Cities 142 (2023) 104555 Contents lists available at ScienceDirect Cities journal homepage: www.elsevier.com/locate/cities Dealing with COVID-19 in Ghanaian urban shared low-income housing: What it reveals and the planning implications Irene Appeaning Addo *, Deborah Atobrah, Mjiba Frehiwot, Benjamin Kobina Kwansa Institute of African Studies, University of Ghana, Legon, Ghana A R T I C L E I N F O A B S T R A C T Keywords: Compound and shared low-income houses in Ghana have economic, social, cultural, and familial advantages. COVID-19 Yet, COVID-19 and its related lockdown and home confinement in two urban cities, Accra and Kumasi, raised Compound house questions about the appropriateness of staying in a compound house while observing the COVID-19 protocols. Shared low-income housing Whereas a few studies have underscored the ineffectiveness of COVID-19 protocols in low-income shared houses, Socioeconomic status Accra these assume a homogeneity of such households without reflecting on the diversities that exist among and be- tween the different categories of low-income households and the imperative nuanced implications for the spread of infectious diseases. Against this backdrop the paper employed qualitative methodologies of in-depth in- terviews and non-participant observations to interrogate the experiences of low-income households’ utilisation of space as they observed COVID-19 protocols. Drawing respondents from four low-income communities in Accra, the authors examined how traditional family households and non-traditional family households implemented the safety protocols and their implications for shared housing. Issues of sharing inadequate communal facilities and public health concerns as well as lack of access to inadequate water and living spaces impacted the respondents’ COVID-19 experience. The study discovered that households’ socioeconomic status is directly related to the management of epidemics in urban spaces in Ghana. 1. Introduction measures were underpinned by education on the disease and its trans- mission as well as preventive measures such as personal hygiene, Ghana recorded its first two cases of COVID-19 in March 2020, which including the washing of hands with soap under running water or led to the government immediately instituting measures to detect, alcohol-based hand sanitizers and wearing face masks and they were contain and prevent the spread of the disease. Some of the measures countermeasures that would minimize the impact of the disease on the included a ban on all public gatherings, closure of schools, churches, Ghanaian populace. mosques and other places of worship on 16th March (Agormeda et al., Research on COVID-19 and urban planning in low-income commu- 2020; Upoalkpajor & Upoalkpajor, 2020). The country banned entry for nities in Ghana has primarily focused on urban slum dwellers percep- travelers coming from a country with more than 200 confirmed COVID- tions, attitudes, and observance of the protocols (Aberese-Ako et al., 19 cases within the previous 14 days on 17th March and required a 2023), the urban poor strategy in mitigating their risk of infection mandatory quarantine of all travelers that arrived in the country 48 h through appropriate hygienic behaviour and following social distancing prior to the closure of the country’s borders on 22nd March; a partial rules (Durizzo et al., 2021), the practicality in observing the protocols in lockdown of Accra including Kasoa in the Central region and Kumasi on urban poor communities using secondary data sources (Yeboah et al., 30th March. With the institution of the partial lockdown in the two 2020) and observing the protocols among homeless and slum dwellers largest cities in Ghana, households were required to stay at home and (Morgan, 2020). Specifically, some of the works have looked at gov- observe the outlined protocols of personal hygiene and physical ernment policies on ‘free water’ initiatives during the pandemic distancing. The restrictions on Accra and Kumasi were lifted on April (Amankwaa & Ampratwum, 2020) and the coping strategies adopted by 20th. However, a new law that enforces the use of face masks was households to manage the impacts of COVID-19 on households (Iddi mandated (Kenu et al., 2020). According to Kenu et al. (2020), these et al., 2021). Another study that looked at architecture, sanitation and * Corresponding author. E-mail address: iappeaningaddo@ug.edu.gh (I. Appeaning Addo). https://doi.org/10.1016/j.cities.2023.104555 Received 22 February 2023; Received in revised form 18 July 2023; Accepted 27 August 2023 Available online 15 September 2023 0264-2751/© 2023 Elsevier Ltd. All rights reserved. I. Appeaning Addo et al. C i t i e s 142 (2023) 104555 COVID-19 in urban low-income communities highlight the link between investigated how they made changes to their living arrangement to sanitation, public health and architecture and calling for re-engagement implement the COVID-19 protocols in ways that reflected their material of architectural professionals with the design of sanitation facilities in reality. those communities (Iossifova et al., 2022). From all the studies on the impact of COVID-19 on urban low-income communities in Ghana, the questions that arise are, how did urban low-income households confront 1.1. African Cities, urban planning, housing and epidemics the pandemic in their shared buildings? Did anything change in their living arrangement and sharing of communal spaces? While Iossifova Globally, urban cities, while more dense than rural areas or the et al. (2022) and Yeboah et al. (2020) used secondary sources to countryside offer more robust health care resources to residents than examine the use of shared facilities in urban low-income communities in their rural counterparts (AbouKorin et al., 2021). However, class im- Accra, this research uses primary data and real-life experiences of urban pacts access to infrastructure, government services, security, and sani- low-income households as they confronted the pandemic and lockdown tation (Kimari, 2021). Njoh (2009) argues that urban planning in in their communities in Accra while remaining in the compound housing African urban cities have a historical colonial legacy that exacerbates with shared facilities. According to Sampson and Johannessen (2020), the class divide. This legacy contributes to cities that are often over- “‘real-life’ vignettes have the potential to allow for the elicitation of rich, populated, home to low-income residents, have formal and informal detailed, and frank comments because of the ways in which they allow housing units and lack proper basic human services. researchers, by association, to temporarily attain the status of an ‘in- United Nations estimate that about 54 % of all global population live sider’ within a group” (2020, 70). in cities. According to the World Urbanisation Prospects, this proportion Implementing the COVID-19 protocols at the micro scale or the is expected to increase to 60 % by 2030 (UNDESA, 2018). Virtually all house level in urban low income communities is challenging. This is the expected growth in the world population will be concentrated in the because the houses are typically crowded and they share communal urban areas of the less developed regions (UNDESA, 2018). Sub-Saharan facilities such as toilets, washrooms and kitchen (Appeaning Addo, Africa, for instance, has experienced a huge increase in the rate of ur- 2016; Afram & Owusu, 2006). Although family compound houses in banisation (Sakketa, 2023). Urbanisation and the growing population Ghana are losing their value (Danso-Wiredu & Poku, 2020; Korboe, present both challenges and opportunities in cities. For example, the 1992) and undergoing transformation and gentrification in urban cen- unique character of population and investment agglomeration that cities ters (Asante & Ehwi, 2022), they are still the primary source of afford- possess could serve as a link for economic, energy, environment, science, able housing for the low-income households in urban areas. Morgan technology and social and economic elements of development. On the (2020) in a commentary argued that the prevention etiquette of social other hand, prevailing poverty, inequalities, unemployment and envi- distancing has become an unattainable goal for the majority of slum ronmental issues, present planning challenges for cities as the growing dwellers and the homeless in Ghana, owing to the absence of stan- urban population has driven ever increasing numbers into informal dardized housing conditions and basic services that support such a shelter in the burgeoning slums in many cities. African urban cities are practice while suggesting measures to decongest such spaces. These also experiencing class and race divide which impacts access to infra- factors may attribute to the argument of Asante et al. (2022) that structure, government services, security, and sanitation (Kimari, 2021). COVID- 19 impacts are expected to be more severe on poor households, There is significant shortage of decent affordable housing and the especially in resource-constraint economies such as Ghana with a housing conditions and the physical environment in which many of the poverty rate of about 24 %. Aberese-Ako et al. (2023) also explained that urban poor live, work, and raise their children lack clean and adequate vulnerable populations such as rural and urban-slum dwellers in Ghana water supply. In addition, the poor urban communities lack trans- are more likely to suffer from the deleterious socio-economic and health portation infrastructure which is reducing efficiency with which devel- effects of COVID-19. The practicality of observing social distancing in oping city’s function. low-income communities