Sorry for not commenting here for a long time - I just got back from a much needed vacation.

I dont want to back-track but a couple things I think will add to the discussion.

Joe you mentioned the three things that are not considered in most projects

• Economics - who is going to pay for the ongoing treatment beyond the initial build
• Microbiology - what is the standard of sanitation that is the 'gold standard' and does the technology reliably meet that level
• Public health - will people continue to use the facility correctly into the future with (or perhaps without) further intervention

I agree with those but think you forgot some important ones

• Scale - How are you actually going to reach the nearly 1 billion people who open defecate? Its essential to design for scale from the beginning if we are looking to tackle this problem globally. This is where I personally think the market is so important - markets exist everywhere in the world and if you can design an approach/model that leverages market forces effectively there is a decent possibility a modified version of that approach could work in lots of places.
• Cost effectiveness - funding is not endless and new generations continue to OD in many places. We need to develop solutions that are effective (from a public health side) and cost effective if we actually want to tackle this challenge all over the world. It might be possible to invest 10 mil to get 10,000 people to all use community managed sanitation system with waste treatment, but those 10,000 people are a drop in the bucket. Just some quick math (I know this is based on assumptions). 10,000 / 1,000,000,000 (total number of people that OD) = .001%. So then we must multiply $10 million x 100,000 to get all those people to stop OD'ing using that approach. That totals $1 billion dollars. Thats a lot of coin.

What is realistic - Solutions cannot just be theoretical or engineered. Of course there is a perfect sanitation solution out there for many situations - one that captures, stores, treats, and/or reuses the waste safely. But I believe that it is actually equally important that the solution is desired! So it must meet the needs and desires of the beneficiaries, and often times health or stopping diarrhea is far lower on the list than being modern, safety, convenience, etc. So in my opinion only solutions that are desired by the beneficiary will be successful and the sad reality is that those solutions are not always perfect from a technical/public health side. So the challenge is merging beneficiaries' desires and the public health goal.

Hope that was helpful and not a distraction.

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Note by moderators: This post was made by a former user with the login name BlakeMcK who is no longer a member of this discussion forum.

The debate that Florian and Joe had last Friday about what works and what should be done and how (and with how much money), reminded me of this article which Rose George recently highlighted on Twitter, where two other gentleman were having a similar debate:

It's a debate about the Millennium Village Project that Jeff Sachs is supporting and Bill Gates is not supporting.


Jeff Sachs bets Bill Gates he can reduce child mortality anywhere

www.humanosphere.org/global-health/2014/...chs-development-bet/

Bill Gates is the latest person share his thoughts about famed development economist Jeff Sachs. His review of the book The Idealist by Nina Munk, which contains a rather unflattering portrayal of Sachs, outlines why he is a fan of Sachs, but thinks Sachs is also wrong. Gates argues that Sachs’s Millennium Villages Project lacks the long term financial support to sustain improvements.

“Through that rear-view mirror, we can see that the project didn’t have an economic model that could sustain successes once the MVP dollars ran out. All of the interventions involved – health, agriculture, infrastructure, education, and business seed money – make sense if carried out carefully, over time,” writes Gates.

[...]

For their part, the MVP and Sachs say that it is difficult to single out what things are causing change. The very point of the MVP is that change has to take place across everything at once, not a single area. Health will improve because people are getting better health services, eating better food and increasing their incomes. All of these improvements will feed into each other, thus lifting people further out of poverty.

And it also reminds me of this challenge/offer that I recently saw by the BMGF on twitter:

Gates Foundation @gatesfoundation · 30. Juni
If you were in charge, how would you change foreign aid? Enter this essay contest, win $20,000: gates.ly/1yURcgh #globaldev

In order to help bring attention to the need for scholarship and fresh ideas in this area, and to encourage broad participation, the Global Development Network (GDN) in partnership with the Bill & Melinda Gates Foundation announces an international essay contest. The contest invites essays on the future of development assistance. The primary objective of the contest is to invite fresh thinking related to the future of aid that can inform the ongoing discourse on development assistance and to make this thinking available to policymakers and key stakeholders.

