WATER AND SANITATION PROGRAM: STUDY 80347 Targeting the Urban Poor and Improving Services in Small Towns Poor-Inclusive Urban Sanitation: An Overview Peter Hawkins, Isabel Blackett, and Chris Heymans August 2013 The Water and Sanitation Program is a multi-donor partnership administered by the World Bank to support poor people in obtaining affordable, safe, and sustainable access to water and sanitation services. Acknowledgments Delivering poor-inclusive urban sanitation requires improved service delivery, rather than a focus on infrastructure. This is the core finding of a global review by WSP on challenges, trends, and approaches at the global, national and city levels to achieve viable poor-inclusive urban sanitation at scale. This paper highlights key observations and lessons from the original study report: “Delivering Sanitation to the Urban Poor: A Scoping Study� (2012; unpublished). This summary was prepared by senior urban water and sanitation specialists Isabel Blackett, Peter Hawkins, and Chris Heymans. The authors wish to thank: Jeremy Colin, who prepared the bulk of the research for the scoping study on which this document is largely based; peer reviewers and colleagues who provided inputs during the conceptualization and research for the report, especially Eddy Perez, Soma Ghosh Moulik, Martin Gambrill, Meike Van Ginnekin, Pete Kolsky, Bernardo Gomez, Josep Ravikumar, Yolande Coombes, Zael Sanz Uriarte, and Nelson Medina; and finally, WSP’s Global Program Manager Jaehyang So and the Regional Team Leaders: Glenn Pearce-Oroz, Almud Weitz, and Juan Costain for their robust guidance and support. This paper is conceived as a work in progress to encourage the exchange of ideas about development issues. For more information, please email the authors at wsp@worldbank.org or visit www.wsp.org. WSP is a multi-donor partnership created in 1978 and administered by the World Bank to support poor people in obtaining affordable, safe, and sustainable access to water and sanitation services. WSP’s donors include Australia, Austria, Canada, Denmark, Finland, France, the Bill & Melinda Gates Foundation, Ireland, Luxembourg, Netherlands, Norway, Sweden, Switzerland, United Kingdom, United States, and the World Bank. WSP reports are published to communicate the results of WSP’s work to the development community. Some sources cited may be informal documents that are not readily available. The findings, interpretations, and conclusions expressed herein are entirely those of the author and should not be attributed to the World Bank or its affiliated organizations, or to members of the Board of Executive Directors of the World Bank or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The material in this publication is copyrighted. Requests for permission to reproduce portions of it should be sent to wsp@worldbank.org. WSP encourages the dissemination of its work and will normally grant permission promptly. For more information, please visit www.wsp.org. © 2013 International Bank for Reconstruction and Development/The World Bank 1818 H Street NW Washington, DC 20433 Telephone: 202-473-1000 Internet: www.worldbank.org Table of Contents I. Scale of the Challenge .............................................................. 1 II. Dimensions of the Urban Sanitation Challenge: What We Know .................................................................................... 3 Population Density: A Defining Challenge for Urban Sanitation ................................................................... 3 Urban Sanitation in Practice....................................................... 3 Issues in the Enabling Environment ........................................... 5 Technical Challenges in the Delivery of Sanitation Services ...... 8 III. The Way Forward..................................................................... 12 Focus on Poor-Inclusive Service Delivery ................................ 12 Service Delivery Framework ..................................................... 12 Meeting the Technical Challenges for Serving Poor Communities .................................................................... 13 Drivers of Change ..................................................................... 14 IV. Concluding Remarks ............................................................... 16 References ............................................................................... 17 Figures 1: Urban Sanitation Coverage in Developing Regions ......................................................... 1 2: South Asia Urban Sanitation Coverage by Wealth Quintiles on Population Weighted Averages from Three Countries, 1995–2008 ....................................... 2 3: Correlation of Stunting with Open Defecation in Urban and Rural Areas ..................................................... 3 4: The Sanitation Service Chain............................................... 3 5: A Service Delivery Framework for Urban Sanitation ................................................................ 13 6: Drivers of Change and Accountability Mechanisms....................................................................... 15 www.wsp.org iii I. Scale of the Challenge Most of the world’s population now lives in urban areas, aggravated by high-density living, inadequate septage and and in developing regions the proportion living in cities solid waste management, and poor drainage. Although the and towns has risen from 35 percent in 1990 to 45 percent number of urban dwellers practicing open defecation has in 2010—from 1.4 billion to 2.5 billion people (Jacobsen fallen overall from 145 million to 101 million, it has risen et al. 2012). A 2008 World Bank analysis estimated that from 14 million to 25 million in Sub-Saharan Africa, and a third of people living on less than US$2 per day reside has fallen only slightly in Southeast Asia, from 19 million in urban areas, and UN-Habitat estimates that just under to 17 million people (UN-Habitat 2010). Both access to 40 percent of urban dwellers live in slums, a number that and the quality of sanitation will need to increase at a much is growing by more than 20 million per year (Baker 2008). faster pace and on a larger scale than in the past to meet this As Figure  1 shows, sanitary conditions in these slums are continuously growing demand. generally poor. Recent African Ministers’ Council on Water (AMCOW)1 Country Status Overviews (CSOs) estimated In many developing countries, there are major disparities that 150 to 180 million urban dwellers in Africa, mostly in access to sanitation in urban areas between rich and poor. living in rapidly growing informal settlements, lack sanita- Global monitoring systems have not yet captured the full tion. Most do not own their