Solid waste management and health in Accra, Ghana - Pierpaolo Mudu Betty Akua Nartey Gina Kanhai Joseph V. Spadaro Julius Fobil
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Solid waste management and health in Accra, Ghana Pierpaolo Mudu Betty Akua Nartey Gina Kanhai Joseph V. Spadaro Julius Fobil w h o u r b a n h e a lt h i n i t i at i v e
Solid waste management and health in Accra, Ghana Pierpaolo Mudu Betty Akua Nartey Gina Kanhai Joseph V. Spadaro Julius Fobil w h o u r b a n h e a lt h i n i t i at i v e
Solid waste management and health in Accra, Ghana/ Pierpaolo Mudu, Betty Akua Nartey, Gina Kanhai, Joseph V Spadaro, Julius Fobil ISBN 978-92-4-002425-0 (electronic version) ISBN 978-92-4-002426-7 (print version) © World Health Organization, 2021 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons. org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization (http://www. wipo.int/amc/en/mediation/rules/). Suggested citation. Mudu P, Nartey BA, Kanhai G, Spadaro JV, Fobil J. Solid waste management and health in Accra, Ghana. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris. Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see http://www.who.int/about/licensing. Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user. General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. The named author alone is responsible for the views expressed in this publication. Cover photo: © Abraham Mwaura/WHO. Design and layout by L’IV Com Sàrl
iii
CONTENTS
Foreword iv
Acknowledgements v
Abbreviations vi
Executive summary vii
1. Introduction 1
1.1 Waste related health effects 3
1.2 E-waste related pollution and health effects in Accra 4
2. Review and assessment of solid waste management in Accra 6
2.1 Methodology 6
2.2 Literature review 6
2.3 Data collection 7
2.4 Study area 7
2.5 Legal framework and historical perspective 8
2.6 Main stakeholders of the waste management sector in Ghana 10
2.7 Current state of solid waste management in Accra 11
3. Assessing the impacts of solid waste management interventions 15
3.1 Tools and methodology 15
3.2 Health impact assessment 16
4. Results 17
4.1 Emission scenarios 17
4.2 Modelling emissions and concentration values for health impact assessment 20
5. Discussion 22
5.1 Emission scenarios 22
5.2 Health impact assessment: limitations 22
5.3 Policy interventions: suggestions and actions 23
6. Conclusion 25
6.1 Suggestions for solid waste management improvements 25
6.2 Health impacts – scenario projections 26
References 27
Annex 33iv S O L I D WA S T E M A NAGE ME NT AND H EALTH IN ACCRA, GHANA
FOREWORD
One of the best means of improving health through preventive action is through the improvement
of household and community environments in developing countries (World Resources Institute, UNEP,
UNDP and WB, 1998: ix).1 Other studies have shown that improving household environments could
avert the annual loss of almost 80 million “disability free” years of human life in developing countries –
more than the feasible improvement attributable to all identified environmental measures combined
such as unsafe workplace conditions, ambient air pollution and traffic injuries (McGranahan et al.,
1996: 111; World Bank, 1993).2,3 Some of these problems in our human settlements, especially large
metropolitan areas such as the Greater Accra Metropolitan Area, include: inadequate potable water
supply, unsanitary conditions, uncollected rubbish and waste, among others. A water, sanitation and
hygiene (WASH) focus has been dominant under WASH programmes but little attention has been
given to solid waste management and health.
This gap is being addressed for Accra in this study using various scenarios focusing on the air pollution,
health and climate change impacts of different solid waste management practices. It seeks to
direct the attention of policy-makers to the implications of various technological options for solid
waste management on health. Although this is quite innovative, much greater benefits could accrue
from more detailed intra-urban analysis given the increasing inequalities in wealth, solid waste
management and health in Accra. This was not immediately possible because of inadequacies in
the available data.
With its focus on modelling the impact of different solid waste management practices, this study
should be of great interest to those planning and managing the metropolis, given the impact
improvements could make to the quality of life of all its citizens.
Professor Jacob Songsore
Ghana Academy of Arts and Sciences
7 December 2020
1
World Resources Institute, UNEP, UNDP and WB (1998). A guide to the global environment. Oxford: Oxford University Press.
2
McGranahan G, Songsore J, Kjellen M (1996). Sustainability, poverty and urban environmental transitions. In: Cedric Pugh (ed.). Sustainability, the
environment and urbanization. London: Earthscan; 103–133.
3
World Bank (1993). World development report: investing in health. Oxford: Oxford University Press.v ACKNOWLEDGEMENTS This report was developed by Pierpaolo Mudu (Department of Environment, Climate Change and Health, World Health Organization [WHO]), Betty Akua Nartey (University of Ghana), Gina Kanhai (University of Graz, Austria), Joseph V. Spadaro (Spadaro Environmental Research Consultants, United States of America) and Julius Fobil (University of Ghana). Samuel Agyei-Mensah (University of Ghana) and Francesco Forastiere (Imperial College, London) reviewed the final draft of the report. Support in data collection and analysis was provided by John Arko-Mensah (University of Ghana). Additional assistance was provided by Gordon Dakuu (WHO Ghana Country Office), Thiago Hérick de Sá, (Department of Environment, Climate Change and Health WHO), Sandra Mazo-Nix (Climate and Clean Air Coalition [CCAC]). Assistance in the organization of data and dissemination of results was given by Michael Hinsch and Abraham Mwaura (Department of Environment, Climate Change and Health, WHO) and Sandra Cavalieri (CCAC). In coordination with the Accra Metropolitan Assembly Waste Management Department and Ghana Health Service, this report includes information on municipal waste impacts. The Solid Waste Emissions Estimation Tool (SWEET) was developed by the US Environmental Protection Agency (with support from Abt Associates and SCS Engineers) on behalf of the CCAC Municipal Solid Waste Initiative. The authors would like to acknowledge the US Environmental Protection Agency and its team of contractors, particularly Ben Matek (Abt Associates) and Alex Stege (SCS Engineers) for their support in using the SWEET. Comments at an early stage of the project were provided by Samuel Kpodo (Accra Metropolitan Assembly) and Carlos Dora (School of Public Health, Columbia University, New York). Comments and suggestions to improve the final draft were given by Nathalie Roebbel (Department of Environment, Climate Change and Health, WHO). Special thanks to Maria Neira (Department of Environment, Climate Change and Health, WHO) for her support. The preliminary results of the analysis were presented at the Accra Metropolitan Assembly, in August 2018, at the session on “Air pollution management and health evidence – industry and waste sector”, within the US EPA Megacities, CCAC Urban Health Initiative (UHI), World Bank Joint Workshop Series. This work was supported by the CCAC through the grant provided for the Urban Health and Short- Lived Climate Pollutants (SLCP) Reduction Project in Accra. Support was also provided by the Government of Norway through its financial contribution to advance WHO’s work on air pollution and health, which contributed to the completion of this product.
