Ghana's water safety journey: A review of efforts toward a risked-based water quality management

Water is a critical resource essential for sustaining life, health, and economic development. However, ensuring universal access to safe drinking water remains a significant global challenge, especially in low- and middle-income countries (LMICs), where waterborne diseases are a leading cause of morbidity and mortality (WHO 2017b, 2023). Ghana, like many LMICs, continues to grapple with water quality challenges, even as significant strides have been made to expand access to improved water sources. The country's water supply systems are diverse, consisting of both centralized urban networks and decentralized systems serving rural and small-town populations (REAL-Water 2023a). Many of these systems, however, remain vulnerable to contamination due to environmental degradation, ageing infrastructure, and operational inefficiencies (Yeleliere et al. 2018; Duncan 2020; Yeboah et al. 2022; REAL-Water 2023b; Bakobie et al. 2024; Urban WASH Project 2024).

Given the susceptibility of drinking water supply systems to various hazards ranging from microbial contamination to chemical pollutants, preventive approaches to water safety have gained global traction (Gunnarsdottir et al. 2012; Tsitsifli & Tsoukalas 2021). One such approach is the water safety plan (WSP), a risk-based framework that emphasizes hazard identification, risk management, and the continuous monitoring of water supply systems from source to tap. The World Health Organization (WHO) has endorsed WSPs as the most effective method for ensuring drinking water safety, particularly in contexts where conventional, end-point testing methods have proved insufficient (WHO 2008, 2017b). WSPs are now widely adopted and integrated into the regulatory frameworks of many countries (Gunnarsdottir et al. 2012, 2015; WHO/IWA 2017; Ferrero et al. 2019; Macleod et al. 2020).

In line with global recommendations, Ghana has embraced WSPs through its National Drinking Water Quality Management Framework (NDWQMF), positioning WSPs as the core strategy for water quality management across the country's various water supply systems (Ministry of Water Resource Works and Housing 2015). This shift from a reactive to a proactive water quality management approach reflects a broader national commitment to risk-based water safety practices.

WSPs are being implemented by public utilities and small-town water suppliers in both rural and urban areas (REAL-Water 2023c). For example, the Community Water and Sanitation Agency (CWSA) is implementing WSPs for rural piped water systems under its management. The urban water utility, Ghana Water Limited (GWL), has also started a WSP in a few of its systems with plans to scale-up nationwide. WSPs are also gaining interest among donor-supported, safe water enterprises (SWEs) (REAL-Water 2023c, 2023b).

While the application of WSPs and related policies and regulations are widespread, evidence of the systematic implementation and effectiveness of WSPs in improving water quality and health outcomes remains limited, particularly in LMICs (Setty et al. 2017). In Ghana, there is a lack of systematic evidence regarding their adoption, level of implementation, and the enabling environment required for their effectiveness. Thus, the extent of WSP adoption and the factors that enable or hinder their success have not been fully explored. This paper, therefore, synthesizes current WSP implementation efforts in Ghana, evaluates the enabling environment, identifies gaps in practice, and offers recommendations for improving the effectiveness and scaling up WSPs across the country.

Risk-based water quality management has become an essential framework for addressing water contamination complexities, focusing on systematic risk identification, assessment, and mitigation throughout the water supply chain (Hrudey et al. 2006). At the core of this approach is the WSP, which applies multiple barrier principles, Hazard Analysis and Critical Control Points (HACCPs) to ensure water safety from the catchment to consumption (WHO 2008, 2017c). WSPs are universally applicable, adaptable to systems of varying sizes and complexities, and require active involvement from all stakeholders (Ferrero et al. 2019).

Several countries have implemented WSPs, with documented experiences from Uganda (Godfrey & Howard 2004; Kanyesigye et al. 2019), South Africa (Viljoen 2010), Ethiopia (Rickert et al. 2019), Ghana (Obeng et al. 2020; Sheehan et al. 2023), Colombia (Pérez-Vidal et al. 2020), Australia (Jayaratne 2008), the Pacific Islands (Hasan et al. 2011), Iceland (Gunnarsdóttir & Gissurarson 2008), Germany (Mälzer et al. 2010), Portugal (Vieira 2011; Roeger & Tavares 2018), Italy (Sorlini et al. 2017), France and Spain (Setty et al. 2017), Bangladesh (Shamsuzzoha et al. 2018), Jamaica, Brazil, Peru, and Costa Rica (Rinehold et al. 2011), the United States (Amjad et al. 2016), and China (Li et al. 2020).

