UNIVERSITY OF GHANA ANALYSIS OF SANITATION PROMOTION STRATEGIES OF KANESHIE MARKET COMPLEX, ACCRA BY YVONNE AKOSUA ODURO (10168777) THIS THESIS/DISSERTATION IS SUBMITTED TO THE UNIVERSITY OF GHANA, LEGON IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE AWARD OF MPHIL HEALTH SERVICES MANAGEMENT DEGREE JULY, 2015 University of Ghana http://ugspace.ug.edu.gh i DECLARATION I do hereby declare that this work is the result of my own research and has not been presented by anyone for any academic award in this or any other university. All references used in the work have been fully acknowledged. I bear sole responsibility for any shortcomings. ........................................................... .................................................... YVONNE AKOSUA ODURO DATE (10168777) University of Ghana http://ugspace.ug.edu.gh ii CERTIFICATION I hereby certify that this thesis was supervised in accordance with procedures laid down by the University of Ghana. ……………………………. ……………………………. J. N. BAWOLE (PHD) DATE (SUPERVISOR) University of Ghana http://ugspace.ug.edu.gh iii DEDICATION To Anthony Yaw Oduro and Joana Hassan. You made it happen. University of Ghana http://ugspace.ug.edu.gh iv ACKNOWLEDGEMENT I thank the Almighty God for this grace. I am grateful to Dr. J. N. Bawole, my supervisor for his guidance, contribution and encouragement during the supervision of my work. I am also grateful to the Department of Public Administration and Health Services Management for their contribution towards the completion of this work. I am also indebted to the Accra Markets Ltd, the management company of Kaneshie Market Complex for granting me permission and all the assistance I needed while studying their organization. To all who helped in diverse ways, I am very grateful. University of Ghana http://ugspace.ug.edu.gh v TABLE OF CONTENTS DECLARATION.................................................................................................................i CERTIFICATION..............................................................................................................ii DEDICATION .................................................................................................................iii ACKNOWLEDGEMENT ................................................................................................iv LIST OF FIGURES ..........................................................................................................ix LIST OF ABBREVIATIONS............................................................................................x ABSTRACT ....................................................................................................................xii CHAPTER ONE ................................................................................................................1 INTRODUCTION..............................................................................................................1 1.1 Background of the study.........................................................................................1 1.2 Research Problem ...................................................................................................4 1.3 Research objective ..................................................................................................6 1.4 Research questions..................................................................................................6 1.5 Significance of the Study........................................................................................6 1.6 Scope of the study...................................................................................................7 1.7 Definition of terms..................................................................................................7 1.8 Chapter disposition ................................................................................................8 1.9 Conclusion..............................................................................................................9 CHAPTER TWO..............................................................................................................10 LITERATURE REVIEW ................................................................................................10 2.1 Introduction ..........................................................................................................10 University of Ghana http://ugspace.ug.edu.gh vi 2.2 The concept of sanitation ......................................................................................10 2.3 Urban sanitation ....................................................................................................12 2.4 Sanitation promotion strategies ............................................................................14 2.5 Ghana’s environmental sanitation situation .........................................................15 2.6 Stakeholders in sanitation promotion ...................................................................19 2.6.1 The government ........................................................................................21 2.6.2 The health sector .......................................................................................22 2.6.3 I/NGOs, community based organisations (CBOs) and civil society groups……………………………………………………....22 2.6.4 The private sector ......................................................................................23 2.7 Sanitation in markets.............................................................................................23 2.8 Dealing with sanitation in public places ...............................................................26 2.9 Conclusion ............................................................................................................34 CHAPTER THREE..........................................................................................................36 METHODOLOGY ..........................................................................................................36 3.1 Introduction ..........................................................................................................36 3.2 The research paradigm .........................................................................................36 3.3 Research design ....................................................................................................38 3.4 Sources of data .....................................................................................................39 3.5 Sampling ………………………………………..…….…………………………40 3.5.1 Population of study ...................................................................................40 3.5.2 Sample size ...............................................................................................41 3.5.3 Sampling technique ..................................................................................42 University of Ghana http://ugspace.ug.edu.gh vii 3.6 Limitations of the study .......................................................................................43 3.7 Instrumentation .....................................................................................................44 3.8 Data gathering procedure .....................................................................................44 3.9 Mode and instruments for data analysis ...............................................................45 3.10 Ethical considerations ..........................................................................................46 3.11 Conclusion ............................................................................................................47 CHAPTER FOUR..….......................................................................................................48 DATA ANALYSIS AND DISCUSSION OF FINDINGS............................................. 48 4.1 Introduction ......................................................................................................... 48 4.2 Strategies for promoting sanitation in the market ............................................... 48 4.2.1 Communication ........................................................................................ 49 4.2.2 Individual and group responsible activities .............................................. 51 4.3 Access to water and sanitation hardware ............................................................ 54 4.3.1 Water supply……..................................................................................... 55 4.3.2 Improved sanitation …………………………………….….…………… 56 4.3.3 Sanitation materials ……………………………………..………...……. 58 4.4 Providing an enabling environment ………………………….……...…………. 60 4.4.1 Cross-sector and stakeholder participation ……………….…….……… 61 4.4.2 Financing and cost recovery ………………………………,,,.………… 64 4.4.3 Prompt identification of challenges …………………………...…..…… 66 4.4.4 Conclusion ……………………………………………....……...……… 70 University of Ghana http://ugspace.ug.edu.gh viii CHAPTER FIVE …………………………………...………………………….……… 71 SUMMARY, CONCLUSION AND RECOMMEDATIONS ……….....….…………. 71 5.1 Introduction ……………………………………………............…….………… 71 5.2 Summary of major findings ……………..……………….………….………… 71 5.3 Conclusion ……………………………………………………..…….………… 74 5.4 Recommendations ………………….…………………………...….…..……… 75 REFERENCES ……………………………...…………………...………….………… 77 APPENDICES ………………………….…………………………….…….…………. 89 APPENDIX 1: Interview Guide for Officials …………………...…...……….….……. 89 APPENDIX 2: Interview Guide for Tenants …………………………...……...……… 93 APPENDIX 3: Interview Guide for Customers ………………..……...……...………. 97 University of Ghana http://ugspace.ug.edu.gh ix LIST OF FIGURES Fig. 2.1: The Hygiene Improvement Framework ……………..………………….……..… 32 Fig. 2.2: The Sanitation Promotion Framework ……………..…………....……….……… 33 Fig. 4.1: Celebrity Joselyn Dumas on cholera education tour of Kaneshie Market ….…… 50 Fig. 4.2: A well-swept section of the Kaneshie Market ……………..………....…...….…. 52 Fig. 4.3: An overflown refuse container in Kaneshie Market ……………..…...…...….…. 60 University of Ghana http://ugspace.ug.edu.gh x LIST OF ABBREVIATIONS AMA Accra Metropolitan Assembly BCC Behaviour Change Communication BOF Biodegradable Organic Fraction CBO Community-Based Organisations CHC Community Health Clubs CLTS Community-Led Total Sanitation DANIDA Danish International Development Agency EHP Environmental Health Project GNA Ghana News Agency HIF Hygiene Improvement Framework I/NGOs International/Non-Governmental Organisations LMICs Low and Middle Income Countries MCI Millennium Cities Initiative MDAs Ministries, Departments and Agencies MDGs Millennium Development Goals MFAD Ministry of Foreign Affairs, Denmark MINT Materials in Transition MLGRD Ministry of Local Government and Rural Development MMDAs Metropolitan, Municipal and District Assemblies MVP Millennium Villages Project MWRWH Ministry of Water Resources Works and Housing NESSAP National Environmental Sanitation Strategy Action Plan PHAST Participatory Hygiene and Sanitation Tran University of Ghana http://ugspace.ug.edu.gh xi SYND Strategic Youth Network Development UNDP United Nations Development Programme UNICEF United Nations Children’s Fund USAID United State Agency for International Development VERC Village Education Resource Center WASH Water, Sanitation and Hygiene WBG World Bank Group WEEE Waste Electrical Electronic Equipment WES Water and Environmental Sanitation WHO World Health Organisations WSP Water and Sanitation Program WSP Water and Sanitation Program WSSCC Water Supply and Sanitation Collaborative Council University of Ghana http://ugspace.ug.edu.gh xii ABSTRACT This study sought to investigate the sanitation promotion strategies in the Kaneshie Market Complex. It looked at actual activities, access to water and sanitation hardware and participation of stakeholders in promoting sanitation. The qualitative study design was used for the study. A total of fifty people made up of ten officials, twenty tenants and twenty customers were purposively selected to respond to a number of questions on sanitation in the market. Interview guides were therefore prepared and interviews were conducted. Responses were later grouped under main topics in line with the objectives and research questions. The study revealed mostly preventive strategies with several activities targeted at promoting sanitation in the market. The activities include sweeping, washing of floors, organization of clean-up exercises, spraying and fumigation, use of sanctions and punishments. There are also several sources of water, toilet facilities and other sanitation promotion hardware. In terms of stakeholder participation, those with responsible roles in sanitation promotion are doing quite well. However, their works are fraught with challenges in areas of staffing, financing, population growth, attitude and behavioural problems as well as power crisis. The major drawback in sanitation in the market is waste collection which is under the prerogative of the Accra Metropolitan Assembly (AMA) and inability of the service providers to meet their demand has (A become a source of worry to the management of the market. It is therefore suggested that the market expands its infrastructural base to