vi S O L I D WA S T E M A NAGE ME NT AND H EALTH IN ACCRA, GHANA
ABBREVIATIONS
ACaRP Accra Composting and Recycling Plant
AMA Accra Metropolitan Assembly
BAU business-as-usual
BC black carbon
CCAC Climate and Clean Air Coalition
CH4 methane
CO2 carbon dioxide
CO2eq carbon dioxide equivalent
EPA-Ghana Environmental Protection Agency Ghana
GAMA Greater Accra Metropolitan Area
GHG greenhouse gas
HFCs hydrofluorocarbons
HIA health impact assessment
IPCC Intergovernmental Panel on Climate Change
MLGRD Ministry of Local Government and Rural Development
MMDAs metropolitan, municipal and district assemblies
NOx nitrogen oxide
PAHs polycyclic aromatic hydrocarbons
PM particulate matter
PMWMD Phase Model of Waste Management Development
RUWM Robust Uniform World Model
SDG Sustainable Development Goal
SLCPs short-lived climate pollutants
SWEET Solid Waste Emissions Estimation Tool
SWM solid waste management
UHI Urban Health Initiative (WHO)
UNDP United Nations Development Programme
UNEP United Nations Environment Programme
UWM urban waste management
WASH water, sanitation and hygiene
WB World Bank
WHO World Health Organizationvii
EXECUTIVE SUMMARY
The aim of this report is to provide an overview of the current solid waste management (SWM)
situation in contemporary Accra, Ghana, and assess its impact on health and well-being.
Accra is a city that has grown enormously in the last decades. According to the most recent census
(2010), the total population of Greater Accra is approximately 4 million, with approximately 1 850 000
inhabitants living in urban Accra.
The main goal of the study is to inform local air quality and climate change policies. To achieve this,
the study:
• investigated the framework of SWM in Accra;
• assessed the contribution of urban SWM activities to local air pollution and climate change
by estimating the quantity of short-lived climate pollutants (SLCPs) emitted using the Solid
Waste Emissions Estimation Tool (SWEET); and
• produced estimates on the health impacts directly related to current and potential SWM
activities.
SWM activities are as diverse as the SLCP they generate. Greenhouse gas (GHG) reductions should
be coordinated with established targets on SLCPs to ensure that average global temperatures
do not increase excessively (IPCC, 2018). Ending open burning and upgrading dumps to landfills
with gas capture were found to be potential pathways to reduce climate forcing pollutants, and
generate positive health impacts. Additionally, the diversion of solid waste via composting and
recycling is effective in lowering emission levels of some SLCPs such as particulate matter (PM) and
black carbon (BC). It is therefore important that SWM is executed in an integrated manner in order
to reduce emissions and not endanger public health and well-being.
In summary, an overview of the current SWM situation in Accra and analysis of the different scenarios
produced the following results:
• Waste management is an environmental emergency in Accra, but solutions can be
implemented to improve the situation.
• There is a serious shortage of reliable SWM data for Accra on management methods and
environmental loads.
• A combination of methodologies and tools was used, and the data generated can be
compared with other available data to understand the current situation and future trends.
• A rapid assessment approach was developed for the health impact assessment of SWM,
which can be easily replicated in other contexts.v i ii S O L I D WA S T E M A NAGE ME NT AND H EALTH IN ACCRA, GHANA
• SWM is responsible for significant emissions of GHGs and critical air pollutants, including BC.
Realistic scenarios to reduce these contaminants are feasible.
• Waste management options, such as recycling, composting and landfill, can have
different health impacts that are difficult to assess, and although the evidence is still limited
regarding the effects on specific health endpoints, there is a need to monitor and analyse
potentially hazardous exposure situations.
• Air pollution represents a real threat to the health of the population, requiring a
coordinated call to action by policy-makers and waste operators to protect public health.
– In particular, if ceasing open burning is achieved by 2030 an annual reduction of 120
premature deaths could be achieved.
– Other scenarios for waste management, such as increasing composting and recycling,
produce important reductions in carbon dioxide (CO2) emissions.1 1. INTRODUCTION Managing today’s cities, with both the rapidity and scale of urban transformations, is becoming increasingly challenging. The rapid urbanization across the developing world has exceeded the capacity of most cities to provide sufficient services to their citizens, leading to daunting sustainability challenges related to housing, infrastructure, basic services, food security, health, education, decent jobs, safety, natural resources constraints, pollution, governance structures and socio-political instability (Achankeng, 2003; Cohen, 2006; Fobil et al., 2008; Ezeah & Roberts, 2012; Hoornweg & Bhada-Tata, 2012; Pieterse & Parnell, 2014; Almazán-Casali et al., 2019; OECD/SWAC, 2020). Around the world today, many cities are faced with the challenging task of how to achieve a balance between reaping the benefits of urbanization while decreasing the risks of its negative impacts (Cohen, 2006). A major negative consequence of economic development on human health is air pollution. The work of the WHO Urban Health Initiative (UHI) mainly focuses on three sectors: household energy, ground transport and waste, with several underlying workstreams on land use and health. During the UHI work on SWM five objectives were pursued: 1. Capacity building through training of staff at local government level to support policy related to mitigating SWM health impacts. 2. Exchange of knowledge at local and international levels. 3. Review current status of knowledge and existing policy scenarios for SWM plans and their health impacts. 4. Contribute to the estimates of the impacts of waste management in Accra. 5. Develop policy suggestions to improve the collection, transport, recycling and disposal of municipal refuse at neighbourhood level, with particular attention to socioeconomic inequalities within the study areas. The main goal in many developing countries is the basic provision of food, shelter, security and livelihoods for their citizens (Konteh, 2009). This leads to municipal solid waste generation and its management being neglected, with no formally organized waste collection and/or insufficient waste management and recycling policies and practices (Seo et al., 2004; Al-Khatib et al., 2010; Hoornweg & Bhada-Tata, 2012; Marshall & Farahbakhsh, 2013). When SWM is not prioritized in developing countries, it ends up affecting public health (Wilson, 2007; Coffey & Coad, 2010). In Africa, it is expected that the challenges associated with waste management will significantly worsen due to high population growth and the health hazards associated with inadequate waste collection and treatment (Guerrero et al., 2013). Unsustainable SWM is a global issue through its negative impacts on the environment, air quality, human health and quality of life (Ma & Hipel, 2016; Ferronato & Torretta, 2019). As the global population increases, solid waste generation also increases. Waste generated worldwide is expected to increase from about 1.3 billion tonnes per year, to about 2.2 billion tonnes per year by 2025 (Hoornweg & Bhada-Tata, 2012). In developing countries, rapid urbanization and
2 S O L I D WA S T E M A NAGE ME NT AND H EALTH IN ACCRA, GHANA
population growth contribute to ever increasing volumes of waste generation, exerting great
pressure on an already over strained SWM system (Vij, 2012) and increasing demand for improved
waste management services.
