Urban Health Updates
Wasted Health: The Tragic Case of Dumpsites | | Source: by Thomas Dimech | Resource, 8 September 2015 |
A new report by the International Solid Waste Association (ISWA) is highlighting the ‘global health emergency’ affecting tens of millions of people in developing countries who lack good sanitation infrastructure.
The report, ‘Wasted Health: The Tragic Case of Dumpsites’, illustrates how the issues surrounding open dumpsites in the developed world 40 years ago are still prevalent in developing countries, but are also being compounded by unprecedented issues such as the unregulated accumulation of discarded electronics, mobile phones, and medical waste.
Some of the main problems identified in the report include:
- open dumpsites receive roughly 40 per cent of the world’s waste and serve about 3.5 to 4 billion people;
- there has been a substantial rise in unregulated dumping of mobile devices, electronic appliances, medical and municipal waste, accelerating the scale of the threat and health risks;
- uncontrolled burning of waste releases gases and toxins into the atmosphere;
- open waste sites in India, Indonesia and the Philippines are more detrimental to life expectancy than malaria;
- 64 million people’s lives (equal to the population of France) are affected by world’s 50 largest dumpsites;
- in addition to the human and environmental impacts, the financial cost of open dumpsites runs into the tens of billions of US dollars.
In preparing the report, researchers analysed 373 toxic waste sites in India, Indonesia and the Philippines, where, the report says, ‘an estimated 8.6 million people are at risk of exposure to lead, asbestos, hexavalent chromium and other hazardous materials’.
It continues: ‘Among those people at risk, the exposure could cause a loss of around 829,000 years of good health as a result of disease, disability or early death. In comparison, malaria in these countries, whose combined population is nearly 1.6 billion, causes the loss of 725,000 healthy years.’
The report also states that over 42 million tonnes of e-waste was generated in 2014 and a lack of trained labour and investment in recycling infrastructure has meant that much of the waste is simply dumped in open landfills, which can lead to further health issues as they can be burnt, exposing locals to dangerous pollutants, heavy metals, volatile compounds and soot.
Call for a ‘global alliance’ to address the issue
Releasing the report, Antonis Mavropoulos, Chairman of the ISWA Scientific and Technical Committee and author of the report, called for immediate action: “Little or no coordinated action is being taken at present and to be effective change can only happen if there is a global alliance to address the issue among governments and key stakeholder organisations.
“We need to start with a plan of how we finance the closure and relocation of the most dangerous sites urgently and provide support through resources of capital and expertise. While the cost will be substantial, it represents an opportunity to invest in the infrastructure and economy of these emerging and poor nations. In addition, the outlay required to close the most risky dumpsites will be just a small fraction of the cost of their health impacts.”
David Newman, ISWA President, said: “The recommendations of this report are clear: the international community has an urgent task ahead in closing waste dumps globally, for the sake of populations affected by them, because they live in or near them, but also because all the world’s people are breathing in the toxins released by burning on open dumps. And the greenhouse gas emissions involved are huge too, and unless we act, the growth of open dumping is inevitable.”
He added: “ISWA and its experts are willing to take part in this global clean up and will, with other interested parties, collaborate on drawing attention to the damage caused to human health through poor waste management practices.”
Can we shift waste to value through 3D printing in Tanzania? World Bank Blog, Sept 2015. Author: C. Paradi-Guilford.
Plastic waste, in particular PET, which is typically found in soda bottles, is becoming abundant in African cities. In Dar es Salaam, one of the most rapidly urbanizing cities in Africa,BORDA found that about 400 tons of plastic waste per day remains uncollected or unrecycled. Although about 98 percent of the solid waste generated per day can be recycled or composted, 90 percent is disposed in dumpsites.
At the same time, the recycling industry has started to grow because of new initiatives, community organizations and private companies. There are a few organizations that repurpose waste into arts and crafts, tools or apply it as a source of energy – such as WasteDar. However, the majority collect or purchase plastic waste from collectors, primarily with a view to export, rather than recycle or reuse locally.
