How an innovative waste and sanitation partnership is improving health outcomes in Ghana

It's well known that sanitation plays a key role in preventing diseases like diarrhea, cholera, and malaria. What's less well known, however, is that sanitation also plays a role in other conditions like stunting that affect millions of children around the world.

Poor sanitation, for example, can contribute to diarrheal diseases and other infections that can impair nutrient absorption in children, leading to chronic malnutrition and stunting. Contaminated water sources can also harbor pathogens such as bacteria, viruses, and parasites that cause diseases like cholera, typhoid fever, and intestinal worms that can lead to chronic inflammation of the intestines, malabsorption of nutrients, and ultimately stunted growth.

In the southern Ghanaian city of Kumasi, a partnership between two social enterprises –Safisana and Clean Team Ghana – is showing how a circular approach to waste can not only significantly improve waste management and sanitation, but also help decrease incidence of disease and potentially impact conditions such as stunting.

As part of the collaboration, Clean Team Ghana collects fecal waste from 3,200 local households and delivers it to Safisana, which also collects organic waste from the area's three main food markets. Safisana processes the organic and fecal waste into biogas, green electricity, and biofertilizer through an anaerobic digestion process, which means bacteria breaks down organic matter in the absence of oxygen. The Kusami operation currently produces only fertilizer, but the company has plans to expand operations to also produce biogas.

Exemplars News spoke with Elikplim Asilevi, the manager of Safisana Ghana, and Abigail Aruna, the CEO of Clean Team Ghana, about their innovative partnership and what lessons they have to share with other enterprises considering similar collaborations.

In your own words, could you tell us about Safisana and the problem you're trying to solve?

Asilevi: Safisana is a health and climate company specializing in waste-to-resource solutions. We collect and process fecal and organic waste, transforming them into biogas, green electricity, and a certified biofertilizer through an anaerobic digestion process. Our main plant is the first of its kind in Ghana and is located in Ashaiman, a non-sewered, urban and poor community that's grappling with insufficient sanitation and waste facilities. By integrating fecal sludge, solid waste, and wastewater treatment into one solution, Safisana has revolutionized the approach to waste management in Ghana. Our vision is to enhance the health and environmental conditions for millions residing in poor urban areas without sewer systems. By transforming this waste into resources, Safisana promotes sustainable practices and mitigates climate and environmental impacts.

Another problem we solve is the sanitation-related health crisis. Worldwide, around 829,000 people die each year from poor sanitation and hygiene. Approximately 19,000 Ghanaians die each year from sanitation-related diseases such as diarrhea, cholera, and malaria. Waste evacuation embolization plays a crucial role in mitigating the prevalence of sanitation-related illnesses. By effectively removing waste, we significantly reduce the exposure of communities to this waste, thereby potentially eradicating these diseases altogether.

With the biofertilizer we produce and sell under the brand of Asase Gyefo, we also contribute to solving the problem of food insecurity since healthy soils are indispensable to providing the vital nutrients, water, oxygen, and root support required for our food-production plants to thrive. Additionally, soils act as protective shields for delicate plant roots against severe temperature variations. The decades-long application of chemical fertilizers poses potential threat to soil health by altering the pH balance of the soil, disrupting beneficial microbial activities, and escalating pest infestations. It is known that up to 40% of all soil worldwide is moderately or severely degraded – a figure we anticipate to rise to 90% by 2050. That's just in the next 30 years. If harmful practices such as the use of chemical fertilizers continue, this will occur even before 2050.

The production and use of biofertilizers have also emerged as important priority areas globally in view of the growing demand for safe and healthy food and long-term sustainability. Biofertilizers not only ensure food safety but also improve the biodiversity of the soil. Our biofertilizer is rich in nutrients and minerals, because it is made from organic waste. It contains live microorganisms that can be applied directly to the soil, boosting its structure, water-holding ability, and nutrient retention.

Could you tell us a bit more about your circular approach to waste management and how it can help improve water, sanitation, and hygiene (WASH)?

Asilevi: Our approach serves as a preventive health measure. The process involves the collection of wastewater, thicker sludge, and organic waste and subsequently transforming them into valuable products for daily use within the same community. It is worth noting that about 95% of all wastewater in developing nations remains unfiltered and goes back into the system.

Furthermore, fecal waste is frequently discharged directly into local water sources without any treatment leading to significant public health issues. As I mentioned, the collection, treatment, and the reuse of fecal waste significantly reduces the risk of disease transmission by minimizing direct human exposure to the waste thereby promoting overall health within communities, particularly those that are underserved or not served at all.

Could you tell us about the composting production site you've established in partnership with Clean Team Ghana in Kumasi?

