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A child runs across a plank of wood that forms a makeshift bridge across an open sewer in Old Fadama. Located in Ghana's capital Accra and colloquially referred to as 'Sodom and Gomorrah', Old Fadama is Ghana's largest slum, home to some 80 000 people. With no public sanitation services at all, what limited toilet facilities that exist in the community are privately owned and operate on a pay-per-use basis. People who cannot pay, children, for example, defecate in the open or in plastic bags.