Sanitation: what are the problems? - IRC International Water and Sanitation Centre

Sanitation: what are the problems?

Why are so many developing countries doing so badly in providing all their citizens with good sanitation? Why are they not investing in sanitation? Are they not very concerned about the resulting morbidity and mortality? There have been many fine words, of course, as evidenced in the Declarations of all the various recent Regional Sanitation Conferences, but not that much subsequent action.

It can’t be because there aren’t any good sanitation systems. We all know (or we all should know) what systems are appropriate in what situations – for example, my choices would be:

• in low-density rural areas: arborloos, fossas alternas, single-pit VIP latrines and single-pit pour-flush latrines;
• in medium-density towns and large villages: urine-diverting ventilated improved vault latrines - these are always alternating twin-vault systems (or UD-VIVs, for short; they are also known as eThekwini latrines − but we need lower-cost versions) and alternating twin-pit pour-flush latrines, although simplified sewerage may be cheaper (or affordable and preferred); and
• in high-density urban areas: simplified sewerage (also known as condominial sewerage) and low-cost combined sewerage or, where these options are unaffordable, SPARC-style community-managed sanitation blocks.

Not many options, so not really that difficult to understand them all.

So why aren’t these systems being implemented on the scale required? It can’t be because there isn’t the money because any development bank will fund a well prepared proposal to improve sanitation access by the urban or rural poor (funds are even available to help governments prepare such projects). So what is preventing developing countries doing better?

Some countries have done really well – for example, Malaysia and Thailand in 2008:

	Malaysia	Thailand
Urban areas	Improved sanitation: 96% Shared sanitation: 4%	Improved sanitation: 95% Shared sanitation: 5%
Rural areas	Improved sanitation: 95% Shared sanitation: 4% Open defecation: 1%	Improved sanitation: 96% Shared sanitation: 4%

Have these two countries done so well because they ‘think clean’ and have ‘invested in clean’? There are quite a few countries that don’t seem to be thinking clean – at least as evidenced by the numbers of their citizens who are open defecators: in 2008 there were 27 countries in Africa with over 20% of the population having to defecate in the open, 8 in Asia and 2 in Latin America and the Caribbean (the developing-country average was 21%). Some countries have tackled open defecation rather well – for example, in Viet Nam only 6% of the population practised open defecation in 2008, compared with 42% in 1990.

So what is stopping other countries doing as well as Malaysia and Thailand? Why do they not think clean? Well, judging by their poor record of action, senior politicians and senior civil servants do not seem to think that thinking clean or investing in clean is that important (and, of course, there can be no solutions without political solutions). Another huge problem is the technical ignorance of local engineers who are generally paid too little to be motivated to correct this. And, of course, there’s too much corruption in general and in the water and sanitation sector in particular.

How can bilateral and multilateral aid agencies best help developing-country governments do more? My opinion is that development aid in the water and sanitation sector should concentrate on the provision of technical training to close the sanitation knowledge gap that currently hampers sanitation planning and implementation. The development banks should do what they currently do (or should be doing) – providing good technical advice and loans for really well prepared projects – but on a much larger scale. All other development aid should be output-based aid and reserved for those countries which have excessively high numbers of open defecators. We have to tackle the ‘Bottom Billion’ first.

Duncan Mara, University of Leeds, UK

Keywords

• Capacity development
• Financing
• Policies & legislation
• Sanitation
• Technology

Uganda: Without Planning, Urban Areas Wallow in Filth and Disease | WASH news Africa

Uganda: Without Planning, Urban Areas Wallow in Filth and Disease | WASH news Africa

Posted on April 7, 2010 by westerhof| Leave a comment

Urban living can be bad for your health — at least in Uganda. To mark World Health Day tomorrow, whose theme this year is urbanisation and health, the Daily Monitor will run a two-part series, beginning with this story, on the many dire health consequences of the country’s failure to plan its cities, by Evelyn Lirri

On the porch of a tiny mud-and-wattle hut in a slum section of Ggaba, a Kampala suburb, Ms Sarah Namutebi, 29, sits clasping her nine-month-old baby. She looks deeply worried.

Ms Namutebi’s baby, looking frail and dehydrated, has been down with diarrhea for the past three weeks. The baby’s eyes are sunken and the mother is desperately struggling to save its life.

It is easy to see why the child is sick. In front of the one-roomed house runs a drainage ditch carrying a mass of sewage, rotting garbage and plastic materials. The unsightly hodgepodge emits a horrid stench that suffocates the neighbourhood.

This is the reality of life for an estimated 3.3 million of the 5.5 million Ugandans who live in urban areas today.

Effective urban planning and enforcement would improve living conditions and sharply reduce disease. But the population is growing far faster than authorities can plan, hobbled by lack of funding, incompetence and corruption, can keep up.

