RESUMEN
Extreme weather events pose significant threats to urban health in low- and middle-income countries, particularly in sub-Saharan Africa where there are systemic health challenges. This paper investigates health system vulnerabilities associated with flooding and extreme heat, along with strategies for resilience building by service providers and community members, in Accra and Tamale, Ghana. We employed field observations, rainfall records, temperature measurements, and semi-structured interviews in health facilities within selected areas of both cities. Results indicate that poor building conditions, unstable power supply, poor sanitation and hygiene, and the built environment reduce access to healthcare for residents of poor urban areas. Health facilities are sited in low-lying areas with poor drainage systems and can be 6 °C warmer at night than reported by official records from nearby weather stations. This is due to a combination of greater thermal inertia of the buildings and the urban heat island effect. Flooding and extreme heat interact with socioeconomic conditions to impact physical infrastructure and disrupt community health as well as health facility operations. Community members and health facilities make infrastructural and operational adjustments to reduce extreme weather stress and improve healthcare provision to clients. These measures include: mobilisation of residents to clear rubbish and unclog drains; elevating equipment to protect it from floods; improving ventilation during extreme heat; and using alternative power sources for emergency surgery and storage during outages. Stakeholders recommend additional actions to manage flood and heat impacts on health in their cities, such as, improving the capacity of drainage systems to carry floodwaters, and routine temperature monitoring to better manage heat in health facilities. Finally, more timely and targeted information systems and emergency response plans are required to ensure preparedness for extreme weather events in urban areas.
Asunto(s)
Clima Extremo , Ciudades , Atención a la Salud , Ghana , Instituciones de Salud , Calor , Humanos , Tiempo (Meteorología)RESUMEN
BACKGROUND: The generation and management of solid waste pose potential adverse impacts on human health and the environment. OBJECTIVE: The present study examines the operational performance of municipal solid waste (MSW) disposal in the Wa Municipality, Ghana. METHODS: The study applied both qualitative and quantitative research methods and modelled the Wa Municipality's MSW disposal system using the municipal solid waste decision support tool (MSW DST). Acid gases (sulphur oxides and nitrogen oxides) and total particulate matter that have a direct impact on human health were set as the objective functions for modelling five MSW disposal scenarios. The modelled scenarios were: 1) landfill disposal only; 2) composting and landfill disposal; 3) composting, incineration, refuse derived fuels (RDF) and landfill disposal; 4) separation, composting, incineration, RDF and landfill disposal; and 5) separation, transfer, material recovery, composting, incineration, RDF and landfill disposal. The pollutants chosen as indicators for substance flow analysis included lead, cadmium, arsenic, mercury, copper, chromium, and zinc. RESULTS: Scenarios 4 and 5 produced the least engineering cost of 1 150 000 US $/year for the entire MSW disposal system, whereas scenario 2 produced the highest cost of 1 340 000 US $/year. Scenario 5 produced the least average health impacts of -5.812E-04 lbs/year, while scenario 2 generated the highest engineering cost and produced the highest average health impact of 9.358E-05 lbs/year. Scenarios 5 and 4, which included waste-to-energy conversion in the systems, produced the lowest average health impacts (-5.812E-04 lbs/year and -5.611E-04 lbs/year, respectively). CONCLUSIONS: The adoption of an integrated solid waste management concept, including waste-to-energy technologies, will not only help to lessen MSW disposal hazards, but also to produce alternative sources of energy for Ghana and other developing countries. COMPETING INTERESTS: The authors declare no competing financial interests.