The Unfinished Business of Sanitation

Executive Summary

2.6 billion people throughout the world, primarily in developing countries, lack the access to basic sanitation that most people in developed countries take completely for granted. As one of the targets of the Millennium Development Goals, there has been a movement to halve the proportion of persons without such access by 2015. Although there has been a decline in persons without sanitation, “business as usual” will not be able to finish the job. There should be a greater push for innovative solutions to provide access to sustainable, environmentally safe, efficient, and convenient sanitation globally. This paper places an emphasis on ecological sanitation that aims to protect both human health and the environment while limiting the waste of potable water. An integrated solution to “think globally but act locally” is discussed.

Definitions

Sanitation can be thought of as a continuum or a ladder of services, from unimproved sanitation on one end to improved facilities on the other. Unimproved sanitation includes open pits, hanging toilets, facilities that flush to streets, yards, open sewers or other locations, or defecation in the bush or open fields (WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP), 2006). Improved sanitation ranges from basic pit latrines to improved pit latrines, pour-flush facilities, and conventional sewers (United Nations Development Programme (UNDP), 2006). It also includes ecological sanitation toilets.

Basic sanitation, as described by the UN Millennium Project Task Force on Water and Sanitation, is “the lowest-cost option for securing sustainable access to safe, hygienic, and convenient facilities and services for excreta and sullage disposal that provide privacy and dignity while ensuring a clean and healthful living environment both at home and in the neighborhood of users” (UN Millennium Project, 2004).

1. The Current Situation

Introduction

In Geneva, between 1580 and 1739, three out of every ten babies died before their first birthday. In the late 1600s, London’s infant mortality rate was above one in four infants (Rosen, 1993). Foul sewage was rampant in city streets, and epidemics of infectious diseases such as cholera and the plague were just as abundant. In the 1840s, social reformers in Great Britain began arguing for public action to ensure that each household had a toilet and access to clean water (UNDP, 2006). In 2005, however, the infant mortality rate in Switzerland was ranked the 15th lowest of 226 countries, at 4.39 deaths per 1000 live births. This extreme improvement in mortality rates is due largely to the installation of sewer systems and improvements in sanitation brought about during the industrial revolution. The developed countries now boast 99% coverage in both sanitation and drinking water (WHO/UNICEF JMP, 2006).

In sharp contrast to the thoughtless and almost automatic ease of basic hygiene, sanitation, and water supply in developed countries, many of those in developing nations, particularly in Africa and Asia, face the same daily challenges in finding potable water and ways to defecate safely and privately that Europeans and Americans dealt with more than 200 years ago. The same statistics from Geneva in the 16th and 17th century can be applied now: four out of every ten people in the world do not have access to the simplest latrines (UN Millennium Project, 2004). In fact, 2.6 billion people, almost a third of the entire human population, currently lack access to basic sanitation and are thus limited to unimproved facilities (refer to Figure 1 for proportions of unserved populations by region) (WHO/UNICEF JMP, 2006). In some areas, persons have no facilities whatsoever, and are forced to defecate in the bush or open fields.

It should also be noted that there are areas, even within developed countries, that still lack sanitation. It is estimated that 12% of American Indian and Alaska Native homes in the United States lack safe and adequate water supply and waste disposal facilities (Indian Health Services, 2007). These populations reside in the poorest counties within the third richest country in the world (International Monetary Fund, 2005) and cannot continue to be ignored.

Cycle of Poverty

This lack of basic sanitation is limited to the poor, 660 million of whom live on less than US$2 a day. The cycle of poverty that ensnares so many involves a limited amount of time and money for education and thus a reduced potential for skill- and knowledge-based development. This leads to lower production and an inability to maintain savings. Infectious diseases such as lower respiratory infections, HIV/AIDS, diarrheal diseases, tuberculosis and malaria disproportionately affect the poor, killing millions each year. In addition, certain diseases of poverty that could be eliminated with clean water, proper sanitation and hygiene, such as trachoma, lymphatic filariasis, and leprosy cause chronic disability and stigma, and thus keep the poor from escaping the cycle. (Global Health Council, 2007). Morbidity from intestinal parasites such as hookworm leads to cognitive impairments, massive dysentery, or anemia that limits millions of children’s education and learning abilities (Poverty-Environment Partnership (PEP), 2005).