This risk-based model offers distinct advantages over traditional approaches, emphasizing proactive contamination prevention, fostering a comprehensive understanding of the water system, and promoting collaborative involvement among suppliers, regulators, and communities (WHO 2017c). In various countries, the implementation of WSPs has led to significant improvements in water safety. In Australia, for instance, WSPs have proven effective in managing microbial and chemical risks across diverse systems (Hamilton et al. 2006). Gunnarsdottir et al. (2012) reported a 14% reduction in clinical diarrhea rates following WSP adoption. Additionally, Tsitsifli & Tsoukalas (2021) reported improved water quality, higher operational efficiency, reduced costs, and fewer customer complaints with WSP implementation. Setty et al. (2018) also noted substantial declines in low-chlorine events and water quality complaints after WSP adoption.

Despite these benefits, WSP implementation remains challenging in low-income settings (Mahmud et al. 2007; Kanyesigye et al. 2019; Alazaiza et al. 2022), where robust regulatory frameworks, sufficient resources, and institutional capacities are often limited, particularly in small towns (Perrier et al. 2014). Success factors include adequate funding, trained staff, precise hazard assessment, and efficient coordination and monitoring systems (Tsitsifli & Tsoukalas 2021). By facilitating better communication on water supplies, WSPs strengthen stakeholder relationships, yet barriers remain in ensuring the needed institutional support and resources for widespread adoption.

The study employed an extensive narrative review approach to assess WSP implementation efforts in Ghana. The approach comprised a literature review supplemented by key informant interviews. Secondary data were primarily sourced from peer-reviewed articles, government and institutional reports, policy documents, and case studies (Pandya 2022; Sukhera 2022). The literature selection was guided by their relevance to the research objectives, with a focus on materials that provide insight into water safety and quality management practices in Ghana and comparable contexts.

Scholarly articles were retrieved from academic databases such as PubMed, Google Scholar, and Scopus using key search terms like ‘water quality management,’ ‘risk-based management,’ ‘water safety regulations,’ and ‘water safety plans.’ Articles from these sources were synthesized to understand international guidelines, regulations, tools, resources, and the enabling environment for WSP adoption and implementation globally.

Government reports and policy documents were reviewed to contextualize the policy and institutional frameworks governing WSP adoption in Ghana. This included an examination of national water policies, regulatory frameworks, and institutional arrangements. Additionally, technical reports from non-governmental organizations (NGOs) and international development agencies (IDAs) were also analyzed to gather field evidence on the successes and challenges of WSP implementation in Ghana.

Water supply in Ghana is categorized as urban or rural. GWL is the public utility responsible for urban water supply, currently operating 88 urban water supply systems throughout the country. Presently, GWL can only meet the water needs of about 77% of the urban population (GWCL 2019). This has created a gap filled by alternative water service options such as self-supply, water tankers, and privately operated boreholes with standpipes. Self-supply refers to residents who have invested in their own water systems, such as boreholes, hand-dug wells, or rainwater systems. Tanker systems rely on either GWL or other independent water sources, such as private boreholes, and sell to tertiary vendors or directly to consumers. Most water vendors who operate private boreholes sell water to people within their neighborhood.

Rural water supply refers to water services for small towns and rural areas and is delivered by CWSA, District Assemblies via community-based water and WSMTs, SWEs, and informal private operators. The three most common rural water supply schemes in Ghana are as follows:

• (i) Point source schemes – dug wells, boreholes, and limited mechanized borehole schemes, serving populations of less than 2,000.

• (ii) Small communities piped water supplies serving populations of between 2,000 and 5,000.

• (iii) Small-town piped water supply serving populations of 5,000 and above.

CWSA operates over 179 small-town piped systems across the country (CWSA 2023). The District Assemblies, through WSMTs, oversee over 800 small piped water systems and 32,871 point sources. SWEs are NGOs or private companies that manage water systems under Build–Operate–Transfer (BOT) contracts or management contracts with the District Assemblies (REAL-Water 2023a). Safe water network (SWN), one of the main SWEs in Ghana, is managing over 104 piped water systems. Additionally, there are over 1,500 systems operated by informal water suppliers.

