Settlements and public health are intrinsically interconnected. Thus, the nature of settlements affect public health whereas public health issues also influence the design of settlements and cities. For example, historical evidence shows that European cities during the bubonic plague in the 18th Century metamorphosed in response to the threats posed by the plague. This subsequently contributed to the emergence of the renaissance cities.

From the onset of the Covid-19 pandemic, government, scientific community, media and Civil Society Groups have consistently educated the public and encouraged them to adopt the safety protocols. However, past and emerging data continue to point to cities, particularly Accra and Kumasi, as Ghana's hotspots for Covid-19.

This is partly attributed to the high concentration of Ghana’s urban population in these cities. Human settlements, and for that matter cities, are living organisms and such, could die from pandemic or any health related problems. It has therefore become necessary to express my professional view as a Development Planner & Policy Analyst, and also a member of the Committee on Health in the 8th parliament on the nexus between cities and pandemics, drawing on the lessons from Covid-19.

This piece is intended to evaluate Ghana’s preparedness against the deadly virus, and make proposals on how to enhance the resilience of the Ghanaian human settlements against pandemics.

According to the Ministry of Health, the country’s Covid-19 reported cases on Monday, May 24, 2021, stood at approximately 93,775 persons with 780 deaths and 91,857 recoveries. Although this is alarming (considering the incidence rate), comparing these figures to the global statistics of reported cases demonstrates prudent management of Covid-19 by President Nana Addo Dankwa Akufo Addo.

Compliance with safety protocols such as social distancing, wearing of recommended nose masks and personal hygiene (e.g., regular hand washing with soap, application of alcohol-based hand sanitizers) profoundly reduce the risk of contracting Covid-19. It is imperative to stress the point that government has effectively curtailed the spread of the virus through its insistence on the need to observe the laid down protocols by the Ministry of Health and the World Health Organization despite the haphazard nature of our cities.

Nonetheless, please permit me to emphatically state that our cities, towns and villages in many instances do not promote compliance with the Covid-19 safety protocols or future pandemics. For instance, out of a total of 1,138 Covid-19 active cases as of May 24, 2021, Accra and Kumasi accounted for 68.80% and 11.16%, respectively. This implies that the two cities account for 79.96% of the total Covid-19 active cases in Ghana.

In his book 'Planet of Slums', Chris Abani observed as he let his mind drift and stared at the city, half slum and half paradise. How could a place be so ugly and violent, yet beautiful at the same time?” Unfortunately, this is exactly the reflection of our cities, half slum and half paradise. For the latter, observing the Covid-19 safety protocols is a walk in the park, but the former, a herculean task to accomplish. This has been rightly articulated by scholars such as Yeboah, Takyi, Amponsah and Anaafo, who wrote on the “…the practicality of the Covid-19 social distancing guidelines to the urban poor in the Ghanaian context”, Indeed, adherence to the Covid-19 protocols, particularly social/physical distancing and frequent washing of hands, has proven to be incredibly challenging considering the haphazard developments of our towns and cities.

While I acknowledged the free distribution of water by the President in the early stages of the pandemic, it is a known fact that many areas in Ghana lack basic social facilities, including access to potable water for regular hand washing, which according to experts, is a major requirement for mitigating the spread of Covid-19 and possibly future pandemics. Accordingly, maintaining personal hygiene is a challenge since it is difficult for Ghanaians to have access to water supply and basic sanitation services. Furthermore, Many households' lack of access to potable water is the manifestation of poverty and unplanned human settlements in Ghana.

Unlike the Town and Country Planning Ordinance 1945 (CAP 84), which designated some areas as planning areas, the new Land Use and Spatial Planning Act 2016 (Act 925) makes all areas in Ghana a planning area. The implication is that under the repealed colonial legislation, planning was carried out through a piecemeal approach. This therefore meant that not all areas qualified for and benefited from planning interventions. This partly explains the haphazard growth of many old settlements.

Metropolitan, Municipal and District Assemblies are the designated planning authorities commonly blamed for this planning failure. However, the Land Use and Spatial Planning Act 2016 (Act 925) provides adequate legal power and responsibility to local planning authorities to regulate and ensure proper spatial management of land uses within their respective jurisdiction. As a result of the new planning legislation, and the ever-increasing haphazard developments in our cities, many have argued and described planning authorities as incapable of keeping up with the growth of human settlements.