The Rural/Urban Gap

The gap in access to sanitation and adequate water supply is not limited to developed and developing countries. There is also a vast difference between rural and urban areas. Improved sanitation coverage in urban areas increased a small amount from 79% to 80% between 1990 and 2004. In rural areas, coverage increased by thirteen points during the same time period but is still very low at 39% (WHO/UNICEF JMP, 2006). This means that 611 million people in urban areas and 2 billion people in rural areas are still without access to improved sanitation. Certain factors complicate the situation. First, in most developing countries, rural populations are increasingly migrating to urban areas; this adds to the number of urban populations lacking access to sanitation (WHO/UNICEF JMP, 2006). Beginning in 2007, the world urban population will be greater than the rural population (WHO/UNICEF JMP, 2006). Much of the migrating populations continue to move into slum areas that inherently lack sustainable sanitation facilities. Slums are defined by their high population density, poor urban infrastructure, prolonged poverty, and lack of secure tenure (WHO/UNICEF JMP, 2006), whether they are central city tenements or “spontaneous squatter settlements without legal recognition or rights, sprawling at the edge of cities” (Cities Alliance, 1999). In Mumbai, India, for example, 55% of the urban population lives in about 2,000 slums (World Bank, 2006). Without improved sanitation, residents are forced into open defecation, feces disposal with solid waste, or “flying toilets”, the practice of defecation into plastic bags which are then thrown into ditches or roads (UNDP, 2006). Although small bore sewers and condominial systems are the most sustainable and healthy solutions for these high density areas (WHO/UNICEF JMP, 2006), the costs of connecting every household to a sewerage system can be daunting. In these circumstances, communal toilets that are well-built and maintained will be sufficient (WHO/UNICEF JMP, 2006).

Millennium Development Goals

In 2000, every member country of the United Nations agreed to a commitment to make “the right to development a reality for everyone” (United Nations (UN), 2000). This vision for the future specifically included “… less poverty, hunger and disease, greater survival prospects for mothers and their infants, better educated children, equal opportunities for women, and a healthier environment” (UN, 2006). Eight Millennium Development Goals (MDGs) were thus developed to provide a tangible path, with targets and deadlines in order to reach this vision. Target 10, which is “To cut in half, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation” (UNDP, 2006), is one of the most important objectives of this global project, since sustainable water resources management and development is indeed a key to achieving all of the MDGs (UN Millennium Project, 2004). Unfortunately, as of 2006, we are extremely behind on this essential target. Although sanitation coverage was provided to 1.2 billion people between 1990 and 2004, an additional 300 million people needed to have been served during this time for us to be on track for the 2015 goal (UN, 2006). In fact, half of the developing world still lacks basic sanitation. If we continue with “business as usual”, we will leave millions of people without even this most basic right.

Benefits of Sanitation

As stated previously, the absence of sanitation has had devastating implications on health. 1.8 million children die annually from diarrheal diseases, which are the second leading cause of death for children across the world (Refer to Figure 2). Sanitation has such a profound impact on health that safe disposal of children’s feces would reduce diarrhea morbidity by 40% (UNDP, 2006). Improving water supply would reduce diarrhea morbidity by 21%, while additional improvements to drinking water quality, such as point-of-use disinfection and safe storage also reduces it by 45%. Even washing hands at critical times reduces morbidity from diarrheal diseases by 35% (UNDP, 2006).

The impact of sanitation is not restricted to health, however. It has been shown to be extremely costeffective, reducing health costs and increasing economic growth, all of which are necessary in alleviating poverty (WHO/UNICEF JMP, 2006). A cost-benefit analysis conducted in 2004 by the World Health Organization (WHO) found that for every US$1 invested in Target 10 of the MDGs, between US$3 and US$34 would be returned depending on the region (World Health Organization (WHO), 2004). In fact, with an additional investment of around US$11.3 billion per year, there will be an annual economic benefit of US$84 billion. Achieving both parts of Target 10, including halving the proportion of people without sustainable access to improved water supply and improved sanitation, would amount to $7.3 billion annual savings in health costs, US$750 million annual savings in adult employment days gained, and US$64 billion in annual time savings (WHO, 2004).

