Solid waste management and health in Accra, Ghana Pierpaolo Mudu Betty Akua Nartey Gina Kanhai Joseph V. Spadaro Julius Fobil

w h o u r b a n h e a l t h i n i t i a t i v e

Solid waste management and health in Accra, Ghana Pierpaolo Mudu Betty Akua Nartey Gina Kanhai Joseph V. Spadaro Julius Fobil

w h o u r b a n h e a l t h i n i t i a t i v e Solid waste management and health in Accra, Ghana/ Pierpaolo Mudu, Betty Akua Nartey, Gina Kanhai, Joseph V Spadaro, Julius Fobil

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Design and layout by L’IV Com Sàrl iii

CONTENTS

Foreword iv

Acknowledgements v

Abbreviations vi

Executive summary vii

1. Introduction 1 1.1 Waste related health effects 3 1.2 E-waste related pollution and health effects in Accra 4 2. Review and assessment of solid waste management in Accra 6 2.1 Methodology 6 2.2 Literature review 6 2.3 Data collection 7 2.4 Study area 7 2.5 Legal framework and historical perspective 8 2.6 Main stakeholders of the waste management sector in Ghana 10 2.7 Current state of solid waste management in Accra 11 3. Assessing the impacts of solid waste management interventions 15 3.1 Tools and methodology 15 3.2 Health impact assessment 16 4. Results 17

4.1 Emission scenarios 17 4.2 Modelling emissions and concentration values for health impact assessment 20 5. Discussion 22

5.1 Emission scenarios 22 5.2 Health impact assessment: limitations 22 5.3 Policy interventions: suggestions and actions 23 6. Conclusion 25 6.1 Suggestions for solid waste management improvements 25 6.2 Health impacts – scenario projections 26 References 27

Annex 33 iv SOLID WASTE MANAGEMENT AND HEALTH IN ACCRA, GHANA

FOREWORD

One of the best means of improving health through preventive action is through the improvement of household and community environments in developing countries (World Resources Institute, UNEP, UNDP and WB, 1998: ix).1 Other studies have shown that improving household environments could avert the annual loss of almost 80 million “disability free” years of human life in developing countries – more than the feasible improvement attributable to all identified environmental measures combined such as unsafe workplace conditions, ambient air pollution and traffic injuries (McGranahan et al., 1996: 111; World Bank, 1993).2,3 Some of these problems in our human settlements, especially large metropolitan areas such as the Greater Accra Metropolitan Area, include: inadequate potable water supply, unsanitary conditions, uncollected rubbish and waste, among others. A water, sanitation and hygiene (WASH) focus has been dominant under WASH programmes but little attention has been given to solid waste management and health.

This gap is being addressed for Accra in this study using various scenarios focusing on the air pollution, health and climate change impacts of different solid waste management practices. It seeks to direct the attention of policy-makers to the implications of various technological options for solid waste management on health. Although this is quite innovative, much greater benefits could accrue from more detailed intra-urban analysis given the increasing inequalities in wealth, solid waste management and health in Accra. This was not immediately possible because of inadequacies in the available data.

With its focus on modelling the impact of different solid waste management practices, this study should be of great interest to those planning and managing the metropolis, given the impact improvements could make to the quality of life of all its citizens.

Professor Jacob Songsore Ghana Academy of Arts and Sciences

7 December 2020

1 World Resources Institute, UNEP, UNDP and WB (1998). A guide to the global environment. Oxford: Oxford University Press. 2 McGranahan G, Songsore J, Kjellen M (1996). Sustainability, poverty and urban environmental transitions. In: Cedric Pugh (ed.). Sustainability, the environment and urbanization. London: Earthscan; 103–133. 3 World Bank (1993). World development report: investing in health. Oxford: Oxford University Press. v

ACKNOWLEDGEMENTS

This report was developed by Pierpaolo Mudu (Department of Environment, Climate Change and Health, World Health Organization [WHO]), Betty Akua Nartey (University of Ghana), Gina Kanhai (University of Graz, Austria), Joseph V. Spadaro (Spadaro Environmental Research Consultants, United States of America) and Julius Fobil (University of Ghana).

Samuel Agyei-Mensah (University of Ghana) and Francesco Forastiere (Imperial College, London) reviewed the final draft of the report.

Support in data collection and analysis was provided by John Arko-Mensah (University of Ghana). Additional assistance was provided by Gordon Dakuu (WHO Ghana Country Office), Thiago Hérick de Sá, (Department of Environment, Climate Change and Health WHO), Sandra Mazo-Nix (Climate and Clean Air Coalition [CCAC]). Assistance in the organization of data and dissemination of results was given by Michael Hinsch and Abraham Mwaura (Department of Environment, Climate Change and Health, WHO) and Sandra Cavalieri (CCAC).

In coordination with the Accra Metropolitan Assembly Waste Management Department and Ghana Health Service, this report includes information on municipal waste impacts.

The Solid Waste Emissions Estimation Tool (SWEET) was developed by the US Environmental Protection Agency (with support from Abt Associates and SCS Engineers) on behalf of the CCAC Municipal Solid Waste Initiative. The authors would like to acknowledge the US Environmental Protection Agency and its team of contractors, particularly Ben Matek (Abt Associates) and Alex Stege (SCS Engineers) for their support in using the SWEET.

Comments at an early stage of the project were provided by Samuel Kpodo (Accra Metropolitan Assembly) and Carlos Dora (School of Public Health, Columbia University, New York). Comments and suggestions to improve the final draft were given by Nathalie Roebbel (Department of Environment, Climate Change and Health, WHO).

Special thanks to Maria Neira (Department of Environment, Climate Change and Health, WHO) for her support.

The preliminary results of the analysis were presented at the Accra Metropolitan Assembly, in August 2018, at the session on “Air pollution management and health evidence – industry and waste sector”, within the US EPA Megacities, CCAC Urban Health Initiative (UHI), World Bank Joint Workshop Series.

This work was supported by the CCAC through the grant provided for the Urban Health and Short- Lived Climate Pollutants (SLCP) Reduction Project in Accra.

Support was also provided by the Government of Norway through its financial contribution to advance WHO’s work on air pollution and health, which contributed to the completion of this product. vi SOLID WASTE MANAGEMENT AND HEALTH IN ACCRA, GHANA

ABBREVIATIONS

ACaRP Accra Composting and Recycling Plant AMA Accra Metropolitan Assembly BAU business-as-usual BC black carbon CCAC Climate and Clean Air Coalition

CH4 methane

CO2 carbon dioxide

CO2eq carbon dioxide equivalent EPA-Ghana Environmental Protection Agency Ghana GAMA Greater Accra Metropolitan Area GHG greenhouse gas HFCs hydrofluorocarbons HIA health impact assessment IPCC Intergovernmental Panel on Climate Change MLGRD Ministry of Local Government and Rural Development MMDAs metropolitan, municipal and district assemblies NOx nitrogen oxide PAHs polycyclic aromatic hydrocarbons PM particulate matter PMWMD Phase Model of Waste Management Development RUWM Robust Uniform World Model SDG Sustainable Development Goal SLCPs short-lived climate pollutants SWEET Solid Waste Emissions Estimation Tool SWM solid waste management UHI Urban Health Initiative (WHO) UNDP United Nations Development Programme UNEP United Nations Environment Programme UWM urban waste management WASH water, sanitation and hygiene WB World Bank WHO World Health Organization vii

EXECUTIVE SUMMARY

The aim of this report is to provide an overview of the current solid waste management (SWM) situation in contemporary Accra, Ghana, and assess its impact on health and well-being.

Accra is a city that has grown enormously in the last decades. According to the most recent census (2010), the total population of Greater Accra is approximately 4 million, with approximately 1 850 000 inhabitants living in urban Accra.

The main goal of the study is to inform local air quality and climate change policies. To achieve this, the study:

• investigated the framework of SWM in Accra;

• assessed the contribution of urban SWM activities to local air pollution and climate change by estimating the quantity of short-lived climate pollutants (SLCPs) emitted using the Solid Waste Emissions Estimation Tool (SWEET); and

• produced estimates on the health impacts directly related to current and potential SWM activities.

SWM activities are as diverse as the SLCP they generate. Greenhouse gas (GHG) reductions should be coordinated with established targets on SLCPs to ensure that average global temperatures do not increase excessively (IPCC, 2018). Ending open burning and upgrading dumps to landfills with gas capture were found to be potential pathways to reduce climate forcing pollutants, and generate positive health impacts. Additionally, the diversion of solid waste via composting and recycling is effective in lowering emission levels of some SLCPs such as particulate matter (PM) and black carbon (BC). It is therefore important that SWM is executed in an integrated manner in order to reduce emissions and not endanger public health and well-being.

In summary, an overview of the current SWM situation in Accra and analysis of the different scenarios produced the following results:

• Waste management is an environmental emergency in Accra, but solutions can be implemented to improve the situation.

• There is a serious shortage of reliable SWM data for Accra on management methods and environmental loads.

• A combination of methodologies and tools was used, and the data generated can be compared with other available data to understand the current situation and future trends.

• A rapid assessment approach was developed for the health impact assessment of SWM, which can be easily replicated in other contexts. viii SOLID WASTE MANAGEMENT AND HEALTH IN ACCRA, GHANA

• SWM is responsible for significant emissions of GHGs and critical air pollutants, including BC. Realistic scenarios to reduce these contaminants are feasible.

• Waste management options, such as recycling, composting and landfill, can have different health impacts that are difficult to assess, and although the evidence is still limited regarding the effects on specific health endpoints, there is a need to monitor and analyse potentially hazardous exposure situations.