However, as some scholars and practitioners argued, planning authorities are not the only ones to blame for this phenomenon. In elucidating this claim, some planning scholars have maintained that factors such as complex land tenure systems, unresponsive planning legislation, acute human resource shortage and political interference account for the poorly planned settlements.

Despite the new planning legislative framework, many recalcitrant developers continue to flout planning regulations by putting up structures or initiating physical developments without prior approval from the Metropolitan, Municipal and District Assemblies. As a result, many settlements have emerged without proper layout which could provide adequate space for enhanced ventilation. Access to potable water in these settlements is a challenge; a situation that has the tendency to exacerbate the risk of contracting Covid-19, particularly in the event of any exposure to the virus.

Ghana’s population is now estimated at 30 million. More than half of the estimated population reside in urban areas where access to quality housing is a challenge. A large share of the urban population resides in Accra and Kumasi, which are described as primate cities and reveal the worse forms of the ills that are associated with rapid urbanization (such as poor housing, proliferation of slums and congestion). Ghana Statistical Service, in its Ghana Living Standard Survey Round 7, reports that about half (i.e., 49.9%) of households in Ghana occupy a single room.

The situation is more precarious in the urban areas where about 53% of households occupy a single room. The overwhelming housing deficit implies that many people share and continue to live in single rooms. Indeed, in some instances, as many as eight, ten or more persons share a single room, which is more than the United Nation’s recommended standard of two persons per room and Ghana’s standard of three persons per room. The high room occupancy rates undermine compliance with Covid-19 safety protocols such as social distancing and hygiene and could foster the spread of the disease in the future.

To address the housing deficits, which is central to the fight against Covid-19 and other anticipated pandemics, Ghana requires about 5.7 million rooms to adequately house the population currently without access to quality housing. This underscores the profound roles of human settlements in promoting the resilience of residents to pandemics.

However, Ghana’s story is not all gloomy due to some interventions of His Excellency the President of the Republic of Ghana. Permit me to draw your attention to the construction of 204 and 312 affordable housing units in Tema and Asokore Mampong, respectively. This amongst others is to reduce the high room occupancy rates which could facilitate compliance with the Covid-19 social distancing and hygiene protocols.

That notwithstanding, it behooves on us particularly prospective developers to exhaust all necessary procedures leading to the approval and subsequent construction of physical structures. Metropolitan, Municipal and District Assemblies are required to ensure that land uses and physical development (including housing) at the local levels conform to the local physical plans. These are to ensure proper layout and good ventilation, which are necessities to combat future pandemics.

More so, I would urge the Government of Ghana to incentivize the private sector to increase the housing stock to help to address the housing deficits. Strategies such as land banking and financial support to investors can eliminate the barriers against access to land (such as high value, multiple sales and inaccessibility due to land guards) and building materials and ultimately increase the supply of housing in Ghana. Compact cities should be promoted to help address sprawl. Inclusionary housing by private developers with support from government may be a useful strategy in this regard.

The public is also strongly encouraged to curtail unnecessary visits to family members particularly where existing accommodation cannot cater for an extra person in observing the Covid-19 protocol of physical distancing. Elsewhere in Europe, smart cities have contributed to contact tracing and surveillance. The concept of smart cities using technology in the future would make our cities prepared for any future pandemic. The starting point could be promotion of “internet of things” as has been articulated by Peprah, Amponsah and Oduro in their paper “a system view of smart mobility and its implications for Ghanaian cities”. This strategy can enhance e-commerce and “working-from-home” and ultimately reduce travels without undermining productivity. The capacity of the citizenry will need to be enhanced to foster adoption. Utility service providers (such as the Ghana Water Company Limited and Community Water and Sanitation Agency) should be supported to improve their services to human settlements.

In conclusion, the aforementioned proposals require multi-stakeholder collaboration to plan, execute and manage. The central and local government institutions are encouraged to create an environment that could enable the private sector and civil society groups, while working within existing regulations, help to improve Ghanaian settlements and make the residents resilient to Covid-19 and other future pandemics. All these are anchored to a responsive population. Hence, education should be unrelenting while enforcement of human settlement and Covid-19 regulations must continue.

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The writer is a member of Parliament's Health Committee and MP for Manhyia North in the Ashanti Region