JKMakowka wrote: "The Power of Numbers: Why the MDGs were flawed (and post2015 goals look set to go the same way)"
Ultimately the entire effort is utterly top-down driven, with the main "result producers" (e.g. China) not even really caring about it.

Interesting blog and discussion! However I feel that the actual point of this blog post/discussion is more the general question the efectiveness of international development cooperation. E.g. the countries like China that made real progresses in the last decades made this independent of ODA, while countries that receive intensive ODA since a long time did only progress little. Objective and montioring frameworks are just a part in this bigger question, I think.

Now, while I'm quite sceptical that a meaningful monitoring of a global objectives framework can be acheived, I'm still convinced it's important to have such a framework. The MDGs have been quite strong in guiding governments and cooperation agencies in their efforts, and this has been a good thing in my experience. What we need is more flexibility to adapt objetivis to the different countries, and more detailed, less simplistic goals that capture better the quality and sustainbility dimensions. I think the SDGs go in a good direction here, though I admit I'm not so much up to date of the details of the process and content of the SDGs.

Florian wrote: For good indicators I'm on really on the loss. I agree that the management and the sustainability of installations should be measured (is it operated/used well?, at all? does it still in 10 years). But this would just add so much complexity to the monitoring task, that it will be very difficult to be used. Already the current rather simplistic JMP framework is extremly difficult to apply coherently and thoroughly and provide meaningfull data. A (global) monitoring system that is simple enough so it can actually be applied, and detailed enough to be pertinent? Not sure if that is possible at all.

This is getting a bit off topic, but I think this interesting blog post might be relevant:
"The Power of Numbers: Why the MDGs were flawed (and post2015 goals look set to go the same way)"
Ultimately the entire effort is utterly top-down driven, with the main "result producers" (e.g. China) not even really caring about it.

P.S.: I agree that health targets sound great in theory, but are non-implementable and if they fail to show impact (which they will, but not necessarily because the intervention doesn't work) they can endanger funding of good initiatives in sanitation.

christoph wrote: How do you measure health related positive effects of sanitation?

Very good question and extremely difficult to answer! Although measuring health impacts seems like a very good and intuitive indicator for WASH (basically every project I come across has this somewhere as impact indicator), I've yet to find an example where this has actually worked.

Everywhere I've tried so far, or seen people trying, available health data was just not good or detailed enough to deduce clear tendencies in the area of intervention, let alone attribute the specific impact of the interventions to a change of the health situation. (Actually I know one example where it has worked, but it is so specific that it just prooves the point.)

For good indicators I'm on really on the loss. I agree that the management and the sustainability of installations should be measured (is it operated/used well?, at all? does it still in 10 years). But this would just add so much complexity to the monitoring task, that it will be very difficult to be used. Already the current rather simplistic JMP framework is extremly difficult to apply coherently and thoroughly and provide meaningfull data. A (global) monitoring system that is simple enough so it can actually be applied, and detailed enough to be pertinent? Not sure if that is possible at all.

How do you measure health related positive effects of sanitation?

Joes comment about the Blog of Brian Arbogast´s post was the reason to open this question.

Joe point out that it is not enough to have the reduction of untreated fecal material, he is of the opinion that it is necessary to link it to health indicators.

I am working in several countries in Latin America. One of our tasks is to prove that investment in sanitation really enhances the health of the population. This is quite tricky. Very often the health aspects are overlapped by a serious of aspects. We identified the following aspects as factors which make the health indicator only a “secondary” indicator as the direct relation is not valid:

• Hospital statistics often do not differentiate between the rural and the city population. How do you measure the effects in a certain area if the numbers are just for a whole municipality?
• There are practices where the family lives very close to domestic animals – therefore the positive effect of sanitation is overlapped by other factors.
• The sewerage of an area for sure enhances the sanitation situation of that area but at the same time might be worse by the production of untreated wastewater for another area. When this affects less people, a positive balance points to a gain in health. Is that true?

