Water Currents: Peri-Urban Sanitation

Waste collected from Sanergy Fresh Life Toilets is taken daily to a central processing facility outside of Nairobi, Kenya. Wheelbarrows and handcarts facilitate waste collection in informal settlements, where the only roads are narrow and unpaved. Photo credit: Sanergy

A central goal of the U.S. Government Global Water Strategy is to facilitate sustainable access to safe drinking water and sanitation services, and promote the adoption of key hygiene behaviors. Such improvements are especially important in underserved peri-urban areas that often lack access to these services.

This issue of Water Currents highlights recent studies and resources on fecal sludge management, container-based sanitation, shared sanitation, and other topics. As noted in USAID’s Water and Development Plan included in the U.S. Global Water Strategy, separating individuals and communities from human waste, properly treating fecal waste, and promoting key behaviors that lessen the risk of illness are critical sanitation and hygiene interventions that reduce diarrheal disease, child mortality, malnutrition, neglected tropical diseases, and other waterborne illnesses, such as cholera. The first six studies are from the Creating Demand for Peri-Urban Sanitation (SanDem) project, which aims to better understand how to improve the quality of peri-urban sanitation using demand-side/behavior change approaches in Lusaka, Zambia.

We would like to thank staff from Sanitation and Hygiene Applied Research for Equity (SHARE) for contributing content to this issue. SHARE generates evidence to improve policy and practice worldwide to achieve universal access to effective, sustainable, and equitable sanitation and hygiene.         


Creating Demand for Peri-Urban Sanitation (SanDem) Studies
Theory-Driven Formative Research on On-Site, Shared Sanitation Quality Improvement among Landlords and Tenants in Peri-Urban Lusaka, Zambia. International Journal of Environmental Health Research, November 2018. Researchers conducted in-depth, on-site interactive interviews with landlords and tenants in a neighborhood in peri-urban Lusaka to understand on-site, shared sanitation quality improvement behaviors and preferences.

The Social Dynamics around Shared Sanitation in an Informal Settlement of Lusaka, Zambia. Journal of Water, Sanitation and Hygiene for Development, December 2018. This study explored the social dynamics affecting collective management of shared sanitation in the Bauleni compound of Lusaka, Zambia. The social dynamics illuminated here provide an important basis for the development of a behavioral intervention targeted towards improving urban sanitation.

Assessing Peri-Urban Sanitation Quality Using a Theoretically Derived Composite Measure in Lusaka, Zambia. Journal of Water, Sanitation and Hygiene for Development, July 2018. Researchers created the Peri-Urban Healthy Toilet Index for measuring on-site, peri-urban sanitation quality. They used it to assess sanitation quality in a peri-urban area in Lusaka, Zambia.

Using a Theory-Driven Creative Process to Design a Peri-Urban On-Site Sanitation Quality Improvement Intervention. BMC Public Health, May 2019. This article describes the development of a behavior change intervention to improve on-site, peri-urban sanitation quality in Lusaka, Zambia, using the Behavior Centered Design framework.

Effect of a Behaviour Change Intervention on the Quality of Peri-Urban Sanitation in Lusaka, Zambia: A Randomised Controlled Trial. The Lancet Planetary Health, April 2019. Researchers tested a scalable, demand-side behavior change intervention to motivate landlords to improve the quality of shared toilets within their plots, finding it could improve the structural quality and cleanliness of shared sanitation without subsidy or provision of the relevant infrastructure.

Understanding Demand for Higher Quality Sanitation in Peri-Urban Lusaka, Zambia through Stated and Revealed Preference Analysis. Social Science & Medicine, May 2019. Interventions leveraging landlords' profit motives could lead to significant improvements in peri-urban sanitation quality, reduced diarrheal disease transmission, and increased well-being without subsidies or infrastructure investments by governments or NGOs.

Scaling Market Based Sanitation: Desk Review on Market-Based Rural Sanitation Development Programs. USAID Water, Sanitation, and Hygiene Partnerships and Learning for Sustainability (WASHPaLS) Project, June 2018. This desk review describes the current state of knowledge in market-based sanitation (MBS) and establishes a framework to analyze, design, and improve MBS interventions. It is based on a survey of approximately 600 documents on MBS and interviews with sector experts and program personnel.
‘Top-Down’ Planning for Scalable Sustainable Sanitation in High-Density Low-Income Urban Areas: Is It More Appropriate than ‘Bottom-Up’ Planning? Journal of Water, Sanitation and Hygiene for Development, January 2018. The authors state that if the sanitation target of the Sustainable Development Goals is to have any chance of success, then a community-sensitive, top-down planning approach must be adopted for sanitation provision in high-density, low-income urban areas.

