A New Paradigm for Urban Sanitation - An Urgent Need

Addressing the urban sanitation crisis: Time for a radical shift

SUBMITTED BY MARTIN GAMBRILL ON WED, 11/16/2016

Co-authors:

The Bill & Melinda Gates Foundation – Jan Willem Rosenboom
The University of Leeds – Barbara Evans
Emory University – Christine Moe & Eduardo Perez
The World Bank – Sophie Trémolet, Valérie Sturm, Clémentine Stip
WaterAid – Andrés Hueso
Plan International – Darren Saywell

Children in Maputo, Mozambique
Photo credit:
Isabel Blackett/The World Bank

A successful city is economically and culturally vibrant, healthy, safe, clean and attractive to business and tourism, and provides quality of life to its citizens. This vision is appealing but remains hard to realize as developing cities have to cope with changing demographics and climate with limited financial and human resources. The sustainable development goals have given a new impetus for cities to be inclusive, safe, resilient and sustainable (SDG11), ensure citizens’ health and wellbeing (SDG3) and secure access to sustainable water and sanitation services (SDG6).

World Toilet Day on November 19th is the opportunity to remind ourselves of a few facts and propose a set of guiding principles for a renewed and revitalized urban sanitation agenda.

Many cities struggle to deal with the most basic municipal task of managing human excreta. Some are effectively “drowning” in human waste. Urban population growth continuously outpaces gains in improved sanitation access and, globally, nearly one billion people live in urban slums with poor or no sanitation. Only 26% of urban excreta is deemed to be safely managed. The results? Environmental degradation, endemic disease leading to mortality and morbidity, especially among children, poor school attendance and performance, low productivity, constraints on the delivery of essential urban services such as housing, transport, safe water and drainage, and, ultimately, limits on economic growth and urban development. In short, a silent crisis that impedes the realization of the urban transformation framed in SDG11.

Urban sanitation has a fundamental role to play in achieving the SDG goals identified above. Business as usual will fail to deliver the kind of sanitation that underpins the envisioned urban transformation, by operating at too small a scale and focusing on infrastructure alone rather than on city-wide solutions. What is required is a radical shift in mindsets and practices towards an urban sanitation approach that impacts political priorities, funding, planning, design, management and governance.

Mobile desludging tank being wheeled out of an alley in the
city of Hanoi, Vietnam. Photo credit: Jan Willem Rosenboom

This radical shift will require the engagement of all stakeholders and a political transformation that touches all citizens, rich and poor, informal and formal, to facilitate the roll out of universal urban sanitation services. This is critical not only for reasons of equity, and to respond to the human right to sanitation, but also because the consequences of inadequate sanitation eventually affect everyone, as excreta-related pathogens spread easily across dense urban environments.

To make progress, urban development professionals and stakeholders need to better understand how sanitation impacts the functions and form of the city and how it supports economic development and promotes equity. To achieve sustainable, equitable and safe management of excreta for the whole city, sanitation sector professionals must transform their thinking and practices to deploy both old and new solutions in smarter ways.

We, from The Bill & Melinda Gates Foundation, The University of Leeds, Emory University, WaterAid, Plan International and The World Bank, have come together as a group of practitioners to galvanize this agenda by sharing conversations globally and mobilizing contributions from decision-makers and other practitioners across disciplines.

We propose that this renewed urban sanitation agenda should aim to:

• Embed sanitation within the framework of urban governance and municipal services provision.
• Establish clear roles and responsibilities, with accountability and transparency.
• Provide ‘safe management’ of excreta throughout the sanitation chain – for both onsite sanitation and sewers – to ensure separation of fecal contamination from people across the whole city.
• Focus on outcomes rather than technologies – allowing for diversity of solutions and approaches.
• Base decisions on secure operational budgets being available (including for operation and maintenance).
• Facilitate progressive realization, building on what is already in place.
• Commit resources to training city leaders and technicians of the future to solve complex problems rather than deliver predetermined solutions.

 On this World Toilet Day, we invite you to join us in responding to this shared responsibility.

Related:

• Toolkit: Tools for diagnosing urban sanitation challenges
• Blog: Targeting urban sanitation: Looking behind aggregated city-level data
• Blog: Fecal Sludge Management: the invisible elephant in urban sanitation
• Blog: 5 lessons to manage fecal sludge better 
• Blog: A tale of two cities: how cities can improve fecal sludge management 

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Submitted on the water blog last week but important enough to be very widely distributed, including in the more fortunate regions where clean water and effective sanitation is the norm.

Most Australians live with good to excellent water quality and decent effective sanitation.   That is not the situation in many regions of the world, where urban sanitation is, well,............. bloody awful! [ in the Australian vernacular].