But in contrary to Brian I do think the indicator should be treated fecal material or better “safe final destination for fecal matter”. Why? I saw to many treatment plants which are not working. So does a not working treatment plant count as “treated fecal waste or not”? I admit…this indicator is far more difficult to judge than “non treated fecal waste”. But I think it is not sufficient just to build fecal matter treatment plants – they have to be operated as well.

I agree as well that there might be a very large (necessary) discussion about what is treated. So I think the best indicator would be “safe final destination for fecal matter” - with a need to discuss "what is safe final destination".

Looking forward to your comments.

Christoph

Chris - in my view it is you that is responsible for showing that your ecosan system kills pathogens not anyone else. I do not apologise for my own blog, I have worked in composting faecal wastes and am convinced that dry systems do not consistently kill pathogens to safe levels due to the lack of oxygen and imprecision of C:N ratios. I do not believe they are safe to use without good healthcare provision and/or microbiological monitoring. Extensive research on UDDT, particularly in South Africa suggests that there remain significant health risks associated with emptying the facecal wastes. And finally, even if model systems are tested, it is impossible to be sure of the condition of the pathogens within the waste from any given system without batch testing it.

There is some literature on the subject, I invite you to investigate it. I am away this week (coincidentally at a microbiology conference) if you really want to discuss the scientific research on this point, I am happy to have a robust discussion when I return.

Dear Joe,

Ecological Sanitation (EcoSan) is not equivalent to composting toilets. It is a much broader concept, very close to that of Sustainable Sanitation.

en.wikipedia.org/wiki/Ecological_sanitation :
--
Ecological sanitation (Ecosan) is based on an overall view of material flows as part of an ecologically and economically sustainable wastewater management system tailored to the needs of the users and to the respective local conditions. It ... is ... a new philosophy in handling substances that have so far been seen simply as wastewater and water-carried waste for disposal.

According to Esrey et al. (2003) ecological sanitation can be defined as a system that:

Prevents disease and promotes health
Protects the environment and conserves water
Recovers and recycles nutrients and organic matter
--

One of the main (and potentially purist) manifestations of EcoSan is the Urine-diverting Dry Toilet (UDDT), which is the principal subject of the Ecological Sanitation book
www.ecosanres.org/pdf_files/Ecological_Sanitation_2004.pdf

EcoSan also includes Constructed Wetlands, since natural processes are used and the nutrients go back safely to productive ecosystems.

It may be true that adding urea to feces helps to sanitize them, but there is much more water in urine than urea. One of the most important reasons to separate urine in UDDTs is to keep the feces as dry and aerated as possible, thus reducing smell (which is mostly due to the loss of valuable nitrogen in the form of ammonia).

Please share with us the studies that supposedly debunk the safety of the finished biosolids from composting toilets or UDDTs. If, in fact, a significant amount of pathogens remain, the biosolids could be spread out in the sun to receive UV radiation, heated in a solar oven (apparently 65°C for an hour is sufficient), thermophilically composted, or it could be added mechanically to cover new feces (and never be released into the open environment) ... and this would still be EcoSan, especially if the urine (with 90% of the nutrients) is used to fertilize plants.

I use my real name and I invite anyone who is interested to see, use and analyze our UDDTs here in Puyo, Ecuador. Finished biosolid samples could also be sent internationally for analysis, as there is apparently no limitation on their being shipped:
stamps.custhelp.com/app/answers/detail/a...content-restrictions
(The real risk is in the fresh feces that are already transported everywhere, inside people.)

I would like to invite you, Joe, to be less inflammatory and sweeping in your statements (including in blogs that are linked to). If we do not agree with someone, we should try to politely explain why we believe differently, without belittling or insulting anyone. When we criticize anything, we should hopefully pair this with a constructive suggestion of how to do things better.