absorb the growing population of traders in order to increase its control in sanitation. In addition, management must look at other technologies in waste management that can draw organisations who need the residues as raw materials, and also use the water and improved sanitation facilities to recover cost of sanitation promotion. University of Ghana http://ugspace.ug.edu.gh i DECLARATION I do hereby declare that this work is the result of my own research and has not been presented by anyone for any academic award in this or any other university. All references used in the work have been fully acknowledged. I bear sole responsibility for any shortcomings. ........................................................... .................................................... YVONNE AKOSUA ODURO DATE (10168777) University of Ghana http://ugspace.ug.edu.gh ii CERTIFICATION I hereby certify that this thesis was supervised in accordance with procedures laid down by the University of Ghana. ……………………………. ……………………………. J. N. BAWOLE (PHD) DATE (SUPERVISOR) University of Ghana http://ugspace.ug.edu.gh iii DEDICATION To Anthony Yaw Oduro and Joana Hassan. You made it happen. University of Ghana http://ugspace.ug.edu.gh iv ACKNOWLEDGEMENT I thank the Almighty God for this grace. I am grateful to Dr. J. N. Bawole, my supervisor for his guidance, contribution and encouragement during the supervision of my work. I am also grateful to the Department of Public Administration and Health Services Management for their contribution towards the completion of this work. I am also indebted to the Accra Markets Ltd, the management company of Kaneshie Market Complex for granting me permission and all the assistance I needed while studying their organization. To all who helped in diverse ways, I am very grateful. University of Ghana http://ugspace.ug.edu.gh v TABLE OF CONTENTS DECLARATION.................................................................................................................i CERTIFICATION..............................................................................................................ii DEDICATION .................................................................................................................iii ACKNOWLEDGEMENT ................................................................................................iv LIST OF FIGURES ..........................................................................................................ix LIST OF ABBREVIATIONS............................................................................................x ABSTRACT ....................................................................................................................xii CHAPTER ONE ................................................................................................................1 INTRODUCTION..............................................................................................................1 1.1 Background of the study.........................................................................................1 1.2 Research Problem ...................................................................................................4 1.3 Research objective ..................................................................................................6 1.4 Research questions..................................................................................................6 1.5 Significance of the Study........................................................................................6 1.6 Scope of the study...................................................................................................7 1.7 Definition of terms..................................................................................................7 1.8 Chapter disposition ................................................................................................8 1.9 Conclusion..............................................................................................................9 CHAPTER TWO................................................. .............................................................10 LITERATURE REVIEW ................................................................................................10 2.1 Introduction ..........................................................................................................10 University of Ghana http://ugspace.ug.edu.gh vi 2.2 The concept of sanitation ......................................................................................10 2.3 Urban sanitation ....................................... .............................................................12 2.4 Sanitation promotion strategies ............................................................................14 2.5 Ghana’s environmental sanitation situation .........................................................15 2.6 Stakeholders in sanitation promotion ...................................................................19 2.6.1 The government ........................................................................................21 2.6.2 The health sector .......................................................................................22 2.6.3 I/NGOs, community based organisations (CBOs) and civil society groups……………………………………………………....22 2.6.4 The private sector ......................................................................................23 2.7 Sanitation in markets.............................................................................................23 2.8 Dealing with sanitation in public places ...............................................................26 2.9 Conclusion ...................................................................................................... ......34 CHAPTER THREE..........................................................................................................36 METHODOLOGY ..........................................................................................................36 3.1 Introduction ..........................................................................................................36 3.2 The research paradigm .........................................................................................36 3.3 Research design ....................................................................................................38 3.4 Sources of data .....................................................................................................39 3.5 Sampling ………………………………………..…….…………………………40 3.5.1 Population of study ...................................................................................40 3.5.2 Sample size ...............................................................................................41 3.5.3 Sampling technique ..................................................................................42 University of Ghana http://ugspace.ug.edu.gh vii 3.6 Limitations of the study .......................................................................................43 3.7 Instrumentation .....................................................................................................44 3.8 Data gathering procedure .....................................................................................44 3.9 Mode and instruments for data analysis ...............................................................45 3.10 Ethical considerations ..........................................................................................46 3.11 Conclusion ............................................................................................................47 CHAPTER FOUR..….......................................................................................................48 DATA ANALYSIS AND DISCUSSION OF FINDINGS............................................. 48 4.1 Introduction ......................................................................................................... 48 4.2 Strategies for promoting sanitation in the market ............................................... 48 4.2.1 Communication ........................................................................................ 49 4.2.2 Individual and group responsible activities .............................................. 51 4.3 Access to water and sanitation hardware ............................................................ 54 4.3.1 Water supply……..................................................................................... 55 4.3.2 Improved sanitation …………………………………….….…………… 56 4.3.3 Sanitation materials ……………………………………..………...……. 58 4.4 Providing an enabling environment ………………………….……...…………. 60 4.4.1 Cross-sector and stakeholder participation ……………….…….……… 61 4.4.2 Financing and cost recovery ………………………………,,,.………… 64 4.4.3 Prompt identification of challenges …………………………...…..…… 66 4.4.4 Conclusion ……………………………………………....……...……… 70 University of Ghana http://ugspace.ug.edu.gh viii CHAPTER FIVE …………………………………...………………………….……… 71 SUMMARY, CONCLUSION AND RECOMMEDATIONS ……….....….…………. 71 5.1 Introduction ……………………………………………............…….………… 71 5.2 Summary of major findings ……………..……………….………….………… 71 5.3 Conclusion ……………………………………………………..…….………… 74 5.4 Recommendations ………………….…………………………...….…..……… 75 REFERENCES ……………………………...…………………...………….………… 77 APPENDICES ………………………….…………………………….…….…………. 89 APPENDIX 1: Interview Guide for Officials …………………...…...……….….……. 89 APPENDIX 2: Interview Guide for Tenants …………………………...……...……… 93 APPENDIX 3: Interview Guide for Customers ………………..……...……...………. 97 University of Ghana http://ugspace.ug.edu.gh ix LIST OF FIGURES Fig. 2.1: The Hygiene Improvement Framework ……………..………………….……..… 32 Fig. 2.2: The Sanitation Promotion Framework ……………..…………....……….……… 33 Fig. 4.1: Celebrity Joselyn Dumas on cholera education tour of Kaneshie Market ….…… 50 Fig. 4.2: A well-swept section of the Kaneshie Market ……………..………....…...….…. 52 Fig. 4.3: An overflown refuse container in Kaneshie Market ……………..…...…...….…. 60 University of Ghana http://ugspace.ug.edu.gh x LIST OF ABBREVIATIONS AMA Accra Metropolitan Assembly BCC Behaviour Change Communication BOF Biodegradable Organic Fraction CBO Community-Based Organisations CHC Community Health Clubs CLTS Community-Led Total Sanitation DANIDA Danish International Development Agency EHP Environmental Health Project GNA Ghana News Agency HIF Hygiene Improvement Framework I/NGOs International/Non-Governmental Organisations LMICs Low and Middle Income Countries MCI Millennium Cities Initiative MDAs Ministries, Departments and Agencies MDGs Millennium Development Goals MFAD Ministry of Foreign Affairs, Denmark MINT Materials in Transition MLGRD Ministry of Local Government and Rural Development MMDAs Metropolitan, Municipal and District Assemblies MVP Millennium Villages Project MWRWH Ministry of Water Resources Works and Housing NESSAP National Environmental Sanitation Strategy Action Plan PHAST Participatory Hygiene and Sanitation Tran University of Ghana http://ugspace.ug.edu.gh xi SYND Strategic Youth Network Development UNDP United Nations Development Programme UNICEF United Nations Children’s Fund USAID United State Agency for International Development VERC Village Education Resource Center WASH Water, Sanitation and Hygiene WBG World Bank Group WEEE Waste Electrical Electronic Equipment WES Water and Environmental Sanitation WHO World Health Organisations WSP Water and Sanitation Program WSP Water and Sanitation Program WSSCC Water Supply and Sanitation Collaborative Council University of Ghana http://ugspace.ug.edu.gh xii ABSTRACT This study sought to investigate the sanitation promotion strategies in the Kaneshie Market Complex. It looked at actual activities, access to water and sanitation hardware and participation of stakeholders in promoting sanitation. The qualitative study design was used for the study. A total of fifty people made up of ten officials, twenty tenants and twenty customers were purposively selected to respond to a number of questions on sanitation in the market. Interview guides were therefore prepared and interviews were conducted. Responses were later grouped under main topics in line with the objectives and research questions. The study revealed mostly preventive strategies with several activities targeted at promoting sanitation in the market. The activities include sweeping, washing of floors, organization of clean-up exercises, spraying and fumigation, use of sanctions and punishments. There are also several sources of water, toilet facilities and other sanitation promotion hardware. In terms of stakeholder participation, those with responsible roles in sanitation promotion are doing quite well. However, their works are fraught with challenges in areas of staffing, financing, population growth, attitude and behavioural problems as well as power crisis. The major drawback in sanitation in the market is waste collection which is under the prerogative of the Accra Metropolitan Assembly (AMA) and inability of the service providers to meet their demand has (A become a source of worry to the management of the market. It is therefore suggested that the market expands its infrastructural base to absorb the growing population of traders in order to increase its control in sanitation. In addition, management must look at other technologies in waste management that can draw organisations who need the residues as raw materials, and also use the water and improved sanitation facilities to recover cost of sanitation promotion. University of Ghana http://ugspace.ug.edu.gh 1 CHAPTER ONE INTRODUCTION 1.1 Backgroun d of the study Since the year 2000, the world now has a global agenda from which countries can draw knowledge and experience. Known as the Millennium Development Goals (MDGs), eight goals have been set with specific targets to help accelerate the development of many countries all over the world, especially Low and Middle Income Countries (LMICs). Of the eight goals, Goal 7 is aimed at ensuring environmental sustainability. One of the targets is to half, by 2015, the proportion of the population without sustainable access to safe drinking water and basic sanitation (WHO, 2006). 