• Air pollution represents a real threat to the health of the population, requiring a coordinated call to action by policy-makers and waste operators to protect public health. – In particular, if ceasing open burning is achieved by 2030 an annual reduction of 120 premature deaths could be achieved. – Other scenarios for waste management, such as increasing composting and recycling,

produce important reductions in carbon dioxide (CO2) emissions. 1

1. INTRODUCTION

Managing today’s cities, with both the rapidity and scale of urban transformations, is becoming increasingly challenging. The rapid urbanization across the developing world has exceeded the capacity of most cities to provide sufficient services to their citizens, leading to daunting sustainability challenges related to housing, infrastructure, basic services, food security, health, education, decent jobs, safety, natural resources constraints, pollution, governance structures and socio-political instability (Achankeng, 2003; Cohen, 2006; Fobil et al., 2008; Ezeah & Roberts, 2012; Hoornweg & Bhada-Tata, 2012; Pieterse & Parnell, 2014; Almazán-Casali et al., 2019; OECD/SWAC, 2020). Around the world today, many cities are faced with the challenging task of how to achieve a balance between reaping the benefits of urbanization while decreasing the risks of its negative impacts (Cohen, 2006).

A major negative consequence of economic development on human health is air pollution. The work of the WHO Urban Health Initiative (UHI) mainly focuses on three sectors: household energy, ground transport and waste, with several underlying workstreams on land use and health. During the UHI work on SWM five objectives were pursued:

1. Capacity building through training of staff at local government level to support policy related to mitigating SWM health impacts.

2. Exchange of knowledge at local and international levels.

3. Review current status of knowledge and existing policy scenarios for SWM plans and their health impacts.

4. Contribute to the estimates of the impacts of waste management in Accra.

5. Develop policy suggestions to improve the collection, transport, recycling and disposal of municipal refuse at neighbourhood level, with particular attention to socioeconomic inequalities within the study areas.

The main goal in many developing countries is the basic provision of food, shelter, security and livelihoods for their citizens (Konteh, 2009). This leads to municipal solid waste generation and its management being neglected, with no formally organized waste collection and/or insufficient waste management and recycling policies and practices (Seo et al., 2004; Al-Khatib et al., 2010; Hoornweg & Bhada-Tata, 2012; Marshall & Farahbakhsh, 2013). When SWM is not prioritized in developing countries, it ends up affecting public health (Wilson, 2007; Coffey & Coad, 2010). In Africa, it is expected that the challenges associated with waste management will significantly worsen due to high population growth and the health hazards associated with inadequate waste collection and treatment (Guerrero et al., 2013). Unsustainable SWM is a global issue through its negative impacts on the environment, air quality, human health and quality of life (Ma & Hipel, 2016; Ferronato & Torretta, 2019). As the global population increases, solid waste generation also increases. Waste generated worldwide is expected to increase from about 1.3 billion tonnes per year, to about 2.2 billion tonnes per year by 2025 (Hoornweg & Bhada-Tata, 2012). In developing countries, rapid urbanization and 2 SOLID WASTE MANAGEMENT AND HEALTH IN ACCRA, GHANA

population growth contribute to ever increasing volumes of waste generation, exerting great pressure on an already over strained SWM system (Vij, 2012) and increasing demand for improved waste management services.

Urban areas in comparison with rural regions are especially in need of adequate waste services, as they are areas of intense economic activity, leading to the generation of significant volumes of waste per square metre. In lower middle-income countries, this problem is further exacerbated by a lack of accessible roads for waste collection, inadequate funds for waste collection, and inadequate waste equipment (Fobil, Kolawole et al., 2010). Solid waste collection, especially in low-income urban communities, is frequently inadequate. Hence, residents in these areas are left to dispose of their waste through practices such as open burning and indiscriminate dumping of solid and liquid waste, which contribute to air and water pollution. Hence, residents in these areas are left to dispose of their waste through practices such as open burning and indiscriminate dumping of solid and liquid waste, which contribute to air and water pollution (Lemieux et al., 2004; Wiedinmyer et al., 2014; Ferronato & Torretta, 2019).

The Basel Convention defined “waste” as “substances or objects which are disposed of, or are intended to be disposed of, or are required to be disposed of by the provisions of national law” (Basel Convention, 1989). Waste can be classified based on its physical state, chemical composition and source (UNEP, 2005). Nevertheless, similar to the majority of environmental stressors, the “nature” of waste is problematic. “There is no standard or typical solid waste; in fact no two wastes will be identical. […] There is a need for thorough analysis of data to be collected” (WHO Regional Office for Europe, 1991: 34). In the previous definition we could have substituted the words “air pollution” or “contaminated water” for the word “waste”. Due to the challenges faced in managing SWM, it is a recurring theme in the Sustainable Development Goals (SDGs). The SDG 11.3 target, for example, calls for attention to municipal and other waste management, and SDG 12.4 focuses on achieving the environmentally sound management of chemicals and all wastes throughout their life cycle, while SDG 12.5 targets the substantial reduction of waste generation through prevention, reduction, recycling and reuse. Regardless of the difficulty in categorizing the waste produced, SWM is an essential service to achieve the following objectives: protection of public health; promotion of hygiene; recycling of materials; avoidance of waste; reduction of waste quantities; and reduction of emissions and residuals (WHO Regional Office for Europe, 1991).

SWM activities (the collection, storage, transport, recovery and disposal of waste, including incineration) are not only associated with contamination of soil, water and air, but also contribute to global warming through the emissions of GHGs. There is a significant association between solid waste generation rates and ground-level ozone and SLCP emissions, such as methane, hydrofluorocarbons (HFCs) and BC (Hoornweg & Bhada-Tata, 2012). SLCPs have shorter lifespans in the atmosphere than GHGs. For instance, BC has a lifespan of a few days to weeks in the atmosphere, whereas

methane has a lifespan of around 12 years and CO2 100 years or more. Despite the short period of time in the atmosphere, SLCPs have a remarkable effect both directly and indirectly on local climate change, agriculture and human health. Various research activities have investigated the implications of waste generation and emissions (Gentil & Christensen, 2009; Friedrich & Trois, 2011). In 2000, developing countries contributed approximately 29% of global GHG emissions (Bogner et al., 2008). This is expected to increase to 64% and 76% in 2030 and 2050 respectively, due to copious amount of methane emitted from landfill sites (Monni et al., 2006). Methane generated from landfill contributed to about 90% of emissions from the waste sector, and approximately 18% of global anthropogenic emissions of methane in 2004 (Bogner et al., 2008). 3

Urban centres in low-income countries produce a higher percentage of organic waste compared with high-income countries, where the majority of the waste is inorganic (Hoornweg & Bhada-Tata, 2012). Given the link between organic waste and emissions of SLCPs, municipal waste management processes, including collection, and composting and recycling, are important activities in maintaining both healthy ecosystems and environmental sanitation in cities; and contribute to decelerating global warming and its harmful effects. The complexity and difficulty in estimating the health risks involved in waste production and management should not prevent us from analysing these risks (Bond et al., 2005; Forastiere et al., 2011).

The case of the city of Accra is relevant because for a number of years there has been extensive debate on how to improve a situation that can still be managed before it enters an emergency stage, where planning, and sustainable and efficient use of resources, are jeopardized. Data from the Ghana Health Service 2010 indicate that 60% of the most prevalent diseases are linked to insufficient environmental sanitation (Oteng-Ababio, 2011). To counteract the expected trend of significantly worsening environmental and population health in African cities, steps toward improving waste management need to be taken. This report provides insights on the nexus of air pollution, health and waste management in Accra, Ghana, by considering alternative management strategies. The modelled policy scenarios are based on planned measures in Accra, or informed by research insights suggesting innovative interventions that could be adopted to attain emission reductions.

The focus of this report is on four main components:

• an overview of the health effects of the waste sector;

• a review and assessment of the current SWM situation in Accra;

• an estimation of the health impacts of different SWM scenarios; and

• suggested policy actions.

1.1 Waste related health effects

Waste can be generated by various sources: domestic, commercial, industrial, construction and health care.1 Although we want to concentrate our focus on the health consequences of the treatment of domestic sources, in particular concerning air pollution, from the literature it is difficult to understand the different impacts of the individual sources. Waste production and (mis)management pose health hazards to people living near waste disposal sites and to workers involved with waste treatment (Suess & Huismans, 1983; Cointreau, 2006; Yang et al., 2018; Ferronato & Torretta, 2019).

Waste management, from generation through to final disposal, is associated with different patterns of exposure that have been linked to increased cases of birth defects (e.g. low birth weight), pre- term birth and reproductive disorders, elevated cancer risks and mortality, congenital anomalies, and respiratory diseases in workers and people who live near waste sites (Rushton, 2003; Giusti, 2009; Mattiello et al., 2013).

1 Although not the objective of this report, it is important to consider that health care waste “carries a greater potential for causing infection and injury than any other type of waste, and inadequate or inappropriate management is likely to have serious public health consequences and deleterious effects on the environment” (Chartier et al., 2014). For the Accra situation, see Asante et al. (2013); Williams (2013); Udofia et al. (2017). 4 SOLID WASTE MANAGEMENT AND HEALTH IN ACCRA, GHANA

There are numerous studies, on, for example, landfill (Vrijheid, 2000; Redfearn & Roberts, 2002; Rushton, 2003; Crowley et al., 2003; Porta et al., 2009); and incineration (Vrijheid, 2000; Hu & Shy, 2001; Redfearn & Roberts, 2002; Crowley et al., 2003; Rushton, 2003; Franchini et al., 2004; Porta et al., 2009). In some cases there is a significant increase in health risks from SWM to the exposed populations, while in others there is no a clear trend (Ma & Hipel, 2016; Fazzo et al., 2017; Ncube et al., 2017). “Management of solid waste (mainly landfills and incineration) releases a number of toxic substances, most in small quantities and at extremely low levels. Because of the wide range of pollutants, the different pathways of exposure, long-term low-level exposure, and the potential for synergism among the pollutants, concerns remain about potential health effects but there are many uncertainties involved in the assessment” (Porta et al., 2009: 1). “The evidence of causal relationship with hazardous waste was defined as limited for: liver, bladder, breast and testis cancers and non-Hodgkin lymphoma. Among non-neoplastic diseases, asthma was found to be related to hazardous waste with limited evidence. We evaluated as limited the evidence of the association between the exposure to hazardous waste and adverse birth outcomes, including low birth weight, pre-term birth, congenital anomalies overall and anomalies of the urogenital, connective and musculoskeletal systems. The evidence of a causal relationship was defined as inadequate for most other health outcomes.” (Fazzo et al., 2017: 8). Improvements in research design, better exposure measurement, clearer outcome definitions, and adjustment for confounding factors will offer better systematic knowledge on the health outcomes associated with waste mismanagement (Mattiello et al., 2013).