is challenging. This is because the socio- Urban planning and management decisions affect the liveability of economic conditions of the urban poor make them use uncoordinated cities. Several studies have demonstrated the relationship between public transport systems, patronize unorganized markets and have urban planning and public health from the perspectives of trans- limited access to water and sanitation (Yeboah et al., 2020). Hence, portation, mental health, and disease epidemics (Astell-Burt & Feng, Anaafo et al. (2021) proposed an agenda for addressing future epidemics 2019; Corburn, 2004; Duhl et al., 1999). Giles-Corti et al. (2016) iden- in public spaces to revolve around the co-evolution and co-creation of tified local and regional interventions that when combined would pro- new forms of societal values that are less materialistic and individual- mote healthy cities calling for a multisector development approach istic but rather more egalitarian in nature. involving health officials and city planners to deal with non- Again, the wholesale management of COVID-19 in low-income communicable diseases. According to Davis (2022), planning, which communities in Accra without any consideration of the existing urban encompasses city design and planning policy, has both constructed the characteristics is problematic. The lumping together of low-income challenge of infectious disease epidemics while at the same time households and communities as homogenous entity without recognis- developed processes, actions and strategies to contain, isolate and treat ing the differences and unique characteristics of each community did not them. Furthermore, planning has shaped the trajectories of other epi- create a sense of ownership and did not introduce context-specific demics, “and/or about the relationship between understandings of dis- strategies to confront COVID-19. Research by Anaafo et al. (2021) ease in cities and the development of planning control and regulation” revealed serious structural problems in the housing, transport, health (Davis, 2022,1). This is because the emergence and spread of diseases, as and water, sanitation and hygiene sectors in Ghana which inhibited the well as their tendency to re-emerge is dependent on the interplay of efficiency of the urban systems limiting policy makers to effectively deal several environmental factors (Davis, 2022). with pandemics in cities. The paper discusses the challenges confronting The incidence of COVID 19 has many social and spatial implications urban low-income households in shared housing in dealing with epi- on built environments while generating new patterns and configurations demics and argue that urban planners and policy makers knowledge of of use. According to Megahed and Ghoneim (2021), architectural and the facilities present in urban low-income communities will enable them urban spaces relating to infectious disease epidemics are not only to develop effective disease management. The objectives of the study planned to quarantine based on immediate and precautionary measures were, to examine in what ways low-income households in shared but has design and planning implications in all building types and urban housing negotiated their spaces during the lockdown in Accra and spaces. According to Hoffman (2014), some of the contributing factors leading to the spread of epidemics include, demographic and 2 I. Appeaning Addo et al. C i t i e s 142 (2023) 104555 environmental conditions, advances in technology, economic develop- Nima is in the Ayawaso East municipality, while Madina is in the La ment, changes in land use, and international trade and travel. Nkwantanang-Madina municipality as indicated in Table 1. The 2021 The risk factors for COVID-19 include high population density in a population and housing census identified Accra Metropolitan Area as particular space, low-income situations, and other socio-political issues 100 % urban with a population of 284,124 persons and average like racism (Frumkin, 2021). Fears of transmission and prolonged public household size of 2.8 persons. Ayawaso East municipality has a popu- health crisis deepen the risk (Megahed & Ghoneim, 2021) and results in lation of 53,004 persons and average household size of 3.1 persons, and health inequities and injustices in these spaces and the built environ- it is also 100 % urban. La Nkwantanang Madina municipality has a ment in general (Hasan et al., 2021). According to Frumkin (2021), it is a population of 220,757 persons and average household size of 3.0 per- general knowledge that the COVID-19 pandemic has deepened the sons with 85 % of the municipality being classified as urban. urban divide, where urbanites are globally faced with an urban-poverty Nima is a low-income community and one of the largest and the phenomenon. The policy response to the management of COVID-19 has oldest Zongos1 in Ghana with origins dating as far back as 1836. usually included restrictions to human movement, including staying at Although Nima has been described as a slum community (Abass & home, changes in mode of travel, human movement to less dense areas, Kucukmehmetoglu, 2021) and having a socio-spatially marginalized design of buildings, and an increase in the importance placed on outdoor population left behind by urban development, Ghana’s Ministry of Inner spaces (Frumkin, 2021; Lai et al., 2020). Other pandemics in history City and Zongo Development (MICZD) has sought to improve the social brought about changes regarding sanitation, innovation in architectural and infrastructural development of Zongos, or ‘stranger’s quarters’ in planning, improved infrastructure, among others while Pinheiro and Ghana. Now, the layout of Nima introduces a state of fluidity that drives Luís (2020) point out the relationship between the built environment opportunity as social networks form the basis for social capital and infectious disease spread. (Appeaning Addo, 2013; Ofosu-Kusi, 2020). While Nima is predomi- According to Ujunwa et al. (2021), the adverse economic effect of nantly a low-income multi-ethnic community, James Town, on the other COVID-19 in African countries is uneven and appears worse, resulting in hand is predominantly a Ga indigenous community located along the increased extreme poverty, pressure on the health sector, and tight Gulf of Guinea albeit with a minority of non-Ga inhabitants. It is densely financing constraints, and the limited capacity of governments to pro- populated with about 250 persons per hectare and the housing quality is vide safety-nets for the most vulnerable. The authors argued that the low. Although vulnerability in James Town is high, it is designated as pandemic is exacting a larger toll on the economies of Sub-Saharan tenure-secured and matured slum2 by the Accra Metropolitan Authority African economies like South Africa, Nigeria, Kenya, and Ghana and (Tutu et al., 2017). In 2020, over four hundred permanent and tempo- that the enormous benefit Africa derived from globalization, during the rary structures were demolished to enable the construction of the James COVID-19 pandemic, calls for a rethink of African Union’s globalization Town Fishing Harbour Complex, an ultra-modern fish landing facility, strategy, as well as strategies to mitigate African economies from the by China Aid. Kisseman is a small informal migrant low-class commu- vulnerability of future pandemic. nity with a population of less than 5000 residents and located close to These events led to uneven and complex urban planning in- middle-class residential areas of Legon, Achimota and Dome. Madina is terventions (Silver, 2015) reinforced by the colonial planning approach a fast growing and a heterogenous sub-urban middle-class settlement used in planning for African urban cities. The planning approach has located in Accra, about two miles north of the University of Ghana, been condemned by Appeaning Addo and Mba (2022) as piecemeal and Legon. It hosts a big market with market days on Wednesdays and Sat- undertaken as part of a nationalist agenda. According to Bolay (2015), urdays. All these communities benefitted from the government of Ghana efforts made to plan cities in emerging and developing countries are food intervention during the COVID-19 lockdown instituted in Greater confronted with multiple issues including poor socio-economic levels, Accra and Kumasi Metropolitan areas. low levels of public investments, weak local administration, and large The residential stratification of these communities allows for dependence on external donors. important continuities and legacies from the past and showcases neighbourhood attachments that is rooted in indigenous cultural tradi- 2. Study areas tions and lived experiences and that act as social capital for households (Owusu & Baidoo, 2021; Appeaning Addo, 2013; Arguello et al., 2013). Four communities in the Greater Accra Region were selected for the However, Tutu et al. (2017) observed that migrants who live on the survey. Accra is both the administrative and economic capital of Ghana margins of society are adversely impacted by poor environmental con- and hosts the headquarters of several government agencies. It is also one ditions that make them susceptible to environmentally induced diseases of the cities that was most affected by the COVID-19 pandemic in Ghana. such as malaria, cholera, and typhoid. It was thus inferred that people According to the Ghana Health Service (GHS, 2021) statistics, the staying in the margins of the urban areas are likely to be affected COVID-19 count in the Greater Accra Region as of 31st December 2022 significantly by the COVID-19 pandemic. stood at 97,320, thus being the leading region with the most cases of The 2021 national population and housing census estimates the total about 57 % of the national total of 169,586 and followed by the Ashanti number of compound houses to be about 28.5 % (533,286) of all housing Region with a total count of 22,619 cases. The high incidence of the stock in Accra. Compound houses bring together extended families and COVID-19 cases in Accra and Kumasi propelled the government of offers close kinship connections. Most compound houses are multi- Ghana to lockdown these two cities and the surrounding communities at habited and it is home to different households who could form part of the peak of the pandemic in March 2020. On May 2020, the BBC re- the extended family or may not have any blood relations (Addo, 2014). ported that the Greater Accra Region was leading COVID-19 infections In this kind of living arrangement, a plethora of socioeconomic and recording 1852 cases out of a total 2169 in Ghana (BBC, 2020). Within the same month, the Ghana News Agency (GNA, 2020) reported that the Ghana Health Service identified Tema, Korle Klottey, Accra Metropolis 1 and Kpone Katamanso as hotspots for the COVID-19 cases with the Accra Zongo refers to a community that is dominated with the Hausas and asso- Metropolis reporting 10 cases and La Nkwantanang-Madina Munici- ciated with a Moslems. Samuel Ntewusu (2011) has researched extensively on pality reporting four cases in May. These statistics made the Accra Zongo communities in Ghana. 