An urban sanitation primer

Pete Kolsky, WSP HQpkolsky@worldbank.org

Perspectives/prejudices A primer… basic and not detailed

not intended to insult anybody’s intelligence or competence

Public health perspective A preoccupation with basic needs

Reaching those with “no access” Myths? More like “science and

folklore” Will try to distinguish the two

Definitions of sanitation1. “Safe interaction with human excreta”2. “Facilities required for safe management

of excreta…not hygiene promotion”3. Environmental sanitation

The environmental services required for healthy living…includes water supply, sanitation, drainage, solid waste management, etc.

For this presentation, will lean towards 2nd definition

The good news in sanitation…

747 million gained access to sanitation from 1990 to 2000!

Population Served

1990Million

s

2000Millions

%Change

Urban 1877 2442 30%

Rural 1028 1210 18%

Total 2905 3652 26%

…and the bad news

Because of population growth, there were 42 million more without access over the decade!

And these numbers are probably optimistic!

Population Unserved

1990Millions

2000Millions

%Change

Urban 415 403 -3%

Rural 1946 2000 +3%

Total 2361 2403 +2%

Sanitation and disease Diarrhoea

2.2 million deaths/year worldwide > 4 lakh in India alone…1000/day = 40/hr 1 billion episodes of diarrhoea per year in

India…2-3 episodes/child/year Most vulnerable (and most infectious) are

under 5…mostly under 2 Yet many believe that child’s faeces are

“safe” Worms (Hookworm, roundworm)

Billions of cases Transmitted through soil contamination

The F-diagramme

Faeces

Fluids

New Victi

m

Fingers

Flies

Fields/Floors

Food

Implications for sanitation & health

Sanitation is more than “keeping water supplies clean” Other routes are generally more

important Hardware without hygiene will get

us nowhere The biggest and toughest challenge

is management of faeces of kids < 2

Basic technical factors Your water supply and disposal determine

your sanitation options…

All four present in many South Asian cities

Water?

Disposal

Little wastewate

r

Lots of wastewate

r

Onsite Latrines, TPPF

Septic tanks, soakaways

Offsite Conservancy Sewerage

On-site, little water Pit latrine Principles:

Isolate the waste from human contact When full, dig new pit, seal old one. Store for > 1 year to reduce/eliminate risk Empty, recycle/dispose of contents (sludge)

Problems/challenges: High water table, rocky soils Sludge management needs to be

considered No sullage (“grey” water) management

Twin-Pit Pour Flush

Principles: Water-flush and seal controls odours Brick in diversion box blocks off filled pit for one

year before emptying, recycling compost Disadvantages:

As with pit latrine, except smell, easier alternation

Diversion box

Water-sealed slab

Pits

EcoSan Latrine contents “stabilized” after a

year’s isolation…can use as compost Basis of Twin Pit Pour Flush

EcoSan focus on urine separation…use urine as ammonia source, solids stabilize better

Build above ground to facilitate emptying

EcoSan (cont’d) Question: If we can’t sell the most

basic on-site sanitation at 500 Rs/HH, why do we think we can sell more expensive EcoSan? When economics of compost used as

justification, check market very carefully Areas of high GW table, rocky soil,

extra cost of EcoSan relatively small…

On-site, lots of water (septic tanks)

Principles: Solids settle out before sewage seeps into soil…soil

then filters sewage Problems:

Cannot “seep” into clay or plugged soil or high WT Sludge mgemt: must empty from time to time, and

where does sludge go?

Settled

sludge

Scum

Gravel-filled infiltration bed,

open-jointed pipe

On-site sanitation and groundwater

On-site sanitation systems can contaminate groundwater, esp. in areas of high GW table.

Can often be controlled by adequate distance (15m in most soils)

Where perceived as a problem…1. Is groundwater used for water supply?2. Is alternative water supply cheaper/easier

than not doing on-site sanitation?

Off-site, little water “Conservancy” or bucket/basket

system Rightly condemned as hazardous

to its workers but… …Where it exists, do we deny it? …Can we improve it?

Off-site: lots of water Sewerage! The engineer’s favourite!! Principle:

Water carries excreta through pipes to treatment works…

Problems/challenges: Expensive!!!! Needs a steady water supply A lot goes into rivers untreated… …and most sewage ttmt protects fish, not

people…

It’s all got to go somewhere…

Seweragea) Consider outlet/informal reuse carefullyb) Sludge…where does it go?

Septic tanks, pit latrines, TPPFa) Sludge management…how handled?

1) Wet sludge (septic tanks) decentral. ttmt2) Dry sludge from latrines solid waste

chain?

Public health notions of sewage treatment

How do you know sewage is bad? Smell Colour Dead fish Algae Sludge banks

If somebody removed all those problems, would the water be OK?

What sewage treatment does

Removes solids (SS) Removes organic load that depletes

oxygen that kills fish (BOD) Some removes nutrients for algae (N, P) VERY FEW REMOVE PATHOGENS

As Klaus said this morning, detention time & sunlight are your best disinfectants

Chlorination is NOT a straightforward solution Organic demand + particles poor disinfection

Nature of the challenge Lack of demand Lack of interest (political will) Lack of ownership It’s not cheap It involves deep psycho-cultural issues Like all public goods, subject to politics Often technically difficult (esp. urban) Hygiene promotion is poorly understood… …other than that, it’s straightforward!

Particularly urban issues Urban sanitation matters more…

Higher population densities More likely to be complicated by water to

spread muck around Institutional challenges, and

opportunities, are more complex Role of utility for wastewater? Role of utility for onsite sanitation? Heterogeneous populations, “communities”

WardCity

River & Environs

Peri-domestic

(street, school, work-place)

Home

Sewage Treatment

Plant

Home

Peri-domestic

WardCity

River & Environs

(street, school,

work-place)

Outfall

Collector

Primary network Secondary

network

House Connection

What’s the point? Household perception matches

public health perception! FIRST get it out of the home, THEN

out of street, THEN address overall city waste management issues

Engineers/managers perception of priorities is in reverse for variety of reasons (cost, complexity, prestige)

Peri-domestic

Ward

City

(street,school, workplace)

Home

Central Treatment Works

Primary Sewers

Secondary Sewers

House Connections

Three network approaches Slum networking (Parikh)

Slums located along the “waste collectors” of the city…

If you upgrade these collectors, marginal cost of serving slums is small…include them!

Orangi Pilot Project model HH and street organise, manage construction

of secondary (street) infrastructure; Municipality/utility manages primaries and ttmt

Condominial (Latin America, utility driven) Similar to OPP, more integrated into planning,

various contract options for maintenance

Generic institutional issues Who’s doing it now?

Sanitation is like housing… 1. People do for themselves 2. Largely informal arrangements

Who’s responsible in gov’t? Health dep’t Water dep’t …Neither of whom is necessarily appropriate…

How well can formal meet informal? How can we nudge, cajole, promote the

evolution of the mix in the right direction?

Scaling up? Definition?

Increased volume of facility construction and use

Sustainable Do we mean

“How can we get 300,000 new latrines a year?”

OR “How can we build a sustainable industry?”

Why is scaling up difficult? “How come we have great projects and

lousy programmes?” Intensity of commitment

High % ownership of commitment on pilots Span of control

Complex interventions handled at project level Capacity

How many good NGOs/agencies are there? Calibre of staff…All the good ones are taken…

Sustainable industry requirements

If somebody can make a buck out of it, it will expand…if they can’t, it won’t…

Demand Why people want sanitation (demand study in

Philippines) 1. lack of smell and flies2. cleaner surroundings3. privacy4. less embarrassment when friends visit5. less gastrointestinal disease

Yet how do we sell it? “No demand without tenure!!”

Sanitation as a business Good sensible marketing

Offer a range of options… At least as important “Design to price”

(Midnapur a good example) Understand/facilitate the growth of

the industry Subsidies? Cash flow? Materials?

Hygiene Promotion & Sanitation Marketing

Hygiene promotio

n

Sanitation

Marketing

What’s being promoted? Behaviour Hardware

Could you sell it for money?

No Yes

Does it cost a lot of cash? No Yes

Does it involve credit? No Often

Does it require constant attention?

Yes No

Prime audiences? Whole family Purse holder

Who is likely to do it? Health workers

Masons

Is it easy to monitor? No Yes

Some Principles of Hygiene Promotion

3 priorities Hand-washing at right times with soap (or

other agent?) Safe disposal of faeces Safe management of water

DON’T add more messages Repeat often Be positive, don’t preach…Avoid

Doctors, Death and Diarrhoea

Appropriate gov’t support Clear consistent policy framework

Clear leadership, clear authority (esp. urban) Enabler not provider…

Five-year (production) plan died with the Soviet Union

Start from a mix of technologies, move to another mix of technologies with greater coverage…but not through direct provision

Subsidize promotion, not production

Strong encouragement of individual HHs… examples of Midnapur, Vietnam (likely)

Some credit issues/options Sanitation is like a bridge…

…building 90% doesn’t count for much!

Therefore a “lumpy” investment Credit issues

South Asia the home of micro-credit… You can tell me more than I can tell you!!

One example from Vietnam…

Revolving funds for sanitation: Vietnam

A credit system for household sanitation improvement (latrines, septic tanks, sewerage connections)

Women’s Union manages the credit through savings-credit groups

A linkage with income generation and public awareness of health/environment issues

Target: Low income families Coverage of 80-90% of HH in city (approx

14,000)

Saving-Credit groups

Organized in groups of 12-15 persons.

Saving of 20,000 VND/mo (US $1.3) required throughout loan period

Savings provide 480,000 VND ($32 US) towards repayment of the principle

Savings can be on-lent to other savings-credit group members for income generation.

Achievement so far (April 2002)

High number of borrowers Over 350 Savings-Credit Groups formed Over 4000 borrowers in less than 1 year

80% of borrowers construct their household’s sanitation facility within two months of receiving the loan

Nearly all of sanitation facilities are constructed within three months of disbursement

High repayment rate 95 %

Main points of the news1. Put sanitation in public health context

Means to an end, not an end in itself Kids < 2 most important of all Household most important focus of intervention

2. The biggest issue is behaviour change Hygiene issues, barely touched on here Must learn to market sanitation at both

household and community Hygiene is hard-to-monitor, not as popular as

sanitation hardware for project funding

Main points of news (cont’d)

3. Generating demand There is no gain in providing sanitation

people don’t want Hygiene promotion ≠sanitation marketing

4. What’s the problem you have to solve? Must consider on-site/off-site, water/w.o. water to

define options

5. The ring diagrammes Helps to keep priorities clear for interventions Helps to identify breakdowns in “the faecal

chain”…don’t forget sludge management!!

Main points of news (cont’d)

6. Institutional realism The five-year plan forces what is not

wanted…and will be self-defeating Trying to nudge, cajole, promote, steer a

shift in mix from “now” to a better “future” Need clear leadership and accountability in

gov’t Defining the mix of formal/informal and the

role of utility

7. Credit/finance matters Micro-credit worth exploring

Some provisional principles

Sanitation cannot be only for the poor Plenty of “middle-class slums” with appalling

sanitation… there is no excuse! Need to “segment” the market to build an

industry…internal cross-subsidy? Sanitation promotion through status?

Start where you are…not where you want to be

Don’t race to transform with alien technology people don’t understand, haven’t experienced

Work with those who are currently providing the service…learn from their reality

Provisional principles (2) Keep mechanisms, benefits clear…

“Elimination of open defecation” a worthwhile goal, but don’t forget infants’ excreta

Public toilets, shared latrines? Need to observe behaviour before counting “lives saved”

Most sewage treatment is (a) expensive and (b) has minimal public health impact

Justification is environmental, not public health

Provisional principles (3) The perfect is the enemy of the good…

Beware of engineers’ “minimal acceptable standards of sanitation”

Design to affordable price…just like every other business Focus on excreta, not all environmental problems

Be pragmatic about subsidies Subsidize promotion more than production…When

overall demand takes off, production can remain sustainable…”people not waiting for a subsidy”

Sewerage has always been subsidized…why subsidize only those with house connections?

For sewerage, subsidize connection, not O & M

Some approaches to discuss

Developing the market Find out determinants, constraints on

demand Reduce them (redesign sanitation,

sell better, subsidize promotion, purchase?)

Support “infant industry” Get out of the way…

Approaches to discuss (2) NGO “triggering” of total

sanitation Current WSP/Wateraid/VERC work in

Bangladesh, Maharashtra How many NGOs, what scale can be

managed? Utility/CBO partnership on network

Outermost branches of “tree” managed by CBO, trunks by utility