Health Facilities

Health Centres and Coverage(OPD)

Elmina Health Centre 5478;, Kissi Health Centre 5697; Agona Health Centre 3681; Komenda Health Centre 6011; with a total of 20867.The District also has a district hospital that is the Ankaful General/Leprosarium and Psychiatric Hospital. There are four functioning CHPS compounds in the district with residing Community Health Officer (CHO) who attends to clients with minor ailments, immunizations, home visiting etc.  These are located in the following areas:

Anteamboa in the Kissi sub-district, Atonkwa in the Elmina sub-district, Aburansa in the Komenda sub-district and Benyadze in the Agona sub-district.The district has two functioning private maternity homes namely Paa Waterbury Home at Elmina and Nyametease Maternity Home at Komenda.

Safe Motherhood

With the introduction of the Free Delivery System, two thousand four hundred and sixty one (2461) women benefitted from the scheme from November 2003 to September 2004.For the first half of the year 2004, nine hundred and five (905) women benefitted.  Trained TBA’s also conduct deliveries in the communities and this helps to relieve midwives in the health facilities of some of their work load.  The assembly has spent a major part of its resources to provide facilities for health personnel and other para-medical staff.

Environmental Pollution

The present sanitation situation in Elmina is not healthy indicating environmental problems in Elmina. Poor management of both solid and liquid waste in any form adversely affects the health of the people. The old town with a population of over 22,000 have only five disposal facilities that are emptied once a day. Since they are located far apart, most people find it convenient disposing off refuse in open drains and any available places. This habit blocks the drains leading to breeding of mosquitoes and flooding.

Most of the houses have the removable toilets (pan latrines), which can no longer be used due to the absence of conservancy labourers. As a result human excrement is dumped in open spaces, drains and into the lagoon. These bad habits have almost always led to the outbreak of diseases like cholera, yaws, dysentery and malaria.

Most of the areas like St. Jago and Java Hills decide to burn the refuse to make way for continuous dumping, end up creating atmospheric pollution, which is a health hazard to the people in the vicinity. These attitudes besides, causing health hazards also drain the financial resources of the government, increasing the poverty levels of the people and personal development is also impaired. In order to diminish the negative influence environmental pollution has on health, the following suggestions are put forward:

•Provision of adequate waste disposal equipment and facilities.
•Reconstruction of the drain from the Chapel Square to the lagoon to carry about 60% of the old town’s waste water. Presently, this drain is in a dilapidated state to the extent that no amount of desilting or covering can help the free flow of water in it. Other drains also need to be improved.
•Educate individual landlords / ladies to provide household toilets

Agriculture

Fishing - During bumper harvest, a lot of people visit the beach and this comes along with increase in waste generation. Unfortunately, there are no disposal facilities at the high landing site and the refuse is dumped haphazardly. Fish offal removed is also dumped anyhow serving as breeding places for flies, rats and insects, which are vectors of many diseases.

These kind of environmental problems can cause an outbreak of diseases like dysentery, yaws and cholera as a result of the poor environmental situation. Waste dumps near houses also collect water and breed mosquitoes profusely leading to malaria cases. Most residents do not relate malaria to the breeding of mosquitoes in their surroundings as a result of poor environment, thus making the control very difficult. There is therefore the need to increase the awareness among the fisher folks and also get them involved in waste collection.

Pig Rearing

Residents of the old town especially around Ayisa rare a lot of pigs and allow them to stay in their filthy nature causing health nuisance by littering the streets and also blocking traffic.

Drying Of Stinking Fish

Drying of stinking fish at Ayisa near the Mpoben fish-landing site is very offensive making the place very difficult for human habitation.

Salt Winning

Salt ponds in Elmina are located in areas, whicn are not accessible, and therefore no organised refuse collection can take place there. Indiscriminate dumping of refuse is very common coupled with open defecation making the areas environmantally unfriendly for the workers and also render their products unsuitable for human consumption.