Socially and environmentally, waste management is one of the biggest challenges for an increasingly urbanized world. Waste pickers can earn as little as US$1-2 a day in dangerous conditions with little opportunity for advancement. They make up some of the most disadvantaged communities living in deep poverty.
Through a new market for sorted waste materials, these communities may access higher income generation opportunities in a sustainable manner. This presents an opportunity to explore turning this waste into value more close to home.
At the same time, 3D Printing is expanding
3D printing is an additive manufacturing process that applies layers of materials (typically plastic) to develop an object that is made up of thinly sliced horizontal layers. The design of the object is made in a Computer-Aided Design program using a 3D modeling, then is inputted into the 3D printer. Gaining popularity, 3D scanners are also used to make a digital copy of ab object. 3D printers take an input of filament consisting of varying types of plastic to create the object.
3D printers can be found in schools and other training institutions, digital fabrication and maker spaces, small research and development (R&D) labs…or even one’s home. Maker spaces or digital fabrication laboratories make these openly available. They are small-scale workshops that offer digital fabrication services to the tinkerers, creative problem solvers, entrepreneurs or anyone who wishes to apply and build on their technical skills. They were originally designed as prototyping platforms for local entrepreneurs, but they have now expanded to universities and higher education facilities.
Check out the Fab Foundation to learn more about the international network that supports digital fabrication spaces called “Fab labs.” These spaces are rarely built in isolation and often are integrated into existing innovation, startup, academic, and entrepreneurial ecosystems.
Wait, how does plastic waste connect to 3D printing?
A nascent opportunity to rethink the way we use, or rather reuse, plastic is the growing market for 3D printer filament. Predictions suggest that 3D printing filament market will reach $1.052 million by 2019. Currently, the cost of one kilogram (kg) of filament anywhere between $25 and $40. However, in new markets, such as Tanzania, this cost can go up to as much as $60 or even $80, including fees for shipping from China. This creates a barrier for the burgeoning local communities interested in 3D printing to access the necessary supplies.
Filament can be sourced directly from waste picker groups in developing countries. Filament with the Ethical Filament (“EF”) mark is produced ethically on a ‘fair trade’ basis, enabling waste pickers to receive more income from the recyclable materials they collect.
Companies like Protoprint are already taking advantage of this opportunity by conducting a pilot study in cooperation with Waste Pickers in India to develop ethical 3D printer filament made out of HDPE plastic. This filament can also be used for 3D printing prototypes or products themselves depending on their complexity and design.
Below are three current initiatives that are working in the recycled plastic space in varying capacities.
- Refil is a company based out of the Netherlands that is creating high quality affordable 3D printer filament out of recycled plastic. Through a specially developed process they are recycling car dashboards, into ABS plastic filament.
- The Plastic Bank is working on developing an open source extruder that creates filament from industrial waste/ocean plastic. To look at the open source hardware schematics.
- Appropedia is a wiki page for collaborative solutions to address sustainability and poverty reduction, including plastics for 3D printing.
- Tech for Trade is a UK charity that works with local entrepreneurs to test innovative approaches for building sustainable technology businesses. They founded the Ethical Filament Foundation, which aims to ensure income sustainability of waste pickers, reduce the environmental impact of 3D printing and onboarding recycled filament producers to use their Ethical Filament Standard.
- FabLab Bohol: The plastic upcycling project in Bohol, Philippines is an initiative that recycles used plastic materials to generate income for the community. One of the main products is plastic piping for septic tank use to protect the local marine life.
- Agbogbloshie Makerspace Platform (AMP): It is a transnational youth-driven project in Ghana to promote maker ecosystems in Africa, starting at Agbogbloshie. The agenda is collective action to prototype tools and co-create a hybrid digital-physical platform for recycling of ewaste material, making, sharing and trading.
