Should shared sanitation services be considered 'improved' sanitation? (and MDG implications)

  • joeturner
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Should shared sanitation services be considered 'improved' sanitation? (and MDG implications)

Hello friends,

I've just noticed this interesting review article in PlOS ONE: www.plosone.org/article/info%3Adoi%2F10....journal.pone.0093300

The authors say that shared facilities are not counted as improved sanitation (for example for MDG target), but that maybe they should be.

Interested to hear thoughts.

Edit:

On closer examination, it does seem to suggest that a change might not be a good idea:

In general, the evidence suggests that those relying on shared sanitation facilities compared to IHLs are at increased risk of adverse health outcomes, including diarrhoeal disease, helminth infection, poliomyelitis, as well as prematurity, antepartum fetal death and perinatal death. The evidence on diarrhoeal disease and on helminth infection reflects a consistent pattern across most studies and study sites, while the evidence on poliomyelitis and adverse birth outcomes was generated from single studies. On the other hand, research found no increased risk of trachoma associated with reliance on shared sanitation.


+++++++++

Shared Sanitation versus Individual Household Latrines: A Systematic Review of Health Outcomes
Marieke Heijnen, Oliver Cumming, Rachel Peletz, Gabrielle Ka-Seen Chan, Joe Brown, Kelly Baker, Thomas Clasen
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  • JKMakowka
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Re: should shared sanitation services be considered 'improved' sanitation?

This is a constant topic here in Uganda as the government is counting shared facilities towards their sanitation coverage goal.

I think that due to mostly non-technical and non-health related reasons they should not count towards a policy goal (which the MDG "improved sanitation" category is).

Microbiologist & emergency WASH specialist
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  • joeturner
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Re: should shared sanitation services be considered 'improved' sanitation?

Thanks Krischan - can you tell me some of the non-technical and non-health related reasons why you think they should not count towards the policy goal (or maybe that is not your opinion but the one held in Uganda, I'm not clear from your post).
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  • muench
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Re: should shared sanitation services be considered 'improved' sanitation?

It depends what you compare it to: Shared sanitation is usually not as good as household-level sanitation but shared sanitation can be better than nothing (or better than open defecation).

Just think of the acclaimed Sanergy model with shared (public) sanitation... ( forum.susana.org/forum/categories/52-mob...ry-loo-user-and-kiva )

So I do think that "shared sanitation" should have some sort of impact on the MDG counting for sanitation.

This has been discussed at length by the working groups that have been discussing possible MDGs after the year 2015. See here in this thread from 2012:
forum.susana.org/forum/categories/80-glo...anitation-monitoring

In fact, recently I received the attached document by Eddy Perez entitled "WASH POST-2015: proposed targets and indicators for drinking-water, sanitation and hygiene" (April 2014). In there you find the following statement which sounds reasonable to me:

Each of the following sanitation facility types is
considered as basic sanitation for monitoring
progress toward the household sanitation
targets, if the facility is shared among no more
than 5 families or 30 persons
, whichever is
fewer, and if the users know each other.


It's a nice compromise: "shared" would be counted but only if not shared with too many people, and not shared with strangers.

Actually I am not up to scratch where this process with the future MDGs or SDGs is at right now (see here on Sustainable Development Goals, SDGs: forum.susana.org/forum/categories/80-glo...velopment-goals-sdgs )

If anyone can enlighten us (Jonathan? Madelein? Chris Z.?), that would be appreciated.

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Elisabeth

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  • JKMakowka
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Re: Should shared sanitation services be considered 'improved' sanitation? (and MDG implications)

The Ugandan government figure that includes shared sanitation is something like 70% coverage, while the MDG figure is something like 30%. Even though I agree that shared sanitation is better than nothing in most cases (and is definitely needed in urban settings) it is mainly an additional service to household level sanitation and can't replace it. Thus counting it towards sanitation coverage (with usually hugely inflated user numbers) will just result in a neat excuse for governments to continue with their business as usual.

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  • F H Mughal
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Re: Should shared sanitation services be considered 'improved' sanitation? (and MDG implications)

While Elisabeth has a point, when she says: "Shared sanitation is usually not as good as household-level sanitation but shared sanitation can be better than nothing (or better than open defecation)." Examining strictly in the context of this region, I have seen shared sanitation facilities that are simply dirty, unhygienic and pathetic. This could be due to the fact that, in shared facilities, no one is responsible for maintenance. May be, there could be a different case in developed countries.

I would, therefore, support the authors' views - shared sanitation facilities should not be counted as improved sanitation.