The global adoption and promotion of WSPs trace their roots to the systematic risk management practices originally developed for the food industry, particularly through the HACCP system. Initially implemented in the 1960s in the USA to ensure food safety, the application of HACCP principles to water systems was first recognized by Havelaar (1994). While some countries, including Switzerland, Iceland, France, and Slovenia, quickly integrated HACCP principles into their water management practices, the broader application of these principles to drinking water safety remained limited until later efforts (WHO 2014; Baum & Bartram 2018).

The WHO played a pivotal role in expanding these practices globally. Between 1994 and 2004, WHO led the development of international guidelines that established WSPs as a central component of drinking water safety. This effort culminated in the inclusion of WSPs in the 2004 WHO Guidelines for Drinking Water Quality and the 2004 International Water Association (IWA) Bonn Charter for Safe Drinking Water (IWA 2004; WHO 2008). These guidelines were further reinforced by regional frameworks, such as the Australian Drinking Water Guidelines and the European Union's Drinking Water Directive (DWD), which introduced systematic risk assessment into national legislation (Australia National Health and Medical Council 2013; EC 2015). As a result, WSPs have become a globally recognized standard for managing drinking water safety, promoting a proactive and preventive approach to public health protection.

In Ghana, traditional water quality management practices prevailed until the early 2000s. During this period, the country relied on end-of-pipe approaches to ensure drinking water safety, focusing primarily on water treatment processes without a comprehensive risk-based management framework. However, the early 2000s marked a shift toward the adoption of risk-based approaches, beginning with the development of national water policies and legislative instruments, including the National Water Policy, Water Safety Framework, and the Public Health Act (MWRHW 2007; CWSA 2010). These policies provided the necessary frameworks and guidelines for ensuring water safety from the source to the point of consumption.

Initial efforts to implement a risk-based water quality management approach in urban areas of Ghana began around 2004. During this time, GWL, in collaboration with Aqua Vitens Rand Limited, initiated the development of WSPs for a few of its water supply systems (Saboor & Nyarko 2014). However, these efforts were short-lived due to a lack of regulatory enforcement for WSP adoption and fragmented policies that did not cohesively support a risk-based approach. Challenges such as poor coordination among sector organizations and the absence of established guidelines for comprehensive drinking water quality management further hindered the progress.

A significant turning point came in 2015 when Ghana officially adopted a risk-based approach to managing drinking water quality by developing its NDWQMF (Ministry of Water Resource Works and Housing 2015). The NDWQMF institutionalized the WSP approach as the primary tool for systematic water quality management across all drinking water supply systems in the country. This framework mandates that all water systems, regardless of type, size, or management model, adopt WSPs as best practices for managing water quality from the source to the point of use. By identifying potential hazards and vulnerabilities at each stage, the NDWQMF enables targeted interventions and preventive measures to ensure water quality throughout the entire service chain. For Ghana, the adoption of the NDWQMF represents a promising pathway toward sustainable and resilient water safety, with the potential to significantly improve hazard control, regulatory compliance, water quality, asset management, communication, staff knowledge, treatment costs, and public health outcomes (Gunnarsdottir et al. 2012; Setty et al. 2017; Baum & Bartram 2018).

Following the development of the NDWQMF, the implementation of WSPs was actively promoted among key stakeholders through workshops, conferences, and training programs. Support from organizations such as the United Nations Children's Fund (UNICEF) and WHO was instrumental in training key sector actors and institutions at both national and sub-national levels. These training programs covered technical skills such as water quality monitoring, risk assessment, treatment operations, WSP documentation, regulation, and compliance, as well as soft skills like risk communication and collaboration. Through these efforts, draft WSP guidance materials and training modules essential for nationwide WSP implementation were developed.

The Government of Ghana (GoG)-UNICEF Water, Sanitation, and Hygiene (WASH) Programme (2018–2022), supported by the Netherlands Government, piloted WSPs in rural water systems. In 2017, this program supported the implementation of WSPs in 10 selected water supply systems across five regions of Ghana: Central, Volta, Northern, Upper East, and Upper West. The pilot project aimed to provide insights into the practical application of WSPs in the Ghanaian context and gather lessons for scaling up the approach nationwide (REAL-Water 2023c). Following the pilot, the CWSA trained its staff and began implementing WSPs across all its systems.

