Water quality challenges and public health risks in the Greater Accra Region, Ghana: a critical review

Abstract

Access to safe drinking water remains a critical challenge in many rapidly urbanising regions of sub-Saharan Africa. In the Greater Accra Region of Ghana, rapid population growth, urban sprawl and environmental degradation continue to strain water quality and supply systems. This review critically synthesises peer-reviewed and grey literature to examine drinking water contamination sources, treatment systems, regulatory frameworks and associated public health impacts in the region. Despite continued investments in water infrastructure, over 50% of residents still rely on unsafe or unreliable water sources, exposing them to contaminants such as Escherichia coli, heavy metals, nitrates and other pollutants. Municipal systems meet only 40% of daily demand, leading to widespread reliance on sachet water and household-level treatment methods, many of which lack regulation and scientific validation. Systemic issues, including fragmented institutional mandates, weak enforcement of standards and limited monitoring of emerging contaminants persist. Waterborne diseases such as diarrhoea, cholera and typhoid fever remain prevalent, especially among children and marginalized groups. This study recommends strengthening decentralised treatment technologies, expanding microbial and chemical monitoring, improving regulatory coordination and intensifying public education. These interventions are vital to ensuring equitable, reliable and health-protective drinking water access amid ongoing urbanisation and environmental pressures.