As urban density rises especially in poorer countries urban sanitation seems to decline.  It does need reversing to allow a rise in dignity and health for the less fortunate.

World Toilet Day 2016 - November 19 was a time for reflection and change.

Sanitation Pays Off - BIG TIME for Development in Asia

Globally, the sanitation Millennium Development Goal target is well off track. 

However, many countries in Southeast Asia have made substantial progress, although a number of them will not reach the sanitation MDG target by 2015.

 Many countries have recently revised their sanitation strategies in order to rapidly scale up sanitation and aim for universal access by 2030.

According to a new study from the Water Global Practices Water and Sanitation Program (WSP), sanitation has been shown to have significant economic and social returns in the six countries studied (Cambodia, Yunnan province of China, Indonesia, Lao PDR, the Philippines, and Vietnam) and benefits in both urban and rural settings exceed costs in almost all cases. 

The Economic Assessment of Sanitation Interventions in Southeast Asia found that all sanitation interventions examined have benefits that exceed costs, when compared with “no sanitation facility.” Economic benefits of sanitation are at least five times higher than economic costs in rural areas and at least three times higher for urban areas. 

Other key findings include:

- In rural areas, the most basic sanitation type, the pit latrine, had returns of at least five times its costs in all but one country, Cambodia. Across both wet and dry pit latrines, the returns are highest in Lao PDR at over eight times.

- In urban areas, pit latrines remain a feasible, affordable, and efficient sanitation option in some settings where density is low. Septic tanks were also found to be economically viable in all countries, with economic returns of around two or more per unit spent.

In all countries and for most sanitation technologies, health benefits and time savings accounted for the majority of the overall benefits. 

Some intangible benefits not quantifiable  from the above estimates were also shown to be important to households, including dignity, comfort, prestige, security, gender equality, household cleanliness, and aesthetics of the community environment. Because of inter-personal variation in responses, it was difficult to present population level averages for these intangible benefits. 

The benefits of reduced water pollution from improved fecal sludge or sewage management were not fully counted for those interventions that reduced release of fecal matter into the environment because of the methodological difficulties and data constraints involved in such valuations.

The report, which is part of the second phase of the Economics of Sanitation Initiative (ESI) launched initially in East Asia in 2007, provides sanitation decision makers with compelling evidence that directly compares the costs and benefits of alternative sanitation options across multiple contexts and countries.

Read the blog from Guy Hutton: "Why choosing the preferred sanitation solution should be more like grocery shopping."

For more information, please visit www.wsp.org

World Toilet Day - 2014

It seems simple for those in western society...........the use of a decent toilet.  It is NOT that way for many in developing countries, and particularly in India.  Simple sanitation and hand washing associated with it is a critical issue in developing areas and reducing simple illnesses.

Today marks the second annual UN World Toilet Day, an important opportunity to promote global efforts to achieve universal access to sanitation by 2030. 

With a focus on equality and dignity, this year, World Toilet Day aims to highlight sanitation as a global development priority, especially for women and girls who must compromise their dignity and put their safety at risk when lack of access to sanitation forces them to defecate in the open.

Sanitation impacts multiple sectors of development, but the connection with gender equality is particularly important.

As outlined in a blog by World Bank Group Senior Director for Gender Caren Grown and Senior Director for Water Junaid Ahmad, advancing equality for women in developing countries is not only the right thing to do, it makes good economic sense. 

The relationship between gender equality and sanitation and water services is reciprocal. Just as investing in sanitation and water services benefits gender equity, improvements in gender equity can meanwhile advance improved sanitation and water services.

Ending poverty by 2030 and boosting shared prosperity - the World Bank Group’s twin corporate goals - is possible only if we continue pressing to fully understand such obstacles to gender equity and service delivery.

Poor Sanitation A Child Killer in India

Poor Sanitation in India May Afflict Well-Fed Children With Malnutrition

12 Photos

SHEOHAR DISTRICT, India — He wore thick black eyeliner to ward off the evil eye, but Vivek, a tiny 1-year-old living in a village of mud huts and diminutive people, had nonetheless fallen victim to India’s great scourge of malnutrition.

His parents seemed to be doing all the right things. His mother still breast-fed him. His family had six goats, access to fresh buffalo milk and a hut filled with hundreds of pounds of wheat and potatoes. The economy of the state where he lives has for years grown faster than almost any other. His mother said she fed him as much as he would eat and took him four times to doctors, who diagnosed malnutrition. Just before Vivek was born in this green landscape of small plots and grazing water buffalo near the Nepali border, the family even got electricity.

So why was Vivek malnourished?