In 2018, the Public Utilities Regulatory Commission (PURC) integrated WSPs as a key performance indicator for GWL, prompting the development of a framework to standardize WSP implementation across the 88 water supply systems managed by GWL (Public Utilities Regulatory Commission 2022). To strengthen WSP adoption, GWL sought support from the WHO and the IWA, with additional technical assistance from WSP experts at Yarra Valley Water and Coliban Water in Victoria, Australia (Sheehan et al. 2023).

The components of enabling environments are wide ranging (WSUP 2018; USAID 2022). The enabling environment for water and sanitation has been defined as the policy, capacity, institutional, and financial frameworks necessary for sustaining and replicating large-scale water and sanitation interventions (WSUP 2018; Trimmer et al. 2023). The laws, regulations, policies, and institutional arrangements that support water safety and WSP implementation in Ghana are described in the following.

This section presents an overview of the legal, policy, and regulatory framework guiding the water sector. This has been grouped into three sections: the first section presents the various acts of Parliament (laws) establishing specific institutions and mandates; the second section shows the two main water sector policies and the final section presents the main strategies and plans for both rural and urban settings in the country. The legal framework describing the laws that established the key institutions and their mandates is summarized in Table 1. 

The relevant water quality and resource management regulations are as follows:

• GS 175: Water Quality – It provides the specifications for drinking water.

• GS 220: Water Quality – It provides the specifications for natural mineral water (packaged water – sachet and bottled water).

• GS 786: Code of Hygienic Practices for the Collection, Processing, and Marketing of Potable Water – recommends appropriate techniques for hygienic handling of potable water. Water Quality – MMDAs monitor water quality, including tanker supply, packaged water, and at premises (Act 851). FDA regulates packaged water (bottled water and sachet) production and operations.

• Water Use Regulation (LI 1692): It outlines the procedure for acquiring water rights for various categories of water uses.

• Environmental Assessment Regulation (LI 1652): Outlines the procedure for protecting the environment (air, land, and water) through the Environmental Impact Assessment Management plans.

• Drilling License Regulation (LI 1827): It outlines the procedure for acquiring a drilling license to construct a well or borehole for abstraction or groundwater monitoring.

• Buffer zone regulation (in the process): It provides comprehensive measures and actions to guide the coordinated creation of vegetative buffers for the preservation and functioning of our water bodies and vital ecosystems.

The institutional framework for water services in Ghana delineates the roles and responsibilities of various entities involved in national and sector policy formulation, planning, regulation, and service delivery. At the national level, the Central Government, through the National Development Planning Commission (NDPC), drives the overarching development agenda. The Ministry of Sanitation and Water Resources (MSWR) plays a central role in this framework, being responsible for policy formulation, sector coordination, and the harmonization of water-related activities. Within the MSWR, the Water Directorate coordinates water supply initiatives across both rural and urban areas. This directorate also oversees the Water Resources Commission (WRC), which is responsible for protecting water resources and regulating water resource abstraction to ensure sustainable management. Regulation of urban water quality falls under the PURC, which audits compliance with water quality and safety standards through a dedicated Water Quality Inspectorate. The GWL and the CWSA are the primary entities responsible for providing safe water in urban and rural communities, respectively. For specific sectors such as education and health, water services are managed by the respective ministries (Ministry of Education and Ministry of Health), who deploy technical personnel within local governments to enhance water service management at schools and health facilities. The detailed roles and responsibilities of other actors in the water services sector are summarized in Table 2.

GWL has established protocols for treating and distributing potable drinking water to its customers, ensuring compliance with the GSA for drinking water quality (refer to Supplementary Information SI 1 for water quality standards). The Water Quality Assurance Department within GWL oversees the production and distribution of safe water to consumers. Key parameters, including Escherichia coli (E. coli), turbidity, pH, color, and residual chlorine, are regularly tested at regional treatment plant laboratories to ensure compliance with standards. Monthly reports on water quality are submitted by GWL to the PURC for evaluation. PURC reviews these reports and takes appropriate actions to ensure GWL adheres to established service standards. Additionally, PURC addresses consumer complaints related to billing, water quality, or service interruptions and works with GWL to resolve these issues, ensuring consumer rights are protected.

