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™ Iiiiin Iu Iliii University of Ghana http://ugspace.ug.edu.gh ,7 A 4 '4 0 . i <-.3 The Batme Library ™ iiiiiniuiliii THESES ROOM 3 0^92 1078 5986 8 G354309 University of Ghana http://ugspace.ug.edu.gh T H E ROLE OF VOLTA RURAL WATER SUPPLY AND SANITATION PROJECT IN PROMOTING HEALTH AND HYGIENE EDUCATION IN THE RURAL AREAS OF THE VOLTA REGION by Douglas Etse Titiati A Dissertation submitted to the Institute of Adult Education, University of Ghana in partial fulfilment of the requirements of the Degree of Master of Arts in Adult Education MAY, 1997 University of Ghana http://ugspace.ug.edu.gh DECLARATION It is hereby declared that the work herein described was carried out solely by me under supervision, and has neither wholly or partially been presented elsewhere for another degree. (DOUGLAS E. TITIATI) CANDIDATE MR. L. DORVLO SUPERVISOR .r (m r . k o f i sp& b i -m e n s a h ; SUPERVISOR University of Ghana http://ugspace.ug.edu.gh D E D ICATION This dissertation is dedicated to the memory of my brother, the late Frederick Besah Titiati, who could not live to see the fruit of his moral and material support. May his soul rest in peace. ii University of Ghana http://ugspace.ug.edu.gh ACKNOWLEDGEMENT I owe a debt of gratitude to the following individuals and organisation for helping me in diverse ways in the collection of data for this dissertation as well as the final write up. My first 'thanks' goes to my two resourceful supervisors, Messrs. L.T.K. Dorvlo and Kofi Siabi-Mensah, for their patience, guidance and constructive criticism, without which this work would never have been produced. I am also grateful to the Management and staff of the Volta Rural Water Supply and Sanitation project for accepting me into their fold and giving me access to every single material or verbal information that I needed, during the data gathering stage of this dissertation. I would also not forget Miss Grace B. Annan of the Department of Economics, University of Ghana, who diligently typed this manuscript from the draft stage to the final print out. Finally, but not the least, I thank the Almighty God, for giving me the strength and wisdom to carry out this task. University of Ghana http://ugspace.ug.edu.gh TABLE OF CONTENTS PAGE Declaration ........................................ i Dedication ........................................ ii Acknowledgements ................................... iii Table of Contents ................................... iv List of T a b l e s ........................................ v Abstract ... ........................................ vi CHAPTER ONE Introduction ........... ... ... ............. 1 The Problem ....... ....... ... ............. 2 Theoretical Framework ................................. 4 Research Methodology ............. ... ............. 5 Setting ... ... ... ... ... ............. 7 Significance of the Study ...... ... ............. 13 Problems of the Study ...................................14 Organisation of the Study ...... ... ............. 14 CHAPTER TWO LITERATURE REVIEW The Concept of Health Education ....... ............. 16 The Role of the Health E d u c a t o r ....... ............. 18 Community Participation in Health Education Programme... 20 The Role of Women in Health Education ................. 23 Relationship Between Water Supply, Sanitation and Health Education ............................. 25 CHAPTER THREE TRADITIONAL KNOWLEDGE. ATTITUDES. BELIEFS AND PRACTICES OF THE PEOPLE OF VOLTA REGION WHICH THE HEALTH EDUCATION PROGRAMME SEEKS TO INFLUENCE Concept of H e a l t h ........................................ 34 Awareness of Health Hazards ............................. .35 Relationship Between Water and Health .................. .36 Sanitation and Health ....................................37 Knowledge of Disease Prevention .........................38 Previous Knowledge of Health Education ................. .40 Present Sources of Health Education ... ............. .41 The People's Preferences with Regards to Health Education Programme: ........................42 Conclusion ............................................. ..43 iv University of Ghana http://ugspace.ug.edu.gh CHAPTER FOUR ACTIVITIES OF VRWSS PROJECT WITH SPECIAL REFERENCE TO HEALTH AND HYGIENE EDUCATION Project Organisation ................................... 44 The Health Organisation .................................. 45 The Health and Hygiene Education Component of the P r o j e c t ...................................46 Community Health Education ............................. 47 CHAPTER FIVE ANALYSIS AND DISCUSSION OF DATA Achievements of the Health Education Programme so far... 57 Community Participation .................................. 57 Other Activities of the Project in Building Capacity for Health Education ............................. 