Sand Winning

Although the control of sea erosion is a national problem beyond the capabilities of the District Assembly, there are practices such as winning of sand from the beaches, which exacerbate the erosion process. This negative activity leads to erosion and flooding during heavy rains or high tide and breeding of mosquitoes, which affect the health of the inhabitants in the area. There is an urgent need for the enforcement of the Assembly’s Bye/laws on sand winning.

Beach Pollution

Through the combination of factors such as lack of inadequate disposal facilities, population pressure and other bad habits, the beaches have been turned into toilets and refuse dumps serving as breeding grounds for vectors of diseases like cholera and dysentery etc. This situation is most serious at the Mpoben fish-landing site near the Castle.

Transport

Constant exposure to excessive and continuous noise could lead to hearing impairment. Noise stress also could lead to hearing impairment. Noise stress also causes changes in blood circulation and heart beat as well as nervous reactions. Noise related health risks within Elmina is concentrated around the centre of the town from Chapel Square to the Castle area and the sources include the following

•Vehicular traffic noise made worse by bad driving habits particularly of commercial drivers.
•Music shops, beer bars, entertainment places and funerals.
•Open-air religious and social activities.

Tourism

Tourism even though has a positive impact on the economy also has its negative effects on the environment and health if not well planned. Increase number of tourist would eventually lead to increase in waste production and should have a corresponding number of sanitary facilities, such as refuse containers, decent toilet facilities and eating places to contain the waste, If this were not done, the health of the people would be at risk.

An increased number of tourists could also encourage prostitution and result in an increased numbers of Sexually Transmitted Diseases. Although there is no evidence that tourism and prostitution are connected (prostitution also exists without tourists) there is a major concern among groups that tourism should be managed well in order to avoid such negative impact.

Conflicting Interests

Environmental health is very complex and comprises of a lot of activities. The environment has a direct effect on the health of the people in a particular area. The improvement of the environment (cleaning of drains, cleaning and burning of refuse dumps, using of toilet facilities) has a direct effect on them and is the cause of many diseases leading to poverty since a grater proportion of people’s income is spent on treatment of preventable diseases like malaria, diarrhoea and other water borne diseases. It is of interest to note that most people do not even accept the fact that, diseases that affect them are related to a poor and healthy environment.

The KEEA District Assembly, together with the Diocese of Cape Coast and staff of the ECHMP have therefore prepared a project proposal that is funded by Cordaid/Memisa and is focussing on environmental health and personal hygiene. KEEA Distric Assembly will undertake a massive clean up campaign and make people aware of the impact of waste on their health. The increasing number of tourist would also mean more waste generation and increasing pressure on health facilities.

Management Organisation

At the local level the District Assembly is responsible for cleaning the environment on a daily basis. This is however putting an immense pressure on the resources of the Assembly. Since cost recovery from the average resident in Elmina is difficult (due to poverty and lack of awareness) other manners of revenue generation should be explored.Local people like the Assemblymen, CBO’s, local groups, the Traditional Council and NGO’s also help and play a greater role in all environmental activities. These people cannot be left out in any communal activity directed at the upkeep of the environment. The Assembly provides services to the communities at the grassroot level through the Environmental Health and Sanitation Staff, a unit of the District Assembly.

Section 34 of Cap 86 of the town’s ordinance empowers, the Environment Health Staff normally to enter any premises or community to advise or take any action to prevent any environmental hazard. The Environmental Protection Agency (EPA) also has the responsibility of playing a leading role as an advisory institution in making sure that projects carried out or any other activity do not have negative impact on the environment which will adversely affect the health of the people.The EPA Act 490 of 1994 empowers the EPA to carry out the above function. The Ministry of Health, which is responsible for the health activities in the district, plays a leading role in the communities and also supports financially in the environmental health and personal hygiene issues in the district through the District Health Co-ordinating Committee (DHCC) with the view of preventing diseases.

Flooding

Most of the built-up suburbs like Bakaano, Essermu, Bantuma, Mbofra Akyinmu and Esuekyir were apparently part of the low-lying flood plain of the lagoon. These areas have been reclaimed using the dredged spoils of the lagoon and protected from high water levels in the lagoon by the retaining walls in concrete and stone wall.The underlying soils have, therefore, a very low infiltration capacity. With the characteristic heavy rainfalls during rainy seasons in the town and the clayey nature of its soil derived from the weathered gravities from the ridges and lagoons, clay beds response to rainfall is fast and runoff is heavy lacking good and adequate drainage system, the runoffs tends to stay on the developed areas for long time before evaporating.

