An urban sanitation primer

Pete Kolsky, WSP HQ

pkolsky@worldbank.org

Perspectives/prejudices

A primer basic and not detailed

Public health perspective

A preoccupation with basic needs

not intended to insult anybodys

intelligence or competence

Reaching those with no access

Myths? More like science and

folklore

Will try to distinguish the two

Definitions of sanitation
Safe interaction with human excreta
Facilities required for safe management
of excretanot hygiene promotion
Environmental sanitation

1.
2.

3.

The environmental services required for

healthy livingincludes water supply,
sanitation, drainage, solid waste management,
etc.

For this presentation, will lean towards

2nd definition

The good news in

sanitation
Population
Served
Urban
Rural
Total

1990
2000
%
Million Millions Change
s
1877
1028
2905

2442
1210
3652

30%
18%
26%

747 million gained access to sanitation

from 1990 to 2000!

and the bad news

Population
Unserved

1990 2000
Million Millions
s

%
Change

Urban
Rural
Total

415
1946
2361

-3%
+3%
+2%

403
2000
2403

Because of population growth, there were 42

million more without access over the decade!
And these numbers are probably optimistic!

Sanitation and disease

Diarrhoea

2.2 million deaths/year worldwide

> 4 lakh in India alone1000/day = 40/hr
1 billion episodes of diarrhoea per year in
India2-3 episodes/child/year
Most vulnerable (and most infectious) are
under 5mostly under 2
Yet many believe that childs faeces are safe

Worms (Hookworm, roundworm)

Billions of cases
Transmitted through soil contamination

The F-diagramme
Fluid
s

Faece
s

Finger
s
Flies

Fields/
Floors

Food

New
Victi
m

Implications for sanitation

& health

Sanitation is more than keeping

water supplies clean

Other routes are generally more

important

Hardware without hygiene will get

us nowhere
The biggest and toughest challenge
is management of faeces of kids < 2

Basic technical factors

Your water supply and disposal determine

your sanitation options
Little
wastewate
r

Lots of
wastewate
r

Onsite

Latrines,
TPPF

Septic tanks,
soakaways

Offsite

Conservancy Sewerage

Water?
Disposal

All four present in many South Asian cities

On-site, little water

Pit latrine
Principles:

Isolate the waste from human contact

When full, dig new pit, seal old one.
Store for > 1 year to reduce/eliminate risk
Empty, recycle/dispose of contents (sludge)

Problems/challenges:

High water table, rocky soils

Sludge management needs to be considered
No sullage (grey water) management

Twin-Pit Pour Flush

Diversio
n box
Watersealed
slab

Principles:

Pit
s

Water-flush and seal controls odours

Brick in diversion box blocks off filled pit for one
year before emptying, recycling compost

Disadvantages:

As with pit latrine, except smell, easier

alternation

EcoSan

Latrine contents stabilized after a

years isolationcan use as compost

Basis of Twin Pit Pour Flush

EcoSan focus on urine separation

use urine as ammonia source, solids
stabilize better
Build above ground to facilitate
emptying

EcoSan (contd)

Question: If we cant sell the most

basic on-site sanitation at 500 Rs/HH,
why do we think we can sell more
expensive EcoSan?

When economics of compost used as

justification, check market very carefully

Areas of high GW table, rocky soil,

extra cost of EcoSan relatively small

On-site, lots of water

(septic tanks)
Scu
m

Gravel-filled
infiltration bed,
open-jointed pipe

Settle
d
Principles:
sludg

Solids settle out before sewage seeps into soilsoil

e

then filters sewage

Problems:

Cannot seep into clay or plugged soil or high WT

Sludge mgemt: must empty from time to time, and
where does sludge go?

On-site sanitation and

groundwater

On-site sanitation systems can

contaminate groundwater, esp. in
areas of high GW table.
Can often be controlled by adequate
distance (15m in most soils)
Where perceived as a problem
1.
2.

Is groundwater used for water supply?

Is alternative water supply cheaper/easier
than not doing on-site sanitation?

Off-site, little water

Conservancy or bucket/basket
system
Rightly condemned as hazardous
to its workers but
Where it exists, do we deny it?
Can we improve it?

Off-site: lots of water

Sewerage! The engineers favourite!!

Principle:

Water carries excreta through pipes to

treatment works

Problems/challenges:

Expensive!!!!
Needs a steady water supply
A lot goes into rivers untreated
and most sewage ttmt protects fish, not
people

Its all got to go

somewhere

Sewerage
a)
b)

Consider outlet/informal reuse carefully

Sludgewhere does it go?

