Tag Archives: shared sanitation

The continuing conundrum of shared sanitation in slums

The continuing conundrum of shared sanitation in slums. OUPblog, Dec 28 2015.  by Marieke Heijnen.

An excerpt – Some have argued that shared sanitation facilities are the only solution in slums, due to space and cost limitations. But the discussion continues—some research argues that the focus should be less on the user of the shared facility, and more on the facility itself. Others note that sanitation provision needs to go beyond technology or user-numbers, and include factors of culture, affordability and ownership. Overall, research shows that a simple statement of ‘shared sanitation’ does not account for the diversity of shared sanitation found in different settings—the different ‘forms’ of shared sanitation and the lack of consensus on definitions complicates monitoring for international targets.

With increasing urbanisation, sanitation in slums will become a more pressing issue. Providing adequate, safe and accessible sanitation for all users in slums is a public health priority which requires a multifaceted approach, considering the actual facilities as well as increasing education and empowerment among the potential users. In addition, accountability from landlords and local government is essential. In order for shared sanitation facilities to be a sustainable step on the sanitation ladder, policy makers, programme implementers, and target communities must join forces to ensure the facilities are culturally appropriate, affordable, well-maintained, and user-friendly. Then hopefully, we can ensure that all facilities—whether shared or used by one household—provide the health, comfort, and privacy benefits that a toilet really should.

Read the complete article.


Shared sanitaion for the urban poor: understanding what works

The MapSan study aims to explore the links between sanitation, population density, and health outcomes in Maputo, Mozambique. The video describes a controlled, before-and-after trial of an urban sanitation intervention to reduce enteric infections in children:

Shared Sanitation versus Individual Household Latrines: A Systematic Review of Health Outcomes

Shared Sanitation versus Individual Household Latrines: A Systematic Review of Health Outcomes. PLoS One, April 2014.

Authors: Marieke Heijnen, Oliver Cumming, Rachel Peletz, Gabrielle Ka-Seen Chan, Joe Brown, Kelly Baker, Thomas Clasen.

Background: More than 761 million people rely on shared sanitation facilities. These have historically been excluded from international sanitation targets, regardless of the service level, due to concerns about acceptability, hygiene and access. In connection with a proposed change in such policy, we undertook this review to identify and summarize existing evidence that compares health outcomes associated with shared sanitation versus individual household latrines.

Methods and Findings: Shared sanitation included any type of facilities intended for the containment of human faeces and used by more than one household, but excluded public facilities. Health outcomes included diarrhoea, helminth infections, enteric fevers, other faecal-oral diseases, trachoma and adverse maternal or birth outcomes. Studies were included regardless of design, location, language or publication status. Studies were assessed for methodological quality using the STROBE guidelines. Twenty-two studies conducted in 21 countries met the inclusion criteria. Studies show a pattern of increased risk of adverse health outcomes associated with shared sanitation compared to individual household latrines. A meta-analysis of 12 studies reporting on diarrhoea found increased odds of disease associated with reliance on shared sanitation (odds ratio (OR) 1.44, 95% CI: 1.18–1.76).

Conclusion: Evidence to date does not support a change of existing policy of excluding shared sanitation from the definition of improved sanitation used in international monitoring and targets. However, such evidence is limited, does not adequately address likely confounding, and does not identify potentially important distinctions among types of shared facilities. As reliance on shared sanitation is increasing, further research is necessary to determine the circumstances, if any, under which shared sanitation can offer a safe, appropriate and acceptable alternative to individual household latrines.