An Annotated Bibliography on Shared Sanitation – November 28, 2016

An Annotated Bibliography of 2015 and 2016 Studies and Reports on Shared Sanitation – November 28, 2016

 2016 Studies and Reports

1 – Shared sanitation: to include or to exclude? Trans Roy Soc Trop Med & Hygiene, May 2016. Duncan Mara.  (Abstract/order)
Recent research has shown that neighbor-shared toilets perform much better than large communal toilets. The successful development of community-designed, built and managed sanitation-and-water blocks in very poor urban areas in India should be adapted and adopted throughout urban slums in developing countries, with a caretaker employed to keep the facilities clean. Such shared sanitation should be classified as ‘basic’, sometimes as ‘safely-managed’, sanitation, so contributing to the achievement of the sanitation target of the Sustainable Development Goals.

2 – Can behaviour change approaches improve the cleanliness and functionality of shared toilets? A randomised control trial in Dhaka, Bangladesh. WSUP, May 2016.
(Full text)
This project demonstrated that a behavior change communication intervention built upon in-depth qualitative understanding of the perspective and constraints of local residents could improve toilet cleanliness, even in the setting of severe constraints: notably water shortages and the absence of fecal sludge management systems. The most important step towards improving environmental sanitation in Dhaka is to address the absence of any fecal sludge management system. To improve the quality and cleanliness of shared facilities, behavior change strategies targeting the central role that landlords and community managers play can be particularly effective. Future research might explore: 1) how compound managers and/or landlords can make improvements to toilet cleanliness without project-funded hardware; 2) how to leverage mass media approaches to reduce the cost of behavior change communication; 3) how the effectiveness of specific behavior change strategies varies by gender; and 4) further evaluations to assess the sustainability of these efforts to improve toilet cleanliness.

3 – Sanitation and Hygiene-Specific Risk Factors for Moderate-to-Severe Diarrhea in Young Children in the Global Enteric Multicenter Study, 2007–2011: Case-Control Study. PLoS Medicine, May 2016. Kelly K. Baker, Ciara E. O’Reilly, et. al. (Full text)
These findings show that sharing a sanitation facility with one or two other households is associated with an increased risk of moderate to severe diarrhea n young children. Because this was an observational study, these findings only show an association between the use of shared sanitation facilities and MSD risk; they cannot prove that using shared facilities causes diarrhea. It could be, for example, that households who decide to invest in a private sanitation facility also prioritize safe hygiene practices. The reduced risk of diarrhea in these households might then be the result of everyone washing their hands after using the toilet rather than the result of having a private latrine. Nevertheless, these findings suggest that interventions aimed at increasing access to private household sanitation facilities might reduce the global MSD burden. Moreover, they suggest that shared sanitation facilities should continue to be classified as “unimproved” for the purposes of monitoring global access to sanitation.

4 – Seasonal variations and shared latrine cleaning practices in the slums of Kampala city, Uganda. BMC Public Health, April 2016. Japheth Kwiringir, Peter Atekyerez, et. al.
(Full text)
Wet seasons were associated with, mud and stagnant water, flooding pits and a repugnant smell from the latrine cubicle which made cleaning difficult. During the dry season, latrines became relatively cleaner than during the wet season. The presence of many child(ren) users during school days as well as the influx of market goers for the roadside weekly markets compromised the cleaning outcomes for these shared sanitation facilities. Shared latrine cleaning in slums is impacted by seasonal variations related to weather conditions and human activity. The wet seasons made the already bad sanitation situation worse. The seasonal fluctuations in the state of shared slum sanitation relate to a wider malaise in the population and an implied capacity deficit among urban authorities. Poor sanitation in slums is part of a broader urban mismanagement conundrum pointing towards the urgent need for multiple interventions aimed at improving the general urban living conditions well beyond sanitation.

5 – Policy Note: Should Public Toilets Be Part of Urban Sanitation Solutions for Poor Families Living in Slums? Emory University’s Center for Global Safe Water, Sanitation, and Hygiene, April 2016. Full text | Full text, pdf
Although households would prefer to have private facilities, conditions suggest that shared public toilets will, for the foreseeable future, continue to be the main available option for defecation in the slums of Accra. In this context, efforts are needed to improve existing and new public toilets to make them hygienic and safely managed in order to provide sanitation services that result in public health benefits. Since public toilets do not meet the JMP criteria for an improved toilet, they also do not meet current government of Ghana standards. This in turn creates a disincentive for local governments to invest in public toilets and related safe management of the fecal sludge as part of their urban sanitation services.

The findings reported in this policy note lead to the recommendation that in order to protect the public health of families living in urban slums, the government of Ghana should reform their current policies regarding public toilets in urban slums despite not being recognized by the WHO/UNICEF JMP. Reforms to consider include formal recognition of public toilets as viable sanitation solutions, exploring possible partnerships with the private sector to finance, operate and maintain public toilets, development of regulations and standards for public toilets, and effective monitoring of compliance. In addition, the government should review financing approaches to ensure that sanitation services are affordable to all populations living in slum areas.