Septic tanks, pit latrines, TPPF

a)

Sludge managementhow handled?

1)
2)

Wet sludge (septic tanks) decentral. ttmt

Dry sludge from latrines solid waste
chain?

Public health notions of

sewage treatment

How do you know sewage is bad?

Smell
Colour
Dead fish
Algae
Sludge banks

If somebody removed all those

problems, would the water be OK?

What sewage treatment

does

Removes solids (SS)

Removes organic load that depletes
oxygen that kills fish (BOD)
Some removes nutrients for algae (N, P)
VERY FEW REMOVE PATHOGENS

As Klaus said this morning, detention time &

sunlight are your best disinfectants
Chlorination is NOT a straightforward solution

Organic demand + particles poor disinfection

Nature of the challenge

Lack of demand
Lack of interest (political will)
Lack of ownership
Its not cheap
It involves deep psycho-cultural issues
Like all public goods, subject to politics
Often technically difficult (esp. urban)
Hygiene promotion is poorly understood
other than that, its straightforward!

Particularly urban issues

Urban sanitation matters more

Higher population densities

More likely to be complicated by water to
spread muck around

Institutional challenges, and

opportunities, are more complex

Role of utility for wastewater?

Role of utility for onsite sanitation?
Heterogeneous populations, communities

River &
Environs
City

Home

Peridomestic

(street,
school,
workplace)

Ward

Primary
network

Secondary
network

City

Collector

Peri- Ward
domestic

Home

House
Connection
(street,
school,

Sewage
Treatment
Plant

workplace)

Outfall

River &
Environs

Whats the point?

Household perception matches

public health perception!

FIRST get it out of the home, THEN

out of street, THEN address overall
city waste management issues
Engineers/managers perception of
priorities is in reverse for variety of
reasons (cost, complexity, prestige)

Home
Peridomestic

(street,school,

Ward

workplace)

City

Central Treatment
Works
Primary
Sewers
Secondary
Sewers
House
Connections

Three network approaches

Slum networking (Parikh)

Orangi Pilot Project model

Slums located along the waste collectors of

the city
If you upgrade these collectors, marginal cost
of serving slums is smallinclude them!
HH and street organise, manage construction of
secondary (street) infrastructure;
Municipality/utility manages primaries and ttmt

Condominial (Latin America, utility driven)

Similar to OPP, more integrated into planning,

various contract options for maintenance

Generic institutional issues

Whos doing it now?

Sanitation is like housing

Whos responsible in govt?

1. People do for themselves

2. Largely informal arrangements

Health dept
Water dept
Neither of whom is necessarily appropriate

How well can formal meet informal?

How can we nudge, cajole, promote the
evolution of the mix in the right direction?

Scaling up?

Definition?

Increased volume of facility construction

and use
Sustainable

Do we mean

How can we get 300,000 new latrines a

year?
OR
How can we build a sustainable industry?

Why is scaling up difficult?

How come we have great projects and

lousy programmes?
Intensity of commitment

Span of control

High % ownership of commitment on pilots

Complex interventions handled at project level

Capacity

How many good NGOs/agencies are there?

Calibre of staffAll the good ones are taken

Sustainable industry
requirements

If somebody can make a buck out of it, it

will expandif they cant, it wont
Demand

Why people want sanitation (demand study in

Philippines)
1.
2.
3.
4.
5.

lack of smell and flies

cleaner surroundings
privacy
less embarrassment when friends visit
less gastrointestinal disease

Yet how do we sell it?

No demand without tenure!!

Sanitation as a business

Good sensible marketing

Offer a range of options

At least as important Design to price

(Midnapur a good example)

Understand/facilitate the growth of

the industry

Subsidies?
Cash flow?
Materials?

Hygiene Promotion &

Sanitation Marketing
Hygiene
promotio
n

Sanitatio
n
Marketin
g

Behaviour

Hardware

Could you sell it for

money?

No

Yes

Does it cost a lot of cash?

No

Yes

Does it involve credit?

No

Often

Does it require constant

attention?

Yes

No

Prime audiences?

Whole family

Purse holder

Who is likely to do it?

Health

Masons

Whats being promoted?

