USAID/Afghanistan – Latrine & Sanitation Options Manual

Latrine & Sanitation Options Manual, 2010. USAID/Afghanistan Sustainable Water Supply & Sanitation Project. 

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OBJECTIVE OF THIS MANUAL

Poor sanitation is endemic across Afghanistan and exacts a heavy toll on public health. In response, the Ministry of Rural Rehabilitation and Development (MRRD), multiple donors, the United Nations, several implementers, and USAID are engaged in providing funding and technical leadership to sanitation programs and facility construction throughout the country. These resources are sorely needed, but money and technologies alone cannot solve the problem. Donors and implementers must agree to promote, and uniformly apply sound social development, public health, marketing, finance, and technical guidance to the health-focused planning of new investments and the delivery of sustainable sanitation services.

This Manual aims to meet these needs by serving as a practical guide for Component 2 of USAID‘s Sustainable Water Supply and Sanitation Project (SWSS) and the selection of sanitation technology options to satisfy local desires and meet national needs. While this Manual is developed specifically for SWSS, it is hoped that it will be a living document for the professionals and organizations working to address fecal contamination across Afghanistan.

INTENDED USERS OF THIS MANUAL
This Manual has been written for both engineering and non-engineering field practitioners responsible for the design, construction, and sustainable operation of sanitation programs and facilities. It is primarily intended as a guide for all aspects of SWSS‘ sanitation programs and facility improvements. The Manual is designed to be used by SWSS, its partners from across the United States Government (USG), and its Afghan collaborators to make appropriate choices and engage effectively with engineers working in the field.

USAID/Afghanistan – Afghan Sustainable Water Supply & Sanitation (SWSS) Project

Afghan Sustainable Water Supply & Sanitation (SWSS) Project, 2012. Sustainable Health Outcomes Unit, Project Final Report.

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USAID/Afghanistan

Introduction
The USAID Sustainable Water Supply and Sanitation (SWSS) project, led by Tetra Tech ARD, was designed to improve the sustainability of rural infrastructure and the health of rural populations through a balanced commitment to providing water supply and sanitation facilities and improving community hygiene behaviors. It built upon the significant work done in the water supply, sanitation, and hygiene (WASH) sector in Afghanistan over the previous five years. A national policy framework was in place, engineering standards were set, and over 100 projects had provided facilities in rural communities.

Despite this high level of investment, extremely low percentages of rural Afghans used improved water supplies or sanitation facilities. Widespread utilization of water systems, sanitation facilities, and a core set of hygiene behaviors is the foundation for achieving health impacts. Without health impacts, especially among women and children under the age of five, rural water and sanitation (WatSan) projects were not reaching their goal of reducing the time and money spent by farming families on treating diarrheal diseases, allowing them more time for activities that improve their economic well-being.

Afghanistan, Kabul: toilet tribulations

For Kabul’s estimated population of 4-5 million there are only 35 public toilets, according to the municipal authorities.

“We need at least 65 extra public latrines in Kabul immediately,” Nesar Ahmad Habibi, head of Kabul’s waste management authority, told IRIN, adding that the lack of government action and limited resources had prevented the construction of sufficient public toilets in the city.

“We have even sent proposals to the president’s office but to no avail,” he said.

Many people are forced to defecate and urinate in the open: “It’s not that we don’t want to use a latrine, it’s because there is no latrine,” said Arifullah, a local man.

“If you have a pain in your stomach and there is no toilet how long can you wait?” asked another man.

Only five of the 35 public toilets have facilities for the disabled – well below what is needed given the large number of disabled people resulting from three decades of turmoil.

People who use the latrines have to pay a small fee to cover maintenance and cleaning – 5-10 Afghanis [10-20 US cents], a sum that the large number of extremely poor people in the city would prefer to avoid paying.

A rapidly growing population, lack of modern sewage systems, significant waste management problems and the lack of public toilets in Kabul are causing environmental and health risks, according to experts.

No soap

“I don’t use the latrines because they are extremely dirty,” said Abdul Jamil, a young man. “There is also no soap to wash your hands.”

None of Kabul’s public toilets provide soap or hand-drying facilities.

Whilst hand-washing is crucial for disease prevention, soap is also not available in toilets in most Kabul schools, officials in the Ministry of Education said.

“Inappropriate latrines, open defecation and poor waste management cause serious diseases and damage the environment,” Hassan al-Sayed, country director of the French NGO Solidarités, told IRIN.

Waste management

In September 2008 Kabul Municipality said that up to 90 percent of the 3,000 tons of solid waste produced in the capital every day was managed and dealt with.

