https://orcid.org/0000-0003-4528-3086
Figures
Abstract
The global community is not on track to achieve Sustainable Development Goal 6 (SDG 6) by 2030. Many low- and middle-income countries like Ghana still struggle with water insecurity. In semi-arid regions like Ghana’s Upper West, climate change has worsened water insecurity, leading to health and livelihood consequences. In UWR, limited studies have explored water insecurity in rural areas. This study fills a knowledge gap by investigating the determinants of water insecurity in Ghana’s Upper West Region (UWR) from a political ecology of health (PEH) perspective. It comprehensively explores the interplay of social, economic, political, environmental, and health-related factors contributing to water insecurity in the UWR. The results from binary logistic regression show that households in the wealthier category (OR = 0.475, p<0.05) and those that spent less than thirty minutes on a roundtrip to fetch water (OR = 0.474, p<0.01) were less likely to experience water insecurity. On the other hand, households that did not use rainwater harvesting methods (OR = 2.117, p<0.01), had to travel over a kilometer to access water (OR = 3.249, p<0.01), had inadequate water storage systems (OR = 2.290, p<0.001), did not treat their water (OR = 2.601, p<0.001), were exposed to water-induced infections (OR = 3.473, p<0.001), did not receive any water, hygiene, and sanitation education (OR = 2.575, p<0.01), and faced water scarcity during the dry season (OR = 2.340, p<0.001) were at a higher risk of experiencing water insecurity. To mitigate the risks of water insecurity and adverse health impacts, policymakers and practitioners must work together to educate households on effective water conservation, storage, and treatment techniques. It is recommended that households harvest rainwater as a coping strategy, construct appropriate storage systems, and treat their water. Communal self-help water investments should be encouraged and supported. Given the significant aquifers and semi-arid landscape of the UWR, investing in groundwater development should be a top priority.
Citation: Pienaah CKA, Saaka SA, Batung E, Mohammed K, Luginaah I (2024) Household water insecurity experience in the Upper West Region of Ghana: Insights for effective water resource management. PLOS Water 3(6): e0000216. https://doi.org/10.1371/journal.pwat.0000216
Editor: Francis Dakyaga, SD Dombo University of Business and Integrated Developmental Studies, GHANA
Received: October 13, 2023; Accepted: April 29, 2024; Published: June 6, 2024
Copyright: © 2024 Pienaah et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the paper and its Supporting Information files.
Funding: The author(s) received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
1. Introduction
Safe water, also called potable water, is free from pathogens and contaminants that can cause health problems [1,2]. It meets quality standards set by local health regulations or international guidelines, like the World Health Organization [1]. Safe water is essential for health, a fundamental human right, and a component of effective health protection policies [1–3]. The lack of access to safe and sustainable water for essential human needs results in water insecurity [4,5]. Water insecurity is a major global issue that affects individuals, households, communities, and nations [5]. Water insecurity has far-reaching negative impacts on health, economies, and the environment, such as malnutrition, dehydration, waterborne diseases, food insecurity, migration, displacement, conflicts, ecosystem degradation, and climate change [5]. It also affects education, deepens gender inequalities, and perpetuates poverty [5]. Notwithstanding the global drive to achieve the sustainable development goal (SDG6)-water and sanitation for all [5], unfortunately, as of 2022, there are still 2.2 billion people worldwide who still need access to safe drinking water [5]. About 60% of the 790 million people in Sub-Saharan Africa (SSA) are particularly affected, exhibiting the challenges of attaining Sustainable Development Goal 6 [5,6].
Currently, Ghana has safe water coverage for 41.4% of its population, and only 13% use managed sanitation that is considered safe [1,3]. Regarding access to improved drinking water sources in Ghana, the 2021 census found that 92% of households have access to improved drinking water sources. However, there is significant variation between urban and rural areas (97.8% vs. 83%) and across different regions. The highest access rates were found in the Greater Accra, Bono, and Upper West regions (98.3%, 97.5%, and 97.3%, respectively). At the same time, the lowest was in Oti, North East, and Savannah regions (77.1%, 74.8%, and 70.5%, respectively) [7].
This progress has been reported to significantly reduce the number of people without access to improved water throughout the country [8,9]. Although the national data shows high coverage of improved water sources in the Upper West Region (UWR), rural areas still face water insecurity. Relying on improved water sources does not guarantee safe and sustainable access to water throughout the year in rural areas. Even communities covered by improved water sources may face insecurity due to contamination, breakdowns, or lack of nearby water supply systems. In that context, the Ghana Statistical Service’s multiple indicator cluster survey found that 93.5% of households in the UWR are at risk of fecal contamination in their drinking water due to various water contaminants throughout the region [10]. In contrast to the national figures, the Community Water and Sanitation Agency (CWSA), responsible for providing water and sanitation to the rural areas of the UWR, has reported a water coverage rate of 74.13% in its 2021 reform report. This water supply system serves a rural population of 567,570 out of 884,197 individuals and is powered by 2,139 boreholes and 27 Small Town Piped Water Supply Systems (STPWSSs). Despite these achievements, the CWSA has acknowledged household water insecurity challenges [11].