Water Shortages

Water shortages are occurring globally and will continue to occur for many reasons. Recent reports have cited global warming as responsible for possible water shortages in Asia by 2050 that can affect a billion people (Associated Press, 2007). The World Water Development Report in 2006 noted that although the world has enough freshwater, it is unevenly distributed (UNESCO, 2006). This is due to mismanagement, corruption, and lack of appropriate institutions in addition to limited resources and environmental changes. Regardless of the causes, 1.1 billion people still do not have access to adequate drinking water (WHO/UNICEF JMP, 2006). This means that the flush toilets that are ubiquitous in the developed world are impossible to implement in these areas. Extraordinary amounts of potable water are used in these toilets, meaning that for the 35 kilograms of feces and 500 liters of urine that each person produces in one year, about 15,000 liters of wastewater is also produced (Sida, 2000). Thus, innovative technologies must be employed globally to deal with water shortages in sanitation and other areas, including irrigation and manufacturing.

Best Practices

Orangi Project

The Orangi Pilot Project in Karachi, Pakistan is an exemplary model of community mobilization. For the past 20 years, it has worked to bring sanitation to millions of slum dwellers and has achieved near-universal participation through a collective perception of benefits and an acceptance of joint responsibility (UNDP, 2006). A local NGO started working with communities on the sanitation problems of Orangi, a katchi abadi by focusing on its sewage ridden lanes. Through dialogue and education, residents formed groups to construct sewer channels and then cooperated to form neighborhood channels to collect waste from multiple lanes. These channels were first discharged into drains, but the city eventually agreed to finance trunk sewers and transport the waste away from the community. By training community workers for construction and maintenance, the Orangi Project was able to reduce costs by 80%. These efforts have reduced infant mortality rates from 130 deaths per 1,000 births in the 1980s to 37 deaths per 1,000 births in 2003 (UN Habitat, 2003).

Bangladesh: Total Sanitation

The total sanitation project in Bangladesh has also been very successful. It began with a Bangladeshi NGO in the late 1990s, but now entails more than 600 NGOs that work with district authorities (UNDP, 2006). First, local communities are engaged in discussing open defecation and the health problems related to it. Residents walk to defecation zones (the “walk of shame”) and calculate the amount of excreta (the “excreta calculation”) that the village produces and dumps in the environment. This increases momentum and demand for sanitation and sanitation-related business. Bangladesh is now internationally known for producing low-cost latrines (UNDP, 2006). It is the model of a community-led total sanitization effort, which has now facilitated the elimination of open defecation in 400 villages and 15,000 families (Kar, 2003).

Sulabh International Social Service Organisation

This organization, founded in 1970 by Dr. Bindeshwar Pathak, works to promote “human rights, environmental sanitation, health and hygiene, non-conventional sources of energy, waste management and social reforms through education, training and awareness campaign” (http://www.sulabhinternational.org). Using “Sulabh Shauchalaya” technology that is appropriate for the culture and geographical area, while at the same time being affordable, the organization has been able to bring these facilities to 1.2 million urban and rural homes (Pathak, 2004) and 7,500 “pay and use” community toilets known as Sulabh Complexes that offer bath, laundry, and urinal facilities and generate biogas and biofertilizer (http://www.sulabhinternational.org).

Sulabh has maintained that programs that fulfill three key principles simultaneously can achieve long-term sustainability (Pathak, 2004). These critical principles are:

• Equity within the sanitation sector which means that all segments of society, rich and poor alike, have access to safe, appropriate sanitation systems adapted to their needs and means.
• Health promotion and protection from disease which means that systems are capable of protecting people from excreta related disease transmission.
• Protection of environment which means that future sanitation systems must neither pollute ecosystems nor deplete scarce resources.

Sulabh is notable in that it addresses the sanitation problems of the lowest castes in Indian society and using an entrepreneurial rather than a charity model. It enters into contracts with municipalities and public sector providers to construct toilet blocks with public funds, while local authorities provide land and finance the initial connections, but all recurrent costs are financed by user fees (UNDP, 2006). It has thus been recognized as a Global Urban Best Practice by the United Nations Center for Human Settlements at the Habitat II Conference in Istanbul in 1996.

