The Greater Accra Metropolitan Area (GAMA) in Ghana has a population of over 4 million people. And while Ghana has risen to middle income country status, its sanitation system is like that of a low income country. GAMA has 11 Municipal and Metropolitan Assemblies 
(MMAs) authorizing subsystems that have their own political economy and readiness for working on specific issues. Sanitation efforts lacked a results-orientation, cooperation, collaboration and accountability. 
To make progress, the following adaptive challenges needed to be addressed: 

  • How to develop strong implementation teams with a clear vision and improved capacity to deliver results.
  • How to create a more integrated approach to implementation in the MMAs, where those people who own the problem and those who can help move forward on it are involved   in the work.

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