Urban areas in comparison with rural regions are especially in need of adequate waste services,
as they are areas of intense economic activity, leading to the generation of significant volumes of
waste per square metre. In lower middle-income countries, this problem is further exacerbated by a
lack of accessible roads for waste collection, inadequate funds for waste collection, and inadequate
waste equipment (Fobil, Kolawole et al., 2010). Solid waste collection, especially in low-income urban
communities, is frequently inadequate. Hence, residents in these areas are left to dispose of their
waste through practices such as open burning and indiscriminate dumping of solid and liquid waste,
which contribute to air and water pollution. Hence, residents in these areas are left to dispose of
their waste through practices such as open burning and indiscriminate dumping of solid and liquid
waste, which contribute to air and water pollution (Lemieux et al., 2004; Wiedinmyer et al., 2014;
Ferronato & Torretta, 2019).
The Basel Convention defined “waste” as “substances or objects which are disposed of, or are
intended to be disposed of, or are required to be disposed of by the provisions of national law”
(Basel Convention, 1989). Waste can be classified based on its physical state, chemical composition
and source (UNEP, 2005). Nevertheless, similar to the majority of environmental stressors, the “nature”
of waste is problematic. “There is no standard or typical solid waste; in fact no two wastes will be
identical. […] There is a need for thorough analysis of data to be collected” (WHO Regional Office
for Europe, 1991: 34). In the previous definition we could have substituted the words “air pollution”
or “contaminated water” for the word “waste”. Due to the challenges faced in managing SWM, it is
a recurring theme in the Sustainable Development Goals (SDGs). The SDG 11.3 target, for example,
calls for attention to municipal and other waste management, and SDG 12.4 focuses on achieving
the environmentally sound management of chemicals and all wastes throughout their life cycle,
while SDG 12.5 targets the substantial reduction of waste generation through prevention, reduction,
recycling and reuse. Regardless of the difficulty in categorizing the waste produced, SWM is an
essential service to achieve the following objectives: protection of public health; promotion of
hygiene; recycling of materials; avoidance of waste; reduction of waste quantities; and reduction
of emissions and residuals (WHO Regional Office for Europe, 1991).
SWM activities (the collection, storage, transport, recovery and disposal of waste, including
incineration) are not only associated with contamination of soil, water and air, but also contribute to
global warming through the emissions of GHGs. There is a significant association between solid waste
generation rates and ground-level ozone and SLCP emissions, such as methane, hydrofluorocarbons
(HFCs) and BC (Hoornweg & Bhada-Tata, 2012). SLCPs have shorter lifespans in the atmosphere
than GHGs. For instance, BC has a lifespan of a few days to weeks in the atmosphere, whereas
methane has a lifespan of around 12 years and CO2 100 years or more. Despite the short period
of time in the atmosphere, SLCPs have a remarkable effect both directly and indirectly on local
climate change, agriculture and human health. Various research activities have investigated the
implications of waste generation and emissions (Gentil & Christensen, 2009; Friedrich & Trois, 2011).
In 2000, developing countries contributed approximately 29% of global GHG emissions (Bogner et
al., 2008). This is expected to increase to 64% and 76% in 2030 and 2050 respectively, due to copious
amount of methane emitted from landfill sites (Monni et al., 2006). Methane generated from landfill
contributed to about 90% of emissions from the waste sector, and approximately 18% of global
anthropogenic emissions of methane in 2004 (Bogner et al., 2008).3
Urban centres in low-income countries produce a higher percentage of organic waste compared
with high-income countries, where the majority of the waste is inorganic (Hoornweg & Bhada-Tata,
2012). Given the link between organic waste and emissions of SLCPs, municipal waste management
processes, including collection, and composting and recycling, are important activities in maintaining
both healthy ecosystems and environmental sanitation in cities; and contribute to decelerating
global warming and its harmful effects. The complexity and difficulty in estimating the health risks
involved in waste production and management should not prevent us from analysing these risks
(Bond et al., 2005; Forastiere et al., 2011).
The case of the city of Accra is relevant because for a number of years there has been extensive
debate on how to improve a situation that can still be managed before it enters an emergency
stage, where planning, and sustainable and efficient use of resources, are jeopardized. Data from the
Ghana Health Service 2010 indicate that 60% of the most prevalent diseases are linked to insufficient
environmental sanitation (Oteng-Ababio, 2011). To counteract the expected trend of significantly
worsening environmental and population health in African cities, steps toward improving waste
management need to be taken. This report provides insights on the nexus of air pollution, health
and waste management in Accra, Ghana, by considering alternative management strategies. The
modelled policy scenarios are based on planned measures in Accra, or informed by research insights
suggesting innovative interventions that could be adopted to attain emission reductions.
The focus of this report is on four main components:
• an overview of the health effects of the waste sector;
• a review and assessment of the current SWM situation in Accra;
• an estimation of the health impacts of different SWM scenarios; and
• suggested policy actions.
1.1 Waste related health effects
Waste can be generated by various sources: domestic, commercial, industrial, construction and
health care.1 Although we want to concentrate our focus on the health consequences of the
treatment of domestic sources, in particular concerning air pollution, from the literature it is difficult to
understand the different impacts of the individual sources. Waste production and (mis)management
pose health hazards to people living near waste disposal sites and to workers involved with waste
treatment (Suess & Huismans, 1983; Cointreau, 2006; Yang et al., 2018; Ferronato & Torretta, 2019).
