Process Evaluation of Greater Accra Sustainable Sanitation and Livelihoods Improvement Project (2017-2026), The Case of Adenta Municipality

Abstract

Introduction: Over the past decade, Ghana’s urban basic sanitation coverage rose from 21% in 2010 to 27% in 2016. However, these gains remain marginal to achieving access to adequate and equitable sanitation and hygiene for all by 2030. Launched in 2017, the Greater Accra Sustainable Sanitation and Livelihoods Improvement Project (GASSLIP) sought to accelerate access to sustainable sanitation infrastructure and services in the region. Objective: To conduct a process evaluation of the implementation of the sanitation component of the Greater Accra Sustainable Sanitation and Livelihoods Improvement Project (GASSLIP) in the Adenta Municipality. Methods: Guided by the Reach and Implementation dimensions of the RE-AIM framework, this cross-sectional mixed-methods evaluation solicited data from households in Adenta and staff of Adenta Municipal Assembly (AdMA). Structured questionnaires and checklists collected quantitative data on coverage, reasons for participation, characteristics of participants, and delivery protocol adherence. Key informant interviews with AdMA staff explored qualitative data on implementation experiences including adaptations, barriers and facilitators. Quantitative data was analyzed in STATA 15 and Microsoft Excel 2021, using descriptive statistics, Fishers exact test and multiple logistic regression model. Qualitative data was coded and thematically analysed using NVivo 11. Results: Eighty-five percent (85%) of participants benefited from GASSLIP with 82% receiving biodigesters, 11.7% pit latrines, 4.3% handwashing facilities and 24.6% receiving behavioural change education. Convenience and ease of access was a prominent reason (88.9%) for participation. Multivariable logistic regression identified age, education, occupation, income, and household ownership as significant socio-economic characteristics associated with beneficiary status. Delivery protocol adherence was high (96%). Implementation experiences included enhanced training, expanded eligibility, adjusted outreach timing, increased construction targets, strong local collaboration, and technical partner support with funding constraints being a main barrier. Conclusion: While GASSLIP achieved high infrastructure coverage and institutional adherence to delivery protocols, its extension into sustainable sanitation practices is limited by low coverage of behaviour-change activities and equity gaps. Strengthening community outreach, tailoring mobilisation strategies, and establishing sanitation-infrastructure loan mechanisms are essential to expanding implementation gains.