The regulation of packaged water, including sachet and bottled water, falls under the purview of the Food and Drugs Authority (FDA). The GSA sets standards for the physical, chemical, and microbiological qualities of packaged drinking water. All producers of packaged water are required to register with the FDA, providing detailed information on their production facilities, water sources, and quality control procedures. Depending on the type and scale of production, specific licenses may be required by the FDA. Routine inspections and audits of packaged water production facilities are conducted by the FDA to verify compliance with hygiene practices, water quality testing procedures, and labeling requirements. The FDA conducts random sampling of packaged water from the market for independent testing to verify adherence to quality standards, with samples collected from production facilities, distribution points, or the market. This approach helps identify and address potential contamination issues.

Water quality regulation for tanker water supply is guided by the PURC Tanker Guidelines, which mandate that licensed tanker operators form associations, fill tankers at controlled points, use only potable water, and comply with cleanliness and disinfection requirements (Public Utilities Regulatory Commission 2008). However, water from tanker services often fails to meet national standards, with microbial contamination being a common issue, underscoring gaps in quality control and monitoring (Salifu et al. 2019; Appiah-Effah et al. 2021). Enforcement of regulations for tanker trucks and sachet water producers tends to be inconsistent, with many sachet water producers not registered with the FDA (Dzodzomenyo et al. 2018).

In rural areas and small towns, the CWSA and District Assemblies share responsibility for regulating drinking water quality and ensuring safe water supply. According to the NDWQMF, water quality monitoring should be conducted as prescribed in Table 3. The CWSA sets standards and guidelines for safe water provision and supports District Assemblies in ensuring compliance by service providers. Water quality assurance is overseen by District Environmental Health Units and regional CWSA offices, with integration into the District Monitoring and Evaluation System (DiMES). There is currently no systematic monitoring of water quality at point sources, except for the initial water quality tests conducted before the facilities are handed over to communities, despite the sampling frequency being specified in the NDWQMF (Afriyie & Ferber 2018).

WSP implementation has been initiated across several water systems in Ghana, albeit with varying levels of progress. In urban areas, GWL has rolled out WSPs at three water treatment plants (WTPs): Kwanyako WTP in the Central Region and Owabi and Odaso WTPs in the Ashanti Region. With a total of 88 water supply systems under its management, GWL is currently developing WSPs for an additional 20 systems. The initiative's pilot phase commenced at the Kwanyako WTP, selected for its existing draft WSP and suitability as a model for other GWL-operated systems (Sheehan et al. 2023).

Despite years of piloting WSP, the scale-up to other systems has stalled. Most GWL water systems continue to rely on reactive water quality management practices and prioritize infrastructure expansion to increase access rather than fully adopting a risk-based approach to water safety. Stakeholder interviews identified several barriers to broader WSP adoption, including resource limitations, operational challenges, and a lack of regulatory impetus and clear timelines for implementation. GWL faces significant resource constraints due to budgetary limitations and competing priorities. The utility has not prioritized financial resource allocation for comprehensive WSP adoption, often focusing on the maintenance of ageing infrastructure, addressing system failures, and ensuring a continuous water supply. These immediate operational demands divert attention and resources away from long-term risk management initiatives, such as the development and implementation of WSPs. Furthermore, the internal structures of the utility lack clarity regarding roles and responsibilities for WSP development and enforcement, hindering institutionalization of the WSP framework within the utility. Regarding regulations, the PURC, responsible for economic and quality of service regulation in urban areas, has historically not established effective accountability mechanisms to promote WSP implementation by GWL. Until recently, PURC did not include WSPs as key performance indicators (KPIs) for GWL, which would have provided a clear incentive for compliance by the utility.

In rural areas, WSP implementation initially began with pilot projects in 10 piped water systems, designed to adapt the WSP framework to the rural context and inform future scale-up strategies (Sheehan et al. 2023). The CWSA made significant strides in 2017 by recruiting over 834 professional staff, including engineers, technicians, water safety specialists, and revenue collectors, to oversee the management of rural water systems and to support WSP implementation (CWSA 2020). Since then, the agency has developed and implemented WSPs for over 177 piped water supply systems across rural Ghana.

In parallel, the SWN, a private sector entity, has initiated WSP development for 46 water systems serving rural areas and small towns, with plans to extend WSP implementation to all 104 systems by 2026 (REAL-Water 2023b, 2023c). However, WSP implementation has not yet commenced for water systems managed by WSMTs, nor for water supplies in schools and healthcare facilities. Additionally, the development of WSPs for more than 30,000 point sources managed by small water committees remains uninitiated.