Waste management, from generation through to final disposal, is associated with different patterns
of exposure that have been linked to increased cases of birth defects (e.g. low birth weight), pre-
term birth and reproductive disorders, elevated cancer risks and mortality, congenital anomalies,
and respiratory diseases in workers and people who live near waste sites (Rushton, 2003; Giusti, 2009;
Mattiello et al., 2013).
1
Although not the objective of this report, it is important to consider that health care waste “carries a greater potential for causing infection and injury than
any other type of waste, and inadequate or inappropriate management is likely to have serious public health consequences and deleterious effects on the
environment” (Chartier et al., 2014). For the Accra situation, see Asante et al. (2013); Williams (2013); Udofia et al. (2017).4 S O L I D WA S T E M A NAGE ME NT AND H EALTH IN ACCRA, GHANA
There are numerous studies, on, for example, landfill (Vrijheid, 2000; Redfearn & Roberts, 2002; Rushton,
2003; Crowley et al., 2003; Porta et al., 2009); and incineration (Vrijheid, 2000; Hu & Shy, 2001; Redfearn
& Roberts, 2002; Crowley et al., 2003; Rushton, 2003; Franchini et al., 2004; Porta et al., 2009). In some
cases there is a significant increase in health risks from SWM to the exposed populations, while in
others there is no a clear trend (Ma & Hipel, 2016; Fazzo et al., 2017; Ncube et al., 2017).“Management
of solid waste (mainly landfills and incineration) releases a number of toxic substances, most in small
quantities and at extremely low levels. Because of the wide range of pollutants, the different pathways
of exposure, long-term low-level exposure, and the potential for synergism among the pollutants,
concerns remain about potential health effects but there are many uncertainties involved in the
assessment” (Porta et al., 2009: 1). “The evidence of causal relationship with hazardous waste was
defined as limited for: liver, bladder, breast and testis cancers and non-Hodgkin lymphoma. Among
non-neoplastic diseases, asthma was found to be related to hazardous waste with limited evidence.
We evaluated as limited the evidence of the association between the exposure to hazardous waste
and adverse birth outcomes, including low birth weight, pre-term birth, congenital anomalies overall
and anomalies of the urogenital, connective and musculoskeletal systems. The evidence of a causal
relationship was defined as inadequate for most other health outcomes.” (Fazzo et al., 2017: 8).
Improvements in research design, better exposure measurement, clearer outcome definitions, and
adjustment for confounding factors will offer better systematic knowledge on the health outcomes
associated with waste mismanagement (Mattiello et al., 2013).
Furthermore, exposure to e-waste has a number of potential consequences on health and evidence
is accumulating (Grant et al., 2013; WHO, 2021), with the Agbogbloshie e-waste recycling site in Accra
representing a special case study tackled in Section 1.2.
1.2 E-waste related pollution and health effects in Accra
The informal recycling of electronic waste using low-tech methods, for example, the burning of
plastic cables to recuperate copper or other valuable metals, releases a range of contaminants (e.g.
mercury, cadmium, lead and dioxin-related compounds) into the ambient environment. E-waste is a
serious source of contamination in Accra, in particular at the Agbogbloshie site (Daum et al., 2017).
The origin of the thousands of tonnes of e-waste is importation from Europe (Schluep et al., 2012).
The Agbogbloshie area has been derogatively called by outsiders “Sodom and Gomorrah”,
highlighting the controversial representation of the area for the last two decades (COHRE, 2004;
Oteng-Ababio & van der Velden, 2019). Whatever its name, the high toxicity of the area, overcrowding,
poor-quality housing and lack of health care is well known (Owusu-Ansah et al., 2016). For example,
the release of chlorinated, brominated and mixed halogenated dioxin-related compounds from
open burning of e-waste into soils has been measured (Tue et al., 2015). Environmental contamination
is exacerbated by the interplay of several contaminants, for example metals and bromine with
dioxin-related compounds (Fujimori et al., 2015), metals (Itai et al., 2014; Kyere et al., 2017) and
polycyclic aromatic hydrocarbons (PAHs) at Agbogbloshie (Feldt et al., 2014; Wittsiepe et al., 2015;
Daso et al., 2016). The analysis of 132 samples collected from the Agbogbloshie e-waste processing
site confirmed ubiquitous high levels of contamination from heavy metals (Wittsiepe et al., 2016;
Kyere et al., 2017). “Exceptionally high concentrations (e.g. 1-hr average PM10 exceeding 2000 μg/
m3) were sometimes encountered near combustion sources, including open fires at the e-waste site
and spoil piles. 24-hr PM2.5 levels averaged 31, 88 and 57 μg/m3 at upwind, e-waste and downwind
sites, respectively, and PM10 averaged 145, 214 and 190 μg/m3” (Kwarteng et al., 2020).5 Exposure to contamination poses serious health risk to both adults and children working informally at the e-waste site (Akormedi et al., 2013; Obiri et al., 2016; Amoabeng et al., 2020). Biomonitoring at the Agbogbloshie e-waste site found higher than expected levels of heavy metals and PAHs, which pose serious health risks to informal workers at the site and contribute to the overall toxic exposure of the residential community. Recent occupational health investigations have reported that burning of e-waste is likely to produce the highest levels of cadmium, lead and arsenic bioaccumulation (Srigboh et al., 2016). However, the people working at the site generally have little knowledge of the link between their health status and their work (Yu et al., 2016), and access to health care has yet to be improved (Asampong, 2015).
6 S O L I D WA S T E M A NAGE ME NT AND H EALTH IN ACCRA, GHANA
2. REVIEW AND ASSESSMENT OF
SOLID WASTE MANAGEMENT IN
ACCRA
2.1 Methodology
A combination of methods and tools was used and the data generated can be compared with
other available information to understand the current situation and alternative scenarios going
forward. This – a new approach for an African city – has been developed and applied to provide a
health impact assessment (HIA) of SWM. This is an approach that can be replicated in other contexts.
The methodology involved the following tasks:
• Compile scientific articles and reports published on waste- and health-related impacts in
Accra.
• Review future development plans on waste treatment.
• Define alternative waste treatment scenarios and assess the GHG and SLCP emissions out
to year 2030.
• Calculate future health impacts.