Caption: The Plastic Bank’s Open Sourced Extruder
Examples of 3D printed products
- Infant Vein Finder Students from the University of Nairobi created an infant vein finder to address the infant mortality rate in Kenya. (Kenya)
- Weather Stations USAID developed a 3D printed weather station that integrates with a raspberry pi to provide instant access to weather data. (Zambia)
- Umbilical Cord Clip Field Ready developed the design and provided communities with access to printers to print the clips. (Haiti)
- Prosthetics 3D printed prosthetics for amputees specifically in developing economies. (Kenya)
- Solar Panel Bases Village Energy piloted using 3D printers to make their solar panel bases to decrease production time. (Uganda)
Green Digital Fabrication in Tanzania
Through the Green Digital Fabrication initiative in Tanzania, the World Bank will test the opportunity to shift PET plastic waste to value through collaboration across the recycling industry, local innovators and entrepreneurs, makers and tinkerers, leveraging 3D printers and new, low-cost PET extruder technology. The initiative will assess the feasibility and the market opportunity to turn PET plastic waste into 3D printer filament that can be sold locally or globally, and to then print unique, locally appropriate and marketable products, which could be then traded and sold by waste collectors back to their communities.
Through the practical application of 3D printing in the context of plastic waste, the initiative also aims contribute to the broader movement on turning waste to value as well as the development of local maker and digital fabrication communities.
The initiative is funded by the ICT4D Trust Fund at the World Bank, and is a partnership between the World Bank,COSTECH, Tena Recycling, Tech for Trade and the Ethical Filament Foundation, the Buni Hub, and STIClab.
Bringing Back the Water: USAID’s Indonesia Urban Water, Sanitation and Hygiene (IUWASH) program, Frontlines, Sept/Oct 2015.
Changes in weather patterns are already affecting everyday life in Indonesia. On the islands of Sumatra and Java, places naturally lush with vegetation, rivers and streams are beginning to dry up, exacerbated by heavy deforestation and expanding urban areas.
When it does rain, it is often more intense now and causes flooding in downstream populated areas. USAID’s Indonesia Urban Water, Sanitation and Hygiene (IUWASH) program has promoted a simple way to collect this rain and return it to groundwater aquifers: infiltration ponds.
Read the complete article.
A Corridor of Contrasts: On the road from Abidjan to Lagos, urbanization offers risk and opportunity, hardship and hope
A Corridor of Contrasts: On the road from Abidjan to Lagos, urbanization offers risk and opportunity, hardship and hope, 2015. African Strategies for Health.
To document issues affecting the health of people living in urban areas along the corridor, the US Agency for International Development’s (USAID) Africa Bureau and Global Health Bureau commissioned African Strategies for Health (ASH) to capture the stories of people who live and work along the road.
In January 2015, a journalist and photographer traveled the route and interviewed USAID staff, private and public health service providers, USAID implementing partners, and urban residents. This report is a compilation of those stories and the recommendations made by people living along the corridor for improving services for those who need it most.
MIT/CITE – USAID: Evaluation of water filters in Ahmedabad, Oct 2015.
Background – CITE’s household water filter evaluation allowed us to study innovations with the potential to better the lives of India’s “water poor”—the 76 million people in the country who lack improved drinking water.
CITE teams studied over 100 models of householder water filters from nine major brands available on the market in Ahmedabad, India. These models fell into three main categories: conventional particle filtration (cloth/jali mesh), gravity non-electric filters, and reverse osmosis filters.
In Ahmedabad, MIT students and researchers worked closely with students from local Indian universities to conduct the evaluation. Another student team spent the summer in the Consumer Reports labs in Yonkers, New York conducting lab tests of the same models being tested in the field.
CITE used multi-criteria analysis and Consumer Reports-style rating charts to guide its water filter evaluation report, which was released in October 2015.
- Cloth and jali filters are cheap and common among low-income users, but are not effective in reducing E.coli, or turbidity.
- Gravity non-electric filters are moderately priced and far more effective than cloth filters at reducing E.coli and turbidity.