The result: rapidly-growing mass slums where poor sanitation, dust, lack of proper ventilation, overcrowding and uncollected garbage all pollute and choke the living environment, making urban centres a death trap for dwellers (read a special report on rot of our towns in tomorrow’s Daily Monitor).

The problem promises to get worse before it improves. “Uganda is fast urbanising and if you don’t address urbanisation problems like health, water and infrastructure you will have a catastrophe,” warns Mr Urban Tibamanya, the state minister for Urban Development.

The consequences are already here to see. In Kampala alone, some 40 per cent of the city’s 1.8 million residents live in informal settlements like Katanga, Wabigalo-Namuwongo, Makerere-Kivulu, Ggaba, Kifumbira and Kisenyi.

Records show most communicable and hygiene-related infections break out in these areas, which often are unplanned and lack adequate housing and access to clean water and sanitation.

Intestinal worms, diarrhea and asthma topped the list of the most prevalent diseases in Kampala city between 2006 and 2009. Kampala City Council’s health division says these diseases jointly contribute to more than 80 per cent of the disease burden in the city.

In 2009, 43,434 intestinal infections were registered in Kampala district from common parasitic worms like ascaris, tapeworms and pinworms found in unfiltered water. Acute diarrhea cases totaled 27,694 cases, while persistent diarrhea cases reached 9,717.

In Ggaba mission slum, diarrhea is so common that few there consider it a disease anymore. Rather, it is seen as a normal part of life.

Cholera, another deadly disease usually associated with poor hygiene, had been dropping, from 1,104 cases in the 2006/7 financial year, to just 40 the year after, but the number of cases increased to 74 in 2009. Dr. John Lule, the KCC chief health inspector, said increased public education and awareness on hygiene and sanitation have contributed to this decline over the years.

Respiratory illnesses also are on the rise. According to the State of the World Cities report 2010/2011 published by the United Nations Human Settlements Programme (UN-Habitat), acute respiratory infection cases in Uganda are high in slum and rural areas- with slums and rural areas. Twenty-three per cent of their residents suffer acute respiratory infections, compared to only 14 per cent of residents in urban non-slum areas.

Many of the hygiene-related illnesses arise from poor sanitation. Although latrine coverage in Kampala district stands at 85 per cent, health experts say the access is not even geographically because many slum dwellers cannot afford the Shs100 they are charged to use them. As a result, many end up using polythene bags — commonly referred to in slum parlance as “flying toilets” – to dispose of their waste.

The indiscriminate disposal of human waste, officials say, is the reason underlying perennial cholera outbreak in the city.

Organised developments

Most of these diseases can be prevented by making the environment healthier through proper planning, health experts say.

Source: Evelyn Lirri, Monitor / allAfrica.com, 6 April 2010

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Uganda: Kampala to get four sewers | WASH news Africa

Uganda: Kampala to get four sewers | WASH news Africa

Posted on August 19, 2010 by westerhof| Leave a comment

The National Water and Sewerage Corporation, the Uganda water utility company, is to construct four sewage treatment plants in Kampala city and its suburbs.

The plants to be set up in the city suburbs of Nakivubo, Kinawataka, Lubigi and Nalukolongo, are expected to improve sanitation services from the current 7% of the city’s population to 30%. The city currently has only one sewage treatment plant.

NWSC’s Managing Director, Dr William Muhairwe said at a press conference in Kampala recently the project will be financed by the European Union, African Development Bank and Uganda Government at Euro 68 million.

“The project aims at improving environmental sustainability of Lake Victoria basin by reducing pollution entering the lake and improving the quality of lives of residents in informal settlements through management of sludge from domestic sanitation facilities,” Dr Muhairwe said.

“The plan is to have 100% sewer coverage in the central business district of Kampala”. Uganda is said to be one of the least sewered countries in the world. According to the work plan, the works will involve construction of a new sewerage treatment plant with a capacity of 45,000 cubic metres per day that will treat both sewage and waste discharge in Nakivubo channel, construction of a central treatment facility for toxic effluent from small scale industries dealing in toxic chemicals.

Dr Muhairwe, however, said that the works are being hampered by encroachers that are settling in the catchment areas where the project is supposed to cover. Kampala City Council (KCC) Mayor Nasser Sebaggala, refuted allegations that KCC had given out land meant for the project to developers.

He blamed the Uganda Land Commission for giving out land without KCC’s consent. “It is not KCC that is giving out the land,” Sebaggala said. The project will entail undertaking a sewerage management and an industrial effluent study, rehabilitation of the current sewage treatment plant at Bugolobi to improve its performance.

