One Health Policy Brief No 2

ONE HEALTH AND URBAN TRANSFORMATION
POLICY BRIEF 2/2020
Risks and sustainable solutions to vector and water-borne disease

Recommendations for the Greater Accra Metropolitan Area
Joshua Ntajal, Ana Maria Perez Arredondo, Merveille Koissi Savi
The human population in the Greater Accra the health of humans, animals, and their shared
Metropolitan Area has four-times increased since environment. One Health relies on inter- and
1970, now counting more than 2.5 million people. multi-sectoral collaborations consolidating
Growth resulted from the combined effects efforts to address the complexity of different
of natural population growth and migration factors affecting health. In 2017, a technical
triggered by the economic attractiveness of the working group was formed by diverse Ghanaian
city. Increasing population density has brought ministries, government agencies, donors, and
about overcrowding, unplanned urban sprawl, bi-lateral organizations to develop a national
and encroachment into natural habitats. These One Health policy and promote inter-sectoral
developments do not match with the land-use collaborations at the human-animal-environment
planning processes involving limited access to interface to address and prevent diseases, with a
safe water supply, sanitation, and the set-up of particular focus on zoonoses. Notwithstanding,
hygiene infrastructure. In addition, they have infectious diseases, particularly malaria and
impacts on the urban environment and health diarrheal diseases, continue to be leading causes
through air, water, and noise pollution. Urban of mortality and morbidity in the Greater Accra
environmental degradation exposes ecosystems, Metropolitan Area, thereby presenting a great
including humans to health hazards and risks, burden to public health. These diseases are
through the emergence and re-emergence of linked to the interactions between humans,
infectious diseases. Over the past year, the vectors reservoirs, and poor sanitation.
Greater Accra Metropolitan Area has become Malaria and diarrheal diseases were selected
the hotspot of water-related infectious diseases, as part of the implementation of the NRW-
including malaria and diarrheal diseases, while Forschungskolleg ‘One Health and Urban
the existing fragile healthcare system is over- Transformation’ to develop integrated and
capacitated. sustainable solutions to tackle the consequent
Steps towards One Health in Ghana? health challenges in the Greater Accra
Metropolitan Area. The research project
Efforts have been made to coordinate and facilitate
comprised three focus areas; i) identifying the
collaborations to prevent and manage public
role of political institutions and social networks
health-related issues in the country over the past
in health policy and environments, ii) linking land
years. However, cooperation among institutions
use, human-water interactions, and water-borne
has been reported as a major challenge. One
diseases, and iii) identify the underlining driving
of the latest efforts is the adoption of One
factors necessary for the optimization of malaria
Health, which is a holistic approach accounting
control measures.
for complex problems affecting livelihoods and
1
A section of the Odaw River at Agbogbloshie, Accra showing wastes disposal and water pollution.
Photo taken by Joshua Ntajal, during data collection in February 2019.
KEY FINDINGS Linking land use, human-water interactions, and