2 The term ‘slum’ in this article is being used due to is prominence in existing Metropolis and La Nkwantanang-Madina municipality places of concern literature. However, the authors contend that this word immediately conjures for COVID-19 infection and ideal study areas for the research. images and ideas about residents in these areas that is derogatory. The classi- The four communities that were selected for the survey are Nima, fication of communities identified as ‘slums’ should be researched to include a James Town, Kisseman and Madina. As indicated on the map in Fig. 1. race, class and nation analysis, although, this paper is not in a position to Jamestown and Kisseman are located in the Accra Metropolitan Area, address this important topic. 3 I. Appeaning Addo et al. C i t i e s 142 (2023) 104555 Fig. 1. Map of Ghana showing the four study communities in Accra including Nima, James Town, Kisseman and Madina. Table 1 Summary of population statistics in the four study communities in the Greater Accra Region. Administrative areas Study communities Population by administrative areas Average household size Number of sleeping rooms in dwelling units Accra Metropolitan Area Jamestown 284,124 2.8 97,937 Kisseman Ayawaso East Municipality Nima 53,004 3.1 16,859 La Nkwantanang Madina Municipality Madina 220,757 3.0 71,483 Source: 2021 Population and Housing Census. cultural relationships develop (Addo, 2014). Residents benefit from the COVID-19 protocols in the compounds. Generally, respondents spoke existing informal social networks and rent-free accommodation (Danso- about how they, their household and compound members utilised space Wiredu & Poku, 2020). At the same time the sharing of facilities is a and managed relationships as they observed COVID-19 protocols of source of conflict in these houses. Compound houses are privately lockdown, hand hygiene and social distancing. A head of household or owned. any responsible adult who could answer the questions was interviewed from each compound house. In each community, a community facili- 3. Research method tator was first identified to assist in obtaining permission from com- munity leaders for engaging with community members. All the A qualitative research approach was used in the data collection with necessary traditional and community protocols for such activities were each of the authors leading data collection in one of the four commu- observed. The community facilitator then introduced us to residents in nities. A semi-structured interview guide was used to collect data on the the community who were willing to participate in the research. In- household characteristics, the characteristics of the compound house, terviews lasted between fifty minutes to an hour and a half, and each the sharing of facilities during the lockdown and the observation of respondent got token gifts of sanitisers, soap and paper tissue to 4 I. Appeaning Addo et al. C i t i e s 142 (2023) 104555 Table 2 Summary of residential characteristics and research approach of the four study communities in Accra. Locality Characteristics of community Research approach Number of respondents Language of communication Jamestown Low-class indigenous Ga • Community entry gained through a community facilitator. 7 respondents all family Ga community • Compounds randomly sampled based on availability and members. willingness of participants. • In-depth interviews of household heads and representatives. • Interviews recorded and transcribed. Kisseman Low-class migrant community • Community entry gained through the traditional leader or the 7 respondents (1 chief/ landlord, English, Twi and Ga chief. 2 tenants, 4 family members) • Compounds randomly sampled based on availability and willingness of participants. • In-depth interviews of household heads and representatives. • Interviews recorded and transcribed. Nima Low-class Muslim Zongo and • Reconnaissance survey done prior to survey. 4 respondents (3 family English, Hausa multi-ethnic community. • Community entry gained through a community youth leader. members, 1 tenant) • Compounds randomly sampled based on availability and willingness of participants. • In-depth interviews of household heads and representatives. • Interviews recorded and transcribed. Madina Middle-class Muslim Zongo and • The researchers identified individual compounds without going 8 respondents Twi, Hausa and multi-ethnic community through an intermediary due to the urbanized nature of the (1 chief/ landlord, 2 landlords, 5 English community. tenants) • Compounds randomly sampled based on availability and willingness of participants. • In-depth interviews of household heads and representatives. • Interviews recorded and transcribed. reinforce the need to keep the COVID-19 protocols even though it was a 4. Results year after the pandemic. Fieldwork was conducted in October 2021. Ethical consideration of confidentiality and anonymity, voluntary In all 26 persons were interviewed from four communities – four participation and the utmost protection of participants’ interest was from Nima, seven from Kisseman, eight from Madina and seven from observed in the conduct of the study. However, due to the unique James Town. Four of the respondents were landlords, eight were tenants characteristics of each community, different strategies were employed and 14 were family members who were staying in family houses and by the four groups of researchers and their assistants in the collection of were not paying rent. The ages of the respondents ranged between 30 data in the four study communities. and 87 years and in one house in Nima up to 40 persons were staying on In Madina, due to the diverse nature of housing in the community, one compound with 25 rooms. In other houses, there were less than 10 the team spent two days prior to data collection to do a reconnaissance persons staying on a compound. survey and to identify compound houses of interest. Two main localities From the interviews, we observed that although the people com- in Madina (a Muslim Zongo community and a multi-ethnic densely plained about hardships, they showed resourcefulness and demon- populated community) were selected for the data collection. In all, eight strated innovation in the management of COVID-19 in the various interviews were conducted in eight households, comprising house compounds. Government assistance in the form of subsidized water and owner/landlord (2), chief (1), and tenants (5). Six of the interviews were electricity supply made a great difference in helping the respondents to conducted in Twi (the dominant local language in the area). One of the implement some of the COVID-19 protocols of regular hand washing. respondents spoke Hausa, but her sister interpreted it in Twi. The last Yet in terms of living arrangement, the urban households could not one was in English. make any changes because they were limited in their access to addi- In James Town, which is predominantly an overcrowded and tional housing. Landlords had already rented part of their rooms out to indigenous community of the Ga people of Accra, had its own unique tenants and the tenants could not make any extensions to the rented characteristics that promoted a healthy communal living. In-depth data units. was collected from seven respondents comprising four females and three males, randomly selected from interspersed households to ensure that 4.1. Housing characteristics and accessing utility services during COVID- the data is general and varied enough. All interviews were conducted in 19 pandemic and lockdown Ga. In Kisseman, members of the Chief’s household were among the Generally, the walls of the buildings were constructed with sandcrete seven household heads interviewed besides other households within the blocks. It was only in Nima that some houses were built with mud. community. The various interviews were transcribed and coded into However, those walls were rendered with cement plaster making it different themes. All interviews were conducted in English. impermeable to rain. While all the compounds were enclosed with In Nima, four households were interviewed from different houses. several room units, there were differences observed in the configuration Each compound house had a minimum of 6 households. One of the in- of the compound houses. The