One of the primary reasons for the lack of WSP adoption by WSMTs is the unclear delineation of responsibilities regarding water quality monitoring and WSP compliance in the rural and small-town water sector. The CWSA, traditionally responsible for setting standards and guidelines for safe water supply in rural areas and ensuring compliance by service providers, has transitioned into a utility service provider. This shift has created a regulatory vacuum, as the CWSA's new role as a utility leaves the rural sector without a designated independent body to oversee and verify WSP implementation. As a result, the lack of clear regulatory oversight and enforcement mechanisms continues to pose a challenge to the adoption of WSPs in rural water systems, particularly those managed by WSMTs.

After a few years of WSP pilot in both urban and rural water systems, UNICEF and the MSWR commissioned a WSP audit in November 2020 to evaluate the level of implementation. The audit focused on verifying the accuracy and completeness of WSP documentation and the extent of WSP implementation by pilot water systems (UNICEF/MSWR 2020). The audit identified several strengths in the urban systems, such as the establishment of a 19-member core WSP team, primarily composed of GWL staff, and comprehensive documentation that covered system descriptions, hazard identification and risk management, control measures, and customer complaints management. The audit also revealed significant gaps in WSP implementation. In the urban context, the WSP team lacked representation from key stakeholders such as the EPA and the WRC. There were also deficiencies in the regularity of team meetings and WSP framework descriptions (such as incomplete hazard lists, inadequate improvement plans, insufficient monitoring practices, and a lack of standard operating procedures) (UNICEF/MSWR 2020). The audit further noted a lack of climate resilience planning within the WSPs, which is critical for ensuring long-term sustainability in the face of environmental and climatic changes. In the rural system, similar strengths and weaknesses were identified. While there was effective team formation and documentation, critical gaps remained, including incomplete hazard lists, weak connections between hazards and improvement plans, and the need for additional documentation such as monitoring plans, emergency procedures, internal audit mechanisms, and climate-related risk assessments (see Supplementary Information SI 3 for the full list of strengths and gaps).

Drinking water supply systems face inherent vulnerabilities due to their structural complexities and exposure to numerous hazards (Tsitsifli & Tsoukalas 2021). In view of this, many water utilities globally have adopted preventive risk-based management approaches, such as WSPs, to address these risks. These approaches yield substantial benefits, including comprehensive hazard identification, selection of effective control measures, establishment of robust monitoring systems, and increased consumer confidence (Gunnarsdottir et al. 2012; Setty et al. 2017; Roeger & Tavares 2018; Alazaiza et al. 2022). Notably, WSPs deliver strong returns on investment, with estimated savings of up to six times their implementation costs through reductions in health-related expenses (String & Lantagne 2016).

Nevertheless, substantial barriers persist in the adoption and implementation of WSPs. Key challenges of adoption include the lack of legal mandates and regulatory enforcement (Ferrero et al. 2019; Kanyesigye et al. 2019), limited operational resources, inadequate financial support (Martel 2006; String & Lantagne 2016), and gaps in training and experience among staff (Bartram et al. 2009; Gunnarsdottir et al. 2012; Amjad et al. 2016; Kumpel et al. 2018). Additionally, the quality of WSP implementation often suffers due to inadequate documentation, incomplete hazard identification, and non-representative teams and limited stakeholder engagements (Mahmud et al. 2007; Loret et al. 2016; Kanyesigye et al. 2019; Aali et al. 2021; Tsitsifli & Tsoukalas 2021).

Our findings demonstrate that WSP implementation in Ghana faces similar challenges, impeding both the broader adoption and sustainability of WSPs. As underscored globally, a comprehensive and well-documented system description is crucial to WSP success, forming the foundation for hazard identification, risk assessment, and management (Kanyesigye et al. 2019). The WHO/IWA global status report on WSPs emphasizes that each step – team formation, system characterization, risk assessment, improvement planning, monitoring, verification, and periodic review – requires balanced and thorough attention to fully realize the benefits of WSPs (WHO/IWA 2017).

Our study also highlights the need for more inclusive and multi-sectoral WSP teams in Ghana. Effective WSPs rely on diverse, representative teams to incorporate a range of expertise and perspectives. The absence of key stakeholders, such as regulators, public health authorities, and community representatives, can lead to oversight of critical risks or inadequate control measures. Bartram et al. (2009) emphasize that a multi-sectoral approach involving all relevant stakeholders is essential to developing a comprehensive risk management plan that addresses the unique needs of each water system.

