the pressure on the few public toilets.

In spite of the fact that 20% of residents were satisfied with the level of service offered by the public toilets, 80% indicated a sordid state of affairs in the provision of services.

As a way of improving the situation, residents were of the opinion that the DA and/or service provider should as a matter of principle play one or more of the following roles:

•    Provision of disinfectants and water to cleanse toilets effectively and regularly
•    Frequent dislodging 
•    Regular collection and burning of all papers and other anal cleansing materials
•    Construct modern facilities and do away with bucket type
•    Monitor and educate users of toilet facilities
•    Enforcing sanitary bye-laws
•    Provide lighting
•    Private participation in management of toilets
•    Ensure proper design of toilet facilities
•    Relocate some toilets which are so close to residential houses
•    Rehabilitation of existing toilets
•    Construction of new toilet facilities

There are no treatment facilities for excreta.  Final disposal points for seepage (from dislodged toilets) are open pits in outskirts of town.  The danger involved in this practice leaves much to be desired.  Present poor management of most public toilets should lend support to the provision of household toilets under GoG/AFD Rural and Small Town Water Supply and Sanitation Project in the Brong Ahafo Region.

Sullage

Sullage is mostly collected at the point of generation and disposal off on-site or transported a few metres away from source of generation to disposal.  Sullage from bathrooms is collected in soakage pits, catch pits or left to flow on ground behind the bathroom.

Contents of catch pits are scooped out and thrown around about 5m radius from collection point.  Those with buckets inside the catch pit to collect the waste water from the bathroom are taken about 10-20m away from the bathroom and poured on any available ground space.

Collection points, which serve as final disposal points, have created very unsightly conditions of wastewater stagnation behind most bathrooms.  Mosquito breeding, growth of algae and soil helminthes as a result of this scenario, together with offensive odour nuisance is not far fetched.  Methods of bathroom collection and disposal are given below:

User fees are levied per visit to the public toilets.  These fees are fixed by the DA implementation by the Care-takers.  Presently a minimum of fee of GH¢0.5p is charged only for human waste management at the public toilets.  This could be woefully inadequate looking at the sordid state of public toilets.  Users of home toilets also pay GH¢20.00 per trip of cesspool emptier for emptying contents of their ceptic tanks, a purely private arrangement.  This amount is subsidized by the DA as compared to the cost of fuel, disinfectants and maintenance of the cesspool emptier.

Solid Waste
Solid Waste Generation and Composition

Knowledge of the source and types of waste, together with data on its composition, generation rates, is basic to the planning, design and operation of all the elements in the waste management system.
i) Type and Sources of Solid Waste

The types and sources of solid waste generated in the district as identified during the field survey is shown in Table 11

Ratio of putrescible to non-putrescible waste is about 85:15 by volume

1. Estimation of Solid Waste (Refuse) The average rate of refuse generation per house estimated during the field survey was done by:
2. Direct measurements of refuse storage 
3. Verification of actual amounts of refuse generated in containers
4. Interaction with respondents as to recyclable/recovered portions which were deducted from total amounts generated and 
5. Obtaining frequency of emptying of containers from respondents.

The above investigations yielded the following results after some statistical computations:

Majority of the solid waste generated in the district is organic, with a compostable portion estimated to be above 80% by weight.  The large organic fraction seems to justify investment in biological conversion (composting) or digestion technology.  A high percentage of the population is in farming and investigation is necessary to establish if compost will be patronized for farming. The fraction of refuse that is not easily degradable consists mainly of ash and plastics – used as food and ice water wrappers. 

Specific Problematic Solid Waste Fraction

Interviews and observation conducted at the markets and Lorry Parks indicate that waste fractions within the main waste stream are polythene materials and fruit wastes.

Polythene Materials

Different sizes of discarded polythene materials are used for wrapping all kinds of items sold in markets and Lorry Park.  This results in high proportion of polythene (about 3% by weight) in the waste system.  The inadequate number of receptacles for collection f the waste creates unsightly conditions as waste is scattered when the wind blows.  On rainy days, it is carried away by run offs into drains and other waterways to block and choke drainage paths.  At the intermediate dump sites polythene materials are generally difficult to degrade under natural conditions. The high-density type of polythene materials do not undergo complete combustion and adds to the mountain of wastes

Fruit waste

Waste from fruit such as mangoes and banana by their method of storage and disposal (cluttering / littering of grounds) and collection times (every 24 hours) attracts a lot of flies and other pests of diseases to its location, especially market and lorry park premises.  They also create unsightly conditions.  The provision of proper storage receptacles and public education on the proper usage could minimize the problems associated with fruit waste.

Methods of Refuse Disposal

Field investigation revealed that in the Nkoranza South district 35.0% of households practice crude dumping of waste, solid wastes are dumped at unapproved dump sites, Residents dump their household refuse in the nearby bush or forest which are not designated for the purpose.  About 48% of residents dump their refuse at a designated refuse site or containers. Table 1.68 Shows the methods of refuse disposal in the district.