Water insecurity is a critical challenge in the UWR, yet it has received limited empirical evidence. Some studies, primarily qualitative, have reported isolated aspects of water insecurity in the UWR, including poor sanitation and diarrhea cases [8], surface water pollution [12], small water system management challenges [13], and challenges in access and utilization [14]. These challenges in the UWR are reported to particularly impact vulnerable groups such as women, girls, and children, who often bear the responsibility of fetching water [14,15]. Climate change exacerbates these challenges, affecting many smallholder farmers [16–18]. However, this creates a knowledge gap in how the complex relationship of essential dimensions of water security, such as demographic, socioeconomic, sociocultural, socio-political, health, and environmental factors, shape water insecurity in the UWR. Given the significant impact of water insecurity on many aspects of people’s health and livelihoods, this is a primary concern. Without a comprehensive understanding of the factors contributing to water insecurity and their broader implications, policymakers, and practitioners will struggle to develop effective interventions to address this issue and achieve SDG 6 (water and sanitation for all). To fill this knowledge gap, this study comprehensively investigates the determinants of household water insecurity in the UWR from a political ecology of health (PEH) perspective. The research question is: what factors influence water insecurity in the rural context of UWR? Given the increasing effects of climate change, the study also aims to identify promising areas for further research and targeted interventions to help alleviate water insecurity in the semi-arid UWR and similar regions in SSA. Following the introduction, this paper is structured into six sections. These include the theoretical framework, study context, methodology, results, discussion and limitations, and conclusion and policy recommendations.
2. Theoretical framework
This study is grounded on the Political Ecology of Health (PEH) ‐ a subfield of Political Ecology (PE) ‐ which examines the impact of political, social, and economic factors on health outcomes through environmental pathways [19–21]. Specifically, PEH examines how environmental policies and management decisions affect public health, which is crucial in water security [22,23]. By applying PEH, this study aims to reveal the power dynamics and inequalities that contribute to water insecurity, highlighting the role of human agency and socio-political structures in shaping environmental outcomes [24]. PEH posits that ecological issues, including water insecurity, are linked to the socio-political and economic contexts in which they occur [23]. For example, economic disparities can lead households with more resources, such as wealth, to secure their water needs by investing in private water sources like boreholes. On the other hand, less-resourced households are left to fend for themselves, competing for limited water resources. This unequal access to safe water is a direct consequence of economic disparities [21].
PEH challenges the notion that water scarcity is solely a result of physical shortages. Instead, it emphasizes how such scarcities are produced and exacerbated by unequal power relations and governance structures [21,25]. PEH examines how policy decisions and infrastructure investments reflect societal values and power relations, which can often lead to the marginalization of certain groups. Moreover, PEH brings attention to the role of environmental variability, such as the impact of climate change and seasonal changes on water availability. It emphasizes the significance of community engagement and public health in addressing water insecurity [20–22]. Integrated approaches that combine health promotion, education, and sustainable resource management are necessary to address vulnerable communities with unsafe water access points. For instance, the Community-Led Total Sanitation (CLTS) model has demonstrated that improving WASH education and practices can significantly reduce water-related health risks [3,9]. This underscores the importance of integrated health and environmental management approaches in tackling waterborne diseases from the PEH perspective [11,19,21].
PEH advocates for participatory governance and including local knowledge and practices in water management strategies [23,25]. For example, in some communities within the UWR, community water and sanitation committees (WATSANs) have been responsible for overseeing local water supply systems, ensuring their functionality, and the fair distribution of water resources. This demonstrates the efficacy of engaging local communities in water management decision-making processes, harnessing their expertise and traditional techniques to create long-lasting and sustainable solutions.
In addition, PEH examines the connection between climate variability, land use adaptations, and water management practices regarding water insecurity issues [23,26]. This approach enables an examination of how environmental degradation, influenced by both actions and global economic systems, contributes to the vulnerability of water supplies. For example, in the semi-arid region UWR, exposure to extreme climate events like floods, dry spells, storm surges, droughts, and unpredictable rainfall could potentially restrict access to safe water and have a far-reaching impact on their food production systems and health [16]. Grounding this study in PEH, it recognizes water insecurity as a complex issue involving environmental, economic, social, and political factors. This theoretical framework facilitates a deeper understanding of the systemic inequalities and governance challenges that contribute to water insecurity in the UWR of Ghana, guiding the development of more effective and equitable solutions for public health improvement.
