In the almost total absence of government-provided services, what limited toilet facilities exist in Old Fadama are privately owned and operate on a pay-per-use basis. No systemic waste disposal infrastructure exists, and the situation is compounded by the fact that people who cannot pay often defecate near such toilets, or dispose of excrement around them. Colloquially referred to as 'Sodom and Gomorrah, Old Fadama is located in Ghana's capital Accra and is home to some some 80,000 people.