Furthermore, exposure to e-waste has a number of potential consequences on health and evidence is accumulating (Grant et al., 2013; WHO, 2021), with the Agbogbloshie e-waste recycling site in Accra representing a special case study tackled in Section 1.2.

1.2 E-waste related pollution and health effects in Accra

The informal recycling of electronic waste using low-tech methods, for example, the burning of plastic cables to recuperate copper or other valuable metals, releases a range of contaminants (e.g. mercury, cadmium, lead and dioxin-related compounds) into the ambient environment. E-waste is a serious source of contamination in Accra, in particular at the Agbogbloshie site (Daum et al., 2017). The origin of the thousands of tonnes of e-waste is importation from Europe (Schluep et al., 2012).

The Agbogbloshie area has been derogatively called by outsiders “Sodom and Gomorrah”, highlighting the controversial representation of the area for the last two decades (COHRE, 2004; Oteng-Ababio & van der Velden, 2019). Whatever its name, the high toxicity of the area, overcrowding, poor-quality housing and lack of health care is well known (Owusu-Ansah et al., 2016). For example, the release of chlorinated, brominated and mixed halogenated dioxin-related compounds from open burning of e-waste into soils has been measured (Tue et al., 2015). Environmental contamination is exacerbated by the interplay of several contaminants, for example metals and bromine with dioxin-related compounds (Fujimori et al., 2015), metals (Itai et al., 2014; Kyere et al., 2017) and polycyclic aromatic hydrocarbons (PAHs) at Agbogbloshie (Feldt et al., 2014; Wittsiepe et al., 2015; Daso et al., 2016). The analysis of 132 samples collected from the Agbogbloshie e-waste processing site confirmed ubiquitous high levels of contamination from heavy metals (Wittsiepe et al., 2016;

Kyere et al., 2017). “Exceptionally high concentrations (e.g. 1-hr average PM10 exceeding 2000 μg/ m3) were sometimes encountered near combustion sources, including open fires at the e-waste site 3 and spoil piles. 24-hr PM2.5 levels averaged 31, 88 and 57 μg/m at upwind, e-waste and downwind 3 sites, respectively, and PM10 averaged 145, 214 and 190 μg/m ” (Kwarteng et al., 2020). 5

Exposure to contamination poses serious health risk to both adults and children working informally at the e-waste site (Akormedi et al., 2013; Obiri et al., 2016; Amoabeng et al., 2020). Biomonitoring at the Agbogbloshie e-waste site found higher than expected levels of heavy metals and PAHs, which pose serious health risks to informal workers at the site and contribute to the overall toxic exposure of the residential community. Recent occupational health investigations have reported that burning of e-waste is likely to produce the highest levels of cadmium, lead and arsenic bioaccumulation (Srigboh et al., 2016). However, the people working at the site generally have little knowledge of the link between their health status and their work (Yu et al., 2016), and access to health care has yet to be improved (Asampong, 2015). 6 SOLID WASTE MANAGEMENT AND HEALTH IN ACCRA, GHANA

2. REVIEW AND ASSESSMENT OF SOLID WASTE MANAGEMENT IN ACCRA

2.1 Methodology

A combination of methods and tools was used and the data generated can be compared with other available information to understand the current situation and alternative scenarios going forward. This – a new approach for an African city – has been developed and applied to provide a health impact assessment (HIA) of SWM. This is an approach that can be replicated in other contexts.

The methodology involved the following tasks:

• Compile scientific articles and reports published on waste- and health-related impacts in Accra.

• Review future development plans on waste treatment.

• Define alternative waste treatment scenarios and assess the GHG and SLCP emissions out to year 2030.

• Calculate future health impacts.

• Integrate information collected to provide useful insights for decision-making and public health protection.

• Organize seminars and training with local experts.

A WHO focal point collaborated in supporting all the activities described. Local stakeholders and experts participated in the data collection and analysis.

2.2 Literature review

The overview of published articles provided an introductory basis for the analysis of and discussion on SWM trends. The review included scientific literature published and listed in Pubmed, Scopus and the Web of Science as well as major reports from international agencies and nongovernmental organizations. The literature search used two keywords “waste” and “Accra” and identified more than 100 articles; mostly related to e-waste issues. In addition, documents on practices in waste generation, waste characterization and treatment, and recent trends for the city of Accra were reviewed. 7

2.3 Data collection

Data on waste generation were gathered from secondary sources. Baseline information was collected from local and national institutions. Relevant waste management data were obtained from institutions such as the Accra Compost and Recycling Plant (ACaRP) in Medie, Accra Metropolitan Assembly (AMA), and Nsumia and Tema landfills. Some data were also obtained from Zoomlion Company Limited, J Stanley Owusu and Co. Limited, Metropolitan Waste and Allied Services, Meskworld Co. Limited, Tropical Waste Limited and Jekora Ventures Limited. Other data on waste management processes were also retrieved from published sources (scientific literature, census reports, national surveys, local government reports), as well as through interviews, site visits and direct observations.

2.4 Study area

The study area was the city of Accra. According to census data, in 2000, Accra’s population was 1 659 000 and it had increased to 1 849 000 in 2010 (Ghana Statistical Service, 2014). Over the same period the population of the Greater Accra Region increased from 2 906 000 to 4 010 000 (Ghana Statistical Service, 2012). The city of Accra extends for 140 km2, and the Greater Accra Region for 3245 km2. The population in the Greater Accra Metropolitan Area (GAMA) accounts for 17% of the population of Ghana.

The city’s annual growth rate is more than 3%, among the highest for capital cities in Africa. Population projections for 2030 are 2 913 124 for the city of Accra and 6 319 212 for the Greater Accra Region. The latest official projection indicates a population of 4 943 100 for the Greater Accra Region in 2019.

The city of Accra alone generates nearly 900 000 metric tonnes of solid waste annually and approximately 2200 metric tonnes of waste per day, with a waste generation rate that has increased since 2000 from about 0.5 kg/person/day (CCAC, 2016),1 to around 0.74 kg/person/day (Miezah, 2015).2 In the Greater Accra Region, some landfill and dumpsites are very close, even less than 100 m, from resident populations. Results obtained from sampling sites, across the dry and wet seasons, showed a considerable presence of bacteria and microbial (bioaerosols) contamination in the air at the landfill and dumpsites (Odonkor & Mahami, 2020). In this study, we have considered household waste for the city of Accra, and have excluded the industrial waste contribution from refineries and oil industries in Tema, which need specific analysis and approaches (Mudu et al., 2014). In particular, for Tema, various investigations have produced results of concern about the air pollution due to industrial activities (Ofosu et al., 2012; Amoatey et al., 2018; Amoatey et al., 2019).3

1 In the 1990s, the daily per capita generation was estimated to be 0.4 kg (Boadi & Kuitunen, 2003). 2 In order to have an idea of the amount of waste generated in Accra, consider that Organisation for Economic Co-operation and Development countries generate almost half of the world’s waste (per capita values range from 1.1 to 3.7 kg per person per day with an average of 2.2 kg/capita/day), while Africa and South Asia are the regions that produce the least waste. “Waste generation in sub-Saharan Africa is approximately 62 million tonnes per year. Per capita waste generation is generally low in this region, but spans a wide range, from 0.09 to 3.0 kg per person per day, with an average of 0.65 kg/capita/day” (Hoornweg & Bhada-Tata, 2012: 8). 3 The results of the application of dispersion modelling to simulate the concentration of PM2.5 from the Tema oil refinery showed concentration levels of −3 −3 concerns both for 24-hour (38.8 µg m ) and annual (12.6 µg m ) PM2.5 values. “Cardiopulmonary disease related mortalities due to PM2.5 exposure (181 deaths for adults and 24 deaths for children) were found high compared to deaths caused by lung cancer (137 deaths for adults and 16 deaths for children).” (Amoatey et al., 2018: 1181). 8 SOLID WASTE MANAGEMENT AND HEALTH IN ACCRA, GHANA

2.5 Legal framework and historical perspective

Table 2.1 provides a summary of the legal and regulatory measures governing SWM in Accra, giving an overview of the official and organizational framework. Included are laws governing the protection of public health and providing related public health standards for hygiene; and environmental laws governing environmental protection and providing related discharge standards or ambient environmental standards. The mapping of the organizational and legal framework takes into account the general framework of:

• environmental assessment laws which specify what actions require environmental impact assessment;

• laws which specify public participation procedures in planning, environmental assessment and project approval.

More significantly, legislation should establish:

• Laws which define hazardous wastes and specify their methods of management, including: – local ordinances which stipulate the responsibility of citizens to store, sort, recycle, discharge, and/or dispose of their solid wastes; – local ordinances which prohibit littering and clandestine dumping; – local ordinances outlining the management of hazardous wastes; – local laws, policies and procedures governing involvement of the private sector in solid waste services; and – local laws or agreements which specify the institutional arrangement for SWM.

• Policies on recycling and resource recovery.

• Tariff structures and procedures which govern cost recovery for SWM.

• Laws which define the roles and responsibilities of provincial and local governments in SWM.

• Sanctions provided under each of the laws and regulations discussed.