3. Materials and methods
3.1 Study context
The semi-arid UWR is in the northwestern corner of the savannah ecological zone of Ghana [27,28]. It is located between coordinates 9.8°-11.0° N and 1.6°-3.0° W [27,28] (as shown in Fig 1). The region has an estimated population of 901,502. Sadly, the UWR is one of Ghana’s poorest regions, with a distressing 90% of residents living on under a dollar each day [10]. Approximately 80% of the population and 80.4% of households in the region rely on subsistence agriculture. Women make up 42% of the workforce [27–30]. In the UWR, shea products are the primary source of livelihood for most women [29]. Poverty rates in the districts of Wa East, Wa West, and Nadowli-Kaleo, where this study took place, are 92.4%, 83.8%, and 68.5%, respectively, according to the Ghana Poverty Map Report [31]. The region faces multiple climatic stressors (e.g., floods, droughts, dry spells, erratic rainfall, storm surges, pets, and disease outbreaks) contributing to various challenges, including water, food, nutrition, and income insecurity [16–18]. The region is also characterized by bushfires and harmattan during the dry season, further exacerbating water scarcity issues [27,29,30,32]. The region has limited irrigation resources, especially surface water resources. Moreover, poor sanitation practices and infrastructure issues, such as inadequate access to clean water sources and poor waste disposal systems, contribute to water insecurity in the UWR [31]. These issues affect the availability of safe drinking water and increase the risk of waterborne diseases, leading to poor health outcomes among residents [33]. The region also faces environmental pollution and outmigration as residents opt for various livelihoods [33]. The healthcare system is particularly challenged in rural areas [33] as well as limited water supply sources, treatment, management committees, and infrastructural systems [11].
The UWR still faces significant water insecurity and environmental challenges due to multiple climate stressors and limited water resources [16]. The UWR region has an adequate water table for groundwater development [34]. The region has only one notable resilient surface water source, the Black Volta River, while other major dams such as Siiru, Sankana, Tanina, Busa, Dakyie, Takpo, Baleofili, Goli, Yeleyiri, and Dobile that were supposed to serve irrigation and livelihoods needs are either collapsed or at the verge of collapsing. Moreover, open-defecation practices pollute the region’s relatively scarce surface water bodies with feces [12]. Several efforts on projects and programs have been implemented to address water insecurity in the UWR. These include the Sustainable Rural Water Supply and Sanitation Project (SRWSP), and the United States five-year project on Water, Sanitation, and Hygiene (WASH) in Northern Ghana, including the UWR. The Community Water and Sanitation Agency (CWSA) has been actively involved in reforms in the region, focusing on managing Small Towns Piped Water Supply Systems (STPWSSs), construction of boreholes, and formation of Water and Sanitation Management Committees (WATSANs) [11]. The Ministry of Local Government and Rural Development has also provided several boreholes to different communities in the UWR through the municipalities and districts. Several NGOs (such as UNICEF, WaterAid, and ProNET North), faith-based organizations, civil society organizations, volunteer groups, individuals, and self-help at the community level have provided water to different communities. Despite the challenges, such as the limited number of operational dams, insufficient resources for completing some dams, and concerns about sustainability, particularly considering escalating climatic stressors like floods in the peak of the rainy season, associated with the Ghanaian government’s One Village One Dam (1V1D) flagship project, it is one commendable effort to provide each village in northern Ghana with a dam to reduce water insecurity.
