Author Archives: WASHplus

The Consequences of Deteriorating Sanitation in Nigeria

The Consequences of Deteriorating Sanitation in Nigeria | Source: Council on Foreign Relations Blog, July 23, 2015 |

This is a guest post by Anna Bezruki, an intern for the Council on Foreign Relations Global Health Program. She studies biology at Bryn Mawr College.

According to the final report on Millennium Development Goals (MDGs) released earlier this month, more than a third of the world population (2.4 billion) is still without improved sanitation.

Children play at a slum in Ijegun Egba, a suburb of Nigeria's commercial capital of Lagos, July 2, 2008. (Courtesy Reuters/George Esiri)

Children play at a slum in Ijegun Egba, a suburb of Nigeria’s commercial capital of Lagos, July 2, 2008. (Courtesy Reuters/George Esiri)

The target to halve the global population without adequate toilets by 2015 has not been reached. Consequently, sanitation has been pushed on to the post-2015 sustainable development goals (SDGs).

Although India is perhaps the most widely cited failure, accounting for roughly half of open defecation worldwide, it is at least making progress toward the SDG target. The same cannot be said for Nigeria. Lacking the political infrastructure to reform sanitation and faced with security and political concerns that overshadow development goals, Nigeria is struggling to reverse the trend.

Unlike in India, where the percentage of people with access to a toilet shared by only one family increased by eighteen points between 1990 and 2012, that percentage declined in Nigeria from 37 to 28 percent.

This incongruity is best illustrated by the fact that there are more than three times as many cell phones in Nigeria as people who have access to adequate toilets. This means thirty-nine million defecate outside, sixteen million more today than in 1990.

Poor sanitation contributes to diarrheal diseases and malnutrition through fecal contamination of food and water. One gram of feces can contain one hundred parasite eggs, one million bacteria, and ten million viruses.

Diarrheal diseases kill approximately 121,800 Nigerians, including 87,100 children under the age of five each year. Eighty-eight percent of those deaths are attributed to poor sanitation. Poor sanitation is thought to strain the immune system to the point that permanent stunting and other manifestations of malnutrition can result.

More than 40 percent of Nigerian children under the age of five are stunted, and malnutrition is the underlying cause of death in more than 50 percent of the approximately 804,000 deaths annually in the same age range.

The impact of inadequate toilets goes beyond hazardous exposure to feces. A survey conducted by WaterAid, a nonprofit organization focusing on providing safe water and sanitation access, in a Lagos slum revealed that the 69 percent of women and girls without access to toilets are at higher risk of verbal and physical harassment when they relieve themselves.

The effects of poor sanitation are also costing Nigeria economically. The Nigerian Water and Sanitation Program estimates that poor sanitation costs the country at least three billion U.S. dollars each year in lost productivity and health care expenditures.

While estimates vary, in 2011, Nigeria invested approximately $550 million, less than 0.1 percent of GDP, on sanitation, a number which has likely decreased since then. This is less than a quarter of the approximately $2.3 billion annually that would have been necessary to meet the MDG target.

It will take more than money and infrastructure to fix Nigeria’s sanitation. Even if investments were to sufficiently rise, the lack of a single government entity with complete responsibility for sanitation within the government, as well as widespread corruption and a lack of community support, would likely hamper efforts.

Providing latrines without first creating demand within the community has failed repeatedly, including in India, where latrines have been repurposed for extra storage. There are also other problems, like a treasury emptied by corruption and the war on Boko Haram, that top President Buhari’s agenda.

While these are immediate threats that require intense focus, sanitation is an essential long-term investment that will help Nigeria grow.  

Breaking the Next Taboo: Menstrual Hygiene within CLTS

Breaking the Next Taboo: Menstrual Hygiene within CLTS.  Frontiers of CLTS: Innovations and Insights, July 2015.

Authors: Sharon Roose and Tom Rankin, Plan International and Sue Cavill, Independent Consultant

Most adolescent girls and women menstruate. This means that for five to seven days each month they bleed through their vagina. This monthly bleeding is often accompanied by abdominal cramps, headaches, mood changes and general lethargy all of which can be exacerbated by social stigma, myths and a lack of requisite infrastructure to manage menstruation safely, privately and hygienically. Frontiers_Issue-6_MHM

The accumulated impact of these issues have significant implications for women and girls and the potential to limit their opportunity for education, equality, income generation and societal participation, all of which hamper self-worth and confidence.