Transition Management for Improving the Sustainability of WASH Services in Informal Settlements in Sub-Saharan Africa—An Exploration. Sustainability, November 2018. This paper identifies five dimensions that contribute to unsustainability of WASH services in informal settlements in sub-Saharan Africa and makes recommendations based on these challenges.

Urban Sanitation: Where to Next? 40th WEDC International Conference, July 2017. The authors explain that with better understanding and decision-support tools, it is time to embrace urban complexity; to place sanitation back into the wider human-technology-environment systems of the city; and to plan for integrated basic services in the domestic and peri-domestic domains.

The Sanitation Cityscape Conceptual Framework: Understanding Urban Sanitation Systems. IRC, 2019. This paper, drafted for the IRC WASH systems symposium, describes the Sanitation Cityscape Framework and how it locates sanitation service delivery within a wider urban systems framework.

Container-Based Sanitation
Container-Based Sanitation: One Way to Reach the Last Mile for Sanitation Services. Water Blog, February 2019. Container-based sanitation (CBS) consists of an end-to-end service—i.e., one provided along the entire sanitation service chain—that collects excreta hygienically from toilets designed with sealable, removable containers and which strives to ensure that the excreta is safely treated and disposed of or reused.

Health Risks for Sanitation Service Workers along a Container-Based Urine Collection System and Resource Recovery Value Chain. Environmental Science & Technology, May 2019. CBS within a comprehensive service system value chain offers a low-cost sanitation option with potential for revenue generation, but may increase microbial health risks to sanitation service workers.

Exploring Exposure Risk and Safe Management of Container-Based Sanitation Systems: A Case Study from Kenya. Waterlines, October 2018. The analysis identified nine critical control points where exposure risks may be either prevented or reduced via the implementation of relevant control measures.

Fecal Sludge Management
Scheduled Emptying Services as an Entry Point for Change. SNV, February 2019. The aim of this paper is to inform sector thinking and practice on fecal sludge emptying. It shares examples from SNV’s programs in Indonesia, Nepal, and Bangladesh.

Methods to Reliably Estimate Faecal Sludge Quantities and Qualities for the Design of Treatment Technologies and Management Solutions. Journal of Environmental Management, October 2018. The demand for infrastructure to manage fecal sludge is increasing. However, no reliable method exists to estimate total accumulated quantities and qualities. This study proposes an approach that averages out complexities to estimate conditions at a centralized to semi-centralized scale required for management and treatment technology solutions.

Formally Engaging the Private Sector for Fecal Sludge Management Services: Experiences from Six African Cities. 41st WEDC Conference, July 2018. In sub-Saharan Africa, the Partnership Cities Project supported six grantees to develop urban on-site sanitation service across the sanitation value chain. This paper presents the findings from a review of these projects.

Gender Issues
Exploring the Complex Relationship Between Women’s Sanitation Practices and Household Diarrhea in the Slums of Nairobi: A Cross-Sectional Study. BMC Infectious Diseases, March 2019. Meeting health targets to reduce the prevalence of diarrheal diseases in informal settlements requires paying particular attention to the needs of women living in these environments.

Not Just Any Toilet – Women’s Solutions to Sanitation in Informal Settlements in Nairobi. Development in Practice, September 2018. The purpose of this study was to provide women with an opportunity to share their perspectives on and solutions to sanitation challenges in informal settlements. The findings highlight the need to address women-specific burdens associated with sanitation in such settlements.

Women’s Sanitation Practices in Informal Settlements: A Multi-Level Analysis of Factors Influencing Utilisation in Nairobi, Kenya. Global Public Health, October 2018. This study investigated factors associated with women’s common sanitation patterns. The findings suggest that the availability of toilets alone may not be enough to eliminate sanitation-related health risks in informal settlements.

A Mixed-Methods Study of Women’s Sanitation Utilization in Informal Settlements in Kenya. PLoS One, March 2019. Women living in informal settlements are disproportionately affected by lack of access to sanitation. A majority of women in this study utilized an unsafe method of disposal at least once in a 24-hour period that increased their risk of direct exposure to waste and harmful pathogens.

Health Aspects
Guidelines on Sanitation and Health. World Health Organization, 2018. This set of guidelines summarizes the evidence on the effectiveness of a range of sanitation interventions. It identifies gaps in the evidence base to guide future research efforts.

