Public toilets and their customers in low-income Accra, Ghana

<jats:p> 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. </jats:p>