Every weekday morning in Ghana’s largest cities, the same ritual unfolds: even before the sun has risen, one side of the motorway fills as commuters, who live mostly on the outskirts of the cities, pile into vehicles that crawl toward ministries, hospitals, universities, courts and commercial centres clustered in the city’s core.
By mid-morning, thousands of engines idle in queues stretching for kilometres. Passengers sit in overheated trotros. Roadside traders breathe in a haze of exhaust fumes. By evening, the traffic reverses as commuters go home.
Most Ghanaians think of this ordeal as simply “congestion” that they must endure. But urban planners and public-health experts say the daily gridlock is a serious design error — and one that is killing and sickening Ghanaians.
Air pollution is estimated to contribute to 35,000 premature deaths in Ghana every year. While public attention often focuses on ageing vehicles, industrial emissions and open burning, experts say another major driver of pollution is hiding in plain sight: The way Ghana’s cities are designed.
“If you have all your essential services in one location, you are causing the worst kind of pollution,” said Mr Alex Johnson, an urban planner with the Accra Metropolitan Assembly. “Transport cannot be thought of as a separate thing. It is central to everything.”
For decades, jobs, healthcare, education, commerce and government services have been concentrated within a handful of urban centres while the people lived further and further on the outer rings of the city. The result is a daily migration of millions of people travelling along the same corridors at the same time. Now what was once seen as an inconvenience is emerging as a public health crisis.
Experts say the roots of the problem lie in decades, of poor urban planning which has concentrated opportunity in a few locations while growing populations, rising home prices and urbanisation mean residential communities have expanded farther from economic centres. Government offices, major hospitals, universities, courts and commercial hubs remain clustered within limited areas, forcing millions of residents to commute long distances every day.
The solution is not simply wider roads or more buses.
“The congestion we experience every day is the symptom,” Johnson says. “The underlying condition is how we have allowed our cities to grow. Almost all of Accra’s growth has manifested as unplanned expansion paired with rising motorisation, rather than planned, transit-oriented development. Building additional roads alone cannot solve the problem.”
Johnson rejects promised investments in clean energy electric vehicles as the sole solution. ”Much public discussion about air pollution focuses on vehicle technology, fuel quality, and emissions standards,” he says. “While these remain important, urban planning deserves far greater attention because it determines how much driving occurs in the first place. You could put the cleanest engines in the world on Accra’s roads, but if urban planning continues generating longer and more frequent trips, emissions will remain high. Planning is the upstream solution. Vehicle technology is the downstream fix.”
Instead, Johnson says, Ghana must deliberately decentralise public institutions, encourage businesses to establish operations in secondary urban centres, and improve public transport links connecting these emerging hubs. “We have to redistribute opportunity. People should be able to live, work, learn and access services closer to where they are.”
The health burden now falls directly on commuters and roadside workers who inhale dangerous fine particulate matter, nitrogen dioxide and black carbon that experts say is fuelling the fast-growing epidemics of chronic diseases like asthma, heart disease, diabetes and cancer.
Kwabena Boateng is a prime example. A clerk living in Kasoa, wakes at 4:30 a.m. with his seven-year-old daughter Akosua to beat the gridlock. They spend nearly three hours each morning trapped inside a cramped, idling trotro, breathing thick polluted air before Akosua reaches school.
“By the time I sit at my desk, I am already exhausted, and my daughter frequently complains of chest tightness and burning eyes,” Boateng says. “We have no choice. Everything important — the jobs, the good schools, the head offices — is stuck in the centre of Accra.”
For those working directly on the asphalt, the pollution is relentless. Kofi Mensah, a 52-year-old taxi driver who has spent 20 years navigating the congested Graphic Road–Kwame Nkrumah Circle corridor, has developed a persistent cough, chronic headaches and breathlessness. His ageing vehicle has no cabin filter to clean the air he inhales for 10 hours a day. “I thought it was only the weather or just ageing,” Mensah says quietly, after learning from this reporter of the link between prolonged traffic idling and lung degradation. “I never knew the traffic itself was making me sick.”
Medical professionals confirm these are not isolated cases. “Repeated exposure contributes to chronic inflammation, worsens asthma, reduces lung function, and increases the risk of chronic respiratory diseases,” warns Dr Sandra Owusu-Kwarteng, a pulmonologist at Komfo Anokye Teaching Hospital. “These particles enter the bloodstream, directly contributing to cardiovascular problems such as hypertension, heart disease and stroke.”
The cost is being borne by the whole economy, diverting money from badly needed schools, roads and infrastructure. Public health data tracking 500 patients with pollution-linked conditions — including COPD, heart disease, lung cancer, stroke and childhood pneumonia — reveals an annual treatment bill of about GH₵174 million ($US15 million). The National Health Insurance Scheme covers 70 percent of that. Families pay the remaining GH₵52 million out of pocket.
”Our urban development model isn’t creating air pollution by accident; it is producing exactly the conditions in which air pollution thrives, and someone is always paying the medical bill,” Johnson says.
Successful efforts to redesign Accra communities have shown a better way
There have been successful efforts to rethink Accra’s design. In the community of Pokuase on Accra’s north-west edge, urban planners have paired housing with local economic hubs reducing the need for residents to travel into central Accra.
“We call them ‘complementary facilities’, says Patricia Onny, Deputy Director of Urban Roads. “When we plan communities, we also consider schools, banks, shopping centres, markets and other services. The objective is to ensure people can meet daily needs close to where they live.”
She traces much of Accra’s dysfunction to colonial-era layouts that were never properly enforced. Land reserved for schools and public services was steadily converted to churches and private residences. “If land is planned for a particular purpose, it should remain for that purpose,” she says. “Assemblies must enforce those plans.”
For Justina Ama, a resident of Pokuase, the difference is already noticeable. Three years ago, she operated a stall in central Accra, enduring a two-hour commute while her children travelled across town to school.
“We were constantly sick, and I was spending half my income on transport,” she recalls. After relocating, she moved her business to the local market and enrolled her children in schools nearby. “Most of what I need is right here now. My children walk to school safely, and I only travel into central Accra when absolutely necessary.”
International cities offer models for Ghana’s planners
Planners argue Ghana must look to international models of decentralisation. Cities like Medellín in Colombia and Kigali in Rwanda have embraced planning that brings jobs, housing and services together, eliminating long commutes. Investing in smarter urban design also yields substantial returns: using the World Health Organisation’s Health Economic Assessment Tool, planners estimate that investments in safe walking and cycling infrastructure alone could avoid $96 million in health-service costs over ten years in Accra.
”When people think about air pollution, they usually look at vehicle exhaust pipes,” Johnson says. “Change the structure of your community first. Then change the dominant mode by which people travel. When people experience clean air, they understand what it feels like to be truly healthy — and they will demand more.”
Tomorrow morning before dawn, Kwabena Boateng and his daughter will step back into the Kasoa gridlock, and Kofi Mensah will turn his ignition at Circle. They cannot choose cleaner air. Their exposure was pre-determined by decades of planning decisions, where roads were widened, where ministries were built, and whose health was factored into the blueprint. Until those blueprints change, experts say, millions of Ghanaians will continue to suffer poor health outcomes unnecessarily.
This story was produced in collaboration with New Narratives as part of the Clean Air Reporting
BY KINGSLEY E. HOPE
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