The salt winning methods used have led to the draining of the Ahwin Stream channel to discharge into the lagoon away from the salt ponds. It is apparent that the current shape of Elmina has also been influenced by these economic ventures. In addition to the characteristics of heavy rainfall in Elmina, other factors aggravate the problem.These factors add up to the inadequate capacities of drainage in the town, erosion and high water levels in the Benya Lagoon. Flooding is caused by poor and inadequate removal / discharge of excess storm water from an area. Excess water in Elmina is in the form of storm water and / or domestic waste water. At some built -up areas, excess water is generated from high tidal effect in the Benya Lagoon.

During heavy rainfalls, high runoff is generated throughout the town particularly in the built-up areas, which have been rendered impervious with roofs and pavements and by reducing natural storage through filling of depressions. The unpaved areas have clayey soils with low infiltration capacity.Consequently, during rainy periods parts of the town get flooded and the accumulated water often remains on the surface for days. This occur because there are poor drainage gradient and their capacities are inadequate. In the newly developed suburbs, there are few drains.

Flooding in Elmina result from the lack of good drainage system. Heavy runoff washed down the slopes/hills of Java Hill, St. Jago Hill, and St. Joseph Hill, also rainstorms coinciding with high tidal waters from the Benya Lagoon, and this inundate some areas to a depth of about 0.5 metres.In some cases an extra high tide without rainfall or storm will cause flooding. The damage from such occurrences is often more of a nuisance or an inconvenience than a hazard. A survey of a recent / current rainstorm which flooded some suburbs was conducted during this study.

This rainstorm coincided with high tidal wave and houses along the banks of Benya Lagoon as far away as 150 metres from the lagoon at Bakaano, Esuekyir, some part of Neizer’s Garden and Lime Street (old market area) as well as Victoria Park, were inundated / flooded. No lives were lost though, damage to properties was high. The inundation lasted for more than 3 hours until the high water level in the lagoon receded. At Teterkesem, houses near the lagoon were flooded for more than a day. At Bakaano petty traders who displayed their wares on tables or in temporary structures like wooden kiosks, were unable to sell their wares.

Fishermen who normally mended their nets on Tuesdays could not work. Members of the Atekyim Pentecost Church could not enter their place of worship because it was flooded. (Around the Pentecost Church is called Atekyim meaning flooded area). The place was named after its flooding nature. At Teterkesem about twenty-five houses were inundated but damage assessment was difficult. This is because residents normally move their things, which are likely to be submerged to neighbours’ houses on higher grounds before the water reaches the highest level.

The following section describes the specific problems in most of the worst affected areas of the town as observed during the site inspection. At the Bakaano suburb, which borders the Benya Lagoon in the southern part of the town, commercial activities along the lagoon banks and residential houses are protected by a retaining wall along the lagoon bank.However, when tidal water level is usually high, some portions of the wall are overtopped. Also tidal water passes through the channel whose outfalls serve as conduits for the tidal water upstream and in most cases the channel are overtopped. This situation is worsened when rainstorm coincides with high tidal water level.

At Teterkesem where most of the residential houses are located on the flood plain of the lagoon, the houses are flooded whenever there is high tide in the lagoon or heavy rainfall. Resident in their effort to develop some protection against the frequent occurrences, dump refuse at the banks to raise the ground level. These form an’ obstruction to runoff entering the lagoon whenever there is a rainstorm. A similar situation prevails at Essermu and Mbofra Akyinmu,

Erosion

The hilly areas of suburbs, like St. Jago Hill, St. Joseph Hill and Java Hill etc. experience or suffer from erosion. At these suburbs, where buildings are built on slopes, the high velocities of the runoff erode the topsoil exposing foundations of most buildings located along the hills/slopes resulting in the problem of slope stability. The eroded material eventually ends up in the few drains of inadequate capacities and where velocities are less than self-cleansing; they get deposited, further reducing the drains’ capacities resulting in flooding.