2015 Studies and Reports

6 – Effectiveness of group discussions and commitment in improving cleaning behaviour of shared sanitation users in Kampala, Uganda slums. Soc Sci Med. 2015 Dec. Tumwebaze IK, Mosler HJ. (Abstract)
We evaluated the effectiveness of group discussions and commitment in improving the cleaning behavior of shared sanitation users in three urban slums in Kampala, Uganda. The study follows the risk, attitudes, norms, abilities and self-regulation (RANAS) model of behaviour change and some factors of the social dilemma theory. Compared to the control, discussions and discussions + commitment significantly improved shared toilet users’ cleaning behavior. The rate of improvement was observed through behavioral determinants such as cleaning obligation, cleaning ease, cleaning approval and affective beliefs. Our study findings show that group discussions and commitment interventions derived from RANAS model of behavior change are effective in improving the shared sanitation users’ cleaning behavior.

7 – Neighbour-shared versus communal latrines in urban slums: a cross-sectional study in Orissa, India exploring household demographics, accessibility, privacy, use and cleanliness. Trans R Soc Trop Med Hyg. 2015 Nov uthors: Heijnen M, Routray P, Torondel B, Clasen T. (Full text)
We sought to explore differences between neighbor-shared and communal latrines in terms household demographics, accessibility, facilities and use. Compared to neighbor-shared facilities, households relying on communal facilities were poorer, larger, less educated, less likely to have access to piped water and more likely to have a member practicing open defecation. Communal latrines were also less accessible, less likely to have water or a hand washing station on site and cleaned less frequently; they were more likely to have visible feces and flies present. We found significant differences between neighbor-shared and communal facilities in terms of user demographics, access, facilities and cleanliness that could potentially explain differences in health. These findings highlight the need for a shared sanitation policy that focuses not just on the number of users, but also on maintenance, accessibility, cleanliness and provision of water and hand washing facilities.

8 – Shared Sanitation Versus Individual Household Latrines in Urban Slums: A Cross-Sectional Study in Orissa, India. Am J Trop Med Hyg. 2015 Aug Authors: Heijnen M, Routray P, Torondel B, Clasen T.
(Full text)
A large and growing proportion of the global population rely on shared sanitation facilities despite evidence of a potential increased risk of adverse health outcomes compared with individual household latrines (IHLs). We sought to explore differences between households relying on shared sanitation versus IHLs in terms of demographics, sanitation facilities, and fecal exposure. Shared facilities were less likely to be functional, less clean, and more likely to have feces and flies. No differences in fecal contamination of drinking water or hand-rinse samples were found. Important differences exist among households accessing shared facilities versus IHLs that may partly explain the apparent adverse health outcomes associated with shared sanitation. As these factors may capture differences in risk and promote sanitary improvements, they should be considered in future policy.

9 – Redefining shared sanitation. Bull World Health Organ. 2015 Jul 1. Thilde Rheinländer, et. al. (Full text)
Key sanitation stakeholders and donors should recognize the potential of household shared sanitation as an important driver behind sanitation progress in African and Asian high-density areas and low-income populations. Accepting household shared sanitation as a suitable toilet type could have major implications. This would legitimize innovative funding mechanisms, shared maintenance schemes and upgrading of large numbers of existing shared toilets to acceptable standards. We argue that the focus for future sanitation programs should be on improving the hygienic standards of shared facilities to a level that satisfies and protects sanitation users – irrespective of the toilet design. If well managed, household shared sanitation can be a feasible, economical, practical and socially acceptable choice for millions of sanitation users.

10 – Public toilets and their customers in low-income Accra, Ghana. Environment and Urbanization, 2015. D Peprah, et. al.
(Full text)
This study explores public toilet use, characteristics of public toilet customers and possible improvements to public toilet facilities in four neighborhoods in Accra, Ghana, the country with the highest reliance on shared sanitation facilities globally. Reliance on public toilets ranged considerably depending on neighborhood affluence, but even some people living in compounds with a private toilet used a public toilet. The vast majority of users were adults. Few public toilet customers could foresee owning a household toilet in the coming year, mostly because of lack of space, and they voiced desires for more and cleaner public toilets with better provision of handwashing facilities. Improved accessibility and management of public toilets, along with facilities more suitable for children, could reduce open defecation.

11 – The Sanitation Ladder, What Constitutes an Improved Form of Sanitation? Env Sci Tech, Dec 2014. Josephine L. R. Exley, Bernard Lisek, et al. (Full text)
This study aimed to assess whether the MDG classifications and JMP sanitation ladder corresponded to hygienic proxies. Latrines were purposefully sampled in urban and rural Tanzania. Three hygienic proxies were measured: E. coli on points of hand contact, helminth at point of foot contact, and number of flies. The MDG classifications “improved” vs “unimproved” did not describe the observed differences in E. coli concentrations. Disaggregating the data into the JMP sanitation ladder, on average “shared” facilities were the least contaminated. The findings do not support the current assumption that shared facilities of an adequate technology should be classified for MDG purposes as “unimproved”.

12 – Determinants of usage of communal sanitation facilities in informal settlements of Kisumu, Kenya. Environment and Urbanization, 2015. S Simiyu. (Full text)
Residents of informal settlements in developing countries are faced with various challenges, including a lack of household sanitation facilities, which leads to use of alternative methods such as open defecation. The lack of household sanitation facilities and consequent use of improper methods necessitated the introduction of communal sanitation facilities in informal settlements as a way of increasing access to and use of sanitation facilities. However, little is known about their use and effectiveness, particularly in Africa’s informal settlements. This study used a number of quantitative and qualitative methods to assess determinants of use of communal sanitation facilities in informal settlements of Kisumu, a city in Kenya. Findings reveal that factors such as location/siting, inadequate maintenance, economic aspects, and gender issues influence the use of communal facilities, and they should therefore be included in future sanitation interventions.

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