3.2 Data and sample
The data collection procedure for the broader study on "the impact of Community Resource Management Area (CREMA) on improving livelihoods and climate change resilience in the UWR, Ghana," was conducted in two stages. In the first stage, we selected three out of four districts/municipals in the UWR, namely Wa East, Wa West, Nadowli-Kaleo, and Sissala East municipal, which have operational CREMAs. The selection was purposive, and we included only the districts with CREMAs (Wa East, Wa West, and Nadowli-Kaleo) and excluded the Sissala East municipality. These districts were selected because they have CREMAs within the broader scope of the study. Four CREMA areas existed within these districts: Chakali Sungmaalu CREMA in Wa East, Dorimo Paramountcy and Wechiua CREMAs in Wa West, and Zukpiri CREMA in Nadowli-Kaleo. We randomly selected 18 CREMA and 18 non-CREMA communities across the districts. In the second stage, we compiled a list of households in each study community. We defined a household as having at least one member involved in agricultural activities, according to the Ghana Statistical Service’s 2017/18 Census of Agriculture [27]. The compiled list contained a total of 2,604 households. We used Raosoft’s sample calculation to determine the minimum sample threshold for unbiased findings in our study at a 95% confidence level, which yielded 335. However, to increase the predictive power of our analysis, we opted to increase the sample size to 517 [16]. To ensure that our sample included equal participation opportunities for female and male-headed households, we systematically and randomly selected every fifth household from the list [16]. In each household, one adult (18 years above) representative of the household agreed by the household (i.e., household head, lead farmer) responded to the survey questionnaire on behalf of the household. All verbal consent was obtained in the presence of another adult household member, a spouse, and a local community leader (such as an assembly member, CREMA executive, or unit committee member), who were informed of the study objectives, safety, and ethical implications. The data was collected by trained field enumerators who visited the selected households and administered the survey questionnaires in the respondent’s preferred language. We also conducted quality checks to ensure the data collected was accurate and reliable. To assess household water insecurity, we used the Household Water Insecurity Experience (HWISE) scale [35], which was administered alongside a broader survey questionnaire covering various thematic areas such as sociodemographic, water security, sanitation and hygiene, food security, agriculture production and livelihoods, environmental conservation, energy insecurity, food insecurity, climate change preparedness, resilience, mitigation, and adaptation, gender, household relations and well-being, and Covid-19. We collected the data between November 10, 2022, and January 31, 2023. The study received ethical approval from the Non-Medical Research Board (NMRB) at the University of Western Ontario, Canada and adheres to inclusivity in Global Research (see S1 Text).
3.3 Measures
3.3.1 Outcome variable.
Water insecurity is the outcome variable for this research, measured using the Household HWISE scale [35]. The HWISE-12 Scale comprises 12 questions querying household experiences with life-disrupting water-related challenges in the preceding four weeks [35]. Items related to psychological and emotional distress (worry, anger, shame), disruptions in hygiene practices (insufficient water for washing/laundering, handwashing, bathing), challenges with water consumption (not having desired amounts to drink, modifying foods eaten, going to sleep thirsty), and water-related disruptions (changes in schedules, limited primary water sources, no usable or drinkable water). Response options include ’never’ (scored as 0), ’rarely’ (1–2 times scored as 1), ’sometimes’ (3–10 times scored as 2), or ’often and always’ (more than 10 times scored as 3). Total scores range from 0 to 36. Households with HWISE scores ≥12 are considered water insecure [35]. Scores are further categorized as water-secure (HWISE-12 scores <12) or water-insecure (HWISE-12 scores ≥12) and dichotomized into a binary variable (0 = water-secure households, 1 = water-insecure households). Researchers have widely used the HWISE scale [36–38].
3.3.2 Predictor variables.
We included other theoretically important independent variables grounded on the broader water security and political ecology literature [2,14,16,17,36–38]. The variables are age (0 = 18–29, 1 = 30–39, 2 = 40–49, 3 = 50–59, 4 = 60 above), education (0 = no formal education, 1 = primary, 2 = secondary or above), gender of the respondent (0 = male, 1 = female), marital status (0 = married, 1 = single, 2 = widowed/divorced/separated), religion (0 = Christian, 1 = Muslim, 2 = African tradition), infants children present (0 = no child under five years, 1 = children under five years); household size (0 = 1–4, 1 = 5–8, 2 = 9+), Household wealth was measured using a composite index that evaluated the ownership of various consumer goods and assets, such as livestock, electronics, farm machinery, motorized equipment, flooring materials, and toilet facilities. This index ranked households according to quintile and assigned a score of 0 to the first quintile (i.e., the poorest), 1 to the second quintile (i.e., poorer), 2 to the third quintile (i.e., middle), 3 to the fourth quintile (i.e., richer), and 4 to the fifth quintile (i.e., richest). Rainwater harvesting, identified as a coping strategy, involves collecting and storing rainwater for their water supply needs. To assess this variable, households were asked whether households harvest rainwater. The responses were coded as households that harvest rainwater (coded as "yes" = 1) and those that do not (coded as "no" = 0). Households that harvest rainwater use different strategies to collect and store the water. The most common one is rooftop catchment systems (mostly Zinc plates), where gutters are installed on the roofs of homes or other structures to collect rainwater channeled into