Do the urban poor want household taps? Community preferences and willingness to pay for household taps in Accra, Ghana.

In Sub-Saharan Africa, only 35% of the urban population has piped water on premises despite the economic (time savings) and public health benefits that household taps offer. In the urban informal settlements, even fewer people own household taps. However, while there is extensive literature on everyday urban water insecurity in the region, far less attention has focused on whether the urban poor are interested in private taps, and if so, what service attributes are important to them. We implemented a choice experiment in Nima, an urban settlement in Accra, Ghana, to investigate community preferences and willingness to pay (WTP) for household taps. We used a comprehensive set of system attributes including days of service, service hours, water pressure, water quality, connection fees, monthly payment, and management, an attribute very few WTP studies have explored. Results from the choice experiment show that residents are more sensitive to time (not day) of service delivery, quality of water, connection fees, and monthly water bills. Households had no preference between a 24-h supply and 12-h supply during the day. Households preferred Accra Metropolitan Assembly (AMA) to Ghana Water Company Limited (GWCL) as the service provider and were willing to pay more for a system managed by AMA, an indication of declining trust in GWCL. The findings provide valuable information that policymakers and water utilities can use to assess the feasibility and cost effectiveness of extending household taps to poor urban settlements.

Variations in household water affordability and water insecurity: An intersectional perspective from 18 low- and middle-income countries.

Compounding systems of marginalization differentiate and shape water-related risks. Yet, quantitative water security scholarship rarely assesses such risks through intersectionality, a paradigm that conceptualizes and examines racial, gendered, class, and other oppressions as interdependent. Using an intersectionality approach, we analyze the relationships between household head gender and self-reported socio-economic status, and water affordability (proportion of monthly income spent on water) and water insecurity (a composite measure of 11 self-reported experiences) for over 4000 households across 18 low- and middle-income countries in Central and South America, Africa, and Asia. Interaction terms and composite categorical variables were included in regression models, adjusting for putative confounders. Among households with a high socio-economic status, the proportion of monthly income spent on water differed by household head gender. In contrast, greater household water insecurity was associated with lower socio-economic status and did not meaningfully vary by the gender of the household head. We contextualize and interpret these experiences through larger systems of power and privilege. Overall, our results provide evidence of broad intersectional patterns from diverse sites, while indicating that their nature and magnitude depend on local contexts. Through a critical reflection on the study's value and limitations, including the operationalization of social contexts across different sites, we propose methodological approaches to advance multi-sited and quantitative intersectional research on water affordability and water insecurity. These approaches include developing scale-appropriate models, analyzing complementarities and differences between site-specific and multi-sited data, collecting data on gendered power relations, and measuring the impacts of household water insecurity.

The potential of composting toilets in addressing the challenges of faecal sludge management in community-led total sanitation (CLTS).

Community-led total sanitation (CLTS) is increasingly promoted globally as an innovative approach to addressing the sanitation challenge in developing countries, especially in the rural areas where access to sanitation remains poor. However, a significant challenge in CLTS is poor management of faecal sludge when pits are full. In this regard, composting toilets offer a potentially viable and ecologically sound method for effective and efficient faecal sludge management, by providing fertilisers that act as soil conditioners, and ultimately contribute to clean environment, food security, good health, and poverty alleviation. Despite these advantages, there is limited knowledge on why and how composting toilets can be successfully integrated into CLTS initiatives. In this paper, we use the case of Ghana to demonstrate that integrating composting toilets into the CLTS approach is a feasible option for sustainable and environmentally friendly faecal sludge management in rural areas where agriculture is the predominant livelihood activity.

Water journeys: Household water insecurity, health risks, and embodiment in slums and informal settlements.

Water insecurity is a critical public-health challenge in Africa's urban informal settlements, where most of the population often lacks access to household taps. In these settings, water fetching is disproportionately performed by women. While water fetching is physically laborious and exposes women to multiple risks, the water-insecurity literature has predominantly focused on household experiences, ignoring women's water-collection journeys. This paper uses the water journey as a window into the embodied dimensions of water insecurity. Combining theoretical insights from embodiment, embodied political ecology of health, and time geographies, we use video-recorded walking interviews to analyze women's everyday water journeys in Ntopwa, an urban informal settlement in Blantyre, Malawi, from initial decision making through exposure to water-fetching risks and household practices regarding use and storage. We identify three principal sources of environmental risk- terrain, built environment, and human behavior-that present challenges for water collectors. Using the walking interview as a heuristic, we show how the seemingly simple practice of water fetching is compounded by complex decision making, constant spatiotemporal trade-offs, and exposure to diverse risks, all of which have embodied health consequences. Based on our findings, we conclude that interventions seeking to improve household water insecurity must consider the embodied effects of water-fetching journeys. This study also provides methodological insights into using walking interviews and videos for water and health research.

Stressed, anxious, and sick from the floods: A photovoice study of climate extremes, differentiated vulnerabilities, and health in Old Fadama, Accra, Ghana.

Although there is a large and growing literature on anticipated climate change impacts on health, we know very little about the linkages between differentiated vulnerabilities to climate extremes and adverse physical and mental health outcomes. In this paper, we examine how recurrent flooding interacts with gendered vulnerability, social differentiation, and place-related historical and structural processes to produce unequal physical and mental health outcomes. We situated the study in Old Fadama, Ghana, using a Photovoice approach (n = 20) and theoretical concepts from political ecologies of health and feminist political ecology. Overall, the study revealed several adverse physical and mental health impacts of flooding, with vulnerability differentiated based particularly on gender and age, but also housing, class, and income. Our findings suggest the need for greater attentiveness to social differentiation in scholarship involving political ecologies of health. The paper builds on the health and place literature by linking the social and contextual to the medical.