land and/or houses, and lack scale of the sanitation challenge in urban areas,2 but disaggre- incentives to invest in sanitation (WSP 2009). gated data show differences in access to sanitation between the richest and poorest quintiles to be more than 80 per- Urban sanitation coverage in rapidly urbanizing developing centage points in some countries (AMCOW 2011). In Sub- regions has increased only slightly over the last 20 years, and Saharan Africa, the lowest wealth quintile had only the number of people without access to improved sanita- 42 percent access to improved sanitation, compared to 91 tion has grown 35 percent, to 684 million people. Although percent for the richest quintile between 2004 and 2009 access to toilets is generally higher in urban than in rural (JMP 2012). Figure 2 shows even greater inequity in areas, sanitary conditions for poor people in urban areas are South Asia. FIGURE 1: URBAN SANITATION COVERAGE IN DEVELOPING REGIONS 3.0 Unimproved Open Defecation 4% Open Defecation 100% 2.5 10% 6% Population (bn) Unimproved 12% Population (%) 80% Shared 17% 2.0 Shared 13% 1.5 60% 1.0 40% 65% Improved 73% Improved 0.5 20% 0.0 0% 1990 2000 2010 1990 2000 2010 Source: JMP (2012) 1 AMCOW is a multilateral forum of Ministers of Water in the African Region, formed in 2002 to promote cooperation, social, and economic development and poverty eradication among member states. It has also supported the monitoring of water and sanitation data and policy dialogue, including working with the World Bank’s Water and Sanitation Program (WSP) on Country Status Overviews (CSOs) see AMCOW 2010 and AMCOW 2011. 2 Indicators such as the percentage of urban liquid wastes collected and treated are not recorded by the Joint Monitoring Programme (JMP) or any other global monitoring system. www.wsp.org 1 Poor-Inclusive Urban Sanitation Scale of the Challenge FIGURE 2: SOUTH ASIA URBAN SANITATION COVERAGE BY These disparities highlight a pressing need to address the WEALTH QUINTILES ON POPULATION WEIGHTED AVERAGES urban sanitation challenge comprehensively, with empha- FROM THREE COUNTRIES, 1995–2008 sis on including slum dwellers and poor communities that Poorest 2nd 3rd 4th Richest 2 have typically been neglected. Without concerted interven- 6 tion, the prospects of cholera, diarrhea, and worm infec- 4 1 18 tions will increase, jeopardizing education, productivity, and the quality of life for all urban dwellers.3 51 6 56 74 77 Coverage (%) 86 87 94 4 93 94 8 76 4 45 8 36 5 7 18 19 4 8 2 7 1995 2008 1995 2008 1995 2008 1995 2008 1995 2008 IMPROVED AND SHARED UNIMPROVED OPEN DEFECATION Source: JMP (2012) 3 Since 2008, WSP studies of the Economic Impacts of Sanitation in East Asia, South Asia, Africa and Latin America, and the Caribbean have shown the economic impacts of inadequate sanitation on productivity and equity generally, and on public health budgets. 2 Targeting the Urban Poor and Improving Services in Small Towns II. Dimensions of the Urban Sanitation Challenge: What We Know Population Density: A Defining Challenge for FIGURE 3: CORRELATION OF STUNTING WITH OPEN Urban Sanitation DEFECATION IN URBAN AND RURAL AREAS The defining characteristic of the urban environment from 3 the sanitation perspective is population density, which Effect on child height of 2.5 has two major consequences. First, it exposes individuals eliminating open 2 defecation to pollution created by others. For example, Figure 3, de- Under 3 rived from Demographic and Health Survey (DHS) data 1.5 years old in 130 countries (Spears 2013), shows that poor sanitation 1 Under 5 is more strongly correlated with stunting in urban than in years old 0.5 rural areas. This effect is virtually independent of income and related variables, so all residents are at risk from poor 0 Urban Rural urban sanitation, not just the poorly served low-income communities. To be effective, therefore, urban sanitation must be developed, financed, managed, and maintained must be poor-inclusive and implemented within a citywide sustainably as part of the service delivery chain, rather than framework. as stand-alone items of infrastructure. The second major consequence of high population density Urban Sanitation in Practice is that in the smaller spaces occupied by poor families there In reality, urban sanitation frequently falls far short of these may not be sufficient space to cover and safely abandon a requirements. Deficiencies may occur in the diverse links full latrine pit and construct a new one elsewhere, as can be of the sanitation service chain or through failure to serve done in lower density areas. This creates a need for a sanita- certain subgroups of the urban community. tion service chain in urban areas to hygienically remove and transport the fecal material and then make it harmless (see Many towns and cities in developing countries have a mix- Figure 4). ture of on- and off-site sanitation facilities and services, some provided by householders, some by private develop- The removal and transport steps are typically achieved in ers, and some by the municipality or utility (Evans et  al. one of two ways. Sewerage washes the fecal matter through 2006). Established low-income settlements rarely lack a pipe system using water and, frequently, pumping sta- sanitation facilities completely. As the following discussion tions. Alternatively, fecal sludge is accumulated on-site in a shows, however, several factors may contribute to the poor pit or septic tank, emptied periodically, and taken by road sanitary conditions. These include: to treatment. Either way, the absence or weakness of any link in the sanitation service chain will cause fecal pollution • poorly constructed or maintained on-site sanitation and negatively impact public health. facilities • inadequate water supply Although some of these sanitation services require infra- • toilets discharging into poorly functioning open structure such as latrines, sewers, or treatment plants, all drains blocked with uncollected solid waste FIGURE 4: THE SANITATION SERVICE CHAIN Containment Removal Transport Treatment Reuse/ Disposal www.wsp.org 3 Poor-Inclusive Urban Sanitation Dimensions of the Urban Sanitation Challenge: What We Know • malfunctioning and abandoned communal toilet spaces in many cities requires that dedicated pro-poor ini- facilities tiatives be undertaken in the context of a citywide sanita- • inadequate services for managing the fecal sludge tion services framework. from on-site facilities, etc. Inadequate Services In densely settled slums, the scramble for living space means Evidence on the functionality of the full sanitation service that houses are sometimes built directly over open drains, chain is scant, as global monitoring data does not capture exacerbating