There was a moment in the room when the conversation shifted.
It was no longer just about the numbers. It became about structure, accountability and who is actually in charge.
A high-level stakeholder engagement in Accra, convened by the Institute of Statistical, Social and Economic Research at the University of Ghana, ended with a strong and shared position: Ghana’s sanitation crisis requires a dedicated regulatory authority for the Water, Sanitation and Hygiene sector.
The call followed the presentation of a sobering study showing that Ghana loses more than GHS 6.2 billion annually to diseases linked to poor waste management and sanitation.
Cost of inaction
The research, led by Prof. Peter Quartey and Dr. Kwame Adjei-Mantey, titled An Economic Analysis of the Benefits of Adequate Investment in Waste Management and Sanitation in Ghana, laid bare the scale of the problem.
Five sanitation-related diseases of malaria, cholera, pneumonia, typhoid fever and diarrhoea account for nearly 31.9 million lost workdays each year and an estimated 177,222 deaths.
Direct medical costs alone amount to about GHS 5.8 billion annually, with an additional GHS 650 million lost through reduced productivity.
In simple terms, Ghana is spending far more dealing with preventable illness than it is investing in prevention.
Currently, the country spends an average of about GHS 38 per tonne of waste generated.
The researchers described this as disproportionately low when weighed against the public health and economic consequences.
The regulatory gap
But beyond the numbers, what dominated the discussions was fragmentation.
Participants including policymakers, Members of Parliament, local government officials, development partners, civil society organizations and private sector actors repeatedly pointed to weak coordination and overlapping institutional mandates within the WASH space.
Some argued that sanitation continues to suffer because responsibility is dispersed across multiple ministries, agencies and assemblies without a single, empowered body to regulate standards, enforce compliance and coordinate financing.
By the end of the engagement, there was broad agreement that establishing a National WASH Regulatory Authority could provide the structural backbone the sector currently lacks.
Not everyone framed it exactly the same way. A few participants cautioned against simply adding another bureaucratic layer.
But even those voices acknowledged the need for stronger central oversight, clearer accountability lines and enforceable standards and a financing including revenue generation paths for such an authority to adequately champion the course of the sector.
Whether through a newly created authority or a legally strengthened and consolidated framework, the consensus was clear: the current arrangement is not delivering optimal results.
The investment case even strengthens the argument
The study’s cost-benefit modelling further reinforced the case for reform.
Under the existing business-as-usual approach, every GHS 1 invested in waste management generates about GHS 180 in economic returns. Under a best-case scenario, where investment rises to approximately GHS 1,028 per tonne in line with lower-middle-income benchmarks, returns could increase to GHS 556 per GHS 1 invested.
Projected national benefits under enhanced investment could reach GHS 58 billion in 2025 and rise to GHS 67.2 billion by 2032.
Those figures changed the tone of the debate. Sanitation stopped sounding like a cost centre. It began to look like one of the highest-return public investments available.
And when investment of that scale is involved, regulation becomes unavoidable.
Targeted oversight for high-risk areas
Stakeholders also acknowledged that sanitation challenges vary significantly between urban slums, peri-urban settlements and rural communities.
Prof. Quartey noted that waste management in hard-to-reach communities requires flexible and often more expensive collection systems.
A regulatory authority, participants argued, could standardize service benchmarks while allowing contextual implementation models.
Concerns about uncollected waste, dumping into drains and water bodies, and inconsistent enforcement of sanitation by-laws were cited as further evidence of weak regulatory coordination.
Beyond infrastructure: Jobs and education
The discussions extended to green jobs, recycling and skills development. Investment in sanitation, stakeholders noted, could unlock employment opportunities across the waste value chain.
However, such expansion would require standards, certification systems and clear operational guidelines. Again, regulation surfaced as a central enabler.
A shift in framing
By the close of the forum, one point had crystallized: Ghana’s sanitation losses are not just a public health issue. They are a governance issue.
The research team concluded that annual sanitation-related losses far exceed current spending levels. Participants agreed that without a coherent regulatory framework to align financing, enforce standards and coordinate institutional mandates, increased investment alone may not yield optimal results.
In that sense, the consensus for establishing a dedicated WASH regulatory authority was not reactionary. It was structural.
Sanitation, the stakeholders emphasized, must move from being treated as a residual expenditure to being governed as a core pillar of national development.