It is a question being asked about children across India, where a long economic boom has done little to reduce the vast number of children who are malnourished and stunted, leaving them with mental and physical deficits that will haunt them their entire lives. Now, an emerging body of scientific studies suggest that Vivek and many of the 162 million other children under the age of 5 in the world who are malnourished are suffering less a lack of food than poor sanitation.

Poor Sanitation Linked to Malnutrition in India

New research on malnutrition, which leads to childhood stunting, suggests that a root cause may be an abundance of human waste polluting soil and water, rather than a scarcity of food.

Afghanistan

60%

Percentage of children under 5 who are stunted

50

Ethiopia

India

India

Pakistan

40

Nepal

Nigeria

Uganda

30

Togo

Ghana

Haiti

20

Senegal

10

Number of people who defecate outdoors

per square kilometer

0

0

50

100

150

Sources: Demographic and Health Surveys, USAID (stunting data, latest year available); World Health Organization, Unicef (defecation data, 2012)

Like almost everyone else in their village, Vivek and his family have no toilet, and the district where they live has the highest concentration of people who defecate outdoors. As a result, children are exposed to a bacterial brew that often sickens them, leaving them unable to attain a healthy body weight no matter how much food they eat.

“These children’s bodies divert energy and nutrients away from growth and brain development to prioritize infection-fighting survival,” said Jean Humphrey, a professor of human nutrition at Johns Hopkins Bloomberg School of Public Health. “When this happens during the first two years of life, children become stunted. What’s particularly disturbing is that the lost height and intelligence are permanent.”

Two years ago, Unicef, the World Health Organization and the World Bank released a major report on child malnutrition that focused entirely on a lack of food. Sanitation was not mentioned. Now, Unicef officials and those from other major charitable organizations said in interviews that they believe that poor sanitation may cause more than half of the world’s stunting problems.

“Our realization about the connection between stunting and sanitation is just emerging,” said Sue Coates, chief of water, sanitation and hygiene at Unicef India. “At this point, it is still just an hypothesis, but it is an incredibly exciting and important one because of its potential impact.”

This research has quietly swept through many of the world’s nutrition and donor organizations in part because it resolves a great mystery: Why are Indian children so much more malnourished than their poorer counterparts in sub-Saharan Africa?

A child raised in India is far more likely to be malnourished than one from the Democratic Republic of Congo, Zimbabwe or Somalia, the planet’s poorest countries. Stunting affects 65 million Indian children under the age of 5, including a third of children from the country’s richest families.

This disconnect between wealth and malnutrition is so striking that economists have concluded that economic growth does almost nothing to reduce malnutrition.

Half of India’s population, or at least 620 million people, defecate outdoors. And while this share has declined slightly in the past decade, an analysis of census data shows that rapid population growth has meant that most Indians are being exposed to more human waste than ever before.

In Sheohar, for instance, a toilet-building program between 2001 and 2011 decreased the share of households without toilets to 80 percent from 87 percent, but population growth meant that exposure to human waste rose by half.

“The difference in average height between Indian and African children can be explained entirely by differing concentrations of open defecation,” said Dean Spears, an economist at the Delhi School of Economics. “There are far more people defecating outside in India more closely to one another’s children and homes than there are in Africa or anywhere else in the world.”

Not only does stunting contribute to the deaths of a million children under the age of 5 each year, but those who survive suffer cognitive deficits and are poorer and sicker than children not affected by stunting. They also may face increased risks for adult illnesses like diabetes, heart attacks and strokes.

“India’s stunting problem represents the largest loss of human potential in any country in history, and it affects 20 times more people in India alone than H.I.V./AIDS does around the world,” said Ramanan Laxminarayan, vice president for research and policy at the Public Health Foundation of India.

India is an increasingly risky place to raise children. The country’s sanitation and air quality are among the worst in the world. Parasitic diseases and infections like tuberculosis, often linked with poor sanitation, are most common in India. More than one in four newborn deaths occur in India.

Open defecation has long been an issue in India. Some ancient Hindu texts advised people to relieve themselves far from home, a practice that Gandhi sought to curb.

“The cause of many of our diseases is the condition of our lavatories and our bad habit of disposing of excreta anywhere and everywhere,” Gandhi wrote in 1925.

Other developing countries have made huge strides in improving sanitation. Just 1 percent of Chinese and 3 percent of Bangladeshis relieve themselves outside compared with half of Indians. Attitudes may be just as important as access to toilets. Constructing and maintaining tens of millions of toilets in India would cost untold billions, a price many voters see no need to pay — a recent survey found that many people prefer going to the bathroom outside.

Few rural households build the sort of inexpensive latrines that have all but eliminated outdoor waste in neighboring Bangladesh.

One analysis found that government spending on toilets pays for itself in increased tax receipts from greater productivity, but the math works only if every member of a family who gets a toilet uses it.