drainage and flooding problems. Improving many of the operations and maintenance challenges. Moni- sanitation in such environments can be even harder than toring reports such as the JMP and other analyses do, how- introducing new infrastructure in communities where there ever, acknowledge problems such as infrastructure falling into is a complete lack of infrastructure and services. It may take disrepair due to ineffective institutions, poor operation and decades to achieve safe management and disposal of excreta maintenance, and inadequate management, causing prob- and wastewater citywide, supported by consumer aware- lems such as broken and flooded pumping stations, leaking ness, sustainable financing, and effective decision-making sewer pipes, and nonfunctional wastewater treatment plants and service delivery systems. (Schmoll et al. 2006, JMP 2012). Country data underscore this. For example, in India, nearly 39 percent of sewage treat- Inequitable Coverage ment plants and pumping stations did not conform to op- In developing countries, parts of a city—usually commer- eration and maintenance standards in 2012 (GOI 2012). cial and high-income residential areas—are often served by a public sewerage system and septic tanks, while low- Fecal sludge and liquid effluents from on-site systems are income areas are served by different types and qualities of often poorly managed. WSP field teams report that a large latrine. Septic tanks and some latrines may be emptied by proportion of the fecal waste collected is buried in back- a mixture of public and privately operated vacuum tankers, yards or dumped on waste land or in natural or manmade while other latrines are either too inaccessible or too poorly drainage channels. Similarly, SANDEC4 found that constructed to allow this, and are emptied by various unhy- gienic manual methods. While urban on-site sanitation programs have been experiencing a major thrust over the last 10–15 years, In Dar Es Salaam, Tanzania, for example, the “supply chain the management of fecal sludge accumulating in for sanitation is reaching the richer, sewer-based wards these installations has largely remained the stepchild within the city, but failing to meet the excreta disposal needs of urban sanitation. As a consequence, the “fecal of the 2 million population dependent on on-site sanita- film� covering many urban areas of developing coun- tion.� In addition, policy and regulation is fragmented at tries persists, with . . . health and environmental haz- the national level, “failing to have any impact other than ards. . . . (Koné et al. 2007) with city based sewerage systems� (IWA 2008). Similarly, in Santa Cruz, Bolivia, sewerage is available to 36 percent of Flooding residents, almost exclusively in the central, fully urbanized Sewers, septic tanks, and latrine pits are located under- area, while peri-urban residents use on-site systems serviced ground and cannot function to protect public health if by an unregulated tanker market (WSP 2010). the area where they are located is flooded. The fecal mate- rial they contain will mix with the floodwaters and cause Thus, ensuring inclusivity usually requires the provision of widespread contamination. Although this problem tends to specifically designed services for poor communities, in ad- affect low-income communities more than others because dition to conventional sewerage services in more privileged they are often located on marginal low-lying land unsuit- areas. However, the complex mix of formal and informal able for formal urban development, the location of many 4 SANDEC (Sanitation in Developing Countries) is a department at the Swiss Federal Institute of Aquatic Science and Technology, EAWAG 4 Targeting the Urban Poor and Improving Services in Small Towns Poor-Inclusive Urban Sanitation Dimensions of the Urban Sanitation Challenge: What We Know users, and on the functionality of sanitation service delivery systems at local and city levels. However, translating such frameworks and tools into major service improvements, especially for the poor, is a significant challenge. In many developing countries, enabling environ- ments are weak, characterized by a lack of effective policy and regulation at the city level, inadequate capacity for sani- tation planning and stakeholder consultation, and insuffi- cient harmonization with established municipal capacities, systems, and budgeting processes. Effectively implementing these frameworks depends on the political drivers for poli- cymaking, resource allocation, and operational decision- Solid waste management is essential if drainage is to function making; and technical focus of the frameworks may lead to these factors being overlooked. In particular, poor com- munities often lack political influence to affect municipal decisions, so sanitary conditions in these communities may cities in the developing world in coastal or riverine areas not be political priorities for decision-makers. means that even more privileged areas may be affected. National policies have tended to place more emphasis on The problem is amplified by inadequate land use planning water than on urban sanitation, and as the next section and control in unplanned slum communities, which often (Finance) shows, this has been reflected in the relative al- have the most severe sanitation problems, and inadequate location of resources to the water and sanitation subsectors. drainage systems, often choked with uncollected solid waste However, this is beginning to change. Recent examples of (Jha et al. 2012). Adequate drainage and solid waste man- programs to establish a specific enabling environment for agement is therefore an essential complement to excreta urban sanitation include the Indonesia Sanitation Sector management services. Development Program (ISSDP) and the National Urban Sanitation Policy (NUSP) of India (Colin 2011, GOI Issues in the Enabling Environment 2012), although little on this scale has occurred elsewhere. Policy Frameworks, Norms, and Standards One notable outcome of both initiatives is the recognition The need to establish an enabling environment for progress of a shortfall, and the allocation of increased financial re- in urban sanitation is widely recognized, but there is little sources to urban sanitation, including for the poor.5 consensus on what this means in specific contexts, and how to make such an environment effective. Finally, national standards, local by-laws, and the environ- mental safeguards of international donors are often quite At a global level, conceptual frameworks and approaches for exacting. It may not always be possible to comply with the planning and design of poor-inclusive urban sanitation them fully, especially when making phased improvements improvements