I agree that it would be wonderful to monitor that everyone be healthy, but this seems very complicated. One indicator could be the number of cases of water-borne diseases (per 1000 persons), as reported by the health ministry of each country, although this depends entirely on the efficiency of each of these ministries (and would also be affected by politics).

I also think that there is much more agreement on what constitutes acceptable treatment. In particular, since Ascaris eggs are largely agreed to be the most resistant of all fecal pathogens and they can be identified with a microscope, any treatment that wipes out Ascaris eggs should be considered adequate.
(Plus they reportedly infect 25% of the world human population,
web.stanford.edu/class/humbio103/ParaSit...s/JLora_ParaSite.htm ) There are details to be worked out for the most efficient monitoring of Ascaris, but in no way does this mean that it is not feasible.

I suggest we should also agree that untreated wastewater going straight into the environment constitutes open defecation, in terms of sanitation, no matter how private and elegant the bathrooms may be.

Brian Arbogast is also correct that it is not just a matter of building the hardware of toilets. We also have to assure that the users assimilate the software about the importance of using toilets and managing them properly... via education, consciousness-raising, community involvement, and follow-up.

Best wishes,
Chris Canaday

I like both Joe's suggestion of focusing on health as well as Brian Arbogast's fecal waste treated as post-2015 sanitation indicators. Key Performance Indicators (KPI) should measure process (fecal waste treated) as well as impact (reduction in mortality / morbidity due to water-borne diseases). Broadly, focus areas could be: (1) impact indicators, (2) process indicators and (3) measurement method (its quality, comprehensiveness, relevance, etc).

Sanitation is recognized as a chain encompassing user apparatus, collection, treatment and utilization. We have focused on the first part till now viz., that everyone has access to the user apparatus. Brian's indicator focuses on something further down (fecal waste treated) because this step pre-supposes (and also requires as a pre-condition in actual practice) user apparatus being available - provided that the method of measuring fecal waste focuses on the entire population instead of waste quantified by measuring discharge from centralized collection systems (though it would be easier to collect such data from centralized systems) - measurement method perspective.

We could also select another process indicator which focuses on utilization viz., fecal waste utilized in a manner that forwards development goals (environment, agriculture, etc) because this presupposes (and requires) all the previous steps. What I essentially like about Brian's suggestion is the shift of focus on a step further downstream than focusing on only the first step.

Sanitation is essentially a solution (a suite of solutions) rather than a "feature" (health, ecology, natural resources, environmental sustainability) and so we need to assess how well a technology helps maximize impact in each of the relevant "features". For instance, safety of women as well as inequity faced by vulnerable population (differently-abled, low-income, children, et al) get addressed with the first step of access to safe user apparatus. Health (reduction in morbidity / mortality due to pathogen transmission) gets addressed at the treatment stage. However, deteriorating soil quality, eutrophication of water bodies and conserving rapidly-depleting natural resources (such as, phosphorous mined for manufacturing fertilizers - we hardly have a century's supply left in the world - or even fossil fuels considering the biogas option) get resolved only when the utilization step is addressed.

Regarding measurement methods, this could also be an important focus area but might be complex because we do not have the supporting science / technology to address important questions. It is important to be able to present an indicator that has adequate scientific certainty but this also means that we can only include criteria for which we have the means for scientific measurement. Therefore, a sanitation technology's impact on the microbiological climate, for instance, may be difficult to include in the measurement method as we do not yet have the right set of questions to be addressed and the scientific methods for measurement.

A possible solution could be to select indicators and measurement methods in a way that enables and accommodates possible trajectories along which technologies can develop in the future. Sanitation is essentially a "solution" and, therefore, it is important to take a future studies approach. We could probably have a framework that includes all important aspects and then develop the indicators that address the different dimensions (process, impact, unaddressed questions in science) in a way that can guide allocation of resources (time, effort, capital) and systems development.