Aruna: Clean Team Ghana is a social enterprise that provides portable household toilets for low-income communities in Kumasi using the container-based sanitation module. Right from our inception, Clean Team has always wanted to close the loop when it comes to sanitation on the entire value chain, from containment and collection all the way to treatment.

We've been able to do collection, containment, and transporting of waste. And we've been able to safely treat waste by drying it to make sure the pathogens died before we would landfill it. But we were also conscious we could actually add value to the waste and turn into compost or some other useful product. So, in 2018, we started talking to Safisana about a possible partnership because they handle the back-end of the sanitation value chain and add value to waste.

We wanted to concentrate on the front-end, which is getting the waste out of communities, and had been on the lookout for a company that could close the loop for us so we don't have to add that onto what we were doing. We actually sent loads of waste from Kumasi to Accra for Safisana to test and come up with a recipe that would be able to produce a good compost. In 2020, they came up with a good recipe to produce good compost – the nutrient levels were really high and met the specifications.

We started the pilot here in Kumasi in August 2022. We got support from the Kumasi Metropolitan Assembly, which has been supporting Clean Team by providing us land at their landfill site. We completed a successful pilot and produced over 36 tons of waste. What we're doing now is sending all our waste to Safisana, about 150 tons of waste monthly. Safisana also collects waste from markets in Kumasi, about 200 tons, and makes a compost they can sell to farmers.

Your partnership with Clean Team Ghana has been praised as a model for collaboration between sanitation providers. Could you tell us more about how you work together to service different parts of the sanitation value chain?

Aruna: Covering the entire sanitation value chain can be very difficult and challenging. It means you need expertise in different areas, including logistics, waste management, and turning waste into compost. It's also really expensive. We decided that we were not waste management experts and didn't want to go into that field since it's so capital intensive. That was why we were looking to collaborate. At the same time, Safisana were also looking to expand their services into Kumasi. Our aims or objectives actually merged and it made good sense for us to collaborate. Sanitation is large and one group cannot do everything. Collaborations like what we have with Safisana are the way to provide holistic sanitation for communities around the world, not just in Ghana.

Could you tell us specifically how this WASH work is helping the community in terms of socioeconomic, environmental, and especially health impacts?

Aruna: Clean Team's service is currently reaching over 3,100 households without toilets and impacting the lives of over 16,000 people. All these people previously were using public toilets that are unhygienic or were practicing open defecation. We're collecting about 150 tons of waste every week from these communities. This waste would have ended up in open drains and caused sanitation-related diseases like diarrhea, cholera, and typhoid, but we are collecting it and sending it to Safisana to be turned into compost.

Since Clean Team started the Kumasi operation in 2010, we've not had any major cholera outbreaks. That's because we're moving all the waste and safely treating it. With our collaboration with Safisana, they're also collecting waste from markets. They're collecting over 200 tons every month which is combined to produce compost that will help food production, improve farmers' yield, give them more money, increase food yields, and help solve our food scarcity challenges. The bio-fertilizers also go a long way to enriching or replenishing the soil to make food production even more sustainable.

In terms of socioeconomic impact, we have over 60 full-time staff that are working for Clean Team. Safisana also has over 60 staff in both Ashaiman and Kumasi. We are providing jobs – and in Ghana, if you provide a job for one person, you are actually improving the lives of more than five people.

In terms of environmental impacts, waste is no longer being dumped in the landfills or in the open to create greenhouse gasses that are affecting the climate. We're making markets cleaner and, by extension, are creating cleaner, more sustainable communities.

Based on your experience, how could the waste management and health sectors better collaborate to improve health outcomes?

Asilevi: Sanitation-related diseases basically arise from exposure to waste. The best way to address this problem is to have preventive health models, such as a Safisana's model to eradicate waste from the community, reducing children's exposure to these hazards. It's also notable that the WASH sector is responsible for waste. The only way to have a holistic solution to this is to foster collaboration between the public and the private sectors. The private sector has the technology, and governments, which run WASH, have the infrastructure to reach the people.

Governments can also address advocacy and policy formulation to augment the efforts of the private sector. For example, governments' agricultural officers, who already have direct contact with farmers, can tell them that it is time we shift from the use of chemical fertilizers to bio-organic fertilizers. That is an example of advocacy.

Then, in terms of policy formulation, the health sector can also collaborate with waste management to implement programs and policies to promote waste reduction and segregation at the source. This helps to minimize the generation of hazardous waste and ensures proper disposal, thereby reducing the risk of infections and environmental contamination. This is how I think that the WASH sector can collaborate with the waste management sector to improve health outcomes.

Editor's Note: More information about the relationship between WASH and stunting can be found here, in a perspective from Dr. Zulfiqar Bhutta.