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Abstract: The absence of piped infrastructure is made good in Ghana by the use of children''s labour – children have become living infrastructure. This paper, focusing on Accra and making use of data collected in detailed earlier research [1] identifies the extent of the problem, indicates the additional health problems that the situation of living infrastructure generates and suggests a range of solutions that are immediately enactable. The research findings of the mid-1990s, on the evidence of the most recent literature, remain valid with no evidence of change in the quality of infrastructural provision for low income residents of Ghana and no fundamental change in sanitation behaviours. This conference – in 2008, the UN International Year of Sanitation – provides a timely opportunity to represent and to more widely disseminate these findings and to initiate a greater discussion about the role of children as living infrastructure and the policy challenges this presents. [Copyright &y& Elsevier]