7he :+2 6anitation 3roPotion +andEooN , S. e[Slains sanitation as ³interventions to reduFe SeoSle’s e[Sosure to diseases E\ SrovidinJ a clean environment in which to live; measures to break the cycle of disease. This usually includes disposing of or hygienic management of human and animal excreta, refuse, and wastewater, the control of disease vectors and the provision of washing facilities for personal and domestic hygiene. Sanitation involves both behaviours and facilities which work together to form a hygienic environPent´. Countries are thereIore enFouraJed to inteJrate these tarJets into their development policies and programmes. According to the Millennium Development Goal Report (2013), gains in sanitation have been impressive but not good enough because poor sanitation can affect health, economic and social development. It further estimated that 70% of people in the urban areas lack access to sanitation even though urban sanitation is a priority. Water, sanitation and hygiene (WASH) are among the powerful drivers of human development as it affects quality of life University of Ghana http://ugspace.ug.edu.gh 2 at many levels, including improved health and economic status (UNICEF/WHO, 2006). µ7here is JroZinJ aZareness aPonJ SuEliF health SraFtitioners that, until SroSer h\Jiene is consistently practiced, both at home and in the community as a whole, the desired impact of improved water and sanitation infrastructure in terms of community health benefits cannot Ee reali]ed´ :$6+ %CC,  . ,t is estiPated that aEout . Pillion Fhildren lose their lives through diarrhea diseases that could have been simply prevented by good sanitation (UNICEF/WHO, 2009). However, effective hygiene and sanitation promotion is a major challenge for many low-income countries (Rheinlander, Samuelson, Dalsgaard & Konradsen, 2010). The World Bank Group (2008) estimates annual economic losses to the tune of $260 billion in developing countries due to po or sanitation and water supply. :hen sanitation iPSroves, SeoSle’s livelihood and health or Zell-being will become better thereby enhancing economic productivity of the masses (Kumie & Ali, 2005). It is therefore important that sanitation is treated as a major sector which encourages research, innovation and development as well as professionalism (Patanayak, Poulos, Yang & Patil, 2009). There is also the need for the development of strategies that can improve the sanitation delivery systems which in themselves must be collaborative in nature because sanitation promotion is a collective responsibility (Allison, 2002). This is particularly important for Ghana because a lot of attention has been placed on hygiene promotion. However, ever since sanitation became known to improve health, many of the developed countries have developed and continue to develop effective sanitation strategies - basic, on- site, food, environmental and ecological - for the various populations (Harvey, 2008). The same cannot be said of many developing and underdeveloped countries (Hossain, & Howard, 2014; Green, de Week, & Suarez, 2013; Mallick, 2010). University of Ghana http://ugspace.ug.edu.gh 3 Adopting a new resolution, the UN General Assembly urged UN Member States and relevant stakeholders to encourage behavioural change and the implementation of policies to increase access to sanitation among the poor, along with a call to end the practice of open-air defecation, which it deemed "extremely harmful" to public health (WHO, 2013). All 189 nations are, at all levels, to ensure the achievability of this goal by formulating and implementing policies on sanitation to eradicate the bad practices that have high rippling effects on even the achievement of the other goals. This has become especially urgent for developing countries like Ghana, where 'development' appears to precede planning (UNICEF/WHO, 2006). In achieving the MDGs which have become a universal development agenda, many institutions have set out to contribute their quotas in diverse ways. Among them is the Millennium Cities Initiative (MCI), a project of the Earth Institute, Columbia University, New York, which was founded in 2006 by world-renowned development economist Jeffrey D. Sachs as the urban counterpart to the Earth Institute's Millennium Villages Project. The Millennium Cities Initiative was established to help select, under-resourced municipalities across sub-Saharan Africa to eradicate soaring urban poverty and attain the Millennium Development Goals (MDGs). MCI assists the "Millennium Cities" - generally regional capitals near to the sites of the Millennium Villages Project (MVP), MCI's sister integrated rural development effort - in identifying critical gaps in realizing the MDGs, as well as the financing, programme and partners capable of filling them. MCI's extensiv e network of partners around the world - including investors, philanthropists and entrepreneurs; non -profits and corporations; and governmental and multilateral institutions - joins MCI in the belief that, for the first time, our generation has the opportunity to complete an urban transformation across Africa and beyond (Columbia University, 2013). University of Ghana http://ugspace.ug.edu.gh 4 1.2 Resea r c h Probl e m Inadequate sanitation is a major cause of diseases world-wide and improving sanitation is known to have a significant beneficial impact on health both in households and across communities. One area which needs good sanitation is the market. Extant research has examined several issues related to sanitation in different countries including participation of communities (Sansom, 201 1; Hadi, 2000). Ghana as a nation also has its share of research in sanitation (Enu, 2013), (Thrift, 2007), (Jenkins & Scott, 2007) and (Whittington, Lauria, Choe & Hughes, 1993). Although these studies have exposed scholars to aspects of sanitation, they are handicapped in the area of sanitation in markets; that is, a notable gap in the discourse is the markets. Municipal authorities are often responsible for sanitation management in most cities, especially waste management (Guerrero, Maas and Hogland, 2012). The Accra Metropolitan Assembly (AMA), the body responsible for all markets in the Accra Metropolis, has adjudged the Kaneshie Market as one of the best in its last market assessment report in 2008. This assertion is in comparison with markets that have poor infrastructure and sanitation. This is likely to give management a false image and may cause complacency in development efforts. An empirical research is therefore needed to accentuate the fact that the Kaneshie Market can be described as best in its own capacity rather than in comparison to poorly managed markets. There is also the need to know the ingredients of best practices in sanitation that can be found in the Kaneshie Market. Also, sanitation management problems usually arise in areas where people gather. One area where large groups of people converge is the market. It is also home to products for human consumption and therefore a central or convergent point for people from all walks of life. Because most markets in Ghana happen to be the first port of call for many travellers, at all University of Ghana http://ugspace.ug.edu.gh 5 times, it has teeming numbers of people. For many people seeking greener pastures, these markets become home perpetually until they can secure alternative accommodation. Media reports over the years have maintained gloomy sanitation practices of markets in Accra but extant empirical literature has been silent on this. There seems to be some neglect of markets which form a major point in the food chain. When it comes to sanitation related issues, there are numerous policies, frameworks, guidelines and legislative instruments by both the Government of Ghana and world bodies such as the Ministry of Water Resources, Works and Housing (2011); Ministry of Local Government and Rural Development (2010); Environmental Sanitation Policy (1999); United Nations Children's Fund (UNICEF) (2005); and others which offer valuable insight into the roles and responsibilities of all stakeholders, including all those directly involved in the activities of markets. Success in sanitation therefore is directly related to stakeholder involvement. In line with this, it is important to ascertain to what extent stakeholder participation has contributed to the assertions made by the AMA (that the Kaneshie Market is one of the best markets in Accra in its 2008 Market Assessment Report). One important aspect of sanitation promotion is the provision of sanitation hardware. For open markets or trading centres of foods and other consumables, there is high risk of contamination (Anandappa, 2013). Extant research has shown that from the farm to the home, there are likely routes of contamination. It is therefore necessary to be sanitation conscious, especially in handling consumables (Bartram and Cairncross, 2010). However, all that is available on markets in Ghana come from media reportage: for example, Bentil (2007), GNA (2014) and Jafaru (2014). Sanitation literature often ends up as an exposition on a single aspect of sanitation such as solid waste management, storm-water management among others. "The focus on all the University of Ghana http://ugspace.ug.edu.gh 6 components of environmental sanitation at this time is justified as there is the need to do more than narrowly promoting hygiene and improved latrines (or toilets) alone" (NESSAP, 2010, 20). This thesis therefore looks at sanitation in the markets in a holistic manner, taking into consideration all the components of environmental sanitation that are likely to be seen in markets. 1.3 Researc h ob j e c t i v e The study seeks to i. Find out the strategies for promoting sanitation at the Kaneshie Market Complex. ii. Investigate access to water and sanitation hardware at the Kaneshie Market Complex, iii. Assess the level of participation of the stakeholders in promoting sanitation in the market. 1.4 Resear ch questions i. Does the Kaneshie Market Complex have specific strategies for promoting sanitation? ii. Do people at the Kaneshie Market Complex have access to water and sanitation hardware? iii. What is the level of participation of stakeholders in sanitation promotion in the Kaneshie Market Complex? 1.5 Significanc e of the Study Poor sanitation poses a lot of health risks and can negatively affect economic and social development (Patanayak et al., 2009). Currently in Ghana, it is one of the most pressing issues when it comes to urbanization and public places where large populations gather (Fried, n.d). With concerned authorities frantically looking for what works best, a study in this area can have many implications. This study has major implications for sanitation policy University of Ghana http://ugspace.ug.edu.gh 7 formulation for the development of effective sanitation strategies for markets in the ever- growing city of Accra. It will also present or make visible the possible steps or measures that can help improve sanitation in the Kaneshie Market in particular. The research considers the study organization in its own capacity, but it will also help all markets in general. It will also contribute to knowledge in the field of sanitation and academia as it will present new dimensions to sanitation research in public health domain. 1.6 Scope of the stu dy The study was conducted in the Kaneshie Market Complex, Accra. The main issue was about sanitation promotion strategies. Therefore, the study looked at specific strategies that the market was using to promote sanitation. The evidence was investigated from the points of the provision of sanitation hardware, sanitation promotion activities and the participation of stakeholders in promoting sanitation at the market. These were the dimensions captured in the objectives, the research questions and the conceptual framework of the study. 