An urban sanitation primer

An urban sanitation primer Pete Kolsky, WSP HQ pkolsky@worldbank.org

Perspectives/prejudices • A primer… basic and not detailed • not intended to insult anybody’s intelligence or competence • Public health perspective • A preoccupation with basic needs • Reaching those with “no access” • Myths? More like “science and folklore” • Will try to distinguish the two

Definitions of sanitation • “Safe interaction with human excreta” • “Facilities required for safe management of excreta…not hygiene promotion” • Environmental sanitation • The environmental services required for healthy living…includes water supply, sanitation, drainage, solid waste management, etc. For this presentation, will lean towards 2nd definition

The good news in sanitation… • 747 milliongained accessto sanitation from 1990 to 2000!

…and the bad news • Because of population growth, there were42 million more without access over the decade! • And these numbers are probably optimistic!

Sanitation and disease • Diarrhoea • 2.2 million deaths/year worldwide • > 4 lakh in India alone…1000/day = 40/hr • 1 billion episodes of diarrhoea per year in India…2-3 episodes/child/year • Most vulnerable (and most infectious) are under 5…mostly under 2 • Yet many believe that child’s faeces are “safe” • Worms (Hookworm, roundworm) • Billions of cases • Transmitted through soil contamination

Fluids Fingers New Victim Faeces Food Flies Fields/Floors The F-diagramme

Implications for sanitation & health • Sanitation is more than “keeping water supplies clean” • Other routes are generally more important • Hardware without hygiene will get us nowhere • The biggest and toughest challenge is management of faeces of kids < 2

Basic technical factors • Your water supply and disposal determine your sanitation options… • All four present in many South Asian cities

On-site, little water • Pit latrine • Principles: • Isolate the waste from human contact • When full, dig new pit, seal old one. • Store for > 1 year to reduce/eliminate risk • Empty, recycle/dispose of contents (sludge) • Problems/challenges: • High water table, rocky soils • Sludge management needs to be considered • No sullage (“grey” water) management

Diversion box Pits Water-sealed slab Twin-Pit Pour Flush • Principles: • Water-flush and seal controls odours • Brick in diversion box blocks off filled pit for one year before emptying, recycling compost • Disadvantages: • As with pit latrine, except smell, easier alternation

EcoSan • Latrine contents “stabilized” after a year’s isolation…can use as compost • Basis of Twin Pit Pour Flush • EcoSan focus on urine separation…use urine as ammonia source, solids stabilize better • Build above ground to facilitate emptying

EcoSan (cont’d) • Question: If we can’t sell the most basic on-site sanitation at 500 Rs/HH, why do we think we can sell more expensive EcoSan? • When economics of compost used as justification, check market very carefully • Areas of high GW table, rocky soil, extra cost of EcoSan relatively small…

Gravel-filled infiltration bed, open-jointed pipe Scum Settled sludge On-site, lots of water (septic tanks) • Principles: • Solids settle out before sewage seeps into soil…soil then filters sewage • Problems: • Cannot “seep” into clay or plugged soil or high WT • Sludge mgemt: must empty from time to time, and where does sludge go?

On-site sanitation and groundwater • On-site sanitation systems can contaminate groundwater, esp. in areas of high GW table. • Can often be controlled by adequate distance (15m in most soils) • Where perceived as a problem… • Is groundwater used for water supply? • Is alternative water supply cheaper/easier than not doing on-site sanitation?

Off-site, little water • “Conservancy” or bucket/basket system • Rightly condemned as hazardous to its workers but… • …Where it exists, do we deny it? • …Can we improve it?

Off-site: lots of water • Sewerage! The engineer’s favourite!! • Principle: • Water carries excreta through pipes to treatment works… • Problems/challenges: • Expensive!!!! • Needs a steady water supply • A lot goes into rivers untreated… • …and most sewage ttmt protects fish, not people…

It’s all got to go somewhere… • Sewerage • Consider outlet/informal reuse carefully • Sludge…where does it go? • Septic tanks, pit latrines, TPPF • Sludge management…how handled? • Wet sludge (septic tanks)  decentral. ttmt • Dry sludge from latrines  solid waste chain?