And, from a future studies perspective, we could probably see all technologies in a "continuum" and simply determine what goals / aspects have been addressed and what needs to be addressed. From a sector perspective, it is important to address all relevant sanitation goals irrespective of the local contexts - make sanitation context agnostic.

For instance, people in temporary accommodation (Internally Displaced Persons (IDP), refugees and people taking shelter from flash floods or some natural disaster, village fairs or annual festivals at religious centers when there is a huge influx of population during only a few days in a year) will require ultra-compact user apparatus that can be built with locally or easily-collectible materials (or even repurposed articles) which provides safety and privacy as well as protect health (prevent cholera outbreaks). Constructing permanent user apparatus may not be an ideal solution for such contexts. Likewise, a "portable" toilet works better in such situations compared to "mobile" toilets. In conclusion, we should simply take each technology and see for which contexts it solves the entire set of sanitation challenges or what else needs to be done.

Thanks and regards,

Sowmya

canaday wrote: Dear Joe,

Thank you for sharing your perspective on your blog,
sanitation.joetnr.net/sanitation-good-in-parts/
where you state:
--
And the sector has its own crazy bunch of loons who want to insist that shitting in a bucket (also known as ecosan) somehow counts as treatment. It doesn't and it isn't.
--

EcoSan does not consist solely in defecating in a bucket and, in many cases, there are no buckets involved at all. And treatment does occur in these buckets and the other containers that are used because, as the feces dry and decompose, fecal pathogens die off at an exponential rate. The key thing is to keep the feces out of the general environment while this is happening, which is incredibly more feasible if they are in a small bucket, as opposed to an entire river of sewage. Solarization, heating, and thermophilic composting can speed up the die-off of pathogens found in the feces collected in UDDTs ... and it would still be EcoSan.

Whilst it might be true that pathogens reduce in ecosan systems, there is plenty of evidence that they never get to safe levels. The idea that it is feasible to treat human faeces via composting toilets is entirely busted.

I dispute the idea that solarization, heating and thermophilic composting are types of ecosan, which is short for ecological sanitation and is synomynous with composting toilets.

I would like to invite you to read this 2-part interview about the dangers of water-based sanitation and the benefits of dry, ecological sanitation:
www.chekhovskalashnikov.com/water-sanitation/
www.chekhovskalashnikov.com/human-waste-disposal/

I have never ever said that water-based sanitation is always preferable nor that dry sanitation is always a bad system. However there is plenty of evidence that dry systems are very often not destroying pathogens in human faeces to safe levels and hence handling faecal wastes even after storage is a major risk to health.

Please allow me to inform you that there are absolutely no loons that currently practice modern EcoSan, especially since they do not produce urine to be kept separate and their nitrogenous waste comes out mixed with their feces.

The seperation of urine and faecal waste has no bearing on whether pathogens are destroyed in the faeces and in fact there is some evidence that the addition of urea to faeces encourages the destruction of pathogens.

Being waterbirds, they mainly defecate straight into their watery habitat, where they have lived for millions of years in fairly low densities and apparently do not normally suffer from water-borne diseases. Humans, on the other hand, are land mammals and over the millions of years we have lived scattered out in the forest and savannah, defecating on the soil. The need for sanitation has arised over recent millennia, with the growth of human population, the formation of densely populated cities, and the concomitant evolution and transmission of disease.

By the way, Ascaris is not a ringworm (which is fungus and not a worm at all
en.wikipedia.org/wiki/Tinea_corporis), but a roundworm or nematode. And it is an excellent indicator, as it is readily identified via the microscope and it is agreed to be the most resistant of all fecal pathogens.

Best wishes,
Chris Canaday

We have had many discussions on this forum about the difficulties associated with identifying active Ascaris. Ascariasis is caused by the roundworm Ascaris lumbricoides, thank you for pointing out my typo.

I reiterate my main point - the need for health and microbial standards. based on robust Quantiative Microbiological Risk Assessment in the sector rather than wishful thinking.