Kisseman’s chief palace comprised three terviews was conducted in Hausa with interpretation, while the three different compounds, namely the main compound being the oldest and remaining interviews was conducted in English with occasional Hausa occupied by the respondent and his household, and two detached engagement. compounds occupied by tenants and extended family members. The The interviews were recorded, translated, and transcribed in English main compound had a central and a spacious courtyard where outdoor for analyses. The collected data from the four communities were not activities such as washing, cooking and relaxation takes place. The necessarily compared but compiled into a single data unless there were compound for the extended family members had a similar arrangement. unique information that needed to be captured. The residential char- However, the tenants did not have any central courtyard but narrow acteristics and research approach have been summarized in Table 2. alleys leading to several quarters of the house as in Fig. 2. Cooking, washing, and bathing of children are often done in front of their room 5 I. Appeaning Addo et al. C i t i e s 142 (2023) 104555 Fig. 2. Very small alley ways leading to individual housing units in a com- Fig. 3. Hanging of cloths and storing of household items extending onto the pound housing in Kisseman. street in James Town. Source: Photograph taken by Irene Appeaning Addo in October 2021. Source: Photograph taken by Deborah Atobrah in October 2021. units leaving very little space for co-tenants to manoeuver their way and night. However, some residents preferred to leave it half open through the maze. during the day, to ensure privacy in the rooms and in the night, they During the COVID-19 pandemic and lockdown, the courtyard preferred to keep the windows shut for security reasons. Very few houses became an important space for socialization, Islamic prayers and had battened and ledged windows, wooden jalousie windows and glass relaxation for the households in compound houses. Households sliding windows. However, during the pandemic, some tenants in congregated in the courtyards and the streets to socialize while others Madina replaced their jalousie windows with louvre blades to allow chose to remain indoors. The large courtyards in some of the buildings constant flow of air into their rooms. This renovation was done with the were used as outdoor space for food preparation, eating, washing and explicit approval of the landlord. Generally, tenants do not have the children’s playground and points of socializing among the men as they right to alter their rented premises. The small windows meant that the sat under big trees to play games and to chat contrary to the COVID-19 rooms were very warm throughout the day. To address the heat, some of protocol that advised against social gathering. In Nima and Madina, the respondents installed ceiling and standing fans in their rooms, but households staying on a compound would gather to offer Islamic the inadequate window sizes made ventilation of the room inefficient. prayers. Most of the enclosed courtyards had a single entrance and exit. Other respondents who were able to afford air conditioners installed it in In James Town, the organization of the housing units were segregated their rooms by taking advantage of the government subsidized elec- and not clustered around a central courtyard, sitting right at the edge of tricity supply plan. One respondent in Nima could not open her window roads. Their outdoor activities spilled over into the streets lying in front because a shop had been constructed right beside the house. of the houses as in Fig. 3. The increased frequency of interaction among Overcrowding in compound houses is a common feature in urban the households gave the impression that the house was overcrowded. A areas in Ghana. However, with the incidence of the pandemic, house- respondent in Nima explained that even though her room unit was holds had to adjust their living arrangements. Despite the adjustment to bigger than most rooms on the compound, she still had the impression household arrangements in Nima, family compounds were still active. that it was crowded because of the fact that everyone stayed indoors At the time of the interview researchers observed that one compound because of the lockdown and fear of the COVID-19 disease. was the location where Sobolo3 was being manufactured to sell. The two Notwithstanding the differences in layouts, the single shared rooms in-laws that were preparing the two barrels full of Sobolo for sale resided had similar characteristics. The room sizes were about 14 ft by 14 ft or at a different compound. This further complicates the number of people less and they were shared by families made up of adults and children. The rooms had either a single or double bay windows, some slightly smaller than the standard 5 ft width. These windows are placed on either one side of a wall or on two sides of the walls. Most of these windows 3 Sobolo is a drink made from hibiscus tea in most West African countries and were adjustable glass louvre blades that are often left open during day some Caribbean countries. 6 I. Appeaning Addo et al. C i t i e s 142 (2023) 104555 utilizing the facilities in the compound and their exposure to COVID-19. 4.2. Confronting the COVID-19 pandemic and lockdown – challenges and In the same household our respondent in Nima explained the changes support she and her household had to make to fulfill the COVID-19 protocol of social distancing and avoiding overcrowding. She commented, The respondents experienced the impact of COVID-19 in various There is one room in which three of them [children] sleep in, my ways. Generally, the respondents acknowledged that they were signifi- husband and I also sleep in one and we had an empty room in which cantly impacted by the incidence of COVID-19 as it affected their live- no one used to sleep in but since the outbreak of the covid, I made lihood and businesses. Some of the respondents were seamstresses, some of the children sleep in it. traders, paid nanny, drivers, etc. While some mentioned that they were physically sick and financially challenged, others complained of mental Most households living in compound houses had access to basic exhaustion resulting from living in constant fear. A respondent in Nima utilities such as electricity and water from different sources including was particularly worried that the pandemic disrupted her religious pipe borne water, wells, bore holes with mechanized pumps and large practices and the constant fear of having her family members infected plastic tanks for water storage as shown in Fig. 4. In other houses in because of the nature of housing arrangement. She commented, Madina, members of the house did not have access to water supply in the houses and so they were compelled to fetch water from communal I do not know what kind of pandemic this is that prevents us from sources or from the neighbour’s house. This arrangement was possible even gathering at the mosque to fellowship with our fellow brothers because of the free water supply policy put in place by the government. and sisters … Usually when one is sick, he/she is able to mingle with The government also implemented a highly subsidized to almost free others but as for this covid you are not able to do so, and you even water supply to the low-income communities. This move was to have to live with your own child in fear. If not for the fact that it is encourage regular washing of hands among the people. In Nima, the God who has given us children, one would have had to separate households interviewed did have access to water, however, outside of himself/herself from his/her own children because of this covid. At one of the compounds was a public bathroom facility. This increased the first when one coughs, what we the Muslims used to say was “Hausa: foot traffic in front of the house and thus increased exposure to COVID- Alhamdulillah i.e., thank God” but now, when one coughs or sneeze 19. In Kisseman, the local government ensured that there was constant everyone tends to fear. It is covid that has brought all these. supply of water by refilling private and government installed storage Another respondent, who clearly showed her frustrations com- tanks in the community. Unfortunately, the water was sold to the plained bitterly about the inefficiencies associated with the government community members although at half the price as recounted by this food intervention but explained her strategy of feeding her family, petty trader in kisseman. She said, I got nothing during the lockdown. It was my daughter who brought There was a woman here who initially gave us access to fetch water me a few items, a bag of rice and other stuff. I bought corn dough from her pipe for free when the government made the announcement from the market to prepare kenkey and that was what we ate. My that they will give us free water but later on she got scared the mother used to prepare kenkey to sell and I picked up the skill from government may renege on the directive, so she sold it to us at a her. So, I cooked a lot of kenkey and that was what we survived on. reduced price. During the lockdown in Greater Accra and Kumasi, the Metropolitan Households took advantage of the free water to place ‘veronica’ Authorities, supported by organisations and philanthropists donated buckets or buckets with installed taps, at the entrances of their com- food packs to needy persons. Churches also donated cash and food pounds or rooms and all members of the house and visitors were support to families to deal with the hardship that households and in- required to regularly wash their hands. dividuals