Source: Joseph Olanyo, East African Business Week / allAfrica.com, 16 August 2010

Africa: Just Building a Million Latrines Won’t Solve Sanitation Crisis | WASH news Africa

Africa: Just Building a Million Latrines Won’t Solve Sanitation Crisis | WASH news Africa

Posted on January 28, 2011 by westerhof| 1 Comment

The deadline for the world to meet its millennium development goals is now only four years away, yet in sub-Saharan Africa, there are still 570 million people without adequate sanitation.

Many technologies designed to solve the problems are parachuted. Some work, most don’t. The lesson should be simple: know the area, know the people.

It is only through talking and listening to the people on the ground that we will be able to make long-lasting and sustainable moves out of poverty. This is especially pertinent when trying to educate people about sanitation and hygiene and bringing about a change in behaviour.

Local knowledge is everything. WaterAid conducted its own research across west Africa into different ethnic groups’ attitudes to going to the toilet. The results go some way to explaining why simply building a latrine is only half the battle.

WaterAid is adapting an approach known as community-led total sanitation (CLTS) in west Africa. First conceived in Bangladesh, it is a concept that has been sweeping across south Asia with impressive results, and many are hoping that it can bring similar results to Africa. It is based on an understanding that the people themselves have the solutions and are best able to determine which interventions will enable them to attain a self-defined, collective destiny.

Instead of focusing on the supply and installation of sanitation hardware to communities, CLTS focuses on changing attitudes and behaviour through community mobilisation to stop open defecation, and to build and use latrines.

Participants have reported that they find the approach engaging, participatory and, most notably, empowering – putting them in control of their own destiny, in a context in which, more often than not, death by disease is accepted with fatalistic submission to the ‘will of God’ or the hex of an enemy or the local witch.

Empowering local communities – especially women – with information that allows them to make decisions pertaining to their health and wellbeing ensures that they “own” the desired change. It is they who can be credited for the health benefits of safe sanitation and hygiene practices. It is they who commit to the necessary behaviour change, they who hold themselves and their peers accountable. Here, help is not coming from outside, but from within – and people are in charge of their own destiny.

Source: Juanita During, The Ghanaian Journal, 27 January 2011

Harnessing Coalitions for WASH in Uganda. WASH experiences in Uganda | WSSCC

Harnessing Coalitions for WASH in Uganda. WASH experiences in Uganda | WSSCC: "Countries
Linking HIV/AIDS and WASH in"

The Role of the National Sanitation Working Group in Scaling Up Sanitation and Hygiene in Uganda | WSSCC

The Role of the National Sanitation Working Group in Scaling Up Sanitation and Hygiene in Uganda | WSSCC

Uganda | WSSCC

Uganda | WSSCC

Uganda: The plight of Kampala’s garbage collectors

Posted on May 26, 2010 by westerhof| Leave a comment

In the scorching midday sun, 25-year-old Bernard (not real name) uses his bare hands to gather garbage into a dirty sack. Dressed in a threadbare overall, and with no gloves, boots or face mask to guard him from the hazardous rotting garbage, Bernard risks catching diseases like cholera while on duty.

“The smell is awful and I have almost lost my sense of smell,” says Bernard, who works for Nabugabo Updeal Joint Venture (NUJV), a private company that cleans Kampala City at a fee.

Bernard’s work starts at about 7:00am, collecting garbage on Ben Kiwanuka street. “In a day, I have two phases of clean-up. The first starts from 7:00am to 12:00pm and the second at around 12:30pm to 7:00pm,” he explains.

The first phase involves collecting over 21 sacks of garbage and loading them onto a waiting truck. He does not have money for lunch and he is not allowed rest till he finishes the day’s work.

Each day, Bernard, who lives in Nakulabye, a Kampala suburb, walks about 10km to and from home. Before heading home, he cleans himself in the dirty stream at Nakivubo channel. He cannot afford to buy water.

“I reach home exhausted and hungry. There is no food so I beg from relatives or friends. I always pay them at the end of the month when I get money. If I do not get any food, I sleep hungry,” Bernard says.

At the end of the month, he earns sh100,000 which is all spent within hours of earning it. “These guys are killing me slowly,” says Bernard, who often falls sick, suffering from diarrhoea, malaria and cough. But he can hardly meet his medical expenses.

“Even when I get sick, I have to work,” he says. “I cannot afford a day off lest I get fired.” If they are lenient with you for skipping a day, he says, 40% of your salary is slashed.

But Bbira Kimulah, the assistant operations manager of Nabugabo Updeal Joint Venture, says they give their workers sick leave. “We deduct (the sick employee’s) salary to hire a temporary worker to stand in for him or her. We do not sack anybody who is sick; we respect their rights,” he says.

Stigma

Bernard explains that when he gets a chance to have a meal, restaurant owners kick him out. “They fear to lose customers because I smell bad ,” he says. He says it is also hard to interact with other people because they fear to associate with ‘stinking people like me’. He often receives insults from people.