include the Strategic Sanitation Approach, as finances allow, or working in densely populated infor- developed in Ghana in the 1990s, IWA’s Sanitation 21, and mal settlements with irregular layouts. In some cities, for SANDEC’s Community-Led Urban Environmental Sani- example, pit latrines are illegal, although there may be tation. Generally, these frameworks encourage a holistic, no other realistic alternative. A degree of flexibility, real- poor-inclusive view of urban sanitation that goes beyond ism and phasing in the application of standards is there- infrastructure, placing greater emphasis on the needs of fore important, and government agencies unwilling to 5 Indonesia increased the central and local government allocation to sanitation development to more than US$400 million in 2012, representing a total annual increase of almost 900 percent since 2006. www.wsp.org 5 Poor-Inclusive Urban Sanitation Dimensions of the Urban Sanitation Challenge: What We Know Kolsky 2008). So far, few countries have put in place sector financing strategies for urban sanitation and some govern- ments are reluctant to allocate funds because improvements (often assuming sewerage as the norm) are perceived as capital intensive, rarely generate significant revenue, and do not always deliver the intended benefits. The AMCOW CSOs for Africa show—on the basis of countries’ own estimates—the impact of this lag in funding for urban sanitation on capital investment requirements to meet the Millennium Development Goals (MDGs). Sig- nificantly, of the estimated US$4.2 billion annual capital expenditure needed for urban sanitation, only US$0.8 bil- lion was expected to materialize. In contrast, an estimated US$2.6 billion of an annual investment requirement of US$4.3 billion for urban water supply was expected to be raised. In 2010, the CSOs estimated that more than US$15 billion is required annually to achieve the water and sanitation sector targets of the 32 countries analyzed. At the aggregate level, a finance gap of at least US$6 billion per year must be closed to meet the targets, and the CSOs cau- tioned that poor targeting between countries and subsec- tors, and weak service delivery mechanisms, could increase the financing gap to at least US$7.2 billion per year. These aggregate investment figures conceal significant differences at the country and subsector level, but they provide some insight into the relative lag of urban sanitation development (AMCOW 2011). Solid waste choking a canal in Semarang, Central Java, Indonesia. The CSOs also point to weak service delivery mechanisms Source: Kathy Eales and poor targeting, emphasizing that the challenge is not only to increase the level of funding available to the sector, but also to ensure that funds are used more effectively. The CSO summary report quoted above (AMCOW 2011) compromise can prevent the realization of significant incre- shows that internally sourced public sector capital fund- mental improvements. ing for urban sanitation in 32 countries in Sub-Saharan Africa meets less than 15 percent of overall requirements, Finance making donor funding a key issue. However, efforts to Presently, when large investments are made in the water put sector transformation on a sustainable path, at a time and sanitation sector, water supply usually receives most when African governments are also calling for greater ju- of the funds. In 2008, for example, of the World Bank’s risdiction, must consider how national urban sanitation US$10.7 billion investment in water and sanitation, 60 per- programs and government frameworks could better sup- cent went to water supply, 29 percent to sewerage and only port cost-effective, poor-inclusive sanitation planning and 11  percent to other forms of sanitation (Rautanen and investment. 6 Targeting the Urban Poor and Improving Services in Small Towns Poor-Inclusive Urban Sanitation Dimensions of the Urban Sanitation Challenge: What We Know Inadequate drainage in a peri-urban neighborhood of Mombasa, Kenya. Source: Chris Heymans Yet, there have been some notable improvements in capital The poorest users may require subsidies to gain access to ad- financing at the city level. The use of sanitation surcharges equate sanitation, but ensuring that subsidies actually reach to fund on-site sanitation investments under the World poor people is a challenge. The World Bank-funded Dakar Bank-supported Ouagadougou Strategic Sanitation Plan Peri-urban On-site Sanitation Program (PAQPUD) in (PSAO) is a rare case of a utility raising enough revenue to Senegal used geographical targeting, working only in peri- cover not only its operational costs but also some invest- urban districts known to have a predominantly low-income ment in on-site sanitation (Verspyck and Guene 2012). In population, but the less poor households were still the main India, a project in Alandur showed that even relatively small beneficiaries (Verspyck and Guene 2012). Concentrating cities can access capital financing for citywide sanitation in- subsidies on the minimum level of service may help address vestments, provided that they have well-developed opera- this bias—as, for instance, in the improved latrines pro- tional and financial plans, and traction among the people gram in Mozambique during the 1980s and 1990s. There affected (Mathur 2002). is a trade-off to be made between the increased transaction www.wsp.org 7 Poor-Inclusive Urban Sanitation Dimensions of the Urban Sanitation Challenge: What We Know costs of better targeting and the cost of subsidizing those this regard. The Indian NGO SPARC, for example, played who do not need such assistance. As discussed in the next a pivotal role as mediator between the municipal corpora- section, it is important to strike the right balance between tion and slum communities in the Mumbai Slum Sanita- interventions that directly benefit the poor and those that tion Program, as did WaterAid’s partner NGOs in Trichy, create viable services for the city as a whole, within a real- India. Often, however, NGOs are more effective in facilitat- istic timeframe for bringing services to all urban dwellers. ing at-scale urban sanitation improvements when local gov- ernment and/or public service providers are also involved in Institutional Arrangements coordinating interventions at scale (WSP 2009). There are no ideal institutional arrangements for providing poor-inclusive urban sanitation services; what works best Small-scale, informal private sector participation in urban will be location specific. However, assigning responsibility on-site sanitation is well-established, particularly in latrine for urban sanitation—clearly and unambiguously—to a construction and pit emptying. Participation of the formal single lead agency