This edition of Frontiers of CLTS illustrates how CLTS programmes can be expanded to address menstrual hygiene management (MHM) in schools
and communities to alleviate these stresses on women and girls.

Its specific objectives are to:

  • Increase the awareness of policy-makers and practitioners on MHM.
  • Engender change by highlighting the synergies between MHM and
    CLTS programmes.
  • Share examples of how MHM interventions have been incorporated
    into CLTS and School-Led Total Sanitation (SLTS) programmes,
    drawing on the innovations and experiences of several organisations.
  • Summarise what can be done to improve MHM through CLTS
    programmes.

WASHplus Weekly: Focus on WASH & Financing

Issue 199| July 17, 2015 | Focus on WASH & Financing

Thanks to Jonathan Annis of TetraTech for suggesting this week’s topic. Resources and studies in this issue include 2015 discussion forums and webinars hosted by the Sustainable Sanitation Alliance (SuSanA), a series of WASH financing briefs, and new USAID Urban Pathway manuals.

DISCUSSION FORUMS/WEBINARS

Urban Sanitation Finance – From Macro to Micro Level, SuSanA Thematic Discussion, June–July 2015. Link
This discussion forum was structured along three themes: Public Finance, Microfinance, andCity Level Sustainable Cost Recovery and was supported by six experts on sanitation finance who provided leadership and addressed questions raised by forum users. Summaries of the discussions are available here.

Webinar about Results-Based Financing (RBF) for Sanitation – April 29, 2015. SuSanA. Link
This webinar was organized under the knowledge management initiative of the Building Demand for Sanitation program of the Bill & Melinda Gates Foundation. Peter Feldman moderated the webinar with support from Pippa Scott and Pete Cranston of Euforic Services. The Stockholm Environment Institute and the SuSanA Secretariat served as hosts.

REPORTS/ARTICLES

Finance Brief 1: Domestic Public Finance for WASH: What, Why, How? 2015. G Norman. Link
This report defines domestic public finance as funds derived from domestic taxes, raised at the national or local level. Domestic public finance is only part of the solution to service delivery in poor communities; user finance and donor finance are also part of the mix. Likewise, domestic public finance forms part of a wider governance puzzle: improving WASH services requires not just more government investment, but also diverse other elements including (for example) clear institutional mandates.

Finance Brief 2: Universal Water and Sanitation: How Did the Rich Countries Do It?2015. Public Finance for WASH. Link
This finance brief briefly summarizes the history of water and sanitation services provision in the U.S., the U.K., and South Korea, and considers whether this historical experience is relevant to low- and middle-income countries today.

Finance Brief 3: Municipal Finance for Sanitation in Three African Cities, 2015. B Edwards. Link (Download free but registration required)
This discussion paper reports data on municipal public finance for sanitation in three African cities, based on in-country examination of available budget records: Ga West Municipality, part of the Greater Accra conglomeration in Ghana; Maputo, capital of Mozambique; and Nakuru County in Kenya, including the city of Nakuru.

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Funky Sink Gets Kids In Cambodia To Wash Up, Could Save Thousands Of Young Lives

Funky Sink Gets Kids In Cambodia To Wash Up, Could Save Thousands Of Young Lives | Source: Huffington Post, July 8 2015 |

Cambodia has the lowest access to sanitation in all of Southeast Asia, and as a result more than 10,000 children die every year due to diarrheal diseases, according to WaterAid. watershed

To help curb those figures, nonprofit WaterSHED recently released the LaBobo, a portable and inexpensive sink whose colorful design encourages kids to improve their hygiene habits.

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WASHplus Weekly: Focus on Waste Pickers

Issue 198| July 10, 2015 | Focus on Waste Pickers

This issue contains recent policy briefs, manuals, videos, and country studies on environmental health conditions and other issues faced by waste pickers. According to Women in Informal Employment: Globalizing and Organizing (WIEGO), recognition is growing that waste pickers contribute to the local economy, to public health and safety, and to environmental sustainability. However, they often face low social status, deplorable living and working conditions, and little support from local governments. washplus-weekly

OVERVIEWS/POLICY

Managing the Emerging Waste Crisis in Developing Countries’ Large Cities, 2015. Institute of Development Studies. Link
This policy briefing identifies some of the key challenges and opportunities for transitioning waste management into resource management, which engages both the formal and informal sector and provides livelihoods for the urban poor. Mainstreaming the informal sector is both economically efficient and financially beneficial for local governments as it reduces the costs of waste management as well as the need for large-scale investments in infrastructure.