were facing as a result of the lockdown and the halting of all In almost all the compounds that we interviewed, toilets and bath- business activities. To deal with the challenges and hardships that the rooms were shared by both the resident landlord and the tenants. It is pandemic had introduced, reaching out to family members in and only when the landlord is absent that the facilities are used by only the outside the compound became one of the survival strategies as reported tenants. However, in Kisseman, one resident landlord explained that his by a respondent in Nima, household does not share the toilet and bathroom with the tenants. In James Town some residents chose to patronize public toilets and bath- We were in difficult times because I didn’t see anyone here who came rooms, partly due to inadequate facilities for the large population in the to help us. It was our brother here whose uncle lives abroad who houses, poorly maintained facilities and the cost involved to clean and remitted us some money. When we received the money, it was as if maintain the facilities. One respondent in Kisseman explained that after we had not seen money before because things were very difficult for each use of the toilet, she had to purchase a bucket of water to flush the us. toilet in the house and that was equivalent to the amount she pays to use All the respondents expressed their frustrations with the incidence of the communal toilet facility and so she decided to patronize the public the epidemic and the attendant lock down. They were particularly facility. A respondent in Kisseman explained that the public toilet was exasperated with the financial challenges that they encountered. As at just about 150 m away from the house and so she could easily walk. the time of the interview in October 2021 some of the households had Generally, each compound had only one toilet and one bath house to not recovered from the shock. The government of Ghana food inter- serve a population of more than 10 persons or three households. In vention was not efficient since it did not reach the urban poor as was Nima, some of the houses had just bathrooms while others had both initially planned. A lady in Kisseman suggested that the best way the toilet and bathroom inside the room unit. This meant that tenants government could share resources for everyone to benefit was for them needed to patronize the public toilets which they explained that it was to use the digital address system. In 2017, Ghana launched the digital just a three-minute walk from the house. There were instances when address system through the Ghana Post. conflict over the use of a particular facility had led to the locking up of Efforts were made by households to observe the COVID-19 protocols the facility and exclusively reserving it for the landlord’s use or tenants of sanitising and washing hands regularly by introducing veronica who contributed to the cleaning and maintaining of the facility. A buckets at the entrance of the buildings. These buckets were regularly landlord in Kisseman explained that right from the beginning of the re-filled with soap water. However, the issue of observing social tenancy, he directs his tenants to use the public toilet and that it is only distancing was hardly observed because only the courtyards and the him and his household that uses the toilets on the compound. streets served as places of socialization. People would often gather to chat and exchange pleasantries. In other instances, co-tenants stayed in their rooms because they were afraid and only came out when it was 7 I. Appeaning Addo et al. C i t i e s 142 (2023) 104555 Fig. 4. Water purchased from private water storing facilities in Kisseman. Source: Photograph taken by Gertrude Aidoo in 2021. necessary. improve low-income shared housing structures. Others desired to have their own supply of water in their rooms. Sharing communal facilities like the public toilets during the pandemic raises the question of public 4.3. Living and using shared and communal facilities under COVID-19 health concerns. A respondent in Kisseman expressed her fears, and lockdown One thing that really worried me was sharing the toilets with the In Kisseman, most of the respondents indicated that they did not public. Even before the lockdown people were not keeping the place have to make any adjustments to their living arrangements during the clean so I had to use detergent to clean up before using it because lockdown. Instead, they rearranged their sleeping arrangement by women easily contract infections from such places. The public toilet deciding that only two persons would sleep in a room while the is small, and it is poorly ventilated so that really troubled me. My remaining members would sleep in family houses within the neigh- wish is that the government will ensure that every house has its own bourhood. Others decided to sleep in opposite directions on the bed as toilet facilities ….. Let’s consider children, they do not have the sense explained by a respondent. to clean up before using the place so they can contract serious in- fections from using the place. I slept with my head at the top of the bed and my feet at the bottom. My wife slept ‘upside’ down with her head at the foot of the bed. My children also didn’t sleep together at that time. One slept on the floor 5. Discussion and the other slept in the couch. 5.1. Challenges The respondents contended that they could not alter their living arrangement because of the limited space and room units available to 5.1.1. Sharing and accessing communal facilities them. A family renting a one or two room unit could not expect to have From the results issues of sharing inadequate communal facilities as additional rooms to implement the policy on social distancing. However, well as inadequate water and sanitation facilities impacted respondents’ views were expressed on the ideal housing situation that they would COVID-19 experience in the four low-income communities in Accra. prefer to deal with the pandemic. A self-contained facility without This finding supports the assertions of several authors who have found a anyone sharing the bathrooms and toilets and having adequate sleeping positive correlation with sharing facilities and the risk of infection. rooms were the preferred choice of the households. One respondent in Hasan et al. (2021) observed in Bangladesh urban slums that there was a Madina strongly commented about the inconveniences associated with significant positive relationship between the risk of COVID-19 infection the sharing of bathrooms, toilet and kitchen and said that her preference and the use of shared facilities especially in crowded spaces. According of an ideal house in the era of COVID-19 pandemic would be a non- to the authors COVID-19 transmission could be through droplet in- sharing house. She remarked, fections and physical distancing is one of the recommended strategies to I’ll make sure that everybody has his/her own self-contained unit manage the disease. Meanwhile, among the low-income communities in [having toilet, bathroom, and kitchen facilities in the room], Accra, compound housing with shared facilities is the predominant everything is in there……. housing type because of rental cost and familial arrangements. The in- heritance system allows families to bequeath houses to their children. Another respondent in Nima commented that she wished every Thus, compound houses are home to different households who could be household would be compelled through the by-laws to have its own part of the extended family or may not have any blood relations toilet and bath enclosed in their rooms and hoped that the pandemic (Appeaning Addo, 2013). In this kind of living arrangement, a plethora could be a strong reason for the government to embark on a project to 8 I. Appeaning Addo et al. C i t i e s 142 (2023) 104555 of socioeconomic and cultural relationships develop (Appeaning Addo, the lockdown and using water for cooking, bathing, and flushing the 2013) with residents benefitting from the existing informal social net- toilet. Although the government offered free water, not all the urban works and rent-free accommodation (Danso-Wiredu & Poku, 2020) low-income households benefitted from this directive. Some still had to notwithstanding the conflict over use of shared facilities. Compound pay a subsidized fee to access water. The challenge of accessing houses are privately owned by individuals and families, and the 2021 improved water during the pandemic in Ghana has been reported by population and housing census estimates the total number of compound several authors (Amankwaa & Ampratwum, 2020; Smiley et al., 2020, houses to be about 28.6 % (535,857) of all housing stock in Accra. Gbedemah et al., 2022). Gbedemah et al. (2022) observed that the main water accessibility challenge during the COVID-19 pandemic was the 5.1.2. Socioeconomic inequalities and access to toilets increased cost of water (41 %) and households had to adapt by storing The issue of sharing facilities in a pandemic situation highlighted the water and buying from vendors at an expensive rate. In the study poverty and socioeconomic inequalities that exist among urban house- communities households had to contend with the distance involved in holds in Accra. Research has shown that sharing sanitation facilities carrying water from a community pipe to flush the communal public increases the risk of infection and results in adverse health outcomes toilet. Water supply inadequacies are felt disproportionally in disad- (Heijnen et al., 2014) and this risk becomes pronounced under epi- vantaged communities despite the many political promises, policy ini- demics. The continuous sharing of toilets