However, officials say waste management capacities have deteriorated sharply in the past year: “Now we collect only about 50 percent of the solid waste produced in Kabul on a daily basis,” said Habibi, citing dwindling resources, staff reductions and broken-down trucks as major problems.

“For waste management in Kabul we need 17,500 staff but we have only 3,000; and we need 2,500 trucks but we only have 119.”

Rapid population growth and unregulated housing developments have created serious social and environmental challenges in Kabul, according to government officials.

Al-Sayed, whose organization has been helping households in Kabul to build hygienic latrines, emphasized the importance of public awareness about sanitation and hygiene.

“What if there are hundreds of safe latrines but people don’t use them,” he said, adding that people should know the risks of open defecation and unsafe latrines.

Only 12 percent of Afghans have access to improved sanitation and less than 25 percent have access to safe drinking water, according to the UN Children’s Fund (UNICEF).

Most Afghans use the traditional dry vault toilet systems which were ranked the worst toilets in the world by WaterAid’s State of the World’s Toilets 2007 report.

Source: IRIN, 16 Nov 2009

Bringing proper sanitation to rural Afghanistan

The second Global Handwashing Day was celebrated on 15 October 2009 in Kabul and 34 provinces of Afghanistan.

“At home, I wash my hands every morning and noon and evening, and also when I come from the toilet,” said 11-year-old Abdullah Farzad.

Afghanistan’s mortality rates are among the highest in the world. One out of four children dies before her or his fifth birthday. High diarrhoea prevalence resulting from poor hygiene practices, lack of access to sanitation facilities and clean water impact heavily on children’s survival and development. According to a joint UNICEF/WHO report released this week, more than 80,000 children under five died as a result of diarrhoea in Afghanistan in 2007.

“When I started to go to school one year ago, one of the first things our teacher explained to us was the importance of washing the hands before eating,” said Abdullah. “Since then, I have explained this to my mother. In the beginning she was skeptical, but when I told her about the examples that we heard at school – from babies who get sick and die – she started to change.”

Promoting a life-saving intervention

The village of Sohol, Afghanistan is enclaved within mountains. Its residents have no running water and access to safe water and sanitation supplies has been difficult for many.

Despite its life-saving potential, hand-washing with soap is seldom practiced in Afghanistan and not always easy to promote. About 22 per cent of households have access to safe water and less than one out of 10 families has access to latrine facilities.

“We have a water-point in Sohol, our village. Usually it is my sister who goes to fetch the water in the morning and the evening, but sometimes I have to help her. It takes about ten minutes from our house to the water-point,” said Abdullah.

Although people may be aware that water alone is not enough, many families still do not want to invest in buying soap.

“In the past many parents said that it is too expensive to buy soap. Last year, community animators came and made clear to them how much this little investment can do, to ensure the health of their families.” said teacher Mohammad Abdullah.

“It was not easy to make them change their mind, because in a remote place like Sohol it is not always simple to have water and soap at hand when you should have it.”

The ‘Healthy School Initiative’

As a follow-up to the 2008 International Year of Sanitation, UNICEF has initiated clean village projects promoting sustainable behaviour changes on key hygiene practices among families.

The ‘healthy schools’ initiative – which includes the construction of separate toilets for girls and boys, safe drinking water systems and the training of teachers on effective hygiene promotion – is also being implemented.

To date, 1,000 schools with a total of about 320,000 students benefit directly from this intervention.

Abdullah’s school is also one out of 126 schools chosen across 11 provinces for a pilot project of the World Food Programme (WFP) and UNICEF, where water and sanitation facilities are combined with a hot meal.

Water-points, toilets and hygiene education are taken care of by UNICEF, while WFP is providing food commodities and kitchen equipment.

It is estimated that more than 70,000 school children participated in this year’s Global Handwashing Day in Afghanistan. In spite of continued conflict, they celebrated together with millions of other children across five continents.

Source: Cornelia Walther, UNICEF, 16 Oct 2009

Afghanistan: Thousands of schools lack drinking water, sanitation

About two million state school students do not have access to safe drinking water and about 75 percent of these schools in Afghanistan do not have safe sanitation facilities, according to UNICEF. “Only 60 percent of schools have water [on site],” Zahida Stanikzai, UNICEF’s water and sanitation expert, told IRIN in Kabul.

Drinking water and sanitation facilities are also insufficient in many other schools. IRIN visited Char Qala Wazir Abad secondary school in Kabul where about 9,000 students have only one hand-operated water pump. “When it gets hot hundreds of students rush to the pump all at once,” said Sharifa, a teacher at the school.

[...] MoE officials acknowledge the lack of drinking water and sanitation facilities at schools but say such problems are limited to only 12 percent of state schools. “This year we will dig 5,000 wells at schools which lack water points,” Asif Nang, MoE’s spokesman, told IRIN.

