Dear SuSanA members,

Below is a recently published article (available for open access) regarding "safely managed" sanitation services

washdev.iwaponline.com/content/early/201.../30/washdev.2017.023

Title: Limited services? The role of shared sanitation in the 2030 Agenda for Sustainable Development
Authors: Barbara Evans, Andrés Hueso, Richard Johnston, Guy Norman, Eddy Pérez, Tom Slaymaker, Sophie Trémolet

Abstract
Target 6.2 of the Sustainable Development Goals calls for universal access to sanitation by 2030. The associated indicator is the population using ‘safely managed’ sanitation services. Shared sanitation is classified as a ‘limited’ sanitation service and some donors and governments are reluctant to invest in it, as it will not count towards achieving target 6.2. This could result in poor citizens in dense slums being left out of any sanitation improvements, while efforts are diverted towards better-off areas where achieving ‘safely managed’ sanitation is easier. There are sound reasons for labelling shared sanitation as ‘limited’ service, the most important being that it is extremely difficult – for global monitoring purposes – to differentiate between shared toilets that are hygienic, accessible and safe, and the more common ones which are poorly designed and managed. There is no reason to stop investing in shared sanitation. ‘Safely managed’ represents a standard countries should aspire to. However, the 2030 Agenda and the human rights recognise the need for intermediate steps and for reducing inequalities. This calls for prioritising investments in high-quality shared toilets in dense informal settlements where it is the only viable option (short of rehousing) for improving sanitation services.


Best wishes,

Pelumi for SuSanA Secretariat

Shared Sanitation

Experts, like Barbara Evans, Andrés Hueso, Richard Johnston, Guy Norman, Eddy Pérez, Tom Slaymaker and Sophie Trémolet (formerly of Tremolet Consulting, now in World Bank), have written a editorial titled: Editorial: Limited services? The role of shared sanitation in the 2030 Agenda for Sustainable Development. They have urged the policymakers and donors to recognise the role the high-quality shared toilets can play in addressing the urgent needs of those living in dense slums, where a toilet in every household is not often an option. They further argue that this is a indispensable step for better health and dignity of the urban poor.

Duncan Mara of University of Leeds was kind enough to send me a paper: “Shared sanitation: to include or to exclude?” Mara appears to be more specific. He says:

“Just over 600 million people used shared sanitation in 2015, but this form of sanitation is not considered ‘improved sanitation’ or, in the current terminology, ‘basic sanitation’ by WHO/UNICEF, principally because they are typically unhygienic. Recent research has shown that neighbour-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.”

Mara has coined the term “neighbour-shared toilets,” and says neighbour-shared toilets perform much better than large communal toilets. This makes sense - neighbour-shared toilets, with services of a caretaker, can perform better than large communal toilets.

On the other hand, authors (which include Sandy Cairncross), writing under “Determinants of quality of shared sanitation facilities in informal settlements: case study of Kisumu, Kenya,” say: “Shared facilities, most of which were dirty, were shared by an average of eight households, and their quality decreased with an increase in the number of households sharing.”

Another paper, “User Perceptions of Shared Sanitation among Rural Households in Indonesia and Bangladesh,” says:

“Our results suggest that private improved sanitation is consistently preferred over any other sanitation option. An increased number of users appeared to negatively affect toilet cleanliness, and lower levels of cleanliness were associated with lower levels of satisfaction. However, when sanitation facilities were clean and shared by a limited number of households, users of shared facilities often reported feeling both satisfied and safe.”

Another paper: “Menstrual Hygiene Practices, WASH Access and the Risk of Urogenital Infection in Women from Odisha, India,” says: “Interventions that ensure women have access to private facilities with water for MHM and that educate women about safer, low-cost MHM materials could reduce urogenital disease among women.”

During Hajj (a Muslim pilgrimage to Makkah and Madinah, Saudi Arabia), where on an average 2.5 million people move from one to another, I found that when toilets are adequate (in numbers), and more importantly, toilet cleaners are always there, toilets remained clean and tidy. On the other hand, shared toilets here in Sindh province, Pakistan, are extremely dirty, pathetic and unhygienic.

So, the bottom line is: if the shared sanitation is opted, then frequent cleaning is the key to their success.

F H Mughal
PS: Protracted length of this post may be excused.

Hi,

Have a look at this article:

blogs.worldbank.org/water/shared-toilets...dignity#comment-1524

Shared sanitation facilities are extremely vital in densly populated low income urban areas. Perhaps you can also look at the UBSUP programme in Kenya. They have constructed more than 7.900 household/plot level shared sanitation facilities and 7 decentralised treatment facilities in approximately 23 towns.

See here: forum.susana.org/forum/categories/167-ma...t-fund-and-giz-kenya

As long as the toilets are constructed as per the technical designs, there is a strong focus on O&M, sanitation marketing, behaviour change, ensuring that one toilet is utilised by a specific number of people on the plot, then it will work!
To expect individual sanitation facilities in densly populated low income areas is not possible bearing in mind the sizes of the plots.

Best regards,

Doreen

Thanks for your response Kris, that's a really interesting perspective; that by keeping it "unimproved", it keeps the door open for further improvements. I wonder if there's a counter-argument whereby the "unimproved" status leads to shared sanitation not being considered in those situations where it is the best solution; e.g. to tackle OD in informal settlements / amongst the homeless.