“Some call me garbage. Others who know me hide when they set their eyes on me. I also hide from those who know me because I feel ashamed. But I cannot do this anymore. This is my job,” he says.

Before he joined garbage collection in January, Bernard used to vend groundnuts for his grandmother in the city to make ends meet. “But when she died, we used all the capital to bury her. I had no option but to join the garbage collecting business. I had a friend who was collecting garbage and moving on the trucks. One day I met him and I asked to accompany him,” he says.

Bernard says he volunteered for the company before he was employed on full time. “When they saw that I was doing good work, they recruited me,” he says.

But after recruitment, Bernard was neither given an appointment letter nor identity card. “My only identification is a uniform. They also registered my name in their office and that is how I get my payments,” he says. He adds that he cannot open a bank account or get a loan from a bank because he lacks a workplace ID.

He says his biggest challenge is working alone on his street, collecting garbage from about 15 restaurants and over 20 shops. “I fear I will collapse and die one day because I get very tired,” says Bernard, who sometimes works at night, collecting garbage from shops he cannot access during the day. His company does not pay him for working extra hours.

Like Bernard, 30-year-old Martha, a street sweeper employed by the same company, starts her work at 7:00am and ends at 7:00pm. Martha says she is worried about lack of maternity and annual leave.

“I have been here for over a year without getting any leave; thank God I have never conceived. Here pregnant women lose their jobs as soon as they go to deliver. We work from January to January.”

Twenty-eight-year-old Lydia (not real name), a street sweeper for Hill Top Enterprises, says: “Recently a taxi knocked me down but I was lucky not to die. Out of sympathy, doctors at Mulago Hospital treated me for free. When I came back to work, I was told there was no compensation for the accident.”

While we moved around with their boss Kimulah, some of his workers were sitting atop the garbage on a truck without any protective gear or uniform. Kimulah admits that the waste is harmful to their health and their workers often get sick or get accidents.

He also says one of their employees was knocked down and injured by a speeding vehicle recently while at work. Kimulah says every month at least two of their workers are victims of motor accidents due to careless driving on the city roads. “We spend sh3m on their treatment every month.”

But his colleague, who declined to speak publicly, says: “That is a lie. They do not mind about our health. When we get sick we suffer on our own.”

Expert’s view about garbage

Dr. Joseph Senzoga, the Kampala City Council coordinator for Epidemic outbreaks, says: “Garbage is full of industrial and home chemicals. These contain toxic fumes and bacteria. Many of these garbage collectors are exposed to worms, respiratory infections and skin diseases,” he says.

NUJV reacts

Kimulah says: “All our workers are given protective gear but some sell them to get money. Others keep it at home because they don’t know how to use it.”

He, however, says they are unable to replace lost or stolen gear because they do not have enough money. “Our operational costs are high. Everyday, we spend about sh65m buying fuel for the garbage collecting trucks. And we have to pay workers.”

Contrary to Martha’s claim, Kimulah says they give three months maternity leave to women workers. “But we give no annual leave because these are casual workers. We do not also give them appointment letters; they are casual workers who may leave any time,” he says.

Fred Serubula, the managing director of Hill Top Enterprises, says: “I do not provide lunch or transport. My company is small and I do not have much money.”

Good habits by other companies

Visensio Odong, president of Waste Pickers Association, an agency advocating for rights of garbage collectors, says out of the 20 private companies, only seven have good working conditions. He lists them as Great Wastes and Recycling Foundation, BIN, BIN I, CITEK, TASK Cleaning Services, Global Cleaning Services and Safi.

“These companies pay workers well and provide protective gear, lunch and transport allowances to their workers,” he says.

What the 2006 Employment Act says

Dr. Emmanuel Otaala, the state minister for labour, says the Employment Act 2006 provides for workers rights. “An employee is entitled to a contract of service, termination of contract, termination notices, and protection of wages, at least eight hours of work, rest and holidays, employment of women, protection of children and care of employees.”

Odongo says some garbage collectors work for long hours without any meal or transport and “some times they are denied wages or paid little money”.

He says some garbage companies pay garbage collectors an average of between sh5,000-sh50,000 a month. “And yet they work for over 12 hours a day.”

He adds that the garbage companies employ over 100,000 workers countrywide. “The problem is that only 106 of these garbage collectors belong to the association which advocates for their rights. I think this is why they are exploited,” he explains.

He adds that joining the association is free. “But some companies are threatening to sack them if they join us. They fear that when they (the workers) join, they will know their rights and demand better services,” Odong says.

Otaala calls upon garbage workers to join trade unions to advocate for their rights. He called on Waste Pickers Association to sensitise garbage workers about their rights.

Source: Frederick Womakuyu and Oyet Okwera, New Vision / allAfrica.com, 24 May 2010.