“[School] toilets are not clean and well maintained. The current design and location of toilets are not acceptable for children, particularly girls… There are no facilities for grown-up girls,” Stanikzai said. “One of the reasons that the girls do not attend school is because there are no sanitation facilities,” said UNICEF’s Jalalabad head of office Prakash Tuladhar. “It is very important that water and sanitation [systems] are built as components of the school programme. If there are no latrines, then it is almost certain that girls will not be attending school.”

Washing hands with soap, particularly after visiting the toilet and before eating, can reduce child morbidity rates caused by diarrhoeal diseases by almost 50 percent, according to UNICEF. However, the practice is poorly understood and is rarely practiced by families, especially in rural communities. “In most of the schools hand washing facilities are not placed in a proper place. There is a lack of resources to provide soap for hand washing,” said UNICEF’s Stanikzai.

[...] Diarrhoea-related diseases account for 20 percent of deaths among children under five in Afghanistan, according to the UN Assistance Mission in Afghanistan. Despite these staggering figures, there is no nationwide data about school absences due to diseases. UNICEF said it had been helping MoE to provide “safe drinking water and sustainable child friendly sanitation facilities and hygiene promotion” in 500 schools over the past few years.

Source: IRIN, 12 May 2009

Afghanistan: UNICEF and Red Cross hygiene promotion activities

Since 2001, Afghanistan has seen tremendous progress, including increased access to safe water in schools, targeted sanitation training, additional community water facilities and the adoption of a new national policy on hygiene. However, more remote areas of the country still face roadblocks to access by aid organizations.

UNICEF has set up a partnership with the Afghan Government to develop sustainable, community-based solutions. Schools and health centres are key entry points. Providing water points and gender-specific latrines results in better health for all, as well as increasing the enrolment of young girls in primary schools.

[...] UNICEF supports women’s literacy initiatives, specifically targeting internally displaced persons and returnees. And UNICEF-sponsored ‘Behaviour Change Committees’ teach populations about safe water, sanitation and hygiene practices.

Another UNICEF-sponsored project in Afghanistan, the ‘Healthy School Initiative’, aims not only to improve the learning environment for children but also to teach them valuable lessons they can share with their families at home. Students are taught the correct way to brush their teeth and wash their hands with soap and water, as well as basic first-aid training.

In the schools, the initiative provides students with drinking water and latrines, de-worming tablets and safe play areas where they can interact with their peers without fear of encountering a landmine.

Source: David Koch, UNICEF, 12 Mar 2009

At a press conference on 24 March 2009, Adrian Edwards, Senior Spokesman of the United Nations Assistance Mission in Afghanistan (UNAMA), reported that in 2009 “UNICEF is aiming to select a village in each province of Afghanistan to showcase how a community can help ensure everyone adopts clean sanitation and hygiene practices”.

The International Committee of the Red Cross (ICRC) reports that its water engineers are working closely with the local water authorities on a range of urban and rural programmes. Hygiene promotion sessions are conducted in madrasas, hammams (bath houses) and other public places, as well as with families in their homes. [In March 2009] the ICRC water and habitat teams carried out:

• an urban project to supply water to 12,000 people in Heart;
• hygiene sessions for over 2,571 people from vulnerable communities in urban areas of Herat, Kabul, Jalalabad, Kandahar and Mazar;
• improvements to the water supply and sanitation systems in one district and two provincial prisons. A total of 648 detainees will benefit from these programmes;
• six rural water supply projects in villages in Bamyan, Herat and Mazar provinces to provide safe water for 22,063 beneficiaries
• some of the planned rehabilitation of Mirwais hospital infrastructure in Kandahar.

Source: ICRC, 16 Apr 2009

Afghanistan: sanitation woes in makeshift IDP camps

Open defecation, lack of toilets and poor sanitation in makeshift internally displaced persons (IDP) camps throughout Afghanistan are a health threat, particularly to children, health workers and aid agencies say. [A]t least 230,000 people are living in formal IDP camps and informal settlements where few sanitary, water and toilet facilities are available.

About 500 families (2,500 individuals) displaced from southern regions have set up shacks, tents and mud huts in Qambar on the western outskirts of Kabul. Most residents there are forced to defecate in the open. Some also use insecure pit latrines or dry vault toilets near their shacks. “In summer we suffer a lot from the stink, and the flies and mosquitoes which are attracted to the scattered faeces and dirt,” Akhtar Gul, an IDP at Qambar camp, told IRIN.

