Impact of Early Life Exposure to Environments with Unimproved Sanitation on Education Outcomes: Evidence from Bangladesh

Impact of Early Life Exposure to Environments with Unimproved Sanitation on Education Outcomes: Evidence from Bangladesh. World Bank, November 2019.

Despite Bangladesh’s notable progress toward the eradication of open defecation, the country still faces severe deficits in the availability of improved sanitation.

This paper analyzes the impact of exposure to unimproved sanitation early in childhood on primary school enrollment status, using pseudo-panel data for children ages six to nine years in Bangladesh.

The results indicate that unimproved sanitation has a negative and significant impact on primary school enrollment. A child’s early exposure to unimproved sanitation decreases the likelihood of being enrolled in primary school by eight to ten percentage points on average compared with a child with access to improved sanitation.

The effect is particularly strong — a difference of 8 to 10 percentage points — for children ages six to seven. It is also strong in rural areas. The results are statistically robust to errors due to potential omitted variable bias.

Turning fecal sludge into a resource: New approaches required to achieve the rural sanitation SDGs

Safely managed sanitation is a focus of the Sustainable Development Goals (SDGs). It is central to stunting reduction and early childhood survival, both identified by the World Bank’s Human Capital Index as critical for humans to develop their full potential. It is widely known that 4.5 billion people lacked access to safely managed sanitation in 2015, according to the Joint Monitoring Programme. Less well understood is that hundreds of millions more people in densely populated rural areas are exposed to significant health risk due to unsafely managed sanitation.

In contrast to urban areas, fecal sludge management (FSM) is not yet recognized as a priority for the rural sanitation sector – it is assumed to be less of an issue because rural areas are more sparsely populated. However, some densely populated areas fall under rural administrations, notably in deltas and on the periphery of rapidly growing rural areas. In these areas there is also a need to safely manage fecal waste. Many sanitation systems that, for lack of scrutiny, are assumed to be improved and safe, but due to lack of scrutiny they fail to safely manage fecal sludge.

A new World Bank report-supported by the Global Water Security and Sanitation Program (GWSP) – and six case studies identified specific causes of health risks in locations in Bangladesh, Bolivia, Egypt, India, and Vietnam. They include compromised construction of on-site sanitation solutions, incorrect technology choices, poorly developed FSM markets, predominantly manual emptying practices and indiscriminate dumping of sludge in the immediate environment. They found that environmental regulations and building codes do not address FSM effectively, and enforcement is often weak. Rural administrations typically lack the mandate and institutional capacity to provide and manage FSM services.

Read the full blog by Joep Verhagen and Pippa Scott

Citation

“Verhagen, Joep; Scott, Pippa. 2019. Safely Managed Sanitation in High-Density Rural Areas : Turning Fecal Sludge into a Resource through Innovative Waste Management. World Bank, Washington, DC. © World Bank. https://openknowledge.worldbank.org/handle/10986/32385 License: CC BY 3.0 IGO.”

 

A systems approach to sanitation – iDE Bangladesh

Bangladesh is a global success story in sanitation, reducing open defecation from 34% in 1990 to less than 1% today. But despite this initial progress, nearly 40% of the country still lacks access to improved sanitation.

To tackle Bangladesh’s sanitation problem iDE takes a comprehensive systems approach to increase improved sanitation coverage.

iDE’s interventions facilitate different actors in the market system, leveraging existing skills and resources, building connections from the local to the national level, and coordinating across public, private, and development sectors to create a complete ecosystem that enables the sustainable, inclusive delivery of improved sanitation products and services.

 

SACOSAN 7: registration closes 15 December

South Asian Conference on Sanitation (SACOSAN),  a government led biennial convention held on a rotational basis in each SAARC country (Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka), provides a platform for interaction on sanitation.

SACOSAN VII will be held on 13-17 February 2018 in Pakistan, hosted by Ministry of Climate Change, Government of Pakistan.

The deadline for registration is 15 December 2017.

Below is an overview of the theme papers and country leads

Theme papers	Lead country
Sanitation as cross cutting (Health and Nutrition)	Afghanistan
Climate Change/Environment and Sanitation	Bangladesh
Sociology of Sanitation	Bhutan
Operation, Maintenance and Sustainability of WASH	India
Policy, Strategy and Sector Planning (institutional arrangements)	Maldives
Human Resource Development for WASH	Nepal
Accountability and Regulation Monitoring and Evaluation	Pakistan or Sri Lanka? [conflicting info on website]
WASH Financing	Sri Lanka or Pakistan? [conflicting info on website]

For more information and updates go to: sacosan.com/

How Public Private Partnerships are Making a Crappy Market Safe Across Bangladesh

How Public Private Partnerships are Making a Crappy Market Safe Across Bangladesh. August 30, 2017. By Sarah Miers – Skoll Foundation, By Lucien Chan – Skoll Foundation.