• Outline the existing procedures for inspection and enforcement of laws.

The most recent and relevant legislative act is the Local Government Act 936 (2016), which:

• Preserves and maintains the districts already in existence.

• Includes “the disposal of waste on land, including the discharge of effluent into a body of still or running water” as part of the definition of “physical development”.

• Re-centralizes the “Waste Management Department” at metropolitan assembly level, removing its counterparts at municipal and district assembly levels.

Under pressure from international organizations, the Government of Ghana has privatized solid 9

Table 2.1 Acts and regulations related to solid waste management

Year Acts and regulations Level 2016 Local Government ACT (ACT 936), 2016 (2016 onwards) National 2010 National Environmental Sanitation Policy (Revised), 2010 National 2010 National Environmental and Sanitation Action Plan (NESSAP) 2010 National 1999 Environmental Assessment Regulations, 1999 (LI 1652) National 1996 National Building Regulations, 1996 (LI 1630) National 1995 Local Government (Accra Metropolitan Assembly) Establishment Instrument, 1995 (LI 1615) Local 1995 Local Government (District Tender Boards) Establishment Regulations, 1995 (LI 1606) Local 1994 National Development Planning Commission Act, 1994 (Act 479) National 1994 National Development Planning (System) Act, 1994, (Act 480) National 1994 Local Government (Urban, Zonal, Town and Town Councils and Unit Committees) Establishment Instrument, Local 1994 (LI 1589) 1994 Environmental Protection Agency Act, 1994 (Act 490) National 1993 Local Government Act, 1993 (Act 462) Local 1993 District Assemblies Common Fund Act, 1993 (Act 455) National 1992 Constitution of the Republic of Ghana,1992 National 1992 Food and Drugs Law 305b (1992) National 1944 Town and Country Planning Ordinances, 1944 (Cap 84) National 1919 Vaccination Ordinance (Cap 76) National 1915 Quarantine Ordinance (Cap 77) National 1911 Mosquito Ordinance (Cap 75) National 1908 Infectious Disease Ordinance (Cap 78) National

waste collection with the target of increasing collection rates as well as tackling some solid waste challenges such as increasing recycling and treatment operations respectful of the environment (World Bank, 1996; Post et al., 2003). Waste management planners in Ghana are currently using the “collect and dispose’’ approach which places more emphasis on the final disposal of waste rather than adopting a more inclusive and sustainable approach to managing waste (Asomani-Boateng, 2007).

Drawing on actual and planning data from 1985 to 2000, a quick analysis of waste collection performance in Ghana offers interesting insights under the two different organizational regimes which operated over the period:

1. initially, entirely public sector;

2. currently, a mix of public-private sector participation.

The analysis reveals that the overall performance of waste collection services in Ghana increased under regime 2, with efficiency increasing rapidly with increased private-sector controls and levels of involvement, e.g. based on the analysis of data available at the Waste Management Department and the Ministry of Local Government and Rural Development (MLGRD), collection rate and disposal improved from 51% in 1998 to about 91% in the 2000 (Fobil et al., 2008). However, such an increase in performance was not sustained beyond 10 years of public-private partnerships and today the 10 SOLID WASTE MANAGEMENT AND HEALTH IN ACCRA, GHANA

system can no longer provide efficient solutions (Oduro-Kwarteng & van Dijk, 2013). The SWM sector in Ghana faces numerous problems related to conflicts that exist within the current institutional and legislative arrangements. Issues include: indiscriminate disposal of waste at unauthorized places, littering, inadequate service coverage and irregularities in waste collection. In the late 1980s and early 1990s, the public-private partnership was effective in containing the deteriorating urban environmental conditions. However, the public-private partnership model failed to sustain the initial momentum in terms of efficiency and performance as a result of the inability of local authorities to capitalize on opportunities and properly deal with the associated risks, thus reversing the gains made in urban environmental management.1 Several gaps exist, for example, the need to reconsider the efficacy and appropriateness of investments in wholesale importation from North America or European countries of SWM technologies into places that are often incompatible with the required physical, social and economic realities (Oteng-Ababio et al., 2013).

2.6 Main stakeholders of the waste management sector in Ghana

The SWM sector in Ghana is organized collaboratively among multiple stakeholders with the MLGRD and the Environmental Protection Agency (EPA-Ghana) playing key roles as implementer and regulator, respectively. The Ghanaian regulatory framework defines the roles and legal obligations of institutions and government bodies. In fact, the Local Government Act 1993 (Act 462) gives the MLGRD three SWM responsibilities:

• policy and planning

• legislation regarding SWM

• the regulation, monitoring and enforcement of SWM activities (Oduro-Kwarteng, 2011).

The situation is somehow complicated by the different responsibilities and mandates attributed by law. The MLGRD is responsible for formulating and implementing policies related to SWM and sanitation. Its duties also include promulgating national legislation and bylaws and providing direction and supervision of the National Environmental Sanitation Policy Co-ordination Council. EPA-Ghana has been mandated to manage and protect the country’s environment and also to educate the general public on sanitation issues. The responsibility of the MLGRD is discharged through the metropolitan, municipal and district assemblies (MMDAs) which are directly under the MLGRD and EPA-Ghana. The MLGRD has the responsibility for the decentralized MMDAs. The MMDAs, the implementing bodies of the MLGRD, have sole responsibility for waste collection and disposal through their waste management and environmental health and sanitation departments which provide services either directly or indirectly through private contractors or franchisees. The MLGRD’s technical guideline (Expanded Sanitary Inspection and Compliance Enforcement) is implemented by the MMDAs in four areas: effective environmental health inspections; dissemination of sanitary information; pest/ vector control; and law enforcement (MLGRD, 2010).

1 Efforts to change the situation are ongoing and the Mayor of Accra received the C40 Cities Bloomberg Philanthropies Award 2019 for achievements in integrating informal waste collection into formal systems in Accra. The programme started in 2016 and was selected by C40 (a network of the world’s megacities committed to addressing climate change) to receive the award (https://www.c40.org/awards/awards-2019/profiles). 11

2.7 Current state of solid waste management in Accra

The development of waste management infrastructure has not kept pace with the increasing population of Accra. This, together with the low cost of labour and weak enforcement of existing legislation, explains the rapid growth in the informal waste sector. In the 1990s, solid waste disposal was dominated by open dumping of waste which was practised by 83% of all households; only 11% of the metropolitan population benefited from a home collection service (Songsore & McGranahan, 1993: 21). Initially, SWM in Accra was entirely a local government service and the collection rate Table 2.2 Waste collection in five neighbourhoods of Accra, 2000 was approximately 67% (World Bank: 1996). In the 2000s, with increasing generation, Neighbourhoods Percentage of collected solid waste waste management became the most Nima 8.6 pressing environmental concern in the city Sabon Zongo 15.1 of Accra (Post et al., 2003; Miezah et al., 2015; Accra New Town 25.3 Alhassan et al., 2020). Results from the 2000 Jamestown 11.0 population and housing census evidence the pressing problem of waste collection Chorkor Down 2.9 activities in low-income communities in Source: Obeng-Odoom (2013) from the 2000 population and housing Accra (Tables 2.2 and 2.3). census, Ghana.

Table 2.3 Waste collection in four communities in Accra, 2017

Type of waste disposal (solid waste) Jamestown Nima Asylum Down East Legon Door-to-door collection 97.5 5.7 46 55.9 Household burned some or all waste 0 2.5 27 34 Public container 0 91.8 22.5 7.6 Household dumped some or all waste indiscriminately 2.5 0 4.9 2.5 Total 100 100 100 100

Source: Results from a survey carried out in 2017 (Kanhai et al., 2019).

The characterization of the neighbourhoods analysed is quite diverse: Chorkor Down and Jamestown are indigenous low-income neighbourhoods; Accra New Town, Nima and Sabon Zongo are low- income slums formed by migrants and they all are high-density areas; Asylum Down is a middle- density and middle-class income area; East Legon is a low-density and high-income area (Obeng- Odoom, 2013). For updated estimates see Table 2.3.

Estimates from 2008 and 2017 show that waste generation has been increasing rapidly in the last two decades (Fobil et al., 2008) (Tables 2.4 and 2.5). In 2017 (Table 2.5), the majority of households in the Greater Accra Region (65.4%) had their solid waste collected, while about 17.4% was disposed of through public dumping. 14.6% of households burned all of their waste (Ghana Statistical Service, 2019, p. 158). There has been an increase in burning and public dumping of rubbish when comparing 2017 with 2010 (Tables 2.4 and 2.5). 12 SOLID WASTE MANAGEMENT AND HEALTH IN ACCRA, GHANA

Table 2.4 Method of rubbish and liquid waste disposal by households, 2010

Method of waste disposal Ghana (%) Greater Accra Accra (%) Region (%) Solid waste disposal Collected 785 889 (14.4) 502 642 (48.5) 298 178 (59.4) Burned by household 584 820 (10.7) 134 654 (13.0) 13 402 (2.7) Public dump (container) 1 299 654 (23.8) 266 287 (25.7) 156 481 (31.2) Public dump (open space) 2 061 403 (37.7) 87 379 (8.4) 23 647 (4.7) Dumped indiscriminately 498 868 (9.1) 22 123 (2.1) 5408 (1.1) Buried by household 182 615 (3.3) 14 003 (1.4) 1412 (0.3) Other 53 805 (1.0) 9282 (0.9) 3375 (0.7) Total 5 467 054 (100.0) 1 036 370 (100.0) 501 903 (100.0) Liquid waste Through the sewerage system 183 169 (3.4) 95 188 (9.2) 41 000 (8.2) Through drainage system into a gutter 594 404 (10.9) 191 228 (18.5) 135 248 (26.9) Through drainage into a pit (soak away) 167 555 (3.1) 55 807 (5.4) 20 012 (4.0) Thrown on to the street/outside 1 538 550 (28.1) 127 782 (12.3) 33 064 (6.6) Thrown into gutter 1 020 096 (18.7) 351 349 (33.9) 236 463 (47.1) Thrown on to compound 1 924 986 (35.2) 208 821 (20.1) 33 436 (6.7) Other 38 294 (0.7) 6195 (0.6) 2680 (0.5) Total 5 467 054 (100.0) 1 036 370 (100.0) 501 903 (100.0)

Source: Elaboration based on census data (Ghana Statistical Service, 2014).