storage containers. The collected rainwater is stored in various containers ranging from large plastic or metal containers, "drums," or tanks, to smaller vessels, such as clay pots, large drums, buckets, or jerry cans "Kufuor gallons." Also, some households dig shallow pits or trenches to capture rainwater, lined with clay or plastic to prevent seepage in sandy or permeable soils. These pits serve as temporary storage during rainy periods, and the water is used especially in the early dry season. Some households also adopt a localized strategy in which storage facilities like jerry cans and large clay pots are either filled with rainwater and buried beneath the ground or left open to be filled in the backyard and farmlands to collect water for usage. Despite the limited number of groundwater storage facilities constructed, some households have access to such facilities, where rainwater is collected and used during water scarcity. Some households have also constructed dugout wells to collect rainwater for use in the early dry season. For instance, depending on their storage capacity and the number of household members and usage, households can use the harvested rainwater for weeks (2–3) and a few months (1–2). Some households with deep wells where rainwater is collected can last 2.5 to 3 months. In addition to the consumption needs of the stored rainwater, it is also used for livestock rearing (e.g., fowls), raising seedlings (e.g., pepper, tomatoes, etc‥) against planting season, and other domestic chores (washing utensils and clothes). This reduces the stress on the limited water sources they may have access to in the community; water source (0 = improved sources, 1 = unimproved sources), water distance (0 = within source of less than 100 meters, 1 = intermediate source, 100 meters to 1 kilometer, 2 = far distance source, above 1 kilometer), roundtrip water fetching time (0 = above 30 minutes, 1 = within 30 minutes), water seasonal availability and reliability (0 = wet season, 1 = dry season), water treatment (0 = treatment, 1 = no treatment), self-rated water storage facility (0 = poor storage facility, 1 = good storage facility), self-reported water-induced infections exposure (0 = no, 1 = yes), water, sanitation and hygiene health education and awareness on water-related (0 = yes, 1 = no), water expenses (GH¢) incurred for the past 12 months before the study was added as continues variable due to its reported nature. To evaluate the perceived household health, participants were asked to compare their household’s overall health with that of other households in the community. The response options included "Excellent," "Very good," "Good," "Fair," and "Poor." In line with previous research [39], we combined the responses into two categories: poor health (including "Fair" and "Poor") and good health (including "Excellent," "Very Good," and "Good") coded as (0 = poor, 1 = good), Self-reported water-induced infections (0 = no, 1 = yes), and District (0 = Nadowli-Kaleo, 1 = Wa East, 2 = Wa West).
3.4 Data analysis
The analysis involved both descriptive and inferential techniques. Specifically, we employed a binary logistic regression model to investigate the association between predictor variables and household water insecurity. Given the dichotomous nature of the outcome variable (water insecurity, binary logistic regression was deemed suitable following the works of [35]. To begin with, we performed univariate analysis of the sample; then, we performed bivariate logistic regression to examine the individual relationships between each predictor variable and the outcome variable. This allowed us to gain insights into their contributions. Subsequently, multivariate binary logistic regression was conducted to comprehend the combined impact of the selected predictor variables on water security. The mathematical equation used for the multiple binary logistic regression model is as follows [40].
In this equation, π represents the probability that an observation falls into the category of the dichotomous Y value (i.e., 1 = water-insecure). The term "exp" denotes the exponential function. β0 is the intercept, β1 is the coefficient of the first predictor variable, and βk is the coefficient of the last predictor variable. The binary regression coefficients are presented as odds ratios. Odds ratios above one (OR > 1) indicate a higher likelihood of water insecurity, while odds ratios below one (OR < 1) indicate a lower likelihood of water insecurity [40]. We ensured our analysis was reliable by testing the linearity assumption of each continuous predictor, evaluating multicollinearity with all variables displaying a VIF below 2.0 and an average VIF of 1.30, indicating minimal multicollinearity, and identifying outliers using diagnostic tests. Relevant covariates were included to address potential confounding, and the Hosmer-Lemeshow test confirmed a good model fit [41]. Stata version 18 was used for the analysis, which produced valid results with a pseudo-R-squared value of 0.218, explaining a moderate portion of the variance in the dependent variable.
4. Results
4.1 Univariate results
Table 1 presents the results of our univariate analysis: The mean Household Water Insecurity was 7.541, with a standard deviation of 9.443. Regarding the water security Status, 67.70% of households are water-secure, while 32.30% are water-insecure. Regarding Infant Children, 35.01% of households had no children under five years old, while 64.99% had children in that age range. Also, 25.92% of households reported using rainwater harvesting, while 74.08% did not. Regarding Water Sources, the majority (94.78%) relied on improved water sources, with only 5.22% using unimproved sources. Concerning Water Distance, 19.34% of households had water sources within or greater than 100 meters, 54.74% had intermediate sources (between 100 meters and 1 kilometer), and 25.92% had far distance sources (above 1 kilometer). Over 57% spent over half an hour fetching water, while just over 42% took 30 minutes or less. Nearly half (48.55%) of households treated their water. Furthermore, 61% had good storage facilities, while 32.30% reported water-induced infections.