has been a significant factor in the suc- private sector on a larger scale in sewerage is less common cess of some programs, including the World Bank-funded except where combined with water supply. Where they PAQPUD in Senegal and PSAO in Burkina Faso (Verspyck do exist, large private sector contracts for operating city and Guene 2012). In Indonesia’s growing urban sanita- water and sanitation services rarely include specific provi- tion program, the formal clarification of stakeholder roles, sions for expanding access to improved sanitation services backed by peer pressure, mutual accountability, and in- for the poor. creased sanitation budgets motivated institutional develop- ment and commitment (Colin 2011). Technical Challenges in the Delivery of Sanitation Services Some programs have established viable institutional ar- The foregoing discussion shows that enabling legal, po- rangements not through the creation of a single lead litical, or institutional conditions are important factors in agency, but by improving coordination between the vari- making service delivery work, but some technical chal- ous stakeholders or establishing new multistakeholder part- lenges remain. Although the first pit latrines and sewers nerships. A good example is the slum networking program were constructed thousands of years ago, there has been Parivartan in Ahmedabad, India. Similarly, a municipality/ surprisingly little development of sanitation technology nongovernmental organization (NGO)/community-based over time.6 Sewerage, managed by local government or a organization (CBO) partnership in the Mumbai Slum utility, has generally been restricted to richer communities, Sanitation Program (in which both WSP and World Bank while self-built on-site systems, often with poor fecal sludge operations participated) helped to overcome delays and management, have been the norm elsewhere. other administrative, technical, and financial hurdles, and to engage users effectively in planning and managing com- Sewerage for Poor Communities munity toilet blocks. Nevertheless, the coordinating role is The service delivery approach does not render large-scale in- important where implementation responsibility is shared, vestments in sewerage networks irrelevant. Such investments and there is a need for leadership (WSP 2009). remain an important part of an overall approach to urban sanitation, but should be viewed as a tool for service delivery, Selecting acceptable and affordable options for improving rather than as a solution in their own right. The risk is consid- sanitation in slums and other low-income neighborhoods ering sewerage as the only “proper� form of urban sanitation, where standard service delivery options may not be applica- which can lead municipal or government officials to choose ble usually requires directly engaging with households and this option even when it is neither technically nor financially small-scale local businesses. NGOs, working closely with viable. Perverse incentives around contracting may also re- CBOs in the target communities, can have a lot to offer in duce the motivation to develop more cost-effective solutions, 6 In 2011, the Bill & Melinda Gates Foundation launched Reinventing the Toilet, based on the observation that little had progressed in sanitation development since the late 1800s. 8 Targeting the Urban Poor and Improving Services in Small Towns Poor-Inclusive Urban Sanitation Dimensions of the Urban Sanitation Challenge: What We Know and risk adversity may militate against trying new options. However, on-site sanitation also has clear limitations. As population densities grow and domestic water consump- tion increases, managing ever larger volumes of wastewater becomes more difficult, and lack of space limits the use of pit latrines, particularly those that must be relocated when the pit fills. Finding more affordable and poor-inclusive options for making the best use of existing and future investments in sewerage is a priority, especially for high-density areas. The evolution of condominial sewerage in Brazil and some other parts of Latin America has been documented exten- sively, but has not been taken up more widely in other parts of the world. This appears to be due to a lack of enabling conditions such as technical capacity, financing mecha- nisms, and the limited regulatory environment in much of Africa and Asia. Another type of low-cost technology, settled sewerage, has been installed in Dakar and is currently being developed in Lusaka, and may offer a viable alternative for users wishing to upgrade to water-seal systems, which often end up discharging into street drains or sewers. These types of systems, and the decentralized wastewater collection and treatment systems (DEWATS) championed by the German NGO Borda, were conceived as commu- nity managed. Experience and recent studies have shown, however, that sewerage becomes more sustainable and cost-effective when the local public sector or utility accepts Despite the presence of a basic, though hygienic, communal co-management responsibility for monitoring facilities, en- toilets located a few meters away, users often value privacy suring repairs and maintenance, as well as ongoing techni- and convenience over downstream consequences. This la- cal support and sanitation promotion (Eales et al. 2012). trine in Palembang, Indonesia, looks quite nice; however, it discharges directly into the river. Community or Shared Toilets Source: Kathy Eales Much has been learned and documented in recent years about effective approaches to communal toilet facilities in low-income residential areas, some of which show prom- ising results. Challenges nevertheless remain, particularly Action project in Mukuru, Nairobi, that has been working with operation, maintenance, and financial viability. Other with the community and schools to ensure access to at least open questions include whether community toilets can, on one hygienic, usable toilet per four households, with on- their own, fully address the sanitation needs of slums and site handwashing facilities (Peal and Evans 2011). If space other low-income areas, and how convenience and safety allows but household toilets are not practicable or afford- can be secured, especially for women and girls. able, shared toilets reserved for the use of small, self-selected groups may be preferable to communal facilities, and the Much less has been written about shared toilets, although sense of ownership created may encourage users to keep the lessons have been documented, for example, in a Practical facilities clean. www.wsp.org 9 Poor-Inclusive Urban Sanitation Dimensions of the Urban Sanitation Challenge: What We Know Well-maintained communal toilets and septic tank system developed