Table 2.5 Type of waste disposal method by type of locality and region, 2017

Method of waste disposal Ghana (%) Greater Accra Region (%) Solid waste disposal Collected 21.9 65.4 Burned by household 19.5 14.6 Public dump 47.8 17.4 Dumped indiscriminately 10.8 2.7 Total 100.0 100.0 Liquid waste Discharged in open area 68.8 32.4 Discharged into drains 25.9 53.6 Septic tank 3.7 12 Discharge into sewer 0.9 2 Other 0.7 0 Total 100.0 100.0

Source: Elaboration based on census data (Ghana Statistical Service, 2019: Table 7.21, 158). 13

“Most poor neighbourhoods and slums are highly susceptible to disease outbreak as a result of a poor attitude towards domestic waste management in these areas. Personal observation and discussions with some residents in low-income areas showed that attitude towards waste management is appalling in these areas due to poor waste management services rendered by purported waste management contractors.” (Fagariba & Song, 2018: III).

Wide socioeconomic inequalities characterize the production of waste and the population of Accra. “High-income areas are provided with more adequate household dustbins and public refuse containers than middle and low-income areas though daily household generations in low and middle-income settlement areas are high” (Fagariba & Song, 2018: III). Surveyed households had limited knowledge of waste-related health hazards in their neighbourhoods. Although households reported diseases that could be associated with environmental factors linked to waste management, 87% of all surveyed households did not think that someone in their household could have fallen ill from a disease related to waste. In middle- and high-income neighbourhoods, waste burning increases substantially when waste is not collected (Kanhai et al., 2019). Although not conclusive, different research has reported that high-income populations are more likely to have space in their homes to bury or burn the waste they generate (Oteng-Ababio et al., 2013; Alhassan et al., 2020).

According to recent estimates, Accra produces approximately 2200 tonnes of solid waste daily, and is expected to exceed 4400 tonnes per day by 2030 (Oteng-Ababio, 2010; 2014; Fagariba & Song, 2018). Waste composition is 65.8% organic matter, 5.3% paper and 10.4% plastic components, and, in small percentages, metals, glass, textiles, leather and rubber (Miezah et al., 2015).

In GAMA waste is formally collected by the following private sector providers: Metropolitan waste, Meskworld, J Stanley-Owusu and Co. Ltd, Jekora and Zoomlion – with about 150 heavy and about 60 light duty diesel trucks. There are three composting plants: the large-scale ACaRP at Adjen-Kotoku, which operates as a public-private partnership arrangement and receives a government subsidy (Oduro-Appiah et al., 2017); the large-scale Teshie compost plant in Ledzokuku-Krowor Municipal Assembly; and a smaller composting plant at the Timber Market, Ashiedu-Keteke Submetropolitan Assembly. Waste is formally recycled at ACaRP, Jekora, Enviroplast Company Limited, City Waste Management Co. Ltd, SkyPlast Enterprise and Blowplast Limited, Coliba Ghana Limited. Yet, most of the recycling companies operate on a small scale. ACaRP is one of the few major recycling plants in Ghana, which sorts/segregates, processes and recycles both solid and liquid waste at final disposal.

Accra is not an exception in Ghana, where landfills and dumpsites are the preferred way to address waste production because of the low operating costs (Kusi et al., 2017). Waste from Accra is disposed at two sanitary landfills: ACaRP (about 80 tonnes deposited per day) and Tema Kpone Katamanso (between 1500 and 2000 tonnes deposited per day from the city of Accra), which are almost full. Additionally, there is one controlled dumpsite: Nsumia. None of these landfills have methane collection services in use. Dumpsites of different dimensions are an existing reality for the city of Accra. For example, the dumpsite of Abokobi, which receives 400 tonnes of waste daily, has a poor drainage system and fires are common throughout the year (Kusi et al., 2017; Tersigni et al., 2018). The city of Accra is highly dependent on neighbouring municipalities for waste disposal, which suggests that the waste disposal system is weak at its core. It should be a priority to modernize the current waste disposal system and to ensure appropriate treatment (Oduro-Appiah, et al., 2017). 14 SOLID WASTE MANAGEMENT AND HEALTH IN ACCRA, GHANA

There are two transfer stations in Accra: Teshie and Achimota. Teshie transfers waste to Kpone landfill in Tema, while Achimota, which was inaugurated in May 2017, transfers to ACaRP. Teshie transfer station has operated problematically for many years, receiving an average of 10 000 tonnes per month (Oteng-Ababio, et al., 2013). Both Teshie and Achimota transfer stations each have a planned capacity of 30 000 tonnes per month. 15

3. ASSESSING THE IMPACTS OF SOLID WASTE MANAGEMENT INTERVENTIONS

3.1 Tools and methodology

The UHI has applied and exploited tools to model the impacts of policies to promote sustainable waste management, and to reduce air pollution levels and associated health risks in Accra. Preliminary estimates of the emission scenarios of policy interventions were modelled using the Solid Waste Emissions Estimation Tool (SWEET)1 developed by the US Environmental Protection Agency on behalf of the CCAC. This tool has been utilized for academic research with a focus on estimating the current emissions of specific waste treatment technologies (Mettetal, et al., 2019; Yapo, et al., 2019), and for rapid assessment of the impacts of SWM options (Premakumara et al., 2018). The purpose of this analysis was to provide support for the development of urban waste management (UWM) policy-driven scenarios for the estimation of expected health and economic impacts.

To calculate the impacts of SWM scenarios two approaches were considered:

1. Using SWEET, estimate the change in emissions related to various policies or hypotheses (see the Annex and Kanhai et al., 2021).

2. Model different land use for some of the current landfills and dumpsites, for example, transformation into green spaces (for details see separate WHO UHI report, Land use, waste, green spaces, air pollution and health in Accra, Ghana).

The first approach is the one presented in this report.

The analysis, carried out using the Excel-based SWEET, made use of routinely generated planning and administrative data as well as published data obtained from the SWM sector to estimate SLCPs associated with waste management activities. The SWEET software was developed by US EPA to support the CCAC initiative to evaluate the impact of SWM sector policies on SLCPs including some urban air pollutants. Data were analysed through the development of scenarios for the SWM sector of Accra, which were informed by existing and planned sector policies, current waste disposal technologies and capacity, and are built in accordance with the Phase Model of Waste Management Development (PMWMD) by Klampfl-Pernold et al. (2010).

1 SWEET is available at: https://ccacoalition.org/en/resources/solid-waste-emissions-estimation-tool-sweet-version-31 16 SOLID WASTE MANAGEMENT AND HEALTH IN ACCRA, GHANA

Three alternative scenarios were created:

• Scenario 1: cease open burning;

• Scenario 2: increase composting and recycling

• Scenario 3: capture landfill gas.

These were then compared with a business-as-usual (BAU) scenario. In the BAU scenario, a 2% annual increase in waste collection capacity is assumed, thereby balancing expected population growth and keeping the technology and capacity used in 2019 stable. Considering the recent past, this is in some ways a hopeful assumption, as, for example, the ACaRP, which opened in 2012, was shut down in 2014 due to a lack of political support (Zainabu, 2014) and only reopened at the beginning of 2017. No major changes or improvements in the use of technology or capacity of the waste management system are currently expected.

The first scenario models the ceasing of open burning by households and the informal sector, starting in 2021. This scenario is modelled via a two-step approach with a second reduction in burning occurring in 2025. No other factors of the waste system are changed and waste collection rates and waste treatment are as in the BAU scenario. The second scenario assumes increased composting and recycling, starting in 2023, where the composting capacity is doubled to 60 000 metric tonnes and recycling capacity is increased by 60% to about 54 000 metric tonnes. No other changes to the BAU scenario are made. In the third scenario, landfill gas capture, starting 2021, assumes all waste collected for final disposal is sent to sanitary landfills with methane gas capture. No other changes to the BAU scenario are made.

The scenarios were modelled in accordance with UWM related policy interventions, after which the impacts of SWM on air quality were estimated (considering air and climate pollutants analysed in the

SWEET tool, e.g. PM2.5, BC and CO2). The strength of this method lay in the careful review of previous research and analysis of the waste management sector in Ghana. SWEET can be considered a policy planning tool that requires less data input than the usual life cycle assessment-based tools. The waste sector has experienced a proliferation of tools, in particular, many using life cycle assessment and running scenario analyses to identify the best waste management options (DEFRA, 2004; Allesch & Brunner, 2014). AirQ+, the software developed by WHO to quantify the impacts of air pollution, was used to model the health outcomes of the various scenarios.1

3.2 Health impact assessment

A methodology based on the intake fraction (for details, see the Annex and Kanhai et al., 2021) was applied to assess the impact of the current situation and of the scenarios. After the estimation of concentrations, the assessment of the health impacts was carried out using the AirQ+ software. The first step was to produce estimates of the concentrations that are related to the different scenarios (for details, see the Annex).

1 For more details on AirQ+ see: https://www.euro.who.int/en/health-topics/environment-and-health/air-quality/activities/airq-software-tool-for-health- risk-assessment-of-air-pollution 17

4. RESULTS

4.1 Emission scenarios

The resident population within and outside the formal collection zones is estimated to be 1 362 000 and 908 000 persons respectively. In terms of waste collection characteristics, the per capita generation rates were 0.74 kg/person/day, with an estimated projected annual growth rate in quantity of waste collected of 2%. The generation rates of waste collected within and outside the formal collection zones were 67% (calculation based on Ghana Statistical Service, 2019) and 40% (conservative estimate) respectively. In the formal collection zones, 246 477 tonnes of the 367 876 tonnes generated by the population were collected.