• Integrate information collected to provide useful insights for decision-making and public
health protection.
• Organize seminars and training with local experts.
A WHO focal point collaborated in supporting all the activities described. Local stakeholders and
experts participated in the data collection and analysis.
2.2 Literature review
The overview of published articles provided an introductory basis for the analysis of and discussion
on SWM trends. The review included scientific literature published and listed in Pubmed, Scopus and
the Web of Science as well as major reports from international agencies and nongovernmental
organizations. The literature search used two keywords “waste” and “Accra” and identified more than
100 articles; mostly related to e-waste issues. In addition, documents on practices in waste generation,
waste characterization and treatment, and recent trends for the city of Accra were reviewed.7 2.3 Data collection Data on waste generation were gathered from secondary sources. Baseline information was collected from local and national institutions. Relevant waste management data were obtained from institutions such as the Accra Compost and Recycling Plant (ACaRP) in Medie, Accra Metropolitan Assembly (AMA), and Nsumia and Tema landfills. Some data were also obtained from Zoomlion Company Limited, J Stanley Owusu and Co. Limited, Metropolitan Waste and Allied Services, Meskworld Co. Limited, Tropical Waste Limited and Jekora Ventures Limited. Other data on waste management processes were also retrieved from published sources (scientific literature, census reports, national surveys, local government reports), as well as through interviews, site visits and direct observations. 2.4 Study area The study area was the city of Accra. According to census data, in 2000, Accra’s population was 1 659 000 and it had increased to 1 849 000 in 2010 (Ghana Statistical Service, 2014). Over the same period the population of the Greater Accra Region increased from 2 906 000 to 4 010 000 (Ghana Statistical Service, 2012). The city of Accra extends for 140 km2, and the Greater Accra Region for 3245 km2. The population in the Greater Accra Metropolitan Area (GAMA) accounts for 17% of the population of Ghana. The city’s annual growth rate is more than 3%, among the highest for capital cities in Africa. Population projections for 2030 are 2 913 124 for the city of Accra and 6 319 212 for the Greater Accra Region. The latest official projection indicates a population of 4 943 100 for the Greater Accra Region in 2019. The city of Accra alone generates nearly 900 000 metric tonnes of solid waste annually and approximately 2200 metric tonnes of waste per day, with a waste generation rate that has increased since 2000 from about 0.5 kg/person/day (CCAC, 2016),1 to around 0.74 kg/person/day (Miezah, 2015).2 In the Greater Accra Region, some landfill and dumpsites are very close, even less than 100 m, from resident populations. Results obtained from sampling sites, across the dry and wet seasons, showed a considerable presence of bacteria and microbial (bioaerosols) contamination in the air at the landfill and dumpsites (Odonkor & Mahami, 2020). In this study, we have considered household waste for the city of Accra, and have excluded the industrial waste contribution from refineries and oil industries in Tema, which need specific analysis and approaches (Mudu et al., 2014). In particular, for Tema, various investigations have produced results of concern about the air pollution due to industrial activities (Ofosu et al., 2012; Amoatey et al., 2018; Amoatey et al., 2019).3 1 In the 1990s, the daily per capita generation was estimated to be 0.4 kg (Boadi & Kuitunen, 2003). 2 In order to have an idea of the amount of waste generated in Accra, consider that Organisation for Economic Co-operation and Development countries generate almost half of the world’s waste (per capita values range from 1.1 to 3.7 kg per person per day with an average of 2.2 kg/capita/day), while Africa and South Asia are the regions that produce the least waste. “Waste generation in sub-Saharan Africa is approximately 62 million tonnes per year. Per capita waste generation is generally low in this region, but spans a wide range, from 0.09 to 3.0 kg per person per day, with an average of 0.65 kg/capita/day” (Hoornweg & Bhada-Tata, 2012: 8). 3 The results of the application of dispersion modelling to simulate the concentration of PM2.5 from the Tema oil refinery showed concentration levels of concerns both for 24-hour (38.8 µg m−3) and annual (12.6 µg m−3) PM2.5 values. “Cardiopulmonary disease related mortalities due to PM2.5 exposure (181 deaths for adults and 24 deaths for children) were found high compared to deaths caused by lung cancer (137 deaths for adults and 16 deaths for children).” (Amoatey et al., 2018: 1181).
8 S O L I D WA S T E M A NAGE ME NT AND H EALTH IN ACCRA, GHANA
2.5 Legal framework and historical perspective
Table 2.1 provides a summary of the legal and regulatory measures governing SWM in Accra, giving
an overview of the official and organizational framework. Included are laws governing the protection
of public health and providing related public health standards for hygiene; and environmental
laws governing environmental protection and providing related discharge standards or ambient
environmental standards. The mapping of the organizational and legal framework takes into account
the general framework of:
• environmental assessment laws which specify what actions require environmental impact
assessment;
• laws which specify public participation procedures in planning, environmental assessment
and project approval.
More significantly, legislation should establish:
• Laws which define hazardous wastes and specify their methods of management, including:
– local ordinances which stipulate the responsibility of citizens to store, sort, recycle,
discharge, and/or dispose of their solid wastes;
– local ordinances which prohibit littering and clandestine dumping;
– local ordinances outlining the management of hazardous wastes;
– local laws, policies and procedures governing involvement of the private sector in solid
waste services; and
– local laws or agreements which specify the institutional arrangement for SWM.
• Policies on recycling and resource recovery.
• Tariff structures and procedures which govern cost recovery for SWM.
• Laws which define the roles and responsibilities of provincial and local governments in
SWM.
• Sanctions provided under each of the laws and regulations discussed.
• Outline the existing procedures for inspection and enforcement of laws.
The most recent and relevant legislative act is the Local Government Act 936 (2016), which:
• Preserves and maintains the districts already in existence.
• Includes “the disposal of waste on land, including the discharge of effluent into a body of
still or running water” as part of the definition of “physical development”.
• Re-centralizes the “Waste Management Department” at metropolitan assembly level,
removing its counterparts at municipal and district assembly levels.