2. The Stakeholders in Sanitation

Primary Stakeholders

The primary stakeholders involved in providing access to sanitation are the residents of rural and urban areas that currently lack such facilities. These residents can be identified as communities or as individuals. Rural communities are valuable in that they are more likely to be able to work together in order to achieve total sanitation coverage. Urban communities are less cohesive and more densely populated, which calls for a different approach, including forming or finding existing community groups.

Women in unserved areas should be given special attention since leadership roles in community management of sanitation and water supplies increase women’s social capital and bargaining power (UN Millennium Project, 2004). Women greatly benefit from improved water supplies and adequate sanitation. Since they are generally responsible, in most cultures, for water management and sanitation at the household level, they are often times expected to walk many hours to bring water back home (United Nations Department of Economic and Social Affairs (UN DESA), 2004). In addition, when improved sanitation is unavailable or located far from home, women have to either forego privacy in the day time or risk relieving themselves after dark, which poses its own dangers, including gastric disorders and violence (UN DESA, 2004). Menstruating girls often have to give up school for lack of privacy. Traditional sanitation programs have been known to exclude these women from the entire process of developing improved sanitation facilities. They must be involved at all stages in order to ensure that they maximally benefit from the facilities and because they are greatly responsible for influencing the hygiene behaviors of their children as well as the maintenance of facilities over time (UN DESA, 2004).

Schools are also very important stakeholders in the process of improving sanitation. Children are very responsive to hygiene behavior changes; they are not only likely to implement newly learned hygiene behaviors for the rest of their lives, they can also serve as change agents in influencing their families and communities. They greatly benefit from improved sanitation facilities within schools, which can limit the transmission of diseases and allow girls who have reached puberty to continue their education. Youth groups can also be used to instill improved hygiene practices.

Regardless of the gender or age of the primary stakeholders, they must be represented in the entire process in order to guarantee sustainable service delivery, usage, and maintenance.

Secondary Stakeholders

Different stages of the implementation of improved sanitation call for different secondary stakeholders. The identification stage has already been sufficiently completed on a global level. The UN Millennium Project Task Force on Water and Sanitation, along with the WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation have provided data and identified necessary key actions. This information is crucial in attaining global coverage.

Intergovernmental organizations and international non-governmental organizations (NGOs) are also necessary stakeholders in reaching Target 10 of the MDGs. The Water and Sanitation Program (WSP), an external partnership program of the World Bank, can serve as a promoter and should have a central role in the global effort for improving sanitation. The WSP has much international influence, and can work with governments at both local and national levels, with backing from the World Bank’s administrative and management processes (http://www.wsp.org).

WaterAid is an influential non-profit NGO that works at multiple levels to help achieve Target 10 of the MDGs. It works with communities, local partner organizations, governments, and international partners to both fund and facilitate increased access to improved sanitation and hygiene education while at the same time advocating for donor and government policy change. It is a crucial stakeholder in the process and must be used for its influence in the communities it serves, its knowledge and previous experience, and its international reputation.

Governments are important in that they can regulate sanitation infrastructure, limit or direct funding, and pass reforms. It is significant to note that governments should not be used to deliver solutions to their constituents but rather to facilitate community-based action (UN Millennium Project, 2004). Governments can sometimes act as latent stakeholders, so care must be taken to keep sanitation on the top of the list of priorities.

Women groups, such as Women in Europe for a Common Future (http://www.wecf.org) are very important in empowering women while working to alleviate poverty. WECF is a “network of organisations and individuals working for sustainable development, protection of human health and environment and poverty reduction…[with an international network consisting of] members and partners in Western and Eastern Europe, the Caucasus and Central Asia” (WECF, 2007).

Religious organizations can be useful in social mobilization and hygiene training. If they can be convinced of the priority that must be given to improved sanitation, they can wield much influence in their communities, since community members often look to religious leaders for advice and support.

Finance organizations, such as the African Water Facility or the World Water Council, should work with both the WSP and local communities to provide financing where local capacity and private resources are not available. Microcredit financing organizations should also be utilized to fund smaller projects.

Large corporations that are employers of many primary stakeholders, as well companies that wield political influence in the area should be involved in an integrated solution. The private sector’s knowledge, resources, and power can be utilized to exponentially increase access to improved sanitation.

