Tag Archives: shared sanitation

Sustainable Development Goals are leaving behind shared sanitation

Sustainable Development Goals are leaving behind shared sanitation. by Kimberly Pugel, IRC Blog, August 2017.

Political drivers, including SDG indicators, directly impact sanitation efforts on the ground.

Here we look at shared sanitation at the national, district, and household levels in Ethiopia, and why it should not be overlooked by the SDGs.

Behind a newly-erected corrugated metal fence in kebele (sub-district) #03 of Woliso woreda (district), Ethiopia, stands a sturdy cement building painted deep green. Located in a densely-populated area, its dark exterior provides a striking contrast to the enclave of brightly coloured houses surrounding it.

Yirgalem Zewude proudly manages the public latrine and shower (shown) in addition to her neighbourhood’s communal latrine. Managing a public latrine requires more time, money, and planning than a communal latrine.

Yirgalem Zewude proudly manages the public latrine and shower (shown) in addition to her neighbourhood’s communal latrine. Managing a public latrine requires more time, money, and planning than a communal latrine.

The building’s six separate doors lead to clean, recently-emptied latrine pits. Standing in front of it, it was so clearly well-maintained that I thought it had just been built. But I learned that Yirgalem Zewude, a local resident, has actually been managing this communal latrine for over 10 years.

Shared latrines like these are often the only viable way to provide sanitation services in areas where housing and people are so densely packed together; they can also be managed safely and sustainably.

However, the indicators published in the newly released Sustainable Development Goals Baseline Report by the Joint Monitoring Programme (JMP) for Water Supply and Sanitation by WHO and UNICEF do not count improved facilities as “basic” if they are shared between more than two households.

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.

Don’t neglect shared latrines in drive for sanitation for all, agencies warn

Shared toilets in Kenya. Photo: Sanergy

Shared toilets in Kenya. Photo: Sanergy

• WaterAid joins WSUP, World Bank and leading academics in urging donors, policymakers and planners not to neglect shared sanitation
• Where private household toilets aren’t yet an option, safe, well-managed shared toilets are a crucial step to further improvement

Funding for safe, shared toilets in fast-growing developing-world cities is at risk of neglect from donors, policymakers and planners, a new journal article authored by sanitation specialists, senior economists and leading academics has warned.

Authors from the World Bank, WaterAid and Water & Sanitation for the Urban Poor have joined leading academics from the University of Leeds and the University of Colorado – Boulder in calling for shared toilets as an essential stepping-stone towards universal sanitation.

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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.

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Sanitation and Hygiene-Specific Risk Factors for Moderate-to-Severe Diarrhea in Young Children in the Global Enteric Multicenter Study

The current issue of PLoS Medicine has an important review on sanitation and hygiene and also below is an analysis of the review by Jonny Crocker and Jamie Bartram.

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 Med, May 2016. Authors: Kelly K. Baker, Ciara E. O’Reilly, Myron M. Levine, Karen L., et al.

Full text: http://goo.gl/z0h9P0

Background – Diarrheal disease is the second leading cause of disease in children less than 5 y of age. Poor water, sanitation, and hygiene conditions are the primary routes of exposure and infection. Sanitation and hygiene interventions are estimated to generate a 36% and 48% reduction in diarrheal risk in young children, respectively. Little is known about whether the number of households sharing a sanitation facility affects a child’s risk of diarrhea. The objective of this study was to describe sanitation and hygiene access across the Global Enteric Multicenter Study (GEMS) sites in Africa and South Asia and to assess sanitation and hygiene exposures, including shared sanitation access, as risk factors for moderate-to-severe diarrhea (MSD) in children less than 5 y of age.

Methods/Findings – The GEMS matched case-control study was conducted between December 1, 2007, and March 3, 2011, at seven sites in Basse, The Gambia; Nyanza Province, Kenya; Bamako, Mali; Manhiça, Mozambique; Mirzapur, Bangladesh; Kolkata, India; and Karachi, Pakistan. Data was collected for 8,592 case children aged <5 y old experiencing MSD and for 12,390 asymptomatic age, gender, and neighborhood-matched controls. An MSD case was defined as a child with a diarrheal illness <7 d duration comprising ≥3 loose stools in 24 h and ≥1 of the following: sunken eyes, skin tenting, dysentery, intravenous (IV) rehydration, or hospitalization. Site-specific conditional logistic regression models were used to explore the association between sanitation and hygiene exposures and MSD. Most households at six sites (>93%) had access to a sanitation facility, while 70% of households in rural Kenya had access to a facility. Practicing open defecation was a risk factor for MSD in children <5 y old in Kenya. Sharing sanitation facilities with 1–2 or ≥3 other households was a statistically significant risk factor for MSD in Kenya, Mali, Mozambique, and Pakistan. Among those with a designated handwashing area near the home, soap or ash were more frequently observed at control households and were significantly protective against MSD in Mozambique and India.