4.2 Bivariate predictors of water insecurity
In Table 2, the bivariate regression analysis revealed significant predictors of household water insecurity. Wealthier households: middle (OR = 0.543, p<0.01), richer (OR = 0.402, p<0.001), and richest (OR = 0.400, P<0.001) had lower odds of water insecurity, indicating a lower likelihood of experiencing water insecurity. Households not harvesting rainwater increased the odds (OR = 2.907, p<0.001), indicating a higher likelihood of water insecurity. Similarly, reliance on unimproved water sources elevated the odds (OR = 2.779, p<0.001), indicating a higher likelihood of water insecurity. A shorter roundtrip water fetching time reduced the odds (OR = 0.681, p<0.01), indicating a lower likelihood of water insecurity. Water scarcity during the dry season also raised the odds (OR = 1.768, p<0.001), indicating a higher likelihood of water insecurity. Furthermore, the lack of water treatment (OR = 2.063, p<0.001) and poor storage facilities (OR = 2.612, p<0.001) increased the odds, indicating a higher likelihood of water insecurity. Moreover, water-induced infection exposure heightened the odds (OR = 3.128, p<0.001), indicating a higher likelihood of water insecurity. The absence of health education and awareness amplified the odds (OR = 2.013, p<0.01), indicating a higher likelihood of water insecurity. Regarding location, households in the Wa West district had lower odds (OR = 0.599, p<0.01) compared to the Nadowli-Kaleo district, indicating a lower likelihood of water insecurity in Wa West.
4.3 Multivariate predictors of water insecurity
Table 2 provides the results of our multivariate analysis. After controlling for other factors, several significant predictors of household water insecurity remained consistent. Respondents from wealthier households, categorized richer, exhibited significantly lower odds of experiencing water insecurity (OR = 0.475, p<0.05) than those from the poorest households. Similarly, households that did not practice rainwater harvesting maintained notably higher odds of water insecurity (OR = 2.117, p<0.01) than those that did. The impact of water distance to the source was significant, with households relying on distance water sources (above 1 kilometer) facing significantly higher odds of water insecurity (OR = 3.249, p<0.01) compared to those with sources within or greater than 100 meters. Additionally, the duration of roundtrip water fetching time remained influential, as households with water fetching time within 30 minutes continued to have significantly lower odds of water insecurity (OR = 0.474, p<0.01) compared to those taking above 30 minutes. Water seasonality was also a significant factor, with households experiencing the dry season having significantly higher odds of water insecurity (OR = 2.340, p<0.001) compared to the wet season. Furthermore, water treatment and storage facilities played a crucial role. Households that did not treat their water had significantly higher odds of water insecurity (OR = 2.601, p<0.001), and those with poor storage facilities faced similar challenges, having significantly higher odds of water insecurity (OR = 2.290, p<0.001) compared to those with good storage facilities. Health-related factors remained significant, as households reporting exposure to water-induced infections had significantly higher odds of water insecurity (OR = 3.473, p<0.001) than those without exposure. Moreover, the absence of water, sanitation, and hygiene (WASH) health education and awareness continued to be associated with higher odds of water insecurity (OR = 2.575, p<0.01). Lastly, the geographical location of households remained a significant predictor. Respondents from the Wa West district had significantly lower odds of water insecurity (OR = 0.423, p<0.01) than the Nadowli-Kaleo district.
5. Discussion
Water insecurity is a problem and a critical global concern with far-reaching consequences for various regions, including the semi-arid Upper West Region of Ghana. This study from the political ecology of health perspective identified several factors that contribute to water insecurity, including the lack of rainwater harvesting practice and infrastructure, reliance on water sources located over a kilometer away, extended roundtrip water-fetching times exceeding thirty minutes, no water treatment and poor storage systems, increased susceptibility to water-borne infections, inadequate WASH education and awareness, and seasonal variation. Additionally, the study found significant disparities in water security between households in Wa West and Nadowli-Kaleo districts. These observations provide the foundation for discussions concerning the water insecurity experience in the UWR.
The observation that water insecurity is less prevalent among households with higher wealth categories supports the notion that economic capital plays a significant role in determining access to and control over water resources. This finding is consistent with previous studies showing that households with financial resources are better equipped to invest in alternative water solutions, such as purchasing clean water or implementing advanced purification systems [17]. This could be explained in the context of household economic status. In urban areas of Ghana, for example, most households rely on Polytank water supply due to the public water systems’ dysfunctional nature. As a result, households without the financial means to afford these systems will likely face water insecurity. Earlier work of Archore et al. found that water insecurity significantly impacts impoverished households, relying on labor-intensive and short-term strategies to cope with the shortage [42]. This inequality highlights the critical influence of socio-economic status on differential access to vital resources, which is a crucial concern of PHE. As usually said, “water is life” underscored the importance of initiatives to improve households’ overall well-being and resilience to water scarcity.
