Accra, Ghana

Accra is one of the fastest growing cities in Africa, with an annual population increase of more than 2%. More than 4 million people live in the Greater Accra Metropolitan Area, with a daily influx of 2.5 million business commuters. The population is expected to grow to 9.6 million by 2050.

Led by WHO, the Urban Health and Short-Lived Climate Pollutants (SLCP) Reduction Project, launched in 2016, worked with international and local government experts to integrate health into transport, household energy, land-use and solid waste management policies.

This project has been a proving ground for the UHI model process. The project’s activities promote the implementation of SLCP reduction strategies by mobilizing and empowering the health sector and building on its influential position, to demonstrate the full range of health benefits that can be achieved from implementing SLCP reduction strategies at the city level.

1. Map stakeholders and policies impacting urban environments

The Initiative started by assessing air quality in the city, mapping sources of air pollution, related policies and initiatives, as well as identifying key stakeholders. Conducted by UN-Habitat and ICLEI Local Governments for Sustainability, the Initiative identified four main sectors impacting air quality: transport (including walking and cycling), energy (household energy for cooking and lighting), solid waste management (including open burning and e-waste) and urban land-use and spatial planning.

2. Building capacity for effective engagement

The second step was to improve the capacities of the health, environment and other city sectors to engage in cross-sector policy-making and communicate effectively with the public on links between climate, air pollutants and health. Experts were trained to engage in cross-sector policy-making and communicate effectively with the public on links between climate, air pollutants and health. This step also involved training on the use of various assessment tools.

3. Tools for assessing health and economic impacts used locally

Tools to assess the health and economic impacts of policies related to air pollution in the identified sectors were evaluated and applied to the local setting. These included: AirQ+ (a software tool for health risk assessment of ambient and household air pollution); HEAT (Health and economic assessment tool for walking and cycling) and WHO’s Household Multiple Emission Sources (HOMES) model, among other tools.

4. Alternative scenarios and policy options tested

Alternative scenarios were tested to identify preferred policy interventions. These scenarios were used to develop city-level action plans and roadmaps, allowing local data and expertise to be unlocked and helping to ensure the sustainability of the work at the country and city level.

• Analysis of ambient air pollution found that if air pollution is reduced to WHO guideline levels, 1790 premature deaths could be prevented every year in Accra and around US$ 247 million in welfare costs saved (2018 figure). 
• Analysis of household air pollution found over 1900 averted deaths and a reduction of 35% in exposure under the most ambitious scenario through the promotion of LPG, biogas or electricity as substitutes for wood and charcoal.
• Analysis of the transport sector estimated 5500 averted deaths from reduced air pollution, and an additional 33 000 averted deaths from increased physical activity in the most ambitious policy scenario projected over the next 35 years – including increasing public transport, fleet fuel economy, and infrastructure for walking and cycling, while reducing reliance on cars – resulting in an economic health benefit of almost US$ 15 million.
• Analysis of the waste management sector found ceasing open burning (a major contributor of black carbon) will lead to a 50% reduction in emissions and 19% capture of landfill gas by 2050.
• Finally, economic analysis of the costs of air pollution in Accra found that the direct costs to individuals, particularly people working in the informal sector to be catastrophic, while the cost benefits of controlling air pollution to be highly cost-effective. The analysis also found the economic welfare benefits of the Bus Rapid Transit in Accra outweigh the costs of the intervention.

5. Urban leaders engaged to communicate cost of inaction 

The Initiative then launched a communications campaign targeting policy-makers, health sector and the public promoting health co-benefits, as well as tools, experiences and lessons learned. In 2018, Accra became the first African city to join the BreatheLife, a global campaign to commit cities to meet the WHO air quality guidelines. Media training to engage editors and publishers led seven media houses to make long-term commitments to follow the air pollution, climate change and health story. Community outreach in eight sub-metro areas using education, theatre groups, school activities and workshops with traditional Chiefs and Queen Mothers led to joint efforts between communities and regulators to mitigate air pollution sources. 

6. Policy tracking and monitoring outcomes

The final step of the Initiative has been to develop a policy-tracking framework to track policy changes and understand the climate and health outcomes of Accra's initiatives. As a result of applying the Urban Health Initiative model process in Accra, various policy recommendations and tools have been incorporated into Accra's local strategies, including the Air Quality Management Plan, the Accra Resilience Strategy and the city’s 2020 Climate Action Plan. Accra has also pledged to cut carbon emissions to zero by 2050.

The city has gained a profile as a global leader in addressing air pollution and mitigating climate change, even winning recognition in 2019 as one of the "World's seven best climate projects" for its efforts to better integrate informal waste collectors into Accra's waste management system. 

The success of the Initiative in Accra has led other cities in Ghana to express interest in applying the model process and representatives from several African cities have travelled to Accra to learn from the city’s approach. The Urban Health Initiative in Accra has shown how equipping the health sector with the data, tools and capacity can unlock the full range of economic and climate benefits for cities through health-informed policies.