Conclusions – This study suggests that sharing a sanitation facility with just one to two other households can increase the risk of MSD in young children, compared to using a private facility. Interventions aimed at increasing access to private household sanitation facilities may reduce the burden of MSD in children. These findings support the current World Health Organization/ United Nations Children’s Emergency Fund (UNICEF) system that categorizes shared sanitation as unimproved.

Interpreting the Global Enteric Multicenter Study (GEMS) Findings on Sanitation, Hygiene, and Diarrhea. PLoS Med, May 2016. Author: Jonny Crocker, Jamie Bartram

Full text: http://goo.gl/6SzZmr

The draft sanitation ladder for measuring SDG progress allows sharing of improved facilities by fewer than five households to count towards ending open defecation [19]. Higher rungs refer to private facilities and safe excreta management. The indicators also interpret access as including use, which was not included in GEMS. Future research should include indicators on use of facilities and excreta management.

Baker and colleagues provide valuable evidence that confirms that private sanitation often provides greater benefits than shared sanitation. Prior evidence suggests health benefits for use of any sanitation facility (including shared) when compared to open defecation [8–10]. This study will inform policy and programming, yet shared facilities may still have a role in addressing open defecation in challenging settings. For reasons beyond just health such as dignity and gender equity [20,21], we should advocate for private access whenever possible.

Baker and colleagues present the best dataset yet on diarrheal disease associated with sanitation and hygiene. They provide compelling evidence on sanitation and hygiene risk factors for MSD and variability in that risk. Importantly, they also demonstrate the feasibility and value of rigorous data collection on health outcomes, something that future studies should develop yet further.

Policy Note: Should Public Toilets Be Part of Urban Sanitation Solutions for Poor Families Living in Slums?

Policy Note: Should Public Toilets Be Part of Urban Sanitation Solutions for Poor Families Living in Slums? April 2016. Emory University’s Center for Global Safe Water, Sanitation, and Hygiene.

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.

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An Annotated Bibliography on Shared Sanitation Studies Published in 2015

An Annotated Bibliography on Shared Sanitation Studies Published in 2015

Below are links to the abstracts or full-text of 4 studies on shared sanitation that were published in 2015. We will continue to update this bibliography with 2016 reports and studies so please send us an email if you have studies to contribute.

1 – Soc Sci Med. 2015 Dec;147:72-9. doi: 10.1016/j.socscimed.2015.10.059.

 Effectiveness of group discussions and commitment in improving cleaning behaviour of shared sanitation users in Kampala, Uganda slums. Authors: Tumwebaze IK, Mosler HJ. (Abstract)

RATIONALE AND OBJECTIVE: Access to and use of hygienic shared sanitation facilities is fundamental in reducing the high risk of diseases such as diarrhoea and respiratory infections. We evaluated the effectiveness of group discussions and commitment in improving the cleaning behaviour 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.

METHODS: A pre-versus post-intervention survey was conducted in three slums of Kampala, Uganda, between December 2012 and September 2013. From the pre-intervention findings, users of dirty sanitation facilities were randomly assigned to discussions, discussions + commitment and control interventions. The interventions were implemented for 3 months with the aim of improving cleaning behaviour. This paper provides an analysis of 119 respondents who belonged to the intervention discussion-only (n = 38), discussions + commitment (n = 41) and the control (no intervention, n = 40) groups.

RESULTS: Compared to the control, discussions and discussions + commitment significantly improved shared toilet users’ cleaning behaviour. The rate of improvement was observed through behavioural determinants such as cleaning obligation, cleaning ease, cleaning approval and affective beliefs.

CONCLUSION: Our study findings show that group discussions and commitment interventions derived from RANAS model of behaviour change are effective in improving the shared sanitation users’ cleaning behaviour.

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