In Bangladesh, nearly half of 55 million urban residents lack the sanitation infrastructure to properly process human waste. The result: massive amounts of raw waste is unsafely dumped, fouling the environment and posing major public health risks. There’s an urgent need to find safe and affordable ways for waste to be collected and treated. 

Water and Sanitation for the Urban Poor (WSUP) works alongside local providers, enabling them to develop their own services, build infrastructure, and attract the funding needed to reach low-income communities. Since its inception in 2005, WSUP has helped nearly 14 million people access clean water and sanitation services across six countries. Earlier this summer, we spent a week investigating WSUP’s SWEEP program, a public-private partnership (PPP) for fecal sludge management (FSM), which resulted in a $2 million investment from the Skoll Foundation to expand across 4 cities and serve 6.8 million people by 2021.

Dhaka is the only city in the country with any sewage infrastructure (just 20 percent coverage), and nearly all non-sewered households rely on manual sweepers–workers who remove the waste at high risk and with little equipment–to empty their on-site pit latrines or septic tanks. More hygienic, mechanical emptying options are limited. Due to failures across the sanitation value chain (containment, emptying, transport, and treatment), nearly all waste is not effectively treated or safely disposed, most often being dumped directly into storm water drains or the environment.

Read the complete article.

Shared toilets as the path to health and dignity

Shared toilets as the path to health and dignity. World Bank Water Blog, July 19, 2017.

Mollar Bosti is a crowded slum in Dhaka, Bangladesh, home to 10,000 people: garment workers, rickshaw drivers, and small traders, all living side-by-side in tiny rooms sandwiched along narrow passageways.

With the land subject to monsoon flooding, and no municipal services to speak of, the people of Mollar Basti have been struggling with a very real problem: what to do with an enormous and growing amount of human faeces.

Traditionally, their ‘hanging latrines’ consisted of bamboo and corrugated metal structures suspended on poles above the ground, allowing waste to fall straight down into a soup of mud and trash below. Residents tell stories of rooms flooded with smelly muck during monsoons; outbreaks of diarrhoea and fever would quickly follow.

But conditions have improved for much of the slum. With help of a local NGO, the residents negotiated permission for improvement from a private landowner, and mapped out areas of need. Today, they proudly show visitors their pristine, well-lit community latrines and water points. They report fewer problems with flooding and disease.

Read the complete article.

We make fake poo in a laboratory – to improve sanitation in Bangladesh

We make fake poo in a laboratory – to improve sanitation in Bangladesh. Phys.org, July 12, 2017.

Across the world, almost three billion people do not have the luxury of a flushing toilet. Instead they rely on static sanitation systems, like pit latrines to deal with their waste. As these are not often connected to a sewer, they require manual emptying and disposal.

Poor understanding of the risks involved means that untreated sludge is often thrown into nearby fields and rivers. The impact of this can be devastating.

Manual emptying. Credit: sswm.info

Yet is is estimated that every dollar invested in better sanitation returns up to US$5.50 in social and economic benefits. These come through increased productivity, reduced healthcare costs and prevention of illness and early death.

A crucial part of improving sanitation lies in researching and developing simpler, more efficient ways of treating sludge in places where a sewerage and centralised waste water treatment is not available.

My research is part of a partnership with the engineering firm Buro Happold (BH) who were asked by WaterAid Bangladesh to find a sludge treatment technology which was effective, practical and affordable.

After considering options which included biogas and pit additives – products used to try and reduce sludge volume – the company opted for unplanted drying beds. They are simple in design and make use of the reasonable amount of sunshine in Bangladesh.

Read the complete article.

Unsafe Child Feces Disposal is Associated with Environmental Enteropathy and Impaired Growth

Unsafe Child Feces Disposal is Associated with Environmental Enteropathy and Impaired Growth.  Journal of Pediatrics, June 2016.

• Full text, pdf

Authors: Christine Marie George, Lauren Oldja, Shwapon Biswas, et al.

Objective – To investigate the relationship between unsafe child feces disposal, environmental enteropathy, and impaired growth, we conducted a prospective cohort study of 216 young children in rural Bangladesh.

Study design – Using a prospective cohort study design in rural Bangladesh, unsafe child feces disposal, using the Joint Monitoring Program definition, was assessed using 5-hour structured observation by trained study personnel as well as caregiver reports. Anthropometric measurements were collected at baseline and at a 9-month follow-up. Stool was analyzed for fecal markers of environmental enteropathy: alpha-1-antitrypsin, myeloperoxidase, neopterin (combined to form an environmental enteropathy disease activity score), and calprotectin.