after several interventions by tiatives and interventions to stymy the existing inequalities in urban the Accra Metropolitan Authority (AMA) to install sanitary facilities water supply (Obeng-Odoom, 2012; Fiasorgbor, 2013). Oteng-Ababio questions Accra’s readiness to deal with future pandemics. In 2018 the et al. (2017, 185) have generally observed that in “developing countries, Accra Metropolitan Assembly launched a ‘one toilet one house’ project increasing urbanization amidst chronic financial constraints sharply to install about 5000 toilets in houses in a suburb in Accra to promote limits the authorities’ ability to provide universal urban infrastructural cleanliness. According to the Member of Parliament who launched the services”. Thus, until the urban water situation in Ghana is resolved, programme, the project sought to promote cleanliness and prevent open future pandemics could have a deleterious effect on households. defecation in the communities (GhanaWeb, 2018). The requirement was that AMA was going to bear 80 % of the cost and households would bear 5.1.4. Ventilation in low-income housing rooms the remaining 20 %. In 2018, households were required to contribute The study also revealed that shared and individual rooms in com- GHS 2000 towards the installation. This amount was subsequently pound houses have inadequate fenestration, single-bay windows, and reduced to GHS 1100 and GHS 600 (AMA, 2018). The Ghana Living are hardly opened at night because of fear of burglary. This is particu- Standards Survey 7 (GSS, 2019) revealed that annual expenditure of the larly worrying given that the lockdown compelled households to remain lowest quintile in Ghana was about GHS 5168. This meant that spending indoors. According to Megahed and Ghoneim (2021), poor indoor GHS 2000 out of that annual expenditure on the installation of a toilet environmental quality and poor ventilation increases the risk of airborne facility was almost impossible. The socio-economic status of the transmission of diseases which is likely to have an impact on occupant households places them in a position where they are not able to afford health. This is because congested spaces with asymptomatic carriers are the cost of installation. Even if they could install one in the house, the potential sources of airborne COVID-19, which, although transmitted number of tenants present on a compound means the only installed toilet via droplets, can survive for several hours in aerosols (Megahed & would not be adequate to serve the population. Public toilets are not Ghoneim, 2021). Thermal discomfort and heat stress may result from clean and efficient. closed windows given that temperatures in Accra could be as high as 38 From our study it was observed that the ratio of toilet to users was degrees Celsius during the daytime (Laue et al., 2022). Another obser- about 40 persons to one toilet in a house and this ratio is quite high. A vation was that the limited sleeping rooms compelled households to similar situation could be described for the bath houses. Recent research disperse and stay apart fearing that household members could contract conducted in Kumasi, the region with the second largest urban popu- COVID-19 and infect each other. lation revealed that about 56 % of housing units in Kumasi have at least one toilet and out of this population, 47 % were excluded from using the 5.1.5. Gendered nature of the economic impact of COVID-19 toilet (Foggitt et al., 2019). The 2021 population and housing census The social construction of gender impacted the experiences of indicates that 30.6 % (519,388) of all households in the Greater Accra women during the COVID-19 pandemic and lockdown. Female partici- Region shared bathroom facilities while Ghana Living Standards Survey pants were still responsible for the expected domestic duties despite the (GLSS) 7 indicated that about 71.4 % of households in Accra share toilet loss in income of both men and women. Female hairdressers, seam- facilities with other households in the same house or different houses or stresses and traders stopped working and as at the time of interview, have their toilet located in another house (GSS, 2019). This situation is some had not managed to resume their businesses because their capital worrying since households would be compelled to defecate indiscrim- had been spent. Mathew et al. (2020) study on self-employed women in inately in open spaces as observed in the GLSS 7. According to the UN Zambia found that women were traditionally involved in buying and Habitat (2021), lack of access to services and overcrowded conditions selling of goods and such businesses were severely affected during the makes certain populations or regions more vulnerable and at higher risk lockdown. Graeber et al. (2021) observed that the gender-gap among the of contracting the COVID-19 virus. Fobil et al. (2010) have also shown self-employed is largely explained by the fact that women dispropor- the relationship between socioeconomic conditions and urban neigh- tionately work in industries that are more severely affected by the bourhood environmental quality. They stated that rapid urbanisation COVID-19 pandemic. The authors conclude the “future policy measures has introduced imbalances in the provision of basic sanitation services intending to mitigate the consequences of such shocks should account which have left urban Accra to form clusters at different levels of for this considerable variation in economic hardship” (Graeber et al., environmental quality conditions. 2021, 1141). Even women who were working in formal setting jobs in Accra were faced with a double burden, they were carrying for family 5.1.3. Access to water among households and extended family while continuing to perform their formal employ- Observing the COVID-19 protocols of regular washing of hands and ment (Frehiwot et al., 2022). ensuring cleanliness became very challenging for some of the re- spondents in the urban communities. This was because most of the 5.2. Benefits houses surveyed did not have their own water supply. They depended on community water supply. Prior to the pandemic, households were 5.2.1. Social support networks fetching water from communal water supply, but the frequency of water Notwithstanding all these challenges, the sharing of compounds use increased due to the increased population staying at home during provided psychological support for the individual households during the 9 I. Appeaning Addo et al. C i t i e s 142 (2023) 104555 time of lockdown and isolation. While several studies show the psy- that they were confronted with several socioeconomic and physical chological effect of isolation on individuals’ mental wellbeing (Agha, challenges. Their worries bordered on religion, finances, living 2021; Grover et al., 2020), the households staying in compound housing arrangement, health, and mental stress. These findings have been re- in Accra fared better under lockdown as they provided support for each ported in several other studies, but the vulnerabilities associated with other and regularly interacted with each other. Killgore et al. (2020) the urban low-income household made it pronounced. In the first place observed that psychological resilience was greater among those who most of these persons were self-employed and depended on daily in- tended to get outside more often, and perceive more social support from come. The effect of COVID-19 on their livelihoods and businesses were family, friends, and significant others. Shared housing may foster or telling as they recounted their income losses. There is a gendered deter healthy living situations for households (Ahrentzen, 2003) but in dimension to this observation. Female hairdressers, seamstresses and this case, the respondents demonstrated that multihabitation became traders stopped working and as at the time of interview, some had not beneficial for their mental health and wellbeing. Access to social support managed to resume their businesses because their capital had been systems from their co-tenants and neighbours helped them to deal with spent. Mathew et al. (2020) study on self-employed women in Zambia the mental stress associated with COVID-19. In terms of fostering found that women were traditionally involved in buying and selling of healthy living situation, the COVID-19 pandemic provided a refreshing goods and such businesses were severely affected during the lockdown. display of conviviality among the people in the precarious urban Graeber et al. (2021) observed that the gender-gap among the self- multicultural space (Neal et al., 2019). A renewed sense of commu- employed is largely explained by the fact that women disproportion- nalism and increased bonding existed among the household as they ately work in industries that are more severely affected by the COVID-19 relied on the informal networks as a social capital for progression in pandemic. The authors conclude the “future policy measures intending urban areas and to manage their vulnerability. to mitigate the consequences of such shocks should account for this considerable variation in economic hardship” (Graeber et al., 2021, 5.2.2. Courtyards as spaces of interaction 1141). Courtyards are important architectural features in compound houses Shared housing may foster or deter healthy living situations for that are used to meet social and commercial needs of families and oc- various household arrangements (Ahrentzen, 2003). In terms of cupants. Notwithstanding the space inadequacies associated with com- fostering healthy living situation, the COVID-19 pandemic provided a pound houses, access to courtyards in compound houses helped the refreshing display of conviviality among the people in the precarious