6 5 Problems and Weaknesses Identified .................. 65 CHAPTER SIX SUMMARY OF FINDINGS. RECOMMENDATIONS AND CONCLUSION Summary ................................................. 67 Logistic and Organisational Structures Put in place to Promote Health Education ...................... 68 Training Programme for Project Staff and Volunteers for Capacity Building and Sustainability of the Programmes ....................................... 70 Health Messages Being Formulated ...................... 72 The Role of the Project in Intensifying Health Education in the Region ........................ 72 Recommendations ........................................ ..76 Conclusion ............................................. ..80 Bibliography ............................................ ..82 Appendix 1 Project Organisation .................. ..84 v University of Ghana http://ugspace.ug.edu.gh LIST OF TABLES Table 1: Population Distribution of the Volta Region According to Districts ............. 8 Table 2: Socio-Cultural Distribution of Volta Volta Region .................................. 13 Table 3: Major Causes of Morbidity: Volta Region, 1980 and 1990 ................................. 29 Table 4: Study Communities by District and Target G r o u p s ........................................ 33 Table 5: District Implementation Plan VRWSS Project: .. 44 Table 6: Statistics of Health Education Programme Implementation Status At The End of June 1996 ......................................... 60 Diagram 1:Action P l a n .................................. 48 FIG.l: Administrative Map of Volta Region ....... 11 vi University of Ghana http://ugspace.ug.edu.gh ABSTRACT The Volta Region is faced with many health hazards that are brought about by the absence of safe drinking water, sanitation facilities, and an effective health education mechanism. This study aims at finding out the contributions of the Volta Rural Water Supply and Sanitation project to the promotion of health and hygiene education in the rural areas of the region. The study found out that in the area of community health, the project has made a significant impact on the people so far as community mobilisation and participation in health and hygiene activities are concerned. Members of the communities are now able to assess their health and hygiene needs and draw action plans for the satisfaction of these needs. Besides, they implement their action plans with minimum external supervision. The school health component of the programme has also brought about positive behavioural changes in pupils with regards to hygienic practices. Some of the indicators of this change in behaviour are washing of hands with soap and water, the use of individual cups and the hygienic handling of food by food vendors who sell on school premises. In addition, the project has put in place adequate mechanism for capacity building and sustainability of the health education programme after the withdrawal of donor support. vii University of Ghana http://ugspace.ug.edu.gh CHAPTER ONE INTRODUCTION Background to the Study: The people of the Volta Region in Ghana are faced with numerous problems relating to the shortage of potable water and sanitation. According to the Annual Statistical Report of the Ministry of Health (1991), four out of the ten leading causes of hospitalisation in 1990 directly relate to water and sanitation. These are malaria, diarrhoea diseases, skin diseases and intestinal worms. Bilharzia, guinea worm and yaws are also prevalent. The situation is not very different at the national level. Against this background, and in recognition of the needs of the people, the Government of Ghana entered into development co­ operation agreement with the Government of Denmark (DANIDA) for a ten year aid package known as the Volta Rural Water Supply and Sanitation Project. It is being implemented by the Ghana Water and Sewerage Corporation and Kruger Consult, a Danish Consulting Engineering Company. 1 University of Ghana http://ugspace.ug.edu.gh The objective of the project is to contribute towards better living and health conditions of the target population in the project area through: (a) The provision of reliable and easily accessible potable drinking water, managed and sustained by the community, and (b) The reduction in water and excreta related diseases by improving sanitation and sanitation related health behaviours, through health education and household adoption of improved latrines. The project took off in March 1993, and has several components such as provision of low cost water supplies and sanitation facilities, training, community mobilisation and health education. THE PROBLEM The purpose of health education is to promote behaviours which are conducive to
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