by Care International in Makassar, South Sulawesi, Indonesia. Source: Kathy Eales Integrated Slum Upgrading Programs However, there is surprisingly little evidence of sanitation Slum upgrading can potentially improve sanitation (and other) improvements at scale under slum upgrading programs. services for the urban poor on a large scale. Some programs set out to address the needs of slums comprehensively by removing Fecal Sludge Management (FSM) the political and legal barriers that leave slums outside the nor- After many years of neglect, governments, development mal framework of public service provision and city governance, agencies, and research organizations are giving this subject and increasingly (but by no means universally) national gov- increased attention. The increasing use of on-site systems to ernments and municipalities are explicitly or tacitly recognizing improve sanitation access for poor people makes FSM in- a certain level of land use rights in unplanned settlements. A creasingly hard to ignore. There has, however, been no break- WSP global toolkit on services to the urban poor found that through yet in establishing and scaling up FSM services for while legal reform is needed to enable the poor to gain secure urban populations in general, or for low-income areas in tenure, adequate housing, and services, innovative strategies to particular, where the problem is most acute.7 These efforts get around land tenure requirements can sometimes be found are necessary as most low-income households are likely to at the local level (WSP 2009). continue using on-site sanitation for the foreseeable future. 7 As part of the Reinventing the Toilet initiative, the Bill & Melinda Gates Foundation is looking at options to safely treat fecal waste on-site. A separate initiative is looking at radical options for local treatment and reuse, which would avoid long haulage distances. 10 Targeting the Urban Poor and Improving Services in Small Towns Poor-Inclusive Urban Sanitation Dimensions of the Urban Sanitation Challenge: What We Know Fecal sludge management in dense, unplanned neighborhoods is well suited to local micro-enterprises, such as this one, which uses a specially designed handpump and a motorized tricycle fitted with a small tank to provide desludging services in Dar Es Salaam, Tanzania. Source: Kathy Eales Emerging lessons include: solid waste entering the pits. These are gradually being developed in a number of places. • Large tankers may not meet access and traffic con- • Fecal sludge management can be improved by ad- ditions. Because many houses in unplanned areas have dressing the upstream link—the latrine itself. For limited road access, fecal sludge may be removed manu- example, in South Africa, pour-flush latrines have ally or by small maneuverable mechanical equipment, been introduced to minimize the ingress of solid and then transferred to a tanker vehicle suitable for road waste, which is the main factor creating a need for transport to the treatment plant. Given frequently poor manual rather than vacuum emptying. This also traffic conditions, larger cities should have several such underlines the need to consider solid waste manage- plants decentralized around the city to reduce haulage ment alongside excreta management. times, which are costly to operators. Depending on local • Removal of waste is an alternative to storage in conditions, transfer facilities (tanks) may be necessary, pits. Several initiatives are underway to develop con- although they may be quite simple. However, ensuring tainerized systems, where there is no pit needing to the regular emptying of transfer tanks may be a chal- be emptied. Instead, households use a container that lenge. Alternatively, some operators may prefer to use can be tightly covered and removed for disposal of a nonpressurized tanker to accept waste directly from the contents and cleansing at an off-site facility. Such primary emptying. systems can also fit easily into high-occupancy ac- • A range of emptying equipment is needed, from commodation, and because they involve virtually no buckets, to hand pumps, to trash pumps and vac- on-site or permanent investment, may be attractive uum systems, as well as rakes and hooks to deal with to slum landlords, or even tenants acting alone. www.wsp.org 11 III. The Way Forward Focus on Poor-Inclusive Service Delivery access them. They are suitable for provision by small The central recommendation arising from this review is businesses, but may also be provided by a utility that any effective response to the urban sanitation challenge company. should view it primarily in terms of improving service deliv- • Public services include fecal sludge treatment, op- ery. The evidence presented here shows that investments in eration and maintenance of sewerage and drainage urban sanitation infrastructure can be more effective if they systems, and solid waste management. They are are planned and managed as part of a service delivery chain, delivered downstream of users, producing mainly supported by enabling policies. This view of sanitation as a public goods, and as such it may not be possible to service, rather than as infrastructure means that: finance them entirely by direct user fees. They are usually delivered by local authorities or utility com- • Cities need effective urban sanitation systems, con- panies, but may also be subcontracted to the private sisting of sustainable processes and service providers sector. Operational costs may be recoverable through that will ensure the safe capture, storage, transport, and user fees, levies, or local taxes, but rarely can the full treatment of excreta in a managed and coordinated capital costs be directly recovered from users. way—not just investments in hardware. • Infrastructure development may require recourse to • The focus should be on outcomes rather than inputs, higher-level (national, state, regional or provincial) so that effective and safe management of excreta, authorities or external financing, because capital rather than the construction of toilets or sewers per costs are often not recoverable. se is the objective of the service delivery chain. Enabling Environment The analysis makes a case for services being poor-inclusive, To be effective, these services require an enabling environ- but also citywide, because in the crowded urban environ- ment that provides policy guidance, rules, and incentives ment, inadequately managed excreta from any household to motivate stakeholders to prioritize sanitation, ensure can potentially contaminate any other, as well as the envi- accountability, and promote the development of adequate ronment and water resources. capacity to deliver the necessary services sustainably and af- fordably, at