occupants to deal with the pandemic. Occupants of the various housing urban multicultural environments (Neal et al., 2019). A renewed sense units socialized and interacted with each other in the courtyards. During of communalism and increased bonding resulted among the households, the lockdown, they would gather in the courtyard to converse or play and they consider informal networks as a social capital for progression games although others preferred to remain indoors. Several authors and managing the precarious situation (Appeaning Addo, 2013). On the have established that courtyards are a microcosm of everyday life and other hand, the limiting spaces and inadequate shared facilities intro- promote social interaction (Lee & Park, 2015), promote community duced some challenges during the lockdown. Research has shown that interactions (Amer, 2016) and cultural sustainability (Huang et al., sharing sanitation facilities increases the risk of infection and results in 2019). McIntosh et al. (2022) study has identified the value of court- adverse health outcomes (Heijnen et al., 2014) making this risk more yards and other outdoor spaces in the recovery of mind in acute mental pronounced under epidemics. healthcare users for therapeutic and rehabilitative engagement by It is recommended that the design and planning of urban low-income increasing the sense of community and interaction. Their study found neighbourhoods should consider the socioeconomic status of the com- out that courtyards promoted connectedness, hope and optimism, munities prior to implementing nationwide directives that may not be identity, meaning and purpose, empowerment, and safety and security. suited to particular communities. Post-epidemics planning requires a In general, a courtyard can offer a positive image for users. While several level of responsiveness that addresses specific challenges and demands researches demonstrated that social media played a positive role in that are not often present in non-crisis planning (UN-Habitat, 2021; maintaining mental wellbeing during the pandemic (Hussain, 2020), Cobbinah, 2022). Addressing these issues must be conducted through a urban low-income households living in compound houses in Accra were people-centered approach that considers the local community as part- fortunate to interact with their co-tenants in the courtyards. ners and agents of their own transformation. Informal settlements in urban centers in Ghana have traditional and non-traditional institutions 6. Conclusion that have cultural and historical relevance to the larger community. These institutions should be part of the larger planning process in post- The research set out to explore how urban low-income households in COVID planning across the African continent. Post-epidemic planning as shared housing managed to observe the COVID-19 protocols given the an accelerated planning process should entertain the short- and long- reality of their materiality and to identify some of the challenges term impact of strategies to address challenges of epidemics. The stra- encountered. Lockdowns were broadly implemented in Accra and tegies should include policies and plans to meet the immediate needs Kumasi and this decision brought a lot of hardship on the urban poor. and to develop a process to tackle these issues that ensures long-term Observing the COVID-19 protocols was very challenging for the urban sustainable development. Again, access to adequate housing among low-income households. low-income household in urban areas is very difficult. Urban low- The results show that urban low-income households managed income housing is usually not central in urban planning but is rather COVID-19 and the mandatory lockdown in ways that reflected their an afterthought of political promises (Appeaning Addo & Mba, 2022). materiality, notwithstanding the challenges and the mental stress they Future policy measures intending to mitigate the consequences of epi- encountered. One thing that the research brought out is the support they demics should take into consideration urban low-income housing for derived from the social networks and communal living, gathering sustainable urban planning. around courtyards and open spaces to interact with each other although they were under lockdown. Enforcing the ‘stay indoors’ as part of the Authors statement lockdown was not upheld rigidly in the indigenous community like James Town. In the other communities, interaction was more at the We the authors declare that we did not receive any funding to compound level. execute this research project. Dealing with the pandemic was challenging enough for the urban low-income households but the implementation of the lockdown exac- erbated their vulnerable situation. The accounts of the respondents show 10 I. Appeaning Addo et al. C i t i e s 142 (2023) 104555 Declaration of competing interest Durizzo, K., Asiedu, E., Van der Merwe, A., Van Niekerk, A., & Günther, I. (2021). Managing the COVID-19 pandemic in poor urban neighborhoods: The case of Accra and Johannesburg. World Development, 137, Article 105175. The authors declare that they have no known competing financial Fiasorgbor, D. A. (2013). Water and sanitation situation in Nima and Teshie, Greater interests or personal relationships that could have appeared to influence Accra region of Ghana. Journal of Toxicology and Environmental Health Sciences, 5(2), the work reported in this paper. 23–28. Fobil, J., May, J., & Kraemer, A. (2010). Assessing the relationship between socioeconomic conditions and urban environmental quality in Accra, Ghana. Data availability International Journal of Environmental Research and Public Health, 7(1), 125–145. Foggitt, E., Cawood, S., Evans, B., & Acheampong, P. (2019). Experiences of shared Data will be made available on request. sanitation–towards a better understanding of access, exclusion and ‘toilet mobility’ in low-income urban areas. Journal of Water, Sanitation and Hygiene for Development, 9(3), 581–590. References Frehiwot, M., Atobrah, D., & Appeaning-Addo, I. (2022). Negotiating spaces, exercising agency and managing multiple roles. Feminist Africa, 3(1), 43–70. Frumkin, H. (2021). COVID-19, the built environment, and health. Environmental Health Abass, A. S., & Kucukmehmetoglu, M. (2021). Transforming slums in Ghana: The urban Perspectives, 129(7), Article 075001. regeneration approach. Cities, 116, Article 103284. Gbedemah, S. F., Eshun, F., Frimpong, L. K., & Okine, P. (2022). Domestic water Aberese-Ako, M., Immurana, M., Dalaba, M. A., Anumu, F. E., Ofosu, A., & Gyapong, M. accessibility during COVID-19: Challenges and coping strategies in Somanya and its (2023). An ethnographic study of multiple factors influencing perceptions, attitudes, surrounding rural communities of Ghana. Urban Governance, 2(2), 305–315. and observance of COVID-19 preventive measures among rural and urban slum Ghana Health Service. (2021). COVID-19 situation dashboard: Ghana. https://www.ghs. dwellers in Ghana. Journal of Environmental and Public Health, 2023. gov.gh/covid19/dashboardm.php. AbouKorin, S. A. A., Han, H., & Mahran, M. G. N. (2021). Role of urban planning Ghana News Agency (GNA). (2020). COVID-19: GHS identifies Tema. Accra Metro and characteristics in forming pandemic resilient cities–Case study of Covid-19 impacts Kpone Katamanso as hotspots: Korle Klottey. https://www.businessghana.com/site on European cities within England, Germany and Italy. Cities, 118, Article 103324. /news/general/212841/COVID-19-GHS-identifies-Tema-Korle-Klottey-Accra-Metr Accra Metropolitan Assembly (AMA). (2018). GAMA household toilet price: 80% off. o-and-Kpone-Katamanso-as-hotspots. https://www.facebook.com/AccraMetropolis/posts/gama-household-toilet-price Ghana Statistical Service (GSS). (2019). Ghana living standards survey 7. Main Report. -80-offthe-accra-metropolitan-assembly-ama-in-collabo/1722831217810335/. Republic of Ghana. Addo, I. A. (2014). Urban low income housing development in Ghana: Politics, policy and GhanaWeb. (2018). Accra Metropolitan Assembly launches 1 house, 1 toilet project. htt challenges. Urban planning: Practices, challenges and benefits (pp. 89–118). ps://www.ghanaweb.com/GhanaHomePage/NewsArchive/Accra-Metropolit Addo, I. A. (2016). Assessing residential satisfaction among low income households in an-Assembly-launches-1-house-1-toilet-project-618101#:~:text=The%20Accra%20 multi-habited dwellings in selected low income communities in Accra. Urban Studies, Metropolitan%20Assembly%20(AMA,toilet%20facility%20in%20every%20househ 53(4), 631–650. old. Afram, S. O., & Owusu, S. E. (2006). Design innovations towards enhancing the quality of Giles-Corti, B., Vernez-Moudon, A., Reis, R., Turrell, G., Dannenberg, A. L., Badland, H., living in multi-storey compound housing for low-income households in Kumasi, Foster, S., Lowe, M., Sallis, J. F., Stevenson, M., & Owen, N. (2016). City planning Ghana. Journal of Science and Technology (Ghana), 26(1), 76–87. and population health: A global challenge. The Lancet, 388(10062), 2912–2924. Agha, S. (2021). Mental well-being and association of the four factors coping structure Graeber, D., Kritikos, A. S., & Seebauer, J. (2021). COVID-19: A crisis of the female self- model: A perspective of people living in lockdown during COVID-19. Ethics, Medicine employed. Journal of Population Economics, 34, 1141–1187. and Public Health, 16, Article 100605. Grover, S., Sahoo, S., Mehra, A., Avasthi, A., Tripathi, A., Subramanyan, A., … Agormedah, E. K., Henaku, E. A., Ayite, D. M. K., & Ansah, E. A. (2020). Online learning Reddy, Y. J. (2020). Psychological impact of COVID-19 lockdown: An online survey in higher education during COVID-19 pandemic: A case of Ghana. Journal of from India. Indian Journal