1.7 Definition of terms Sanitation ³,nterventions to reduFe SeoSle’s e[Sosure to diseases E\ SrovidinJ a Flean environPent in which to live; measures to break the cycle of disease. This usually includes disposing of or hygienic management of human and animal excreta, refuse, and wastewater, the control of disease vectors and the provision of washing facilities for personal and domestic hygiene. Sanitation involves both behaviours and facilities which work together to form a hygienic environPent´ 6anitation 3roPotion, , S. . University of Ghana http://ugspace.ug.edu.gh 8 Sanitation hardwar e Physical articles or items used in sanitation and hygiene promotion such as soap, garbage collectors, dust bins etc. Promotion ³3roPotion involves all the thinJs one Pust do to raise or advance a cause, raise the profile and status of the cause, further the growth and expansion of the cause, and to further its popularity. Promotion, in the public health sense of the word, also involves providing the enabling mechanisms to others so that they may take up the cause armed with effective tools´ 6anitation Promotion, 2008, p.2). Strategy An elaborate and systematic plan of action including several activities aimed at achieving certain goa ls. 1.8 Chapte r dispos ition The study has five chapters in all. The first Chapter contains the introduction to the entire work. It has the background of the study, the research problem, research objectives, research questions, and a brief review of literature. In addition, it also covers the significance of the study, the research approach, scope of the study, definition of terms, chapter disposition and chapter conclusion. Chapter Two basically discusses several issues in existing literature. It includes a chapter introduction, a review of theoretical literature, a review of empirical literature, a conceptual framework and chapter conclusion. This is followed by Chapter three which is the methodology. It explains the research approach, the research design, the sources of data, sampling - population of the study, sampling technique, sample size, frame and the unit of University of Ghana http://ugspace.ug.edu.gh 9 analysis. It also looks at the limitations, instrumentation, the data gathering procedure, mode and instruments for data analysis, ethical concerns and the chapter conclusion. Chapter four is data analysis and discussion of findings. It introduces and analyses the data. It also discusses the findings and further evaluates the research questions. This is followed by the final chapter which comprises the summary of findings, conclusion and recommendations. This chapter ends with lessons for policy implementation and further research. 1.9 Conclusion Sanitation and hygiene matter everywhere and every time because they contribute highly to healthy living, economic development, social dignity and general environmental protection (WBG, 2015). It is for these reasons that all stakeholders must be actively involved in promoting sanitation. In addition, there is the need for innovations to accelerate and sustain the strategies that are put in place towards promoting sanitation. However, this cannot be done without constant research into the area in all places where the absence or inadequate sanitation Fan Ee detriPental to SeoSle’s Zellbeing and their environment. Many policy documents have provided guides from which practitioners can draw knowledge and can develop technologies as well as effective and efficient innovative ideas. Now, much is left for organisations to centre these findings on their individual experiences and needs. University of Ghana http://ugspace.ug.edu.gh 10 CHAPTER TWO LITERATURE REVIEW 2.1 Introducti o n This chapter is devoted to the already existing works on sanitation. It looks at the concept of sanitation and related issues in urban sanitation, documented sanitation promotion strategies, Ghana’s environPental sanitation situation, stakeholders in sanitation promotion and sanitation in market. Further, the chapter also covers theories and models dealing with sanitation including the Improved Behavioural Model for Water Sanitation and Hygiene IBM- WASH (Dreibelbis et al, 2010), Sanitation for All (SAN ALL) (UNICEF, 2000), and the Hygiene Improvement Framework (EHP and partners, 2004) which focus how sanitation promotion must be considered at different levels. 2.2 The conc ep t of sanit ati on 6anitation Fan Ee deIined as the µadoStion of measures to eliminate unhealthy elements esSeFiall\ Zith reJard to dirt and inIeFtions’ 6hastri, 5aval 0aSusNar,  . 6inFe the Sanitation Revolution of the nineteenth century, according to UNEP (2005), there is a growing body of knowledge demonstrating the fact that causes and pressures of any of toda\’s environPental SroElePs Fan Ee traFed EaFN, direFtl\ or indireFtl\, to the liIest\les, choices, values and behaviours of local communities (Daramola, 2012). This therefore calls for a holistic approach of participation in finding solutions thereby establishing the fact that all stakeholders have a role to play in the different processes of environmental sanitation, both in terms of subsidiarity of decision-making processes and sustainability of environmental services in the community (UNEP, 2005). University of Ghana http://ugspace.ug.edu.gh 11 Currentl\, oI the Zorld’s  Eillion SeoSle, soPe . Eillion SeoSle still laFN aFFess to improved sanitation, two-thirds of whom live in Asia and sub-Saharan Africa (WHO, 2006). And so, there is the need to shift away from simply providing centrally planned inIrastruFture to aSSroaFhes that Fan helS Freate and serve SeoSle’s Potivation to iPSrove their own sanitation (WHO/UNICEF, 2013). This is because in developing countries, unimproved sanitation facilities r have become the main cause of widespread and serious health problems. However, improvements in these services show few health benefits unless they are coupled with improved hygiene behaviour (Masangwi et al; 2010; Tsinda et al; 2013). With poor sanitation, poor hygiene, and poor water supply systems still responsible for about 50% of the consequences of childhood and maternal underweight, there appears a link between the two: an exposure to one condition may increase the vulnerability of the affected person to the other (Mara, Lane, Scott & Trouba, 2010). Therefore, there is the need to develop innovative approaches and integrate them into social institutions such as schools, markets and health facilities (Rheingans, Dreibelbis & Freeman, 2006). Also, epidemiological investigations have indicated that even in the absence of latrines that have been the concentration of sanitation strategies, diarrhoeal morbidity can be reduced considerably with the adoption of improved hygiene behaviour (WHO, 1999). Meanwhile, it has been observed that many national data and progress reports on the Millennium Development Goals (MDGs) target on sanitation have focused mostly on access at household levels without reference to access at public places like bus stations, schools and markets in urban areas even though these places are peculiar settings and temporary abode which inhabit people in transit or working for their livelihood (Adenuji & Afolabi, 2010). University of Ghana http://ugspace.ug.edu.gh 12 Urban sanitation is much more complex, mainly because of higher population densities, less- coherent community structures, and opportunities for open defecation (Mara et al; 2010). Urban sanitation must extend beyond the household acquisition of a toilet to a systems-based approach that covers the removal, transport, and safe treatment or disposal of excreta (Mara et al; A 2010). In addition, even though WASH (water, sanitation and hygiene) is a single sector, there has been little progress in achieving access to sanitation because there has been more concentration on water and hygiene (Loevinsohn, Guerrero & Gregorio, 1995). 2.3 Urban san itati on Egun (2011) posits that urban authorities are faced with many problems which they seem incapable of managing or dealing with. Most of these problems often accompany urbanization and one of the areas where they face a challenge is waste management. Waste is generated from residential, commercial, institutional and industrial sources and consists of paper, plastic, glass, cloth, metal and organic materials (Gangwar, Deepali & Gangwar, 2012). Urban centres face several sanitation problems including Waste Electrical and Electronic Equipment (WEEE), Biodegradable Organic Fraction (BOF) which constitutes the largest proportion of solid waste, wastewater, faecal sludge among others (MLGRD, 2010). The rate at which waste generates and accumulates is fast becoming a major environmental health problem in developing countries (Shastri et al; 2010). Indeed, sanitation is a complex issue that is linked not only to health but to social and economic development as well 'araPola,  . 7hat PaNes it an µessential serviFe’ (nvironPental 6anitation 3oliF\, Revised, 2010). Even though there are several approaches, they are mostly geared towards rural sanitation. Much must therefore be done with regard to urban sanitation which is plagued with many challenges (DFID, 2009). University of Ghana http://ugspace.ug.edu.gh 13 In many countries, the collection and disposal of waste is seen solely as the responsibility of the government or the municipal assembly which are unable to execute this successfully due to several difficulties including financial constraints, low level of organizational skills, inadequate staffing among others (Global Waste Management Report, 2007). This is compounded by the majority of the populace who do not consider themselves as sharing in the responsibility of waste collection and disposal (Onibokun, 1999). Meanwhile, lack of sanitation or failure to execute sanitation strategies does not only threaten the health of the people but a threat and a burden to the environment itself (Samanta and Wijk, 2013). Sanitation in urban areas has become a basic necessity for improvement of the quality of life as well as the enhancement of efficiency of the people in their endeavours (Shastri et al/.2010). The complex nature of urban sanitation calls for facilities and services that are cost effective and sustainable. Before these are chosen, there must be proper assessment of local (financial, technical and institutional) capacities as well as site-specific considerations in design, construction and operation of systems (GNSHMP, 2011). Although many governments in collaboration with other stakeholders are making considerable efforts in tackling waste-related problems, many major gaps still exist to be filled making developing countries face uphill challenges to properly manage their waste. Most efforts are now being targeted at reducing the final volumes as well as generating sufficient funds for waste management (Ram, Reddy, Rao & Reddy, 2004). This problem has arisen because of the fact that sanitation has received less attention than water and hygiene even though they have always been seen as a single concept (Harvey, 2008). According to the UNDP Human Development Report (2006), even though sanitation is improving worldwide, same cannot be said of sub-Saharan Africa. University of Ghana http://ugspace.ug.edu.gh 14 7hereIore, there is the need to ZorN toZards the FoPPunities’ understandinJ oI the SroEleP in order to encourage their collective participation. This can lead to the collective transition of local residents from victims to agents of change (Daramola, 2012). Konteh (2008) argues that, among other things, low income countries are unable to address their urban sanitation challenges due to policy weaknesses. Other challenges include inadequate data that must direct the provision of services (Konteh, 2008). 2.4 Sanitation promo tion strategies In promoting sanitation therefore several strategies have been developed by different groups and countries aimed at achieving the Millennium Development Goals. These strategies have varied over time with improvements as the years go by (Government of Nepal Sanitation and Hygiene Master Plan, 2011). This wide range of innovative approaches has been applied in low-income countries. Even though some have shown that peoples demand and interest in sanitation is low, the truth is that many people would want to have sanitation facilities but often cannot afford the cost of what is being offered them. Therefore, there is the need for a change in the way sanitation provision is dealt with; the product must be affordable and appropriate (Cairncross, 2010). Documented strategies include a wide range of innovative approaches which have been applied in low-income countries, including participatory initiatives such as the Participatory Hygiene and Sanitation Transformation tool (PHAST), Community-Led-Total-Sanitation (CLTS) and Community Health Clubs (CHCs). School-based and child-friendly hygiene and sanitation programmes are also widely used in low-income settings (Jenkins and Scott, 2007). Similarly, social marketing approaches, such as promotion of handwashing with soap and using marketing approaches to selling sanitation, are gaining popularity (World Bank EHP, 2005). CLTSs are aimed at promoting self-respect and not merely promoting standards University of Ghana http://ugspace.ug.edu.gh 15 or health issues (Harvey and Mukosha, 2008). This is to give sanitation a different approach other than what professionals in the sector have concentrated on over the years as termed as ³intelleFtual FonstiSation´ .arr 3asteur,  . After evaluating works on different approaches all over the world, the World Bank Water and Sanitation Programme (2005) discovered that many of the strategies severely lacked rigorous evaluations and intervention trials. They further analyzed three strategies: PHAST which uses a participatory approach or methodology to whip up active participation of those who must benefit from the development process, CHCs which comprises health education and community mobilization, aims at enabling people to improve their own hygiene practices and Happy Healthy and Hygienic/ Programme Saniya which targeted risk factors identified for attention in hygiene promotion (Curtis & Kanki, 1998). 