Under pressure from international organizations, the Government of Ghana has privatized solid9
Table 2.1 Acts and regulations related to solid waste management
Year Acts and regulations Level
2016 Local Government ACT (ACT 936), 2016 (2016 onwards) National
2010 National Environmental Sanitation Policy (Revised), 2010 National
2010 National Environmental and Sanitation Action Plan (NESSAP) 2010 National
1999 Environmental Assessment Regulations, 1999 (LI 1652) National
1996 National Building Regulations, 1996 (LI 1630) National
1995 Local Government (Accra Metropolitan Assembly) Establishment Instrument, 1995 (LI 1615) Local
1995 Local Government (District Tender Boards) Establishment Regulations, 1995 (LI 1606) Local
1994 National Development Planning Commission Act, 1994 (Act 479) National
1994 National Development Planning (System) Act, 1994, (Act 480) National
1994 Local Government (Urban, Zonal, Town and Town Councils and Unit Committees) Establishment Instrument, Local
1994 (LI 1589)
1994 Environmental Protection Agency Act, 1994 (Act 490) National
1993 Local Government Act, 1993 (Act 462) Local
1993 District Assemblies Common Fund Act, 1993 (Act 455) National
1992 Constitution of the Republic of Ghana,1992 National
1992 Food and Drugs Law 305b (1992) National
1944 Town and Country Planning Ordinances, 1944 (Cap 84) National
1919 Vaccination Ordinance (Cap 76) National
1915 Quarantine Ordinance (Cap 77) National
1911 Mosquito Ordinance (Cap 75) National
1908 Infectious Disease Ordinance (Cap 78) National
waste collection with the target of increasing collection rates as well as tackling some solid waste
challenges such as increasing recycling and treatment operations respectful of the environment
(World Bank, 1996; Post et al., 2003). Waste management planners in Ghana are currently using the
“collect and dispose’’ approach which places more emphasis on the final disposal of waste rather
than adopting a more inclusive and sustainable approach to managing waste (Asomani-Boateng,
2007).
Drawing on actual and planning data from 1985 to 2000, a quick analysis of waste collection
performance in Ghana offers interesting insights under the two different organizational regimes
which operated over the period:
1. initially, entirely public sector;
2. currently, a mix of public-private sector participation.
The analysis reveals that the overall performance of waste collection services in Ghana increased
under regime 2, with efficiency increasing rapidly with increased private-sector controls and levels
of involvement, e.g. based on the analysis of data available at the Waste Management Department
and the Ministry of Local Government and Rural Development (MLGRD), collection rate and disposal
improved from 51% in 1998 to about 91% in the 2000 (Fobil et al., 2008). However, such an increase
in performance was not sustained beyond 10 years of public-private partnerships and today the10 S O L I D WA S T E M A NAGE ME NT AND H EALTH IN ACCRA, GHANA
system can no longer provide efficient solutions (Oduro-Kwarteng & van Dijk, 2013). The SWM sector
in Ghana faces numerous problems related to conflicts that exist within the current institutional and
legislative arrangements. Issues include: indiscriminate disposal of waste at unauthorized places,
littering, inadequate service coverage and irregularities in waste collection. In the late 1980s and
early 1990s, the public-private partnership was effective in containing the deteriorating urban
environmental conditions. However, the public-private partnership model failed to sustain the initial
momentum in terms of efficiency and performance as a result of the inability of local authorities
to capitalize on opportunities and properly deal with the associated risks, thus reversing the gains
made in urban environmental management.1 Several gaps exist, for example, the need to reconsider
the efficacy and appropriateness of investments in wholesale importation from North America or
European countries of SWM technologies into places that are often incompatible with the required
physical, social and economic realities (Oteng-Ababio et al., 2013).
2.6 Main stakeholders of the waste management sector in Ghana
The SWM sector in Ghana is organized collaboratively among multiple stakeholders with the MLGRD
and the Environmental Protection Agency (EPA-Ghana) playing key roles as implementer and
regulator, respectively. The Ghanaian regulatory framework defines the roles and legal obligations
of institutions and government bodies. In fact, the Local Government Act 1993 (Act 462) gives the
MLGRD three SWM responsibilities:
• policy and planning
• legislation regarding SWM
• the regulation, monitoring and enforcement of SWM activities (Oduro-Kwarteng, 2011).
The situation is somehow complicated by the different responsibilities and mandates attributed by law.
The MLGRD is responsible for formulating and implementing policies related to SWM and sanitation.
Its duties also include promulgating national legislation and bylaws and providing direction and
supervision of the National Environmental Sanitation Policy Co-ordination Council. EPA-Ghana has
been mandated to manage and protect the country’s environment and also to educate the general
public on sanitation issues. The responsibility of the MLGRD is discharged through the metropolitan,
municipal and district assemblies (MMDAs) which are directly under the MLGRD and EPA-Ghana.
The MLGRD has the responsibility for the decentralized MMDAs. The MMDAs, the implementing
bodies of the MLGRD, have sole responsibility for waste collection and disposal through their waste
management and environmental health and sanitation departments which provide services either
directly or indirectly through private contractors or franchisees. The MLGRD’s technical guideline
(Expanded Sanitary Inspection and Compliance Enforcement) is implemented by the MMDAs in
four areas: effective environmental health inspections; dissemination of sanitary information; pest/
vector control; and law enforcement (MLGRD, 2010).
1
Efforts to change the situation are ongoing and the Mayor of Accra received the C40 Cities Bloomberg Philanthropies Award 2019 for achievements in
integrating informal waste collection into formal systems in Accra. The programme started in 2016 and was selected by C40 (a network of the world’s
megacities committed to addressing climate change) to receive the award (https://www.c40.org/awards/awards-2019/profiles).11
2.7 Current state of solid waste management in Accra
The development of waste management infrastructure has not kept pace with the increasing
population of Accra. This, together with the low cost of labour and weak enforcement of existing
legislation, explains the rapid growth in the informal waste sector. In the 1990s, solid waste disposal was
dominated by open dumping of waste which was practised by 83% of all households; only 11% of the
metropolitan population benefited from a home collection service (Songsore & McGranahan, 1993:
21). Initially, SWM in Accra was entirely a local
government service and the collection rate
Table 2.2 Waste collection in five neighbourhoods of Accra, 2000
was approximately 67% (World Bank: 1996).
In the 2000s, with increasing generation, Neighbourhoods Percentage of collected solid waste
waste management became the most
Nima 8.6
pressing environmental concern in the city
Sabon Zongo 15.1
of Accra (Post et al., 2003; Miezah et al., 2015;
Accra New Town 25.3
Alhassan et al., 2020). Results from the 2000
Jamestown 11.0
population and housing census evidence
Chorkor Down 2.9
the pressing problem of waste collection
activities in low-income communities in Source: Obeng-Odoom (2013) from the 2000 population and housing
Accra (Tables 2.2 and 2.3). census, Ghana.