- Reverse osmosis is a popular type of water filter system perceived as the best, but most of these systems are not an affordable option for the poor. Moreover, these filters generate wastewater at rates triples that of the clean water they produce—a negative environmental impact in a water scarce region.
- Postponed assembly at the retail level for certain water filter products can be very effective in scaling the supply chain. The locally branded “Dolphin” reverse osmosis water filters assembled by the distributors and retailers are promising from a scalability perspective.
- Water filters offer a good retail entrepreneurial opportunity since the assembly process is straightforward and requires few technical skills.
- A low-priced water filter is not sufficient for reaching rural populations. The more affordable gravity non-electric models are not readily available in rural areas, where they may be needed most.
- Water filter use seems to be dependent on use of water filters in the past and peer effects. This suggests that sustainable water use may be better suited to community- and neighborhood- scale interventions, rather than market interventions, at least in the short-run.
- A majority of water filter purchasing decisions were influenced by the buyer’s close network, most often a family member.
- Knowledge about household water filters designed for the bottom of the pyramid is low among that market segment. Technology adoption proves difficult when one’s peers do not have knowledge about a particular product.
Sanitation Service Delivery – Making Kumasi a Cleaner City, Sept 2015. Source: PSI Impact |
Sanitation Service Delivery (SSD) is a USAID/West Africa regional urban sanitation project that is implemented by PSI in collaboration with PATH and Water and Sanitation for the Urban Poor (WSUP). The project aims to improve sanitation outcomes by developing and testing scalable business models that engage private sector service providers and by contributing to the creation of a strong enabling environment for sanitation in West Africa. WSUP plays a vital role in supporting government partnership efforts to strengthen public support for improved sanitation and fecal sludge management (FSM) services in Ghana — an important aspect of the SSD.
Highlighting the important role governments will play in this endeavor, Dana Ward, PSI country representative in Ghana and chief of party for Sanitation Service Delivery (SSD) Project in Ghana, Benin, and Cote d’Ivore caught up with Anthony Mensah, director, Waste Management Department Kumasi Metropolitan Authority (KMA), about the city’s strategy to make Kumasi among the five cleanest cities in Africa.
In this Q&A, Anthony Mensah responds to questions on successes and challenges of the Kumasi program. Read the complete article.
Launch of “Strengthening Water and Sanitation in Urban Settings” project in Kolkata.
Kolkata, 12 August 2015: TERI University and the U.S. Agency for International Development (USAID) in association with Coca Cola and The Energy and Resources Institute (TERI) today launched the ‘Strengthening Water and Sanitation in Urban Settings” initiative in Kolkata. The WASH programmes (Water, Sanitation and Hygiene) aim to reach 50,000 beneficiaries in low-income settlements and over 300 professionals through WASH governance studies. It will also reach out to 2,500 students through 20 municipal schools across India.
The goal is to help achieve the Government of India’s sanitation targets by conducting a WASH risk analysis in slums of Kolkata and Chennai. As first steps, two urban neighbourhoods – Kannagi Nagar and Nedunchelliyan Nagar in Chennai, and areas in KMC wards 57 and 58 (Khayari basti, Arupota and Dhapa) in Kolkata – have been chosen for household surveys.
The project will assist in developing participatory intervention strategies in urban areas, and in building the capacity of faculty and students through a model sanitation curriculum.\
Read the complete article.
Urban Malaria: Understanding its Epidemiology, Ecology, and Transmission Across Seven Diverse ICEMR Network Sites
Urban Malaria: Understanding its Epidemiology, Ecology, and TransmissionAcross Seven Diverse ICEMR Network Sites. Am Jnl Trop Med Hyg, Aug 2015.
Authors: Mark L. Wilson, Donald J. Krogstad, et al.
A major public health question is whether urbanization will transform malaria from a rural to an urban disease. However, differences about definitions of urban settings, urban malaria, and whether malaria control should differ between rural and urban areas complicate both the analysis of available data and the development of intervention strategies. This report examines the approach of the International Centers of Excellence for Malaria Research (ICEMR) to urban malaria in Brazil, Colombia, India (Chennai and Goa), Malawi, Senegal, and Uganda. Its major theme is the need to determine whether cases diagnosed in urban areas were imported from surrounding rural areas or resulted from transmission within the urban area.