2.5 Ghana’s Environmental Sanitation Situation As already indicated, epidemiological investigations have indicated that even in the absence of latrines that have been the concentration of sanitation strategies, diarrhoeal morbidity can be reduced considerably with the adoption of improved hygiene behaviour (WHO, 1999). According to NESSAP (2010), there is limited report on the sanitation in totality from all over the nation. Even though WASH (water, sanitation and hygiene) is a single sector, there has been little progress in achieving access to sanitation because there has been more concentration on water and hygiene (Loevinsohn et al; 2004). Many Metropolitan, Municipal and District Assemblies (MMDAs) who are directly tasked Zith the resSonsiEilit\ oI sanitation are SlaJued Zith SroElePs suFh as ³Soor SlanninJ Ior waste management programmes, inadequate equipment and operational funds to support waste management activities, inadequate sites and facilities for waste management operations, inadequate skills and capacity of waste management staff, negative habits, University of Ghana http://ugspace.ug.edu.gh 16 uncoordinated attitudes and the apathy of the general publiF toZards the environPent´ (Atuahene, 2010, p.49). There are other barriers such as neglect of consumer preferences, lack of political will, inappropriate approaches and low prestige and recognition for sanitation workers (WHO Sanitation Promotion Handbook, 1998, p. 11-12). On a general note, the sanitation situation in most parts of Ghana can best be described as a Frisis. ³,t is as shoFNinJ as $,'6, as deEilitatinJ as 0alaria, and as solvaEle as 3olio. 6iPSl\ meeting the sanitation target by 2015 could avert 391 million cases of diarrhea a year (and Zith theP the loss oI \ears oI sFhoolinJ, and \ears oI SroduFtive and soFial liIe ´ (vans et al; 2004), further projecting for any nation $63 billion every year in economic gains simply by meeting the targets of the MDG on sanitation. Even though the cost of doing so may be high, the benefits can actually dwarf the cost (Hutton, Haller & Bartram, 2007). Markets are very important public places that demand a lot of attention when it comes to sanitation. The already available challenges are further being compounded by rapid population levels which result in generation of large amounts of waste and stress on available sanitation hardware (Minghua et al; 2009). No matter the challenges, the effect of poor sanitation is enough to make it worth paying attention to. In Ghana for instance, a lot of attention has been devoted to policy formulation and regulatory frameworks towards promoting sanitation (Fried, n.d). Between 1991 and 2010, there have been twelve policy documents, waste management and environmental guidelines, and legislative instruments that include issues on sanitation. They include the National Environmental Policy, 1991; Local Government Act, 1993 (Act 462); Environmental Protection Agency Act, 1994 (Act 490); Water Resources Commission Act, 1996 (Act 522); National Building Regulations, 1996 (LI 1630) and National Environmental Quality Guidelines (1998). The rest are Environmental Sanitation Policy, 1999; Environmental University of Ghana http://ugspace.ug.edu.gh 17 Assessment Regulations, 1999 (LI 1652); Landfill Guidelines (2002); Guidelines for the Management of Health Care and Veterinary Waste in Ghana (2002); Revised Environmental Sanitation Policy, 2007 and Environmental Sanitation Policy, Revised, 2010. (Environmental Sanitation Policy, Revised, 2010). In these documents, specific actions that must be taken as well as specific roles have been assigned to all stakeholders such as the state, the municipal assemblies, communities, NGOs, individuals, Ministry of Health, educational institutions, the private sector, research institutions among others. Even though policy on environmental sanitation abounds, failure is the norm for urban sanitation infrastructure in Ghana (Murray and Drechsel, 2012). This coupled with other challenges have had wrong bearings on the implementation of successful programmes (WHO Sanitation Promotion Handbook, 1998, p. 13). ³Ghana is a t\SiFal ... suE-saharan $IriFan Fountr\ IaFinJ siJniIiFant sanitation FhallenJes´ (Amoah et al; 2007). In 2010, the Environmental Health and Sanitation Directorate of Ministry of Local Government and Rural Development developed a document known as National Environmental Sanitation Strategy and Action Plan (NESSAP). It referred to the waste generated as µ0aterials in 7ransition´ 0,N7 . 0,N7inJ is aimed at creating awareness for the change of sanitation-Eehaviour FhanJinJ SeoSle’s attitudes toZards all types of wastes as a life-style. MINTing looks at the potential of waste management in the creation of jobs as well as the reduction of cost in waste management (NESSAP, 2010). NESSAP therefore covers all components of environmental sanitation. It is to guide all actors in the various sectors such as the Ministries, Departments and Agencies (MDAs), Metropolitan, Municipal and District Assemblies (MMDAs), NGOs, development partners, traditional authorities and even the media. University of Ghana http://ugspace.ug.edu.gh 18 MINTing is the underlying philosophy for creating awareness for change of attitude towards the handling and disposal of all types of waste by demonstrating that there is value in all the components of wastes. MINTing Zill Freate ³Jreen Follar´ MoEs and has the Sotential to reduce MMDAs cost for waste management. With the philosophy of MINT therefore, waste is simply not discarded. Value is added at the various stages of its transition till it gets to its last end. However, the Strategic Youth Network for Development (SYND), a youth-led NGO advocating for sustainable environment in the areas of Climate Change, Biodiversity, Land Degradation and Water & Sanitation, contend that the policy does not make provision for the active involvement of young people in the processes even though the youth constitute the largest segment influencing the sanitation situation in Ghana (Strategic Youth Network for Development (SYND), 2013). That notwithstanding, the SYND considers the issue of environmental sanitation as affecting every part of human development such as the economy, culture, health, employment among others. It further calls on all stakeholders to help in successful implementation of the policy. This is further corroborated by CHF International, Ghana (2010), in its analysis of the value chain of solid waste management as a programme for Youth Engagement in Service delivery (YES) programme in Accra. Waste management presents employment opportunities for young people (Thieme, 2010). Of the many concerns raised in the Environmental Sanitation Policy, Revised, 2010), is the sanitation situation in markets placing the responsibilities on Metro/Municipal Environmental Health Departments who among other responsibilities must ensure food and water hygiene comprising market sanitation, food establishments, meat and fish hygiene, University of Ghana http://ugspace.ug.edu.gh 19 livestock and poultry management, control of fresh vegetables and water quality control ( Environmental Sanitation Policy, Revised, 2010, p.39). The policy categorically stated that µ'istriFt $ssePElies shall ensure the availaEilit\ oI suitaEle and h\JieniF ParNet IaFilities. The private sector shall be encouraged to build and manage such facilities. Provision for the handling, display and preservation of meat, fish and other perishable foods shall be such as to prevent contamination and decomposition. District assemblies shall make bye-laws allowing for the development of markets by the private sector and providing for their Fontrol,’ S.  . ,t thereIore enFouraJes FaSaFit\ develoSPent, inIorPation eduFation and communication, legislation and regulation, sustainable financing and cost recovery, levels of service, research and development and monitoring and evaluation as key to sanitation promotion by the Assemblies (NESSAP, 2010, p. 49). This is indicative of the collaborative nature in sanitation promotion meaning that the various stakeholders play their role with the deserving urgency (Rheinlander et al, 2010). 2.6 Stakeholders in sanitation promo tion 6taNeholders are iPSortant in sanitation SroPotion. ³6taNeholders Pust Sla\ a Fentral role in setting up priorities and objectives of water and sanitation initiatives in order to ensure relevanFe and aSSroSriateness´ /ienert J, Schnetzer F. & Ingold K, 2013). In Ghana, the development of NESSAP is an example of the work of many stakeholders. They include Regional Coordinating Councils, Ministry of Women and Children (MOWAC), Environmental Protection Agency (EPA), Ministry of Health (MoH), Ministry of Education 0o( aPonJ others. ³7he Ne\ Sla\ers in environPental healthh\Jiene eduFation in Ghana are the MoH, the MLG5' and the 0o(´ N(66$3,  Stakeholders in sanitation promotion are numerous and may vary from country to country. For example, the Government of Nepal developed a sanitation and hygiene master plan in University of Ghana http://ugspace.ug.edu.gh 20 2011. Many stakeholders were involved in the project. There were six government ministries of physical planning and works, health and population, local development, women, children and social welfare, education and sports and finance. In addition, there were NGOs (Non­governmental Organisations, community committees, the Red Cross, sanitation agencies, regional, district village development committees, and municipal level WASH coordinating committees, local government bodies, schools child clubs among others. This is to ensure total participation and also to be able to develop a comprehensive plan that can cover the whole nation (Lienert, Schenetzer & Ingold, 2013). Other global or international agencies working in the sanitation sector include UNICEF, USAID, the World Bank, and the Water Supply and Sanitation Collaborative Council (WSSCC). The U.S. Agency for International Development (USAID) works as an independent agency of the U.S. government and provides development, humanitarian and economic assistance to many countries around the world. The USAID has worked extensively in areas of environmental health and has been supporting the Environmental Health Project (+3 sinFe . 7he United Nations Children’s Fund UN,C(F SroPotes child survival through its Environment and Sanitation (WES) Programme UNICEF is working in more than ninety countries supporting efforts to accelerate access to basic water and sanitation services and improve hygiene behavior. The Water Supply and Sanitation Collaborative Council (WSSCC) was mandated by a 1990 UN Resolution to accelerate progress towards safe water, sanitation and hygiene for all. (The WBEHP and partners, 2004, p.v-vi). Currently working in 33 countries, WSSCC continues to put WASH issues on the global agenda through the management of three main programme of activity: advocacy & communications, thematic working groups and national/regional plans of action. The Water University of Ghana http://ugspace.ug.edu.gh 21 and Sanitation Program (WSP) is an international partnership with a mission to alleviate poverty by helping the poor gain sustained access to improved water and sanitation services. It is administered by the World Bank and forms partnerships to effect the regulatory and structural changes needed for broad sector reform and to develop innovative solutions for planning and implementing sustainable investments (WSSCC, 2010). 2.6.1 Governm ent The World Bank (2005) defines the role of government in hygiene and sanitation promotion and this involves the formulation of sanitation policies that are critical to creating an enabling environment that will further encourage and support increased access to sanitation facilities. After studying the impact of national sanitation policies and the effectiveness of programmes to improve hygiene and sanitation coverage, the World Bank (2005) developed a list of SoliF\ ³inJredients´ ZhiFh are taNen to Ee neFessar\ Fonditions Ior adeTuate SoliFies to allow appropriate enabling environments. National and local government agencies are therefore seen as most important stakeholders (Guerrero, Maas & Hoglans, 2012). The ingredients are political will as evident in areas such as political statements, responsibilities of institutions, resource allocation and projects among others. The next ingredient is acceptance of policies by stakeholders. It is believed that if the relevance of government policies are widely accepted by stakeholders, there is the possibility of better promotion and sustainaEilit\. 