Just to clarify, the aim of my research isn't to be an argument for why it should or should not be reclassified, although that discussion is of interest to me (if I was doing a PhD, maybe...). My dissertation is simply to investigate whether shared sanitation can be the best solution (it looks like most would say it can be in some contexts), and if so, how we might be able to assess i) what those contexts are and ii) how we might design and operate such facilities well (if you have a spare 15 mins, feel free to complete the quick questionnaire on the topic, link below ).

I don't think anyone denies that some types of shared sanitation can be beneficial. The discussion is rather if it should be counted as 'improved' sanitation. The problem I (and probably many practitioners) have with that is the implied consequence that after a household is categorized as having 'improved' sanitation that's usually the end of the story in regards to official government recognition that there is a sanitation issue.

So having a lot of very poor households with usually only temporary access to shared sanitation (how ever good it might be) thus fall out of (for example) the eligibility criteria for government subsidies to improve their sanitation situation is not a good thing.

Edit: if there is a recent movement on that, I suppose (cynically) that this is rather because people realize that the SDG target on sanitation will never be reached without the "trick" of counting some shared sanitation in it after all.

Thanks very much for drawing my attention to that thread, I hadn't seen it.
I wonder if the attitudes of the people posting in that original thread have shifted in the last couple of years - it seems to me that the JMP are more open than ever to the notion that some examples of shared sanitation could be beneficial; particularly in informal settlements (which is something that David Satterthwaite and Duncan Mara have argued for in papers published over the last year or so)

We discussed it here already a while ago:
forum.susana.org/182-sustainable-develop...and-mdg-implications

Hello all,
As you may be aware, the Joint Monitoring Program (JMP) have redefined the sanitation ladder in their 2017 "WASH in the 2030 agenda" report, which sets out the monitoring framework for the SDGs. Within this, "shared sanitation" is defined as being "limited" which is between "basic" and "unimproved". However, as with the MDGs, any form of shared sanitation does not contribute to the SDG target percentages of "population using safely managed sanitation services.
At the same time shared facilities are often used to provide sanitation, particularly for the extremely poor such as slum dwellers and the homeless. As we encounter increasing levels of urban growth, we may see an increase in the number of shared sanitation facilities being designed, and so the question remains, how might shared sanitation be best designed, implemented and operated.
As part of a MSc in Global Urban Development and Planning, I'm writing a dissertation on this, and while I'm able to gather information from leading academics and policy papers, I am also interested to see how experts and practitioners (such as yourselves) view the role of shared sanitation - and compare that to the approach JMP has taken on the topic. If you have a spare 15 minutes, I would really appreciate if you share your views on this topic on a short questionnaire I've developed, here: goo.gl/forms/v9bkYEYRopCk4q5k2 .
I will also be at the WEDC conference next week, encouraging you to do the same, feel free to chat to me then!
Many thanks,
Rob

Doreen wrote: Shared sanitation facilities are paramount in low income urban areas and it is totally wrong to say that they are mostly unhygienic. The expectation that each family will have one toilet in a plot is just not feasible. Taking into consideration that many plots e.g. in Kenya have approximately 5 families living within the plot and there is very very limited space.

Sometimes I have the feeling that the people who actually contributed to some of these policy's/ SDG's have no background information on what is actually happening on the ground.

Yes you can get that feeling very often, but in this case I actually think it is just a different perspective of looking at the topic. SDGs etc. are mostly commitments by national governments and like the GDP are measured in really abstract terms like population coverage statistics and so on.

Based on previous experience, it is just way too easy for the respective government departments to hugely inflate coverage figures using shared sanitation. And even if parts of those shared sanitation facilities are perfectly fine, it is not a good thing to have a government proclaiming success in sanitation coverage (and then diverting funds to other sectors) when the reality on the ground is that unhygienic conditions, long waiting times and difficulties in night time access lead to many people using flying toilets as a common "backup".

Looking at it from this perspective also explains why there seems to be little movement to "soften up" the definition of shared sanitation and/or counting private neighborhood toilets differently, as these governmental negotiations are always a huge game of watering down everything (to avoid real commitments), and changing the definition of shared sanitation is seen as an attempt to water down minimum sanitation standards, even if technically justified.

Edit: over-crowed living conditions are also for many other reasons something the government should not be allowed to just accept by changing their minimum standards. Of course this is not something that will be possible to change over night, and in the meantime shared sanitation is often a good interim solution. But if it becomes accepted as a standard, the incentive to actually improve the overall conditions in the longer term (provide social housing etc.) becomes much lower for government technocrats that just care about numbers and minimum standards (and their next promotion ).

Dear Colleagues,

I agree with Duncan Mara. It is ridiculous to say that shared toilets are not considered as improved sanitation and I simply don't understand how this was thought about.

Shared sanitation facilities are paramount in densely populated low income urban areas. The expectation that each family will have one toilet in a plot is just not feasible. Taking into consideration that many plots e.g. in Kenya have approximately 5 families living within the plot and there is very very limited space.

Sometimes I have the feeling that the people who actually contributed to some of these policy's/ SDG's have not received enough background information on what is actually happening on the ground.

Best regards,

Doreen

Note by moderator: an earlier discussion on this topic took place in 2015 here:
forum.susana.org/182-sustainable-develop...and-mdg-implications
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Below is the abstract of a recently published article by Duncan Mara.

Shared sanitation: to include or to exclude? Trans R Soc Trop Med Hyg (2016) 110 (5): 265-267. doi: 10.1093/trstmh/trw029

Just over 600 million people used shared sanitation in 2015, but this form of sanitation is not considered ‘improved sanitation’ or, in the current terminology, ‘basic sanitation’ by WHO/UNICEF, principally because they are typically unhygienic.

Recent research has shown that neighbour-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.