If infections are being acquired within urban areas, malaria control measures must be targeted within those urban areas to be effective. Conversely, if malaria cases are being imported from rural areas, control measures must be directed at vectors, breeding sites, and infected humans in those rural areas. Similar interventions must be directed differently if infections were acquired within urban areas. The hypothesis underlying the ICEMR approach to urban malaria is that optimal control of urban malaria depends on accurate epidemiologic and entomologic information about transmission
Entering the city: emerging evidence and practices with safety nets in urban areas, 2015.
Author: Ugo Gentilini, World Bank.
Most safety net programs in low and middle-income countries have hitherto been conceived for rural areas. Yet as the global urban population increases and poverty urbanizes, it becomes of utmost importance to understand how to make safety nets work in urban settings. This paper discusses the process of urbanization, the peculiar features of urban poverty, and emerging experiences with urban safety net programs in dozens of countries. It does so by reviewing multidisciplinary literature, examining household survey data, and presenting a compilation of case studies from a first generation of programs.
The paper finds that urban areas pose fundamentally different sets of opportunities and challenges for social protection, and that safety net programs are at the very beginning of a process of urban adaptation. The mixed-performance and preliminary nature of the experiences suggest to put a premium on learning and evidence-generation. This may include revisiting some key design choices and better connecting safety nets to spatial, economic, and social services agendas compelling to urban areas.
Interpersonal communication as an agent of normative influence: a mixed method study among the urban poor in India
Interpersonal communication as an agent of normative influence: a mixed method study among the urban poor in India. Reprod Health. 2015; 12: 71.
Authors: Rajiv N. Rimal, Pooja Sripad, et al.
Background - Although social norms are thought to play an important role in couples’ reproductive decisions, only limited theoretical or empirical guidance exists on how the underlying process works. Using the theory of normative social behavior (TNSB), through a mixed-method design, we investigated the role played by injunctive norms and interpersonal discussion in the relationship between descriptive norms and use of modern contraceptive methods among the urban poor in India.
Methods - Data from a household survey (N = 11,811) were used to test the underlying theoretical propositions, and focus group interviews among men and women were then conducted to obtain more in-depth knowledge about decision-making processes related to modern contraceptive use.
Results - Spousal influence and interpersonal communication emerged as key factors in decision-making, waning in the later years of marriage, and they also moderated the influence of descriptive norms on behaviors. Norms around contraceptive use, which varied by parity, are rapidly changing with the country’s urbanization and increased access to health information.
Conclusion - Open interpersonal discussion, community norms, and perspectives are integral in enabling women and couples to use modern family planning to meet their current fertility desires and warrant sensitivity in the design of family planning policy and programs.
Life in a landfill slum, children’s health, and the Millennium Development Goals. Sci Total Env, Dec 2015.
Authors: Tomoyuki Shibata, et al.
• Waste-pickers and the health and well-being of their children are examined
• Landfill slum (LS) residents do not have a share in improving economies
• LSs illustrate the interrelationship of Millennium Development Goals
• LS mothers and children are exposed to toxic chemicals and pathogens
• MDGs directly and indirectly addresses issues affecting LS children’s health
• Improved solid waste management will benefit LS resident health and well-being
People living in slums can be considered left behind with regard to national successes in achieving Millennium Development Goals (MDGs). The objective of this study was to evaluate the living and working conditions of waste pickers and their children in a landfill slum located in the largest city in eastern Indonesia. A total of 113 people from the landfill slum and 1184 people from the general population participated in face-to-face interviews. Municipal solid waste (MSW) was analyzed for metals, metalloids and fecal indicator bacteria. Ambient air quality including particulate matter was measured in the landfill. Households in the landfill slum were 5.73 (p = 0.04) times more likely to be below the international poverty line (MDG 1: Poverty) and 15.6 times (p < 0.01) more likely to have no one in the household possessing a primary education (MDG 2: Universal Education), and 107 times (p < 0.01) more likely not to have improved sanitation facilities (MDG 7: Environmental Sustainability) when compared to the general population. Diarrhea is one of the leading causes of death in children under five in Indonesia. Young children living in the landfill slum were 2.87 times (p = 0.02) more likely to develop diarrhea than their general population counterparts. Other survey results and environmental measurements suggest that landfill slum children have additional adverse health effects (e.g. infections and poisoning). Poverty underlies several MDG issues that directly or indirectly affect child health. Therefore, eradicating extreme poverty will continue to be the most critical challenge for the MDGs beyond 2015.