6taNeholders’ oEliJations and resSonsiEilities Pust Ee Flearl\ backed by law (Whittington et al., 1993). Other ingredients include appropriate population targeting, adequate and appropriate levels of service, health considerations, the environment, financing options, and clear distinctions in institutional roles and responsibilities (The World Bank, 2005). University of Ghana http://ugspace.ug.edu.gh 22 2.6.2 The Health Sector There is a positive relationship between ill-health and poor water supply, sanitation and hygiene and this has been a major concern of public health (Bartramand and Cairncross, 2010). This makes sanitation promotion one of the most important roles the health sector can play in environmental health planning. This is because the health systems work towards behaviour change in preventing diarrhoeal diseases. The sector which has a wide area of contact between professionals and the people in many ways, can give persistent messages which can help emphasize the need for collective responsibility towards the prevention of environmental health risks (Sanitation and Hygiene Master Plan, 2011). In Ghana for instance, the Ministry of Health often collaborates with the Health Education Unit of the Ghana Health Service to educate the public on health through products such as visual and audio-visual materials, campaigns, adverts among others (MLGRD, 2010). hi addition, they can play an important role in advocacy and leadership because politicians and the general public listen to doctors. That gives the medical profession the responsibility of speaking out on all important health issues, including sanitation (Duncan et al, 2010). 2.6.3 I/NGOs, community bas ed organis ations (CBOs) and civ il society group s I/NGOs and CBOs play catalytic roles in promoting sanitation activities at policy formulation, implementation and monitoring levels by offering support such as financial and materials for hygiene and sanitation promotion. They have potentials in community mobilization, volunteerism and raising awareness on sanitation issues (Sanitation and Hygiene Master Plan, 2014). Examples include the Community-Led Total Sanitation (CLTS), introduce in Bangladesh in the year 2000 by Dr. Kamal Karr, Village Education Resource Centre (VERC) and Water Aid Bangladesh (Samson, 2011). Stakeholders also have the ability to gather resources for advocacy as well as the ability to design technical University of Ghana http://ugspace.ug.edu.gh 23 support for training to fill the knowledge gap, help in developing monitoring frameworks among others (Mehta and Knapp, 2004). In Ghana, I/NGOs have become a part of sanitation programmes especially at the district levels where they offer technical assistance (Welle, 2011). The coalition of NGOs in Water and Sanitation (CONIWAS) has always directly worked towards various issues at district, regional and national levels (Ainuson, 2009). 2.6.4 The Private Sector The private sector includes companies that produce or can produce products that have the ability to help promote sanitation - sanitation hardware producers. Through public-private partnerships, they can be encouraged to localize facilities to fit local demand (Rheinlander et al; 2011). This could take the form of sanitation marketing where marketing principles are used to promote sanitation. It is possible for the private sector to identify and create demand for sanitation and in turn, generate more income (Bramley & Breslin, 2010). They further explained that entrepreneurs can develop relationships with both households and institutions to realize opportunities that are available for sanitation. Also, economic crisis have led to the near collapse of state capacities hence the need for private sector participation in sanitation promotion. In 1999, the Government of Ghana ³envisaJed that all environmental services (waste management, cleansing and sanitation) will be provided either on a full cost-recovery basis by private companies or by service providers under public contraFts´ CrooN $r\ee,  . 2.7 Sanitation in markets ³0arNets´ reIer to shoSSinJ Fentres ZhiFh oIten aFFoPPodate several retail Eusinesses. They may also be referred to as retail outlets. These centres vary across the various University of Ghana http://ugspace.ug.edu.gh 24 continents. In the developed world, shopping centres are often large malls where people desire to visit (Chu, 2009). In Ghana, markets are the main places where retail activities take place. Very few reviewed literature is available on the general sanitation situation in shopping centres. In Ghana there are more open markets than malls. Just like most Sub-Saharan Africa, rapid urbanization has often rendered infrastructure for sanitation poor or inappropriate; unable to meet the demand for sanitation (Amoah, Dreschel, Abaidoo & Henseler 2007). Several studies in markets in Ghana have shown levels of contamination of bacteria on eggs sold in markets (Ansah, Dzoagbe, Teye, Adday & Danquah, 2006), milk and cheese items (raw and fried) sold in markets (Iddrisu, 2007), and beef (Adzitey, Teye, Gifty & Adday, 2010), all in the Tamale metropolis. However, much of the reports on sanitation in markets are those presented by the print and electronic media with varying but gloomy reports which show low coverage: only 31 % of markets in Accra have a drainage system, 26% have toilet facilities and 34% are connected to pipe-borne water (Nyanteng, 1998). Having reported on the sanitation Fonditions in $FFra’s ParNets, %entil  desFriEes several ParNets as sittinJ on µtiPe EoPEs’. 2I the ³/ondon 0arNet´ in $FFra, she Zrote ³Currentl\, the ParNet has turned into a sSraZlinJ Peat shoS Zith huJe Ilies hoverinJ around the beef and mutton meant for sale. The drains remain choked and stinky with unFolleFted JarEaJe Zith Eu]]inJ Ilies that ZelFoPe SeoSle into the ParNets´ %entil,  . The several unhygienic practices such as sitting of eating areas by major drains filled with garbage, washing of carcass in dirty water while standing in the same water, cutting meat on the bare floor among others are major causes of food contamination (Soriyi, Agbogli & 'oJdeP,  . 0eanZhile, the ³/ondon 0arNet´ is not too Iar aZa\ IroP the oIIiFes oI the University of Ghana http://ugspace.ug.edu.gh 25 Accra Metropolitan Assembly who has the responsibility of promoting sanitation in such places (Bentil, 2007). Traders in Accra markets display wares in filthy environments so freely without considering the fact that handling of food in a hygienic manner contributes to the quality of the food (Soriyi et al; 2008). In an instance, the traders at Agbogbloshie, one of the biggest markets in the Accra, were reported to have again dirtied their market and its surroundings to an extent that one cannot believe that it was nine months ago that the Accra Metropolitan Assembly (AMA) spent an estimated 05 billion to clean the market and rid it of all illegal structures and unsanitar\ Fonditions. ³$reas alonJ the Pain road, ZhiFh Zas tarred durinJ the FeEruar\ 2007 exerFise to Ee used E\ FustoPer’s as a SarNinJ lot, have IorFeIull\ Eeen taNen over E\ the traders who display their wares, including tomatoes, onion, pepper and other food items, beside the stinking choked gutters, much to the chagrin of some shoppers who patronise the ParNet´ %entil,  . This is in sharp contrast to the dictates of the many environmental policies that spell out the individual responsibilities in sanitation services delivery. It is the responsibility of each and every individual to ensure sanitation wherever he finds himself -home, work and public SlaFes. 7his is to Ee done throuJh FleaninJ one’s iPPediate environPent or the SroSert\ they occupy as well as drains and places considered access ways (Environmental Sanitation Policy, 1999, pp.5-6). For example, in dealing with the sale of meat in the market, there must be periodic screening of both butchers and sellers; sales points must be thoroughly and constantly cleaned; there must be standardized operating methods such as how to display products and sterilization of tools among others (Adzitey et al., 2010). University of Ghana http://ugspace.ug.edu.gh 26 2. 8 Dealing with sanitation in public places Sanitation promotion has led to the development of decision making models, theoretical models l(and explanatory frameworks (Dreibelbis et al., 2013) mainly because the success of any interventions depend enormously on a combination of structural, behavioural, individual as well as community components (Parker et al, 2012). One of such models is the Integrated Behavioural Model for Water, Sanitation and Hygiene (IBM-:$6+ ZhiFh ³IaFilitates the process of developing interventions that operate beyond the individual and household levels; interventions that operate at the structural level with the capacity to reach largest sections of the poSulation, Eut are also hiJhl\ Fost eIIeFtive´ 6Zeat et al.,  . ,%0-WASH was developed from a study of already existing models and frameworks for behavioural change and the maintenance of such changes (Parker et al., 2012). It was found that most of the existing models were targeted at individuals and sought to understand the behavioural factors without much consideration for larger structures within which the individual finds himself as indicated in earlier works by McLeroy, Bibeau, Stecker & Glanz (1988). There were also indications that, there have been either weak or virtually lack of measurement instruments to rigorously measure and monitor the programs at all levels (Sweat et al., 2006). Developed from a pilot study in Bangladesh by the International Centre for Diarrheal Disease Research (ICDDR), the IBM-WASH has three dimensions consisting of contextual, psychosocial and technological dimensions which are all interactive in nature (Dreibelbis et al., 2006). The contextual dimension concerns the individual and his environment or setting that influences change in behavior that might eventually lead to the adoption of new technologies; the psychosocial which combines behavioural, social and psychological attributes in influencing desirable behavioural outcomes and new technologies; and technological dimensions that consider the appropriateness of new technologies that have University of Ghana http://ugspace.ug.edu.gh 27 influenced their adoption (Janz and Becker, 1984; Bandura, 1989; and Wood, Foster and Kols, 2012). The model also suggested five levels of application, including societal or structural level which deals with policy and regulation, leadership, finance and distribution. Level two is the community which deals with issues concerning availability of and access to resources in the physical environment, shared values, social integration and maintenance of products (McLeroy et al., 1988). Level three is the interpersonal/household level which espouses roles and responsibilities, sharing of access and norms while level four which is the individual, is related to issues such as education and age, status, gender, perceives threats and cost of products (Jenkins and Scott, 2010). Level five is habitual. It considers the favourability of the environment for habits to be formed and how easily and effectively the generated products can be used (Wood et al., 2012). $nother aSSroaFh Zorth notinJ is the ³5iJhts $SSroaFh´ in 6anitation Ior $ll 6$N$// E\ UNICEF (2000) which sees sanitation as promoting human rights and dignity, thereby describing lack of sanitation as ³a SuEliF health disaster´ UN,C(F 6$N$// , , S.  . This is needed for children, girls and women who sometimes had to wait till it is dark to free their bowels in communities without such facilities, the sick and elderly, and the society as a whole. The discomforts brought to these people may also come along with serious illnesses (Mara, 2008). SANALL believes that heightened personal dignity and national pride are two of the many benefits of good sanitation (Songco, 2002). SANALL also identifies what works ² ³SolitiFal Zill and stronJ JovernPent role, promoting behaviour change, reaching school children, giving families a choice, community planning and management and cost sharinJ,´ and Zhat doesn’t - ³JivinJ sanitation loZ priority, narrow IoFus on teFhnoloJ\, iJnorinJ the IaPil\ as a Zhole, a µone-s\steP Iits all’ University of Ghana http://ugspace.ug.edu.gh 28 approach, a top-down approach, and limited acFess to Iunds and Fredit´ UN,C(F, , S. 10-11; Mara, 2008). For policy makers, SANALL suggests eight steps. Step one suggests making sanitation a priority by formulating policies that bring together the works of various agencies as well as empowering the local authorities to develop plans that will work for them best (Songco, 2002). Step two promotes building alliances with civil society groups, the media and private sector to promote the demand for sanitation services at the grassroots (Tayler, Parkinson and Colin, 2003). Step three is developing plans and strategies that will ensure community involvement while step four is to encourage and promote basic hygienic ways of preventing disease transmission (UNICEF, 2000). Step five is to pay close attention to the needs of girls, women and children while step six is to prioritize sanitation programmes in schools in order to promote desirable life-long behavior change as well as a hygienic living environment (Mara, 2008). Step seven is to provide quick alternative access to sanitation during disasters and crises while step eight encourages gathering of information and information sharing on the challenges and successes which can be encouraged through effective monitoring and research (Tayler, Parkinson and Colin, 2003). In dealing with public sanitation needs in order to prevent diarrheal diseases therefore, there must be preventing measures in SlaFe Chin,  . 