Some Principles of
Hygiene Promotion

3 priorities

Hand-washing at right times with soap (or

other agent?)
Safe disposal of faeces
Safe management of water

DONT add more messages

Repeat often
Be positive, dont preachAvoid
Doctors, Death and Diarrhoea

Appropriate govt support

Clear consistent policy framework

Clear leadership, clear authority (esp. urban)

Enabler not provider

Five-year (production) plan died with the Soviet Union

Start from a mix of technologies, move to another
mix of technologies with greater coveragebut not
through direct provision
Subsidize promotion, not production

Strong encouragement of individual HHs

examples of Midnapur, Vietnam (likely)

Some credit issues/options

Sanitation is like a bridge

building 90% doesnt count for

much!
Therefore a lumpy investment

Credit issues

South Asia the home of micro-credit

You can tell me more than I can tell you!!

One example from Vietnam

Revolving funds for

sanitation: Vietnam

A credit system for household sanitation

improvement (latrines, septic tanks,
sewerage connections)
Womens Union manages the credit through
savings-credit groups
A linkage with income generation and public
awareness of health/environment issues
Target:

Low income families

Coverage of 80-90% of HH in city (approx 14,000)

Saving-Credit groups

Organized in groups of 1215 persons.

Saving of 20,000 VND/mo
(US $1.3) required
throughout loan period
Savings provide 480,000
VND ($32 US) towards
repayment of the principle
Savings can be on-lent to
other savings-credit group
members for income
generation.

Achievement so far (April 2002)

High number of borrowers

Over 350 Savings-Credit Groups formed
Over 4000 borrowers in less than 1 year
80% of borrowers construct their households
sanitation facility within two months of
receiving the loan
Nearly all of sanitation facilities are
constructed within three months of
disbursement
High repayment rate 95 %

Main points of the news

1.

Put sanitation in public health context

2.

Means to an end, not an end in itself

Kids < 2 most important of all
Household most important focus of intervention

The biggest issue is behaviour change

Hygiene issues, barely touched on here

Must learn to market sanitation at both household
and community
Hygiene is hard-to-monitor, not as popular as
sanitation hardware for project funding

Main points of news

(contd)
Generating demand

3.

There is no gain in providing sanitation

people dont want
Hygiene promotion sanitation marketing

Whats the problem you have to solve?

4.

Must consider on-site/off-site, water/w.o. water

to define options

The ring diagrammes

5.

Helps to keep priorities clear for interventions

Helps to identify breakdowns in the faecal
chaindont forget sludge management!!

Main points of news

(contd)
Institutional realism

6.

The five-year plan forces what is not

wantedand will be self-defeating
Trying to nudge, cajole, promote, steer a shift
in mix from now to a better future
Need clear leadership and accountability in
govt
Defining the mix of formal/informal and the
role of utility

Credit/finance matters

7.

Micro-credit worth exploring

Some provisional
principles
Sanitation cannot be only for the poor

Plenty of middle-class slums with appalling

sanitation there is no excuse!
Need to segment the market to build an
industryinternal cross-subsidy?
Sanitation promotion through status?

Start where you arenot where you

want to be

Dont race to transform with alien technology

people dont understand, havent experienced
Work with those who are currently providing
the servicelearn from their reality

Provisional principles (2)

Keep mechanisms, benefits clear

Elimination of open defecation a

worthwhile goal, but dont forget infants
excreta
Public toilets, shared latrines? Need to
observe behaviour before counting lives
saved
Most sewage treatment is (a) expensive
and (b) has minimal public health impact

Justification is environmental, not public health

Provisional principles (3)

The perfect is the enemy of the good

Beware of engineers minimal acceptable

standards of sanitation

Design to affordable pricejust like every other business

Focus on excreta, not all environmental problems

Be pragmatic about subsidies

Subsidize promotion more than productionWhen

overall demand takes off, production can remain
sustainablepeople not waiting for a subsidy
Sewerage has always been subsidizedwhy
subsidize only those with house connections?
For sewerage, subsidize connection, not O & M

Some approaches to
discuss

Developing the market

Find out determinants, constraints on

demand
Reduce them (redesign sanitation, sell
better, subsidize promotion,
purchase?)
Support infant industry
Get out of the way

Approaches to discuss (2)

NGO triggering of total sanitation

Current WSP/Wateraid/VERC work in

Bangladesh, Maharashtra
How many NGOs, what scale can be
managed?

Utility/CBO partnership on network

Outermost branches of tree managed by

CBO, trunks by utility