Settlement morphology, demographics, and governance challenges of water, sanitation, and hygiene in low-income urban communities in Ghana

Access to safe water, sanitation, and hygiene (WASH) remains deeply unequal in rapidly urbanizing landscapes of the Global South, underlain by intra-settlement micro-geographies of exclusion, yet remain under-examined. Drawing on mixed-method case study of 150 households of two socio-culturally diverse low-income communities in Ghana’s Greater Accra Metropolitan Area, this study integrates household surveys, spatial analysis, and qualitative interviews to quantify how settlement morphology, socio-economic stratification, and the contribution of communities shape WASH access. Results show statistically significant differences in improved water access (75% in Chorkor vs. 56.4% in Nima; p = 0.017), yet sanitation deprivation is pervasive in both communities, with 87.2% of households in Chorkor and 91.7% in Nima relying on unimproved facilities with two-thirds of households depending on public toilets (62.8% and 63.9%, respectively), reinforcing shared sanitation burden. Distance to water sources remains significant (p < 0.05), with mean fetching distances of 69.49 m in Chorkor and 54.93 m in Nima, while income strongly predicts access to water sources in both sites (p < 0.001 in Chorkor; p = 0.016 in Nima). Solid waste infrastructure reveals contrasting patterns, with fragmented spatial distribution in Chorkor against more even coverage in Nima where improved access reaches 48.6% compared to 33.3% in Chorkor. Notably, community co-production significantly enhances service outcomes in Nima (water p = 0.002; toilets p = 0.047; waste p = 0.002), but not in Chorkor, indicating differences in governance. These findings reveal two distinct regimes of exclusion of spatially segmented inequality in Chorkor and settlement-wide systemic under-service in Nima. The composite access scoring (0–50) demonstrates that WASH exclusion is not uniform but patterned along spatial, socio-economic, and institutional gradients, demanding context-specific upgrading strategies that integrate spatial justice, affordability, and participatory co-management. Therefore, the findings reinforce the broader argument that WASH inequality is not simply a technical deficit but a manifestation of uneven urban development, political marginalisation, climate vulnerability, and governance fragmentation.