Findings – Among 216 households with young children, 84% had an unsafe child feces disposal event during structured observation and 75% had caregiver reported events. There was no significant difference in observed unsafe child feces disposal events for households with or without an improved sanitation option (82% vs 85%, P = .72) or by child’s age (P = .96). Children in households where caregivers reported unsafe child feces disposal had significantly higher environmental enteropathy scores (0.82-point difference, 95% CI 0.11-1.53), and significantly greater odds of being wasted (weight-for-height z score <2 SDs) (9% vs 0%, P = .024). In addition, children in households with observed unsafe feces disposal had significantly reduced change in weight-for-age z-score (0.34 [95% CI 0.68, 0.01] and weight-for-height z score (0.52 [95% CI 0.98, 0.06]).

Conclusion – Unsafe child feces disposal was significantly associated with environmental enteropathy and impaired growth in a pediatric population in rural Bangladesh. Interventions are needed to reduce this high-risk behavior to protect the health of susceptible pediatric populations

Facilitating Access to Finance for Household Investment in Sanitation in Bangladesh

Facilitating Access to Finance for Household Investment in Sanitation in Bangladesh, August 2016. World Bank.

• Full text

Approach to Blended Finance: The provision of an output-based aid (OBA) subsidy to microfinance institutions (MFIs) in Bangladesh is used to help MFIs develop sanitation products and extend their reach to poorer households.

Microfinance (the provision of financial services to low-income people) is emerging as a viable avenue to facilitate increased access to finance for households to water and sanitation products, and for small-scale water service providers’ business development.

OBA is a form of results-based financing where subsidies are paid to service providers based on verification of pre-agreed water and sanitation project targets defined during project design, thereby offering a strong incentive for the delivery of results.

Combining an OBA subsidy with a microfinance loan helps reduce households’ cash constraints by spreading repayment over time, and makes investment in improved sanitation more affordable overall.

 

SNV publications on urban sanitation

SNV’s Urban Sanitation & Hygiene for Health and Development (USHHD) programme works with municipal governments to develop safe, sustainable city-wide services. The programme integrates insights in WASH governance, investment and finance, behavioural change communication and management of the sanitation service chain. We engage private sector, civil society organisations, users and local authorities to improve public health and development opportunities in their city.

As part of our USHHD programme, we have a long term partnership with the Institute for Sustainable Futures, University of Technology Sydney focused on knowledge and learning to improve practice and contribute to the WASH sector knowledge and evidence. Our recent collaborative efforts have resulted in the following papers:

Are we doing the right thing? Critical questioning for city sanitation planning (2016)
Cities are clear examples of complex and rapidly changing systems, particularly in countries where urban population growth and economic development continue apace, and where the socio-political context strongly influences the directions taken. The concept of double-loop learning can be usefully applied to city sanitation planning. This paper prompts practitioners, policy-makers and development agencies to reflect on their approaches to city sanitation planning and the assumptions that underlie them.
Download full paper

Exploring legal and policy aspects of urban sanitation and hygiene (2016)
During 2012-2014, SNV did four country reviews of legal arrangements for urban sanitation and hygiene in Nepal, Bhutan, Bangladesh and Indonesia. Based on these experiences, this guide was developed to provide support and guidance for WASH practitioners undertaking a scan of legal arrangements to inform the design (use of frameworks and tools) and delivery (advocacy for improvements) of urban sanitation and hygiene programs.
Download full paper

A guide to septage transfer stations (2016)
Septage transfer stations have the potential to significantly reduce the amount of faecal sludge entering the environment by providing a local solution for septage disposal. Localised transfer stations shorten the time required for local operators to collect and transport septage, and they will be able to use smaller vacuum tanks that can navigate the densely populated residential areas. This guide provides information on the salient aspects of selecting, designing, building, operating and maintaining a septage transfer station.
Download full paper

Financing sanitation for cities and towns (2014)
Planning and financing for sanitation in cities and towns in developing countries is often ad hoc and piecemeal. Stronger capacity to plan financing for sanitation infrastructure (and services) for the long term will lead to better outcomes. Planning for adequate long-term services requires consideration of the complete sanitation service chain over the lifecycle of the associated service infrastructure. This paper focuses on access to the upfront finance and other lumpy finance needs for initial investment and for rehabilitation and/or replacement as physical systems approach their end of life.
Download full paper

For further information about these papers or the organisations, please contact:
Antoinette Kome (SNV) – akome@snv.org
Juliet Willetts (ISF) on Juliet.willetts@uts.edu.au