Chapter 3 can be used as a basis for risk assessment and management.

You will find control measures to reduce the risk of exposure to faecal pathogens at each step of the chain. Four risk groups are considered: sanitation system users, local community, wider community, sanitation workers.

For example, practical guidance on limiting exposure among sanitation workers (e.g at the conveyance and treatment steps) includes (summary below):

"• Wherever possible motorized emptying and transport should be prioritized over manual emptying and transport.
• All workers should be trained on the risks of handling wastewater and/or faecal sludge and on standard operating procedures (SOPs).
• All workers should wear personal protective equipment (e.g. gloves, masks, hats, full overalls and enclosed waterproof footwear) particularly where manual sewer cleaning or manual emptying is required.

Further details are included in Chapter 4:

These should be combined with periodic health checks, vaccinations and treatment (e.g. deworming), medical insurance (if available).

The onus should be on employers to provide all of these, and these requirements should be included in the regulatory arrangements to which employers are subject. Compliance should be verified by health sector personnel (e.g. environmental or occupational health staff)."

Clearly reaching universal access to safe sanitation chains is an ambitious target in many countries. That's why the Guidelines recommendation 2b talks about prioritizing progressive improvements based on risk assessment and management approaches.

Essentially risk assessment and management approaches ask users to look at the whole sanitation chain, analyzing where the greatest hazards are exposing the most people to excreta, and then design and implement improvements to address these priority risks. Improvements are not only technology or infrastructure, they can also be changes in system management or user behaviors which are collectively implemented by a variety of actors along the chain. The approach also includes regular monitoring and review to check the improvements are working and to continuously adapt and improve.

There are a number of risk assessment tools - the SFD Initiative has been very effective at highlighting major risks at city level to build political will for sanitation investment. WHO promotes Sanitation Safety Planning for more in-depth system assessment and ongoing coordinated system management.

www.who.int/water_sanitation_health/sani...-safety-planning/en/

In the guidelines, you will find a revisited version of the commonly-used F-diagram on faecal-oral disease transmission. Figure 1.1. highlights the role of safe sanitation systems as a primary barrier to transmission by showing the way in which unsafe management at each step of the sanitation chain spreads excreta in the environment. The diagram also captures transmission routes that are not faecal-oral and shows the complex ways in which different hazards and hazardous events interrelate. The diagram forms a conceptual basis for risk assessment and management for sanitation systems.

Take a look at Figure 4.3 (attached) that shows phasing out of unsafe technologies over time arriving at a mix of context specific safe technologies and services.

Table 3.5(also attached) also has information on which systems are most applicably in a variety of contexts – taking physical and enabling environment factors into account.

Thanks to Peter Hawkins and Andy Peal for these contributions to the Guidelines.

In this e-discussion, we would like to dive deeper into recommendations 2 and 3.

Recommendation 2 stresses the importance of context-specific systems that address the entire sanitation chain, highlight the role of local risk assessment and the need for protection of sanitation workers:

Recommendation 2: Ensure universal access to safe systems along the entire sanitation service chain
2.a) The selection of safe sanitation systems should be context specific and respond to local physical, social and institutional conditions.
2.b) Progressive improvements towards safe sanitation systems should be based on risk assessment and management approaches.
2.c) Sanitation workers should be protected from occupational exposure through adequate health and safety measures.

What are the key features of safe management at each step of the sanitation chain? What is the applicability of sanitation systems in different settings? - You will find detailed information in Chapter 3 and in the System fact sheets

Recommendation 3 commends sanitation to be delivered as part of a package of local services and broader development policies and programmes– What are the key elements of an implementation framework for safe sanitation service delivery? – You can find detailed information in Chapter 4

Looking forward to your comments!