7here is the need Ior ³a Pore Ile[iEle approach to policy infrastructure, technical infrastructure and cost recovery in urban sanitation interventions´ 0FFarlane,  . $lso, :+2  FaFtsheets . Flearl\ describes sanitation in public places such as those concerning long-distance bus and railway stations, ships and ports, cordon sanitaries, markets and schools (WHO Factsheets, 2015, p. 93-97). With the world struggling to keep pace with sanitation efforts, the need for developing methods that work best for specific need is also increasing (McConville, 2008). University of Ghana http://ugspace.ug.edu.gh 29 Clearly, dealing with sanitation in public places must be holistic and participatory in order to promote sustainability. This has also led to several approaches that may be considered in planning water and sanitation programmes. These approaches have been used as frameworks by several agencies in the sanitation promotion processes. They include the Strategic Choice Approach (Friend, 1992); Open Planning of Sanitation Systems (Ridderstolpe, 2000); Logical Framework Approach (LFA) (Ortegren, 2004) and Sanitation 21 (IWA, 2006). These frameworks are mostly geared towards planning and show basically steps that must be followed in strategic planning towards sanitation improvement projects. The first of the recommended steps is problem identification to determine the current or prevailing situations and therefore, employs the use of some strategic tools such as PEST and SWOT analysis (Ortegren, 2004). The next step involves the defining of objectives and the expected outcomes that are desired. (IWA, 2006). Next, to determine how to achieve the objectives, and so, a series of options must be considered as well as the available technologies that can possibly be sustained. From the available options comes the next step of process selection that must eventually lead to the action plan of the project (Ortegren, 2004). This is closely followed by monitoring and evaluation to guide to success as well as help correct the shortfalls in the action plan (IWA, 2006). One of the most comprehensive frameworks for fighting diarrhoeal diseases which are a result of bad sanitation is the Hygiene Improvement Framework (The WB EHP and partners, 2004). The framework has three main dimensions or components. The first is improving access to water and sanitation hardware. Its indicators include a water supply system, improved sanitation and household technologies. Water supply looks at the issues of provision of water in terms of quality and quantity to help reduce the risk of contamination of food (Howard & Bartram, 2003). Improved sanitation is the second indicator. It involves University of Ghana http://ugspace.ug.edu.gh 30 the provision of facilities to dispose of human excreta in ways that safeguard the environment and public health. Some disposal techniques include the use of various kinds of latrines, septic tanks, and water-borne toilets. The third indicator, household technologies concerns the ability of individual homes and facilities to provide those items needed in promoting healthy practices such as soap or local substitutes for hand washing, chlorine, filters, hygienic and efficient water storage containers, potties for young children among others (The WBEHP and partners, 2004, p 11). The second component is hygiene promotion. Its first indicator is communication aimed at raising awareness about hygiene facilities as well as practices. It also helps to share information among the targeted group towards the promotion of behavior change. The traditional media, music, song and dance, community drama, literacy materials, leaflets, posters, pamphlets, videos, and home visits are examples of communication channels. (Nunoo, Osman & Nanedo, 2009). Typical venues include community gatherings, health centers, schools, daycare and nutrition centers, and the household (Pinfold, 1999). This makes it important to train health workers, teachers, and community agents in hygiene promotion skills. The second indicator is social mobilization. It is a process of obtaining and maintaining the involvement of various groups and sectors of the community in the control of disease (Nandha & Krishnamoorthy, 2007). This may involve encouraging a community group to design and implement a campaign such as increasing the use of soap for hand washing or to promote the proper use and maintenance of sanitation facilities. Others include social marketing which employs marketing principles such as partnerships with producers of hygiene promotion items to contribute to hygiene promotion; community participation which involves the community (ethnic, religious groups, women, children etc) in the design, implementation and monitoring of strategies aimed at behavior change; and University of Ghana http://ugspace.ug.edu.gh 31 advocacy which seeks to encourage people such donors, program managers, and community representatives to advocate for improved hygiene behaviors and for interventions that support these behaviors to governmental and nongovernmental stakeholders (The WBEHP and partners, 2004, p.12-13) The third component is strengthening the enabling environment. This may take place at the community, municipal, regional, or national levels and may take the forms of policy improvement, institutional strengthening, community organisations and financing partnerships (Dreibelbis, Winch & Leontsini, 2013). Policy improvement assesses the adequacy of national policies, identifies gaps and recommends and builds consensus on developing more effective policies. Institutional strengthening is aimed at helping institutions to clearly define their roles and responsibilities as well as improve their capacity in leadership, systems and procedures, technical competence, and training their staff so they can work effectively (Cairncross, 2010). Next is promoting community involvement. This involves getting the community people to become committed to maintaining the systems put in place. It is believed that when FoPPunit\ PePEers have done the ³ZorN´ and Zhen the\ have FoPPitted their oZn tiPe, effort, and resources to establishing improved water and sanitation systems, they are more committed to following up on and safeguarding their investments. Financing and cost- recovery addresses the issue of cost. This is to promote financial viability in order to secure financing for projects (Bartram et al, 2005). Cross-sector and public-private partnerships involve bringing together several entities, both public and private who would work together using their core competencies through interagency committees, steering committees, and task forces among others (The WBEHP and partners, 2004, p. 15-16). University of Ghana http://ugspace.ug.edu.gh 32 Originally, this framework was developed to promote ways of developing better progammes of preventing childhood diarrhea or diarrhoeal diseases - one of the top three killer diseases in developing countries - and thus a reduction in child mortality (Sanitation and Hygiene Promotion Programming Guidance, 2005). With about 4 billion episodes of diarrhoea-related diseases annually, mainly attributed to three major environmental causes including poor hygiene, poor sanitation and contaminated food and water, an approach is needed to successfully respond to all three conditions comprehensively (Bartram et al., 2005). The framework identifies pathways to contamination as well as blocking those pathways with specific strategies. These strategies in the framework seek to help strengthen each Fountr\’s learninJ SroFess, their SroJraPPinJ and their aEilit\ to develoS SoliFies, rather than to simply provide these countries direct services (The WBEHP and partners, 2004, p.5). The framework is therefore a comprehensive approach to preventing diarrhoea in terms of access to the necessary hardware or technologies, promoting healthy behaviors, and support for long-term sustainability. Fig. 2.1: The Hygiene Improv ement Framework Source: EHP and Partners (2004, P.9) University of Ghana http://ugspace.ug.edu.gh 33 However, this study considers promoting sanitation not only as a means of disease prevention but sees the availability of good sanitation infrastructure and practices as diJniI\inJ as Zell. ³7he laFN oI aFFess to sanitation and the Peans oI Jood h\Jiene is an assault against human diJnit\´ 7ratsFhin,  . 2nFe an orJani]ation taNes it uSon itselI to manage a facility where people gather consistently, there is the need to make sure that the people are provided with a conducive environment for trading: buying and selling in dignifying ways. There must therefore be a framework purposely for promoting sanitation in public places such as markets. The researcher therefore modified the hygiene improvement framework to be used for the study. This is known as the Sanitation Promotion Framework to be used in promoting urban sanitation in public places such as markets. Fig. 2.2: The Sanitati on Promoti on Framework Source: Researcher’s own source. A modification of the hygiene improvement framework. University of Ghana http://ugspace.ug.edu.gh 34 This framework shares in some components of the Hygiene Improvement Framework. This one is purposely suggested to study sanitation in a public place such as the market. The additions include Individual and group responsible activities and prompt challenge identification combined with others to promote not only sanitation but human dignity as Zell. ,ndividuals and JrouSs are needed to SroPote sanitation. ³(IIeFtive sanitation Fannot Ee eIIeFtivel\ delivered E\ outside aJenFies´ /oSe], 0athers, (]]ati, -aPison 0urra\, 2006). Sanitation promotion must not be limited to simply stimulating demand but actual activities as well. Therefore, there is the need for those involved to have specific activities that they must engage in this regard. It is also necessary, among other things, for challenges to be identified and managed so they do not develop into full blown problems. 2.9 Conclusi on Literature reviewed in this chapter has helped in bringing out the fact that sanitation is as essential as food and water and plays a major role in health promotion. It is as much an individual business as it is a collective business. The success of promoting sanitation is therefore dependent both on individual attitude and behaviours as well as communal activities and behavior. Over the years, attention has been paid to poor communities and on the provision of water and improved sanitation and hygiene behavior. However, one area that is in need of attention is public places and institutions where people gather in large numbers with high demand for sanitation services. This area therefore needs attention from all stakeholders as well as academia. Other relevant issues from the review is the current sanitation situation of markets in Accra especially and the need for improved strategies that must extend beyond the household. Also considered is urban sanitation in general terms which seems to running beyond the pace of promoters despite the numerous sanitation policy documents that are developed by University of Ghana http://ugspace.ug.edu.gh 35 government and other agencies. There cannot be desired improvements without the active participation of relevant stakeholders who must recognize and play their roles as needed. In addition to these is how issues of sanitation should be approached in order to provide as well as some documented sanitation promotion strategies. These led to the development of a new framework purposely for sanitation in markets to prevent diarrheal diseases and promote the dignity of the people as well. University of Ghana http://ugspace.ug.edu.gh 36 CHAPTER THREE METHODOLOGY 3.1 Introducti o n The general objective of the study was to identify the sanitation promotion strategies of Kaneshie Market Complex in Accra. This chapter therefore is devoted to explaining the processes and procedures that were employed in accessing the required information; in other words, the methodology of the researFher’s ZorN that led to the IindinJs. 7he FhaSter therefore, looks at the organization under study, the research paradigm and the study design. It further explains the sampling technique, the sampling size, the unit of analysis or sampling frame. In addition, it also considers the instruments to be used in data collection and the management of the data collected and the rationale for selecting such an approach. 3.2 The research paradig m The research paradigm used for this study was the interpretivism approach. It has two assuPStions relativist ontoloJ\ and transaFtional or suEMeFtivist eSistePoloJ\. ³5elativist ontology - assumes that reality as we know it is constructed inter-subjectively through the meanings and understandings developed socially and exponentially. Transactional or subjectivist epistemology - assumes that we cannot separate ourselves from what we know. The investigator and the object of investigation are linked such that who we are and how we understand the world is a central part of how we understand ourselves, others and the Zorld´ Cohen CraEtree, , S.  . ,t is oI the vieZ that in order to trul\ understand a phenomenon, the whole must be examined. This helps the researcher and prevents the study from missing important aspects that must lead to a comprehensive understanding of the whole (Neill, 2006). Considering an aspect of sanitation in Kaneshie Market may present other views than what they people consider as a whole. In the same way, walking through University of Ghana http://ugspace.ug.edu.gh 37 the area may give a view that may be totally different from what is actually the case. The area usuall\ reIerred to as ³.aneshie 0arNet´ is not the saPe as the ³.aneshie 0arNet´ that falls under the Accra Markets Company Ltd. Interpretivism enabled the researcher to gain full understanding of the issues in the market. Interpretivism was therefore chosen because it has the potential to help the researcher gain understanding and deep insight through discovery of multiple meanings. These meanings can further enhance the understanding of the whole situation and not just parts in all its complexities. Without any statistical procedures, this approach can produce findings that can be considered trustworthy and honest (Strauss & Corbin, 1990). This is important for the study because it provided precise information as the respondents intended it. $lso, ³interSretive researFhers assuPe that aFFess to realit\ Jiven or soFiall\ FonstruFted is only through social constructions such as language, consciousness, shared meanings, and instruPents ´ 0\ers, , S. . ³,nterSretivisP SroSoses that there are PultiSle realities, not sinJle realities oI ShenoPena, and that these realities Fan diIIer aFross tiPe and SlaFe´ (Neill, 2006). For this reason, in interpretivism study, the researcher focuses on meaning and may depend on multiple methods to help study the different aspects of the same issue (Collins, 2010, p.38). This was possible through thorough observation apart from the in- depth interviews that were conducted during the study at Kaneshie Market and resulted in ability of the researcher to probe some information provided by tenants and officials especially. Even though the approach is subjective in nature with the likelihood of researcher bias due to the researcher viewpoint and values that may impact the studies, Interpretivism does generate primary data that is high in validity. Indeed, in studying human experiences, it is impossible not to be subjective in totality. The ultimate aim studying about the sanitation University of Ghana http://ugspace.ug.edu.gh 38 situation of Kaneshie Market is to offer a perspective of the situation and provide well- Zritten researFh reSort that reIleFts the researFher’s aEilit\ to illustrate or desFriEe the corresponding phenomenon. Sanitation issues at the Kaneshie Market are very important to the health of the many people that use the market and so this approach helped the researcher to clearly describe the real issues concerning sanitation in the market. 3.3 Research desig n 7he researFh desiJn Ior the stud\ is Tualitative researFh desiJn. ³2ne oI the greatest strengths of the qualitative approach is the richness and depth of explorations and desFriStions´ 0\ers,  . :ith a Tualitative researFh desiJn, the researFher is Sart oI the study itself and must be flexible enough to follow up on observed leads and take on-the-spot decisions (Manicas & Secord, 1982). This is because qualitative research tries to study, understand and interpret things in their natural environments (Denzin &Lincoln, 2011, p.3). This approach is appropriate for the study because it helped the researcher to clearly understand the respondents needs as well as their concerns from their points of view. There was also the flexibility to make some changes in the research process to address new dimensions that were originally overlooked by the researcher. The case study, an example of qualitative design, was used for the study. This approach was seleFted EeFause the stud\ orJani]ation’s aFtivities are Fontinuous SroFesses and thereIore Zill Ee ³Eounded or desFriEed Zithin Fertain SaraPeters, suFh as sSeFiIiF SlaFe and tiPe´ (Cresswell, 2013, p. 98). According to Stake (1995), case studies are useful when the researcher wishes to understand an issue, a problem or something that is of concern. Since the Kaneshie Market has constantly been judged in relation to other markets, the case study helped the researcher to understand the issues concerning the market by its own terms. Therefore, the case study provided an in-depth understanding of the case in question. With University of Ghana http://ugspace.ug.edu.gh 39 this method, the researcher was able to probe further based on the answers from respondents. Also, this design allowed the use of few pictures as forms of data collected (WSP, 2012). The study used the case study design by Yin, (2004). This design consists of three basic steps. Step 1 concerns defining the case after having completed an initial review of literature. Step 2 helps to determine whether to use a single case study or a set of several studies. The sinJle Fase stud\ ³Zill IorFe \ou to devote FareIul attention to that Fase ´ (Yin, 2004, p.5). This was particularly useful for the Kaneshie Market study since there was no comparison with other markets involved. Step 3 helped to determine whether to follow an existing theoretical perspective where the researcher would seek to test a hypothesis, or simply discover things from the scratch. These options gave the researcher the opportunity to choose what to do based on the research questions; that is not to follow any existing theories of sanitation in markets in order to avoid the limitations that might have arisen with such an approach. 3.4 Sources of data Both primary and secondary data were used in completing this research so as to improve the reliability of the study. The primary source of data is the respondents as they gave first-hand information concerning questions raised about Kaneshie Market Complex through interviews. This was through the interviews that were conducted. There were also direct observations by the researcher. The information that was gathered from these constituted the primary data. These provided data for triangulation. The other source of data is the secondary source. Secondary data refers to already available information that the researcher falls on to help identify gaps as well as support the need for further research. Those used for this study included documents from the Accra Markets Company Ltd. which contained information about the market. Others were published peer- University of Ghana http://ugspace.ug.edu.gh 40 reviewed articles and newspapers articles. These sources are often rich in information and can help direct the researcher on a fruitful path. 3.5 Sampli ng 3.5.1 Population of study The population of the study was the Kaneshie Market Complex. It was made up of all areas that fall under the management of the Accra Markets Company which is responsible for managing the market. The Accra Markets Limited is the company responsible for the management of the Kaneshie Market Complex and the Kaneshie Car Park. It was incorporated in 1972 under the Companies Code 1963 (Act 179). It is a Private Limited Liability Company and operates under Legislative Instrument 1043 of 1975. The market was FoPPissioned in . ,t’s vision is µto strive to Ee a SaFe-setter in the provision of modern markets, offering quality goods and excellent services thereby attracting large patronage and high reputation beyond the expectation of our Flientele and staNeholders.’ In terms of organization, the Board of Directors oversees the setting of policy and guidelines for effective running through the Managing Director and his assistant, heads of functional departments and various supervisors. The market was selected because it has been described positively in several regards by the Accra Metropolitan Assembly. In 2008 for instance, AMA Markets Assessment Report indicated that of the thirty (30) markets under its jurisdiction, the Kaneshie Market had first level infrastructure. The reports described the Jeneral Fonditions oI the ParNets as µSerIeFt’ and enFouraJed that PanaJePent oI the infrastructure should make sure that the place is always in very good condition. There are three main floors comprising the ground floor purposely designed for food and agricultural products, the first floor which is for items such as provisions, utensils and rubber University of Ghana http://ugspace.ug.edu.gh 41 products. The second floor is devoted to clothing and other materials. The market has about 10000 tenants and receives about 10000 customers and commuters daily. In addition to this, the market is also divided into groups according to likeness of activities. All fish sellers belong to one group headed by a queen. Same can be said of those selling diIIerent Ninds oI SroduFts, the various drivers’ unions aPonJ others. 7he various heads helS Zith the orJani]ation oI their PePEers and also seeN PePEers’ ZelIare E\ inIorPinJ management about their needs, suggestions and grievances. 3.5.2 Sample si ze In all, a total of 50 respondents were selected for the study. First, ten (10) officials of the Accra Markets Company were selected for interviews. They were made up of the general manager of the company, the head of the sanitation unit and one supervisor from the company. Others were ordinary staff of the market including cleaners, toll collectors and security men and women. The general manager was selected because of his oversight responsibility for the whole market as the person who must see to the general implementation of company policies. The head of the sanitation unit was also interviewed since she is directly involved in the sanitation situations in the market. Interviewing the supervisor as well as general workers was also necessary because it gave an indication of the knowledge base of employees on policies which affect their duties and actual activities. Kaneshie Market is being managed privately. Therefore, the onus lies on management to provide an enabling environment for sanitation promotion. In addition, twenty (20) tenants were also selected purposively. These are people who work in the market throughout the day and the week. It is the place where they make a living. Interviewing them enabled the researcher to understand the situations at the market from University of Ghana http://ugspace.ug.edu.gh 42 their point of view on hygiene and sanitation practices. It also helped to ascertain claims that were made by management towards sanitation. The researcher therefore selected those whose experiences and activities demand high observance of hygiene and sanitation. Even though individuals were selected, the closeness of the stalls were such that other tenants took part freely in the interview process as they shared and verified information from one another when probed. In addition, the presence of other tenants throughout the interviews helped the tenants to also attend to customers who called at their shops. Those given priority included cooked food sellers, meat, fish and live birds traders, grinders and vegetable sellers. Also, twenty (20) customers were also selected purposively. This was to make sure that those interviewed have had contacts ranging from several years to few years and can describe changes over the years and first time observations respectively. Customers are very important stakeholders in the market. Customers of Kaneshie Market may have many reasons for choosing the market over others. It is also possible that they had some sanitation needs while they visit the market. Initial contact with the customers in the market proved quite difficult. The researcher therefore selected fifteen (15) customers who were already known to the researcher who granted interviews in their homes rather than the market where they often go to buy or shop. Interviewing them also helped explain the sanitation situation at the market. Three customers granted interviews as they drove home from the market. Only two customers were interviewed in the market. Here also, several people in the various homes joined in the interviews. 3.5.3 Sampli ng techn iqu e For qualitative data, purposive sampling was employed. It is a non-probability sampling technique. Neuman (2007) explained that it is often used when a researcher tackles unique cases that require in-depth information. Kaneshie market was purposively selected since it is University of Ghana http://ugspace.ug.edu.gh 43 considered the best of the markets in Accra by AMA. The purposive sampling was used for all respondents. This is because the researcher already had in mind a predetermined or specific group from which all respondents were selected. 3.6 Limitations of the study The following are some limitations that occurred: 1. There was the concern initially of the possibility of respondents not giving the right information or withholding important pieces of information, especially those that may iPSliFate theP in duties or siPSl\ Sut a ³FolleFtive µPantra’´