The erosion may lead to slope instability resulting in slumping. A number of measures could be taken to considerably reduce the rate of erosion in the built-up areas in the Lime Street and Java Hills suburbs as well as St. Jago Hill and St. Joseph Hill, residents have pavement in and around their houses presumably as a stop gap measure. These seem to have provided some measure of relief. The primary measures for the erosion control are however, terracing and turfing around St. Joseph Hill, the latter being applied in areas available.

It is preferable to provide Stone-pitch lining to vertical portions of terraces around St. Jago Hill. Generally however, terracing should be kept to heights not exceeding 1 metre. Turfing or grassing will be another useful method of controlling erosion around St. Joseph Hill by reducing the degree of exposure of the surface soil, while holding firmly together the soil particle. The cost of such works could be reduced by community involvement. Attempts could be made to infuse this idea into the general civic character of the people of the affected suburbs through education.

Fire

Most of the suburbs of Elmina Town have a congested character, with small alleys, kiosks and other wooden structures blocking roads and pathways. Many people use kerosene for lighting and cooking, or cook on open charcoal stoves. Around the fishing harbour, fuel dumps are prevalent. The congested area of the town opens it to fire hazards.Last year two 19th-century buildings got burnt down because of the storage of hazardous fluids in annexed kiosks (fuel, alcohol). Looking at the number of open fires in the town it is surprising that fires do not occur more often,

Impact Of Development Activities On Flooding And Erosion

Flooding in Elmina is due to inadequate drainage system in the suburbs. The few drains are sited alongside some portions of the road lanes and their capacities are inadequate. Several storm water drains have been provided over the last few years to combat the flooding problems in the suburbs, although most of the problems in the suburbs have been recently tackled by the World Bank project under the Urban III Rehabilitation Development project, but areas in Teterkesem, Bakaano, Lime Street, Essermu and other suburbs are still subject to flooding due to lack of drain and poor drainage gradient and inadequate capacities to convey the large volumes of storm water.

At Bantuma, and Mbofra Akyinmu, pools of water and deep gullies have been created by runoff because there are shallow and limited drains with poor gradient to convey runoff whenever there is heavy rainstorm. The salt winning method used in the area has been a contributory factor to flooding in the suburbs.The outlets of the few culverts to discharge runoffs into the lagoon have been blocked with walls of the salt ponds along the banks of the lagoon. The main drainage channel in Elmina starts from Chapel Square and runs through the old market, across Lime Street towards Atekyim and finally to its outfall in the Benya Lagoon.

This drain discharges not only storm runoff, but also dry weather flows from the residential areas. Poor construction of the culvert point / section that crosses Atekyim on Nana Amankwah street impede the flow of both storm runoff and dry weather flows.The old trapezoidal stone pitched open drain has developed wear at some sections, which contribute to poor dry weather flow. The invert at the outfall is also below the high water level in the lagoon due to accumulated waste / silt in the lagoon and thus backs-up the runoff in the drain causing flooding when coincides with heavy rainstorm.

From the above narration, it is clear that the drainage and flooding problems caused by heavy rainstorms and lack of good drainage channels with adequate capacities to convey the runoff. The problems are aggravated by high tidal waters in the lagoon, erosion-delivering sediment to reduce drain capacities and poor sanitation.

Competing Interests

Although flooding is causing a nuisance to many residents in Elmina, it is often caused by these residents who dump waste in the river banks and drainage canals causing flooding. Also the development of new areas for salt mining is affecting the tide movement leaving less space for the sea to move land inwards. Erosion is clearly man-made and causing damage to buildings and monuments. However since mining has become a profitable business and is creating employment to several residents it is difficult to stop.

There is a clear conflict between those people who dispose waste and mine sand in places where it is causing damage to buildings and the residents who are affected by the flooding and erosion. Education on these issues to make people aware of the impact of their activities would help to solve the problem. Also identification of mining sites and stronger enforcement of the rules would help in limiting the damage. Planting of trees at Java Hill and St. Joseph Hill would also help in reducing erosion.