“We need a cultural revolution in this country to completely change people’s attitudes toward sanitation and hygiene,” said Jairam Ramesh, an economist and former sanitation minister.

Continue reading the main story

India’s government has for decades tried to resolve the country’s stubborn malnutrition problems by distributing vast stores of subsidized food. But more and better food has largely failed to reverse early stunting, studies have repeatedly shown.

India now spends about $26 billion annually on food and jobs programs, and less than $400 million on improving sanitation — a ratio of more than 60 to 1.

“We need to reverse that ratio entirely,” Dr. Laxminarayan said.

Studies are underway in Bangladesh, Kenya and Zimbabwe to assess the share of stunting attributable to poor sanitation. “Is it 50 percent? Ninety percent? That’s a question worth answering,” said Dr. Stephen Luby, a professor of medicine at Stanford University who is overseeing a trial in Bangladesh that is expected to report its results in 2016. “In the meantime, I think we can all agree that it’s not a good idea to raise children surrounded by poop.”

Better sanitation in the West during the 19th and early 20th centuries led to huge improvements in health long before the advent of vaccines and antibiotics, and researchers have long known that childhood environments play a crucial role in child death and adult height.

The present research on gut diseases in children has focused on a condition resulting from repeated bacterial infections that flatten intestinal linings, reducing by a third the ability to absorb nutrients. A recent study of starving children found that they lacked the crucial gut bacteria needed to digest food.

In a little-discussed but surprising finding, Muslim children in India are 17 percent more likely to survive infancy than Hindus, even though Muslims are generally poorer and less educated. This enormous difference in infant mortality is explained by the fact that Muslims are far more likely to use latrines and live next to others also using latrines, a recent analysis found.

So widespread housing discrimination that confines many Muslims to separate slums may protect their children from increased exposure to the higher levels of waste in Hindu communities and, as a result, save thousands of Indian Muslim babies from death each year.

Just building more toilets, however, may not be enough to save India’s children.

Phool Mati lives in a neighborhood in Varanasi with 12 public toilets, but her 1-year-old grandson, Sandeep, is nonetheless severely malnourished. His mother tries to feed him lentils, milk and other foods as often as she can, but Sandeep is rarely hungry because he is so often sick, Ms. Mati said.

The effluent pipe that served the bathroom building is often clogged. Raw sewage seeps into an adjoining Hindu temple, and, during the monsoon season, it flooded the neighborhood’s homes. The matron of the toilet facility charges two rupees for each use, so most children relieve themselves directly into open drains that run along a central walkway.

No Indian city has a comprehensive waste treatment system, and most Indian rivers are open sewers as a result. But Varanasi, India’s oldest and holiest city, is so awash in human waste that its decrepit condition became a national issue in recent elections. The city’s sewage plants can handle only about 20 percent of the sewage generated in the city, said Ramesh Chopra of Ganga Seva Abhiyanam, a trust for cleaning the river. The rest sloshes into the Ganges or fetid ponds and pits.

Millions of pilgrims bathe in the Ganges along Varanasi’s ancient riverfront, but a stream of human waste — nearly 75 million liters per day — flows directly into the river just above the bathing ghats, steps leading down to the river. Many people wash or brush their teeth beside smaller sewage outlets.

Much of the city’s drinking water comes from the river, and half of Indian households drink from contaminated supplies.  “India’s problems are bigger than just open defecation and a lack of toilets,” Dr. Laxminarayan said.

Suhasini Raj contributed reporting.

A version of this article appears in print on July 15, 2014, on page A1 of the NY Times New York edition with the headline: Malnutrition in Well-Fed Children Is Linked to Poor Sanitation .

Water Demand To Soon Exceed Supply in Many Areas

Analysts with Bank of America Merrill Lynch Global Research have released a report that predicts global demand for fresh water will soon outstrip supply, according to an article on CBS MoneyWatch.

Stylised water supply system

"Water scarcity is a pressing people and planet issue," the report stated.  This is hardly new to many working in the sector, or those in aid / development areas.

According to the article, 768 million people around the world have no access to clean drinking water and 2.5 billion are without proper sanitation, noted the article, while about 2.5 percent of all water on earth is fresh water.

Addressing these issues is a priority for the Water and Sanitation Program [ see more at www.wsp.org] and many simple measures can be effective, especially on the sanitation side.  But fresh water supply is more difficult, with wasteful water use a big issue itself, especially in developed countries.

The report states that humans have already reached "peak water," at or approaching the limit of renewable freshwater supply, the article reported, and half of the world's population will face "water stress" conditions by 2030.

According to the article, as many as 50 nations can be expected to be involved in conflicts over water by 2050.

You can read the full article here.