Up to 20 winning entries will be chosen, and receive $20,000 each. An independent panel will make the final selectionsof the best and most potentially consequential submissions, based on criteria defined. Select winning ideas may be promoted by GDN and the Bill & Melinda Gates Foundation.

The competition is open in three languages. Guidelines are currently posted in English. The French and Spanish versions of the guidelines will be available as of 17 July, 2014.

Essays in English, French and Spanish can be submitted as of now on this platform. However, dedicated platforms for submissions in French and Spanish will also be available as of 17 July, 2014. The closing date for submisison is 15 September, 2014 (14:00 hrs GMT).

- See more at: www.gdn.int/html/page11.php?MID=3&SID=24...sthash.GAp040Qr.dpuf

Just some more food for thought.

Regards,
Elisabeth

joeturner wrote: I think this would look something like a managed community-scale treatment site, probably involving composting. I would pay for a group of people to be trained to manage that site. I don't know about the actual toilet, I am not an engineer, I have less interest in the shape of the unit. I do not believe that dispersed and un-managed systems ever get to acceptable standards.

So once you move on to the next community, who would pay those people you've trained? And some of those people will find a better job, who does the treatment then? What if people don't use the toilets your provided but continue to go to the bush? And will Bill Gates and the Cambodian government be happy with you aiming at a sophisticated (and thus prone to failure) system for 10,000 people, while you could reach 100,000 with good-enough simple latrines*?

Ok, no need to spin that further... The point I tried to demonstrate: It is quite easy to critise the work of people with theoretical arguments, while the work people do is actually increadibly difficult.

* Latrines (pit, pour-flush, whatever) are indeed a good enough solution for many situations in rural areas. If people don't use wells directly next to the latrine, and if density is not so high as to cause a larger scale groundwater pollution, nothing wrong with latrines. Also nothing wrong with burrying sludge or dried feces from latrines somewhere. No need for collection and treatment.

But sorry, now I also deviated the discussion from sanitation marketing and IDE's work. I try to be on topic with the next post...

I would concentrate on working with a smaller number of communities and developing solutions which actually kill pathogens.

I think this would look something like a managed community-scale treatment site, probably involving composting. I would pay for a group of people to be trained to manage that site. I don't know about the actual toilet, I am not an engineer, I have less interest in the shape of the unit. I do not believe that dispersed and un-managed systems ever get to acceptable standards.

I accept that for the same amount of money, I would reach less people than 100,000 latrines. But I also suggest that my money would have a much bigger effect on those individual lives than a latrine would. I would be looking for a way to make that sustainable and pay for the ongoing costs of treatment.

Then, when I had shown that it could be done to an agreed standard, I would move onto another community or set of communities.

I did not mean philosophical, I meant theoretical as opposed to practical

Imagine I am Bill Gates, I give you 10 Million USD and three years to do something about sanitation in rural Cambodia. What you would do?

Yes, it is philosophical because I think the problems with the WASH sector are philsophical not primarily about engineering.

We would rather have thousands of an intervention to sell to donors than a smaller number of interventions that actually work as measured by [an agreed] objective, measurable standard. The easiest standard appears to me to be rates of faecal pathogen disease in the population. If the rate is too high, the intervention is not working.

Sorry, this is all pretty theoretical.

More than 60% of the people in rural Cambodia defecate openly. What exactly should they do else, if not install a pit latrine, a pour-flush toilet or a UDDT?

It is always possible to point to something really bad and say that a solution, however bad, is an improvement. Hence the desperate need for standards in the WASH sector. A 30% improvement of ridiculously high child mortality figures is still unacceptably high.

And I think there is a lot of evidence that users who have received bad interventions in the past are last in the queue when others come around with better solutions - because they're obviously not in the worst situation.

I think it is highly likely that someone who has received (and/or paid for) a latrine today will never get something better. When they therefore receive an intervention which obviously needs ongoing support and faecal management from someone external, this means that they have no alternative but to deal with their own faecal waste at some point in the future. As far as I am concerned, that is not a solution to the problem.

Add into the equation the problems with old technologies, then we have a group of users who are given the most basic WASH intervention and who will never get anything better or climb the mythical 'sanitation ladder'.

joeturner wrote: I do not accept that storage in latrines (with limited or no oversight and emptying expected by users) is ever good enough.