Our findings also suggest that households not harvesting rainwater were more likely to face water insecurity. Rainwater harvesting has been highly valued throughout history in regions with unpredictable rainfall patterns, as it can transform rain into valuable long-term water resources. This finding is consistent with previous studies that stress the vital role of rainwater harvesting in enhancing water security in semi-arid regions [43]. As noted by Achore and Bisung, rainwater harvesting is a practical solution for households to mitigate water insecurity [43]. From a PEH standpoint, access to rainwater alone does not necessarily translate into water security without making water safe for consumption by treatment. In addition, harvesting rainwater in the rainy season could also reduce water-fetching injuries from long distances and help reduce household members’ chances of water-fetching injuries, especially women, girls, and boys. Our study suggests that the absence of rainwater harvesting facilities in the UWR results in waste. This is especially true during the rainy season when rainwater is readily available. As PEH highlights, there is a need to examine the structural barriers and policy frameworks that hinder the adoption of rainwater harvesting. For instance, the lack of water collection systems (such as water storage tanks and roof channel collecting systems) may reveal how governance and institutional support play crucial roles in supporting households to invest in rainwater collection and resource management.
We uncovered that households’ proximity (distance) to water sources is critical in determining water insecurity. The distance to water sources is typically measured in meters or kilometers and refers to the physical distance between a home or community and the nearest water source. While this metric is easy to calculate, it only considers the spatial dimension of water accessibility and does not consider the time or effort involved. We found that households located more than 1 km from their water sources need help accessing safe water. This relationship reflects the challenging physical and labor-intensive demands on marginalized communities in the UWR. Such circumstances often arise due to unequal development and insufficient investment in water infrastructure, which reflects discriminatory political and economic biases that fail to consider the needs of specific populations. This finding aligns with previous research that reported on how long distances affect children and women’s health, primarily responsible for water fetching in Sub-Saharan Africa [44]. In another study in the Wa municipality of the UWR, long distances pose physical and safety risks and discourage regular water collection [17]. In the study, Benebere et al. found that proximity to water sources and travel time for water are key factors contributing to water insecurity among residents [17]. Therefore, it is crucial to prioritize strategies that decentralize water sources, as underscored by political ecology, such as community-led boreholes or innovative initiatives like self-help water infrastructure. Such approaches could significantly mitigate the challenges associated with distance and improve water access for all.
Invariably, consideration must be given to the time required for water collection to ensure water security. The "roundtrip water fetching time" measure encompasses the total time needed to travel to a water source, collect water, and return home, accounting for queuing, waiting, and container filling time. This metric provides a more comprehensive view of the burden of water collection, though it can vary among individuals and from day to day. Our research indicates that lengthy water collection trips (more than 30 minutes) can disrupt household routines and significantly reduce productivity. Water infrastructure in the UWR is insufficient, reflecting discriminatory biases and placing physical demands on marginalized communities, as underscored by PEH. This finding is consistent with the Ghana Statistical Service report, which has shown that prolonged water collection times can have negative socioeconomic consequences, including limited time for education and missed income opportunities [45]. A recent study by Adams in Malawi utilized video-recorded walking interviews to examine women’s daily water journeys and identified terrain, built environment, and human behavior risks associated with prolonged water collection on overall health [46]. A comprehensive approach is necessary to address the challenges of long roundtrip water fetching times. While local water sources may provide a solution, investing in water infrastructure can significantly decrease the time and risks associated with collecting water.
To maintain water quality, it is essential to understand how a lack of water treatment and poor storage can lead to water insecurity. As observed in our study, the lack of water treatment and poor storage systems increased household water insecurity. As underscored by PEH, infrastructure and knowledge play a vital role in this area, and their importance cannot be overstated. PEH emphasized how inequalities in knowledge dissemination and infrastructure investment contribute to environmental injustices, with marginalized communities most affected by inadequate services. Our findings resonate with the works of Lautze and Manthrithilake, which emphasized that untreated water, regardless of its abundance, can pose serious health risks [47].
The importance of treating water cannot be overstated, as it significantly impacts the health and well-being of the community [48]. On the other hand, households could be at higher risk of experiencing water insecurity. This aligns with previous studies emphasizing the consequences of inadequate water storage systems [11]. Even in regions with abundant water sources, ineffective storage methods can lead to significant losses and subsequent insecurity [49]. Proper containment ensures access to sufficient water and minimizes the risk of contamination.
