Evaluation of the community-led total sanitation in Bongo District, Ghana, 2024

Introduction: Open defecation increases the spread of diarrhoea illnesses, especially among children under five years in Ghana. Community-led total sanitation (CLTS) is an intervention implemented by the Environmental Health and Sanitation Department (EHSD) to stop open defecation. We evaluated the objectives, attributes, and usefulness of the CLTS surveillance system in the Bongo District, Upper East Region, Ghana. Methods: Adapting the Centers for Disease Control and Prevention updated guidelines for evaluating public health surveillance systems, the CLTS system was evaluated from 2019 to 2023 using a semi-structured questionnaire. Data was collected through interviews, observations and review and summarised as frequencies, proportions and text. Results: The CLTS system was triggered in 39.3% (66/168) of communities, with 56.1% (37/66) declared Open Defecation Free (ODF). About 619 latrines were constructed over the evaluation period, with 66.7% (14/21) of stakeholders interviewed having latrines in their homes and 52.4% (11/21) having handwashing facilities. About 85.7% (18/21) of community members were aware of faeco-oral transmission of diseases. Introduction of the Basic Sanitation Information System (BaSIS) data source in 2022 did not interrupt the system’s operations. All nine key informants stated that it is easy to identify an OD and ODF community using observation. Data completeness among all seven reporting units was 89.2% (34/37), with 100% reporting. The stability of the system is compromised as it largely depends on Non-Governmental Organisations (NGOs), coupled with a lack of computers for data storage. Triggering and ODF declaration took three to six months. Conclusion: The CLTS system was found to meet its objectives and is useful. It was acceptable, flexible, simple, with good data quality and representative. Reporting timeliness was good, with poor stability. The Government should provide budgetary support to the EHSD to effectively implement CLTS surveillance system.