Local entrepreneurs and traditional sanitation service providers should also be involved in the process. This allows the local economy to benefit from improved sanitation facilities in both construction and service delivery. Using locally manufactured materials and human resources is essential in ensuring sustainability in both implementation and monitoring.

There are several organizations that are essential stakeholders in implementing ecological sanitation. Waste Netherlands specializes in ecological sanitation in urban areas. It is an advisor to development projects in Africa, Asia, Latin America, and Eastern Europe, and carries out assignments with local partners, with the goal of strengthening local capacity (http://www.ecosan.nl/page/169). The SURCO Consortium, co-founded by Waste Netherlands with other local and international NGOs, uses a new waste management approach known as “Integrated Sustainable Waste Management” (ISWM) to deal with urban environmental development (http://www.acepesa.org/surco/english.html). The SanRes Programme in Sweden, funded by Sida, works to support ecological sanitation projects internationally, especially in rural areas. The Programme also works to arrange international conferences, as well as national and local workshops specifically for professionals in developing countries. These organizations, because of their vast knowledge and experience, are instrumental in implementing ecological sanitation facilities globally.

Integrated Solution: The Application of “Think Globally, Act Locally” to Sanitation

In order to tackle MDG Target 10, which is to halve the proportion of persons without access to sanitation by 2015, it is necessary to not only continue with the work we are already doing, but to use innovative approaches on a much larger scale.

Policy

Strong international and national policies are extremely important. Several tactics must be used simultaneously in order to overcome political resistance. This multi-pronged approach involves disseminating information regarding the socioeconomic benefits of improving sanitation to politicians, public information campaigns, public meetings to mobilize broad support, broad policy and institutional reform to help reorient planning towards communities that lack a strong political voice, “ring-fencing” to make financial and managerial processes more transparent, and legislation to improve incentives for good performance (UN Millennium Project, 2004). It is also important to look for historic opportunities to show short-term benefits to policymakers, using these as “confidence building” measures to build social capital for long-term reforms.

Leadership

More tangibly, one international group must focus all efforts in connecting local groups globally with intergovernmental organizations, such as the United Nations or WHO, international and national financing organizations, monitoring agencies, and governments. The Water and Sanitation Program (WSP) of the World Bank is well-prepared to do this. This organization should try to minimize the amount of bureaucracy and increase the turnaround time of applications from NGOs that are working with communities to access funds and make reports. The WSP should work with the Joint Monitoring Programme for Water Supply and Sanitation for production of continual updates on performance and evaluation of programs as well as the status of indicators in reaching the MDG target for water and sanitation. The WSP should also work with governments to push sanitation to the top of the agenda, so that bottom-up approaches will meet with capacity-building reforms from the top down that facilitate the process for target populations. However, it should be noted that reforms and investments should occur simultaneously in order to assure the efficiency and timeliness of the effort (UN Millennium Project, 2004).

Community-based Approaches

Community-based sanitation programs have been shown to be extremely successful in dealing with sanitation problems. In following the example of Bangladesh, it is necessary to begin by building momentum in the community by facilitating awareness of sanitation-related health and economic issues (that are both personal and public). Providing villages with incentives and awards for improving sanitation has also proven successful in South Asia (WSP, 2007). These incentives for “open defecation-free” (ODF) villages have been backed by robust monitoring, and the programs include social mobilization, awareness raising, and market development (WSP, 2007).

Social Marketing

Social marketing is necessary to disperse hygiene education throughout communities. Hygiene education can take many forms, and, indeed, it is necessary for it to take many forms. This includes education in schools (from the youngest to oldest students), dramas performed in public areas, dissemination of information through religious organizations, community meetings, and trained community workers going door-to-door to visit households, etc.

The basic information that must be related to the community, according to the UN Millennium Project (2004) includes:

• Most (preferably all) of the people use the new latrines.
• Children’s feces are properly disposed of.
• Latrines are properly maintained and cleaned.
• Hands are washed by everyone at critical times.
• Water sources are protected, or water is purified before consumption.
• Food is prepared properly: cooked thoroughly, re-heated thoroughly, stored in a way that does not allow it to be contaminated by insects or small animals, and cleaned thoroughly before being eaten raw.

