10 Things You Need to Know About Sanitation 1. What do we mean by "sanitation"? The first challenge for countries seeking to solve the problem of access to sanitation is to define what “sanitation" really means. The second challenge is to decide what aspects are the most important. In other words, what aspect of the problem is going to be dealt with as a priority. This problem is not a simple one and many professionals confuse the two steps. With respect to defining sanitation most professionals would agree that "sanitation" as a whole is a “big idea” which covers inter alia: • safe collection, storage, treatment and disposal/re-use/recycling of human excreta (faeces and urine); • management/re-use/recycling of solid wastes (trash or rubbish); • drainage and disposal/re-use/recycling of household wastewater (often referred to as sullage or grey water); • drainage of storm water ; • treatment and disposal/re-use/recycling of sewage effluents; • collection and management of industrial waste products; and • management of hazardous wastes (including hospital wastes, and chemical/ radioactive and other dangerous substances). For countries with very low access to basic sanitation, increasing the effectiveness of management of excreta at the household level may have the biggest health implications and it may be the biggest challenge. For this reason some countries may legitimately decide to focus their efforts at this level in the short term. In other cases, specific inter-linkages between elements of sanitation mean that a more complete solution may be better – for example in a particularly congested urban community some form of off-site (sewered) sanitation may be the only viable technical choice – in which case there will probably need to be some interventions to improve management of solid wastes and stormwater drainage – otherwise the sewers won’t work. Yet other countries or communities may try for a more complete solution which includes a focus on protecting the environment from contamination (as is the case in countries which already have universal access). In some cases, it will be possible to start with an “ecological” approach to sanitation which seeks to contain, treat and reuse excreta where possible – thus minimizing contamination and making optimum use of resources. The key issue here is that each community, region or country needs to work out what is the most sensible and cost effective way of thinking about sanitation in the short and long term and then act accordingly. Flexibility and pragmatism should be the key words – and both professionals and politicians need to try and see past “experience” and ideas which are developed elsewhere – a pragmatic local approach with an eye to wider environmental issues is likely to result in more progress than blind adherence to a rigid global definition. 2. Why focus on sanitation? Wherever humans gather, their waste also accumulates. Progress in sanitation and improved hygiene has greatly improved health, but many people still have no adequate means of disposing of their waste. This is a growing nuisance for heavily populated areas, carrying the risk of infectious disease, particularly to vulnerable groups such as the very young, the elderly and people suffering from diseases that lower their resistance. Poorly controlled waste also means daily exposure to an unpleasant environment. The build up of faecal contamination in rivers and other waters is not just a human risk: other species are affected, threatening the ecological balance of the environment. The discharge of untreated wastewater and excreta into the environment affects human health by several routes: • By polluting drinking water; • Entry into the food chain, for example via fruits, vegetables or fish and shellfish; • Bathing, recreational and other contact with contaminated waters; • By providing breeding sites for flies and insects that spread diseases; 3. What is the size of the problem? In 2004, only 59% of the world population had access to any type of improved sanitation facility. In other words, 4 out of 10 people around the world have no access to improved sanitation. They are obliged to defecate in the open or use unsanitary facilities, with a serious risk of exposure to sanitation-related diseases. While sanitation coverage has increased from 49% in 1990, a huge effort needs to be made quickly to expand coverage to the MDG target level of 75%. Investing in sanitation infrastructure involves a long project cycle.If the MDG sanitation target is to be achieved, innovative approaches need to be developed to reduce the time span from policymaking to services delivery. The global statistics on sanitation hide the dire situation in some developing regions. With an average coverage in developing regions of 50%, only one out of two people has access to some sort of improved sanitation facility. The regions presenting the lowest coverage are sub-Saharan Africa (37%), Southern Asia (38%) and Eastern Asia (45%). Western Asia (84%) has the highest coverage among developing regions. Out of every three persons unserved, two live in Southern Asia or Eastern Asia. 4. What diseases are associated with poor sanitation? Human excreta have been implicated in the transmission of many infectious diseases including cholera, typhoid, infectious hepatitis, polio, cryptosporidiosis, and ascariasis. WHO (2004) estimates that about 1.8 million people die annually from diarrhoeal diseases where 90% are children under five, mostly in developing countries. Poor sanitation gives many infections the ideal opportunity to spread: plenty of waste and excreta for the flies to breed on, and unsafe water to drink, wash with or swim in. Among human parasitic diseases, schistosomiasis (sometimes called bilharziasis) ranks second behind malaria in terms of socio-economic and public health importance in tropical and subtropical areas. The disease is endemic in 74 developing countries, infecting more than 200 million people. Of these, 20 million suffer severe consequences from the disease. Ascariasis is found worldwide. Infection occurs with greatest frequency in tropical and subtropical regions, and in any areas with inadequate sanitation. Ascariasis is one of the most common human parasitic infections. Up to 10% of the population of the developing world is infected with intestinal worms – a large percentage of
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