Particularly concerning in Ghana is the slow pace of WSP adoption, particularly for systems managed by local entities such as WSMTs, schools, healthcare facilities, and small water committees. The absence of an independent regulatory body for WSP compliance in rural areas, coupled with the limited technical and financial capacities of community-managed water systems, increases the risk of contamination and jeopardizes water quality (WHO/IWA 2017). Effective strategies for promoting WSP adoption in these settings include strengthening systems, enhancing technical capacities, and creating supportive environments for WSP implementation. For instance, developing WSP templates tailored to the unique needs of diverse water systems could simplify the implementation process (Kanyesigye et al. 2019). Additionally, integrating WSP compliance as a performance metric in contracts for water service providers could incentivize adherence to WSPs and empower district authorities to enforce WSP adoption through agreements with WSMTs, private suppliers, and NGOs (Kanyesigye et al. 2019).

An emerging challenge in WSP implementation is the insufficient integration of climate resilience (WHO 2017; Rickert et al. 2019). Increased climate variability, marked by events such as heavy rainfall, droughts, and extreme temperatures, poses additional risks to water safety by introducing new contaminants and straining water resources (Rickert et al. 2019; Ma et al. 2022; Wang et al. 2022).

Without climate resilience planning, WSPs may lose effectiveness over time. As highlighted by Agodzo et al. (2023) and Rickert et al. (2019), climate resilience is becoming increasingly critical, especially in Ghana, where studies highlight the growing impacts of climate variability on water resources (Fagariba et al. 2018; Addi et al. 2021; Agodzo et al. 2023). In this context, integrating climate resilience into WSPs is essential to safeguarding drinking water systems against climate-induced risks. This could involve strategies such as expanding water storage capacity, diversifying water sources to reduce dependence on single sources, improving catchment management to reduce pollution, and investing in infrastructure that withstands extreme weather (WHO 2017a; Grönwall & Oduro-Kwarteng 2018; Rickert et al. 2019). Such adaptations will enable water supply systems to better withstand climate-related challenges and ensure reliable access to safe drinking water.

This study has provided critical insights into the current status of WSP implementation in Ghana, highlighting both the progress made and the barriers to scale-up across urban and rural water systems. Despite initial steps taken by major water utilities like GWL and CWSA, widespread adoption remains limited with significant challenges, including resource constraints, inadequate stakeholder engagement, lack of regulatory oversight, and inadequate documentation. Notably, the study identifies the absence of clear regulatory mandates, accountability mechanisms, and climate resilience planning as critical barriers that threaten the long-term effectiveness of WSPs in Ghana. These findings have practical implications for water utilities, policymakers, and development partners, emphasizing the need for a more structured, inclusive, and well-resourced approach to WSP implementation to ensure public health through safe drinking water. Establishing regulatory frameworks that incentivize WSP adoption through performance-based contracts and accountability mechanisms is urgently needed. Furthermore, integrating climate resilience into WSPs and implementing targeted capacity-building initiatives will ensure water systems, especially those in rural communities and small towns, are not left vulnerable to contamination and climate risks. Future research should concentrate on developing practical frameworks for scaling up WSPs in rural water supply systems.

We would like to express our gratitude to our team members, Prof. Sampson Oduro-Kwarteng, Kwabena Ampong, and Kwadwo Nyantakyi Marfo, for their valuable input at various stages of the study. We are also thankful for the support of our partners at The Aquaya Institute, Karen Setty, Dayna Hansberger, and Ranjiv Khush, for their assistance at various stages of the manuscript preparation. Finally, we sincerely thank all those who agreed to be interviewed for this study.

This work was supported by the Rural Evidence and Learning for Water (REAL-Water) program, which is funded through a Cooperative Agreement (No. 7200AA21CA00014) between the United States Agency for International Development (USAID) and The Aquaya Institute. The authors alone are responsible for the views expressed in this publication, and they do not necessarily represent the decisions or policies of USAID.

G.A.D., E.A.E, C.G., and K.B.N. conceptualized the study, wrote, reviewed, and edited the article.

All relevant data are included in the paper or its Supplementary Information.

The authors declare there is no conflict.