Public pay-per-use toilets are the only alternative to open defecation
for a significant number of people in many low-income, urban neighbourhoods
where insecure tenure, space constraints, and/or cost make private sanitation
facilities unfeasible. This study explores public toilet use, characteristics of
public toilet customers and possible improvements to public toilet facilities in
four neighbourhoods in Accra, Ghana, the country with the highest reliance on
shared sanitation facilities globally. Reliance on public toilets ranged considerably
depending on neighbourhood affluence, but even some people living in compounds
with a private toilet used a public toilet. The vast majority of users were adults. Few
public toilet customers could foresee owning a household toilet in the coming year,
mostly because of lack of space, and they voiced desires for more and cleaner public
toilets with better provision of handwashing facilities. Improved accessibility and
management of public toilets, along with facilities more suitable for children,
could reduce open defecation.