Table 2.3 Waste collection in four communities in Accra, 2017
Type of waste disposal (solid waste) Jamestown Nima Asylum Down East Legon
Door-to-door collection 97.5 5.7 46 55.9
Household burned some or all waste 0 2.5 27 34
Public container 0 91.8 22.5 7.6
Household dumped some or all waste indiscriminately 2.5 0 4.9 2.5
Total 100 100 100 100
Source: Results from a survey carried out in 2017 (Kanhai et al., 2019).
The characterization of the neighbourhoods analysed is quite diverse: Chorkor Down and Jamestown
are indigenous low-income neighbourhoods; Accra New Town, Nima and Sabon Zongo are low-
income slums formed by migrants and they all are high-density areas; Asylum Down is a middle-
density and middle-class income area; East Legon is a low-density and high-income area (Obeng-
Odoom, 2013). For updated estimates see Table 2.3.
Estimates from 2008 and 2017 show that waste generation has been increasing rapidly in the last
two decades (Fobil et al., 2008) (Tables 2.4 and 2.5). In 2017 (Table 2.5), the majority of households in
the Greater Accra Region (65.4%) had their solid waste collected, while about 17.4% was disposed
of through public dumping. 14.6% of households burned all of their waste (Ghana Statistical Service,
2019, p. 158). There has been an increase in burning and public dumping of rubbish when comparing
2017 with 2010 (Tables 2.4 and 2.5).12 S O L I D WA S T E M A NAGE ME NT AND H EALTH IN ACCRA, GHANA
Table 2.4 Method of rubbish and liquid waste disposal by households, 2010
Method of waste disposal Ghana (%) Greater Accra Accra (%)
Region (%)
Solid waste disposal
Collected 785 889 (14.4) 502 642 (48.5) 298 178 (59.4)
Burned by household 584 820 (10.7) 134 654 (13.0) 13 402 (2.7)
Public dump (container) 1 299 654 (23.8) 266 287 (25.7) 156 481 (31.2)
Public dump (open space) 2 061 403 (37.7) 87 379 (8.4) 23 647 (4.7)
Dumped indiscriminately 498 868 (9.1) 22 123 (2.1) 5408 (1.1)
Buried by household 182 615 (3.3) 14 003 (1.4) 1412 (0.3)
Other 53 805 (1.0) 9282 (0.9) 3375 (0.7)
Total 5 467 054 (100.0) 1 036 370 (100.0) 501 903 (100.0)
Liquid waste
Through the sewerage system 183 169 (3.4) 95 188 (9.2) 41 000 (8.2)
Through drainage system into a gutter 594 404 (10.9) 191 228 (18.5) 135 248 (26.9)
Through drainage into a pit (soak away) 167 555 (3.1) 55 807 (5.4) 20 012 (4.0)
Thrown on to the street/outside 1 538 550 (28.1) 127 782 (12.3) 33 064 (6.6)
Thrown into gutter 1 020 096 (18.7) 351 349 (33.9) 236 463 (47.1)
Thrown on to compound 1 924 986 (35.2) 208 821 (20.1) 33 436 (6.7)
Other 38 294 (0.7) 6195 (0.6) 2680 (0.5)
Total 5 467 054 (100.0) 1 036 370 (100.0) 501 903 (100.0)
Source: Elaboration based on census data (Ghana Statistical Service, 2014).
Table 2.5 Type of waste disposal method by type of locality and region, 2017
Method of waste disposal Ghana (%) Greater Accra Region (%)
Solid waste disposal
Collected 21.9 65.4
Burned by household 19.5 14.6
Public dump 47.8 17.4
Dumped indiscriminately 10.8 2.7
Total 100.0 100.0
Liquid waste
Discharged in open area 68.8 32.4
Discharged into drains 25.9 53.6
Septic tank 3.7 12
Discharge into sewer 0.9 2
Other 0.7 0
Total 100.0 100.0
Source: Elaboration based on census data (Ghana Statistical Service, 2019: Table 7.21, 158).13 “Most poor neighbourhoods and slums are highly susceptible to disease outbreak as a result of a poor attitude towards domestic waste management in these areas. Personal observation and discussions with some residents in low-income areas showed that attitude towards waste management is appalling in these areas due to poor waste management services rendered by purported waste management contractors.” (Fagariba & Song, 2018: III). Wide socioeconomic inequalities characterize the production of waste and the population of Accra.“High-income areas are provided with more adequate household dustbins and public refuse containers than middle and low-income areas though daily household generations in low and middle-income settlement areas are high” (Fagariba & Song, 2018: III). Surveyed households had limited knowledge of waste-related health hazards in their neighbourhoods. Although households reported diseases that could be associated with environmental factors linked to waste management, 87% of all surveyed households did not think that someone in their household could have fallen ill from a disease related to waste. In middle- and high-income neighbourhoods, waste burning increases substantially when waste is not collected (Kanhai et al., 2019). Although not conclusive, different research has reported that high-income populations are more likely to have space in their homes to bury or burn the waste they generate (Oteng-Ababio et al., 2013; Alhassan et al., 2020). According to recent estimates, Accra produces approximately 2200 tonnes of solid waste daily, and is expected to exceed 4400 tonnes per day by 2030 (Oteng-Ababio, 2010; 2014; Fagariba & Song, 2018). Waste composition is 65.8% organic matter, 5.3% paper and 10.4% plastic components, and, in small percentages, metals, glass, textiles, leather and rubber (Miezah et al., 2015). In GAMA waste is formally collected by the following private sector providers: Metropolitan waste, Meskworld, J Stanley-Owusu and Co. Ltd, Jekora and Zoomlion – with about 150 heavy and about 60 light duty diesel trucks. There are three composting plants: the large-scale ACaRP at Adjen-Kotoku, which operates as a public-private partnership arrangement and receives a government subsidy (Oduro-Appiah et al., 2017); the large-scale Teshie compost plant in Ledzokuku-Krowor Municipal Assembly; and a smaller composting plant at the Timber Market, Ashiedu-Keteke Submetropolitan Assembly. Waste is formally recycled at ACaRP, Jekora, Enviroplast Company Limited, City Waste Management Co. Ltd, SkyPlast Enterprise and Blowplast Limited, Coliba Ghana Limited. Yet, most of the recycling companies operate on a small scale. ACaRP is one of the few major recycling plants in Ghana, which sorts/segregates, processes and recycles both solid and liquid waste at final disposal. Accra is not an exception in Ghana, where landfills and dumpsites are the preferred way to address waste production because of the low operating costs (Kusi et al., 2017). Waste from Accra is disposed at two sanitary landfills: ACaRP (about 80 tonnes deposited per day) and Tema Kpone Katamanso (between 1500 and 2000 tonnes deposited per day from the city of Accra), which are almost full. Additionally, there is one controlled dumpsite: Nsumia. None of these landfills have methane collection services in use. Dumpsites of different dimensions are an existing reality for the city of Accra. For example, the dumpsite of Abokobi, which receives 400 tonnes of waste daily, has a poor drainage system and fires are common throughout the year (Kusi et al., 2017; Tersigni et al., 2018). The city of Accra is highly dependent on neighbouring municipalities for waste disposal, which suggests that the waste disposal system is weak at its core. It should be a priority to modernize the current waste disposal system and to ensure appropriate treatment (Oduro-Appiah, et al., 2017).