The crucial role of public health interventions and education in addressing water-related issues is underscored by the observed correlation between exposure to water-related infections, lack of WASH (Water, Sanitation, and Hygiene) education (WASH practices), and water insecurity. It is often the case that vulnerable populations bear the brunt of power dynamics that shape public health policies and resource allocation, a concern examined through the lens of PHE. Specifically, households affected by water-related infections are more susceptible to water insecurity. This relationship is not unique to the UWR of Ghana. The academic community recognizes the link between compromised water quality and various health issues. Exposure to poorly stored water can lead to numerous health problems, ranging from gastrointestinal issues to severe waterborne diseases [12,50]. This consensus underscores the crucial role of water quality in determining health and water security. Also, we found that educating communities about the risks associated with water and the significance of practicing proper water management techniques can help them better handle and mitigate the health challenges posed by compromised water sources. This finding emphasizes the need for enhanced health education initiatives to treat and prevent waterborne diseases and highlights how water quality impacts overall community well-being [6,51].
This study has limitations to consider when interpreting the findings. Firstly, the results are based on self-reported data, possibly subject to recall bias. Additionally, the identified associations do not necessarily indicate cause-and-effect relationships. People’s desire to be viewed positively by others can lead to a social desirability bias when answering questions. Conducting longitudinal studies would provide a deeper understanding of water insecurity in the UWR. Despite these limitations, the findings have important policy implications for water security in the UWR and similar semi-arid environments in SSA.
6. Conclusion and policy implications
This study highlights the need for integrated and holistic policy interventions to address water insecurity in Ghana’s UWR. Policymakers, practitioners, and local stakeholders must work together to implement the recommended strategies for the communities’ long-term well-being, sustainability, and resilience. Effective management of water resources is vital not only for the current well-being of the inhabitants but also for the future. We recommend that policies promote integrated water resources management principles that ensure a coordinated approach to managing water and related resources to maximize social and economic welfare without compromising the sustainability of vital ecosystems. Moreover, to enhance the quality and availability of water, there should be an increase in investment (funding) for water infrastructure with a focus on sustainable technologies and practices, including rainwater harvesting, groundwater development, storage, rehabilitation of non-functional water systems, improved piping systems, protecting water sources from pollution, advanced filtration, and treatment technologies (recycling systems). Such strategies can ensure reliable access to safe and sustainable water. In addition, investing in knowledge dissemination (WASH education and awareness creation) is crucial, especially in vulnerable communities facing water insecurity. This will help ensure that everyone, regardless of their socioeconomic status or geographic location, has access to safe water. Community participation in water management decisions and practices is also crucial, and local knowledge and practices should be leveraged to enhance water security and resilience against climate variability (especially in the dry season). It is also recommended that comprehensive water quality monitoring and improvement programs and resource institutions be implemented to provide safe water alongside expanding access to sanitation facilities to reduce waterborne diseases and improve public health outcomes. Other educational programs should be prioritized, such as water conservation and sustainable use targeting communities and households. Raising awareness about the importance of water safety, hygiene, and sanitation can reduce water-related illnesses and improve public health. Gender-sensitive policies that recognize and support the roles and needs of women in water management should also be adopted to ensure equitable access to water resources and decision-making processes. Child-centered interventions should be targeted to reduce the burden of water collection on children, especially girls. Sustainable livelihood strategies should be targeted at households to improve their socioeconomic challenges and enable them to invest in water infrastructure. Finally, increasing collaborations with government and non-governmental organizations (NGOs) and self-help are essential to developing water resources at the community level.
Supporting information
S1 Text. PLOS inclusivity in global research questionnaire responses.
This provides a detailed account of PLOS’s questionnaire responses, demonstrating the study’s commitment to inclusivity and diversity in global research. It also includes insights into how the research design and execution considered various aspects of inclusivity, such as the involvement of underrepresented populations.
https://doi.org/10.1371/journal.pwat.0000216.s001
(DOCX)
Acknowledgments
We sincerely thank the CREMA executives, community leaders, and data collectors who have contributed to this research. We thank Micheal Kogo, Adam Bondogbo, Ganiu Issah, Hasim Funjumah, Bashirudeen Mahamood Kanmaaliba, Bawa Chakilia Alidu, Seidu Baleri, Charity Naalane Yirberyogr, Moomin Abdul Kasim, Albert Azaasuma, Eunice Sindim, Joseph Zuolo Tietaa, and Edith Putiere for their invaluable contributions.
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