Appropriate Technology

Once momentum has been built within the community, it is necessary to discuss various technologies that can be implemented to ensure sustainable basic sanitation. It is vital at this stage, as well as all other stages, to have the community fully involved with the decision-making process. If the community is not involved, there is likely to be many problems with technology appropriateness and management. The technologies should not only be cost-effective but also take into account the environment of the sanitation facilities and the culture of the community.

Ecological Sanitation

One such technology is ecological sanitation (“EcoSan”), which aims to deal with sanitation issues in areas that lack the resources, such as water, money, and institutional capacity, that are necessary for conventional sanitation technologies (CSIR, 2006). It also provides solutions for developed countries that are willing to explore new tactics in fighting the high environmental and economic costs of conventional sanitation strategies. EcoSan emphasizes theimportance of environmental sustainability and is structured on recycling principles. It is a closed-loop system that treats human excreta as a resource to be used for agricultural purposes.

The key features of EcoSan are:

• Prevention of pollution and disease caused by human excreta;
• Treatment of human excreta as a resource rather than as a waste product; and
• Recovery and recycling of the nutrients (CSIR, 2006).

These principles have been used in China for thousands of years, but have more recently been regarded as a mere “second-rate solution for poor people” (CSIR, 2006). Human excreta serve as highly nutritious fertilizer once they are no longer contaminated with parasites. Both dehydrated feces and urine can take the place of commercial fertilizers, protecting water sources from fecal contamination and soil from degradation (CSIR, 2006). Although decentralized systems, waste separation and minimization of dilution are the main features of EcoSan, mixing and centralized systems, like wastewater irrigation, are also possible (http://www.gtz.de). This flexibility makes ecological sanitation highly functional across many different regions with varying needs. The Water and Sanitation Program has reported success with three different types of EcoSan systems in West Africa (refer to Table 1 for details).

In sharp contrast, conventional wastewater systems that utilize sewer networks often mix domestic and industrial wastewater; this prohibits agricultural use of water and sewage sludge because of contamination by heavy metals and other hazardous substances. In addition, the on-site sanitation systems employed in developing countries, such as pit latrines, VIP latrines, and cesspits, use unlined underground chambers that pose risks to groundwater (http://www.gtz.de). Refer to Figure 3 for a visualization of the differences in conventional sanitation and EcoSan.

The community should be informed of various Ecosan technologies and their economic and environmental benefits. If none of these solutions are appropriate for the specific population, more traditional solutions are possible, including simple pit latrines, ventilated improved pit latrines, and pour-flush latrines in rural areas as well as sewerage systems for urban areas.

Biogas as Alternate Fuel

EcoSan also allows for the production of biogas, through the anaerobic digestion of manure, sewage sludge, municipal solid waste, or biodegradable waste into methane and carbon dioxide. Biogas powerplants in urban areas can be used to produce electricity, while micro-plants can provide households with in rural areas with methane gas for the kitchen fireplace. Biogas can also be used as vehicle fuel. Many European countries, especially Germany and those in Scandinavia, have embraced biogas due to the recent need for renewable energy
(http://www.alkane.co.uk/biogas.php). In fact, there is now a bus line in Bern, Switzerland that runs on biogas (http://www.sugre.info).

Microfinance

The involvement of the community during the construction of the facilities is again very important. Residents should fund the projects as much as possible. Microcredit options should be made available to them, and subsidies should be used as a last resort. Microcredit involves providing small loans to the poor without requiring collateral. Both households and small-scale private providers can benefit from microcredit (Saywell & Fonesca, 2006). Microfinance has been used in the past for the construction of household latrines, public toilets, and manual latrine-cleaning services (Saywell & Fonesca, 2006). If subsidies must be used, it is essential that they involve output-based aid. Output-based aid must ensure that service providers are not related to regulators or funding parties, and that competitive pressure and regulatory oversight are optimal (Brook & Petrie, n.d.).

Local Entrepreneurs

Microfinance can allow the local economy to be reenergized with entrepreneurial opportunities in a new sanitation sector. These include small manufacturing facilities for latrine parts, as seen in Bangladesh. Workers and materials from the local area should also be used, so as to ensure that the technology is appropriate and the costs are minimal.

Public-Private Partnerships

Public-private partnerships (PPPs) can be used when neither the residents of an unserved area nor the public sector is able to initiate construction of sanitation facilities. Transfer of ownership can be made back to the public sector once construction is complete.