14 S O L I D WA S T E M A NAGE ME NT AND H EALTH IN ACCRA, GHANA
There are two transfer stations in Accra: Teshie and Achimota. Teshie transfers waste to Kpone landfill
in Tema, while Achimota, which was inaugurated in May 2017, transfers to ACaRP. Teshie transfer
station has operated problematically for many years, receiving an average of 10 000 tonnes per
month (Oteng-Ababio, et al., 2013). Both Teshie and Achimota transfer stations each have a planned
capacity of 30 000 tonnes per month.15
3. ASSESSING THE IMPACTS OF
SOLID WASTE MANAGEMENT
INTERVENTIONS
3.1 Tools and methodology
The UHI has applied and exploited tools to model the impacts of policies to promote sustainable
waste management, and to reduce air pollution levels and associated health risks in Accra.
Preliminary estimates of the emission scenarios of policy interventions were modelled using the Solid
Waste Emissions Estimation Tool (SWEET)1 developed by the US Environmental Protection Agency on
behalf of the CCAC. This tool has been utilized for academic research with a focus on estimating the
current emissions of specific waste treatment technologies (Mettetal, et al., 2019; Yapo, et al., 2019),
and for rapid assessment of the impacts of SWM options (Premakumara et al., 2018). The purpose
of this analysis was to provide support for the development of urban waste management (UWM)
policy-driven scenarios for the estimation of expected health and economic impacts.
To calculate the impacts of SWM scenarios two approaches were considered:
1. Using SWEET, estimate the change in emissions related to various policies or hypotheses (see the
Annex and Kanhai et al., 2021).
2. Model different land use for some of the current landfills and dumpsites, for example, transformation
into green spaces (for details see separate WHO UHI report, Land use, waste, green spaces, air
pollution and health in Accra, Ghana).
The first approach is the one presented in this report.
The analysis, carried out using the Excel-based SWEET, made use of routinely generated planning
and administrative data as well as published data obtained from the SWM sector to estimate
SLCPs associated with waste management activities. The SWEET software was developed by US EPA
to support the CCAC initiative to evaluate the impact of SWM sector policies on SLCPs including
some urban air pollutants. Data were analysed through the development of scenarios for the
SWM sector of Accra, which were informed by existing and planned sector policies, current waste
disposal technologies and capacity, and are built in accordance with the Phase Model of Waste
Management Development (PMWMD) by Klampfl-Pernold et al. (2010).
1
SWEET is available at: https://ccacoalition.org/en/resources/solid-waste-emissions-estimation-tool-sweet-version-3116 S O L I D WA S T E M A NAGE ME NT AND H EALTH IN ACCRA, GHANA
Three alternative scenarios were created:
• Scenario 1: cease open burning;
• Scenario 2: increase composting and recycling
• Scenario 3: capture landfill gas.
These were then compared with a business-as-usual (BAU) scenario. In the BAU scenario, a 2% annual
increase in waste collection capacity is assumed, thereby balancing expected population growth
and keeping the technology and capacity used in 2019 stable. Considering the recent past, this
is in some ways a hopeful assumption, as, for example, the ACaRP, which opened in 2012, was shut
down in 2014 due to a lack of political support (Zainabu, 2014) and only reopened at the beginning
of 2017. No major changes or improvements in the use of technology or capacity of the waste
management system are currently expected.
The first scenario models the ceasing of open burning by households and the informal sector, starting
in 2021. This scenario is modelled via a two-step approach with a second reduction in burning
occurring in 2025. No other factors of the waste system are changed and waste collection rates and
waste treatment are as in the BAU scenario. The second scenario assumes increased composting
and recycling, starting in 2023, where the composting capacity is doubled to 60 000 metric tonnes
and recycling capacity is increased by 60% to about 54 000 metric tonnes. No other changes to the
BAU scenario are made. In the third scenario, landfill gas capture, starting 2021, assumes all waste
collected for final disposal is sent to sanitary landfills with methane gas capture. No other changes
to the BAU scenario are made.
The scenarios were modelled in accordance with UWM related policy interventions, after which the
impacts of SWM on air quality were estimated (considering air and climate pollutants analysed in the
SWEET tool, e.g. PM2.5, BC and CO2). The strength of this method lay in the careful review of previous
research and analysis of the waste management sector in Ghana. SWEET can be considered a policy
planning tool that requires less data input than the usual life cycle assessment-based tools. The waste
sector has experienced a proliferation of tools, in particular, many using life cycle assessment and
running scenario analyses to identify the best waste management options (DEFRA, 2004; Allesch &
Brunner, 2014). AirQ+, the software developed by WHO to quantify the impacts of air pollution, was
used to model the health outcomes of the various scenarios.1
3.2 Health impact assessment
A methodology based on the intake fraction (for details, see the Annex and Kanhai et al., 2021) was
applied to assess the impact of the current situation and of the scenarios. After the estimation of
concentrations, the assessment of the health impacts was carried out using the AirQ+ software. The
first step was to produce estimates of the concentrations that are related to the different scenarios
(for details, see the Annex).
1
For more details on AirQ+ see: https://www.euro.who.int/en/health-topics/environment-and-health/air-quality/activities/airq-software-tool-for-health-
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