Current state and trends of access to sanitation in Ethiopia and the need to revise indicators to monitor progress in the Post-2015 era
Current state and trends of access to sanitation in Ethiopia and the need to revise indicators to monitor progress in the Post-2015 era. BMC Public Health. 2015; 15: 451.
Abebe Beyene,corresponding author Tamene Hailu, Kebede Faris, and Helmut KloosAuthor information ► Article notes ► Copyright and License information ►Go
Background - Investigating the current level and trends of access and identifying the underlying challenges to sanitation system development will be useful in determining directions developing countries are heading as they plan to promote sustainable development goals (post 2015 agenda). This research investigates the status and trends of access to improved sanitation coverage (ISC) in relation to the MDG target in Ethiopia with the aim of identifying prevailing constraints and suggesting the way forward in the post-MDG era.
Method - We examined data from a nationwide inventory conducted in accordance with the sanitation ladder at the national level and from a household survey in randomly selected urban slums in Addis Ababa. The inventory data were analyzed and interpreted using the conceptual model of the sanitation ladder. We used administrative reports and survey results to plot the time trend of the ISC.
Results - The data from the nationwide inventory of sanitation facilities, which are presented along the sanitation ladder reveal that more than half of the Ethiopian population (52.1%) still used unimproved sanitation facilities in 2014. The majority (35.6%) practiced open defecation, implying that the country is far from the MDG target for access to improved sanitation (56%). Most people in urban slums (88.6%) used unimproved sanitation facilities, indicating that the urban poor did not receive adequate sanitation services. Trend analysis shows that access to ISC has increased, but Central Statistical Authority (CSA) data reveal a decline. This discrepancy is due to differences in data collection methods and tools. Dry pit latrines are the most widely used toilet facilities in Ethiopia, accounting for about 97.5% of the ISC.
Conclusion - The sanitation coverage is far from the MDG target and the majority of the population, mainly the urban poor, are living in a polluted environment, exposed to water and sanitation-related diseases. The sanitation coverage estimates might be even lower if proper utilization, regular emptying, and fecal sludge management (FSM) of dry pit latrines were considered as indicators. In order to enhance sanitation services for all in the post-MDG era, urgent action is required that will establish proper monitoring and evaluation systems that can measure real access to ISC.
Sharing reflections on inclusive sanitation. Env & Urbanization, March 2015.
Authors: E Banana, et al.
This paper draws on sanitation innovations in Blantyre (Malawi), Chinhoyi (Zimbabwe), Dar es Salaam (Tanzania) and Kitwe (Zambia) driven by slum(1)/shack dweller federations to consider what an inclusive approach to sanitation would involve. This includes what is possible for low-income households when there is little or no external support, no piped water supply and no city sewers to connect to.
The paper discusses low-income households’ choices in situations where households can only afford US$ 3–4 per month for sanitation (for instance between communal, shared and household provision). It also considers the routes to both spatial and social inclusion (including the role of loan finance in the four cities) and its political underpinnings. In each of the four cities, the community engagement in sanitation intended from the outset to get the engagement and support of local authorities for city-wide sanitation provision
Shared Sanitation Versus Individual Household Latrines in Urban Slums: A Cross-Sectional Study in Orissa, India
Shared Sanitation Versus Individual Household Latrines in Urban Slums: A Cross-Sectional Study in Orissa, India. Am J Trop Med Hyg. 2015 Jun.