Fig. 4.1 shows the total emissions in carbon dioxide equivalent (CO2eq) in Accra starting 2020. In the BAU scenario, the main climate forcing emissions are related to waste processing through uncontrolled waste burning and landfill gas emissions.

Fig. 4.1 450 000 BAU all climate forcing 400 000 emissions (BC, CH4, CO2, NOx organic carbon) by 350 000

source eq

2 300 000

Waste burning 250 000 Landfills Organics management; 200 000 waste collection and transport; waste handling 150 000 Metric tonnes CO equipment 100 000

50 000

0 2020 2023 2026 2029 2032 2035 2038 2041 2044 2047 2050

Waste burning generated emissions of 195 086 metric tonnes CO2eq in 2020. Emissions are expected to rise to 385 919 metric tonnes CO2eq by 2050. The next largest contribution comes from landfills, with emissions of 36 020 metric tonnes CO2eq in 2020 and 246 941 metric tonnes CO2eq in 2050. Waste collection and transport, followed by waste handling equipment and organics management, have comparatively low emissions; collectively, these activities contribute 22 002 metric tonnes CO2eq in 2020 and 43 524 metric tonnes CO2eq in 2050. This leads to the conclusion that to reduce the BAU emissions the challenges of open waste burning and unsanitary dumps in Ghana should be addressed. 18 SOLID WASTE MANAGEMENT AND HEALTH IN ACCRA, GHANA

The emissions of the alternative scenarios are depicted in Fig. 4.2, which shows the projected results of efforts made in ceasing open burning; increased composting and recycling; and upgrading dumps and landfills to sanitary landfills with landfill gas capture. All scenarios start with emissions of

253 109 tonnes of CO2eq in 2020. Ceasing open burning leads to emissions of 190 455 metric tonnes

CO2eq in 2030 and 336 188 in 2050. This is a reduction of 50% relative to the BAU scenario in 2050. The

capture landfill gas scenario emits 333 811 metric tonnes CO2eq in 2030 and 546 026 metric tonnes

CO2eq in 2050. This is a reduction of 18% compared with BAU in 2030 and 19% in 2050. Increasing recycling and composting only has a small effect when compared with projected BAU emissions.

Fig. 4.2 800 000 Total emissions by scenario 700 000 (including BC, CH4, CO2, NOx organic carbon) 600 000 eq 2 BAU 500 000 Cease open burning Increase composting 400 000 and recycling Landfill gas capture 300 000 Metric tonnes CO 200 000

100 000

0 2020 2022 2024 2026 2028 2030 2032 2034 2036 2038 2040 2042 2044 2046 2048 2050

Apart from being the main source of climate forcing emissions, waste burning is also the main contributor of BC emissions to the air in Accra. In 2020, 67 517 metric tonnes of BC were emitted in BAU, whereas this figure doubles by 2050, reaching 133 561 metric tonnes (Fig. 4.3). By comparison, emissions of BC from the other waste management activities is relatively small.

Fig. 4.3 160 000 Baseline black carbon emissions by source over 140 000 time 120 000 eq Waste collection and transport 2 100 000 Waste burning Landfills 80 000 Organics management Waste handling equipment 60 000 Metric tonnes CO 40 000

20 000

0 2020 2022 2024 2026 2028 2030 2032 2034 2036 2038 2040 2042 2044 2046 2048 2050 19

Fig. 4.4 shows the evolution of PM2.5 emissions over time. Clearly, the cease open burning scenario is superior to the other options. By 2050, PM2.5 emissions will have been reduced by 99% relative to BAU. On the other hand, particulate emissions for the other alternatives are aligned with the BAU scenario.

Fig. 4.4 2500

PM2.5 emissions by scenario over time 2000 eq BAU 2 1500 Cease open burning Increase composting and recycling Landfill gas capture 1000 Metric tonnes CO

500

0 2020 2022 2024 2026 2028 2030 2032 2034 2036 2038 2040 2042 2044 2046 2048 2050

Note: *The BAU, increase composting and recycling, and landfill gas capture alternatives mostly overlap.

Methane (CH4) emissions are reduced most in the landfill gas capture scenario, with a reduction of 40% compared with the BAU in 2050 (Fig. 4.5) followed by the scenario of increasing recycling and composting with only 18% reduction in the same timeframe.

Fig. 4.5 300 000

Scenario comparison of CH4 emissions over time 250 000 eq

2 200 000 BAU Cease open burning Increase composting and 150 000 recycling Landfill gas capture 100 000 Metric tonnes CO

50 000

0 2020 2022 2024 2026 2028 2030 2032 2034 2036 2038 2040 2042 2044 2046 2048 2050 20 SOLID WASTE MANAGEMENT AND HEALTH IN ACCRA, GHANA

4.2 Modelling emissions and concentration values for health impact assessment

Table 4.1 shows the PM2.5 emissions and contribution to ambient air concentration for BAU and the

various alternative scenarios. Considering the cease open burning option, the PM2.5 value reduces from 3.24 µg/m3 to 0.19 µg/m3.

3 Table 4.1 Estimated PM2.5 concentrations (µg/m ), 2030

3 Scenario PM2.5 emissions (tonnes/year) PM2.5 concentration (µg/m ) BAU 1432 3.24 Cease open burning 86 0.19 Increase composting and recycling 1435 3.25 Landfill gas capture 1431 3.24

The health impacts of air pollution in Accra due to solid waste have been estimated via a reduction in the levels of air pollution against current levels for: BAU; Scenario 1: cease open burning; Scenario 2: increase composting and recycling; and Scenario 3: landfill gas capture. This means, for example,

to decrease current average levels of PM2.5 by the levels modelled from the emission scenarios (Table 4.1), we modelled a reduction of the average 49.47 µg/m3 concentration value adjusted for the value of the concentration for each scenario. The hypothesis is that only the waste source will affect the levels of air pollution. Additionally, we have taken a fixed mortality rate (non-accidental causes for adults over 25 years old) of 550 deaths per 100 000 population to run the assessment of the various scenarios (Tables 4.2 and 4.3). We have modelled a reduction of the average concentration value for a total population of 2 071 211 in 2015 (projected from the 2010 census population of 1 848 614) in 2030,1 but only adults (age 25+) were considered (approximately 50% of the whole population).

Table 4.2 PM2.5 – health impacts (mortality) for the different scenarios

Central Lower Upper

PM2.5 Scenario: BAU 2030 Estimated attributable proportion (%) 1.60 1.10 2.00 Estimated number of attributable cases 127 90 157

PM2.5 Scenario 1: cease open burning Estimated attributable proportion (%) 0.1 0.1 0.1 Estimated number of attributable cases 7 5 9

PM2.5 Scenario 2: increase composting and recycling Estimated attributable proportion (%) 1.60 1.10 2.00 Estimated number of attributable cases 128 90 157

PM2.5 Scenario 3: landfill gas capture Estimated attributable proportion (%) 1.60 1.10 2.00 Estimated number of attributable cases 127 90 157

Note: The lower and upper values correspond to the 95% confidence interval of the health impact.

1 We assume the total population in 2030 (i.e. 2 913 124, of which 50% are 25 years and older). 21

The share of total (non-accidental) deaths (the estimated attributable proportion) of between 1.1% and 2.0%, and consequently of premature deaths (estimated number of attributable cases) of between 90 and 157, in the adult population, is significant for the BAU and Scenario 2 (Table 4.2).

Table 4.3 PM2.5 – summarized health impacts (reduction in mortality) for the different scenarios, 2030

Attributable cases Scenario Cease open burning Increase composting and recycling Landfill gas capture 2030 120 (85–148) 3 (2–3) 119 (84–147)

These results for urban Accra are to be considered as an underestimation of the occurring burden on health as they show the health gains when considering only mortality (Tables 4.2 and 4.3). In particular, there will be a reduction of 120 premature deaths in 2030 compared with the BAU if Scenario 1, with its ambitious but achievable target of ceasing open burning, is implemented by 2030 and there are no changes in the other polluting sectors. Other scenarios are relevant for the environment, but are not significant in terms of health effects due to reductions in air pollutants. 22 SOLID WASTE MANAGEMENT AND HEALTH IN ACCRA, GHANA

5. DISCUSSION

5.1 Emission scenarios

The appreciable increase in emissions in the BAU scenario clearly highlights the urgency to act regarding waste management developments in Accra over the coming years. In fact, emissions will grow disproportionally fast compared with population increase, exacerbating population health risks.

The strong decrease in overall emissions and associated climate impact in the landfill gas capture scenario is due to methane emissions from landfill sites and wastewater accounting for about 90% of the waste sector’s emissions (Friedrich & Trois, 2011). As limited new technology needs to be introduced at sanitary landfills and no societal change is needed, it is likely that this scenario could be implemented by 2030. As the majority of final disposal sites for waste in Accra are dumpsites (often uncontrolled) infrastructure investments would be required in order to upgrade dumpsites or build new landfills. In any case, it should be considered that landfills and waste incineration have consequences for the environment and health and are not the best options for SWM.

The importance of the three alternative scenarios should be evaluated based on the likelihood of their implementation, their alignment to the PMWMD and the emissions generated. Based on these criteria, the cease open burning alternative has the lowest overall climate forcing effect, and it is the scenario recommended for implementation. While it can be achieved by 2030, it will be a stretch for the implementers due to the need to significantly increase collection capacity and to improve regulatory enforcement. While the landfill gas capture scenario has lower methane emissions, it would require large infrastructure investments, building new sanitary landfill capacity, and guaranteeing robust regulatory enforcement to ensure that all collected waste is diverted to sanitary landfills. However, a quick solution to be considered is the activation of the landfill gas capture for the landfills that already have the necessary technology installed, such as Tema Kpone landfill. Finally, the increase composting and recycling scenario would likely be preferred by society, but needs significant investments in capital, skilled labour, planning capacity and societal participation in waste separation.

