As in virtually every country, the emergence of the coronavirus pandemic in early 2020 led to the rapid introduction of measures in Ghana to prevent its spread. Alongside social distancing and wearing face-coverings, hand-hygiene is universally seen as an important measure. However, in impoverished districts such as Talensi, running water is generally not available. Most people obtain their water in buckets or basins from boreholes which may be some distance from where they live. A simple answer is the Tippy Tap system: a one-gallon plastic container is suspended from a frame made from large twigs held together with string. Once filled, it can be tipped to produce a steady stream of water with which to wash ones hands. This system has been widely used across Ghana but no money was available to train the network of health volunteers in Talensi District in its use. At the request of the District Health Director, Dr Nana's trustees thus agreed in early June to fund a proposal to train about 144 community health volunteers in all Talensi's 72 communities.  They would then be able to teach local communities how to build and use Tippy Taps whilst communicating covid-19 prevention messages. The budget also covered the purchase of 1440 1 gallon plastic containers and other simple materials.  The training was provided from 30 June to 3 July. It was well-organised and seems to have been highly successful. 

A team of monitors visited all the communities in Sept 30- Oct 8 and again on Nov 9-13 to evaluate the effectiveness of the project. 

The first monitoring visits found 1,392/1440 Tippy Taps distributed were standing (96.7%), of which 63.7% were functional and in use. At the second visit, 96.7% were still standing, with 72.7% functional and in use.  Four communities had installed 100% of the Tippy Taps with at least 95% were functional. Community members identified many reasons why the system was beneficial. 

During the monitoring visits, a survey of radio ownership was also conducted to help assess the value of transmitting health information by radio. Of 150 households visited, 29% had a radio.

Various suggestions for improvements were made, including providing bigger capacity systems at public boreholes; replacing the wood structures with metal to make them more robust and resistant to children and animals; providing Tippy Taps for every household and in front of all public toilets.

This project involving all 72 communities in the Talensi District has been successfully implemented with an apparently high level of community enthusiasm and acceptance.  Although not without its limitations, the system was seen by many community members as having a usefulness well beyond that of preventing COVID-19. Much was achieved at a modest cost (about £2600 including two monitoring visits).