Early on in our work in Ghana, we arranged interviews with women looking at their sanitation condition (where they relieved themselves each day) and family health particularly incidents of diarrhea and stomach ailments. . The data is anecdotal but indicated a connection between the condition of the facility and incidents of diarrhea. Women who fared best used facilities at private homes where they were employed to clean or cook. Those who fared worse used the bush or a local pit unkept latrine. We did surface fecal coli counts at the facilities that were mentioned. I wish we had some funding then to augment the statistics as there were just 20-30 interviewed. WE did not publish the results.

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

I would like to concur with the preceding posts and add one aspect that is very important in attitudes towards sanitation. Health and Economic benefits are the major drivers that help people in adopting various sanitation technologies. The other driver, though very applicable in rural settings, is DIGNITY. If people understand that a good sanitary facility can make others to respect you then their attitude towards sanitation would change quite a lot. So at the end it boils down to education and sensitization which is done so well by CLTS.

One more useful paper is attached.

Thank you for your interesting feedback and, for the Pakistani news!!
A recent article by Jennifer Gentry-Shields and Jamie Bartram: Human health and thewater environment: Using the DPSEEA framework to identify the driving forces of disease (attached) has this to say in the abstract:

Sanitation was found to be a widely applicable and effective intervention, targeting the driver/pressure linkage of most of the water-related diseases examined.

The full abstract is:

There is a growing awareness of global forces that threaten human health via the water environment. A better understanding of the dynamic between human health and the water environment would enable prediction of the significant driving forces and effective strategies for coping with or preventing them. This report details the use of the Driving Force–Pressure–State–Exposure–Effect–Action (DPSEEA) framework to explore the linkage between water-related diseases and their significant driving forces. The DPSEEA frameworks indicate that a select group of driving forces, including population growth, agriculture, infrastructure (dams and irrigation), and climate change, is at the root cause of key global disease burdens. Construction of the DPSEEA frameworks also allows for the evaluation of public health interventions. Sanitation was found to be a widely applicable and effective intervention, targeting the driver/pressure linkage of most of the water-related diseases examined. Ultimately, the DPSEEA frameworks offer a platform for constituents in both the health and environmental fields to collaborate and commit to a common goal targeting the same driving forces.

Thank you,

F H Mughal

Public attitude towards sanitation is also a matter of governance, i.e. institutional arrangements and economics.
Costs benefits analyses show that in average for one dollar spent in sanitation (not only infrastructure but also management and hygiene promotion) there is a 5$ economic benefit. This could be a real motivation for governments to invest in sanitation, should they be aware of this link and should this benefit be direct. That is where the challenge lies.
As full cost through uses charges hardly ever cover the cost of sanitation,institutional and financial arrangements should studied to propose a suitable schemes to reach financial balance (and this includes government subsidies). For exemple it could be to give the responsibility of both water and sanitation to the same institution.It is also a matter budgetary decisions (spend less on curative or infrastructure for health and more on preventive). These are hard financial decisions for any government to make and competition between ministerial budgets is always high).

In the end, what I mean is cost benefits analysis backed by sectoral analysis (impact on health / on agriculture / on work productivity etc.) are needed to enhance political will and to translate this will in national and territorial masterplanning. One way to do this is to get external aid agencies (donors, NGOs, bilateral development agencies) to support this kind of studies and long term support to sanitation governance process. Some governments already do it (sanitation master plans are sometimes supported by foreign development agencies). Sanitation country profiles already exist in many countires and are a starting point for this process.

This thread should probably moved to the correct sub-forum (and thus also participate in the small competition ). *

One of the things I think are needed is moving sanitation out of its "ugly" niche where basically only WASH and health experts are interested in it.

One of the really neglected interlinkages of WASH and especially sanitation is with social housing projects. Integration of sanitation issues with questions of equitable housing and the public responsibility to supply affordable but adequate housing in urban areas is probably the most efficient way to push for proper sanitation facilities.

In addition, the next big step in water supply after the MDGs, is to bridge the gap between community water points and on compound or in house water supply, which has been shown to massively increase water safety and overall hygiene and health of people benefiting from it. As with sanitation, water supply at the compound is basically a housing issue.


* Note by moderatur (EvM): you are right, I have moved it to this category now.

Both the posts are interesting and useful. Thank you.

Linking sanitation to health (and to mental health) is a good idea. Do we have some publications and papers that give effective pathways linking poor sanitation to specific diseases, including mental health?
I would request the secretariat and the colleagues to kindly attach the publications with this thread, if possible and convenient. Perhaps, the concrete and strong pathways, linking poor sanitation to health, might sensitize the politicians. I also find the idea of school-based sanitation programs interesting. Perhaps, the secretariat may help on this idea.

I’m attaching 2 articles on sanitation and health, one by Guy Hutton and the other by Duncan Mara et al. that I have. The secretariat has a publication by Dean Spears on stunting, I shared sometime ago (in the library here: www.susana.org/lang-en/library?view=ccbktypeitem&type=2&id=1795 and www.susana.org/lang-en/library?view=ccbktypeitem&type=2&id=1767).

F H Mughal

Thank you so much for the mental health links! Mental health impact is a much neglected aspect of WASH behavioural change, and I'm very glad to see it being addressed on this forum.

I think that what you're getting at is almost a triggered response to poor sanitation that results in a sudden push for change - a scaled-up version of a CLTS intervention, where people feel so disgusted with sanitation conditions that they become proactive and demand change. While social media campaigns have some impact on public attitude, they seem to be more conducive to promoting passive acceptance of new norms, so I'm not sure that they would generate the kind of public demand and governmental pressure that is needed. School-based sanitation programs, on the other hand, may be more effective at instigating action since they have the potential to create a dialogue with students, and can thereby turn them into active participants. If we want the public to fight for improved sanitation, perhaps we should look at the way that local political movements are structured and borrow their tactics for getting people involved and active.

Sanitation in poor developing countries, typically, is not up to the mark. Here, in the rural areas of the Sindh province, Pakistan, nearly 90 per cent of the households do not have acceptable and safe sanitation. Same is the case of drinking water – rural people draw water from ponds for drinking and these unprotected ponds are also used by the cattle for drinking. The village women walk 4 to 6 km (one way) to fetch water on pitchers on their heads, despite their fragile health due to malnutrition.

Climate change continues to impact on sanitation with floods, among others. Adaptation and resiliency is, therefore, required in the field of sanitation, on a large scale. The decision-makers and the government are still unmoved in the field of sanitation. For sensitizing the government, positive public attitudes are pre-requisites and important adjuncts, as the public attitudes give way to public support, which acts as pressuring forces – moving the government to take action.

How can the public attitudes toward sanitation be developed? Is it possible to see fast-tract actions on adaptation and resiliency in the field of sanitation? Perhaps, forum members may like to comment on this.

Thank you,

F H Mughal