An underlying challenge to implementing any of the scenarios is the need to increase waste collection, improve household health awareness and promote adequate participation in waste management. Strategies to increase collection capacity differ by low-, middle- and high-income areas in Accra (Boateng et al., 2016; Kanhai et al., 2019; Alhassan et al., 2020).

5.2 Health impact assessment: limitations

Several limitations have to be taken into consideration in this analysis of the impacts of SWM in Accra. The main limitation lies in the limited input data availability. It is challenging to obtain data related to specific years, and most of the data are extracted from the results of surveys or published reports that were generated for different purposes. Official statistical surveys on waste do not provide information on whether the waste was collected by the formal or informal sector. This poses a challenge as part 23

of the waste that is collected by the informal sector is also burned. It is therefore likely that the waste burning rate is higher than that reported in the 2010 census.

The emission factors built into the SWEET are based on the Intergovernmental Panel on Climate Change (IPCC) waste analysis methodology, while factors related to mobile (vehicle) emissions reflect the United States situation. These data and other assumptions should be carefully reviewed in the context of Ghana. For example, transportation fuel quality and real-world vehicle emission standards are lower in Ghana than in the United States. Further, the tool does not calculate the emissions from decaying indiscriminately dumped waste, an important source contribution in Ghana. Thus, the overall modelled emissions and, therefore, the associated health impacts should be regarded as conservative estimates. In any case, an important advantage of using SWEET is that it allows the user to enter data that reflect local circumstances. The output of the tool then allows characterization of the climate burden and air quality impact on public health due to the different waste management strategies.

The HIA has some limits due to the lack of data for cause-specific mortality and hospitalization at high spatial resolution that could have allowed a more precise analysis of the exposure of people living in the various areas of the city. Nevertheless, our estimates can provide an idea of the relevance of the health impacts of the emissions generated by the waste system. An all-inclusive HIA considering all the health risks, not just limited to PM2.5, is needed to fully understand the health risks from waste management. Waste is not the largest source of PM emissions and, for this reason, it is important to also consider the modelling of health impacts from other sources such as household air pollution and transportation. In fact, additional research should also identify different levels of exposure to

PM2.5 within the population of Accra and provide advice on reducing exposure by population group. The analysis could be improved by estimating the population exposure at a fine grid resolution (e.g. square km grid).

5.3 Policy interventions: suggestions and actions

The contribution of waste management to air pollution in Accra has to be taken into account to curb emissions (Amegah & Agyei-Mensah, 2017). In 2016, the SWM sector contributed 8% of GHG emissions in Ghana (EPA-Ghana, 2019, p. 261). Disposal of solid waste and wastewater handling were the main sources of these emissions (UNEP, 2013: 15). We know that waste management activities, if not properly executed, can contribute to increases in the concentration of air pollution, for example, levels of PM are affected by the burning of waste or activities related to the e-waste sites (Gangwar et al., 2019). Participation of the local population in improving the situation could pave the road to successful solutions, for example, on sorting waste for recycling activities, composting or diverting a significant proportion of solid waste from inefficient disposal by redirecting the organic fraction into urban cultivation (Asomani-Boateng, 2007; Fobil et al., 2010). Policies and actions to be suggested and recommended reflect, in general terms, the arguments and advantages of shifting toward sustainable solutions and circular economy answers (Tisserant et al., 2017).

Suggested policy interventions:

• Build political will and commitment to include health and well-being issues in SWM by considering HIA. 24 SOLID WASTE MANAGEMENT AND HEALTH IN ACCRA, GHANA

• Encourage the decrease of waste production (restrict the import of waste from developed countries and limit the use of plastic).

• Create and/or enforce regulatory frameworks on waste burning and indiscriminate dumping.

• Support waste prevention and communal recycling initiatives.

• Encourage public participation in environmental management issues.

• Regulate urban land use, land ownership and improve urban planning.

• Increase population data collection to guide local and national planning.

• Consider extended producer responsibility.

Suggested actions:

• Increase waste collection and waste treatment.

• Facilitate the separation and collection of waste.

• Improve waste treatment infrastructure.

• Increase equipment and operational funds to support waste management activities.

• Collect reliable waste generation data to assist with planning of waste management programmes.

The big challenge is not only to take a clear direction in terms of circular economy but also to design local, context-specific approaches and interventions that allow long-term development and implementation of “sustainable” SWM. Accra and Ghana have a lot to gain if a sustainable path for SWM is followed (Abalo et al., 2018) and this can be done also considering the enormous knowledge available from the experience of interventions done in other countries (Ezeah & Roberts, 2012; Wilson et al., 2012). 25

6. CONCLUSION

“A healthy city must have a planned programme for effective collection and proper handling and disposal of solid waste so as to create a safe and pleasant urban environment.” (WHO Regional Office for Europe, 1991: 15).

The importance of the analysis presented here for Accra goes obviously beyond Ghana; various issues are similar to other African countries (Babayemi & Dauda, 2009; Okot-Okumu, 2012), but several aspects are global issues. For example, open burning is a global problem affecting many countries (Wiedinmyer et al., 2014; Nagpure et al., 2015; Wang et al., 2017; Das et al., 2018). Despite ranking among the cities globally that produce the lowest quantity of waste per capita, Accra suffers a SWM system that is inadequate for the needs of the population and is a source of environmental stress. The waste sector clearly reveals the interconnection between air pollution and climate change issues. Accra produces approximately 2200 metric tonnes of solid waste daily, and that is expected to double by 2030. According to the latest census data, the majority of households in the Greater Accra Region (65.4%) have their solid waste collected, while about 17.4% is disposed through public dumping, and 14.6% of households burn all of their waste. Burning uncollected solid waste is still done in some neighbourhoods. Although the volume of waste produced is low compared with other cities, SWM is an important environmental and health issue. The modelling of different scenarios for Accra provide some indications of the adverse environmental and health consequences of inadequate handling of the city’s waste. Air pollution contributes to mortality through the development and exacerbation of underlying chronic disease.

The conclusion is organized into two subsections: the first includes general and specific suggestions on SWM improvements; the second provides a discussion on the estimated health impacts from air pollution related to SWM and the 2030 projections from the various scenarios.

6.1 Suggestions for solid waste management improvements

There are several co-benefits of greening the waste sector. Promoting more sustainable practices in waste management offers an opportunity to develop more inclusive health and occupational policies concerning precarious workers, including children, women and older adults engaged in waste collection and recycling. This can play an important role in reducing inequity and promoting a transition toward an economy respectful of the health and well-being of the whole population.

Policy strategy issues:

• The Accra municipality needs to respond to the daily production of solid waste, implementing sustainable solutions.

• Adequate monitoring and enforcement of the SWM system are needed. 26 SOLID WASTE MANAGEMENT AND HEALTH IN ACCRA, GHANA

• There are various gaps, constraints and issues, including social, cultural and political differences that are important to consider in order to implement an integrated SWM system.

• There is the need for an articulated communication plan that takes into account socioeconomic status and gender differences and promotes participation of the population in sustainable solutions.

• The relatively low generation of waste should be controlled and increases in waste production should not be allowed.

• Waste management options, such as recycling, composting, incineration and landfill, impact health and well-being in various ways, particularly for people who work directly with the waste or live near waste sites.

• Strengthening the capacity of the waste sector can have a positive impact on health.

6.2 Health impacts – scenario projections

This analysis identified gaps in data collection, provided the knowledge and tools necessary to build supportive arguments for the reduction of SLCPs by highlighting the health co-benefits of sustainable SWM practices, and presented the impacts of not taking actions to change current trends. The UHI project provided the evidence of the economic and health co-benefits that can be achieved through the reduction of SLCPs at city level by using and adapting an existing set of tools and good practice guidance provided by WHO, customized to local requirements.

The three scenarios modelled – ceasing waste burning; expanding composting and recycling; landfill gas capture – were found to reduce emissions of GHGs and SLCPs compared with the BAU scenario. Additionally, ceasing open burning and landfill gas capture are effective ways of reducing climate forcing pollutants.

The emissions from the different scenarios allow the health impacts to be estimated:

• Considering Scenario 1: ceasing open burning – in 2030 the PM2.5 average concentration value are expected to reduce from 3.2 µg/m3 to 0.2 µg/m3 – for a large population this change produces relevant health and well-being benefits.

• Health benefits – for example, a reduction of 120 premature deaths in 2030 compared with the BAU scenario may be achieved under Scenario 1: ceasing open burning.

Waste is not the largest source of PM pollution, but its proper management can lead to health benefits. Reducing emissions from other sectors is also an important priority in improving air quality. 27

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ANNEX

Solid Waste Emissions Estimation Tool (SWEET)

The SWEET was used in this study for estimating and quantifying SLCPs released during all waste management processes. In 2012, the CCAC, in collaboration with six countries including Ghana and UNEP, created SWEET with the aim to reduce the emission of SLCPs into the atmosphere and improve public health. SWEET was developed by Abt Associates and SCS Engineers on behalf of the United States Environmental Protection Agency (US EPA) and CCAC. The tool was created utilizing the concept of life cycle assessment – a methodological approach for quantifying GHG/SLCP emissions, while taking all phases of the waste life cycle, such as transportation, operation (pre-processing, treatment) and disposal into account. SWEET supports comparison of the level of emissions related to different waste management practices (CCAC, 2016).

SWEET is an Excel-based tool that assists users to quantify emissions of BC, CH4, CO 2, NOx, PM2.5, PM 10, and other atmospheric pollutants. It uses information from US EPA studies and guidelines, peer- reviewed studies and other credible sources. Emissions calculations are based on established and accepted methods, including IPCC guidelines and tools developed by US EPA and the Global Methane Initiative.