the three levels identified in the analysis: Service Delivery Framework The foregoing analysis shows that sanitation services fail • National enabling environment: National (or federal primarily because of an inadequate service delivery chain state) governments should ensure that local authori- rather than a lack of infrastructure. The services in this ties and other responsible agencies deliver services chain are quite diverse, both in scale and in how they can that meet an acceptable standard; have the legal, effectively be provided. financial, and technical means to do so; and have monitoring mechanisms in place to track progress Service Categories and results. Based on the analysis, services can be classified into three • Local governance: Local authorities must take the groups: central role in ensuring adequate sanitation within their jurisdiction by planning, coordinating, and • Customer services typically include supply of mate- monitoring the activities of local stakeholders that rials, construction of sanitation facilities (toilets), are needed to deliver effective sanitation. If citizens management of public toilets, and desludging. or the private sector are to undertake these activi- They are often commercially viable, because they ties, the local authority will need to assume a pro- have a large private good component, although the motion and enforcement role as well. Utilities may poorest households may need targeted subsidies to be responsible for delivering the service, but mostly 12 Targeting the Urban Poor and Improving Services in Small Towns Poor-Inclusive Urban Sanitation The Way Forward under overall planning and coordination by the local Meeting the Technical Challenges authority. This is the key locus for accountability— for Serving Poor Communities upstream to national policymakers and downstream In addition to the need for including and coordinating the to citizens. many diverse stakeholders in urban sanitation, the analysis • Community consultation: To ensure that sanitation identified several technical issues that must be resolved to services reach all households, consultations are re- enable the delivery of appropriate services to poor commu- quired to balance community needs and willingness nities. These include developing to pay for services, and to agree on how communities will play their role in achieving effective sanitation. • at-scale fecal sludge management services for peri- urban, dense, and informal settlements, and criteria Figure 5 summarizes this service delivery framework. for deciding whether to service existing facilities or build new ones that are easier to service; FIGURE 5: A SERVICE DELIVERY FRAMEWORK FOR URBAN SANITATION National Enabling Environment Development Partners % Policy and prioritization of poor-inclusive sanitation % Advocacy % Planning, monitoring, and financing mechanisms % Knowledge % Regulation, legislation, and norms % Funding % Capacity development and technical expertise Local Governance % Planning and coordination % Legislation and enforcement % Monitoring and promotion % Support to local services development Community Consultation % Planning and setting service levels % Sanitation for rented accommodation Customer Public Infrastructure Services Services Development % Materials supply % Sludge treatment % Planning % Construction % Operation of sewerage % Design % Public toilets % Drainage management % Funding % Desludging % Solid waste management % Construction Sustained Poor-inclusive Urban Sanitation Services www.wsp.org 13 Poor-Inclusive Urban Sanitation The Way Forward • viable sanitation options for low-income tenants, such as IBNET, CSOs/Service Delivery Assessments whether individual, shared, or communal; on-site or (SDAs), and the Economics of Sanitation analysis; networked; • development of improved financing mechanisms, and • sanitation systems that work in challenging environ- targeting of subsidies to those unable to afford basic ments, such as houses built over rivers, lakes, or sanitation; coastal waters, on flood plains, on steep or rocky hill- • involvement of viable utilities, exploiting their finan- sides, and in other marginal areas typically occupied cial and technical citywide strength and broad con- by the urban poor; and sumer base; • maximizing the use of sewerage systems for poor commu- • improvement of policy, coupled with fiscal and regu- nities, where connections are often not considered or latory mechanisms, to provide incentives for the re- connection rates are low, limiting the potential im- sponsible authorities to act; pact of such major investments. There are also viable • pressure from development partners to include a range and cheaper alternatives to full conventional sew- of sustainable options that are appropriate for all erage (such as settled or condominial sewerage) as urban residents; well as decentralized systems, which could be more • pressure from civil society, and mechanisms to monitor widely adopted where they are cost-effective. and publicly name and shame those who fall behind; • involvement of users in decision-making on services Drivers of Change and service levels, and marketing of the idea and As discussed in Chapter 2, even a sound framework will not specific practices related to improved sanitation and of itself achieve poor-inclusive urban sanitation, but will hygiene; depend on effective drivers of change, such as: • building coalitions of interests and networks at all lev- els, from urban communities to the international • systematic understanding and use of political economy arena; and analysis, including clear accountability relationships, • partnerships that include users, landlords, civil when planning and implementing urban sanitation society, the private sector, local authorities and projects and programs; utility companies, regulatory agencies, state and na- • evidence-based advocacy, such as documenting and tional governments, donor agencies, and academic disseminating to policymakers the economic results institutions. of defective sanitation, international benchmarking Figure 6 illustrates how such drivers of change function. 