Public health notions of sewage treatment • How do you know sewage is bad? • Smell • Colour • Dead fish • Algae • Sludge banks • If somebody removed all those problems, would the water be OK?

What sewage treatment does • Removes solids (SS) • Removes organic load that depletes oxygen that kills fish (BOD) • Some removes nutrients for algae (N, P) • VERY FEW REMOVE PATHOGENS • As Klaus said this morning, detention time & sunlight are your best disinfectants • Chlorination is NOT a straightforward solution • Organic demand + particles  poor disinfection

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

Particularly urban issues • Urban sanitation matters more… • Higher population densities • More likely to be complicated by water to spread muck around • Institutional challenges, and opportunities, are more complex • Role of utility for wastewater? • Role of utility for onsite sanitation? • Heterogeneous populations, “communities”

River & Environs City Ward Peri-domestic Home (street, school, work-place)

Primary network Secondary network River & Environs City Collector Ward Peri-domestic Home House Connection (street, school, work-place) Sewage Treatment Plant Outfall

What’s the point? • Household perception matches public health perception! • FIRST get it out of the home, THEN out of street, THEN address overall city waste management issues • Engineers/managers perception of priorities is in reverse for variety of reasons (cost, complexity, prestige)

Home Peri-domestic (street,school, workplace) Ward City Central Treatment Works Primary Sewers Secondary Sewers House Connections

Three network approaches • Slum networking (Parikh) • Slums located along the “waste collectors” of the city… • If you upgrade these collectors, marginal cost of serving slums is small…include them! • Orangi Pilot Project model • HH and street organise, manage construction of secondary (street) infrastructure; Municipality/utility manages primaries and ttmt • Condominial (Latin America, utility driven) • Similar to OPP, more integrated into planning, various contract options for maintenance

Generic institutional issues • Who’s doing it now? • Sanitation is like housing… • 1. People do for themselves • 2. Largely informal arrangements • Who’s responsible in gov’t? • Health dep’t • Water dep’t • …Neither of whom is necessarily appropriate… • How well can formal meet informal? • How can we nudge, cajole, promote the evolution of the mix in the right direction?

Scaling up? • Definition? • Increased volume of facility construction and use • Sustainable • Do we mean • “How can we get 300,000 new latrines a year?” OR • “How can we build a sustainable industry?”

Why is scaling up difficult? • “How come we have great projects and lousy programmes?” • Intensity of commitment • High % ownership of commitment on pilots • Span of control • Complex interventions handled at project level • Capacity • How many good NGOs/agencies are there? • Calibre of staff…All the good ones are taken…

Sustainable industry requirements • If somebody can make a buck out of it, it will expand…if they can’t, it won’t… • Demand • Why people want sanitation (demand study in Philippines) 1. lack of smell and flies 2. cleaner surroundings 3. privacy 4. less embarrassment when friends visit 5. less gastrointestinal disease • Yet how do we sell it? • “No demand without tenure!!”

Sanitation as a business • Good sensible marketing • Offer a range of options… • At least as important “Design to price” • (Midnapur a good example) • Understand/facilitate the growth of the industry • Subsidies? • Cash flow? • Materials?

Hygiene Promotion & Sanitation Marketing

Some Principles of Hygiene Promotion • 3 priorities • Hand-washing at right times with soap (or other agent?) • Safe disposal of faeces • Safe management of water • DON’T add more messages • Repeat often • Be positive, don’t preach…Avoid Doctors, Death and Diarrhoea

Appropriate gov’t support • Clear consistent policy framework • Clear leadership, clear authority (esp. urban) • Enabler not provider… • Five-year (production) plan died with the Soviet Union • Start from a mix of technologies, move to another mix of technologies with greater coverage…but not through direct provision • Subsidize promotion, not production • Strong encouragement of individual HHs… examples of Midnapur, Vietnam (likely)