water-borne diseases
There are complex linkages between land
Identifying the role of political institutions and use, human-surface water interactions, and
social networks in health policy and health diarrheal diseases. These linkages draw on
environments the dynamics in the driving forces of land
use and water pollution, and the dynamics
Adapting and mainstreaming combined strategies to in the transmission pathways of diarrheal
tackle threats to human, animal, and environmental diseases. The major drivers of urban land
health to local realities is critical for environmental use dynamics and surface water pollution
conservation, urban development planning, and in the Greater Accra Metropolitan Area are:
the promotion of healthy living in the Greater Urban population growth, unregulated urban
Accra Metropolitan Area. In the metropolis, agricultural activities, non-implementation of
collaboration among sectors has bridged the gaps local development plans, and complicated land
between institutions, specifically in addressing turner systems. On the other hand, inadequate
zoonotic diseases, promoting joint epidemiological safe drinking water supply and insufficiently
training programs for experts in human and animal improved sanitation and hygiene facilities
health, and the understandings of disease ecology compel households to rely on unsafe water
at the local level. However, despite the existing sources and the practice of open defecation,
inter-sectoral collaborations to address public both increasing their exposure to pathogens.
health challenges, there are still limited political and On top of this, poor attitudes towards waste
institutional frameworks for action.
2
disposal (solid and wastewater) is a major adherence of physicians to the procedure of
contributor to water pollution. malaria diagnostic, the compliance of patients
to the drug prescription, and the adoption of
Underlying driving factors of malaria incidence preventive measures (only 43% of people who
in Ghana’s Greater Accra Metropolitan Area possess an insecticide-treated bed net use
Malaria incidence in the Greater Accra them). All the researched factors maintained
Metropolitan Area is mediated by complex intricate feedback loops that keep malaria
interactions of different categories of factors recurring in the Greater Accra Metropolitan
at various scales. Among the interacting factors Area. Similarly, the exploration of the epidemic
are those related to the immediate/ man-made data revealed that there is an uneven
environment (e.g. building pits as ideal breeding distribution of the incidence rate of malaria in
sites of mosquito-vectors), and factors related the Area, with children under 5 years having
to climate variability (rainfall, temperature, the lowest incidence, while old people (65-70)
etc.). A prominent part of the factors is rooted having the highest incidence rate.
in the behavior of households such as the
RECOMMENDATIONS
The interconnectedness between urban systems and health is complex due to the challenges associ-
ated with urban transforma�on processes such as in the Greater Accra Metropolitan Area. The drivers
of urban transforma�on are dynamic with significant influences on the healthcare system and the
transmission pathways of infec�ous diseases. The One Health approach can promote joint efforts and
facilitate processes such as urban infrastructure development, land-use planning, urban environmen-
tal conserva�on, and support efficient health-seeking behavior campaigns. From the results of the
research project, the following strategies are recommended to assist policy formula�on.
• Inclusion of dominant water-related infec�ous diseases (malaria and diarrheal diseases) in the
One Health policy formula�on and implementa�on.
• Community involvement as stakeholders in the development and implementa�on of One
Health policy for Ghana.
• Provision of adequate safe drinking water, and improved sanita�on and hygiene should be
made accessible to all the households in the communi�es in the Greater Accra Metropolitan
Area.
• Involving communi�es and stakeholders at all levels in the development and implementa�on
of health awareness campaigns.
• Joint development and implementa�on of urban land-use planning measures, building codes,
while preven�ng overcrowding and land encroachment in the Greater Accra Metropolitan Area.
• Involving the communi�es in the protec�on and maintenance of water supply, waste manage-
ment, and sanita�on facili�es as well as the maintenance of sufficient hygiene standards.
3
ABOUT THE PROJECT IMPRINT
This research was carried out within the One Zentrum für Entwicklungsforschung (ZEF)
Health & Urban Transformation graduate school. Center for Development Research
The NRW Forschungskolleg One Health and Urban Genscherallee 3, 53113 Bonn / Germany
Transformation – identifying risks and developing Dr. Timo Falkenberg
sustainable solutions is a transdiciplinary graduate Phone: +49 (0) 228 / 73 4634
school seeking integrated interventions to attain
Email: [email protected]
optimal health for humans, animals, plants and the
environment. www.zef.de
One Health and Urban Transformation graduate

school is hosted in Bonn (Germany), at the Center Hochschule Bonn-Rhein-Sieg (H-BRS)
for Development Research (ZEF) in cooperation Sonja Keller
with multiple institutes of the University of Phone: +49 (0) 2241 / 865 9762
Bonn, the International Centre for Sustainable Email: [email protected]
Development (IZNE) of the University of Applied www.h-brs.de
Science Bonn Rhein-Sieg (H-BRS), and the United
Nations University - Institute for Environment and
Human Security (UNU-EHS).
@OneHealthBonn
supported by
UNU-EHS
Institute for Environment
and Human Security

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One Health Policy Brief No 2

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ONE HEALTH AND URBAN TRANSFORMATION

POLICY BRIEF 2/2020

Risks and sustainable solutions to vector and water-borne disease

KEY FINDINGS Linking land use, human-water interactions, and

One Health and Urban Transformation graduate

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