SWEET requires detailed information for quantifying emissions, including waste generation and collection rates, waste flow to different outcome categories (composting, anaerobic digestion, waste combustion, recycling), different composition of waste targeted for diversion from disposal, and landfill and dumpsite features. Emissions are presented in terms of metric tonnes of CO2eq. Estimates for each individual source are then presented in tables or graphs for the entire waste sector.

Underlying SWEET equation for landfill methane generation (US EPA, 2005)

Where: 3 QCH4 = maximum expected methane generation flow rate (m /yr) i = 1 year time increment n = (year of the calculation) – (initial year of waste acceptance) k = methane generation rate (1/yr) 3 L0= potential methane generation capacity (m /Mg) Mi = mass of solid waste disposed in the ith year (Mg) ti = age of the waste mass Mi disposed in the ith year MCF = methane correction factor 34 SOLID WASTE MANAGEMENT AND HEALTH IN ACCRA, GHANA

The error check box in SWEET gave an alert whenever data were wrongly entered, or data were missing. This acted as a self-validation and quality check/assurance during the data entry process. This also ensured that all data points needed for the estimation of SLCP emissions were correctly entered. When all data had been correctly entered, the cell colour appeared grey with a “NO” inscription. However, when there were any missing data or incorrect inputs, the alert box showed red and read “YES”. Terms and units of collection used at the time of data collection were carefully scrutinized to ensure the suitability of the data.

SWEET input data

Table A1.1 Modelled data

Feature Figure Population in formal collection zones 1 362 000 Population outside formal collection zones 906 000 Tota population 2 268 000 Per capita waste generation rate 0.74 kg/capita/day Average annual % growth rate in quantity of waste collected (historical) 2.3% Average annual % growth rate in quantity of waste collected (projected future) 2.3% Percentage of waste generated inside formal collection zones that is collected 67% Percentage of waste generated outside formal collection zones that is collected 40% Total waste collected annually inside formal collection zones 246 477 metric tonnes Total waste generated annually inside formal collection zones 367 876 metric tonnes

Source: Based on Miezah et al. (2015); Ghana Statistical Service (2014; 2019).

Exposure calculations – incremental change in PM2.5 ambient air concentration due to waste treatment emissions, 2019–2030

The incremental change in the annual PM2.5 ambient air urban concentration due to emissions from waste treatment for 2019–2030 was calculated using two methodological approaches. The first method is based on the population inhalation dose as determined using the mass intake fraction with input information specific to the city of Accra from Apte et al. (2012). In the second approach, the concentration increase was estimated using the Robust Uniform World Model (RUWM) methodology

presented in Rabl et al. (2014). The results shown here are average incremental changes in the PM2.5 concentrations at the city level.

Incremental PM2.5 exposure estimates based on the intake fraction approach

The intake fraction is the proportion of the pollutant mass emitted to ambient air which then enters

the human body via the inhalation pathway. The PM2.5 concentration and intake fraction are related through the following relationship:

(1) 35

Where:

iF is the intake fraction, ∆CPM2.5 is the increase in the annual PM2.5 mean urban concentration, QPM2.5

is the PM2.5 annual emission rate, Pop is the urban population size (2.268 million in 2019), and MB is

the population-weighted mean breathing rate. For this study, MB was calculated using the long- term exposure values for the inhalation rate by age group in males and females as recommended 3 by the US EPA (US EPA, 2011). The value for MB is 14.6 m /day per person. iF is calculated using (2):

(2)

Where: LPD is the linear population density (exposed population divided by the square root of the urban footprint, that is, Pop / √A) in units persons per metre, DR is the pollutant dilution rate in m2/s (1550 m2/s for Accra, according to Apte et al., 2012), and A is the urban expansion in km2 (226 km2 for Accra). The value of iF is expressed in parts per million (ppm). The exponents for the variables shown in (2) were calculated using a regression analysis considering only input data for cities in Ghana obtained from the world city database published by Apte et al. (2012).

The annual change in the PM2.5 urban concentration for the city of Accra due to waste-related emissions for 2019 and in future years up to 2030 are summarized in Table A1.2 and Fig. A1.1 for the BAU scenario and for the three alternative scenarios considered in this study. A constant annual population growth rate is assumed between the years 2020 to 2030 of 2.3% per annum. PM2.5 emission rates in Table A1.2 are the output results from the SWEET model.

Table A1.2 Incremental change in the annual PM2.5 concentrations for Accra (intake fraction approach)

BAU Cease open burning Landfill with Increase composting gas capture and recycling Year Persons LPD iF QPM2.5 ∆CPM2.5 QPM2.5 ∆CPM2.5 QPM2.5 ∆CPM2.5 QPM2.5 ∆CPM2.5 millions pers/m ppm tonnes μg/m3 tonnes μg/m3 tonnes μg/m3 tonnes μg/m3 2019 2.268 151 15.0 1141 1.41 1141 1.41 1131 1.40 1141 1.41 2020 2.321 154 15.4 1167 1.45 911 1.13 475 0.59 1167 1.45 2021 2.374 158 15.7 1194 1.48 935 1.16 486 0.60 1194 1.48 2022 2.429 162 16.1 1221 1.52 956 1.19 497 0.62 1221 1.52 2023 2.484 165 16.5 1249 1.56 978 1.22 508 0.63 1252 1.56 2024 2.542 169 16.9 1278 1.59 1000 1.25 520 0.65 1281 1.60 2025 2.600 173 17.3 1307 1.63 86 0.11 82 0.10 1310 1.64 2026 2.660 177 17.7 1337 1.67 86 0.11 84 0.11 1340 1.67 2027 2.721 181 18.2 1368 1.71 87 0.11 86 0.11 1371 1.72 2028 2.784 185 18.6 1400 1.75 87 0.11 88 0.11 1403 1.76 2029 2.848 189 19.1 1432 1.79 87 0.11 90 0.11 1435 1.80 2030 2.913 194 19.5 1465 1.84 88 0.11 92 0.12 1468 1.84 36 SOLID WASTE MANAGEMENT AND HEALTH IN ACCRA, GHANA

Fig. A1.1 3.5 3 PM2.5 incremental change in the annual ambient air 3.0 concentration for Accra according to the intake 2.5 fraction method 2.0 BAU Cease open burning

Increase composting and urban concentration, μg/m 1.5 recycling 2.5 Landfill with LFG capture 1.0

0.5 Incremental PM 0 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030

Incremental PM2.5 exposure estimates based on the Robust Uniform World Model (RUWM)

In the RUWM (Rabl et al., 2014), the incremental change in the PM2.5 city-level concentration attributable to emissions from the waste treatment sector is calculated with (3):

(3)

Where:

kdep is the depletion velocity (m/s), a characteristic speed that accounts for atmospheric pollutant removal due to dry and wet deposition mechanisms. In the case of the city of Accra, the value for

kdep is 0.0059 m/s. σ is a constant in the range of 2 to 4, a value of 3 is assumed in this analysis. The values for the remaining parameters in (3) are the same as used for the intake fraction analysis 2 2 (A = 226 km and DR = 1550 m /s). The waste treatment emission rates QPM_2.5 for the various

scenarios have already been presented in Table A1.2. Once the incremental concentration ∆CPM2.5 is obtained, the intake fraction (iF) is computed using (1).

Table A1.3 shows the incremental changes in the annual PM2.5 city-level concentration for Accra based on the RUWM approach. These data are also shown graphically in Fig. A1.2. Compared with

the intake fraction method, the RUWM estimates for ∆CPM2.5 and iF are 1.8 times larger. 37

Table A1.3 Incremental change in the annual PM2.5 concentration for Accra (RUWM results)

BAU Cease open burning Landfill with Increase composting gas capture and recycling

Year Persons LPD iF QPM2.5 ∆CPM2.5 QPM2.5 ∆CPM2.5 QPM2.5 ∆CPM2.5 QPM2.5 ∆CPM2.5 millions pers/m ppm tonnes μg/m3 tonnes μg/m3 tonnes μg/m3 tonnes μg/m3 2019 2.268 151 27.4 1141 2.59 1141 2.59 1131 2.56 1141 2.59 2020 2.321 154 28.1 1167 2.64 911 2.06 475 1.08 1167 2.64 2021 2.374 158 28.7 1194 2.71 935 2.12 486 1.10 1194 2.71 2022 2.429 162 29.4 1221 2.77 956 2.17 497 1.13 1221 2.77 2023 2.484 165 30.1 1249 2.83 978 2.22 508 1.15 1252 2.84 2024 2.542 169 30.7 1278 2.90 1000 2.27 520 1.18 1281 2.90 2025 2.600 173 31.5 1307 2.96 86 0.20 82 0.19 1310 2.97 2026 2.660 177 32.2 1337 3.03 86 0.20 84 0.19 1340 3.04 2027 2.721 181 32.9 1368 3.10 87 0.20 86 0.20 1371 3.11 2028 2.784 185 33.7 1400 3.17 87 0.20 88 0.20 1403 3.18 2029 2.848 189 34.4 1432 3.25 87 0.20 90 0.20 1435 3.25 2030 2.913 194 35.2 1465 3.32 88 0.20 92 0.21 1468 3.33

Fig. A1.2 3.5 3 PM2.5 incremental change in the annual ambient air 3.0 concentration for Accra according to the RUWM 2.5 methodology 2.0 BAU Cease open burning

Increase composting and urban concentration, μg/m 1.5 recycling 2.5 Landfill with LFG capture 1.0

0.5 Incremental PM 0 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 Department of Environment,­­ Climate Change and Health (ECH) Division of Universal Health Coverage / Healthier Populations World Health Organization

Contact: [email protected]

Further information: www.who.int/urbanhealthinitiative