Some credit issues/options • Sanitation is like a bridge… • …building 90% doesn’t count for much! • Therefore a “lumpy” investment • Credit issues • South Asia the home of micro-credit… • You can tell me more than I can tell you!! • One example from Vietnam…

Revolving funds for sanitation: Vietnam • A credit system for household sanitation improvement (latrines, septic tanks, sewerage connections) • Women’s Union manages the credit through savings-credit groups • A linkage with income generation and public awareness of health/environment issues • Target: • Low income families • Coverage of 80-90% of HH in city (approx 14,000)

Saving-Credit groups • Organized in groups of 12-15 persons. • Saving of 20,000 VND/mo (US $1.3) required throughout loan period • Savings provide 480,000 VND ($32 US) towards repayment of the principle • Savings can be on-lent to other savings-credit group members for income generation.

Achievement so far (April 2002) • High number of borrowers • Over 350 Savings-Credit Groups formed • Over 4000 borrowers in less than 1 year • 80% of borrowers construct their household’s sanitation facility within two months of receiving the loan • Nearly all of sanitation facilities are constructed within three months of disbursement • High repayment rate 95 %

Main points of the news • Put sanitation in public health context • Means to an end, not an end in itself • Kids < 2 most important of all • Household most important focus of intervention • The biggest issue is behaviour change • Hygiene issues, barely touched on here • Must learn to market sanitation at both household and community • Hygiene is hard-to-monitor, not as popular as sanitation hardware for project funding

Main points of news (cont’d) • Generating demand • There is no gain in providing sanitation people don’t want • Hygiene promotion ≠sanitation marketing • What’s the problem you have to solve? • Must consider on-site/off-site, water/w.o. water to define options • The ring diagrammes • Helps to keep priorities clear for interventions • Helps to identify breakdowns in “the faecal chain”…don’t forget sludge management!!

Main points of news (cont’d) • Institutional realism • The five-year plan forces what is not wanted…and will be self-defeating • Trying to nudge, cajole, promote, steer a shift in mix from “now” to a better “future” • Need clear leadership and accountability in gov’t • Defining the mix of formal/informal and the role of utility • Credit/finance matters • Micro-credit worth exploring

Some provisional principles • Sanitation cannot be only for the poor • Plenty of “middle-class slums” with appalling sanitation… there is no excuse! • Need to “segment” the market to build an industry…internal cross-subsidy? • Sanitation promotion through status? • Start where you are…not where you want to be • Don’t race to transform with alien technology people don’t understand, haven’t experienced • Work with those who are currently providing the service…learn from their reality

Provisional principles (2) • Keep mechanisms, benefits clear… • “Elimination of open defecation” a worthwhile goal, but don’t forget infants’ excreta • Public toilets, shared latrines? Need to observe behaviour before counting “lives saved” • Most sewage treatment is (a) expensive and (b) has minimal public health impact • Justification is environmental, not public health

Provisional principles (3) • The perfect is the enemy of the good… • Beware of engineers’“minimal acceptable standards of sanitation” • Design to affordable price…just like every other business • Focus on excreta, not all environmental problems • Be pragmatic about subsidies • Subsidize promotion more than production…When overall demand takes off, production can remain sustainable…”people not waiting for a subsidy” • Sewerage has always been subsidized…why subsidize only those with house connections? • For sewerage, subsidize connection, not O & M

Some approaches to discuss • Developing the market • Find out determinants, constraints on demand • Reduce them (redesign sanitation, sell better, subsidize promotion, purchase?) • Support “infant industry” • Get out of the way…

Approaches to discuss (2) • NGO “triggering” of total sanitation • Current WSP/Wateraid/VERC work in Bangladesh, Maharashtra • How many NGOs, what scale can be managed? • Utility/CBO partnership on network • Outermost branches of “tree” managed by CBO, trunks by utility

An urban sanitation primer