Authors: Heijnen M, Routray P, Torondel B, Clasen T.
A large and growing proportion of the global population rely on shared sanitation facilities despite evidence of a potential increased risk of adverse health outcomes compared with individual household latrines (IHLs). We sought to explore differences between households relying on shared sanitation versus IHLs in terms of demographics, sanitation facilities, and fecal exposure. We surveyed 570 households from 30 slums in Orissa, India, to obtain data on demographics, water, sanitation, and hygiene.
Latrine spot-checks were conducted to collect data on indicators of use, privacy, and cleanliness. We collected samples of drinking water and hand rinses to assess fecal contamination. Households relying on shared sanitation were poorer and less educated than those accessing IHLs. Individuals in sharing households were more likely to practice open defecation. Shared facilities were less likely to be functional, less clean, and more likely to have feces and flies.
No differences in fecal contamination of drinking water or hand-rinse samples were found. Important differences exist among households accessing shared facilities versus IHLs that may partly explain the apparent adverse health outcomes associated with shared sanitation. As these factors may capture differences in risk and promote sanitary improvements, they should be considered in future policy.
Redefining shared sanitation. WHO Bulletin, July 2015.
Authors: Thilde Rheinländer, Flemming Konradsen, Bernard Keraita, Patrick Apoya, and Margaret Gyapong
The proportion of people depending on shared toilets is higher in the least developed countries (16%) and highest in sub-Saharan Africa, where 19% of the population depends on shared sanitation. In the same region, a staggering 33% of the urban population depends on shared sanitation, and in 17 sub-Saharan countries the rates of people using shared sanitation is on the increase. In four Asian countries, Bangladesh, China, Mongolia and the Philippines, over 15% of the population depend on shared sanitation – a number that increases daily.
Current definitions do not account for the diversity of shared sanitation: all shared toilet facilities are by default classified as unimproved by JMP because of the tendency for shared toilets to be poorly managed and unhygienic. However, we argue that shared sanitation should not be automatically assumed to be unimproved.
Usage and Barriers to Use of Latrines in a Ghanaian Peri-Urban Community. Environmental Processes, March 2015
Authors: Peter A. Obeng, Bernard Keraita, Sampson Oduro-Kwarteng, Henrik Bregnhøj, Robert C. Abaidoo, Esi Awuah, Flemming Konradsen
This study was conducted in a Ghanaian peri-urban setting to understand the factors that influence the usage of household and communal latrines and to discuss potential interventions to address existing barriers to regular usage. Data was collected using household survey questionnaires orally administered to 189 and 283 respondents with access to private and communal latrines respectively, five focus group discussions with gender and age groups, as well as observations at latrines. It was found that only 15 % of households had access to latrines at home while the rest depended on communal latrines or practised open defecation.
The ventilated improved pit latrine was the commonest technology used by 47 % of households with private latrines. The residents ranked safety and privacy as the most important factors that influenced their decision to use any latrine. For private latrines, desludging challenges (14 %) and intense odour (7 %) were the most significant technical barriers while the most significant non-technical barriers were lack of immediate access when the latrine is locked or busy (28 %).
For communal latrines, the major technical barrier was intense odour (23 %) while the major non-technical barriers were distance to latrines (28 %), user fees (21 %) and unhygienic conditions (7 %). Regular latrine usage in the study setting may be enhanced by technical support to address desludging challenges and control odour in latrines, as well as social interventions to make communal latrines affordable and more hygienic.
Is it possible to reach low-income urban dwellers with good-quality sanitation? Env & Urbanization, Apr 2015.
Authors: David Satterthwaite, Diana Mitlin, Sheridan Bartlett
Before public or shared toilets are dismissed as appropriate solutions, is it not worth asking their users what their needs are, what is deficient, what should be done to address this, by whom and with what funding? Where there isn’t universal provision for high-quality sanitation, it is only by engagement with those needing solutions in each location that effective, appropriate solutions will be developed.