Forging a New Conceptualization of “The Public” in Waste Management, 2015. M Samson. Link
This paper critically analyzes innovative approaches to including informal waste pickers in service delivery in Belo Horizonte, Brazil, Pune, India, and Bogota, Colombia and argues that by mobilizing collectively to demand formal incorporation into municipal waste management systems waste pickers are expanding both the public sector and the public sphere; transforming relations among the state, formal economy, informal economy, and residents; and contributing to the forging of a more inclusive, participatory, and democratic state.

Solid Waste Management and Social Inclusion of Waste Pickers: Opportunities and Challenges, 2014. M Marello. Link
Authors explore the opportunities and challenges inherent in the model of cooperation between municipal solid waste systems and waste picker cooperatives. Enthusiasm is growing about waste picker inclusion, often as part of “integrated solid waste management.” The World Bank and the InterAmerican Development Bank, for example, have both funded projects to support waste picker integration into formal sector recycling.

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Risk of Adverse Pregnancy Outcomes among Women Practicing Poor Sanitation in Rural India

Risk of Adverse Pregnancy Outcomes among Women Practicing Poor Sanitation in Rural India: A Population-Based Prospective Cohort Study. PloS Medicine, July 2015.

Authors: Bijaya K. Padhi, Kelly K. Baker, et al.

Background The importance of maternal sanitation behaviour during pregnancy for birth outcomes remains unclear. Poor sanitation practices can promote infection and induce stress during pregnancy and may contribute to adverse pregnancy outcomes (APOs). We aimed to assess whether poor sanitation practices were associated with increased risk of APOs such as preterm birth and low birth weight in a population-based study in rural India.

Methods and Findings A prospective cohort of pregnant women (n = 670) in their first trimester of pregnancy was enrolled and followed until birth. Socio-demographic, clinical, and anthropometric factors, along with access to toilets and sanitation practices, were recorded at enrolment (12th week of gestation). A trained community health volunteer conducted home visits to ensure retention in the study and learn about study outcomes during the course of pregnancy. Unadjusted odds ratios (ORs) and adjusted odds ratios (AORs) and 95% confidence intervals for APOs were estimated by logistic regression models. Of the 667 women who were retained at the end of the study, 58.2% practiced open defecation and 25.7% experienced APOs, including 130 (19.4%) preterm births, 95 (14.2%) births with low birth weight, 11 (1.7%) spontaneous abortions, and six (0.9%) stillbirths. Unadjusted ORs for APOs (OR: 2.53; 95% CI: 1.72–3.71), preterm birth (OR: 2.36; 95% CI: 1.54–3.62), and low birth weight (OR: 2.00; 95% CI: 1.24–3.23) were found to be significantly associated with open defecation practices. The association between APOs and open defecation was independent of poverty and caste. Even though we accounted for several key confounding factors in our estimates, the possibility of residual confounding should not be ruled out. We did not identify specific exposure pathways that led to the outcomes.

Conclusions This study provides the first evidence, to our knowledge, that poor sanitation is associated with a higher risk of APOs. Additional studies are required to elucidate the socio-behavioural and/or biological basis of this association so that appropriate targeted interventions might be designed to support improved birth outcomes in vulnerable populations. While it is intuitive to expect that caste and poverty are associated with poor sanitation practice driving APOs, and we cannot rule out additional confounders, our results demonstrate that the association of poor sanitation practices (open defecation) with these outcomes is independent of poverty. Our results support the need to assess the mechanisms, both biological and behavioural, by which limited access to improved sanitation leads to APOs

SUWASA Pathways for Urban Water and Sanitation

Sustainable Water and Sanitation in Africa (SUWASA) is a regional initiative of the US Agency for International Development (USAID), implemented by Tetra Tech, with a mission of fostering the transformation of water and sanitation delivery services in Africa to achieve long-term financial sustainability through the application of market-based principles.

The SUWASA Pathways are tools developed to share experiences, deliver key messages and provide links to useful resources such as manuals, case studies, templates and reports. pathway-intro-home

The SUWASA Pathways were developed by the SUWASA team in consultation with project partners including officials from government ministries, municipalities and regulatory agencies, utility managers, managers of dedicated funding units, private operators, commercial bank representatives, civil society and development partners.

The objective of the Pathways is to communicate complicated reform topics in a highly accessible manner to a broad range of sector stakeholders and to assist with envisioning and sequencing reform efforts. There are many possible reform paths, but the SUWASA Pathways offer viable reform routes. We hope these tools can be widely disseminated and used in the water and sanitation sector.

Available for download and viewing: