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Int rastructure and Training

Needs for Sustainable

Urban San itatio n in Af rica

CommonwealthSecretariat

OBENSRInstitute

305.

INGEKOMEN 17NOV. 1995

L fti~?A~YINTERNATIONAL ~FFE JE CINTI!ØFOR COMMUNITY WATEA ~IWPV~ ANISANITAT~ON(I~Cb

Int rastructure and Training

Needs for Sustainable

U rban San itatio n in Af rica

Guy Howard and Jamie Bartram

Robens Institute

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InfrastruciureandTrainingNeedsfor SuslainableUrbanSanitationin Africa. Guy Howard andJamieBartram.

ISBN 1 8523 711 45

RobensInstitute,University of Surrey,Guildford GU2 5XH, U.K.

1993

It should be notedthat the viewsexpressedin this reportarethoseof theConsultantsand shouldnotbetakennecessarilyto reflectthoseof the CommonwealthSecretariat.

Thisreportis theoutputof a studyundertakenby theRobensInstituteof theUniversityof Surreyonbehalfof theCommonwealthSecretariat.A literaturereviewand fleld visitto Kenya andGhanawereundertakento accesscurreiitpracticeandcollectrelevantexperience.This reportisprepared asanoverviewof the infrastructureand trainingneedsfor sustainableurban sanitation inAfrica, the style and contentof which werediscussedand reviewed with the CommonwealiliSecretariaL

Forewo rd

The themeadoptedat themeetingof CommonwealthMinistersof Health,in Cyprusin October1992, wasEnvironmentandHealth. At theconciusionof that meetinga small numberof keyproposalsweremadefor actionby theCommonwealthSecretariat.Theseinciudedproposalsforregionalprojectswhich werebasedon theparticipants’perceptionsof regional priorities. In theAsiaPacific regiondevelopmentof aneffectiveenvironmentalimpactassessmenttool wasprioritised,while in theCaribbeansolidwastemanagementwasfeit to be thegreatestpriority. InAfrica thereareveryfew townsor cities wheresanitationis adequateand thehealthproblemscreatedby poorsanitationcontinueto bea majorcauseofillnessand death.Hencethetopicchosenfor the African regionswas the assessmentoftraining and infrastructureneedsandclevelopmenrofprojectproposalsfor sustainableurbansanitation.

Early in thepreparationsfor themeetingit hadbeenrecognisedthat theenvironmentalissuesofmostimportanceto healthwere, in general,theresponsibilityof sectorsotherthanhealth.During themeetinghealthsectorrolesweredefinedasadvocacyfor thecreationof health;participationin intersectoralcollaborationandthedevelopmentof environmentalhealthwork;the participationof local communitiesandof womenat all levelsandin all sectorswereemphasised.

After checkingavailableexpertisein the light of theneedsidentifiedby countriesof theAfricaregion,the CommonwealthSecretariatapproachedtheRobensInstituteof the UniversityofSurreyandaskedthemto undertakea studyof sustainablesanitation.The studywasto resultinan overviewpaperconsideringinfrastructuralrequirements,institutionalrolesandtraining needs.Thestudy shouldindicatetherole of thehealthsectorin the areasunderconsideration.Arisingfrom this overviewtheywere askedto suggestproposalsfor actionin theregion. TheMinistershadsiressedtheneedto setdearand achievablegoalsandtargetsfor suchactionanddeterminea defmitetimeframe,preferablywithin thecurrenttriennium.

Thefindingsof theRobensInstitutewere discussedwhena draftwaspresentedto theSecretariatand it wasobviousthatthestudyhadconfirmedtheconcernswhich h&i led to theoriginal choiceof projectandunderlinedthe needfor sharingof existingknowledgeandexpertise,particularlyin thoseareaswherethereis limited documentedexperience.An annexwith specificproposalsis beingpreparedfor latercirculation.

Theintentionof this initial study is to help countriesidentify their trainingneedsandprioritiseinterventions.The recommendationswill emphasisthedevelopmentof trainingprogranimesforpublic andenvironmentalhealthstaff who will facilitate local authority andcommunitysanitationinterventions.During thedevelopmentof suchtrainingprogrammesconsiderationwill begiven to optionssuchasthedevelopmentof small teamswith thenecessarytechnicalexpertiseandhealthknowledgefor undertakingcontractsfor developmentor maintenanceofurbansanitation;andtrainingprogrammesfor cadresof healthworkerswith thebasicskills forpracticalproblemsolving at communitylevel. All the personneltrainedwill begivenopporvunitiesto acquiretheskills for workingwith othersectors,nongovernmentalorganisafions

and membersof the localcommunity.

In true Commonwealthfashionthis study is seenasa catalystto a processof sharingexperienceandexpertisewithin the regionto thebenefitof the peopleliving in urbancommunitieswhosehealthis put atrisk by thepresentlackof adequatesanitation.

K Thairu,MedicalAdvisorandDirector,HealthDepartment,CommonwealthSecretariat.June1993

Executive Summary

Theneedfor adequatesanitationin urbanareasis apressingproblemandonethatmustbe addressedasapriority becauseof its importanceto public health.Poorsanitadonis asignificantfactorcontributingtothe high morbidity andmortality ratescommonlyassociatedwith poor urbanareas,particularlyamongstinfants.Increasedaccessto and useofimprovedsanitalionandwatersuppliesin urbanareaswill contributesignificantly to thereductionin theincidenceof diseasein the urbanpopulation.Toshievethis ‘will involve a multi.-sectoralapproach,inwhich thehealthsectorshouldtake animportantrolein sanitationpromotionandhealtheducation.

Whenassessingthe problemsof urbansanitation,particularlyprovisionof servicesto theurbanpoor, itis dearthatthereare a numberof factorswhichinfluence the sustainabilityandreplicability ofprogrammesof sanitationimprovernent.Institutional,infrastructuralandeducationalfactorswill all affectsustainabilityandreplicability andit is importanttheseare addressedpreparatoryto sanitationprogrammes.

Institutional strengtheningmayberequiredin manycountries and the roles that central and localgovernment,external support agencies,non-governmentalorganisationsandthe privatesectorplay in urbansanitationdefiried. Responsibilityforconstruction,operadon,maintenance,monitoringandmanagementshouldbe decidedat a nationallevelandstrategieplanspreparedfor urbansanitationimprovemenL

There is in general a shortfall in trainedstaff at alllevels to implement sanitationandhealtheducationprogrammes.1f sustainableurbansanitationis to beachieved,thereis a needfor improvedand/orincreasededucationandtrainingof staffworking insanitation. Of particular importanceis thedcvclopmentof appropriateeducationaland trainingcourseswithin African countrieswhich focuson therealproblemsaffectingeachcountryandwhichcansupply professionals to work in sanitationconstruction,operationandmaintenance.Insütudonsshouldbeencouragedto developlinks with otherinstitutionsin theregionandelsewhereto increasecapacity for trainingandresearch.

Technologychoice is critical, the introductionofinappropriate technologies in African cities has

causedwidespreadproblemsof low acceptability,poormaintenanceof facilities,frequeritbreakdownsandlimited repairwork. Technologiesshouldbeidentified which providea healthbenefit,areaffordable,acceptableand can offer, whereappropriate,a significantlevel of communitybasedoperation,maintenanceandmanagement.

Realisticchargesfor sanitationfacilities mustbeleviedif sanitationprogrammesareto be sustainable.Whereincomesare low, sanitationprogrammesinAfrican countriesshouldaim to empowerlow-incomegroupsto acceptan increasedlevel ofresponsibilityfor the managementof sanitationfaciliües.1f healthbenefitsfrom improvedsanitationareto berealised,it is importantthatgoodhygienepracticesareadoptedby thepopulation.To facilitatethis,healtheducationprogrammesrun in paralleltoconstructionprogrammesarerequired.This willgenerallybe theresponsibilityof the healthsector,butis likely to requireinput from othersectors.Theprovisionof community healtheducationwithparticularemphasison sanitationandgoocihygienepracticeis vital to ensurethatoncefacilities areavailabletheyareusedandrnaintainedproperly.

The health sectorhasan importantrole to play inurban sanitationandshoulddevelopa coherentapproachto thehealthproblemsassociatedwith poorsanitation.The provisionof healtheducationinparallelwith construction,inputs to higherandfurthereducationcoursesin public health-relateddisciplinesandtheestablishmencandmonitoringofeffluentandwastequality areall lilcely to fali withinthe healthsectorremit. Wherethe sectordoesnothavethenecessaryexpertiseto fulfil all thesemies,thencooperationwith other sectors,such aseducationandlocal governmentwill beparticularlyimportant.

Much literature is availableconcerningtechnologiesfor urban sanitation,sometextsof particularusearelistedin Annex 2. However,informationregardingtraining strategiesandinstitutionalstrengtheningislimited andproblematicto locate.Disseminationandexchangeof mformationconcerningstrategiesandimplemenLationof trainingfor staffandcommunirieson anationalandregionalbasiswould greatlyassistthedevelopmentof institutionalandtrainingcapacitywithin Africa andshouldbeencouraged.

Contents

Foreword

ExecutiveSummary

Contents

Introduction 1

Institutional Roles 2- RequirementsandKey Players 2- NationalPolicy andInter-sectoralCollaboration 3- Inclividual SectorRoles 5

Training Needsand Provision 10- EducationandTrainingStrategy 11- TrainingNeedsAssessment 12- Engineering,Scientific andTechnicalStaff 13- HealthandEducationStaff 16- CommunityEducation 18

Infrastructure 20- Introduction 20- TechnologyOptionsfor Excreta Disposal 21- TechnologyOptions for WastewaterTreatment 24- TechnologyChoice 25

Programme Implementation 29- Introduction 29- Rolesin Implementation 29- Construction 32- Operation andMaintenance 33- Treatment 34- Health Education 35

Annex 1: National Training and ResearchStrategies 36

Annex 2:Technical Documents 37

Annex 3: Sanitation TechnologyChoice 39

Annex 4: Kumasi StrategieSanitation Plan 40

Annex 5: Acknowledgements 42

Annex 6: References 44

Introduction

The urbanpopulation of Afnica has increaseddramaticallyoverthepasttwo decadesthroughhighbirth ratesin urbanpopularionsandcontinuingmigrationfrom ruralareas.The majonityof theurbanpopulationof Africa are in low-incomegroups,withgenerallysub-standardhousing,few basicservicesandpoorinfrastructure.A largeproportionof theurbanpoonlive in informal settlementson thefningesof citiesor in overcrowdedinnencity areas.

Oenerally,the provisionof adequatewatersupplyandsanitationhasnot keptup with the increaseinpopulationin African cities, andcoverageisparticularly10w in poorerareas.The problemsto thehealthof the populationthat this hascausedhavebeenmassive.The lack of basicsanitationin lowincomeareasis oneof theprincipal causesof thehighratesof morbidity andmortality commonlyassociatedwith theseareas.This ispnimanilyduetothehigh incidenceof ‘faecal-oral’ routediseaseswhich include diarrhoeas,dysentries,cholera,typhoid andviral diseasessuch as infectioushepatitis.Otherdiseaseswhich thnivein theseareasarevector-bornesuchasfilariasis andmalaria(relatedto inadequatesullagedisposalandurbandrainage)andhelminth infectionsdueto poorexcretadisposal(worm infectionssuchas roundwormandhookworm are often more commonin cities thanruralareas).With the highdensityof populationinmostlow-incomeurbansettlementthereis alwaysarisk of epidemicswheresanitationandwatersupplyarepoon.

In the recentpastengineersandplannershaveconcentratedon conventionalsewerageas theonlyviable solution for urbansanitation.This requiresanin-houselevel of water service,complexandsophisticateddesignsandmatenalsandsophisticated

operation andmaintenance regimes carnied out byskilled staff. Sewerage isolatesfresh excreta from theuser but transfers the hazardto anothersitewhereitwill requinetreatment.All thesefactorsgreatlyincreases thecostof sewerageto thepointwhere-

unless the municipal authonities can subsidise theprovisionof sewerage- only awealthy minority willbe able to pay for sewerageservices.Mostmunicipalauthoritiesor governmentsin Africa arenot in the

position to providesubsidiesof thescalerequiredforlangescaleintroductionof sewerage.It mayalso notbe technicallyfeasiblein manyof theinformal low-incomeareasinmoercitiesandon the peripheryofcitiesaswatersupplylevelsarelow, thesupply maybediscontinous,housingis temporaryandaccesscommonlypoon.

1f the healthof the urbanpoor in developingcountnies,andin particularwithin African cities, is tobeimprovedthereis an urgentneedfor langescaleinvestmentin improvedsanitationwhich utilisestechnologywhich is affordable,providesa healthbenefit,cam besutainedandgivesusersconvenienceandprivacy. It is imperative that municipalauthonitiesandgoverninentsin Africa look atthefullthefull rangeof technologiesavailableto them andchooselower costoptionswhich will allow a greatermle for communityparticipationandmanagementofsanitationfacilities.

In conjunctionwith technologyprovisionthereis aneedfor healtheducationin the communitytopromotegoodhygieneandthe needfor properdisposalof humanwastes.For a significant healthbenefit to be realisedsanitationfacilities mustbeusedcorrectly andgoedhygienepracticedto preventthe transmissionof faecal-oraldiseases.The trainingneedsof communitiesneedcarefulevaluation,particularlyif increasedcommunitymanagementis agoal of thenationalsanitationplan.

The lackof trainedstaffandthe levelof generaleducationamongsttheurbanpoonarealsohampeningtheimprovementof sanitaryconditionsin Africancities.Govemmentsneedto idenftfy national trainingneedsfor staff involvedin sanitationprovisionsuchasengineers,technicians,healtheducationstaffandplanners.A cleanstrategyto satisfythesetrainingneedsshould be developedandthe nationaltrainingcapacityincreased.

Hygieneeducation,technicaltraining in openationand maintenance and support for managementstructureswill all need to be addressed if sanicationprovisionin urbanareasis to be sustainable.

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Requirementsand Key Players

Institutional Roles

Thereis a greatneedin mostAfrican countriestoincreasethe institutionalcapacityto supportthedevelopmentandsustainabilityof urbansanitationprogrammes.The strengthof institutionson aregionalandnationallevel needsto beincreasedtoallow governmentsandmunicipalauthoritiesto planmoreeffectivelyandmanageexistingandfuturesanitationfacilitiesefficiently andcost-effecüvely.Staff needto bekeptabreastof currentdevelopmentswithin thefield andresearchcapabilitiesshouldbestrengthenedto improvethe rangeof availabletechnologies,to increaseaffordabilityof technologiesandto ensure that adequate ‘delivery’ systems aredevelopedandrefined.

Thereareanumberof Governmentdepartmentswhoarelikely to be involved in someway with sanitationprogrammes,altliough thesewill vary according tonationalandlocal arrangements.Thesemclude: theMin istry of Health;Ministry of Local Government;Municipal Authorities; Ministry of Works; Ministryof Finance;Ministry of Water;and,the Ministry ofEducation.In additionto thesegovernmentagencies,thereareanumberof otherinterestedgroupswho arealsoinvolved in sanitationimprovement.Thesearelikely to includeeducationalinstitutions;multi-lateralandbi-lateralaid agencies;UN agencies;andinternationalandnationalNon-GovernmentalOrganisations(NGOs).

The recipientcommunitiesarenot strictly an‘institution’, but the aim of increasingnationalinstitutionalcapacityshouldbe to improvethe healthof eachcommunityand the overall population.Thusincreasingthecapacityfor communitiesto makedecisionsandpromotechangeis vital. It is importantto recognisethat the strengthening of the communitycapacity is vital in thedevelopmentalprocess.

Themle eachplayeror institution takesin sanitationprovision will vary between countries;responsibilitiesarenot alwaysdearcut andthereisoften of overlap between sectors. Somerecommendationsfor therolesfor individual sectorsareoutlined later in this section,buL generalprinciplesare notedhere.

The managementand/or constructionof sanitation

faciitiesmay besupportedby anuniberof sectors.Insome cases,the municipal authority will beresponsiblefor the constructionandmanagementofsanitationprogrammes,althoughthesearecommonlyfundedeitherby anexternalsupportagencyand/ornational Government. For example, in Nairobi theMunicipal Authority is responsible for all sanitationprovisionwithin thecity. Alternatively the Municipalauthoritymaytry to redefineits role within sanitationprovisionto thatof monitoringandmanagement.Anexampleof this approachis developmentof astrategicsanitationplanandimplementationof thepilot projectsin the KumasiMetropolitan Area(KMA) in NorthernGhanawhich wasimplementedby the KMA andsupportedby JJNDP-WorldBank.Thisprojectencouragedactiveparticipationof theprivatesectorin a numberof areasof thepmgrammeand theStrategicSanitationPlanthatwas producedrecommendedthat the private sectorrole inconstructionanddesludgingbeexpanded.

Municipal authoritiesandMinistries of LocalGovernmentmay beable to providetechnicalinputto sanitationprogrammesas theycommonly employsomequalifiedandexperiencedstaff. However,resourcesfor materlalandequipmentpurchaseandfor on-goingoperationandmaintenanceare oftenlimited. This is partly dueto limited nationalresources,but often alsodueto poormanagementandalack of activecampaigningfor resourcesatanationallevel. The local governmentsectorisalsooftenpoorlyequippedto deal with healtheducationprogrammesas they maynothavemuchexperienceof providinghealtheducationor havestaffwho cnnimplementsuchprogrammes.

Thehealthsectormay be activelyinvolved in urbansanitationprogrammes,but in many Africancountriesthehealthsectorhasadopteda10w profilewith regardto sanitationprovisionas a wholeandurbansanirationin particular.Whilst thehealthsectorhasmadesomecotitribution to theplanning ofsanitationimprovementat a nationallevel,urbansanitationprovisionhaslargely beenperceivedas alocal governmentresponsibiityandthehealthsectorhasthereforenotbeendirectly involved. Healthsectorinvolvementin urbansanitationprovisionhasalsobeenhamperedby a lack of sufficientresourcesto meetall thedemandsmadeuponthesector.

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As sanitationhas oftenbeenperceivedas anengineeringproblemand as few African healthdepartmentshaveengineerson their staff, theprovisionof urbansanitationhasbeenrelegatedto apositionof minor importanceby the healthsector.This is aweaknessin the sectorand,althoughit isunlikely thatthe healthsectorwill becomeactivelyinvolvedin constructionof sanitationfacilities on alargescale,recrnitrnentof asmallnumberof publichealthscientistsandsanitaryengineerswould greatlyassistthesectorin playing amoreactiverole in theplanningandimplementationof urbansanitation.This would allow thehealthsectorto be abletodevelopandconductmorethoroughmonitoringprogrammes,makea significantcontributionto thenational and local planning of sanitationimprovementprogrammesandbe able to assesshealth benefits of technologies morecomprehensively.

The main role currentlythe healthsectorplaysinsanitationprovisionis throughhealtheducation,environmentalhealthinspectionsandtraining ofcommunityhealthworkers.This is largely theapproachadoptedby the Ministry of Health inGhana.The health sectorshould continue tostrengthenandexpandits rolein healtheducation,training andmonitoring.The sectorshouldplay apmactivepromotionalrole to raiseawarenessaboutthe importanceof sanitationin urbanareasincommunitiesandgovernments.

The strengthof the health sector lies in itsunderstandingof the healthissuesrelatedto poorsanitation.Thisexpertiseshouldbeexploitedtodevelopappropriatehealtheducationprogrammesincommunities,in activelypromotingthe benefitsofgood sanitationandhygieneto thepopulationandbyestablishingadequateeffluentandwastequalitystandardsandsurveillance.

The educationsectorhasbeeninvolved in urbansanitationthroughtheprovisionof formal educationthroughhigherandfurthereducationinstitutionsandschools.Generallytheeducationsectorhasasubstantialresourcein thenumberof trainedteachersof all levels. However,public andenvironmentalhealtheducationhasnot generallybeenaffordedahigh priority by the educationsectorandis slillrestrictedto asmallnumberof specialistgroups,although there have been some innovativeappmachessuchasthe MSccoursein Public HealthEngineeringoffered to medical staff by theUniversityofNairobi.

In many African countriestheeducationsectoralsoprovidesa limited inputto theinformaltraining ofcommunities andfield staff.This hascommonly beenin the form of workshopsandin-service trainingtofield staffandfunctionalliteracyprogrammesaimedatadultsandnon-schoolingchildren.However,informal educationfor adultsandchildren who haveleft schoolis still generallyweak in mostAfricancountriesand, whilst it’s importanceis widelyrecognised,few educationdepartmentshavecommittedsubstantialresourcesto informaleducation.By improving collaborativelinks withExternalSupportAgencies(ESAs),NGOsandothergovernmentdepartments,the educationsector’scapacityfor informal educationcouldbe increasedandshouldhavesomefocuson sanitation.

The financesectorof nationalgovernmentisimportantto sanitationasultimately it will allocateresourcesfor sanitationimprovement.This sectorshouldbeawareof thegeneralbenefit,both in healthandpotentialincomegeneratingdapacity,to thepopulationthat improvedsanitationcnn bring.Theyshouldalsobe involved in policy makingandtechnologyselectionto ensurethatthe econoniiccostaand benefitsareproperlyaddressedatanationallevel.

Externalsupportagencies(ESAs)andNGOsarebothactively involvedin urbansanitationprogrammesandcan make significant contributions to thedevelopmentof sustainableprogrammes.Externalsupportagencieshavegenerallyfocussedon thesupportof otheragencies,such as municipalauthoritiesandNGOswho implementprojects.ForinstanceUnicefandDANIDA amongstothershaveprovidedconsiderablesupportfor the KenyaWaterforHealthOrganisation(KWAHO), anationalNGO,whorunseveralprojectsin low-incomeurbanareasin Kenya.

ESAscommonlyalsosupportinstitutionalcapacitybuildingprojectswhich strengthentraining andeducationfor sanitationprogrammes.For example,the United Kingdom OverseasDevelopmentAdministrationhavesupportedthedevelopmentof apublic environmentalhealthprogramnmewhich aimsto train publichealthinspectorsandhealtheducatorsin Kumasi,Ghana.

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National Policy and Inter-sectoralCollaboration

At a national level, strategie plans for theimprovementof urbansanitationshould bedevelopedwhichclearly identify thenationalgoalsforhealthinrelationtoimprovedsanitation.This shouldincludediscussionof the expectedhealthbenefitsto thepopulation.Someattemptshouldbemadeto quantifythecostto the nationalhealthservicescausedbysanitationrelateddiseases;someprojectionofproductivity lossesthroughwork dayslost causedbysanitationrelateddisease;andtheexpectedeffect ofimprovedsanitationon thesefigures.

Thisplanshouldalsoclearlystatewhat thenationalcostof sanitationprovisionwill be, what externalfundswill be required,how costscanbe sharedbetweenthe governmentandthe usersand whatcommitmentwill be madeto meetlong termoperationandmaintenandecosta.It is importantthattime limits areestablishedto meetinterim andfinalobjectives.

The nationalplan shouldprovideguidelinestomunicipalauthoritieson: technologyselection;programmeimplementation;who should beresponsiblefor donstruction;time scalesforimplementation;costrecoveryplans; communityhealtheducationprogrammes;staff trainingneedsand provision; and, planning for long-termmonitoring andsupportof community basedsanitationprogrammes.This will involve an inter-sectoralapproachandurbansanitationprovisionshouldbe establishedas a key componentof theoveralldevelopment strategyof thecountry.

A forum for information exchangeshouldbeestablished which shouldincluderepresentativesofall the majorplayers in sanitationprovisionincludingappropriategovernmentdepartmentor Ministries,ESAs,NGOsandeducationalinstitutions. Byinvolving all themain playersin theplanningprocessit is morelikely thatthe resultswill be morewidelysupportedandacceptedandthat theneedsof thosewho will ultimatelybenefitfrom improvedsanitationwill adequatelyaddressed.

Regularmeetingsof all sectorsshouldbe heldataseniorlevel, for instancethroughaninter-Ministerialcommittee,andabodyset up to planandmonitoronanational scaleurbansanitationprogrammes.Thisbody may be the above committeeor a sub-committeeandshouldhavethe weight to achievechange andnot be allowedto becomemarginalised

throughlack of political power.To thisendthecommittee or body should include seniorrepresentativesof all interestedpartiessuchasPermanentSecretaries,seniorMunicipal officials andpossiblyrepresentativesof ESAs or NGOs actinginanadvisorycapacity.The recommendationsmadebysuchabodyshouldform thebasisof policy for urbansanitationandbe usedto developlong-termandshort-termaimsandobjectives.

This committeeshouldberesponsiblefor: assigningsectorresponsibilities;establishinginvestmentpriorities; identifying sectorweaknessesandpromotestrengtheningof the sectorsinvolved in urbansanitation;establishingapanelto identify appropriatetechnologiesfor urbanconditions;how costsmayberecoveredfrom users;whethersubsidiesarerequiredand to what level; and,what complimentaryeducationprogrammesshouldbe run in conjunctionwithconstructionprogrammes.Guidelinesfor qualitystandardsof effluentandtreatedwasteandreuseoftreatedwastefrom all sourcesproposedby thehealthsectorshouldbediscussedandstandarclsapprovedatthis level. This forumneednot be technicalbutshouldbeableto cail upontechnicalcommitteestoaddressspecific issuesandproducedearresultsandrecommendations.

To ensurethatimplementationof improvedurbansanitationis effective,oneagencyshouldtake theleadin planningandsupervisingprogrammesofsanitationimprovementevenwheretheseareimplementedby the private sector. In mostcircumstancesthemostappropriatebody for this willbe the Ministry of Local Government,or itsequivalent,andthemunicipal authorities.Theseagenciesare themostinvolved in urbanaffairs anditis theywho shouldretain overallcontrol of urbansanitationimprovementon a local level. However,this doesnotmeanthatthe othersectorsshouldrelythe lead agencyto be solely responsibleforpromotingsanitationprogrammes.All sectorsshouldbeactively involved to ensurethat thekey issuesareaddressedandthaturbansanitationmaintainsahighprofile in governmentpolicy.

A nationalpanelor working party should beresponsiblefor theevaluationof technologieson thebasisof technical,healthbenefit,socialacceptabilityandcostcriteria andmakerecommendationsto theinter-sectoraldommittee.This panelshouldincludeanengineerto assesstechnicalsuitability; a healthprofessionalto assessthe healthbenefitto theusers;an edonomistto providea thoroughcost-benefitanalysisof eachtechnology,taking into accountthe

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long-termbenefitsto theeconomyas a whole intermsof expectedlower healthcarecostsandimprovedproductivity; an educationalistto assessthetraining needsassociatedwith eachtechnology;and,a socialbehaviouristto look at socialandculturalfactorsof technologysuitability.

Conductinga thoroughreview of all availabletechnologiesin sucha ‘holistic’ mannershouldavoidfutureproblemssuchasa technologybeingselectedthatis technicallyfeasibleandcheapbut culturallyinappropriate,with limited healthbenefitand/orwithahigh educationrequirementfor properuse.Technologiesshouldbe identifiedwhich providethemaximumhealthbenefit,aretechnicallyfeasible,low-cost, culturally acceptableandwith theminimum trainingrequiredfor properuse.

The routinemonitoringof effluentandsolid wasteshouldbe an integralpartof anyurbansanitationprogrammeto protecttheenvironmentalandpublichealthof the populationof cities andalsoothercommunitiesdownstreamof discharges.Appropriate,achievablequalitystandardsshouldbeestablished,however,it is importantthat thestandardsadoptedare designedfor the maximumprotection ofenvironmentalandpublichealthandbackedwith thelegal mechanismsto enforcecompliance.A fullyindependentnationalbodyshouldbeestablishedtotakeresponsibilityfor routinemonitoringof wasteanddischargequality.This couldbea healthsectoror anenvironmentsectormle.

Lndividual SectorRoles

IndividualMinistries, educational institutions andexternal agenciesall havedifferent rolesto play inurban sanitationimprovement,which takenas awholeshouldensurethat key issuesareadequatelyaddressed.

LocalGovernment:This is commonlytheleadagencypromotin~urbansanitation,as is the casein Kenyafor example,andshould be responsiblefor the planning andimplementationof programmes.Local governmentshould be responsiblefor recommendinghowprogrammesshould be implemented, whattechnologiesare to be usedandwho shouldberesponsiblefor construction,operationandmaintenance.1f privatecontractorsandNGOsare tobe involved in sanitationprovisionthe Ministry ofLocal Governmentandmunicipal authoritiesshouldclearly definewhatstandardsof constructionare

required,how clifferent contractorsandorganisationsshouldbe involvedandhow sanitationshouldbepromotedin the community.They mustalsodecidewhat their ownrole shouldbein sanitationprovisionandproducea dearplan of how this will beachieved.

Local government,with the assistanceof othersectors,shouldberesponsiblefor thedevelopmentofmunicipal sanitationplanswhich havea strongstrategicelementto them.Theseplansshouldoutlinetimescales,technologies,pilot projects,educationandtraining needs andcostaof sanitationprovision.Municipal authorities should also producecomprehensiveannualreportson the progressofwork, amendplansin light of theseandhighlightanymajorproblemswhich havearisenandstatehowthesewill beaddressed.

Local governmentshouldthereforeprovidea focusforurbansanitationpmvisionandpromotesanitationasapriority interventionin thedevelopmentof urbancentres.It maybe thatlocal governmentwill alsotakeresponsibilityfor themanagementof sewerageandsewagetreatmentand for some areasofsanitationconstruction,for instancein publicplacessuchasmarketsandindustrialareas.It may alsoberesponsiblefor theemptyingof pit latrinesandseptictanks.Adequateresourceswill berequiredto fulfilthesefunctions.

When construction,desludgingandtreatmentarenotthe direct responsibilityof localgovernment,itshouldhavethe capacityto establishworkingguidelinesto ensurepropermanagementof sanitationin thecity. Theseshouldcoverconstructionquality;ensuringaffordability of facility construction;ensuringthatgoedworkingpracticesareadopted(inparticularhealthandsafetyat work); and,formonitoringtheactivitiesandperformanceofimplemenüngagencies.

1f theprivatesectoris involvedin constructionofsanitationinfrastructure,the municipalauthorityshouldkeeparegisterof approvedcontractorswhoare licensedto submit tendersfor constructionprogrammes.Thesecontractorsshouldbe evaluatedin termsof technicalability, fmancialviability andonpastrecordof contractmanagement.Approvedcontractorsdo not necessarilyhaveto belargecompanies- a registershouldideally alsoincludesmallbusinessesandlocal artisanswhocan workwithin their owncommunities.

Municipal authoritiesareoften responsiblefor

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sanitationin hospitals,schoolsandotherinstitutions.Even wherelocal governmentis not directlyresponsibleit shouldactivelypromotesanitationintheseinstitutionsandconsidermaking their prosrisionastatutoryrequirementfor all institutions,aswasrecommendedin the Kumasi StrategicSanitationPlan.Local governmentmayalsoconsiderwhetherpublic institutionsshouldreceiveagreaterlevel ofsubsidythanis generallyavailablefor sanitationimprovement.

!lealth Sector:The health sectorhas an important role to play inurbansanitationat bothnationaland local level.Thehealthsector should be actively involved inproducing national and municipal strategic plans forsanitation improvement and should be directlyresponsiblefor the provisionof communityhealtheducation.The healthsectorshouldalsowork witheducationalinstitutionsto establishand strengthencoursesin public health,includingengineeringandtechnical disciplinesas well as healtheducation.Thehealth sector should also be involved in theestablishmentof adequateeffluentquality standardsandmaytake responsibilityfor surveillanceofdischargesandmonitoringandevaluationofsanitationimpmvemenL

The health sectorshould be a strong advocateofurban sanitation improvement and takea proactivemlein thepromotionof sanitationimprovement.Thesectorshouldrecognisetheprofoundinfluencethatpoor sanitation has on the health of the urbanpopulationandacceptahigh pmfile role in sanitationpromotion and health education. A high proportion ofthe diseasescommonlyencounteredin developingcountries,particularly in low-incomeurbanareas,canbedirectly relatedto inadequatesanitation facilitiesand water supply.As thehealthsectoris responsiblefor thepreventionandtreatmentof thesediseasesitmakes sensethat they should be activelypromotingimprovedsanitationandwatersupply as key issuesfor the health of the population. This is alreadyhappeningin someAfncan countries,for instanceinGhana.

It is not generallyrecommendedthat the healthsectorbecomedirectly involved in the construdtionofsanitationfacilities as therearegenerallyfewtechnicalstaffemployedin the sectorandit would beinappropriatefor the sectorto duplicatethecapacityof othersectors.However,it would increasethecapacityof the healthsectorto promotesanitationata local andnationallevel if someengineeringandscientific staffwereemployed.However,the most

importantrole for the health sectoris the training ofhealthandothersectorprofessionalsto ensure thatthoseconcernedwith sanitationprovisionhaveadearunderstandingof thehealthissuesinvolved.

The healthsectorshouldtake responsibilityforprovidingcommunity healtheducationin parallelwith sanitationconstructionprogrammes.Thismeansthat there should be substantial intersectoralcooperationat a municipal level as well as at anationalpolicy making level. Healtheducationprogrammesmust be linked to construdtionprogrammesand the two seenas essentialandcomplementary.To achievethis the healthsectorshouldbeakey participantin the planningprocesswhensettingconstructiontargetsandplansforsanitationimplementation.No constructionshouldgoaheadwhereinadequateresourcesexist forcomplementarycommunityhealtheducation.Inurbanareastheneedfor healtheducationis often asgreatastheneedfor sanitationfacilities.

Collaborationwith the educationsectormaybeincreased to develop appropriate educationtechniquesand materials for community healtheducationprogrammes.This maybe useful as there isoften usefulexpertisein the developmentofeducationstrategies,appropriateinfonnal educationtechniquesandmaterialswithin theeducationsector.

The health sector should promote collaborationbetweenprojects and agenciesinvolved in healtheducationbothlocallyandnationally to ensurethathigh quality materialsareavailableto all interestedparties.Thereareoftenseveralagenciesdevelopinghealth education programmesand materials whichmay have little contact with eachother. This mayleadto multiplication of materialsandawidevariation in the quality of teaching and materialsusecL A regular forum should be establishedfor theappropriatebodies,be they institutions, aid agenciesor municipal departments, to allow the latestdevelopmentsto bedisseminatedanddiscussedandto encourageinter-agencycooperation.

The healthsectorshouldwork with higherandfurthereducationinstitutionsto ensurethatcoursesofferedwhich arerelevantto public healthandinparticularsanitatiou,haveadequatecoverageofhealthaspects,including basicgerm theory,epidemiology,basicmicrobiology, the banierstodiseasetransmissiötiandsociologyor studiesofhumanbehaviour.The sectorshouldwork withteachinginstitutionsto developtheir curricula tocover thesetopics and provide adviceon teaching

6

materialsdevelopmentand where necessaryprovidea teaching input into suchcourses.Courseswhereasubstantialhealthsectorinputwill be requiredare:sanitaryengineering;undergraduatecivil, mechanicalandchemicalengineeringcoursesin public healthengineeringoptions;public healthscience;diplomasin environmentalhealth;techniciantraining;community health education courses;coursesforprograinmemanagersandplantmanagersetc,

A substantialinputwill berequiredfrom the healthsectorin the assessmentof technologiesfor urbansanitationandwastetreatmentto ensurethatappmpriatetechnologiesareselectedwhich providethe maximumhealthbenefitto theurban population.

The healthsectormaybe theleadagencyin theestablishmentof qualitystandardsfor effluent andtreated waste quality from both domestic andindustrialsources.This is to ensurethat - in additionto environmentalprotection- the healthof thepopulationis protected.Thesestandardsshouldaddressboththe short-termeffectsof pathogeniccontaminationof naturalwatersandtoxic wastefromindustry,andthelong term healtheffectsof exposureto harmfulchemicals.Thehealthsectormayalsobean appropriatebody to takeresponsibilityforsurveillanceor contributeexpertiseto a statutorybody establishedfor this.

Thehealthsectorshouldmonitoruptakeanduseofsanitationfacilities by all sectionsof the communityandto evaluatethe impacton health thatthis effectsandusethis information to define researchneedsinurbansanitation.Researchinto thelinks betweentheimprovementof urbansanitationand improvementsin healthis recognisedto be adifficult areasbut isimportantandafunctionwhichthehealthsectormayfulfil, possibly in collaboration with institutions ofhigher education.Where this research is undertaken,it should attempt not only to give an overall pictureof theeffect of improvedurbansanitationon health,but alsohighlightwhich specificareascontributethemostto healthimpmvementandidentify areaswhichrequirefurtherdevelopmentto provideasignificanthealthimprovement.Thus the individual effectsoffacility provision, health education, educatlonalstatus, financial status and cultural factors (suchasage,sex,religion etc) shouldbe considered. This willrequireinputsfrom othersectors,for instancesocialscienceandeducalion.

EducationSector:The education sector should be a key player in urbansanitationas it is likely to be involvedin theformal

andinformaleducationof thepopulation,particularlychildren.It is alsolikely to havesomeinvolvementinthetrainingof field staffandprofessionals.Wheretheeducationsectorcan takeaproactiverole in thedevelopmentof suitabletraining programmesandcoursesrelevant to sanitation, then the delivery ofsuchtraining is likely to be moreefficient andeffectiveasstaff with educationaltraining will beinvolved.Theeducationsectorneedsto work closelywith othersectorsto identify trainingneedsanddevelopappropriateeducationandtraining strategiesfor the sanitation sector.

Theeducationsectorshouldwork with the healthsectorto developappropriatehigher educationforstudentsstudyingfor degrees,diplomas andcertificatedcoursesin communityhealtheducation.Thehealthsectorcanbestadvisetheeducationsectorwhat subjectsshould be covered,but the educationsectormaybebestableto adviseregardinghow theseshould be presentedfor the students to gain themaximumpracticalbenefit.This lastpoint isimportantbecausestudenteneedto learnskills andtechniqueswhich will help them on graduationto

provideanacceptablequalityof work on sanitationprojects.Highly theoreticalcoursesalonewill notadequatelyprepare graduates for the workingenvironmentandoften resultin aheaviertrainingburdenbeingplacedon employers.

Contactbetweeneducationpmvidersandemployersshouldbe encouragedto ensurethatthegraduatesofappmpriatecourseshaveskills which correspondtothe needsof the employers.Obviously, studente willrequiresometheoreticalbackgroundbut the principalfocus,particularlyin diplomaandcertificatecourses,shouldbethe practicalsolutionof realproblemsencounteredwithin the country.

The education sector should be involved incommunity health educationand assistthe healthsectorto developappropriate participative methodsof teaching methods and the development ofappropriateteachingmaterials.Healtheducationprogrammesshouldbeseenascollaborativeventuresbetweenbothsectorsandtheyshouldwork asa teamto producethebestresultspossible.

Cooperationis alsoimportantbetweenthe localgovernment sectorand the education sector todevelopappropriate coursesof higher and furthereducation. The education sector should work withengineers,technicalstaffandscientiststo identifytrainingneeds,set up coursesfor studentsatdegree,diplomaandcertificatelevelandcollaboratein

7

developingappropriate in-service training for staff.Again thefocusshouldbeon the practicalsolution torealproblemsfoundwithin thecountry’surbanareaswith alower emphasiscm theoreticalcontent,excepton degreecourses.All technical,engineeringandscientificstaffwho will betrainersshould be trainedin educationtechniquesto ensurethat thetrainingtheyprovideis of high quality. This shouldbeimplementedatall levels,from degreecoursestolocal masontrainers.

Institutionsof higher educationshouldlook at waysto collaboratein researchandteachingwith thesectorsinvolvedin sanitation.Universities,collegesandotherteachinginstitutionswhichoffer higherandfurthereducationin relevantsubjectsshouldincreasetheircapacityto collaboratewith otherinstitutionsin-country,regionallyandglobally. This shouldbe atwo-way processwlth teachinginstitutions inindividual countriessharingtheirexpertiseandknowledge withothersregionallyandglobally whilstbeing able to accessexpertisethemselves.Networkingcan be beneficialto all participatinginstitutionsfacilitatingthedevelopmentof teachingandresearchcapacity.Of particularbenefitisnetworkingbetweeninstitutionsin the developingworld to exchangeexpertiseandexperienceofcommonproblemsandpotentialsolutions.Thisshouldnot be restrictedto regional networking butalsoindlude networkingwith institutionsin otherregions of the developing world. For example,African teaching institutions should considerstrengthening and expanding their links withappmpriateinstitutionsin MiaandLatin America.

ESAsandNGOs:Thesecan play a vital role in providing funding,expertise and, sometimes, management ofimplementationof sanitationprogrammes.Theseagencies can also actascatalystsfor changeandpromotethe importanceof sanitationon anatlonalandinternationallevel. ESAsareoftenresponsiblefor fundingof programmesof sanitationprovisionortraining of staff in governmentor municipal authorityemploy.Many of thelargerurbansanitationprojects,such as theUNDP-WorldBankfunded KMA projectare funcled in partor entirelyby ESAs.

IncreasinglyESAs areproviding funds for NGOswhethernationalor international,to implementsanitationprogrammes.This is becausemanyNGOshave agoudreputationfor workingwith thepoorestsectionsof society, of running participativeprogrammes andbeingcost-effective.

Both ESAsand international NGOs have their owntrainingandinstitutionaldevelopmentpolicies. Theyusuallyhaveaccessto expertiseeitherin-countryorfrom expatriateswith appropriateskills andexperience.Many internationalNGOsandUNagenciesattractskilledandeducatedstaffwithincountriesandthis is beneficialin thattheyremainwithin thecountryandcontinueto woi-k in sanitation.Somegovernments,for instancein SierraLeone,assignstaff to NGOs as thisallows theCivil Serviceto retaingoodstaffwith limited financial cost,providesa goudcareerdevelopmentexperienceandensuresthatgovernmentwill in thefuturehavestaffthatarefamiiar with sanitation designsand meansofoperationand maintenance.

NationalNGOs alsoattractsignificantexternalsupport,for instanceKWAHO hassupportfromUnicefandDANIDA arnongstothers.Theseagenciesmay representgood investmentin communitydevelopmentasthey arelikely havealong-terminputinto the community.They may requireinstitutionalstrengtheningthrough training in managementtechniquesandaccountancy,aswell as appropriatetechnical, teaching and mobilisation skilldevelopment~.This training will requiresomeinputfrom thehealthsector,particularly trainingfor healtheducationstaffandhealthtraining for managersandtechnicalstaff.

Privatesector:Privateconstructors may be responsible for some orall of the construction, operationand maintenandeofsanitation facilities. Much of the private sector rolemay be fulfilled by small contractors, for instancelocal masons, working within particular urban areasand often in a locally restricted area within theirdommunity. Where privatecontractorsareemployedthey should be able to demonstrate technicalcapability,financial securityandpreferably,arecordof successfulcontractcompletion.

Private sector activities will benefit from a goodunderstandingof thehealthbenefitsof sanitationandflexibility in their approach to sanitationconstruction. The private sector would also benefitfrom training by the health sector in communitymobilisation techniques.

The community:Whilst it is not strictly accurate to define thecommunityas an institution, it is dearthat in anyprogrammeof urbansanitationimprovementshouldbe gearedto the improvementof healthof thepopulation.As the healthof thepopulationimproves

8

this may help to improve social and economicconditions aspeoplehave more time and energytodevoteto economicactivities.

The community needsto be in the position wherethey cnn make rational decisionswhena choiceisavailable. This is particularly important whencomrnunitiesareexpectedto choosewhich sanitationtechnology they require,as this processwill involveassessingcomplex issues and making valuejudgments. Although communities alreadypossess awealth of knowledge, this may not be focussedonsanitation issuesand communities may not fullyappreciatethe health benefits technologiesprovideand what inputs the community are expected toprovide.

The role of women in technology choiceand inhealth education should be promotedby all sectorsinvolved in urban sanitationprogrammes.Womenoftenmakeveryeffectivehygieneeducatorsas thelargestpart of the target audienceis often otherwomen and children. However, this should not beseenas women’ssolerole in sanitation provision.They should be actively involved in technologychoice, programme implementation and, mostimportantly,managementof sanitationfacilities.Women should be encouragedto takeinitiatives andnot allowed to becomepassivepartners to maledecisionmakers. This is an issuewhich must behandledsensitivelyby all concernedwith sanitationandappropriatemethodeof promoting womensrolein sanitationprovisiondeveloped.

Where sanitation improvement will involve asignificant elementof community management,training andstrengthening of community institutionsis often required.This is clearly seenin the KWAHOproject in Kibera, Nairobi, where institutionalstrengtheningwas seenasapriority. As this is a low-income, informal settlementwith fewbasic servicessupplied the community has had to acceptresponsibilityfor manyof the management decisions.This includes establishinga revolving fund whichcan be used to provide loans for those householdswhowish to dig latrines,settingin placea rotationalsystemfor pit exhausting, allocation of latrines forexhaustion for eachday of operadon, organisation ofclean-updaysandsolid wastedisposal.To adhievethis level of organisation, communities requiresupportfor committeemembersand training in areassuchassimplebook-keeping.

Increasing the capacity of the dommunity to traintheir memberswill greatly assist in making sanitation

and health education programmes sustainable.Ultimately, if sanitation program mesare to besustainable,the community should t.hemselvesbeable to continuetheconstructionof facilities to keepup with populationincreaseandprovideon-goinghealth education, under the overall supervision oflocal municipal authorities,with minimal externalinput. This meansthatsanitationshouldbe viewedasan essential basic service by the community, thatskills exist in the conimunity to construct andmaintainfadiitiesand thaton-goinghealtheducationis provided through parents, community healthworkers, schoolsand other community organisations.To achievethisoftenrequiresextensivetrainingandcommunity managementcapacitybuilding andsupportto establishandstrengthencommunitystructureswhichallow all sectionsof thecommunityto beactively involvedin decisionmaking.

9

Introduction

Training Needs and Provision

In order that the healthbenefitswhichaccruefromimprovedurbansanitationare realised,usersandprovidersneedto be fully awareof thehealthissuesrelatedto sanitation,how to constructandusefacilities correctly andto adoptgood hygienepractice. it is importantthatall thoseconcernedwiththe provision and useof sanitation facilitiesunderstandwhysanitationis importantaswell as howsanitationcanbe improved.This is emphasisedbecauseit is quite common that technicalprofessionalssuchasengineers,builders andsupervisorshavelittle graspof thehealthbenefitofthe work they areengagedin, which canleadtoinappropriateallocationof resourdes.Therationalebehind any programme of sanitation improvementshouldbe to improve thehealthandwell-beingof thepopulation.In order to optimise thehealthbenefitsthataccruefrom sanitationimprovement,designsforsanitationfacilities shouldpreparedwith thehealthaspectsof designconsideredfrom the outsetandnotconcentratesolelyon technicalconsiderations.

Theconstructionof sanitationfacilities is not in itselfsufficientto providea healthbenefitto theuser;theproperuseof the facitity andtheadoptionof goodhygienepractices,such ashandwashingafterdefecationandbeforeeating,arevital for healthimprovements.In many areaswithin cities,particularlyamongst low-income groups with limitedaccess to education,thereis a greatneed for healtheducationto promoteimprovedhygienepractices.

Theprincipal providersof trainingandeducationforurbansanitationare likely to be:

~ the healthsector- throughdevelopmentofcommunityhealth educationprogrammes,input to relevantcoursesof higherandfurther education including public healthengineering,public healthscienceandcommunity health education; providing aninput in thedevelopmentof coursesandeducational materials for school hygieneeducation;thedevelopmentof teachingaidsandin-servicetraining to environmentalhealth officers, health inspectors,communityhealthpromoters, medical andotherhealthstaff;

A the educatlonsector - through theprovisionof relevantcoursesin institutesofhigherandfurthereducation,developmentof healthandhygieneeducationcurriculafor schools and development of teachingmaterials;

A ESAsandNGOs - through technicalandfinancialsupportfor educationandtrainingstrategydevelopmentand implementation;and through direct involvement inimplementalion.

Thecapacityfor providinghighereducationin publichealthin developingcountriesneedsto beincreasedas typically few courses in appropriatesubjectsareavailablein nationalinstitutionsin African nntions.Commonly,a selectfew aresent to developedcountriesto attendstudycourses.As a result fewprofessionalstaffhaveaccessto highertrainingandthereis commonlya shortfall in expertise.Forinstance,therearerelatively fewpradtisingsanitaryengineers in Africa in governmentemploymentandthesameistrue for manyotherdisciplines.

A commonproblemis thatoncea memberof staffhasgaineda further qualificationoutsidethecountrytheybecomemoremarketablem theprivatesector.Itis quite common for governmentstaff go to adeveloped country to study for ahigher degree andon their return leave the governmentservicesoonafter their return in order to pursueacareerin theprivatesectoror outsidetheir own countrywhichmay be financially morerewardingor havebettercareerprospects.1f theseprofessionalsremainwithintheir countryandwork in sanitationwithin theprivate sector they will still be contributingto theoverall developmentof their country. However,it iscommonly the casethat such individuals workoutsidetheir countryandnot alwaysin a relevantfield. This leadsto a ‘bram-drain’ within governmentstructuresandcanresultin vicious circle of sendingstaffoverseasfor trainingandlosing them rapidly ontheirreturn.1f morestaffare trainedin-countryto ahigh level,governmentwill havemorestaffavailableandthe ‘bram-drain’ maybemanageable.

It is importantto establishcareerstrudtures withingovernmentbodiesif good staff are to be retained.Theseshouldbeusedto encouragestaff to remainin

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the sectorby offering progressionto highergradesandthe prospectof further training. Of particularimportanceis to ensurethat thosestaffwho aresupportedto studyat a higherlevel havechallengingwork which is relevantto the subject of their studiesto come back to at the end of the course.Byimmediatelyutilising their newknowledgeandbygivengreaterresponsibility in recognitionof thevalueof their education,staffare Iilcely to feelmoremotivatedand moreinclined to remain in thegovernmentsector.

Education and Training Strategy

There are a number of groups for whom training isrequired,from engineeringandplanningstaffemployedby nationalgovernment,municipalauthoritiesor otheragenciesthroughfield stafftocommunitymembers.It is importantthat for eachgroupathoroughtrainingneedsassessmentis caniedout to identify whattraining is required.A nationalstrategy for training should be developedwhichidentifieswho shouldbe trained,in what, where, howandby whom.

Coursesin appropriatesubjectsshouldbe developedin African countriesandshouldincludetrainingforfield staff and coursesleading to certificates,diplomas and degrees for suitable candidates. Thismeansthat a nationalhumanresourcedevelopmentstrategy should be produced which caters for theneedsfor all staff and community members and notjust academicelites. It is important that entryrequirementsfor suchcoursesare not relaxedsimplyto boostnumbers, rather thecoursesshould attracthigh calibre studente and give high calibre training.

Mechanisms should be put in place to allow ablestudents to carryon through the educationsystem.Thus, an individual who has a technical or tradequalification but who is deemedsuitable, should beto proceedeventually to a degreecoursewithoutrequiring further schoolcertificates. Also maturestudente with possiblylimited formal education butwith extensiveexperienceshouldbeencouragedtoreturnto formal educationat a higher level, forinstanceto a diplomacourseandpotentiallya degreedourse.

Part-time, modular andblock releasecoursesmay beparticularly appropriate in all disciplines toencourageablemembersof staff to increasetheireducation and so their value to sanitationprogrammes.Coursesshould retain a practical basis

and relate to real conditions in the country andregion, with the use of existing projectsandsanitationsystems as case studies.

Eachcountry should develop and strengthen existingeducationand training centreswhichoffer coursesinrelevant subjects,suchaspublic healthengineeringor community health education. Where theseare fewor do notexist, considerationshouldbe given toestablishingnew centres which focus on the needsofthe country. Decentralisation of educationalinstitutionsis alsoimportant, so that it is not only thecapital cities or very large towns who have facilitiesto provide public and environmental healtheducation. Graduatesof coursesshould be able todeveloptheir careers in smaller towns, particularlywhere theseare in poorer aren of the country orwhich have severehealth problems, therebydiscouraging the view that the capital city is the onlyplacein which to developa career.

Institutions in African countries should beencouragedto estabhshlinks with other educationalinstitutions to encourage co-operation andcollaboration in sanitation improvement betweennations. The UNDP-World Bank InternationalTrainingNetwork is one optionalreadyavailable forsuitable instituflonsand whereverappropriate,effortsshould be madeto link into this network. Regionalnetworking has advantages.Adjacent countries mayhavedifferent fields of expertiseand this knowledgecan then be sharedwith other counirieswho possiblyhavegreater expertisein another field. Visitingfellowships and eichangestudentshipscan also helpto build links and assistcountries to developtheirnational institutionalcapacity.

However, considerationshould also be givenestablishinglinks with institutionsin otherareasofthe developing world and with institutions fromdevelopedcountries.The expertiseavailable in theseinstitutions and the different experiencesfromdifferent partsof the developingworld, may helpAfrican institutionsto improve implementation,educationandresearchcapabilities.Thedevelopmentof curriculawill also be enhancedthroughco-operation with other institutions in developingcountries andinstitutions in developedcountries.

At least in the short term, somestudentewill have toreceiveeducation outsidetheir own countryuntil thestructures are in place to provide this locally.Studentewho study abroad andparticularly thosetaking higher degreesshould, amongst their otherroles, be utilised to train others in thecountry where

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Training NeedsAssessrnentthis is appropriate.For instance,theymay beable tocontributeto teachingof undergraduateengineers,orhelp to devisepracticalprojectsandcasestudiesforlocal institutions.This canact asas incentiveforstaff to remain in governmentemployment,particularlyif they are paidfor their time.

Institutionswhichwish to providehighereducationin fields relatedto sanitation,musthavesufficientexpertiseandexperienceeitherin-house,or easilyaccessibleto the institutionto makethem effective.Akey priority is thetrainingof trainersto ensurethatall institutionswhich offer relevantsubjectshaveadequate expertisein their fleld and as teachers. Thisis importantas it is potentiallymoreharmful to havecourseswherethe teachingpersonneldo not havesufficient knowledge and who may pass oninaddurateinformation than to haveno coursesavailableat all.

Sanitationandpublic healthrelatedtopicsmustbeinterestingandattradtiveto studentsin ordertoencouragegoedstudenteto studythem anddevelopacareerwithin the sector.A recentsurvey of civilengineeringstudenteat Addis AbabaUniversity inEthiopia showedthat only oneper cent wereinterestedin working in sanitationcomparedto 80percentwho wantedto be structuralengineers.However,90 percentcitedimprovedsanitationasthe field which would bring aboutthe greatestimprovementin thequality of life. Unlesssanitationcan attract a greater numberof high calibrepersonnel,the sectorwill remain inadequatelystaffed.

Degree courses in public health should not berestricted to engineering disciplines, but also includecommunity education, health and management.Courseswhich provide training in communityeducationand community mobilisation areasimportantas hardengineeringcourses.Staff from alldisciplines should be given training in the basics oftheotherdisciplines,for instanceat theUniversity ofNairobi there is a Masters course in public healthengineering for medical staff. Furthermore,in anincreasingnumberof colleges,engineersare giventheopportunityto learnaboutotheraspectsof publichealthsuchasepidemiology,basic microbiologyandcommunity educationtechniques.This shouldbeencouragedandpractisedmorewidely.

A summaryof the issuesto be addressedwhendevelopinga nationalstrategyfor educationandtraining is givenin Annex 1.

Theprocessof definition of training needsandthedevelopmentof appropriatetraining strategiesshouldbeinteractivewith all the interestedpartiesactivelyinvolved throughouttheprocessfrom inception,through implementationto evaluationandreview.Thepeoplewhoareactuallyto betrainedshouldbeconsultedto establishwhatknowledgethey alreadyhaveandwhat training they feel they want or require.Managersandseniorstaffshouldalsobeconsultedconcerning what training they feel is needed byjunior staff. However,theserecommendationsshouldnot be allowedto becomesthe decidingfactor asthese may have beendistortedby personalobjectives.For training to lie successfulthetraineesthemselvesshould recognise the need for training and feel thatthetraining providedis appropriateandmeetstheirneeds.

Wherecoursesof higher or furthereducationarebeingset up in teachinginstitutions,theprovincialand countryneedsfor training in thesanitationfieldshould lie assessed and curricula developed whichwill satisfytheseneeds.

In-service training for sanitation staff should befocussedon specific topicsandbuild on existingknowledge.The assessmentof in-servicetrainingneedscanbe establishedthrough annualstaffappraisals,discussionsandobservation.

Community training needscan be ascertainedthrough discussion with the community, baselinesurveysandobservations. The typeof trainingandthesubjectmattercoveredin communitytraining isvital for thesustainabilityof sanitarioninterventions.1f communities do-not understand the need forsanitation and how facilities should be used to helpimprove health, the health benefits expected fromimprovedsanitationareunlikely to materialise.

Whereassistancefrom extemaldonorsfor training isanticipated,they shouldideally be involved intraining needs assessmefft to encourage theirinvolvement and facilitate allocation of resourceswhere they will be most effective. However, it shouldlie thenationalandlocal governmentandthepeopleof thecountryand not the donorswho determinetrainingstrategies.

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Staffing Engmeering,ScientificandManagementStaff

Thepeopleinvolvedwith sanitationprogrammesarelikely to comefrom differentbackgroundsandwillbe responsiblefor differentaspectsof sanitationprogrammes.Specialistswill alwaysberequiredtoperformdertainadtivities, for instancean engineerwill berequiredto designsanitationfacilities, andascientistto test effluent quality. However, itadvisalilethatall staffhaveat leastsomeideaof whattheir colleaguesdo.This heipsto enetensionsthatmayexistbetweendifferentgroupsandfostersteamspirit.

There is importantrole for staffwhohavea widerangeof skills which theycan sharewith thecommunity.This is particularlytrue of field staffwho may needto lie able to providehealtheducation,constructsimplesanitationfacilities, carry outsanitaryandhealthinspectionsandtrain membersofthecommunitytodo someorall of thesetasks.Thesestaffareequivalentto environmentalhealthofficers(EHO’s).

Therearea varietyof groupswho will benefitfromtraining in smallbusinesspractice,managementandaddounting.Theseobviouslyinciudelocal artisanswho mayrequire furthertraining in order to lieefficientbut will alsoinclude thosestudyingfor atechnicalqualificationand,potentially,thosestudyingto lie environmentalhealthofficers. In thecaseof local artisanstheseskills maylie passedcmthrougha seriesof short workshopsandcourseswhicharehighly pradticalandallow themto focuscmtheir particulartrade.Studentswho aretakingtechnical coursesmay have small businessmanagementcoursesofferedas anoption duringtheircourse.For thosestudentstraining to becomeenvironmentalhealthofficer, it may lie mostappropriatetooffer shortcoursesin smallbusinessmanagementtrainingafter they haveachievedtheirqualification.

Thedifferentgroupsinvolved in sanitationprovisionhave differing trainingneedsandtheseareoutlinedbelow thefollowingbroadcategories

i~engineering,scientific andmanagementA technicalstaff, EHO’s andlocal artisans;A health and education;a thecommunity.

Thesearethosestaffwho are involved in the design,constructionandmanagementof sanitationfacilitiesand systems. These staff need to have adequatetraining in appropriateengineering,scientific andmanagementtopids.Generallythis will lie doneto alevel equivalent to a highernationaldiploma,butmorecommonly degreeor higherdegreelevel.

Higher degreesin public health or sanitaryengineeringandpublic healthscienceshouldliestrengthened and where non-existent establishedwithin developingcountriesas few suchcoursesarecurrentlyavailable.Most seniorprofessionalstaffonlargesanitationprogrammeswill benefitfrom havinga higherdegreewherestudyis muchmoreintensiveandspecialisedthan first degreesubjects.Inparticular subjects such as contract management andlegal enforcementissuesin sanitationprovisionshould be covered in these courses. The participanrsshouldalso lie encouragedto focuson low-costandinnovative methodsofexcretadisposal andtreatment.It is throughtheuseof suchtechnologiesthat the urbanpoor will haveaccessto adequatesanitalionat a price they can afford.

Staff from professionaldisciplinesshouldlie keptupto datewith developmentsin thesectorandregularin-servicetrainingeventsshouldlie heldto ensurethat staffmaintaininterestandmotivation.Thesein-serviceevente maywell cover aspectsof sanitationapartfrom the strictengineeringor scientific fieldsandmayincludecasestudiesandaccountsof fieldexperience. This should lie encouraged and staffgivenan opportunityto broadentheir knowledgeanddevelop their careers by gaining a greaterunderstandingof all the issuesin sanitationprovision.

Engineers:Undergraduateengineeringcourses should have basic

public healthengineeringas acoredomponentandoptiousin moreadvancedpublic healthengineeringto allow greaterspecialisationfor thosewho wish topursuethis as a career.All undergraduatesshouldhavea liasic knowledgeof theprincipal methodsofexcretaandwastewaterdisposalanda good basicunderstandingof thehealthrisks associatedwith pootsanitation.This shouldincludesectionson basicepidemiology,liasic microhiologyandtheprincipalroutesof transmissionof sanitationrelateddiseases.

Studentsspecialisingin publichealthengineeringshouldstudythe full rangeof technologiesavailablefor excretadisposalandwastewatertreatment

13

including low-cost technologyfor low-incomegroups. They should lie encouraged to assesstechnologiescritically in termsof healthlienefit,potential for community management,socialacceptaliilityandidentify areasfor improvementonexistingtechnologies.It is importantto stressthecommunityrole in technologyselectionandthe needfor all professionalstaff to lie alile to discusssanitationtechnologieswith communitiesandtorecognise the importande of communityempowermen~

Engineeringstudenteshouldalso studyappropriatemethodsof healthpromotionthrough hygieneeducationin order that theyunderstandthemleeducationplays in sanitationimprovement.It is ofgreatimportance that engineers understand the roleof healtheducationin sanitationpromotion andimprovementand recognisethat technical solutionsalonewill not lie sufficient to providethe healthbenefitexpectedfrom improvedsanitation.

Treatmentof wastes,processdesignof treatmentplants,managementof waste,thepotentialfor re-useof treatedwasteand the quality of effluentsdischargedinto the environmentshouldalsoliecovered in optional dourses.Operation andmaintenancerequirementsof disposaland treatmenttechnologiesshouldlie coveredandgraduatesshouldlie awareof the importanceof planning andimplementingoperationandmaintenanceschedulesto the sustainaliilityof sanitationprovision.

Scientjfic:These staff will normally come from either achemicalor biological backgroundandtheytooshouldlie awareof thepublic healthrisksof poorsanitationandinadequatewastetreatment.Inparticulartheyshould lie awareof principlesofexcretadisposal, wastewatertreatmentandestalilishmentof adequateeffluentandsolid wastequality standards.This shouldcovernot onlydomestic wastes liut also industrial discharges.Scientists may also lie involved in technologyassessment, particularly treatment technologies asthese commonly employ chemical or liiologicalprocesses.

As scientificarelikely to conductroutinemonitoringof effluent andwastequality, courseswhich coverplanningof monitoringprogrammes,samplingtedh niques and appropriate analytical techniquesshould lie made available to them. Analyticalqualitycontrol is also vital if the results produced liydifferentlaboratories- nationally or internationally-

areto lie comparalileandvalid andtrainingshouldliegiven to scientiststo ensurethatappropriateanalyticalquality guidelinesareadheredto in alllalioratories.This trainingmaylie giventhroughin-serviceworkshops,althoughthe sulijectshouldalsolie addressed duririg cannes of higheror furtheredudation.

Management:Personnelwill needtraining in areassuch aspersonnelmanagement,budgetpreparation,planningandadministration.This is particularly importantwheretechnicalstaffare promotedto managementpositionson thebasisof their technicalexpertiseandfmd it difficult to dealwith managementprolilems.

Managementtraining for technicalstaffcanlie given,for instance,througha seriesof workshopsandshort(one or two week) courses run liy professionalmanagers.Institutionswith thecapacityto providethis training areoftenavailalilein African countries,for instancethere is an Institute of PulilicAdminisirationandManagementin Freetown,SierraLeone.Where this capacitydoesnot exist, it’sdevelopmentshouldlie treatedasa priority.

Wheregovernmentandmunicipalauthoritiesareadoptingamoreadvisoryrole in sanitation,staffneedto lie trained in their newresponsibilities,inparticular in areas such as: contract management;tenderingprocedures;monitoring of construction;developingstrategiesfor monitoringdischarges,effluent and treatedwastequality; and legalmechanismsfor enforcingcompliancewith codesofpractice and quality standards. 1f government andmunicipal authoritiesmoveaway from construction,staff will alsoneedtraining in handling andinvestigatingcomplaintsandin resolvingdisputeslietweencontractorsandusers.

Technicalstaff,EHO’s and local artisans

TechnicalstaffThese are the field staff who are directly involved inthe construdtion,operationandmaintenanceofsanitationfacilities or in training andsupervisinglocal artisans.Generallythesewill lie staffwithlower formal educntionqualificationsthan thoseatprofessionallevel liut who are likely to haveextensivepractical experienceanda thoroughknowledgeof working with communities or oncontracte.

Field staff involved in constructionshouldlie awareof liasic constructionprinciplesandtechniquesand

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lie competentin liuilding therequiredstructuresandin their operationandmaintenande.Thisrequiresthatstafflie given someformal training prior to startingwork preferalily in a technicalcollegeor institutewith trainedandexperiencedteachers.This trainingcanlie furthersupplementedliy ‘on-the-joli’ training,for instanceduring an initial proliationary period. Inthe past, however, too much emphasis has beenplaced on training on the joli andtoo little on agoodformal technicaltraining.Staffwho only receiveonthejoli training are frequently lessskilled thanformally trainedstaffandoftendevelophaliits ortechniqueswhich adverselyaffectthe standardofconstruction.

It is recommendedthat countriesfurther developexisting technical training institutes locally anddevelop such instituteswherethesearenotexisttoimpmvethequality of technicalstaffavailalile.Theseinstitutes shouldlie decentralisedand spreadthroughoutthecountry, wherethis is possilile,toprovideadequatetraining facilities to all areas.Coursesshouldlie designedto lie theequivalentof anationaldiplomaor certificatewith anemphasisonthe developmentof practicalskills comliined withsomefoundationin the conceptsof constructionengineering.

Mostof the skills necessaryfor sanitationfacilityconstructioncanlie gainedin a generalliuildingcourse.Technicalstaffwill needto lie alle to makeconcretemixesof varying strengths,castconcretestructureslike pipes,join plasticandmetal pipeworkandlie alle to liuild structuresusingliricks, lilocksandtimlier. Forthosetechnicalstaff who work on asanitationprogrammeor wish to in thefuture,options shouldlie availalilein sanitationconstructiontechniqueswhich should cover the principaltechnologiesusedin sanitationimprovementandparticularly focuson low-costtechnologieswhich areappropriatefor low-incomeareas.Operationandmaintenanceof requirementsfor sanitationandwastewater treatment technologies should also liecovered.

Technical institutes should also offer coursesin liasichealth education for technical staff which shouldcovertheprincipal diseasesrelatedtopootsanitation,the main transmissionroutesof sanitationrelateddiseases andthe liarriers to diseasetransmission.Construction staff should have a reasonalily goodideaaboutthehealth lienefite provided liy improvedsanitationanddan, sometimes,makegood healtheducators. Courses in education techniques forhygieneeducation should lie offered to increase the

capacityof technicalstaff to promotesanitationimprovement.

Training of technical staff, aswith all staff, shouldlieseenasan on-golngprocessWith in-servicetrainingeventsandrefreshercoursesheld in constructiontechniques,technicaltraining andhealthpromotion.Staff who do not have any formal technicalqualificationsshouldlie allowedandencouragedtogain thesethroughcoursesat technicalinstitutes.This could lie throughprovisionof aleaveof alisenceliy the employerto completea course,or in thestudente own time.

An alternativestrategyis for technicalcollegesto runcourseswhich canlie takenon a modularbasis,wherestudenteattenda seriesof short modulesof afew weeksor monthsspreadoveraprolongedperiodof time, for instanceseveralyears.In lietweenattendingmodulesat thecollegethestudentecanlieset projects which relateto thework theyareinvolved inandwhich haveto lie completedwithin agivenperiod of time. This systemhasthe advantagethat staffarenotabsentfrom work for morethanshort periodsof time which can lie arrangedtocoincidewith slackperiods in construction,forinstancein therainy season.Also thememlierof staffattendingthecoursedoesnot lose incomewhilststudying,feelsmotivatedliecauseof theopportunityfor studyandmaintainsexistingskills whilst learningnewones.

Technicalstaffwho will lie responsililefor traininglocal artisansin sanitationfacility constructionoroperationandmaintenancewill needtraining ineducationtechniques.It is notsufficient that theyhavegoodskills themselvesas theyneedto lie alile to

passon their knowledgein a form which is readilyunderstood.Theseskills shouldlie taught in specificworkshopswith appropriatestaff trained ineducationaltechniquesandin particularencourageparticipativeleamingandteaching.

Where staffwill lie involved ~n monitoring theperformanceof local contractorsthey shouldlie giventraining in how to conductandplan monitoriugactivities andhow thedatageneratedshouldlie usedto ensurecompliance.In particularstaffwill needtodevelopskills which promoteimprovementthroughpositiveactiononbehalföf the local contractorratherthan threateof punitiveaction.

Envfronmentalhealth ojficers:The trainingof staffwho canundertakea widerangingrole within the community should lie

15

considered as a high priority. Womenshould lieencouragedto enrolontosuch coursesandlieencouragedto learntechnicalskills aswell aseducationtechniques.The promotionof morepositive roles for women than are normallyencounteredin urlian sanitationprogrammeswouldlie lieneflcial in mostAfrican countries.

Coursesfor individuals studying to liecomeenvironmeutalhealthofficers shouldlie strengthenedor estalilishedin technicalinstitutions,partidularlythosewhich alsohavecoursesin coulrnuflity healthin communityhealth educationor links withinstitutionsthatdo run suchcourses.Thesestudenterequirea goedliasic technicaleducationandshouldlie alle to perform manythe tasksthatspecialisedconstructionstaffdan.This will includeelementesuchas simpleslali casting,basicplumliing, joinery,simpledesignwork and lirick/lilock laying. Womenshouldlie encouragedto attendsuchcoursesanddeveloptechnicalaswell aseducationalskills.

Enviroumentalhealth officer training shouldalsocontaina strongcomponentof studyof hygiene,healthandeducationtechniques.Environmentalhealthofficersrequirea thoroughunderstandingofthehealthrisksassocintedwith poorsanitationandhow thesemaylie overcome.Theymay not lie alleto fl11 entirely a specialisthealtheducatorliut shouldlie capalileof performingmostof the tasksof a healtheducatorsrole. Thus thesestudentewill needto liealle to useappropriateeducationmaterialsandtechniques,uuderstandhow diseaseis spreadand toliarriers to diseasetransmissionand liasicepidemiology.

Localartisans:In many sanitationprogrammes,particularly thoseconstructinglow-cost technologiesfor dommunityliasedmanagement,much of the liuilding work isdonely trainedlocal artisanswho residein thedommunity.The useof local masonsandliuilderscanlie importantfor the long-termsustainaliilityof urliansanitationandalso the replicaliility of pilot urliansanitationprogrammesmorewidely.

Whereprivate contractorsareusedto constructsanitationfacilities they will requiretraining indesign, appropriate construction techniques, qualitycontrol and tendering procedures. This should lieoffered liy appropriate local educational institutionswho havea goedunderstandingof theprocessofapprovingdesigns,monitoringcoustructionprogressandqualityandassessingtenders.

Local masonsandliuildersmayneedadditionaltraining in order to lie alle to construct sanitationfacilities to therequiredstandard.Theseskills can liepassedon duringworkshopswhich shouldcoverareassuchas quantityestimationfor latrineslaliconstrudtion,castingreinfordedslalisandpour-flushpans and the installationof vent pipes. Before a localartisan is registeredasan approvedliuilder ofsanitationfacilities, municipal staffshouldlieconfidentthat they havereachedasufficiently hightechnicalstandardthat will ensurethatall sanitationfadilitiesdonstructedmeetmunicipal constructionquality standards.

Wherecodesof practicefor constructionareestalilishedlocalartisansshouldlie madeawareofthem andtraining madeavailableto ensurethattheycan fulfil theserequirements.1f artisansareto sulimittendersto municipalauthoritiesfor sanitationfacilityconstruction,training shouldlie given to ensurethattheyunderstandthe processof sulimitting a tenderandthe managementof acontract.

Wherepit lairinesandseptictanksrequireemptying,local contractorsmayfulfil all orpart of this mle, asis thecasein Dares Salaam,Tanzania.1f this is done,thenthe contractorsmay requlretrainingin the useandmalntenanceof equipment,safedisposalof wasteto protectpublic andenvironmentalhealthandshouldlie awareof healthandsafetypracticestosafeguardtheir staff’s health.This lastpoint is vitalaspoor handlingof wastesduring removalandtransportcanleadto a seriousrisk to the healthofworkers and households whose pite are emptied.

Wherever local artisans are used, the municipalauthoritywill needto monitor their perfonnanceandretain the right to revokelicences to operate if thereis apersistentfailure to comply with constructionquality guidelines,codesof pradticeandsafetystandards.Nevertheless,the municipal authorityshouldseekto estalilisha positive relationshipthroughtraining andmonitoring,ratherthanrely oncensureof failuresas a meansto pursueadequatequality.

HealthandEducationStaff

Therearenumerouspersonnelwith different skillswho may lie involved in health educationandhygienepromotion: environmentalhealthofficers;nursesin clinicsandcommunityhealthprogrammes;healthinspectors;communitydevelopmentworkers;teachers;andspecifidally-trainedhealtheducationstaffattachedto sanitationpmgrammes.

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In somecountriestherolesof differentsectorsmayoverlap,thuscommunitydevelopmentworkersmaylie assignedto environmentalhealthedudationprogrammesashappensin Ghana.In othercountriesstaffmaylie specificallyrecruitedandtrainedforcommunity health education. In addition to staffworking directly with sanitation provisionprogrammesthereare professionalssuchas schoolteadhersand medical staff who also haveanimportantrole to playin healtheducation.

The training needs of each group are slightlydifferentliut it is importantthatall thoseinvolvedinhealthedudationrelatingto sanitationprovisionshouldprovidesimilarandcompatililemessagesabouthealth.It is likely to lie moredamagingto havea series of people giving dommunities different andcontradictoryadvicethan to have no health educationatall.

HealthEducatlonField StaffTheseare thosestaff who are working with asanitationprogrammeor on a complimentaryprogrammeto sanitationprovision. Theymay lieprofessionalswith qualificationsgainedfrominstitutionsin-country or overseasor locally-redruitedstaffwho work in their own community.Although thelevel of training may vary, all staffshould have some training in germtheory,routesofdisease transmi ssion, disease prevention throughenvironmental heal th and participative educationtechniques.

Staffshouldlie collectively alleto reachall sectorsof the community with their healthmessagesandshould lie alle to act as a catalystfor discussionandchangewithin the community. Healtheducationprogrammeswhere the dommunity is activelyinvolved in theeducationprocessare likely to have agreaterimpadt than thosewhere messagesaredelivered to a passive audience. Health educationstaff should lie alle to develop and useappropriateeducationmethodssuch asdrama, songsandfocussed group disdussion and materialssuch as flipchartsin orderto involve the dommunity in theeducationprocess.

The training of healtheducationfield staffcanlieachievedin anumlerof ways, with amixture offormal and ‘on the joli’ training. However, as withtechnicalstaff, in many instances toomuch emphasisin thepasthasbeenplacedon informal trainingwithlimited formal edudationgiven.This canresult infield staff not fully understanding educationtechniquesandnot havinga thoroughgraspof the

transmissionroutesof diseaseandthe liarriers totransmission. It is important that all staff redeivesomeform of trainingaway from their work stationin order that they may concentrate fully on thesuliject matter.

Institutions offering degrees or qunlificationsequivalentto highernationaldiplomas(HND5)should lie encouragedto provide coursesincommunityhealth educationanddevelopment.Courseswith similarthemes,for instancecommunitydevelopmentor primary health,may alreadylieavailalile andwhere this is thecase,institutionsshouldlie encouragedto providea specificoptionindommunityhealtheducation.Thesecoursesshouldcover educationtechniques,educationalmaterialdevelopment,diseasetransmission,germtheory. Atdegreelevel thereshouldalsole a strongcomponentof theoreticalconceptsand theplanningof healtheducationprogrammes.HNDsshouldhavea strongpractical componentand emphasisplaced onimplementationof communityhealthprogrammes.Inlioth cases case studiesusing on-goingorrecenthealtheducationprogrammesshouldlie used.Theseshould cover lioth successfulandunsuddessfulprogrammes50 that studenteunderstandhow andwhy healtheducationprogrammesachievesuccessand why they sometimesfail.

It is lieneficial studenteof lioth degreeandHNDhealth educationcoursesthat public healthinterventionsarecovered.This is importantascommunityhealtheducationstaffhaveto undersrandwhattechnologiescanassistin thepreventionofdisease,which arethe mostappropriatefor particularcircumstances and lie alle to convey the advantages,disadvantages,costandoperationandmaintenancerequirementefor technologyto communities.WheresanitationprogrammesareseFup,dommunities-

particularly in low-incomeareas- mayhavelitfieideaofwhattechnologyis suitableandthus if offereda choicemay find it difficult to selectthebestoption.Thehealth educationstaff can help communitymemlerstodecidewhattypeof sanitaryfacility theyrequirein termsof healthlienefit, operationandmaintenancerequirementsandcost.

Studenteshouldalso lie taughthow to evaluatethesanitaryconditionsof communitiesthroughthe useof techniques such as sanitaryinspectionsandinterviews.Studente should le taught how to use thedatagenerated to improve the focus of education.Many of studentefrom thislevel of educationmaylieinvolved in dommunityhealth worker training andshouldreceivesometraining for trainers.

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All healtheducationstaffwill lienefit fromregularin-servicetraining eventsandworkshopsoncetheystartworking for aprogramme.Theseshouldliedesignedto keepstaff up to date with the latestdevelopmentswithin the healtheducationfield,teaching materials and to exdhange experiende.Workshopsshouldlie short andfocussedon onetopid, for instanceeducatlonmaterialdevelopmentanduse,and lie directly relevantto the work that thestaffare involved in. This will help to keepstaffmotivatedandwill helpto ensurethat thequalityofeducationgivenis good.

OtherProfessionalsAll the aliove refer to staffwho receivetrainingspecifidally in community healtheducationandcommunitydevelopmentandwho work ashealthedudatorson sanitationprogrammes.However,thereareotherprofessionalswho may alsolie mvolved inhealtheducation.Nursesandteachersare two suchgroupswhich are frequently involved in somedommunityeducation,althoughoften coveringawiderrangeof topids.

During training, nursesshouldhaveoptionsin healtheducationavailalile to them,in particularfocussingon appropriateparticipatoryeducationtechniques.Onedritidism sometimesmadealout medicalpersonnelinvolved in health educationis that theygive veryshorttalksduringdlinic sessions.Thesearegenerallynotparticipatory,liut lecturesto groups of,often, motherswith youngchildren. Oliviously staffat clinic sessionshavemany demandson their timeandcannotrealistically le expectedto concentratesolely on hygiene education.However, theimportanceof goedlasic hygieneto healthshouldliestressed.Nurseswho are involved in communityoutreachprojectsshould usetheseas a forum todiscusssanirationand theassociatedhealthrisks withcommunitymemIers.

The medicalprofessionfrequently doesnot seesanitationas its responsibility.However,giventhehigh indidenceof diseasesaffecting thepopulationsof developingcountrieswhich maylie linked to poorsanitationandpoorwatersupply thereis asimportantmle for the medicalprofessionin sanitation.Doctorsmay lie encouragedto studyotherliranchesof healthintervention,for instancetheUniversity of Nairoliioffers an MSc for dodtors in Pulilic HealthEngineering.This may help the healthsectortoprovidea greaterinput into technologyselectionandhelpfocushealthsectorresearchpriorities.

Schoolteacherscanalsolie effectivehealtheducators

andhygieneedudatlonshouldlie incorporatedintothe schoolcurricula. The advantageof teachingchildrento adoptgoedhygienepracticesis thatonceit is acceptedasnormal liehaviour it is likely toremainwith them for life. Children who redeivehealtheducationdanalso lie effedtive healthpromoterswithin thehomeandlietweeneachother.‘Child-to-Child’ healtheducationprogrammewherechildrenpasson health messagesthroughstorytelling to youngerchildrenhaveleen sucdessfullyimplementedin a numlierof couniries,particularly inLatin America.ChÎldrencan alsopersuadeadultetoadoptgoodhygienepractices,as well as their ownfamiliesoncetheyreachadulthood.

Teachersshouldreceivecourseson healtheducationduringcollegecoursesandlater throughin-serviceworkshops.Thisshouldcoveraspectesuchas germtheory,liarriers to diseasetransmission,goodhygienepracticesandtheir effecton health.

CommunityEducation

Particularly in low-income areas where theeducationallevelof the populationis often low andthereis veryrestrictedaccessto servicesthereis aneer! foron-goingeducation.Communityeducationshouldalsolie ameansto improvewomensquality oflife andto empowerthem to takegreatercontrol overtheirlife.

Communityhealtheducationshouldlie participativeandshouldluild on local knowledgeandperceptionsas much aspossille.Comrnunitiesshouldlie activeparticipanisin theedudationprocessandwork withtrainedstaff to identify their training needsandhowthis trainingshouldlie implemented.1f communitiesarenotconsultedandmadepart of theplanningandimplementationprocessthe risk of resistandetoeducationprogrammesis likely to lie higherandimplementationless successful.

Prior to the start of any sanitationprogrammeathoroughknowledge,attitudesandpractice(KAP)surveyof dommunity sanitationshouldlie done.Communitiesshouldlie sensitisedtowardsanitationandthe health risks associatedwith sanitationdiscussedwith them.Thiswill enalilethecommunityandhealthedudationstaff to plan the educationprogrammeandhowit shouldlie implemented.

Communityeducationshouldlie well focussedandrespondto therealneedsof thedommunityandnotdesignedto fit into the programme planners’perceptionof what is needed.Communitiesoften

18

have a good understanding of their healthprolilemsliut may lackresourcesor ideasaboutsolving thesepmlilems.Communitiesare often notawareof howmuch they can do themselves to improveenvironmenralandpulilic healthconditionsandoftenwhat is niostrequiredfrom educationprogrammesisempowerthe dommunitiesto solve their ownproblemsandliecomemoreself-reliant.

In manycommunitiestheremay lie a needfor liasichygieneeducationto ensurethatpeopleuselatrmnes,keep them clean and wash their handsafterdefecationandliefore eating.In particulartrainingmay berequired to ensurethatchildren’sfaecesareproperly disposed of. There is S commonmisconceptionthroughoutthe world thatchildren’sfaecesareharmless.This is not the caseandtheimproperdisposalof children’sfaecesrepresenteatleastthemmehealthnskas that of adult’s faeces.

Wherelatrmnesare introducedparentsare oftenunwilling for their childrento useit as childrenmayIe frightenedliy the dark,frightenedof falhing intothe pit or of snakesor wild animalslieing in thesuperstrudture.1f this is acommonfear,parentsshouldencouragetheir child to defecateinto a panorin oneparticulararea,with thefaecesthrown downthe latrine immediatelyandlioth parentandchildwashingtheir hands.Parenteshouldencouragetheirchildrento usea latrmneas soonas possilileand thisshouldlie further encouragedat schoolsanddommunity centres.

Conimunity training may le provided throughworkshopsforcommunitygroups,discussionswithall sedtionsof the communityand throughhousevisite to meettheoccupanteanddiscusshealthissueswith them.Whereeducationalaidssuchasflip charteanddramasare to lie usedin communityedudationtheseshouldlie thoroughlypre-testedto ensurethatthe messagethey are intendedto donvey isunderstoodly the redipientaudiende.It is alsoimportantthatany matenalsor educationalmethodsusedareculturally andsodially acceptalleto thetargetaudience.1f theeducationlireaksculturaltalioosordealswith culturally sensitivematterswitha lack of respectthen the communitymay liecomequickly ahienatedandresistfurther educationalactivities.Thus,materialsand techniqueswhich havebeensuddessfulin one areashouldnotlie directlytransferredto anotherareawithout first checkingthatit is acceptableandunderstood.1f pre-testingshowsthat changesneedto madetheseshouldlie doneliefore anymasseducationprogrammeisattempted.

It is oftenlieneficial to identify thosememliersof thedommunirywho are interestedm heahthandhaveagoedunderstandingof theneedsfor goedsanitation.Thesepeoplecanle taughtcommunityhealtheducationandliecomecommunityhealthworkerswhosemle is to providea contmuouspresenceof thehealtheducationteam.Communityhealtheducationis a role that is commonlyfilled liy womenasmuchof the focusof hygieneeducationprograrnmesis onwomenandchuldren.Womencanlie verysuccessfulhealtheducatorsparticularlyin their own communitywheretheyareknown.However, this shouldnotleseenas theonly role thatwomencanadoptliut onlypartof their wider responsiliilities within theprogramme.

The useof communityhealtheducatorshasleensuddessrullyimplementedon a numlier of projectsandnotalily on the KWAHO pioject in theKilieraareaof Nairolii, Kenya.Herethe majority of thehealtheducationis donethroughvoluntary healthpromoterswho residein the communityandworkwith thecommunityto improvehealth.Workshopsareorganisedusingthe local community healthworkersto give health educationtalks, communityhealthworkers help the communitymanagementcommittees to allocate times for pit latrinedeshudgingandorganiseclean up days to removesohidwasteandluit it.

Communityhealthpromotersshouldlie given someformal training Out of their community,possililythrougha seriesof shortworkshops.Thisoften helpsto motivate community workers,who areoftenvolunteers,andallows them to give their fullconeentrationto the sulijectina way which may notlie possililein their community.Additional trainingcanle givenon thejoli ly ensuringthat healthworkersareattachedto trainer! stafffor a periodoftime.

Communityhealthworkersandothermemliersof thedommunitycanalso lienefit from visitearrangedtootherareasto look at sanitationprogrammesanddisdusswith othercommunities-commonprolilemsandsolutions.Thisoftenhehpsto give thecommunityfreshmotivationto keepup healthpromotionandalso helpsto focus their attentionon sanitationconditionsandheahthprolilems. It alsoencouragesthem not to feeh isolatedand to realise thatotherdommunitiesalso facesimilarprolilemsandthatsolutionscanlie found.

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Introduction

Infrastructure

The physical infrastructureof urlian sanitationsystemsshouldfaeilitatethe isolation,containmentand/orremovalandinactivation/treatmentof excretaanddomestic wastewater’. From a pulilic heahthengineeringpoint of view it is importantthat allstagesof sanitationfrom initial isolation from theuseronwardareadequatelydesignedfor at theplanningstage.Sucha ‘holistic’ approachhehpstoavoidprolihemsin thefuture andfor communitiesnotcoveredly urlian sanitationprogrammes.

Manycities in thedevelopingworldat presenteitherhaveno fadilities for disposalandtreatmentofwastewaterand excretafor the majority of thepopulationor haveinadequatecapacityfor disposalandtreatment.This has led to thedisposalof excretaandwastewaterinto stormdrainswhich liecomeopensewers with a significant health risk to thepopulation. Mudh of the ‘sewage’ generatedisallowedto flow into receivingwatersuntreated.Thishashed to grossdontaminationof rivers downstreamof dities with the attendant health risks,tocommunities using river water for drinking purposesand to fish andotheraquaticlife.

It is importantthat dueconsiderationis given todomestic non-toilet wastewater, or ‘sullage’, disposalin the planning stage of any urlian sanitationupgradingprogramme.Wheresuhhage is notdisposedof properhyit can causesignifleanthealthrisksto thepopulation if standing Pools form whidh providelireeding sites for mosquitoesand flies.

As theseinsecteare vectorsnotonly for faecal-oraldiseaseliut also diseasessuch as malaria andBancmftianfiliariasis, potentiallireedingsites shouldlie ehiminated.It has beennotedthat in the poorersections of a numlier of cities in India that filiariasisis liecoming an increasing prollem due to poorIntrmnedesignandpoordrainagewhich encouragethelireedingof the Culexpipiensmosquito,the commonvectorof filiariasis.

There is a wide range of technologies availabhe forsafe, adequate exdreta disposah and sullage removalwhich offer differing levehsof serviceandusercomfort. In order for sanitationto lie sustainalile,realisticchargeswill haveto lie leviedon usersofcommunity sanitationsystemssuchas sewerage,to

coveroperatingandmaintenancecosts,inehudingwages.In somedircumstances,it may also lieappropriateto recoversome6f thecapitalinvestmentcosts. Thus, it is unlikely in urlian areasindevelopingdountriesthat onetedhnologycnn lieapphiedon dity-wide liasis as the aliihity andwillingnessto pay for serviceswill vary lietweensocio-economicgroups.Flexilhe approachestosanitationprovisionandcostrecoverywill needto lieintroduced, typically with hesssophistidatedtechnohogyand increasedcommunitymanagementofsystems in poorerateas,with a correspondinglylowerchargestructure.

The treatmentof excretaandwastewatermust lieplannedfor at the startof any sanitationprogrammewith appropriateprocessesidentifiedandplantsliuilLIt is alsoimportantthatmunicipalauthoritiesplan forhow wastewaterandexcretawill lie takento thepointof treatment,particularly whereon-sitemethodsofexcretadisposalwhich requireperiodieemptyingareemployed.Codesof pradtidefor eartageof excretawhich correspond to adequate health andsafetymeasuresareestalilishedto protectstaff involved inexcretahandlingand transport.Quality standardsforeffluent leaving sewage treatmentplantsintoreeeivingwatersshouldlie estalihshedandrigomuslyenforcedto protecttheenvironmentand thehealthofthose dommunities whidh live downstream of asewage treatment plant.

Theintroductionof improvedsanitauonand thetypeof technologyemployedshouldlie ‘demand- led’andgovernedly thewillingnessandaliility to payofcommunitiesor individualsfor thelevel of service.Communitiesshouldlie madeawareof thepossililetechnical options in their area,the financial andmanagementrequirementsfor thosesystemsandallowedto choosethe type of technologyandthelevel of responsilility for managementthey arewilling to take.This will increasethe notion ofownershipof sanitaryfaeilities andthusdontriliutetoimproving thecaretakenof the facilities.

Standardsshould lie set for thedisposalof industrialeffluents/dischargesas well as domesticsewage.Governmentandmunicipal authoritiesshoulddecidewhether it is addeptalile for industrial wastewaters tole disposedof through the seweragesystemand

20

treatedin thesameplant as domestic sewage and ifso what quality the sewageshould lie prior todischargeinto the plant.1f industrialsewageis to lietreatedat source,then standardsof effluentqualityshouldlie set.Thereshouldlie legalenforcementofeffluent quality standardsanddompliancewith thesestandardsliy waste producers.Wherestandardsareintrodueedor tightened,mechanismsfor progressiveimplementationshouldlie estalilished.

Technology Options for Excreta andSullage Disposal

The technologies availalilefor urlianexcretadisposalinciude:

- on-site methods (where exeretaiscontained initially on-site lut may leremovedat a laterpoint);

- sewerage(whieh transportsliut doesnottreatexdreta);

- cartage(whereexcretais transportedto adisposalsite).

When assessingthe feasiliility of differenttechnologiesthecost,easeof operation,maintenancerequirements,anal dleansingmaterialandlevel ofwaterserviceshouldle considered.Theprincipaltechnologies are liriefly descrilied lielow. Forfurtherdesigndetailsreferenceshouldlie madeto suitaliletexte,someof which arelistedin Annex2.

On-sitemethods

There arenumeroustypesof on-sitetechnologiesforthe disposal of excreta,somewill alsoprovideasuitalile meansof sullagedisposalwhilst othersrequiretheseparationof toilet andliousehoidwastewater.Thesetechnologiesare further suli-divided liy high-costsolutions,typically with a highdegreeof usercomfort (for instanceseptictanksandaquaprivies)and lower costtechnologieswhich canprovidean equalhealthlienefit to theuserandalower level of user convenience, usually some formof improvedpit latrine.

Pit latrinesPit latrineshavebeena commonmeansfor excretadisposalin urlian areasfor a long time. In mostdountries there is some tradition of liuilding andusingpit latrinesfor excretadisposal.However,many unimproved traditional latrine designs are

unhygienieandrepresentasignificanthealthrisk tothe usersand,to a lesserextent,the surroundingpopulation.Wherelatrinesarepoorly liuilt andmaintainedtheyprovidebreedingsitesfor flies andproduceoffensiveodours.Thus,in recenttimestherehasleena lieliefamongstplannersandengineersthatpit latrineswerenotappropriatefor urlanareasandthat moresophisticatedandexpensivesystemsofexcretadisposalwerërequired.However,It hasliecomeincreasinglyapparentthat in manysitualionsin urlian areaspit latrinescanoffer a technically,sodially andeconomicallyfeasille improvementofurlian sanitationwith significanthealthlienefits,particularly to the urlian poor who do not haveresourcesto pay forhigh technologyfacilities.

Pit latrinesaregenerallythe cheapestform ofsanitationpossilileandhaveoftenleen introduced inthepoorerareasof cities.Theeaseof operationandconstrudtion make them most appropriate tointroduce into areas \vhere a significant level ofeommunitymanagementis required.However, pitlatrinesdo requireareasonableamountof land to liefeasilile and in urlian areasland is often at apremium.Wherethereis room,whenthe pit fllls anew pit ean lie dug and the slali moved across ontothenewpit.

Wherespacerestrictionslimit the possiliility ofdigginga newpit then latrineswith two pite mayliedug. 1f this systemis usedonly onepit is actuallyinuseatany time.Whencontentereachwithin O.Smofthetopof thepit, it is sealedand theemptypit is putinto use.Thefull pit is lateremptiedandif left for aminimumof two years,thecontentscanlie dugoutmanuallyandusedassoil conditioneror if it hasleencompostedwith otherorganicmaterialit canlie usedasa fertiliser.Wherepitsare small, or thereis onlymomfor onepit it isalsopossilileto empty pite morefrequentiy using mechanical equipment. The types ofequipment required for pit emptyingarediseussedlaterin thissection. - -

Where there is a high water talilepit lawinescanlieraisedto provideadditionalpit volume.However,thereshouldalwayslie a minimum of onemetrelietweenthe lottom of thepit andthe wet seasonwatertalile to preventcontaminationof groundwater.Under these conditions sealedpite mayalso lie used,lut theextracostmay makeothertechnicaloptionsmoreattractive.

Therearea numlierof improvedlatrmnetypes.Allworkon in a similar fashionwith thepit usedfor theisolationof excretafrom humancontactandthe

21

liquid partof the wastein thepit infiltrates into thesoil throughthesidesof thepit or in an adjacentsoakawny.

Jmprovedtraditional designs - theseincludeexamples like the ‘sanplat’ lawine widely deployed inMozamliiqueand increasinglyin othercountries.Generallytheseimprovedlatrines incorporateaconcrete foundation and a hygienic, concrete slaliwhich may or may not lie reinforced. The ‘sanplat’design utilises a domed slali which requires noreinforcementliecauseit’s shapeprovidessufficientstructuralstrength.This representsa consideralilecost reduction in comparison with reinforced slalidesigns.

Improvedtraditionaldesignsof latrine are rarelyventilatedandthuspotentialprolilemswith smeil andflies remain.Theseprolilems can lie partiallyovercomely theuseof a ‘stopper’ which fite thesquat/pedestalhole andis kept in placewhilst thelawine is not in use.However there will always lesomeaceessto flies whilst thestopperis off the holeandsomeodourprolilems.Wherepeoplecommonlywashin thetoilet areathe meof irnpmvedtraditionallawinesmaylie prollematicasthis maydecreasethelife of the pit, possilily affect the rate of solidsdigestionandhavea limited impact on fly or odourreduction.However,in manylow-incomeareastheintroductionof an improved latrine liasedontraditional designs and at low cost may well lie anappmpriatesolution with asignificanthealthlienefit.

VentilatedImproveddesigns- theseare latrineswhich havea ventpipe to removeodoursandwhichhave a fly-proof mesh on top of the pipe, which cangreatlyreducethenumliersof flies lireedingin thepit. Theselatrinescanlie morehygienicandpleasantthan traditional designs when properly maintained.However, there aredisadvantagesin their useinurlian areas,in partieularcorrectsiting mayliedifficult. In order that the mechanism for odourcontrol will work properly,thereneedsto le dearflow of air aeross the top of the vent pipe, thus thelatrine should lie in an area where there are nobuildings higher than the top of the pipe in theimmediatevicinity..

Pour-flushlatrines - theselatrmnes have a water-sealset in the slali or pedestal to prevent odour and flylireeding andusually requirea minimum of 1-3 litresperflush. Pour-flushlatrinescanlie constructedwithanoffsetpit or onedirectly lieneaththeslali and theliquid waste either infiltrating through the sides andliase of the pit or in a soakaway adjacent to the pit.

Thesquatslali or pedestalmay lie locatedindoorsoroutside.Theselatrinesarepartieularlyappropriatewherewateris usedfor analcleansingas users arealreadyusedto canyingwater whengoing todefecate.Theyare moreexpensivethanother typesof latrineliut canprovide a high level of service tothe users, isolate excreta from humancontactandcanlie easilyconnectedto sewersat a later date ifrequired.

SepticTanksTheseare a more high cost on-site sanitationtechnologywhich gives theusersthelienefits ofconventionalseweragewith flush toileteandcanalsodisposeof domesticsullage.The tankis offsetfromthe houseandconnectedto the toilet andotherdomesticwastewaterliy a shortdrain. The tank holdsthe solids and an adjacent soakaway is used todispose of the effluent. Septic tanks require areasonalile amount of land for constructing the tankand soakaway and require periodicemptying, usunilyevery fewyears.This mustlie donesafelyas septictankscontain freshexcretawhich representsasignificant healthrisk. Emptying is commonlydonely vacuumtankerwith the contentstaken to atreatmentsewageplant. Septic tankscanlie easilyconnectedto sewersifrequiredandare commonlyfound in largehousesoccupiedliy the wealthiergroupsin thecity.

AquapriviesTheseare similar to a septic tank and can lieconnectedto flush toilets andtakemostof thehouseholdsullage.Aquapriviesconsistof a largetankwith a watersealformed liy a simpledownpipeinto the tank to preventodouror fly prolilems.However,unlike the septictank the chamlierof theaquaprivyis rlghtlieneaththe toilet andnotoff-setliut like septictanksrequireperiodicemptying.Thetank is conneetedto a drainfieldor soakawaytodisposeof the effluent.Watermust lie addedeachday to maintain the water seal and there arefrequently prolilems with keeping the seal intact,which leadsto odourandfly prolilems.Aquapriviesareexpensive,requir~relatively large areas of landandoffer no realadvantagesoverpour-flushlatrines.Theyarelikely only lie usedin higherincomeareaswithin cities.

On-sitesullagedisposalEven with low leveLsof water service (for instancecommunal tapstand)most families generateaeonsideralileamountof sullageperday.As a roughguide, a household which collecte water from a streettapstandwill generatealiout25-30 litres of sullage

22

percapitaper dayminusany water usedfor analcleansing or toilet flushing. In many urliancommunitiestheprovisionfor sullagedisposalispoor or non-existent. In areasthatareservedliysewers,septietanksor aquapriviessullagecanliedisposedoff with toilet wastes.Wherepit latrinesareusedit is notadvisalileto throw sullageinto thepit.In lowerdensityareasa soakawaycanlie constructedif thesoil is sufficiendypermealileor wheresullageis usedto irrigale householdgardens.

In manyareasthesoil is notsufficientlypermealiletoallow the infiltration of the volumesof watergeneratedand in highdensityareasit maydifficult tofind room fora soakaway,thussullageis often eitherjust thrown out into thestreetor into stormdrains.Neitheris a hygienicmethodof sullagedisposal.Sullagestil! containsfaecalcontamination(althoughat low levels in comparisonwithsewage)andorganicmatter.As stormdrainsare designedfor far greaterflows thereare likely to lie lilockageswhichwillcausethepondingof sullageandthusencouragethelireedingof mosquitoesandflies with the attendanthealthrisk. Wherewater is thrown into thestreetoryard it is likely that standingPools wil! form.Whereverpossilile sullageshoüldlie disposedof intoaeovereddrainor a soak pit to protectthe user’shealth.

Sewerage

ConventionalSewerage:Water-liornedisposalofexcretaand(sometimes)otherhouseholdwastewaterthroughconventionalsewerageis often consideredthe mostsuitalile meansof providingurlian areaswith adequatesanitaryfacilities. Whilst the leve!ofserviceofferedly the useof conventionalsewerageand the convenienceprovidedfor theuseris high, it

is expensiveandgenerallyleyondthe meansof poorpeopleto pay for. Thus unlessthe municipal ornationa!authoritieshavesufficientresourcestosulisidise the construction, operation andmaintenanceof seweragein a city it is unlikely toservemorethan a minority of the inhaliitants.

Conventionalsewerscarryall househo!dwastewaterandsolids througha seriesof pipesdirect to atreatmentplant. Largediameter(minimum 225nim)pipesof concrete,asliestoscement,dayorPYC arelaid at relativelysteepminimumgradienteto ensureaminimumvelocity requiredto keepsolids in constantsuspensionis met, usuallylietween0.6 to 1 metrepersecond.Whereliulky analeleansingmaterialis usedor sandis usedfor seouringkitchenutensilsvelocitiesof not lessthan 1 metreperseeondare

requiredto preventli!ockageof the sewer.To ahievethe requiredgradiente,sewerscommonlyhaveto lielaid quite deeplyandexpensivepumpingstationsrequiredto lift sewageto highere!evations.

Sewersrequireperiodiceleaningand inspectionandto facilitate this mspectionhatchesmustlie pmvidedalong the line of the sewer for access.Whereconventionalsewerageis useclit is unlikely that thecommunityservedeanundertakethe maintenancework andthusstaffmustlie employedto undertakethesetasks.

Shallow sewerage:This is a form of modifiedseweragewhich providesthe healthlienefits andconvenience of conventionalsewerageto theuserliutat reducedcost:Shallowsewers,as the namesuggests,are laid at shal!ower depths thanconventionalsewerage,generallyusepipes of asmallerdiameterandare luid at shallowergradientsall of whieh reducesthecostof sewerinstallation.Sewersare laid a!ong the sides of roads andalleywaysto protectthe pipes from damagefromvehiclesandas a resultPVC pipescan often lie usedinsteadof concrete.Inspectionholesarealsoshallowerwhich againreducescost.

Unlike conventional sewerage where solide are keptin suspension continuonsly shallow sewerage workson theprincipal that if a lilockage occurs, water willliuild up liehind the obstructionandreachapointwherethepressureisTsufficient to re-suspendthesolid particles.Thussolidemovedownthesewerin aseriesof movementeratherthana continuousflow asin conventional sewers. As there is no need to keepsolids in constant suspension, the water requirementto keepsha!low sewersfunetioningcorreetlyisreduced.The laterals to each household are kept asshortaspossilileandwithin a shortdistanceof thehousejoin !atera!sservinga lilock. As the flowthrough thelilock lateralwill lie relativelyhigh, thereis rare!yaprolilem in ensuringthatsufficientwaterisavailalileto resuspendsolide.

There is far greaterpotential for communitymanagementof shallowseweragein comparisonwithconventionalsewersascleaningandinspectionismuchsimpler andas thesewersareshal!owertheseis!essrisk to inspeetors.Communitymanagementofshal!owseweragesystemshasleensuceessfu!lyimp!ementedin theOrangiPilot Projectin Lahore,Pakistan.

Small-boresewerage:This is anotherform ofmodifiedseweragewhich usesaninterceptortankon

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householdor laneplote to containsolidsandsmalldiameterpipesto removeeffluent.As smallerpipesare requiredthecostof the sewersis reducedandason!y liquid fiows throughthesewersthey canlie ltdat flat gradientswith fewer inspectionholes.Theinterceptortanksneedregu!ardesludgingandthiscanincreasethecostconsideralily.

Small liore seweragecanle effective.However,in anumlerof instancestherehaveleenprolilemswithoverfiow of solidefrom the interceptortank into thepipeswhich cancauseIlockages.Thismaylie due toseveralreasons,liut frequently thereisaprolilemofunder-designof tanksso that if emptyingis not doneatthecorrecttime thereis litde or no extracapacity.Anothercommonprolilemis thatif largevolumesofwaterperiodicallyflush throughan interceptortankwhich is small, theforcecanlie sufficientto carrysomesolideinto the pipe.Theseprollems canlieovercomethroughproperdesign,operationandmaintenance.

As with shallow seweragethereis greaterpotentialfor communitymanagementof small-lioresewersthanconventionalsewerage.Little inspectionworkofthe pipesis requiredas theyessentiallyonly carryliquid and,if theinterceptortankis well designedandregularlyemptied,the risk of lilockagesis 10w.Communityemptyingof the interceptortanks maynot lie possilile.

Cartage

Direct cartage: This involves the removalof freshexcretato an off-site disposalpoint. Cartageispractisedin urlian areasin manypartsof thedevelopingworld, mostfrequently throughtheuseofliucketor panlatrines.Thesearelatrmneswherealiucketis kept undera seatin the privy whichisemptiedly handon aregularliasis (usual!yevery2-3days)andtransportedto adumpingsite in ahandcartor someothermeans.This is extremelyhazardoustohealth,for thepeoplewhocol!ect the wasteand,to alesserextent,the usersof the latrineand thegeneralpulilic as raw excretamaylie spilt in streetsastheliuckets are emptied. Commonly it is also found thatthe excreta is not treatedaftercollection liut merelydump~dat the nearest convenient point, such aswastegroundor stormdrains.Thisrepresentsa majorhealthhazard.

Mechanicalcartage:cartagecanalsolie operatedlyusingvault !atrineswhich completelyisolatetheexcretafrom humancontactandwhich areregu!arlydesludged,usuallyusingmechanicalequipment.This

is expensiveandmaystil! representsomehealthriskparticularlyto theemptier.

In some other circumstances cartageis alsorequired,usuallywhereon-sitemethodrofexcretadisposalareoperatedsuchasseptictanksandsinglepit latrines.Providedthis work is doneeitherly professionalswith adequatetraining in appropriatehea!th andsafetypracticesandprotectiveclothing,thiscanlieoperatedsafely.

Desludgingequipment:this commonlywoiics liy theremovalof wasteliy suctionprovidedliy a vacuumtank which may lie manua!ly or mechanicallypowered. Mechanically powereddesludgingequipmentis moreproneto lireakdown liecauseofthe heavywearIt receivesandas thisequipmentiscommon!ymadein developedcountries,thereisthereforeaforeign exchangerequirementto purehaseparts.It is alsooftendifficult to serviceall areasofthe city - particu!arlypoor andcongestedareas- asaccessforvehic!esmaylie prolilematical.Thiscanlieovercomeusingsmallerliody designsor systemswherethe vacuumtankcan lie removedfrom theliody of thevehicle.However,mechanicalequipmentdoeshavea far greatercapacityfor sludgeremovalthanmanualmethodsandwhereuserscanaffordtheserviceandareaccessililemaylie appropriate.

Manuallyoperateddesludgingequipmentworksonthesameprincipal as mechanica!des!udgersliut thepowerto apply suctionis providedly hand.Thesetechnologiesareoftenappnçriatein low-incomeandinaccessilileareasof cities wherelargetrucksmaynotlie alleto reachandhavelieen widelyusedinDares Salaamandin Alidjan. Thereis consideralilepotentialfor privatesectorinvolvementin manualandmechanicaldesludging.

Technotogy Options for WastewaterTreatment

It is importantthat wastewaterandexcretaareadequate!ytreatedliefore dischargeinto theenvironmenLPit latrineswhichcontainexcretafor at!easttwo yearsperform theprocessof lireakdownand inactivationof pathogenson-site.Thus in someareaspit latrmnecontentsaredugout safe!yliy handaftertwo yearsandappliedas a soil conditionerforagriculture.Thisprocesscanlie improvedliy addingadditionalorganicmatenalto thepit during it’s useto producen compostwhichcanlie usedto fertilisecrops.Theproductsof other formsof excretaandwastewaterdisposal,suchassewers,septictanksor

24

pit lairinesthat areemptiedmom regularly thaneverytwo yearsrequire treatmentas thesecontainrawexcretaandrepresenta significanthealthrisk.

Thereareanumlierof waysof treatingwastewaterandsolid waste:disposalof solids in landfill;treatmentof solid and liquid wastein wastestahilisationponde(WSPs);treatmentof liquid andsolid usirig conventional sewagetreatmenttechnologiessuchasliofilters.

Conventionalsewagetreatmenttechnology:this willsignificantly inereasethe costof treatment.Mostplanteusecomplextechnologywhichrequireskilledpersonnelto operateandmaintaintheplant. Thechemicalsandsparepartsrequiredly theplantsmaynot lie availallehaveto lie importedwhich implies aforeign exchangerequirement.Theeffluent leavingconventionaltreatmentworks maylie improvedintermsof liological oxygendemand(BOD) andsuspendedsolids (SS)content,liut stil! representasignificant health risk due the presenceofmicroliiologicalpathogens.

Wastestabilisationponds:thesearea seriesof pondeinto which the liquid andsolid wasteflows andisretainedfor sufficient time for the solidcontenttosettleout, for the liological badto lie reducedandfor pathogensto die 0ff. Thereare much cheapertooperateandmaintain thanconventionalsewagetreatmentworks,employlow technologyand requireliule or no mechanicalequipment.They do however,requirea sulistantialamountof land which hasoftenleen usedas an argumentfor not usingwastestalilisationpondefor urlian wastewatertreatment.However,thelower long term costsandthepotentialincomefrom the reuseof treatedwastemayoutweighthe initial land costs.Also wastestalilisationpondsdo produceeffluent of highquality particularlywithregardto microliobogicalcriteria.Figuresas low as30 faecalcoliformsper lOOmi andBOD of 17 mgflhaveleenoltainedfrom pond seriesin Brasil. Thesefiguresare letter than thosecommonlyassociatedwith conventionalsewagetreatmentplanis.

In atypical pond series,wasteflows initially into ananaeroliicpond wherethe majority of the solidearedepositedon thefloor of thepond.Septic tankandpitlatrine wastesmay also lie dumpedin theanaeroliicpond.Thesolid wastedeconiposesunderanaeroliicconditionsat theliottom of thepond andmanyof thepathogenssettleOut with the sedimentadsolide.Following theanaeroliicpond theliquid wastefiowsthrough,usually,a facultativepond and then oneormorematurationponds.The facultativepondmay

still containsomesolideandoperateson a partiallyaeratedregimewith aeroliicconditionsfound nearthesurfaceof thepondand anaeroliicconditionsatthe liottom. The maturationpondsare completelyaerohicanddevelopanalga!liloom whichkills offmostharmful lacterialeft in thewastewater.

Theeffluent from the final pondis dischargedintothereceivingwatersor may lie usedfor irrigationwateror for aquaculture.1f the effluent is to liereused it should meet the folbowing qualityguidelines:

Restrictedirrigation(Irees,indusirialcrops.foddercropsandpasture)

Forfurther detailsof wastewaterreuseandwastestalilisationponds,refer to the pulilicationslist inAnnex2.

TechnologyChoice

Technologyselectionis avital stagein urliansanitationprovisionas inappropriatetechnobogiesarelikely to resultin slow uptake,poormaintenanceandrapid lireakdown.Thetechnologyselectedneedsto:satisfythe usersneeds;lie affordalle; providearecognisalilehealthlienefit; andlie technicallyfeasilile in the areawhereite useis proposed.Alltheseissuesmustlie addressedwhendecidingwhichtechnologiesareappropriatefor urlian areasandunderwhatconditionseach is suitable.It is unlikelythatasingletechnologycansatisfy theentireurlianpopulation‘5 needsandmunicipalauthoritiesshouldlie flexilile in theirapproachto technologyselectionandhow the technologywill lie delivered.An outlineschemefor the decision making proeessoftechnologyselectionis sumniarisedin Annex3.

Techno!ogy selection is a vital part ofimpbementationandthis mustlie donesensitivelyandlie demand-bed.This meansthatit shouldle the userswho selectthe technologytheywant for theirhousehold.Municipal authoritiesshouldhaveinformation availalilewhich will helpcommunitiesdecidewhat technologytheyrequire,which mayinclude negativeinformationalout inappropriate

Forunrestrictedirrigation (edihiecrops,sportsfieldsandpulilic parks)

1 vialilenematodeeggperlire

cl vialibenematodeperlire

0 FC/10Cm!

<1000FC/IOOnil

25

technologies.

Whenassessingwhich technobogiesarepotentialbysuitalbefor usein urlan areasthe healthlienefitprovidedliy eachshould lie evabuatedandthosewhich do notgive a significantheabthlienefit shoubdlie rejected.Of key importancefor heabthlienefitassessmentis whethera technologywill isolatefreshexcretafrom humancontactexceptundercontrolbedconditionswith trainedstaffusingadequatesafetyequipment.

An initial evaluationof this type will commonlyelinfinatemostformsof directcartage,in particulartheuseof liucket batrmnesas theseposea significanthealthrisk. Wheresaaieform of cartageis required,for instancein emptyingpit batrinesor septictanks,the risk to thepeopleemployedfor this shouldleassessedat the startandif imp!ementeddearcodesof practicewhich correspondto adequatehea!thandsafetyprotectionestalilishedandthoroughtraininggivenin this useof equipment.

Havingselecteda rangeof technobogieswhichwillprovideahealth lienefit themunicipal authorityshouldcriticalby assessunderwhatconditionseachtechnobogymay lie appropriate,in order that thecommunitycanassessthe mostsuitalile technologyto the meettheir needsanddesires.This assessmentwill involve considerationof a numlier of factors:technical(including housingdensity and type,geologicalconditions,levebsof watersupply serviceandoperationabandmaintenancerequirements);social; and,financial. Thesefactorsarerelatedandcannotlie viewedin isolation.However,theheabthlienefit affordedly eachtechnologymustle ofparamountimportance.Someof theprincipal factorsaffectingtechnologychoicearediscussedbebow.

Housingand landavailabilityThe densityof housing,thenumlier of peoplelivingin eachliuilding, their incomelevel, existingsanitationtechnologiesand issuesof ownersbipalbimposeconstrainteon technobogychoice.Wherehousingis verydenseon-site technobogiesareunlikebyto le suitalle andan off-site methodofexcretadisposalwill lie required.Wherea bargenumlier of peoplelive in one liuilding, on-sitefacilitiesmay haveto lie sharedif this is acceptalileor off-sitetechnologieswith individualconnectionsused.

In low-incomeareasthe aliibity andwilbingnesstopaymay lie such as to necessitatesharedfacilities.Inhigh-incomeareasindividual connectionsmay le

moreapproprlnteasusersare~more1ikelyto lie alleandwiblrng to payfor higherlevelsof convenience.Wherehousesare ownedly afamily who residethese, an individual on-site facility or connection tooff-site technologymaylie appropriate.In areasofrentedaccommodationthen sharedfacibitiesmayliemoresuiralbe,dependingon the numlierof peopleliving in theluilding, their incomeandrelativecosteof differentoptions.

On-sitetechnologiesincluding pit latrines,septictanksandaquaprivieswill requirean adequateamountof open spacefor: a reasonalileset-liackdistancefrom the housefor latrines(3-6m); to digpite andconstructtanks;providedrain fields orsoakawaysfor wastewater;irnd,if pits are to leemptiedthenreasonalileaccessfor desludgingequipment.

Ofparticular importancewill lie availallespacefordisposalof sullageandinfiltration of effluent.InKumasi, Ghana, it was calculatedthat 1m2 of drainfiebd wasrequiredforevery 15-25 litres perday ofbiquid waste.Thus,for a liuilding which houses20peoplewho use30 litres perday,all essentiallysullage,wil! requirea minimumof 24m2 for subbagedisposal(using amaximumfigure of 1m2 per25bilres/percapita/perday).

Seweragehaslittle spatialconstraint,liut requireahigh level of water service,suitalibeplumliing andaccess for connectionsto lateralandmainlinesewerswith spacefor inspectionholes.

GeologicalConditionsThekey geologicalconstraintson technobogysuitaliility are:dirty waterinfiltration rate;soibandrock type;depthto thewater talile; and,depthto theimpermeallelayer. Dirty infiltration rateisimportantas this is likeby to lie bower thanthe ratefor cleanwaterinfibtration assubbageand lquid wastescontainsolid, organidand liinlogical loadewhichcan lilockporesandolistruct seepage.It is importantto assesssaturatedsoil infiltration ratesasdrain fields andsoakaways will function at least part of the timeundertheseconditions.Pit batrineswhereliquidwastesinfiltrate into the soil will functionundertheseconditions at their liaseandsidesasthepit fills.

It is importantto le surethatsoakaways,drain fieldsandpit latrmneswill stil! functionandremoveliquidduringperiodsof beavytuin aswell asin dry periods.The infiltration mieneedsto lie sufficientto removethe requiredvolume of water eachday lut bowenoughto ablow properfiltration through thesoiband

26

rock to removesolide,liacteriaandorganics. consumptionas is thecasewith batrines.

The depthto water talile is importantas suilageandpit latrine liquid wasteneedsseveralmetersofunsaturatedsoil to percolatethroughto removepathogens.This depthvarieswith soil typewith finesoils like silt anddayrequiringasmallerdistancethencoarsesoits like sandor loams.Wheretheimpermealilelayer is cboseto the groundsurfacethereis likely to lea shallow water talile andthusagreaterrisk of dontaminationof groundwaterfromliquid wastes.

Soil type andunderlyinggeologywill dictatetherateof infiltration and whether there is risk ofdontaminatinggroundwater.Wheresoils areverypermealileandthe water talile is highthereis asignificantrisk of groundwatercontaminationwhichhasirnpbicationsfor iie suicalility for drinking water.The contamination can lie from liacteria andpathogensor from exeessivenitrateliuild up, lioth ofwhich haveimplicationsfor humanhealthif theaquifer is usedfordrinking water supply. This risk isparticularbyhigh in urlianareaswherepit lawinesandon-site sul!age disposal is practised as theconcentrationof the liiobogicalbadis high andthesurvival rateof liacteriain groundwaterincreasedasthenutrient bad is raised.The samemay alsotrueofnitrate liufid up in urliangroundwaters.

In areasof very permealilesoil androck,particubarlywheretherearealso high water ralles,theuseof on-site methodsof sublagedisposaland lawinesusingpercolationof liquid wastesmay nôtle appropriate.Undertheseconditionseitheron-sitetechnologieswhich storebiquid wastesandpossilily sullagein awater-tightpit whidh is regularbyemptiedmay liemostappropriate.Abternatively,toilet wastesmaylestoredin a water-lightpit andemptiedandsullage(which carriesa lower liiobogical bad)disposedofon-siteor in coveredsurfacedrains.Seweragemayalsolie as appropriatemethodof wastewaterdisposalundertheseconditions.

LevelofwatersupplyserviceAll water-liornemethodsof sanitationrequireavolumeof water to lie flushedclown thesystemeachtime theyare used.Conventionalseweragerequiresaminimumwater consumptionof 65 b/c/d to ensureasufficientflow through thesewers.Otherforms ofseweragehaveleen implementedwith waterdonsumptionas 10w as27 l/c/d, largely madepossilibemodified designcriteria.On-sitemethodsmayrequireahigh leve! of waterconsurriptionandservice,for instandeseptictanks,osa very low

Generally,wherethereis a waterserviceto thehousetheneithersomeform of sewerageor aseptictankislikely to lie mostappropriMe.Where water issuppliedata yard level of servicethenmodifiedsewerageor pour-flushlatrinesmaylie usedandwherewater is suppliedat communabpointe,forinstancea tapstandin a street,thensomeform of pitlawineis likely tole the mostappropriateoption.1fpeoplehavealow daily watereonsumptionandhaveto collect their waterfrom somedistance,it isunlikebythattheywill collectsufficientwaterto flushtoilete.This representea significanthealthrisk andasappropriatemethodof excretadisposalselectedwhich takesthis into accounL

OperationandmaintenanceThe level of operationandmaintenancerequiredandwho is responsilibearekey issuesin sanitationprovision. In general, in low income urliancommunitiesthe usersof the facility shouldlieresponsililefor the operationandmaintenanceof theindividualsanitationfacility theyhaveaccessto. Thismeansthatwhereon-sitemethodeare usedtheuserwill le responsililefor all operationandmaintenance,apartfrom emptying.

Seweragesystemsaremorecomplex,althoughtheuserwill lie responsilibefor the donnectionin thehouse;responsilulityfor maintainingsewersystemsmayle bessclearlydefinedandavarietyof situationscanoccur. In someareas,fbr instandein poor areasofLahore,Pakistan,community managementofmodified sewerage bas leen successfullyimplementedandmastof theroutine inspectionworkisundertakenly communitymemliers.In otherareas,in particularhigher indomeareas,operationandmaintenanceis the respunsiliility of the seweragecompanywho levy a chargeon the usersin ordertocover costs. Generally the more complexmaintenanceliecomes,the lower thepotentiabforcommunity invobvementandthe greaterthe costtothe user.

CostBoth initial capital andrecurrentoperationand-

maintenancecostsè±èrta stronginfluenceontechnobogychoice.Water-liornesystemsareusuallymoreexpensivepercapitathanon-sitesystemsasthey invobve the layingof pipesandrequiremoreextensiveoperationandmaintenance.

The proportionof thecostof instabbationandoperationandmaintenancewhich will lie liorne ly

27

the userand the bevelof sulisidy (if any)offeredlythe municipalauthorityorgovernmentwill influencethe technologychosen.Technologiesshouldlieintroducedon the liasis on user’swillingnessandaliility to pay for theserviceofferedandthealiiity ofthe municipalauthorityto enforcepaymentand topurchaseequipmentandmaterialsin the initialconstructionphase.

Which-everof the technobogiesarechosen,it isimportantthat designsarekept asbow-costas isfeasilibeandtechnologieschosenon the lasisofgreatestlienefit at the leastcost.Wibbingnessandaliility to payarelikeby to vary lietweenbow andhighincome groups.High incomegroupsmay le wibbingto payaroundfive percentof their annualincomeforimprovedsanitation,bow-incomegroupsmay onbyhavetwo percentor lessof their annuabincomeavailalibefor improvedsanitation.

It is importantthat high-technologyfadiities for highincomegroupsarenotsulisidisedas the expenseofbowerincomegroups.1f sulsidiesare to lie offeredtheyshouldgo to thepoorratherthan theweabthyasthis will haveagreateroverallpulilic healthlenefit.

E.ristingtechnologyThepresenceof existingsanitationtechnologieswill~f~t userchoiceashouseholdswill generalbyonbyinvestin facilitieswhich they perceiveasprovidingan improvedserviceto thatalreadyavaibalibe.Househobdswith no sanitationfacilities aremorelikely to investin mastavailalibetechnobogicaloptions,for instancea pit latrine. However,if ahouseholdalreadyownsor hasaccessto a facibitywith high userconvenience(for exampbea septictank) theyarebikeby to le unwilling to investin apitlatrine.

PersonalpreferenceThisis very importantbecauseif the usersdo not likethesanitationfacibitiesavaibaliletheyareunbikely tousethem cemaintainthem properby.Often personalpreferencewilb lie greatbyinfbuencedly thewiblingnessandaliity to pay of theuser.1f waterhasto lie purchasedor lirought from a long distanceusersareunlikely to desirewater-lornesewerage.Equally,in high incomeareaswhere thereis gond watersuppby,pit lawinesareunbikely to acceptalile.

Theremay alsolie cubturabandrebigiousfactorswhich influencetechnobogysebection.Key areasthismay effectin communitytechnologychoiceare theneedfor waterfor analcbeansing(seeliebow) and theacceptalibityof mixed-sexsanitationfacilities. 1f

communitieswantseparatesanitatlonfacilities forlioth sexes,this will raisethe costof sanitationandmaymeanthat certaintechnologies,for instancesewerage,arenotappropriate.- --

AnalcleansingmethodThe methodof anab cleansinghasimportantimplicationsfor technobogychoice.For exampbe,certainmaterialsmaylilock restricteddiameterpipes,or if wateris usedfor anal cbeansingthis mayadverselyaffect the performanceof pit batrinesespeciallywheretheseare to lie emptied.Whereliulky materialssuchascorncolis or stonesare usedit is inappropriateto usepour-flushbatrinesorreswicteddiametersewerageas the dischargepipesarebikely to lilock. Wherethesematerialsareusedthendry pit batnnesaremostsuitalile.Wherewaterisusedfor analcleansingthenpour-flushlawinesaresuitalileasis modifled sewerage.Papermayle easilyflushedthroughsewersliut if restricteddiametersewerage,pour-flushor bow-vobumeflush toilets areusedit maycauselilockagesto form.

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Introduction

Programme Implementation

Programmesof sanitationimprovementhavefrequentbyrun into prolilems,many of which can lietraced to poor initial planning and a back ofconsultationwith community andotherkey players.In particular,programmeshavetendedto fail liecauseinappropriatetechnobogiesanddeliverysystemshaveleenintroduced.1f the technobogyintroducezldoesnotperceivedneeds,if it too expensiveor if it isdeliveredin sucha way as to provokea negativereactionin theuser,thenit is unlikeby to lie usedormaintainedproperby.

Technobogy selection is a vitab part ofimpbementationand thismustlie donesensitivebyandle demand-led.This meansthat it shouldle theuserwho sebectsthe particubartechnobogytheywantfortheir household.Municipab authoritiesshouldactivebydisseminateinformation which will helpcornmunitiesandusersdecidewhattechnobogytheyrequire,which may incbudenegativeInformationaliout inappropriatetechnobogies.

How programmesareimplementedisalso importanLCommunitiesshouldlie involved in the whobeprocessfrom initial planning,throughconstructiontoevaluation.The programmeshoubdnot lie imposedon the community, lut rather grow wlth thecommunity. Thus, ideabby, it should lie thecommunity who demandssanitationandinitiatestechnobogysebection.This is a longprocess,liut inthe end it is more bikely to lie sustaiualileandrepbicalibethana programmewheretheintroductionofan imposedtechnobogyhappensveryquickly.

Before any barge-scaleprogrammesof urlansanitationare started,thereshouldlie a pilot phase.This will abbowgovernmente,donors,municipalnuthoritiesandothersto assesswhethertheirapproachis appropriateor whetherchangesneedtolie made.Useshouldlie madeof pilot projectstooptimisethe costof sanitationandto maximiseilsimpact.Pilotprojectecanalsolie usefulwhenothercommunitieswishto selectappropriatetechnobogiesandbevelsof communitymanagement.By oliservinga rangeof technobogieson pilot projecteandthroughdiscussionwith othercommunities,decisionsregarding technobogychoice can lie greatlyfacilitated.

Rolesin Programme Implementation

Many governmentand municipal departmentsresponsililefor theprovisionof sanitationin urlianareasarelieginning to reassesstheir robeswithin thesectoranddeveboptheir modusoperandi50 as to

maximisethe useof their resources.Generably,Govemmentsahdmûni~ipâlauthoritiesin devebopingcounwieshavelimited resourcesandmanybegitimatedemandson these.Thus theseauthoritiesanddepartments are assessing’ whether directinvolvementin constructionof sanitationfacilitiesisacost-effectivewayof utilising their resourcesorwhetherthey shoubd,in fact, changetheir role to anadvisoryandmonitoringrole. In thissituationtheywould lie responsililefor estalibishingpolicy andstandardeandmonitoring thequalityof constructionandoperationandmaintenanceof systems,compiingaregisterof approvedcontractors,helpingresolvedisputesandsupportingcommunityorganisationsresponsilibefor managingtheir own sanitationfacilities. - -- - -

Theconstructionof sanitaryfacilities is expenstveandabthougha largeproportionof implementationcostamaycomefrom externabaid,mostprojectealsodemandan input from the implementingagencyinthecountry.Often few resource~aremadeavailalibefor operationandmaintenancecostsliy donorsasit isassumedthat the governmentof the countrywillsupplytheresourcesrequiredfor this. This moneymaylie difficult to find, particubarbywhen themajority of resourcesalbocatedfor sanitationhavealreadyleencommittedto theconstructionof newprojects.Thus thereare frequentlireakdownsinexistingsystemsdue to poor maintenanceandoftenlittle moneyfor repairwork. In manycircumstancesthis is aggravatedif sparepartsareneededmany ofwhichmay haveto comefrom developedcountries,wbuchgivesrise to a hardcurrencyrequirement.

The costeto nationalandlocalgovernmentof directinvolvementin construetionof sanitationfacibitiesarelong-tenn.Staffwill haveto leempboyedandinorder to retaingood staff, theymay lie offeredpermanentcontracts.Evenwhenno moneyis comingin from donorsto liuild new systems,the work forcemuststill le paid.A fleetof vehiclesneecbedforconstructionmustalsolie repairedandmaintainedregardlessof it is requiredatagiventime.

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NationalGovernment

Nationalgovernmenthasa numlierof key robestoplay in urlian sanitation.It shoubdpromotesanitationto the urlian populationandto potentialdonors;devebopnationalpolicies;ensureinformationalioutapproprintetechnobogiesis disseminated;promoteand developmunicipabplans andprovideguidebinesfor implementation.

Nationalgovernmentis well pbacetlto promotesanitalionin urlianareasto lioth theurlanpopulationandto potentialdonors.Thepublic healthlenefit tothe popubationshouldlie stressedandthe needforgoodsanitationasa priority in devebopmentpromotedto the urlian popubation.Nationabgovernmentshoubdapproachthe internationaldonorcommunity to attractfunding for largeurliansanitationprogrammes.

TheMinistries andinter-sectoralcommitteesconcernedwith urlian sanitationshouldproducenationalpobiciesof Sanitation provision.Theseshoubdincbude:the role of communitiesin planning,implementationandmanagementof sanitationprogrammes;educationandtraining strategiesforhenbth; standardsfor effluent andtrentedwastequality; constructionstandardsandcodesof practice;andstrategiesfor long-termfollow-up andsupportofurlian sanitationprogrammes.Thesepolicies shouldoutline measuresto ensurethaton-goingoperationand maintenanceschedubescnn lie adhered to andensurethatalb thoseresponsililehavetherequisitetrainingandaccessto equipmentandspares.

A rangeof technobogiesthatareappropriatein urlanconditionsshouldle identifiedon anationwidelasis.This informationshould lie disseminatedthroughlocal governmentto the communitieswho will lieresponsililefor thefinal technobogychoice.1f thecommunity areto makea rationaldecisionliasedonthe healthlienefit providedliy the facility, howdifficubt andexpensivethefacility wilb lie liuibd andmaintain,how easyit is to use andwhether it istechnicably fensilile for their area they must havenccessto full informationaliout eachtechnobogyinanunderstandalibeform. All technobogiesshouldleevabuatedin termsof their approprintenessanddearguidebinesestalibishedfor where individuabtechnobogiesareappropriateandwherethey arenot.

Guidelinesshouldle devebopedfor theintroductionof urlian sanitationtechnologieson anationwide andcity-wideliasis liy nationabgovernment.Theseguidebinesshoubd lie disseminatedto local

governmentandusedto devebopmunicipal strategicsanitationplanswith nationabagenciesprovidingadviceandsupportto local government.

It is importantthatnationalgovernmentensurethatproposed programmesof urlan sanitationimprovementare testedon a pilot scabe,to assesswhetherthey sustainalibeandrepbicalile in otherurlian areaswithin the countryandprovidea goodworking modebfor othermunicipalitiesto folbow. Alltechnobogiesdeemedappropriateforurlian sanitationshoubdlie tried on pibotprojectsprior to any bargescaleimplementationto ensurethatthe technobogyisappropriateandsatisfiesthe population’sneeds.Communitiesshoubdle given thechanceto olservethepilot projectin operntionanddiscusswith staffandthe communitiesinvolved thesuitalibity andprolibems of the technobogy.This will helpcoinmunitiesto decidewhattypeof technobogyandwhat bevelof managementtheyare wibling toprovide.

SurveillanceNationalgovernmentshould,preferally,ensurefulfilment of thesurveillancefunction liy thecreationof an independ~ntliody which is representedatnationallevel andhasoperationalcapacityatregionalleveb. It is important that the surveillanceofdischargesandeffluentquality shouldle doneliy asagencyotherthanthatresponsilileforconstruction,operationandmaintenanceof sanitationfacibitiessoas to avoid anyconflict of interest.Evenwheremunicipalauthoritiesarenot directly responsilileforconstruetion,theyarebikely to managingcontractewith privatecompaniesandthusa potentialconflictof interestwill existe.

Themostsuitalilesectorto takeresponsiliility for thesurveillanceprogrammein manycircumstancesmaylie the healthsector,as theprotectionof pulibic andenvironmentalhealth is of paramountimportanceinenforcingcompliancewith quabity standards.Thehealthsectormayalreadyempboyprofessionalswiththeskibs to conductasurveillanceprogramme,andifnotshouldle alile to attractsuitalily quabifiedstaff.An abternativeapproachmay lie to estalilishacompletelyindependentsurveillancelody composedof personnelfrom civil service,academicandprivatesectorliackgrounde.No matterhow thesurveillancelody is organised,it is importantthat it receivesadequatefundingto carry out theassignedandhasrealpdhucalandbegalpowerto enforcecompliance.

Thesurveillanceliody shouldle staffedly qualifiedengineers,sdientistsandhealthinspectorsor

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environmentalhenbthofficerswho haveagoodunderstandingof how a surveillanceprogrammeshouldle impbementedandarelackedup with nrangeof staturorymeasuresto enalileenforcementofcompbiancewith standarde.

Thesurveillanceof sanitationis likely to form partofa largerprogrammewhich mayassessotheraspectsof environmentalhealthsuchaswatersupplyqualityandsobidwastemanagementand,possilily, foodquality. It is important,thatsanitationreceivesdueattention,asmany of theprolilems causedfrom poorenvironmentabhealthare influencedto somedegreely the coverageandquabity of thesanitationprovision. Surveillancestaffshouldleresponsillefor theon-goingmonitoringof environmentalhealthconditionsand invest.igatecompbaintsof pollutioneventsanddeteriorationof environmentalhealthconditions.Theyshouldhave thesupportandnccessto legab mechanismsto enforcecompbiancewithquality standardsand the meansto prosecuteoffenders.Theseofticersshouldmonitor all activitiesrebatingto environmentalhenlthandensurethat asadequatequality of serviceisprovided.

The surveillanceliody shoubdmonitoreffluentdischargesandireatedwastefrom sewagetreatmentplantsand industrial complexesand enforcecompliancewith statutoryregillationsof effluent andtreatedwastequality. It shouldalsomonitor disposalof wastefrom septictanksandpit lawines,beachatefrom landfill siteswheresobidwasteis liuried andcommenton overall urliansanitationcoverage.Atnational level, throughoverviewreportsto theinter-sectorabcommittee,the surveillanceliody mayalsoplay a promotionabrole ensuringthat propersanitationremainsa priority at a nationalbevel.

In many Africnn countries,such asGhanaandKenya, the needfor n nationabindependentsurveillance lody is recognised and leingimplemented,althoughfundingremainsa prolilem. Itis importantthat the surveillanceliody hasrealpowersandconsequentlyneedsadequatefunding toattractappropriatestaffandequip baloratories.Unfortunateby,to dateevenin countrieswhereindependentlodieshaveleenestalilishedthe’re hasoften leen a backof funding andthis hasbed tolimited impact of surveillance in improvingenvironmentalconditions.

MunlcbpalRoles

Municipal authoritieshavetraditionally leenresponsililefor theprovisionof urlan sanitation,and

in manyAfrican countriesthis may still le thecase.However,theyhavegenerallysufferedfrom abackofsufficientresourcesto servetheentirepopulationandasa resultonly thewealthiersectionsof urlianareasarenowcommonlyservedliy sanitationfacilities.

Thecontinuedlelief amongstengineersandplannersthat conventionalsewerageandsewagetreatmentworksarethe mostsultalilemethodsof sanitationprovisionin urlian areashasexacerliatedthis.Resourcesin manyAfrican cities havenot evenleensufficient to keepwhatsewerageandtreatmentsystemsthey havefunctioningproperly.Theresubtoftheseconstraintshasleengrosscoataminationof theurlian environment and it’s surroundings.Consequently,many municipal authoritiesarereassessingtheirrole in urlian sanitationprovisiontoevabuatewhetherconstructionis acost-effectivemethodof depboyinglimited resources.Somemunicipabauthoritiesnow proposeto contractconstructionout to hefrivate~sectorandto NGOsandconcentratetheir resoumesonamonitoringandadvisoryrole.

Wheretheprivatesectoror NGOs areresponsilileforconstructionof facilities, all programmesofconstructionshoübdlie approvedliy the municipabauthority andit is importantthatoverablmanagementof the provisionof sanitationfacilities to the urlianpopulationremainswith the municipal authorities.Thus,whilst municipabauthoritiesmaynot lieactuallyconstructing facilities, theyshouldleresponsilbefor approvingdesignsandestimatesandshouldlie responsililefor monitoringprogressandqualityof consiruction. - -

Municipal authoritiesshouldusethe informationavailalibeto them concerningthemake-upof thecityandusingthenationabguidelinesto devebopstrategicplans for sanitationimprovementand how suchprogrammesshoubdlie implemented.The is may liedoneon a‘housing-type’areaapproach,thatis thecity is divided into areascorrespondingto housingtypesandincomelevelswith a rangeof appropriatetechnobogieswhich may lie appropriateto thecommunityduringruchnobogyselectionin eacharea.Themunicipalauthorityshouldalsomonitor thecoverageof thepopubationwith sanitationandusethis informationto updatetheirplan.

It is importantthat whenmunicipal authoritiesareestalilishingsanitationprogranimesthat minimumservicestandardeare establishedandenforced.Thismayhelp to clarify whatis expectedfrom individualhouseholdsin termsof environmentabheabth

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improvementandwhat luilders of new dwellingsshouldprovide. An exampbeof thestrategicplanningapproachwith regardto technobogyselectionandservicestandardformulation is given in Annex4 andwhich outlinestheapproachof Kumasi MetropolitanAuthorityin NorthernGhana.

Stafffrom governmentor municipal work Ibrcesmaylie secondedto constructionprogrammeswith theprogrammeleing respoasililefor paying anabbowance.Staff suchas engineers,techniciansandheabtheducatorsmayle assignedto work abongsidethe staffof the companyor organisationresponsilibeforconstruction.Thishasthreeadvantages:

- municipalstaffhavedirectexperienceofworking on the project and a goodunderstandingof how thetechnobogyworks,themajorcausesof lreakdown,theoperationandmaintenanceroutinesandrepairwork;

- the implementingagencyhaveaccesstoqualified andexperiencedstaffwho havelocalknowledge;

- staff get a chanceto gain valualbeexperienceon appropriateprojectswhichstrengthenstheinstitutionabcapacityof thecountry to replicateandsustainsuccessfulprogrammesof urlan sanitationprovision.

In orderto faciitatethe monitoringandmanagementof constructionprojects,the municipaldepartmentresponsililefor sanitation(andpossilily otherenvironmentalheabthconcernslike water suppbyandsolid wastedisposal)shouldestalilisha contractsandcommissioningdepartrnentwho will issuerequestsfor tendersandmanagecontractedprojecte.

Thecontractedepartmentshouldlie staffedly wellqualifiedengineersandheadedly a seniorengineerwith extensivemanagementandsanitaryengineeringexperience.Juniorengineersshouldlie attachedtothe departmentto ensurethatthey get rebevantworkexperience.The contractsdepartmentshouldalsocontainfinanciabstaff to assisttheengineeringstaffin assessingpotentiabcontractors,tendersandmonitorthequality of service.The financialstaffwillassesstendersand liide for contractwork to seeifthey meetthe guidelinesset liy the municipalauthoritiesandnationalgovernment,whethercontractorsare financiabbyalle to fulfil theircommitmentsandto ensurethatreasonalibechargesare leviedon theusersfor constructionof facilities,wasteremovaland treatmentof wastes.Heabth

professionalsmay assessproposedplanssulimittedly contractorsto ensuredesignswill provide therequiredhealthlenefit andadviseengineeringstaffon the improvementsrequiredin order to meetstatutoryhealthregulations.

Contractdepartmentstaffshouldfor keepa registerof all approvedorganisations,individualsandcompanieswhich arelicensedto constnictsanitationfacibities.Standardsfor designandconstructionshoubdlie setliy thedepartmentfobbowing nationalguidelinesandtheseshoubdlie monitoredandenforcedly departrnentstaff.

In somecountriessurveillancemaystibb fall in themunicipalauthoritiesremit. Wherethis is thecasethesurveillanceliody shouldlekeptquiteseparatefromthecontracts/constructiondepartmentup to aseniorbevel.Thuseachsectionwould leheadedly adeputydirector,or equivalent,who lothreportto theheadoftheenvironmentalhealthservicesorequivalent.

Construction

1f bocalor nationabgovernmentarenot going toundertakethe constructionof newprogrammesofurlian sanitation then suitalibe agenciesforimplementationmustle identified.Thereare twoprincipal typesof agencywhich maylie consideredwhenbookingforasexecutingagency:

Localor internationalcommercia,!contractors.Theuseofconiractorshasleensuccessfulinanumberofurlian sanitationprogrammesIn devebopingcounwiesand on larger projects with higher capitalrequirementsandlinIe conimunitymanagement,operationandmaintenance,they canlie effective.Wherecommercialcontractorsareempboyedit isimportantthatdearstandardsfor constructionandoperationandmaintenancearesetliy the appropriatemunicipabdepartmentandtheseareregularlychecked.

Whena projectisproposedliy a municipal authorityor governmentwhictfisto leput out to commercialtenderit mustlie ensuredthat the contractorcan:demonstratethe level of technicalexpertiserequlred;hassufficientresourcesor financial liacking to liealle to finish theconstructionwork; can work withcommunitiesin asensitiveandcollaliorativemanner;is registeredcontractorwith themunicipalauthority;and,preferaliby, has a good recordof timelycompletionof contracts.

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Thereis alwayspotentialthat tenderingproceduresmaylie underminedly fraudulentpractice.It is theresponsilility of lioth the contract and thesurveillanceliodiesto le vigilant andthatoffendersaredeabtwith rigorously, for instanceimmediatedisqualification from tenderingfor othercontractsanywherein thecountryfor a pre-deterrninedperiodof tune.

It hasliecomea commonperceptionihat frivatecontractorscanprovidesanitationfacilitiesin urlianareasat a bowercostandmorerapid ratethanmunicipabauthorities.This is liasedlargelyon theperformanceof the privatesectorin otherareaswhich has often leen letter than governmentperformance.However, this approachappearsnottohaveleentestedon a long term large sanitationprogrammeandsomecautionshoubdlie exercisedwhen advocatingprivatesectorinvobvement.Nonetheless, documents like the KumasiMetropolitan AreaStrategicSanitationPlangive adetailedlireakdownof proposedprivatesectorinvobvementin sanitationprovisionwhichcertainbyappearsfeasilibe.

A pilot project(s)usingthisapproachis neededwhich shouldrun for anumlerof years(at leastfive)to seewhetherit is workalilein reality. Certainlyforthe higherincomegroupsthereis little doulit that theprivatesectorcanprovide theservicesrequiredat acostthe usersare willing to pay.Thebowerincomegroupsmaynotle in this position,thussomeform ofsulisidisationmaylie required.Thiscaneitherliethroughboansandgrantsto householders(asproposedin the KMA StrategicSanitationPlan),direct paymentsfrom municipalauthoritiestocontractors,or liy usingeithergovernmentor NGOsto proviclefacilities in thebowerincomeareas.

NOOsandcommunityorganisations.The useofNGOsandcommunityliasedorganisationsfor theimpbementationof sanitationprovision,particubarlyin poorerareasof dities, is widespread-and can le

effective. Theseprogrammesoftenattractexternalfundingand in this casedo not placeagreatlurdenon municipal resources.The majority of suchprogrammesfocuson theprovisionof sanitationfacilities to bow incomegroupsandin sucha wayasto promotedommunitylevel managementoftechnobogy.Commonbylatrinesand modifiedseweragesystemsareprovidedwith thecommunityexpectedto provide a significant contriliutiontowardsrecurrentcost,Ialiour andoperationandmaintenance.Theseschemeshaveleen verysuccessfulin many poorurlian areas,for instancethe-

KWAHO projectin theKileraareain Nairoli.

Many bow-incomeareasin devebopingcountriesareinformal andillegal settiemente.Due to thenatureofthesesettlemente,governmenteareoften reluctanttoprovide ~officialt liasic servicesas this may lieinterpretedasformalising or begitimisingthesettlement.It is perceivedthat this is bikely toencouragenew informal settlementsin thehopethatthis will also in time lie formalised. Due to theinsecurityof their tenureon land,many inhahitantsoflow-incomeandinformabareasareunwilbing tocommittime andresourcesto deveboplasteservicesfor thecommunityastheyfeel that this mayle takenawayfrom themat any time. Landlordearealsooftenreluctantto commit their resourcesto servicedevelopmentandwish to maxmiiseprofit

This was the scenario in Kiliera liut throughnegotiationand sensitisatidn,KWAHO havemanagedto provide‘makeshift’ liasic serviceswiththecooperationof the municipalauthorities.Thissettbementis informal in natureandhadvirtually noliasic servicessuchas water, sanitationorsolid wasteremoval.Waterhadtale boughtfrom vendorswhosold thewateratvery infiatedprices,solidwastewasalbowedto luild up in the lanesandstreetsandthemajority of the populationpractisedopenairdefecationas therewerefew latrinesavaibalibeforus& - -

With theassistanceof KWAHO, thecommunityhavenow formedgroupswho managewater pointsconnectedto themain supply.Water is soldfromthesekiosks, liut at a far lower price than fromcommercialsellers.Lawinesareleing putup in theareapaldfor liy the landbordsof thedwelling whichareemptiedon a six mdnthbyliasis andgarliageisliurnt on weekbylasis.Landlordsw~rçpersuadedtoinstablbatrinesly their tenants(someof whomthreatenedto withhoid their rent until sanitationfacilities weresupplied)andly discussionwithKWAHO staff.Althoughconditionsarestill far fromperfect,the Kiliera projectdoesiblustratejust howmuchcanle donein areaswhieh areoften perceivedas difficult to work in andwherethereis noofficialmunicipalpolicy of upgrading.

Operation andmaintenance

Who is responsillefor operationandmaintenancewibb largely dependon thetypeof technobogyused,whatlevel of communityorganisationexisteandtheusers’ income.In high-incomeareasIn möstAfrican

33

citieswhereeitherconventionalsewerageorseptictanksareused,all operationandmaintenanceislikeby to lie carriedouteither liy the municipalauthorityor liy a privatecompanycontractedto dothe work. Thiscontractis likeby to lie with themunicipabauthority liut may in somecasesliedirectlywith theusers.

In many bow-income areas operation andmaintenancemay lie carriedout liy a widerangeofindividualsandorganisations.On-sitetechnologiesmay only requirepit emptyingandtheuseror aprivatecontractormay lie responsilibe.Somemodifiedseweragesystemshaverelatively complexoperationandmaintenancerequirementswhich maylie undertaken liy dontractors01 municipalauthorities.However, in someprogrammes,suchasthe OrangiPilotProject in Lahore,Pakistan,thedommunity themselvesweretrainedto do much oftheroutineebeaningandinspectionof sewerlinesandexternalhelp only soughtwheremajorprollenisarose.

Pit emptying:is areawherethepotentialexistsforthe privatesectorto play an importantrole inprovidingadequatesanitationservices.It hasleencommentedthatpit or septictankemptyingshouldnot lie entrustedto the privatesectoras they arebikeby to lireakcodesof practiceanddumpuntreatedwasteat the nearestconvenientspotratherthan takeit to the designatedtreatmentplantor landfill site.However,in practiceit hasleenshownthatprivateoperatorscanprovidea flexilibe, inexpensiveserviceto usersandcanoften reachparteof urlian areasthatmunicipal fleets find difficult lecauseof accessprolilems.

In 1991/1992astudywas undertakenin Dar esSabaamto look at methodsof pit and septictankemptying.Two of the methodsweremunicipaloperatedmechanisedvacuumexhausttankerswhichcouldempty morethanonepit liefore emptyingthevacuumtank, the third method wasa manuablyoperatedsystemof pit emptyingusinghandcartsandwhich wasprivatebyoperated.In termsof consumersatisfactionandvaluefor moneyit was‘apparent,particubarlyamongstbowerincomegroups,that theprivatebyrun systemwasviewedasa superiorserviceto themunicipal service.Thiswasbargelylecauseitwascheaper,quickerandmoreflexilile. Thepriceforemptyingwasnegotiatedlietweenthecustomerandsupplierandpriceswerekept affordalile as thetechnobogyusedwasbow-costandusedmanuablypoweredequipmentwhich couldle repairedIocally.

Theprivateemptying teamsofferedarangeofservicessuchaspartial emptying,to matchconsumerneeds.Thewaiting timeforpit emptyingwasmuchshorterfor theprivateteamswhogenerallyarrivedwithin aweekof agreeingto emptya householdepit.The largemunicipaltni±stook severalweeksleforefulfilling thecontract,oftendid not fubly empty thepit whilst chargingthe full emptyingfee,could notaecessall sectionsof the city andgavea generablypoorerlevel of service.

Whereprivatecontractorsareusedforemptyingofpits andseptictanksit is importantthat they areawarewherethewasteshouldle takenandregularlymonitoredto ensurethat theydo takewastethere.The surveillanceliody should have statutorymeasuresto enforcecompliancewith regulationsconcerningthedumpingof wasteandwastehandlingpractiees,andshoubdlie alle to revokeoperatorslicencesif theylreaktheseregulations.

Wherefull pitsareleft for at leasttwo yearsthehouseholdmay lie responsililefor removingthecontentsor aprivatecontractormaylie used.Thewastemay lie then eitherusedon the family’s ownfarmingplot or sobdto someoneebsewho hasband.

SewageTreatment

The sewagetreatmentworksmay lie operatedandmaintainedliy themunicipabauthorityor in somecircumstaneesly private-waterandseweragedompanies.Treatmentworks may redeiveonbydomesticsewage,orcomliined domesticandindustriabsewage.It is generalbyletter to separatedomesticandindustrial wastewith the industrialwastetreatedmi site.This isliecause it is easiertotreatindustriab sewagein a concentratedform thanwhen it is diluted ly domesticsewage.Industrialwastescommonlycontainsignificant bevelsof highlytoxic heavy metalsandotherchemicalswhoseremovalis moredifficult andmuchmore expensiveonceit is diluted. It is alsorelativebyeasyandinexpensivetoueatdomesticwasteso thatit can lereusedor dischargedinto the environmentwithoutrepresentinga significanthealthrisk.

Ifreuseofteatedwastein agricultureor aquacultureis considered,thentreatmentworks shouldonbyreceivedomesticwasteas therewill a high healthrisk if toxic industrialwasteis usedas irrigationwateror soibconditioner.Wheresewageis separatedthenindustryshouldlie responsililefor pretreatingtheireffluentprior to dischargeinto municipab

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seweragesystemsor into receivingwaters,wherenecessary.Effluentsshouldlie monitoredto ensurethey meetquality standardeandmeasuresshouldliemadeavaibalibeto enforcecompliance.

Careshouldlie takento monitordischargesfrom liothdomesticsewagetreatmentpbantsindustrialdischarges,landfïll leachatesandtreatedwasteleingreusedto ensurethat they meetthenationabqualitystandarde.Thesestandardeshouldle enforcedanda‘polbuter pays’principle estalilishedfor remedialwork and persistentcontravention result in moresevereâdtion.An independent,preferalilynational,liody shouldle responsilileformonitoringdischargesandshouldhavethe legabandpolitical powertoenforcecomplianceandprosecuteoffenders.Thismay lie partof the Ministry of Health,Ministry ofEnvironmentor aseparatesurveilbanceliody. This isdiscussedearbierin thetest.

Wherethemunicipal authorityis responsilbefor theoperationandmanagementof sewagetreatmentplante,theremaystil le role for theprivatesectorinthe reuseof thetreatedwasteandeffbuent.Effluentfrom wastestalilisationpondscanoftenlie usedasirrigation waterprovidedit meetsthequalitystandardeoutlined earlier.Themunicipal authoritycan eitherseil theeffluentdirect to farmers,useit onitsown irrigatedpropertyor sell it to anintermediarywho then sellstheeffluent to farrners.One potentialuseis to supplythe effluent at bow-costto low-incomefarmersfrom theurlian fringe to helpdeveloptheir agricultureto lie moreproductive.Thiswill helpin the country’soveralldevelopmentliy promotinggrowthatthepoorerendsof societyandencourageafairerdistriliution of wealth.Howeverthe reuseofeffluent is organisedit is vital thattheeffluentmeetstherequiredquality standardeandthatmeasuresarein pbaceto enforcecompliance.

Maturationpondecan lie usedfor aquacultureandcould lie rentedout to fish farming groupsto helprecovercosteor the municipal authority canitselfliecomeinvolvedin aquacubture.Treatedsobidwastecan lie usedas a soil conditioneron farmsor onforestryprojects.

The contentsof pit batrineswhidh areleft for twoyears(andpossililyalsocomposted)can leusedas asoil conditionerandfertiliser. The contentsof pitlatrinemay le usedly thehouseholdfor useon theirown farmingplotsor sold to farmersor otherurliandweblerswho haveband.It is importantthatthemunicipal authoritymonitors thereuseof pit latrmnewastesto ensurethattheyarebeft for asufficient

amountof time to lie safe.This is aminimumof twoyearsfor dry lawinesandbongerif the pitsare wet.Underno accountshouldrawexcretale usedas asoil conditionerasthis representsasignificanthealthrisk to lioth the farm workersandtheconsumersoftheproduce.

Health Education

Healtheducationshoubdlie providedunder thedirection of theheabthsectorandimplementedas acompbimentaryprogrammewith constructionprogrammes.In urlian communitieswith poorsanitationthereis commonbya needfor heabtheducation,andevenin higher incomeareas,clinicsandhealthworkersshouldpromotegoedsanitationandhygieneliehaviour.Healtheducationis anon-goingprocesswhicli shouldstartleforeconstructionof sanitationfacibities leginsandshouldcarryonaftertheconstructionphaseis over. 1f a programmeis well designedandlocal communitiesempoweredto providetheir ownheabtheducation,it shouldlecomeself-sustaining. = - -

Given thelong term natureof healtheducationit ismostappropriatefor it to lie providedunderthedirectionof thehealth sector,eitherliy health sectorstaffor liy localNGOs.Inpute from internationalNGOs andESAs mayhelp in the devebopmentofsuitalilematerialsfor heabtheducationprogrammes,to train staffandcommunitymemliersas healtheducators,to fund pilot projecteandto strengthenlocal institutionalcapacityto conducttrainingandpromotehealthediication.However,in thelongtermit is thecommunities.their indigenousorganisationsandthelocal authoritieswho will makethe healtheducationprogrammesititainalibe.Heabtheducationprogrammesshoubdlie replicalilesothat a liasicformat of urlian communityhealtheducationcan leestalilishfor thecountry.Thiswill help to standardisethequalityof educationprovidednationwide.

It is vitai thathealtheducationis seenasa continuousprocessandonethatrequiresthe supportnot only ofcommunities,localNGOs andmunkipalauthorities,liut alsofrom the healthandeducationsectorsandatlocal andnationablevel. In thelong term the healthlienefits thatcan accruefrom improvedurliansanitationwill only le fully realisedif thepopulationunderstandandpracticesafehygienicmethodsofexcretadisposalandpersonalhygiene.

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Annex 1: Issues to be Addressed in Developing Training Capacity

To ensurethat sanitation interventionsaresustainalile,it is importantthatAfrican countriesdevelopadequatetraining which will providethemwith the quabity of staff they require. Acomprehensivehumanresourcesdevelopmentstrategyshouldlie devebopedat anationallevelwhich identifiestheeducationandtrainingneedsforsanirationandhow theseshouldle met. Appropriatecoursesof studyin pulilic andenvironmentalhealthrelatedsulijecteshouldle estalibishedandlinks withinstitutionsof higherandfurther educationwithineachcountry andelsewheredeveboped.Careerstructuresfor stafflinked to progressivetrainingshouldleestablishedto allow staffto progresswithinthesanitationsector.

Issuesto lie consideredin the estalilishmentofappropriatetraining siructuresfor all coneernedwithurliansanitationcanlesummarisedas fobbows:

Universities:strengtheningof existinghigherandfirst degreecoursesin appropriateengineering,scientific, heabth,educationand communitydevebopmentdisciplineswhich havea significantelementof sanitationrebatedtopics.Wherethesedonot existtheninstitutionsin devebopingcountriesshouldle encouragedto either estalibishappropriatecoursesor to set up optionswithin appropriateexistingcourses.Engineersandscientisteshoubdlegiventraining in liasic healthconceptsandeducationtechniques.Education,health andcommunitydevebopmentstaffshouldle given lasictraining inpulilic healthengineeringandscience.Modubarcoursesandnationabdiplomacoursesshouldlieencouragedand provision made to inciudeexperiencedmaturestudentswith lower formaleducationto attendcourses.Utilisation of externabstaffwith appropriatequalificationsto strengthencoursecontentInstitutionsshouldlie encouragedtoestalibishlinks with otherinstitutionswithin eachcountry,the region andouteideto increaseteachingcapacityandencouragenetworking.

Technicalcolleges:strengtheningof existinginstitutionsprovidingcoursesin environmentabhealth,heabtheducationandtechnicaltradesatdiploma or certificatelevel.Wherethesedo not existinstitutionsshouldlie encouragedto estallishsuchcourses.Decentralisationof trainingprovisiontoabbowstudentethroughoutthe countryto receivetraining in theareaandnot haveto travel to capitab

cities or thelargesturlian centres.Courseswhichprovidegoodtechnicaland educationskills should leestalibished, with training in small lusinessmangementalsogiven. The focusfor educationprofessionalsshouldlie on participativetechniquesandall studentsshoubdreceivetraining in healthpromotionandeducationtechniques.Modubarandpart-time coursesshould lie encouragedandprovision madefor nïaturestudentswith bowerformal educationto attendcourses.Coursesfor thetrainingof trainersshouldle estallishedtoassistincommunitytraining. Utilisation of externalstaffw~ithappropriate qualifications to strengthen coursecontent.

In-servicetraining: this shouldinclude workshopsand training coursesandle regularto keepstaffup todate with the batest developments,to providerefresher training and to exchangeexperience.Coursesshoubdlie short,participativeandfocussedon particularsulijectssvith directrelevanceto work inthe urlian sanitationsector.Use of staff from otherprogrammesandfrom outeideagenciesshouldlieencouraged. - - -

Commwiitytraining: this shouldle participativeandprovidedthroughworkshopsanddemandactivecommunityinvobvementat all stages.Healtheducationshouldfocuson keymessagessuchashandwashingafterdefecationandlieforeeating.It isiniportantthathealth educationprovidesan impetusfor communitiestcrdemandsanitationas a liasicservice,to construct,operateandmaintainfacilitiesproperly and to ensurethatcommunitymemlersusefadiitiesproperly.Materialsandteachingaideshouldle usedsensitivebyandmustlie pre-testedprior touseto ensurethatthey areunderstoodandacceptedly the targetaudience.Alle memliersof thecommunity shouldlie trainedto work as localcommunity healthpromotersandgiven supportandliackup from theprogramme.Wherelocal artisansareto lie trainedtheyshouldlie given a thoroughpracticabtraining in constructiontechniques,contracttenderingandmangement.

36

Annex 2: Technical Documents For Sanitatlon Design

The following are documentsthat will beusefulin assessingdesigncriteria for sanitationfacility designand associax~dactivities:

AppropriateSanitationAlternarives:A PlanningandDesignManual,Kalbermatten,John,M; Julius, DeAnne,S;Gunnerson,Charles,G; and Mara, D, Duncan.JohnsHopkinsUniversity Press,Baltimore,USA. 1982.ISBN 0-8018-2584.~9. -

AppropriateSanitationAlternatives:A TechnicalandEconomicAppraisal,Kalbermatten,John,M; Julius,DeAnne,S;Gunnerson,Charles,G; and Mara,D, Duncan.JohnsHopkinsUniversityPress,Baltimore,USA. 1982.ISBN 0-8018-2578-4.

ThedesignofShallowSewerSystems,UNTiCS (Habitat).Nairobi, Kenya. 1986. ISBN 92-1-131019-9.

TheDesignofSmallBoreSewersSystems,Otis, Richard,J andMara,D, Duncan.TechnicalAdvisory NoteNo 14.World Bank.Washington.1985. -

Sanitationwit/zoutwater, Winbiad,Uno andKilama, Wen.MacMill~nEducationLtd. HongKong. 1985.ISBN 0-333-39139-X.

Ferrocementpour-flushlatrine, Trinidad,A andRobles-Austrico,L. InternationalFerrocementInformation Centre,Asian Instituteof Teclinology.Bangkok,Thailand.1987.ISBN974-8200-63-9.

A guide to thedevelopmentofon-sitesanitation,Franceys,R, Pickford, JandReed,R.WHO. England.1992.ISBN 92-4-15443-0.

Smallexcretadisposalsystems,Feacham,R andCairncross,S.TheRossInsititute,LondonSchoolof Tropical Medicine. 1978.ISBN 0900995084.

Noteson theDesignand Operationof WasteStabilizationFonds in Warm ClimatesofDevelopingCounrries,World BankTechnicalPaper7, Arthur, J.P.InternationalBankforReconstruction/WoridBank. Washington,USA. 1983.ISBN 0-8213-0137-3.

Guidelinesfor thesafeuseof wastewaterandexcretain agriculture and aquaculrure,Mara,D. andCairncross,S. World HealthOrganization.England.1989.ISBN 924 1542489.

CommunityHealthand Sanitation,Ker,C. (ed). IntermediateTeclinologyPublications.Exeter,UK. 1990.ISBN 1 85339018 6.

How to Build and Usea CompostLatrine, Winblad,U. andKilama,W. SIDA. Stockholm.1981.ISBN 91-586-7009-2. -

On-SiteSanitation:Building on Local Practice,IRC OccasionalPaper 16. Wegelin-

Schuringa,M. IRC. TheHague,Netherlands.1991.

Planning of CommunicationSupport(Information, Motivation and Education)in SanirationProjectsand Programs,TAGTechnicalNoteNo. 2., Perret,H.E.TheInternationalBank forReconstruction/TheWorld Bank.Washington,USA. 1983.

37

Social FeasabilityAnalysisin Low-~CosrSanitationProjects,TAGTechnicalNoteNo. 5,Perret,H.E. TheInternationalBank for ReconstrucrionfFheWorld Bank.Washington,USA.1983.

Monitoring and EvaluationofCommunicationSupportActivities in Low-CostSanitationProjects, TAG TechnicalNote No. 11 Perret, H.E. The International Bank forReconstruction/TheWorld Bank.Washington,USA. 1984.

AppropriateSanitationfor Verj LowIncomeCominunitiesVolume1, PeterMorgan.BlairResearchInstitute/WHO.Zimbabwe.1992.

AppropriareSanitationfor VeryLowIncomeCommuniriesVolumeII PeterMorgan.BlairResearchInstitute/WHO.Zimbabwe.1992. - -

WasteStabilisationPonds:A DesignManualfor EastAfrica, D.D. Mara, G.P. Alabaster,H.W. Pearsonand S.W. MiUs. LagoonTechnologyInternational. Leeds. 1992.

38

Annex 3: Sanitatlon Technology Selection

a pour—flush is cheaperthananaquapnvyif

fundingis important.1ftx,thoptionsaretooex~nsiveStartagainwith thc box Iessthan

3 litres ofwateravailableforfiushing

39

Annex 4: Strategic Sanitation Plan for Kumasi MetropolitanAuthority, Northern Ghana, UNDP-World Bank.

The Strategic Sanitation Plan for KumasiMeiropolitanAuthority wasproducedin 1991 withUNDP-WorldBank support.The relevant sectionsrelating to technology choice and servicerequirementsis summarisedbelow.

Kumasi is a city of 600,000people,75 per centofwhom haveno accessto domesticsanitationfacilities 40 percentusepublic latrines,25 percentusebucketlatrines,5 percentusetraditionalpitlatrines,5 percentdefecatein theopenandonly 25percenthave accessto householdwater closets.About 90 per centof the communal and domesticbucketlatrinesareemptiedinto openstreams orvacantlots.The storm drainsareessentiallyopensewersandtheriver Odais grosslycontaminatedfora numberof milesdownstream.

A strategicsanitationplan wasdevelopedto addresstheseproblemsandreducethehealthrisk to thelx)pulationby the isolation,removalandtreatmentofexcreta. Only those sectionsrelevant to theinfrastructuresectionof thispaperareoutlinedbelow.

A minimum servicestandardwasdevelopedfor allhouseholdsin thecity asfoliows:

- panlatrinesareprohibited;

- dischargesof excreta at both new andexistingresidences,anddischargesofsullageat new residencesis prohibited;thesewastemustbe containedon one’sproperty or conveyedoff-site through anapprovedsewersystem.

- where depth to the watertableis lessthantwo meters, on-site systemsmay not beconstructedfor newhousing~,however,on-sitesystemsmay beconstructedforexistinghousingwhere thedepth to the water table isless than two meters if toilet waste issegregatedfrom otherwastewateranddisposedof separately;

- the constructionof new public sanitationfadiities is permiuedonly in markets,light

indusirlal areas,schoolsandinstitutions;

- Kuniasi doubleventilated improved pit(KVIP) latrines or flush toilets (pour-flushor watercloset/septictabks)arerequiredforhomeinstallations;

- household,public and institutionalfacilitiesmustbeconstructedaccordingtothedesignsandspecificationsset out in the‘Guidelines for the ConstructionofSanitationFaciities’;

- clischargesof industrialwastewaterfromnew andextstingindustriesshouldbeas faras practicablebe containedfor pretreatmentat the industrial location and can bedischargedinto thecity’s sewersystemorreceivingwatersonly whentheymeetthequality standardsdictatedby thebye-lawsofKMÂ.

For the purposesof the strategic plan, the housing inKumasiwasdivided Intofour maingroups:

- tenementarea,most residencesare in 2-3storeybuildingshaving20-30roomssharedby 10-20 families (40-100 persons).Populationdensitiesbetween300 and 600persons/hectare.Total of 25 percentof allhouseholds.

- indigenous area, homes usuallysinglestoreybuildingswith 5-10roomssharedby4-10families (20-50persons).Total of 53percent of all households.

- new governmentarea,housingfor themostpartof smglestoreybuildingsin constructedrows. Usually oneor two householdsperbuilding. Total of 16 per cent of allhouseholds.

- high-costareas,mostly detached,singlestoreybuildingswith largeplot sizesandlow population density. Total of six percentof all households.

40

After thedefinition of thesehousingtypesandassessinga rangeof potentialtechnologiesthestrategie plan recommends the followingtechnologiesbe offered to communitiesasappropriatefor usein Kumasi:

- tenementareas:sirnplified sewerage.thiswas selectedbecausethe highdensityofhousingprecludedthe useof pit latrinesorconstructionof septictanks.Thoseseptictanksin usein theareacurrentlydischargetheir liquid wasteinto thestreetdrainsthusposingasignificanthealthrisk.

- indigenousarea: on-sitetechnology,usersto be given achoiceof VIP, pour-flushlatrinesor septictanks,basedon theirwillingnessto pay.

- newgovernment:all haveseptictanks,butsomeof theseareunderdesignedfor thewastewaterflow andgo generallyoverfiowinto thestreetdrains.Eithersewersor septictanksshouldbe constructedfornew housingand where overfiowing occur eithercommunalsewersor drain fields shouldbeconstructed.

- high-con:as theseareashaveinternalplumbing,either septictankswith on-siteeffluentdrain fields or simplified sewers.

All technologieswerematchedwith technicalfeasibility, socialacceptabilityanduserswillingnessto pay for improvedserviceswrth subsidiesandloanswere to beavallablefor low-incomeareas.

The strategieplan is aimedatphasingout all bucketlatrinesby the year2000,and to providèsewerageconnectionto 26 percentof thepopulation,septictanks to 17 percentandaVIP designusingtwin pilsto 45 percentof thepopuladonby theyear2000.Nofurther public latrineswereto be buik exceptatcomniunalareassuchas marketsandlorry parks,althoughsomeexistingpublic latrinesservingverylow-incomeareaswouldberetained.

41

Annex 5: Acknowledgements

The authors would like to thank the following for their assistancein the

preparationof this paper:

Mr Velli Aalto, WHO SanitaryEngineer,WorldHealthOrganisation,Nairobi, Kenya.

Dr GrahamP. Alabaster,HumanSettlementsOfficer, ResearchandDevelopmentDivision,UnitedNationsCentrefor HumanSettlements(HABITAT), Nairobi, Kenya.

Mr S.H. Charania, Deputy Director of Water Development(Research),Ministry of LandRecla.mation,RegionalandWaterDevelopment,Nairobi, Kenya.

Mr Aggrey Chemonges,SeniorProgrammeOfficer, KenyaWaterfor HealthOrganisation(KWAIHO), Nairobi, Kenya.

Mr AndreDzikius, AssociateExperton EnvironmentalHealthandHumanSettlements,ResearchandDevelopmentDivision, UnitedNationsCentrefor HumanSettlements(HABITAT), Nairobi,Kenya. -

Mr N Gebremendliin,ProjectOfficer, UnitedNationsEnvironment Programme, Nairobi, Kenya.

Mr Lars Kailren, Water and Sanitary Engineer,UNDP-World Bank Regional Water andSanitationGroup (EasternAfrica), TheWorldBank,Nairobi, Kenya.

Ms TheresaN. Kodo, Community Health Promoter, Kenya Water for Health Orgariisation(KWAHO), Nairobi,Kenya.

Mr Mandara,HeadComputerServices,Ministry of Land Reclamation, RegionalandWaterDevelopment,Nairobi, Kenya.

Mr SimeonMakondiege,ProjectOfficer (WaterandSanitation),Unicef, Nairobi, Kenya.

Dr TomaszSudra,Chief Training Unit, United NationsCentrefor HumanSettlements

(HABiTAT), Nairobi, Kenya. -- - -~ - -

Ms Verle van der Weerd, Programme Officer, GEMS/Water, United Nations EnvironmentProgramme,Nairobi,Kenya.

Mr Weru,PrincipalChemist,Ministry of Land Reclamation,RegionalandWaterDevelopment,

Nairobi,Kenya.

Dr Adibo, HeadMedicalDepartment,Ministry of Health,Accra, Ghana.

Mr Ato Brown, UNDP-World BankRegionalWaterandSanitationGroup(West Africa), World

Bank,Accra, Ghana

Mr Rod Stem,TCO, EnvironmentProtectionCouncil,Accra,Ghana

Nr Nigel Ede,CountryDirector, ActionAid, Tamale,Ghana

Mr Ron Bannerman,CountryRepresentative,WaterAid, Accra,Ghana

42

Mr Coby Asmah,HeadHumanResourcesDevelopment,WaterAid,Accra, Ghana

Mr GregGoidstein,RUD/WHO, Genëva;SwitzerlancL

Miss Karin Loch, Landuseplanner,Edinburgh,Scotland

43

Annex 6: References

This report was prepared inlight of comments received from practitionersand extensive review of available literature. Principal source documentsarelistedbelow:

Appropriare SanirationAlternatives:A Planningand DesignManual, Kalbermatten,John,M;Julius,DeAnne,S;Gunnerson,Charles,G; andMara,D, Duncan.JohnsHopkins UniversityPress,Baltimore,USA. 1982.ISBN 0-8018-25~84-9. - -

AppropriateSanirationAlrernatives:A TechnicalandEconomicAppraisal,Kalbermatten,John,M; Julius,DeAnne,S;Gunnerson,Charles,G; andMara,D, Duncan.JohnsHopkins UniversityPress,Baltimore, USA. 1982.ISEN 0-8018-2578-4. -

ThedesignofShallowSewerSystems,UNCHS (Habitat). Nairobi, Kenya. 1986. ISBN 92-1-131019-9.

TheDesignof SmallBoreSewersSystems,Otis, Richard,J and Mara,D, Duncan.TechnicalAdvisory Note No 14. World Bank. Washinton.1985. - -

A guide to thedevelopmentofon-sitesanitation,Franceys,R, Pickford,J andReed,R. WHO.EnglancL1992.ISBN 92-4-15443-0.

EnvironmenralProblemsand theUrban Householdin Third World Countries,McGranahan,G.StockholmEnvironment Institule. Stockholm,Sweden.1991.ISBN 91-8a116-42-5.

Urban LowCostSanitationProject:Recommendationsfor EnvironmentalSanitationSolutionsfor Peri-urbanAreasof Tanga.In the Contextof theOverall Goalsof theProject, (Draft)Blacjett,1. ForWorld-Bank/tJNDPRWSG-EA,Nairobi.199Z.- - - - -

NGO Supportto Informal Settlements.A CaseStudyof Kibera, Nairobi, Kunguru, J. andMwiraria, M. 1991.

HouseholdDemandfor ImprovedSanitationServices:A CaseSrudyofKumasi,Ghana,Waterand SanitationReportNo. 3. Whittington, D., Lauria. D.T., Wright, A.M., Choe,K., Hughes,J.A. and Swarna,V. UNDP-World BankWaterandSanitationProgram.World Bank. 1992.

Healthofthe Urban Poor in DevelopingCountries,HarphamT. ParasitölogyToday,vol 2, no.11. 1986.

COMPETComparitiveStudyon Pit EmptyingTechnologies.Dar esSalaam,Final Report(Draft), WasteConsultants,Gouda,Netherlands.1991/1992.

StraregicSanitarionPlanfor Kumasi(Draft), Kumasi Metropolitan Assembly,Republicof

Ghana.1991.

Seweragefor low-incomecommunitiesin Pakistan,Taylor,K. Waterlines,vol 9, No.l. 1990.

Low-costunconventionalsewerage,Vines, M. andReed,R. Waterlines,vol 9, No. 1. 1990.

Kumasi’speoplepayfor bettersanitationservices,Kinley, D. Sourcemagazine.1992.

44

Evaluationofa low-costself-helpperi-urbansanitationprogramme,Orangi Pilot Project,Orangi Town,Karachi, Pakistan,Abbot. J.M. and Lumbers, J.P. Department of CivilEngineering,Imperial College,Univerity of London,UK.

Training civil engineerisin Kenya,Gecaga,J. In ‘Sanitationin developingcountries’,proceedingsof aworksopon training heldinLobaatse,Botswana.IRDC. 1980.

Backto basics:A community-basedenvironmentalhealthprojectin WestPoint, Monrovia,Liberia, Stephens,C. In ‘EnvironmentandUrbanization,Vol 3, No. 1, ppl4ø-l46.BIED. 1991.WasteManagementandSanitation:Integrationand CoordinatedApproachesto Solutions,Singh,N. Paperpreparedfor theTenthCommonwealthHealthMinistersMeeting,Nicosia,Cyprus,1992.

EnvironmentandHealth, Governmentof Kenya.Paperpreparedfor theTenthCommonwealthHealthMinistersMeeting,Nicosia,Cyprus,1992.

An Approachto SolutionsRegardingtheEffectofPoor SanitaryConditionson theEnvironmentandHumanHealth, Governmentof Malawi. Paperpreparedfor the TenthCommonwealthHealthMinistersMeeting,Nicosia,Cyprus,1992.

Environmentand Health, Governmentof Zimbabwe. Paperpreparedfor the TenthCommonwealthHealthMinistersMeeting,Nicosia,Cyprus,1992.

HealthandEnvironment,Governmentof Tanzania.Paperpreparedfor theTenthCommonwealthHealthMinistersMeeting,Nicosia,Cyprus,1992.

HealthAspecrsof theSocialEnvironment:HealthandRapidUrbanisationin DevelopingCountries,Stephens,C. Paperpreparedfor theTenthCommonwealthHealthMinistersMeeting,Nicosia,Cyprus,1992.

Environmentand Health: An Overviewof CommonwealthExperience,CommonwealthSecretariat.Paperpreparedfor the Tenth CommonwealthHealthMinisters Meeting, Nicosia,Cyprus,1992.

TheRoleof theHealthSectorin UrbanDevelopment,Hassouna,W.A. BackgroundpaperforWHO ExpertCommitteeon EnvironmentalHealthin UrbanDevelopment,Geneva,1990.

Urban Changein the Third World: Recenttrends,underlyingcauses,futureprospects,Satterthwaite,D. Backgroundpaperfor WHO Expert Committeeon EnvironmentalHealth inUrbanDevelopment,Geneva,1990.

HealthBurdenofUrbanisation,Williams, B.T. Background paper for WHO ExpertCommitteeon EnvironmentalHealth in UrbanDevelopment,Geneva,1990.

PlanningandManagingUrbanInfrastructures:InstitutionalDevelopmentandStrengthening,Vigier, F.C.D.Backgronndpaperfor WHO ExpertCommitteeon EnvironmentalHealthinUrbanDevelopment,Geneva,1990.

Low-Cost Oprions for Urban Sanitation, Shelley, J. Urban edge, Vol 11, No10. 1987.

Waste Stabilisation Ponds: A Design Manual for East Africa, D.D. Mara,G.P. Alabaster, H.W. Pearson and S.W. Mills. Lagoon TechnologyInternational.Leeds.1992.

45

t1

305.40 931N

Infrastructure and Training

Needs for Sustainable

Urban Sanîtation in Africa:

Appendix:

Recommendations for Action

ROBENSCommonwealth Institute

Secretariat

~e/JVGEKOMEw1? NOV. 1995

LIB}?A~YINTERNAtIONAC ~ CINT~FOR COMMUNnY WATEfl ~1JP~ ANUSANITATIc~N(IRC~

Int rastructure and Training

Needs for Sustainable

Urban Sanitation in Africa:

App endix:

Recommendations for Action

Guy Howard and Jamie Bartram

Robens Institute

-- University of Surrey~. RFFFNCE

v~,A;a~SUI-’F~LY

T~ ~) The I-h~iu~~. (070j 8~4~9ii ext. 141/142

~ilLO: ?ÖÇ. 40 q~,jJ

t

1? NOV. 1995

LIE3RARYINTERr%jATIONAC ~FFE~Nce C~T~FOR COMMUNITY WATER ~ ANISANITATIÖN (IRC)

Infrastructure and Training

Needs for Sustainable

Urban Sanitation in Atrica:

Appendix:

Recommendations for Action

Guy Howard and Jamie Bartram

Robens Institute

University of Surrey~ pr

~A~Lr~ SUF~LY~: 2~~9~DThe Hagu~

iei. (O]Ü 8~4~i1ext 141/142

~J /.?r/

InfrastructureandTraining Needsfor SustainableUrbanSanitalionin Africa: Recominendationsfor Action.

GuyHowardandJamieBartram.

RobensInstitute,Universityof Surrey,Guildford GU2 5XH, U.K.

1993

It shouldbenotedthattheviewsexpressedin thisdocumentare thoseof theConsultantsandshouldnot betakennecessarilyto reflect thoseof theCommonwealthSecretariat.

This documentis the appendixto thereport ‘InfrastructureandTrainingNeedsfor SustainableUrbanSanilationin Africa’ (ISBN 1 85 23 71145)andis partof theoutputof astudyundertakenby theRobensInstituteon behalfof theCommonweakhSecretariat.A literaturereviewandfield visits to KenyaandGhanawereundertakento accesscurrentpractice,collectrelevantexperienceanddiscussfuturedevelopments.Thisappendixis preparedasgeneralrecommendationsfor actionsto be takento promoteandachievesustainableurbansanirationin Africa, the style andcontentofwhich werediscussedandreviewedwith the ComrnonwealihSecretariat.

Executive Summary

The needfor adequatesanitationin urbanareasofAfrica is a pressingproblemandonethatmustbeaddressedas apriority becauseof its iinportancetopublic health.Poorsanitationis asignifïcantfactorcontributingto thehigh morbidityandmortality ratescommonly associatedwith poor urban areas,particularlyaniongstinfants. Increasedaccessto anduseof improvedsanitationandwatersuppliesinurbanareaswill contributesignificantly to thereductionin theincidenceof diseasein the urbanpopulation.To achievethis will involve a multi-sectotal approachand theneedfor sanitationpromotionat all levels.The healthsectorshouldtakean importantrole in policy development,standardsetting, strategicplanning,monitoring andhealtheducation.

When assessingthe problemsof urbansanitation,particularlyprovisionof servicesto theurbanpoot, itis dear that therearea numberof factorswhichinfluencethe sustainabilityandreplicability ofprogrammesof sanitationirnprovement.Institutional,infrastructuralandeducationalfactorswill all affectsustainabilityandreplicability andit is importanttheseareaddressedpreparatoryto thestartofsanitationprogrammes.

Institutional strengtheningmayberequiredin manycountriesand the roles thatcentra!andlocalgovernment,externa!support agencies,non-governmentalorganisationsandthe privatesectorplay in urbansanitationdefined.Responsibilityforconstruction,operation,maintenance,monitoringandmanagementshouldbe decidedat a nationallevelandstrategicplanspreparedfor urbansanitationirnprovemenL

Thereis in generala shortfall in trainedstaffat alllevelsto implementsanitationandhealtheducationprogrammes.1f sustainableurbansanitationis to beachieved,thereis aneedfor improvedand/orincreasededucationandtraining of staffworking insanitation. Of particular importance is thedevelopmentof appropriateeducationalandtrainingcourseswithin African countneswhich focuson thereal problemsaffectingeachcountryandwhich cansupply professionalsto work in sanitationconstruction,operationandmaintenance.Insututionsshould beencouragedto developlinks with otherinstitutions in theregionand elsewhereto increase

capacityfor trainingandresearch.

Technologychoiceis critical. The introductionofinappropriatetechnologiesin African cities hascausedwidespreadproblemsof 10w acceptability,poormaintenanceof facilities, frequentbreakdownsandlimited repairwork. Technologiesshouldbeidentified which provideahealthbenefit, areaffordable,acceptableandcan offer, whereappropriate,asignificantlevel of communitybasedoperation,maintenanceandmanagement.

Realisticchargesfor sanitationfacilities mustbeleviedif sanitationprogrammesareto besustainable.Whereincomesare low, sanitationprogrammesinAfrican couritriesshouldaim to empowerlow-incomegroupsandin particularwomen,to acceptanincreasedlevel of responsibilityfor themanagementof sanitationfacilities.1f healthbenefitsfromimprovedsanitationareto berealised,it is importantthatgoodhygienepracticesareadoptedby thepopulation.To facilitate this, healtheducationprogrammesrun in parallel to constructionprogrammesarerequired.This will generallybetheresponsibilityof the healthsector,but is likely torequireinputrrbm othersectôrs.The provisionofcommunityhealtheducationwit parlicularemphasison sanitationandgood hygienepracticeis vital toensurethatoncefacilitiesareavailabletheyareusedandmaintainedproperly.

The healthsectorhasan importantrole to play inurbansanitationandshoulddevelopacoherentapproachto the healthproblemsassociatedwith poorsanitation.Policy development,strategieplanning,provisionof healtheducationin parallelwithconstruction,inputstohigherandfurthereducationcoursesin public health-relateddisciplinesandtheestablishmentandmonitoringof standardsof effiuentandwastequality areall likely to fall within thehealthsectorremit. Wherethesectordoesnot havethenecessaryeipertiseto fulfil all theseroles,thencooperationwith othersectors,suchas educationandlocalgovernmentwill beparticularlyimportant.

Of particularimportancefor the developmentofsustainableurbansanitationprogrammesin Africaarepolicy developmentandstrategieplanningatnationalandregional levelswhich addressthepublichealthproblemsof insanitaryexeretadisposalin

1

urbanareas.Theseshouldemphasisepublic healthiniprovementandcreateanenablingenvironmentforthis to be achieved.Thismay involve thesettingofadequatesrandardsfor construction,waterandeffluent quality, by implementingroutine monitoringand inspectionprogrammeswhich havethepowertoenforcecompliancewith quality standardsand thedevelopmentof appropriateeducationandtraining.

The promotionof community-basedinterventionstolmproveurbansanitationwill becomeincreasinglyimportant,particularlyto meetthe needsof the lowincomeurbanpopulations.It is thesegroupswhohaveleastaccessto sanitation,areexposedto thegreatestpublic healthrisk andwho areleastabletopaymunicipal authoritiesfor the costof operationandmaintenanceby municipal staff. Throughthedevelopmentof strategieswhich encouragecommunityconstruction,operation,maintenanceandmanagementof sanitationfacilities,the potentialforurbansanitationimprovementsto be sustainablewillbesignificantly raised.

Thedevelopmentof increasedopportunitiesforappropriateeducationand training for thoseinterestedin pursuingacareerin public healthandstaffalreadyemployedin the sectoris importanttoincreasethenumberandquality of sanitationstaff. Inparticularthe developmentof a cadreof field staffwho canundertakea wide rangeof public andenvironmental health work in low incomecommunitiesareneeded.Thesestaff will becommunitybasedfleldworkerswho canundertakeawiderangeof public andenvironmentalhealthinterventionsrangingfrom constructionof watersuppliesandsanitationfacilities to providingbasichealtheducationand monitoringenvitonmentalquality. Theseprofessionalsshouldalso beabletolearnfrom andsharetheir skills with communitymembers,particularly women,to enablethem to takeincreasingresponsibility for theenvironmentalqualityof their surroundings.

Interventionsin theseareaswill providethepoliticalwill to achievemmprovements,increasethelikelihoodof commitmentof sufficientresourcesto realisethoseimprovementsandraisethe numbersof availableskilled personnelwith which to achievethesetargets.

ProposedAction for SustainableUrbanSanitation

This documentis theappendixto an overviewpaperconsideringthe infrastructureandtraining needsforsustalnableurbansanitationin Africa producedbythe RobensInstitute for the CommonwealthSecretariat.An objectiveof thispaperwas to identifya small numberof areasin which activity was apriority becauseof the public healthneedandinwhich interventionis likely to haveapositiveimpact.Factorssuchasreplicability andinternationalrelevancewerethereforeimportant.

To addressthe issueshighlightedabove,it isrecommendedthat considerationis given to projectsin threekeyareas:

- the developmentof flexible, progressiveeducationfor with astrong practical focusfor field staffinvolved in urbansanitationorother environmental/publichealth projectsand those wishing to pursuea career inenvironmentalhealth.

- strategiesto support the developmentofpolicy making at national level and topromote exchangeof information at seniorpolicy makinglevel.

- identify existing projecis of urbansanitation provision, promote theirestablishmentwhereabsentand specificallysupport exchangeof experience betweenprojects throughseminars,conferencesandnewsletters.

Outlineproposalsfor projectsto supporteachoftheseinitiativesarepresentedon thefollowing pages.

2

Environmental Heatth Education

Introduction

The needfor a cadreof well-trainedprofessionalenvironmentalhealthstaffwas clearlyhighlightedinthepaperpreparedfor theCommonwealthSecretariaton trainingand infrastructureneedsforsustainableurbansanitation.Well trainedandqualifiedstaffwhocan undertaketechnical work in addition toenvironmentalhealthinspectionarecurrentlyoneofthe leastavailablegroupsin Africa. The trainingofsucha group shouldbe seenasa priority in nationalhumanresourcedevelopmentprogrammesfor mostAfrican nations.Thesestaff shouldbe trainedto theequivalentof higherdiplomalevel.

Studeniswho graduatefrom sucha coursearelikelyto be employedas field staffwho will work in andwith urbancommunities,particularly low incomegroups,to improveenvironmentalandpublic healthconditions.Sucha cadrewould includeindividualswho can takeresponsibilityfor: constructionofsanitationfacilities; constructionof watersupplies;monitoringandsanitaryinspectionof water supplies;monitoring of dischargesfrom both industrial anddomestic sewagetreatmentworks; buildinginspectionanddrainageprovision;andfor providinghygieneeducation.Of key importancewill be theability of suchstaff to be ableto transfertheir skillsandprovideadviceto thecommunitieswith whomthey work.

Project Strategy

It is proposedthat this coursebe implementedas apilot project in severalcountrieswhich caneitherfunction asregional(international)training centresand/orasdemonstrationprojectsfor othercountriesin their region.As therearetwo Commonwealthregions in Africa (WestAfrica andEast,CentralandSouthernAfrica) it is recommendedthatonepilotprojectbeset up in the WestAfrica region,asthisonly comprisesfour countries,and two in theEast,CentralandSouthernAfrica region. It is proposedthat thesebe in Ghanato serve the WestAfricaregionandUgandaandZambiato servethe East,CentralandSouthernAfrica region. It is importanttonote that thesepilot coursesshouldbe usedas ademonstrationfor all African countriesin eachregionand notonly Commonwealthmemberstates.

Thesecoursesshouldpreferablybe run in existing

educationinstitutesratherthanestablishingnewfacilities. Themostsuitableinstituteswould betechnicalcollegesor polytechnics,but auniversitycouldalsobe used.Although thiscoursewould bedesignedto meetthe needsof fieldworkersatahighernationaldiploma level, if thereis sufficientdemandit couldalsobe seenas thebasisfor thedevelopmentof environmentalandpublic healthcoursesof a higher level.The developmentof thiscourseshouldbe seenas partof a wider humanresourcedevelopmentprogrammeaimedat satisfyingthe needsof all levels of staff working onenvironmentalandpublichealthprojects.

To ensurethatthis courseaddressesreal needsitwould be importantbeforeits establishmentthatregional, stateandmunicipal authoritiesareconsulted,aswell astheprivatesectorandExtemalSupportAgencies(ESAs)andNon-GovemmentalOrganisations(NGOs). Thedemandfor training andtheperceptionsof the trainingneedsof their currentstaffandlevel of futurestaff will help to definewhereemphasisis requiredandto finalisecoursecontent.

Training Structure

The aim of this course to provide flexible,appropriateeducationin environmentalhealth forfield staff who work or plan to work on urbanenvironmentalhealthprogrammes.The proposedcourseshouldbestructuredso as to allow studentetotakethis courseon a modularbasis.Thecoursewillalsobe opento olderstaffwith relevantexperiencebutpossiblylowerformalqualifications.

Thecourseshouldlast for threeyearsif takenin oneblockandwouldbe suitablefor studentewhohaverecentlyleft secondaryschoolwith reasonablegrades,particularly in technicalandsciencesubjects.However,being modular, the coursewould beavailable for staff currently employed onenvironmentalhealthprogrammesto studywithoutleavingtheir positionsfor too long aperiod.Themodularapproachalsoaimstx increaseaccessforpoorerstudentewh5may not beableto afford tofollow thecoursefull time.

The coursewouldbe practicallyorientatedwith

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studentsacquiringskills which canbe useddirecilyin urbancommunitiesandwouldcoverall aspectsofenvironmentalhealthincludingsanitation.Thecoursewould be taughtthrougha mixture of: lectures;practicals;groupand individual projecis;casestudies;andfield visite to urbanareasbothwith andwithoutexistingsanitationfacilities. Studentewouldbeexpectedto undertakeeitheragroupor individualprojectin anappropriatefield in urbanenvironmentalhealth.The needfor theseto be practical isemphasisedto allow studentsto utilisetheir skills.Examplesof suitableprojectswould include:employmenton an existing urbanenvironmentalhealthprogramme,establishinga smallscalesanitationprojectandconstructionof smallwatersuppliesin a low incomeurbanarea. Graduationwillbeon successfulcompletionandpassingof allmodulesin thecourseandsatisfactoryprojectreportfrom thetutorand/oremployerwhereappropriate.

Coursecontent

Therewill be threekey themesto the course:constructionandtechnology(watersupplies,sanitation,drainageandbuilding); education(hygiene,environmentalandpublic health); andinspectionandmonitoring (watersupplies,sewagedischargesandhouseholds).

Constructionandtechnology:

Thissectionwill covertheprincipal technologiesandconstructiontechniquesemployedin environmentalhealth engineering,with particularemphasison 10wcost optionsfor 10w incomegroups.The coursewillbe orientatedtowardsthepracticalapplicationofconstructiontechniquesand usesof differenttechnologies.On completionstudenteshouldbeableto plan,designandconstructsimplewatersupplies,sanitationfacilities, basicstructuresanddrainageforlow incomegroups.

This sectionwill be split into four modules:afoundation in construction and technology;sanitation;watersupply;buildmganddrainage.

Foundation- engineeringandhealth;concretemixes;concretetypes (ferrocement, reinforcedconcrete,unreinforcedconcrete);usesof blocks,bricks andmassconcrete;health andsafetyat work; basicplumbing; materialsestimation;simplesurveying.

Water supply - waterandhealth; thewatercycle andbasic hydrology; groundwater;simple water

engineering;handdugwell construction;handpumps;springprotection;tubewellsinking; rainwaterharvesting;smallstoragetank construction;operationandmaintenance;basicwater treallnent communityparticipationandmanagement.

Sanitation- excretaandhealth;on-sitesanitationtechnologieswater-bornesanitation;on-sitesanitationconstruction;solid wastemanagementandwastewatertreatment;compostingandreuseofwastes; technology selection; communityparticipation andmanagementof sanitation;groundwaterprotection.

Building andurbandrainage - buildingsandhealth;good buildingpractice;brick laying; basicjoinery;roofing; vectorcontrol; on-sitesullageremovaltechnologies;urbandrainageandhealth; stormwaterdrainage.

Education:

This modulewill focus on communityeducationtechniquesandmaterialdevelopment.

Educatzontechniques- settingobjectives;selectionof target audience; collecting information;communicationandparticipatorylearning;meetingsandworkshops;massmedia;drama,stonesandsongs;training of communityhealthvolunteers;baselinesurveys.

Material development- selectionof media;visualandaudiomatenlals;monitoringandevaluationofeducationmaterials;local productionof materials;community training in materials use anddevelopment.

Inspectionandmonitoring

Watersupply - watergualityandhealth;biological,chemicalandphysicalpropertiesof water;criticalparametersof water quality; drinking waterstandards;domesticand industrialpollution ofwater; on-sitewaterquality testing; taboratorytechniques;sanitaryinspectionsof water supplies;useof monitoring andinspectiondatafor remedialand preventative actions; planning andimplementationof water supply monitoringprogrammes;codesof practicefor construction,operationandmaintenance

Effluentsand solidwaste- effluentandsolidwastestandards;analyticaltechmques;monitoringthereuseof treatedwasteandeffluent; naturalwaterquality;

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useof datato enforcecompliancewith standards;reuseof effluentsfor irnigation;planningandimplementing monitoring progtammes;environmentalimpactof effluentsandsolidwastes;codesof practicesfor construction,operationandmaintenance;mtroductionto urbanairpollution.

Building - building inspection;building qualitystandards;environmentalhazardsinsidedwellings;pestcontrol; indoor air quality; useof datato planremedialactions;building codesof practice.

CourseStructure

As this courseis newandwill requireextemalinputsin its initial establishment,it is proposedto staggerthe startof the pilot projects.This will havetheaddedadvantageof allowing anylesso~slearntduring the establishmentandteachingon the firstcourseto beusedon the laterpilot projects.Forinstance,a pilot coursecouldbe establishedfirst inUganda,with ayearlater the secondpilot coursestartingin Ghanaandin thefollowing yearthe coursein Zambiaestablished.

Appropriatestaff in eachcountryto teachon thiscourseshould be identified and given any further

training required to meet the standarddemandedoftheteachingstaff. Input will berequiredfor betweenfive andten teachingstaff fôr thecoursewith avaryinganrountteachingrequiredof eachmemberofstaff. Staffwho arealreadyemployedby the hostinstitution shouldbe usedwhereverpossible,althoughsomestaffmayneedto be recruited toprovidecertainelementsof the course.An initialintakeof amaximumof 20 studenteis suggestedinthefirst yearof eachpilot course.

Eachinstitution providing the coursein thepilotscalewill needto havefully equjppedworkshopsandareasonablebudgetto purchasematenialsand toolsfor the students.Whenthe final yearprojectsareundertakenmoneyshouldalsobeavailablefor thestudenteto applyfor materialswhererequired.

As thecoursesprogress,disseminatloneventeshouldbeheldto shareexperiencesof runningthecourse,tohighlight anyproblemsandhow thesehavebeenovercomeand how the counsemodel shouldbedevelopedin the future. Theseeventswill enableleadersin othercountrieswithin eachregion to assesshow successfulthecourseshavebeenandhow theymaybeadaptedto suiteachcountriesneeds.

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Policy Making

Introduction Project Strategy

Theestabhshmentof anenablingenvironmentwhichpositively promotesgood urbanenvironmentalsanitation and encouragesestablishmentofappropriateinitiatives to improveconditionsin urbanareasis of greatimportanceto thesustainabilityandreplicability of urbansanitationprojects.Centraltothis are:strengtheningof theinstitutional capacityinenvironmentalhealth;settingof suitablestandards;establishinglegislation;initiating strategicurbanenvironmentalhealthplanning;andestimationofresourcesrequiredto meetplannedtargetsandimprovingtheefficiencyof resourceuse.

Thereis aneedto furtherdeveloppolicy makingandstrategicplanning for environmentalhealthmanagementin generalandfor sustainableurbansanitationin particular. Urbansanitationshouldbecome- whereit is not already- akeycomponentof nationaldevelopmentplans.

Thereis commonlya perceptionamongstpolicymakersthatoperationalstaff makeunreasonabledemandson limited (budgetary)resoureesandamongstoperationalstaffthatpolicy makersfail tounderstandtheimportance(and thereforebudgetrequirement)of the activitiesin which they areinvolved. In reality bothareattemptingto optimisetheuseof limited resourcesand thereis much to begainedby increasingcommunicationandcooperationin planningbetweenthem.

The processof strategieplanningis little developedin somecountriesand furthermore,supportfor this isonly likely to be effectivewhere management(policy-makersandseniorstaff from èperationaldivisions)areawareof theneedfor andusefulnessofthisapproach.

It is recommendedthat for a limited numberofcountrieswhich expressinterestin developingstrategieplanning for urban sanitationthat supportbeprovidedfor the developmentof urbandiagnosticstudies.Thisshouldleadon to the developmentofstrategieurbansanitationplanswhich shouldberevisedduringtheir first two yearsof operation.

By its naturestrategieplanningis adynamicprocessand thespecificnatureof supportwhich will berequiredeannotbe determinedin advance.Thepurposeof this project is not to supportthedevelopmentof urban sanitationper se,but rathertosupportthedevelopmentof nationalcapacityto planeffectively andefficiently for the developmentofsustainableurbansanitation.

Sinceastralegicplan is developedprogressively,it isrecommendedthatexternalsupportshouldbe ofrelatively low intensityoveraperiodof threeyears.During this time it is anticipatedthatactivitieswithinthe following frameworkwouldbe developedby ateamcomprisingindividualsfrom bothpolicymakingandoperationalinstitutions. Theframeworkisbasedon thatusedfor environmentalmanagementsystemsandwill vary significantly in detaildependingon wherethewotk is undertaken.

- investigate,collateandsummaniseexistinginformation concerning urban sanitation(coverage, cost use, effectiveness,monitoringetc);

- review information requirements formanagement purposes and identifyinformationneeds;

- produceanoverview‘diagnostic’ surveyof urban sanitation (a ‘state of urbansanitation’report);

- as an outcomeof developmentof - thesurvey, idénLification of research needs,monitoning requirements,priority areasandimplementationtargets;leadingto:

- anoutlinefive yearplan with the first twoyears developedin detailwhich is revisedand updated annually in advance ofMinisterial budget submissions and isachievablewithin theprevailingconditions.

An importantaimof theprojectwouldbe to ensurethat personsfrom operationalandpolicy-makinglevelswork togetherto developan achievableandoptimisedplan of activity which is revisedandmodifiedon aregular(annualbasis).

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Project outputsThe developmentof policies toward urbanenvironmentalhealthconditions,ineludingsanitation,is typically theresponsibilityof nationaland localgovernmentpolicy makers.Howeven,regional(international)dialogueandexchangeof experienceandexpertisemay helpgovernmentsidentifyappropriatestrategies.To facilitate the widerdisseminationof the experienceobtainedandespeciallyregardingthe usefulnessof thistypeofplanning it recommendedthat disseminatio~activitiesbe built into theprojectframework. Thismay be achieved - for instance - throughpresentationsby involved countriesat ameetingofCommonwealthMinistersof Health.

Project structure

As notedpreviouslythedetailednatureof activitiesto be undertakenin this projectwill bedetenninedinlight of nationalconditions.It is suggestedthatparticipatingcountriesbeself-selecting.

Whereverpossiblethefirst stageof projectinitiationshouldinvolve theestablishmentof an inter-sectoralcommitteewith responsibilityforurbansanitation.This committeeshouldhaveclean termsof referenceandbeconstitutedprincipally by policy-makingandoperationalagencies.The constitutionaüdroleofthis committeeis coveredin somedetail in thebodyof this report. Howeverit is importantto notetheneedto ensurethat theviews of all interestedpartiesincludingnon-governmentalbodiesare takenintoaccountand thatadvantageshouldbe takenof othersourcesof expertadvice.

Externalsupportprovided to the projectshouldbelargelylimited to anadvisoryrole to this committeeand,whereappropniateto its constituentagencies.

Anticipatedoutputsin participatingcountriesinclude:

- adiagnosticsurveyof urbansanitation;

- inereasedawarenesrofpolicy makersofenvironmental healthandspecificaily urbansanitatkYnissuds; -

- developmentof strategie planning forurban sânitation;whiéhmay include all orsome of the following, depending onnationalconditions:

guidelines for sanitalionprogrammes;

national standardsand supportinglegislation;

development of low-costmanagementorientatedmonitoringactivities;

identificationof trainingneeds andpotentialsolutions.

Throughdisseminationit is hopedthatawarenessoftheworth of strategieplanningandof theprocessthisinvolves maybeadoptedby otherAfrican countries.

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Promotion of Urban Sanitation Projects

As an adjunct to theproceedingtwo projectproposals,individual Afriean Commonwealthmemberstatesshouldprioritise the supportofexistingandestablishmentof new pilot projectswhich embody theprinciples outlined in theoverviewpapa.

In countnieswherethe traininginitiatives outlinedaboveareproposed,it will be importantthatstudentehave aceessto relevant urban environmental healthprojeets,preferablyprojectsineluding somesanitationupgrading.

Similarly, successfulimplementationof strategieplanningasoutlinedearlier,is likely to requirepilotprojects for the purposesof monitoring andevaluation.

It is recommendedthat the CommonwealthSecretariatassistmemberstatesin attractingfundingfor projectsof this type.

The experienceandexpertisegainedfrom pilot urbanenvironmentalhealthprojectsshouldbeas widelydisseminatedandpromotedas possible.It isrecommendedthattheSecretariatdirectly supportaseriesof bi-annualseminarsor conferences,foreitheraregionalor continentalaudienceto achievethis.Theexchangefrom all countniesthroughoutAfricamay be particularly useful and allow cross-fertilisationof ideasthroughoutthecontinent.

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