The Sanitation Ladder, What Constitutes an Improved Form of Sanitation? Env Sci Tech, Dec 2014.
Authors: Josephine L. R. Exley, Bernard Liseka, Oliver Cumming, and Jeroen H. J Ensink
This study aimed to assess whether the MDG classifications and JMP sanitation ladder corresponded to hygienic proxies. Latrines were purposefully sampled in urban and rural Tanzania. Three hygienic proxies were measured: E. coli on points of hand contact, helminth at point of foot contact, and number of flies. Additionally, samples were collected from comparable surfaces in the household, and a questionnaire on management and use, combined with a visual inspection of the latrine’s design was conducted. In total, 341 latrines were sampled.
The MDG classifications “improved” vs “unimproved” did not describe the observed differences in E. coli concentrations. Disaggregating the data into the JMP sanitation ladder, on average “shared” facilities were the least contaminated: 9.2 vs 17.7 (“improved”) and 137 E. coli/100 mL (“unimproved”) (p = 0.04, p < 0.001). Logistic regression analysis suggests that both the presence of a slab and sharing a facility is protective against faecal-oral exposure (OR 0.18 95% CI 0.10, 0.34 and OR 0.52, 95% CI 0.29, 0.92). The findings do not support the current assumption that shared facilities of an adequate technology should be classified for MDG purposes as “unimproved”.
Shared Sanitation Versus Individual Household Latrines in Urban Slums: A Cross-Sectional Study in Orissa, India
Shared Sanitation Versus Individual Household Latrines in Urban Slums: A Cross-Sectional Study in Orissa, India. Am Jnl Trop Med Hyg, June 2015.
Authors: Marieke Heijnen, Parimita Routray, Belen Torondel and Thomas Clasen
A large and growing proportion of the global population rely on shared sanitation facilities despite evidence of a potential increased risk of adverse health outcomes compared with individual household latrines (IHLs). We sought to explore differences between households relying on shared sanitation versus IHLs in terms of demographics, sanitation facilities, and fecal exposure. We surveyed 570 households from 30 slums in Orissa, India, to obtain data on demographics, water, sanitation, and hygiene. Latrine spot-checks were conducted to collect data on indicators of use, privacy, and cleanliness. We collected samples of drinking water and hand rinses to assess fecal contamination.
Households relying on shared sanitation were poorer and less educated than those accessing IHLs. Individuals in sharing households were more likely to practice open defecation. Shared facilities were less likely to be functional, less clean, and more likely to have feces and flies. No differences in fecal contamination of drinking water or hand-rinse samples were found. Important differences exist among households accessing shared facilities versus IHLs that may partly explain the apparent adverse health outcomes associated with shared sanitation. As these factors may capture differences in risk and promote sanitary improvements, they should be considered in future policy.
Container-based sanitation: assessing costs and effectiveness of excreta management in Cap Haitien, Haiti
Container-based sanitation: assessing costs and effectiveness of excreta management in Cap Haitien, Haiti. Env & Urbanization, Apr 2015.
Authors: S Tilman.
Container-based sanitation (CBS) – in which wastes are captured in sealable containers that are then transported to treatment facilities – is an alternative sanitation option in urban areas where on-site sanitation and sewerage are infeasible. This paper presents the results of a pilot household CBS service in Cap Haitien, Haiti. We quantify the excreta generated weekly in a dense urban slum,(1) the proportion safely removed via container-based public and household toilets, and the costs associated with these systems.
The CBS service yielded an approximately 3.5-fold decrease in the unmanaged share of faeces produced, and nearly eliminated the reported use of open defecation and “flying toilets” among service recipients. The costs of this pilot small-scale service were higher than those of large-scale waterborne sewerage, but economies of scale have the potential to reduce CBS costs over time. The paper concludes with a discussion of planning and policy implications of incorporating CBS into the menu of sanitation options for rapidly growing cities.