One question is how an ideal or at least satisfactory sanitation system for a village or a community could look like, the other question is how to get there.

I think it is quite common place that it is very difficult or impossible to go from 0 to 100 % in one big jump, but that things can only evolve step-wise.

In a situation like in Cambodia where open defection is still a major problem, making people want to have toilets and actually invest in toilets is a huge step forwards, even it it might be just the step from 0 to 30%.

Insisting in that 30 % is not good enough, only 100 % is good enough, will just lead to nothing be done at all.

I believe meso (community) scale managed systems are the only relable way to kill faecal pathogens. I do not accept that storage in latrines (with limited or no oversight and emptying expected by users) is ever good enough.

Systems that store very liquid sludges seem to me to be the worst of all options. I can see that they can be made to work, but I think the number of places where they can be described as sustainable are very limited. And the more liquid they are, the greater the risk of environmental/health problems.

joeturner wrote: using very old technology of disputed worth.

Well... Twin-pit pour-flush toilets might be old, but I do think they can be quite OK in very rural settings with lots of space and the right hydrogeological conditions for it.

Millions of people and programs in Asia swear by them. We have had discussions here on the forum about their adoption in South Africa (work of Dave Still and colleagues):
forum.susana.org/forum/categories/141-ot...dea-for-south-africa

So it's a bit harsh to rule them out like this... (I agree, the safe and economical faecal sludge management system must we worked out as well).
(Or which other type of toilet would you promote in rural areas of Cambodia, Joe?)

I also totally agree with what Florian and Heike have said that not one size toilet fits all circumstances, there should be a real, informed choice of toilet technologies, and this "informed choice" is the tricky part - like Heike pointed out. Most of the time people don't have enough information to make an informed choice - or for whatever reason the "wrong" choices are made; and it is also an interesting point to ponder, like Heike said:

AND: up to what point the kind of toilet, the kind of onsite storage and onsite treatment really can be a private decision?

(don't forget e.g. in Germany we have a law obliging every household to connect to a sewer if there is a sewer ("Anschlusszwang") - huge disputes with people who run their own local constructed wetland and don't agree with paying the sewer fees - but that's a topic for a different thread (it may already be on the forum somewhere else)).

Greetings,
Elisabeth

Note by moderator (EvM):
This thread has now been separated from the thread where it originated (forum.susana.org/forum/categories/142-up...mit=12&start=12#9223), as it developed more into a separate topic.

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I feel this is part of a much wider discussion - namely what exactly is the point of WASH.

Given that there are so many engineers, it is not surprising that the emphasis is usually on the 'volume' of infrastructure - number of latrines, amount of coverage and so on.

But this seems to me to ignore several important aspects:

• Economics - who is going to pay for the ongoing treatment beyond the initial build
• Microbiology - what is the standard of sanitation that is the 'gold standard' and does the technology reliably meet that level
• Public health - will people continue to use the facility correctly into the future with (or perhaps without) further intervention

It seems to me that too many of those in the sector are fixated with technological fixes rather than the real prize - providing safe, sustainable sanitation which stops infections from killing people. The way some talk about these things suggests that they are actually 'in the business' of providing latrines rather than 'in the business' of providing safe sanitation.

But even on the engineering level, I think this approach is flawed. Latrines are really old technology - even UDDTs have been around for decades. The safety of them is disputed. They frequently cause environmental problems. Users frequently stop using them, use them for other things, abandon them when they break.

I don't agree that it is a situation where ongoing management of sludge can be ignored because it is an ongoing health issue.

I take Elisabeth's point that there might be some advantages in that this technology could 'buy some time' - but it is not clear the time period over which the 100,000 latrines have been built (in this case, but equally applying to other cases) so I am not sure this is such a good argument. Presumably those which were built first (perhaps years ago) will need to be emptied first even as new latrines are continued to be rolled out. The 'time bought' may therefore be negligible.

I therefore do not think it is 'ideal' that the pieces are joined up, but absolutely essential if the goal is sustainable sanitation which continues to stop people dying of faecal pathogens. If the goal is to say that we're great because we have installed x thousand units using very old technology of disputed worth - well, fair enough, but that is not sustainable sanitation.