[...] Anne Garella, head of the Action contre la Faim (ACF) country mission, told [news agency] IRIN they had applied to build toilets and water points for the Qambar IDPs but had failed to get permission from the government. In January [2009] the government permitted ACF to provide drinking water to the Qambar IDPs for six months; ACF has been delivering two tankers of water a day.

“The number of IDPs in the camp is increasing every day and we are very concerned about their access to drinking water after June,” said Garella, adding: “A longer-term solution would be for the government to allow us to dig wells and build toilets there.”

The need for safe drinking water will increase in the coming months and the government is expected to extend Qambar’s water delivery deadline to beyond June [2009], according to aid workers.

Source: IRIN, 23 Apr 2009

Workshop: Developing Innovative Approaches to Environmental Water and Sanitation in Afghanistan and Pakistan, Abbottabad, Pakistan, 2-4 March 2009

The workshop ‘Developing Innovative Approaches to Environmental Water and Sanitation in Afghanistan and Pakistan – Linking Applied Research, Capacity Building and Institution Building’, will be held in Abbottabad, Pakistan, on March 2nd-4th, 2009.

The workshop is funded by the Norwegian Agency for Development Cooperation (NORAD), and run jointly by the NORAGRIC – Department of International Environment and Development Studies at the Norwegian University of Life Sciences (UMB), and COMSATS Institute of Information Technology (CIIT), Abbottabad.

The purpose of the workshop is to gather key researchers, implementers and policymakers working in WATSAN in Afghanistan and Pakistan, and see how they can move forward together in developing sustainable approaches and innovative technologies to challenges currently being faced in this sector.

Read the invitation letter here

For more information, please do respond here but contact::

Dr. Bahadar Nawab, Head of Department, Department of Development Studies, COMSATS Institute for Information Technology (CIIT), Abbottabad, Pakistan, bahadar [at] ciit.net.pk, +92-992-383591-7; +92-345-5854226

Dr. Gry Synnevaag, Head of Department, Department of International Environment and Development Studies (Noragric), Norwegian University of Life Sciences (UMB), Norway, gry.synnevag [at] umb.no

Afghanistan: medical waste poses health risk in urban areas

Solid waste produced by the health-care system in Kabul and other major cities is not being properly managed and poses a serious public health risk, according to health experts.

Medical waste – including used needles and syringes, soiled dressings, body parts, diagnostic samples, blood, chemicals, pharmaceuticals and medical devices – is lying in open rubbish dumps near hospitals in urban areas.

[...]

Afghanistan does not have bylaws on the safe management of medical waste, and over 60 public and private hospitals in Kabul do not have incinerators or other equipment to deal with the problem.

[...]

At least seven children involved in scavenging in Herat Province, western Afghanistan, have been infected by hepatitis B, syphilis and suspected cases of HIV, the Children Protection Action Network (C-PAN) reported.

[...]

Officials at Kabul Municipality also reported at least two suspected cases of hepatitis B among city cleaners in September.

Related web site: WHO – Healthcare Waste Management

Source: IRIN, 14 Oct 2008

Afghanistan: UN assisting Afghan authorities to respond to diarrhoea outbreak

United Nations agencies are helping authorities to respond to a diarrhoea outbreak in Afghanistan, where only about a quarter of the population has access to safe drinking water and 20 per cent of child deaths is attributed to the easily preventable disease.

According to the Afghan Ministry of Public Health, the outbreak is located mainly in five provinces – Nangarhar, Nuristan, Laghman, Samangan and Faryab – with a few cases also reported in seven others. Twenty-two people have died out of the almost 4,000 cases reported so far.

The UN World Health Organization (WHO) says the authorities are managing the outbreak well and have taken all necessary steps.

[...]

In light of the current outbreak, Dr. [Rana Grabar] Kakar, [WHO Technical Officer, emphasized the need to ensure the use of safe drinking water by either boiling it or using chlorine tablets. People should also be careful about the foods that might become contaminated by bad water.

[...]

By washing hands with soap, families and communities can help reduce child mortality rates from diarrhoeal diseases by almost 50 per cent. This is one of the key messages being highlighted across the country as part of the observance of the first ever Global Handwashing Day, which is 15 October.

UNICEF is also assisting efforts to tackle the outbreak by digging wells, providing safe drinking water and distributing basic health kits, particularly in remote areas.

"This pump provides our village with water which is good, but the area that surrounds it is muddy and filled with sewage. This makes transporting the water really hard work." Oxfam

The struggle for water is one of the themes depicted in a series of photographs [Afghanistan: Unheard Voices, Oxfam] by Afghan women currently on display in New York.

Source: UN, 13 Oct 2008 [see also transcript of UMANA press conference, 13 Oct 2008]