Dear Joe,

Thank you for sharing your perspective on your blog,
sanitation.joetnr.net/sanitation-good-in-parts/
where you state:
--
And the sector has its own crazy bunch of loons who want to insist that shitting in a bucket (also known as ecosan) somehow counts as treatment. It doesn't and it isn't.
--

EcoSan does not consist solely in defecating in a bucket and, in many cases, there are no buckets involved at all. And treatment does occur in these buckets and the other containers that are used because, as the feces dry and decompose, fecal pathogens die off at an exponential rate. The key thing is to keep the feces out of the general environment while this is happening, which is incredibly more feasible if they are in a small bucket, as opposed to an entire river of sewage. Solarization, heating, and thermophilic composting can speed up the die-off of pathogens found in the feces collected in UDDTs ... and it would still be EcoSan.

I would like to invite you to read this 2-part interview about the dangers of water-based sanitation and the benefits of dry, ecological sanitation:
www.chekhovskalashnikov.com/water-sanitation/
www.chekhovskalashnikov.com/human-waste-disposal/

Please allow me to inform you that there are absolutely no loons that currently practice modern EcoSan, especially since they do not produce urine to be kept separate and their nitrogenous waste comes out mixed with their feces. Being waterbirds, they mainly defecate straight into their watery habitat, where they have lived for millions of years in fairly low densities and apparently do not normally suffer from water-borne diseases. Humans, on the other hand, are land mammals and over the millions of years we have lived scattered out in the forest and savannah, defecating on the soil. The need for sanitation has arised over recent millennia, with the growth of human population, the formation of densely populated cities, and the concomitant evolution and transmission of disease.

By the way, Ascaris is not a ringworm (which is fungus and not a worm at all
en.wikipedia.org/wiki/Tinea_corporis), but a roundworm or nematode. And it is an excellent indicator, as it is readily identified via the microscope and it is agreed to be the most resistant of all fecal pathogens.

Best wishes,
Chris Canaday

I think it is a really good piece with a lot of challenges to the sanitation sector. I think some might roll their eyes and say that the Gates Foundation "would say that, wouldn't they", but there is very clearly a lack of understanding, measurement and even agreement on what counts as safe sanitation - to the extent that we have many who would rather emphasise the number of latrines they have built than the effectiveness and sustainability of their faecal treatment systems.

One point I disagree with in the blog is this one:

We need to start thinking about — and measuring — our progress in a way that captures the full sanitation challenge, one that captures that cities like Dhaka aren’t today achieving sanitation levels nearing perfect, but rather recognizes they have a long way to go. Fortunately, one single indicator can capture this: the amount of untreated fecal waste that gets released into the environment. A commitment to reduce untreated waste would drive the necessary investments in fecal sludge management in urban and peri-urban areas, while complementing investments to end open defecation in rural areas.

If we cannot agree when faecal waste is treated and do not have the funds to tell objectively when it is safe microbiologically, this is a useless indicator.

In my view, the only indicator we actually have is based on health: how many people are getting sick from infections caused by faecal pathogens. Once we know that, we can discuss what is an 'acceptable' number of incidents (and/or possibly deaths) of infections and work out a safe dose rate of interactions with faecal wastes and safe ways to deal with it.

And we can then, for once, actually have a way to tell if sanitation systems are acceptably working or not and spend more time thinking about the holistic risks associated with systems and behaviours rather than simply focussing on the numbers of systems built.

Hi,

Brian Arbogast, Director, Water Sanitation Hygiene, Bill & Melinda Gates Foundation recently posted a blog on Devex*: Choosing the right post -2015 sanitation indicators
www.devex.com/news/choosing-the-right-po...ion-indicators-84219

As we had quite a few posts on the forum about the post-2015 sanitation indicators, I thought this blog post would be interesting for quite a few of you.

It's also interesting to read the comments he got for his blog post (5 so far).

Thanks.

Roshan


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