Maintenance

Successful construction does not signify automatic and permanent access to improved sanitation. Sustained maintenance and service delivery are essential. Hygiene education cannot be stopped prematurely and must cover most of the population.

Gender Equity

It is also crucial to include women in the social mobilization of the community for increased access to sanitation. Women should be used as managers of facilities and trained to educate other women, especially since they are in charge of the education of their children and most of the sanitation and water problems of their households. Women have also been the focus of microfinance programs because they are more likely to use loans to benefit the entire family. The involvement and full representation of women in the process of improving sanitation will most likely lead to greater gender equity and female empowerment.

Coverage

Although the worse-hit areas are still in Africa and South Asia, there are still many rural areas throughout the world without improved sanitation, including Eastern Europe and even North America. It is important to address all affected areas when considering a global solution to sanitation and water supply.

3. Obstacles and Challenges

There are many obstacles and challenges to achieving global coverage in improved sanitation. Primarily, a lack of political will can completely undermine the entire process. This can occur for several reasons. For example, investments in other sectors can appear to have higher returns than those in sanitation. In countries such as South Africa or Morocco, many advances have been made in increasing access to water in cities and rural areas, but sanitation has not made much progress (UNDP, 2006). It can also occur when advocates such as technical specialists or civil society actors cannot make a compelling case to decision-makers for the socioeconomic benefits of access to sanitation (UN Millennium Project, 2004). Another challenge is changing status quo arrangements that are beneficial to politically influential groups but harmful to increased access.

Often, families give higher priority to water because lack of clean water is more immediately life-threatening, and the benefits of having a sustainable water supply can be seen in individual households, whereas the benefits of sanitation become much more apparent when entire communities have improved facilities (UNDP, 2006).

Problems can also arise when sanitation experts insist that Western sanitation technology, including sewerage and septic tanks, is the only way to improve sanitation (Pathak, 2004). Although optimal, these techniques are incapable of sustaining sanitation in most of the developing countries in Asia, Africa, and Latin America that are characterized by low income status, technology constraints, and limitations in infrastructure (Pathak, 2004). Sometimes, technologies that are offered to communities are mismatched to the communities’ specific needs and capabilities. This can occur when products are designed by engineers without community participation and then delivered by government agencies that are not held accountable (UNDP, 2006).

Timing can be a barrier in the improvement of sanitation as well. Advocates must find ways to make progress within one political cycle, even after decades of neglect. This is difficult when donor cycles and national planning cycles generally operate in two to three years but sanitation programs require planning frames of ten to fifteen years (UNDP, 2006). Advocates must also find ways to show politicians that reforms are necessary even if they do not yield visible results during their office terms (UN Millennium Project, 2004).

Institutional constraints, such as chronic dysfunction of existing arrangements or a complete lack of appropriate institutions are also important barriers that must be addressed. Financial constrains are another obvious barrier. Even simple pit latrines can cost between US$20 and US$45, which can cost months of income for the millions of people who live on less than US$2 a day. Microcredit can be helpful in these situations.

Stigma is often a problem when addressing sanitation issues because of the cultural and personal taboos against talking about human excreta and its disposal. Because of these taboos, parallels have been drawn between the lack of discussion and progress in sanitation and the treatment of HIV/AIDS (UNDP, 2006). There is a difference, however, in that with HIV/AIDS all members of the population are at risk, regardless of socioeconomic status, gender, or race; with access to sanitation, the problem is entirely among the poor (UNDP, 2006). By increasing awareness of the problem internationally, with events like World Water Day on March 22, more pressure can be put on the governments of countries to not only discuss sanitation, but make it a high-priority objective.

5. Summary

6. Conclusions

Overall, the best way to approach the problem of a global lack of basic sanitation is to adopt a global vision but act locally to produce real and sustainable results. This will take a lot of man-power, but if managed efficiently, transparently, and appropriately, it is attainable, provided we connect all stakeholders and make special efforts to protect vulnerable people, including women and the very poor, both of whom lack a political voice in many areas. We are behind on meeting the target of halving the proportion of persons without sanitation by 2015, but with momentum and innovation, it is possible to achieve this goal.

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