Water, Sanitation, and Hygiene for Public Health (WASH4PH)

ULTIMATE OUTCOME 1000: Improved health (including maternal, newborn and child health) of girls, boys, women and men in Ghana’s Upper East Region  

INTERMEDIATE OUTCOMES

1100: Increased use of gender/age responsive and sustainable Water, Sanitation and Hygiene (WASH) services and facilities in Bongo and Kassena Nankana West Districts

1200: Increased effectiveness at the community, district and regional levels to support WASH services delivery

IMMEDIATE OUTCOMES

1110: Increased access to gender and age appropriate WASH facilities in communities, health facilities and schools

1120: Increased awareness on the impact of safe hygiene practices on health in communities, health facilities and schools

1210: Increased capacity of local government to integrate gender sensitive WASH and health considerations in planning and budgeting in Bongo and Kassena Nankana West districts

1220: Increased awareness of benefits of WASH and Health integrated planning in other districts and regions

The WASH4PH project achieved significant and measurable improvements in access to WASH services, hygiene practices, systems strengthening, and community-level empowerment in Bongo and Kassena Nankana West districts of Ghana’s Upper East Region. These results collectively contributed to improved public health outcomes, particularly for women, children, and vulnerable populations.

Improved Access to Safe Water and Sanitation

Over the life of the project, 55,895 people gained access to safe water and 42,136 people gained access to improved sanitation and hygiene services across schools, communities, and health care facilities. The project successfully delivered comprehensive WASH packages to all eight targeted health care facilities and all fifteen targeted schools, exceeding several infrastructure-related targets.

In health care facilities, 100% of the targeted sites now have reliable, on-site water supply, gender-responsive sanitation facilities, inclusive handwashing stations, and biomedical waste management systems, including incinerators. These improvements directly benefit 27,755 health facility users and have strengthened infection prevention and control standards in clinical settings.

In schools, safe water and gender-appropriate sanitation facilities were installed or rehabilitated in all targeted institutions. A total of 2,230 pupils (1,074 girls and 1,156 boys) now benefit from improved WASH services. Facilities incorporated menstrual hygiene management (MHM) considerations, accessibility features, and inclusive design, contributing to safer and more dignified learning environments for girls and boys.

At the community level, access to water reached 100% of the 23 partner communities. Household sanitation coverage increased substantially from a baseline of approximately 2–3% to over 1,100 household latrines constructed. While severe flooding during the reporting period caused 278 latrine collapses, communities demonstrated strong ownership by committing to rebuilding using more climate-resilient designs. Six communities are progressing toward Open Defecation Free (ODF) status.

Improved Hygiene Behaviours and Awareness

The project generated meaningful improvements in hygiene knowledge and practices at household, school, and health facility levels.

In schools, the presence of handwashing facilities with soap and water increased from 10% at baseline to 93.3%, exceeding the 80% target. Thirty-two School Health Clubs were formed—more than double the original target—strengthening peer learning and embedding hygiene promotion within school systems. Students increasingly participated in national hygiene and menstrual health campaigns, reinforcing behaviour change messaging.

Among health care workers, knowledge of the six critical moments for handwashing improved from 77.5% at baseline to 95%, surpassing the 90% target. Additionally, 100% of targeted health facilities now consistently provide soap and water at handwashing stations.

At household level, the presence of handwashing facilities with soap/ash and water increased from 9.5% at baseline to 64.1%, nearly reaching the 65% target. Community awareness of at least four critical handwashing moments increased from 22.5% to 59.7%, demonstrating strong upward momentum in behaviour change.

Perceptions of health outcomes also improved significantly. Approximately 89% of community members reported that their health had improved over the life of the project, citing increased cleanliness, reduced open defecation, improved service delivery in health facilities, and stronger understanding of the links between WASH and disease prevention.

Strengthened Community and Institutional Capacity

Beyond infrastructure delivery, WASH4PH significantly strengthened local systems and institutional capacity to sustain WASH gains.

Thirty-six Water and Sanitation Management Teams (WSMTs) were formed and trained, with at least 35% female representation, supporting community-level management of water systems. Two hundred healthcare workers received training in WASH, infection prevention and control, and integrated WASH–nutrition linkages.

At district level, capacity was strengthened to integrate gender-sensitive WASH and health considerations into planning and budgeting processes. Advocacy efforts aligned with national policy priorities and the WHO Resolution on WASH in Health Care Facilities, strengthening local government engagement and accountability.

Eight WASH cooperatives were established and operational—exceeding the original target of three. Women’s groups were mobilized and supported to engage in WASH-related livelihoods, including soap production, inventory management schemes, and production of reusable menstrual hygiene products. These groups became important platforms for citizen advocacy, accountability, and challenging harmful gender norms.

Participatory gender and environmental analyses were conducted across project sites, embedding equity, inclusion, and sustainability considerations into WASH programming. Women’s groups in particular emerged as strong mobilizing actors, advocating for improved services and greater responsiveness from district leadership.

Contribution to Improved Health Outcomes

The combination of improved infrastructure, strengthened hygiene behaviours, enhanced service delivery in health facilities, and empowered community advocacy contributed to measurable progress toward the ultimate outcome of improved health in the Upper East Region.

Although heavy flooding temporarily delayed formal certification of ODF communities, environmental sanitation conditions improved significantly, and communities demonstrated resilience and ownership by reinvesting in improved latrine construction.

Collectively, the WASH4PH project delivered durable improvements in access, behaviour change, institutional capacity, and gender-responsive service delivery, creating strong foundations for sustained public health gains beyond the life of the project.