Urban Sanitation Coverage and Environmental Fecal Contamination: Links Between the Household and Public Environments of Accra, Ghana. PLoS One, July 2018. This study examined associations between sanitation and fecal contamination in public environments in four low-income neighborhoods in Accra, Ghana. Findings suggest that clustering of contained household sanitation, even when shared, may be associated with lower levels of fecal contamination in the immediate area.

Relationships Between Shared Sanitation Facilities and Diarrhoeal and Soil-Transmitted Helminth Infections: An Analytical Review. Journal of Water, Sanitation and Hygiene for Development, April 2019. This paper presents an analytical review of studies on the relationship between the use of shared sanitation and the prevalence of diarrheal disease and soil-transmitted helminth infections.

Water and Sanitation Challenges and Impact on Health in Informal Settlements. Future Health Systems, December 2018. A review of the current state of water and sanitation challenges in informal settlements recommends a wider provision of public toilets with guiding rules and regulations that can be implemented by key trusted community representatives selected by residents.

Bacterial Contamination on Latrine Surfaces in Community and Household Latrines in Kathmandu, Nepal. International Journal of Environmental Research and Public Health, January 2019. A study that measured and compared bacterial contamination on community and household latrine surfaces in Kathmandu, Nepal, found that well-maintained community latrines may be as clean, or cleaner, than household latrines, supporting the use of community latrines in a low-income country setting.

Institutions/Water Utilities
USAID Financial Institutions Reform and Expansion–Debt and Infrastructure Project Ex-Post Evaluation. USAID Water Communications and Knowledge Management Project (CKM), September 2018. From 1994 to 2011, USAID's Financial Institutions Reform and Expansion–Debt and Infrastructure Project activity partnered with India’s central, state, and municipal governments to expand sustainable water and sanitation access to the poor. Water CKM evaluated the project seven years after it closed to assess its long-term sustainability.

Designing for Sustainability: Bringing Citywide Inclusive Sanitation to Debre Birhan, Ethiopia. USAID Sustainable WASH Systems (SWS) Learning Partnership, March 2019. This webinar discusses SWS efforts to work with local actors in Debre Birhan to strengthen local service delivery in coordination with a World Bank project that is providing substantial new sanitation infrastructure investment.

Cross-Subsidies for Improved Sanitation in Low Income Settlements: Assessing the Willingness to Pay of Water Utility Customers in Kenyan Cities. World Development, March 2019. The findings in this study suggest that cross-subsidies may offer a means to support financing of safe sanitation for low-income households.

Shared Sanitation
Shared Sanitation Management and the Role of Social Capital: Findings from an Urban Sanitation Intervention in Maputo, Mozambique. International Journal of Environmental Research and Public Health, October 2018. Researchers explored the determinants of shared sanitation management within the context of a larger-scale health impact evaluation of an improved, shared sanitation facility in Maputo, Mozambique. Social capital played a critical role in the success of both formal and informal management strategies.

Limited Services? The Role of Shared Sanitation in the 2030 Agenda for Sustainable Development. Journal of Water, Sanitation and Hygiene for Development, September 2017. The authors call for prioritizing investments in high-quality shared toilets in dense informal settlements where such toilets are the only viable option (short of rehousing) for improving sanitation services.

Other Resources
An Examination of Community-Led Total Sanitation’s (CLTS) Contributions toward Universal Sanitation. USAID Water, Sanitation, and Hygiene Partnerships and Sustainability Project (WASHPaLS), April 2018. The review offers a description of CLTS interventions and discusses circumstances in which CLTS works best, highlights the most promising implementation modalities, and describes instances where CLTS may not be suitable. 

Innovations for Urban Sanitation: Adapting Community-Led Approaches. Practical Action, 2018. This book addresses calls from practitioners for practical guidance on how to mobilize communities and improve different parts of the sanitation chain in urban areas. It offers a set of approaches to move toward safely managed sanitation services and provides examples of towns and cities in Africa, South Asia, and Southeast Asia.

Globalwaters.org – The USAID Water Office supports this website as a global knowledge resource for USAID staff, implementing partners, water specialists, and the broader international development community. The site provides users with the latest news, learnings, and resources from USAID and its partners, and is designed to facilitate knowledge-sharing and collaboration.

SaniPath – The SaniPath Rapid Assessment Tool aims to assess exposure to fecal contamination in urban, low-income settings. The tool is under development by the Center for Global Safe Water at Emory University with funding from the Bill & Melinda Gates Foundation.