14 Targeting the Urban Poor and Improving Services in Small Towns Poor-Inclusive Urban Sanitation The Way Forward FIGURE 6: DRIVERS OF CHANGE AND ACCOUNTABILITY MECHANISMS Services to Reach Poor Communities Effective fecal sludge management Sanitation for low-cost rental accommodation Sanitation systems for challenging environments Optimal usage of sewerage systems Service Delivery Framework National enabling environment Local governance Accountability Accountability Mechanisms Mechanisms Community engagement Effective service providers Drivers Political factors, knowledge Policy and fiscal incentives Sustainable financing Clarity and separation of roles www.wsp.org 15 IV. Concluding Remarks Although this overview of urban sanitation has shown that Massive investments in infrastructure to address urban the current situation is far from ideal, and that widespread sanitation in developing countries have often resulted in improvements will not occur at the present rate of prog- patchy and unreliable coverage, mostly for richer users, and ress, it also identifies initiatives that have potential for wider frequently leaving poorer communities to fend for them- replication. There is no “silver bullet� that will deliver im- selves. If urban sanitation is to deliver its full potential pub- proved sanitation to the developing world’s burgeoning cit- lic health, economic, social, and environmental benefits to ies, and some key technical issues remain to be resolved, but urban dwellers, it must reach all communities, as poor ex- much can be achieved by applying what is already known creta management in one area results in contamination that and proven in practice. can affect all citizens in densely populated urban spaces. Even where interventions prioritize and target poor neigh- Delivery of effective sanitation to all urban dwellers requires borhoods, they should be delivered within a citywide inclu- the whole chain of services, supported by a combination of sive approach. domestic, decentralized, or fully networked infrastructure. This, in turn, requires an appropriate enabling environ- By applying these lessons learned and addressing the tech- ment that can engage the many stakeholders involved, from nical issues yet to be resolved, significant progress can be communities to national governments, to drive change and made over the medium term, in consonance with the post- secure sustainable financing for services provided through 2015 agenda of sanitation services for all. both the market and the public sector, reinforced by clearly defined accountability mechanisms. 16 Targeting the Urban Poor and Improving Services in Small Towns Poor-Inclusive Urban Sanitation References References More than 200 documents were consulted in preparation International Water Association. 2008 (updated 2010). of the global review. Those mentioned below are only those 10 Things You Should Know about Sanitation, Sanita- related to specific examples and data referred to in the text tion 21. London: World Health Organization. of this overview. www.unwater.org/wwd08/docs/10Things.pdf. M. Jacobsen, M. Webster, and K. Vairavamoorthy. 2012. African Ministers Council on Water (AMCOW). The Future of Water in African Cities: Why Waste Water? 2010. AMCOW Country Status Overviews. Washington, DC: The World Bank. Washington, DC: The World Bank/Water and A. K. Jha, R. Bloch, and J. Lamond. 2012. Cities and Sanitation Program. http://www.wsp.org/content/ Flooding. A Guide to Integrated Urban. Flood Risk pathways-progress-status-water-and-sanitation-africa Management for the 21st Century. Washington, DC: African Ministers Council on Water (AMCOW). 2011. The World Bank. AMCOW Country Status Overviews—Regional Joint Monitoring Programme (JMP). 2012. Progress on Synthesis Report. Pathways to Progress: Transitioning Drinking Water and Sanitation: 2012 Update. Wash- to Country-Led Service Delivery Pathways to Meet Af- ington, DC: World Health Organization/UNICEF. rica’s Water Supply and Sanitation Targets. Washington, D. Koné, M. Strauss, and D. Saywell. 2007. Towards an DC: The World Bank/Water and Sanitation Program. Improved Faecal Sludge Management (FSM), Proceed- http://www.wsp.org/sites/wsp.org/files/publications/ ings of the First International Symposium on Faecal CSO-Synthesis-Report.pdf. Sludge Management Policy. Dübendorf, Switzerland: J. Baker. 2008. Urban Poverty: A Global View. Washington, Eawag Publishing. DC: The World Bank. M. Mathur. 2002. “Alandur Sewerage Project: A Success J. Colin. 2011. Lessons in Urban Sanitation Development, Story of Public-Private Partnership Arrangements.� Indonesia Sanitation Sector Development Program India Infrastructure Report 2002, Governance Issues for 2006–2010, WSP Field Note. Washington, DC: Commercialization. New Delhi: Oxford University Water and Sanitation Program. http://www.wsp.org/ Press. sites/wsp.org/files/publications/WSP-lessons-urban- A. Peal and B. Evans. 2011. Breaking Barriers in Water and sanitation-indonesia.pdf. Sanitation Service Delivery to Informal Settlements, Case K. Eales et al. 2012. Review of Community Managed Study of the Mukuru Model. Nairobi, Kenya: Practical Decentralized Wastewater Treatment Systems (DEWATS) Action. in Indonesia, WSP Field Note. Washington, DC: S. L. Rautanen and P. Kolsky. 2008. Challenges and Water and Sanitation Program. Opportunities for Increasing Quantity and Improving B. E. Evans and D. Saywell, and the Sanitation 21 Task Quality of Bank Lending in Sanitation, presentation Force. 2006. Sanitation 21: Simple Approaches to Com- at Sustainable Development Network (SDN) Week. plex Sanitation—A Draft Framework for Analysis, Lon- Washington, DC: The World Bank. don: International Water Association. http://iwahq O. Schmoll, G. Howard, J. Chilton, and I. Chorus, eds. .org/contentsuite/upload/iwa/Document/ 2006. Protecting Groundwater for Health: Managing Sanitation21.pdf. the Quality of Drinking-Water Sources, World Health Government of India, Ministry of Urban Development. Organization Water Series. London: IWA Publishing. 2008. National Urban Sanitation Policy, Delhi. D. Spears. 2013. How Much International Variation in Government of India, Ministry of Urban Development. Child Height Can Sanitation Explain? World Bank 2012. Improving Water Supply and Sanitation Services Policy Research Working Paper 6351. Washington, Advisory Note. DC: The World Bank. www.wsp.org 17 Poor-Inclusive Urban Sanitation References UN-Habitat. 2010. State of the World’s Cities. Nairobi, Guidance Notes on Services to the Urban Poor. Washington, Kenya: United Nations Human Settlements Pro- DC: The World Bank/Water and Sanitation Program. gramme. http://www.unhabitat.org/documents/ http://www.wsp.org/sites/wsp.org/files/publications/ SOWC10/R5.pdf Main_Global_Guidance_Note.pdf R. Verspyck and O. Guene. 2012. Urban Sanitation Expe- WSP. 2010. Los Servicios de Limpieza de Cámaras Sépti- riences of Senegal and Burkina Faso: Broadening Urban cas, Recolección y Disposición Final de Lodos Fecales en Sanitation Activities. Washington, DC: The World Zonas Periurbanas de la Ciudad de Santa Cruz. Bolivia: Bank. http://water.worldbank.org/node/84161. The World Bank/Water and Sanitation Program. WSP . 2009. Global Experiences on Expanding Water and Sani- tation Services to the Urban Poor, accompanying volume to 18 Targeting the Urban Poor and Improving Services in Small Towns