of Psychiatry, 62(4), 354. Educational Technology and Online Learning, 3(3), 183–210. Hasan, S. M., Das, S., Hanifi, S. M. A., Shafique, S., Rasheed, S., & Reidpath, D. D. (2021). Ahrentzen, S. (2003). Double indemnity or double delight? The health consequences of A place-based analysis of COVID-19 risk factors in Bangladesh urban slums: A shared housing and “doubling up”. Journal of Social Issues, 59(3), 547–568. secondary analysis of World Bank microdata. BMC Public Health, 21(1), 1–6. Amankwaa, G., & Ampratwum, E. F. (2020). COVID-19 ‘free water’ initiatives in the Heijnen, M., Cumming, O., Peletz, R., Chan, G. K. S., Brown, J., Baker, K., & Clasen, T. Global South: What does the Ghanaian case mean for equitable and sustainable (2014). Shared sanitation versus individual household latrines: A systematic review water services? Water International, 45(7–8), 722–729. of health outcomes. PLoS One, 9(4), Article e93300. Amer, M. B. K. B. (2016). Courtyards: Influence of the Indian traditional architectural Hoffman, L. M. (2014). Epidemics. The Wiley Blackwell Encyclopedia of Health, Illness, element on community interactions. Behavior, and Society, 501–505. Anaafo, D., Owusu-Addo, E., & Takyi, S. A. (2021). Urban planning and public policy Huang, B. X., Chiou, S. C., & Li, W. Y. (2019). Study on courtyard residence and cultural responses to the management of COVID-19 in Ghana. Cities & Health, 5(sup1), sustainability: Reading Chinese traditional Siheyuan through Space Syntax. S280–S294. Sustainability, 11(6), 1582. Appeaning Addo, I. (2013, December). Perceptions and acceptability of multihabitation Hussain, W. (2020). Role of social media in COVID-19 pandemic. The International as an urban low income housing strategy in Greater Accra Metropolitan Area, Ghana. Journal of Frontier Sciences, 4(2), 59–60. In , 24, No. 4. Urban forum (pp. 543–571). Dordrecht: Springer Netherlands. Iddi, S., Obiri-Yeboah, D., Aboh, I. K., Quansah, R., Owusu, S. A., Enyan, N. I. E., … Appeaning Addo, I., & Mba, C. C. (2022). Genealogies of Ghana’s housing crisis: The role Armah, F. A. (2021). Coping strategies adapted by Ghanaians during the COVID-19 of colonial interventions and neoliberal reforms. International Journal of Housing crisis and lockdown: A population-based study. PLoS One, 16(6), Article e0253800. Policy, 22(2), 299–313. Iossifova, D., Baker, J., Byrom, H., Gao, J., Law, Z. H., Stewart, B., … Sengupta, U. Arguello, J. E. M., Grant, R., Oteng-Ababio, M., & Ayele, B. M. (2013). Downgrading–an (2022). Architecture, sanitation and COVID-19: Design interventions in resource- overlooked reality in African cities: Reflections from an indigenous neighborhood of limited settings (Accra, Ghana). In Urban Infrastructuring: Reconfigurations, Accra, Ghana. Applied Geography, 36, 23–30. transformations and sustainability in the global south (pp. 277–295). Springer Nature Asante, D., Twumasi, M. A., Sakyi, A. S. K., Gyamerah, S., & Asante, B. (2022). A socio- Singapore: Singapore. geographic perspective of health and economic impacts of COVID-19 on poor Kenu, E., Frimpong, J., & Koram, K. (2020). Responding to the COVID-19 pandemic in households in Ghana. GeoJournal, 87(5), 4113–4125. Ghana. Ghana Medical Journal, 54(2), 72–73. Asante, L. A., & Ehwi, R. J. (2022). Housing transformation, rent gap and gentrification Killgore, W. D., Taylor, E. C., Cloonan, S. A., & Dailey, N. S. (2020). Psychological in Ghana’s traditional houses: Insight from compound houses in Bantama, Kumasi. resilience during the COVID-19 lockdown. Psychiatry Research, 291, Article 113216. Housing Studies, 37(4), 578–604. Kimari, W. (2021). The story of a pump: Life, death and afterlives within an urban Astell-Burt, T., & Feng, X. (2019). Association of urban green space with mental health planning of “divide and rule” in Nairobi, Kenya. Urban Geography, 42(2), 141–160. and general health among adults in Australia. JAMA Network Open, 2(7), e198209. Korboe, D. (1992). Family-houses in Ghanaian cities: To be or not to be? Urban Studies, BBC News. (2020). Coronavirus: Greater Accra lead Covid-19 infections for Ghana. htt 29(7), 1159–1171. ps://www.bbc.com/pidgin/world-52510586. Lai, K. Y., Webster, C., Kumari, S., & Sarkar, C. (2020). The nature of cities and the Covid- Bolay, J. C. (2015). Urban planning in Africa: Which alternative for poor cities? The case 19 pandemic. Current Opinion in Environmental Sustainability, 46, 27–31. of Koudougou in Burkina Faso. Current Urban Studies, 3(ARTICLE), 413–431. Laue, F., Adegun, O. B., & Ley, A. (2022). Heat stress adaptation within informal, low- Cobbinah, P. B. (2022). Enabling urban planning action in Africa: The praxis and oddity income urban settlements in Africa. Sustainability, 14(13), 8182. of COVID-19 pandemic response. Journal of Planning Literature, 37(1), 83–87. Lee, M. S., & Park, Y. (2015). The courtyard as a microcosm of everyday life and social Corburn, J. (2004). Confronting the challenges in reconnecting urban planning and interaction. Architectural Research, 17(2), 65–74. public health. American Journal of Public Health, 94(4), 541–546. Mathew, N., Deborah, I., Karonga, T., & Rumbidzai, C. (2020). The impact of COVID-19 Danso-Wiredu, E. Y., & Poku, A. (2020). Family compound housing system losing its lockdown in a developing country: Narratives of self-employed women in Ndola, value in Ghana: A threat to future housing of the poor. Housing Policy Debate, 30(6), Zambia. Health Care for Women International, 41(11-12), 1370–1383. 1016–1032. McIntosh, J., Marques, B., & Jenkin, G. (2022). The role of courtyards within acute Davis, J. (2022). The caring city: Ethics of urban design. Bristol, UK: Bristol University mental health wards: Designing with recovery in mind. International Journal of Press. Environmental Research and Public Health, 19(18), 11414. Duhl, L. J., Sanchez, A. K., & World Health Organization. (1999). Healthy cities and the Megahed, N. A., & Ghoneim, E. M. (2021). Indoor air quality: Rethinking rules of city planning process: A background document on links between health and urban planning building design strategies in post-pandemic architecture. Environmental Research, (No. EUR/ICP/CHDV 03 04 03). Copenhagen: WHO Regional Office for Europe. 193, Article 110471. 11 I. Appeaning Addo et al. C i t i e s 142 (2023) 104555 Morgan, A. K. (2020). Making COVID-19 prevention etiquette of social distancing a Sampson, H., & Johannessen, I. A. (2020). Turning on the tap: The benefits of using ‘real- reality for the homeless and slum dwellers in Ghana: Lessons for consideration. Local life’ vignettes in qualitative research interviews. Qualitative Research, 20(1), 56–72. Environment, 25(7), 536–539. https://doi.org/10.1080/13549839.2020.1789854 Silver, J. (2015). Disrupted infrastructures: An urban political ecology of interrupted Neal, S., Bennett, K., Cochrane, A., & Mohan, G. (2019). Community and conviviality? electricity in Accra. International Journal of Urban and Regional Research, 39(5), Informal social life in multicultural places. Sociology, 53(1), 69–86. 984–1003. Njoh, A. J. (2009). Urban planning as a tool of power and social control in colonial Smiley, S. L., Agbemor, B. D., Adams, E. A., & Tutu, R. (2020). COVID-19 and water Africa. Planning Perspectives, 24(3), 301–317. access in Sub-Saharan Africa: Ghana’s free water directive may not benefit water Ntewusu, S. A. (2011). Settling in and holding on: A socio-economic history of northern insecure households. African Geographical Review, 39(4), 398–404. traders and transporters in Accra’s Tudu: 1908–2008 (Doctoral dissertation,. Leiden Tutu, R. A., Boateng, J. K., Busingye, J. D., & Ameyaw, E. (2017). Asymmetry in an University. uneven place: migrants’ lifestyles, social capital, and self-rated health status in Obeng-Odoom, F. (2012). Beyond access to water. Development in Practice, 22(8), James Town, Accra. GeoJournal, 82, 907–921. 1135–1146. Ujunwa, A. I., Ujunwa, A., & Okoyeuzu, C. R. (2021). Rethinking African globalisation Ofosu-Kusi, Y. (2020). The future African society: Informality as a potential for development agenda: Lessons from COVID-19. Research in Globalization, 3, Article 100055. and progress. The Challenge of African potentials: Conviviality, informality and futurity UN-Habitat. (2021). Annual report 2021. https://unhabitat.org/sites/default/files/2022 (p. 13). /05/2021_annual_report.pdf. Oteng-Ababio, M., Smout, I., & Yankson, P. W. (2017, June). Poverty politics and United Nations Department of Economic and Social Affairs (UNDESA). (2018). 2018 governance of potable water services: The core–periphery syntax in Metropolitan revision of world urbanization prospects. https://www.un.org/en/desa/2 Accra, Ghana. In , Vol. 28, No. 2. Urban Forum (pp. 185–203). Netherlands: Springer. 018-revision-world-urbanization-prospects#:~:text=Today%2C%2055%25%20of% Owusu, S., & Baidoo, S. T. (2021). Providing a safety net for the vulnerable persons in 20the%20world’s,increase%20to%2068%25%20by%202050. Ghana: Does the extended family matter? International Journal of Social Welfare, 30 Upoalkpajor, J. L. N., & Upoalkpajor, C. B. (2020). The impact of COVID-19 on education (2), 208–215. in Ghana. Asian Journal of Education and Social Studies, 9(1), 23–33. Pinheiro, M. D., & Luís, N. C. (2020). COVID-19 could leverage a sustainable built Yeboah, A. S., Takyi, S. A., Amponsah, O., & Anaafo, D. (2020). Assessing the practicality environment. Sustainability, 12(14), 5863. of the COVID-19 social distancing guidelines to the urban poor in the Ghanaian Sakketa, T. G. (2023). Urbanisation and rural development in sub-Saharan Africa: A context. Social Sciences & Humanities Open, 2(1), Article 100087. review of pathways and impacts. Research in Globalization, Article 100133. 12