F H Mughal

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  • jkohlitz
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Re: Should shared sanitation services be considered 'improved' sanitation? (and MDG implications)

Aside from increased health risks that may be associated with shared sanitation versus an individual household latrine, shared sanitation often suffers in other dimensions as well: Harassment of women using the facilities after dark, poor accessibility for people living with disabilities and pay-per-use fees that could lead poor people to pay more for sanitation in the long-run than richer people (such as is often the case with water) come to mind. I guess I'm thinking more of an urban, public facility run by the government or entrepreneur though.
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Re: Should shared sanitation services be considered 'improved' sanitation? (and MDG implications)

Yes, I was also mainly thinking of public facilities, but the same applies also to households sharing a toilet.

Attached a good policy brief on the issue from u-act research project (with findings from Kampala).

Christoph discussed an included very interesting diagram on perception of cleanliness Vs. number of users here : forum.susana.org/forum/categories/106-us...-kampala-uganda#6567 .

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  • PatrickBBB
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Re: Should shared sanitation services be considered 'improved' sanitation? (and MDG implications)

I have been following this discussion for a while. Excuse me for reiterating, but it seems to me that everyone is agreeing that including shared sanitation services (all of it) to the sanitation coverage is not advisable. I concur to this. The argument that it brings an incentive to implement shared sanitation facilities over household sanitation facilities technology is valid.

Elizabeth suggests that some of the shared sanitation services should be contribute to the sanitation coverage. This definitely makes sense in my opinion. I am wondering though, what are the implications on monitoring? Would it make monitoring too complex and time-consuming? Is there any merit to this concern?

Happy learning. :)
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  • dietvorst
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Re: Should shared sanitation services be considered 'improved' sanitation? (and MDG implications)

Meera Mehta and Dinesh Mehta of CEPT University in India have been doing research on group toilets as an alternative to community toilets (CTs). They have summarised their findings so far in Ideas for India :

Group toilets help address two key issues that affect demand for individual on-premise toilets. Household surveys across cities in the states of Gujarat and Maharashtra suggest that principal reasons for households not having on-premise toilets is space constraints and lack of affordability.

A group toilet programme can overcome the space constraint, by identifying a location for a toilet that can serve 2-4 families, within the properties of the families. When these families share a toilet, the affordability issue is also resolved, as costs are shared and public subsidies become available to all the families sharing the toilet. Analysis in a small town in Maharashtra suggests that this programme can be fully supported through local funds, without waiting for any state or national funding. When more families shift to group toilets, CTs can be closed down. This would result in savings in expenditure on their operation and maintenance as well as free up public land. To accelerate this process, however, innovative financing from corporates under their Corporate Social Responsibility (CSR) and social investors needs to be explored.

Conventionally public subsidy for toilets under programmes such as Integrated Low Cost Sanitation (ILCS) is linked to the toilet. In many states, public funds are also used to build CTs. However, incentive for households to use the group toilet option is possible using smart subsidies that are provided on a per household basis rather than on a per toilet basis as conventionally done. The extent of subsidy can be minimised by facilitating access of households to a variety of micro-credit options through self-help groups (SHGs), microfinance institutions (MFIs), credit cooperative societies or the new housing finance companies being set up with a focus on small loans.


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  • dineshmehta100
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Re: Should shared sanitation services be considered 'improved' sanitation? (and MDG implications)

Check this note on Open defecation in cities: A faltering India story. In this note we argue for shared services. We need to have a common taxonomy (see the footnote 2 in the paper) on the use of the term "Shared toilet"

ideasforindia.in/article.aspx?article_id=276
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  • thilde
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Re: Should shared sanitation services be considered 'improved' sanitation? (and MDG implications)

Dear All,
Just published this piece on 'shared sanitation definitons' on the WHO bulletin:
who.int/bulletin/online_first/BLT.14.144980.pdf?ua=1
The Bulletin is a peer reviewed academic jpurnal with focus on LMIC settings and Health. It is one of the most acknowledged journals in Environmental Health.

The paper is (by accident) online and freely assesible for one month, before going into the printed version. Feel free to download it.

I would like to take a more pragmatic and non-technocratic stand point on this issue of shared sanitation - especially since urban and low cost sanitation will be one of our times largest sanitation challanges, with a need for innovative solutions, and not just ingeneering wise 'good' solutions:

I think its high time we leave the rigid JMP classifications, and get a better sense of the range of sanitation solutions people use; A shared facility can be many different things - and CAN BE CLEAN! It all depends on maintenance - not on technical design.

For maybe millions of people in poor urban settings, shared sanitation will be the only realistic toilet option (maybe apart from open defecation); there is no Space, no Money and no Interest in investing in a private household toilet; Migrating people, temporary tenants, and single-person households, will never opt for investing in their own toilet.

We need to adjust our designs, our sanitation goals and our monitoring definitions to that reality.

Hope you enjoy (and maybe get a little bit provoked by the paper!),

Regards,
Thilde Rheinländer

Thilde Rheinländer,
Researcher with interests in socio-cultural factors in WASH
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