84289 A Brief for Policy Makers East Asia and the Pacific Region Urban Sanitation Review: Actions Needed The World Bank, with support from the Australian Government, conducted in-depth sector studies in three countries of East Asia Pacific – Indonesia, the Philippines and Vietnam – and synthesized the analyses and findings in a single report entitled East Asia and the Pacific Region Urban Sanitation Review: Actions Needed. This report recommends ways these countries and others in the Region can expand and improve urban sanitation services in an inclusive and sustainable way. A bout 2.5 billion people worldwide lack ade- While access to sanitation is high, collection and treat- quate sanitation – that’s one third of the glob- ment rates are low. Access to improved sanitation in al population – and 660 million of them live in urban areas is high (around 77 percent on average for East Asia and Pacific (JMP 2012). Inadequate sanita- the three focus countries).1 However, adequate collec- tion takes a tremendous toll on the quality of peoples’ tion and treatment rates are significantly lower, as less lives, the environment, and the economy. than 6 percent of the septage or wastewater2 reaches a properly functioning treatment plant (Figure 1). Without effective urban sanitation, there is a high risk of epidemic diseases such as cholera, as well as the Figure 1: Urban sanitation situation chronic effects of poor health from diarrhea and even (urban population-weighted average across the three countries) death. Inadequate sanitation pollutes water supplies, 100 rendering them unsuitable for drinking, irrigation, and other purposes. Poor sanitation facilities – together 80 Percent (coverage) with contaminated water supplies – account for about 60 88 percent of diarrheal deaths worldwide (JMP). 40 The economic impact of inadequate sanitation is sub- stantial. East Asia is rapidly urbanizing and its cities 20 are engines of economic growth. But while there has 0 been economic progress in these urban areas, sani- Access Access to Septic Septage Wastewater tation conditions have not improved. Each year, poor to water sanitation tanks treated treated quality sanitation costs Vietnam 1.3 percent of GDP, the Philippines 1.5 percent of GDP, and Indonesia 2.3 1 JMP defines sanitation access as “access to a facility that hygienically percent of GDP. separates human excreta from human contact.” 2 Septage (solid waste from septic tanks that includes fecal coliform) and wastewater that is contaminated with human feces. A Brief for Policy Makers Sectoral Issues The report identifies the main issues from the national to the provincial and local levels; affecting service provision in the sanitation however, there are important gaps in the enabling sector as follows: environment hampering effective implementation of programs. People-centered Policies ppThe limited number of professionals in the sector ppPublic awareness is low due to uninformed demand inhibits capacity. In the focus countries, the capac- for sanitation: the negative impacts of unhygienic ity is not adequate to carry out sanitation services sanitation practices on human health are not widely in a sustainable manner. known. Ultimately, it is the demand from people ppThere is also insufficient managerial and financial that will lead to better sanitation practices. Citizen autonomy in service provision, and this makes it initiatives to clean-up the environment have been less feasible for a utility to make commercially and successful and are likely to continue, and constant technically sound decisions. public vigilance ensures better sector performance. ppBetter information exchange is needed, as this Viable financial schemes facilitates forming and understanding opinions. ppSubstantial financing is needed to develop infra- structure and provide sustainable services for Cost-effective technical solutions urban sanitation. By some estimates, investment ppInadequate collection and treatment makes waste- levels of at least US$250 per person are needed. water a vector for disease. ppPolicies are not backed by viable financing. While ppPoor design and maintenance of septic tanks make the focus countries have sector policies, they still septage a vector for disease. need to develop, fund and implement sanitation programs with a clear expenditure framework. ppSound project preparation is often missing, result- ppFinancing operating costs is an immediate challenge, ing in a risk of over-design and under-utilization of sanitation improvement facilities. as tariffs are too low to meet operating costs in any of the focus countries and government and munic- Sustainable institutions for quality service ipal authorities are often reluctant to raise tariffs because of concern about reaction from citizens. ppUrban sanitation requires horizontal coordination, across a range of sectors, and vertical coordination A Brief for Policy Makers Recommendations To make and keep cities clean and healthy, sanitation facilities create health risks, especially the following recommendations should be in areas where shallow groundwater is used for implemented: drinking water. Improvements in septic tank man- agement are not capital intensive, but do require People-centered Policies capable institutions. Regulations are also needed to establish responsibilities and enforce the regu- ppIntegrate sanitation with city development lar de-sludging of septic tanks. plans. Urban areas need to develop City Sanitation Plans that identify issues and cost-effective solu- ppCollect and treat wastewater at least cost. It is tions, as clean and healthy cities will help to elimi- important to collect wastewater before it reaches nate water-borne diseases and improve the quality water bodies, as it is a major vector for diseases. of life of many people that live in the vicinity of Connection to sewers is also important to remove untreated wastewater and raw sewerage. polluted water from neighborhoods. Specific ppDesign and implement behavior change com- analysis should be carried out at the city level to munication strategies. An informed public is the determine whether separate or combined sewers most effective driver of change. Information and should be developed to ensure cost-effectiveness. education campaigns, focusing on the collective ppAdopt climate-smart sanitation strategies. gains of quality sanitation and the associated ben- Such strategies should ensure that: flooding and efits for public health, environmental protection, climate change uncertainties are included in fea- and economic development can build civic aware- sibility studies; and solid waste management is ness leading to change in sanitation practices. addressed to help reduce urban flooding from garbage-clogged drains and sewers. Furthermore, Cost-effective Technical Solutions consideration should be given to utilizing sani- ppPrioritize the collection and treatment of sep- tation by-products that have value – such as bio- tage. Septic tanks are prevalent in East Asia, but solids that can be used for fuel or fertilizer and their operation is not optimal. Poorly maintained water that can be re-used for agricultural purposes. Figure 2: Recommendations s ed Maximize use of Vi Integrate sanitation with ie er ab Sch consumer fees to meet lic nt city development plans le em operating costs Po -Ce Fin es e an pl cia o Pe l Promote information, Secure capital needs education, through sanitation communication expenditure framework Sustainable Sanitation Services Prioritize collection and treatment of septage Strengthen the service provider Collect and treat wastewater at least cost ity on le Co ech rv or al uti nab st no Se s f T ice -E lo Qu stit stai ffe gi Adopt climate smart Develop city-wide In Su cti es strategies sanitation strategies ve A Brief for Policy Makers Sustainable Institutions for Quality Services Viable Financial Schemes ppDevelop city-wide sanitation strategies. A com- ppSecure capital needs through a sanitation prehensive, action-oriented national program for expenditure framework. This framework should urban sanitation, with targets and funding, should be linked to the fiscal plans of the central and local be put in place in each country to improve ser- governments. In addition, efforts should be taken vices. Furthermore, City Sanitation Plans should to seek private financing of infrastructure; regu- incorporate the concerns of the poor, including the latory changes should be pursued to attract com- elimination of open defecation, improving access mercial capital and private operators; and the to finance for sanitation improvements, and the funding strategies need to be developed working improvement of sanitation services in informal with a wide range of central government minis- settlements. tries. Financing should also be in place to support ppIntegrate urban water management. Since water the poor. supply and sanitation are linked, water and sani- ppMaximize the use of consumer fees to meet tation issues should be addressed jointly through operating costs. Wastewater costs should be fully a robust regulatory environment at the local level paid by the polluter or user and charges should that ensures quality of services at economic costs. meet operating costs. This could be accomplished Urban sanitation services should be commercial- by linking the water and wastewater fees, which ized so that costs associated with delivering the would create incentives to minimize water con- services can be recovered. Furthermore, monitor- sumption and thereby reduce wastewater genera- ing and evaluation systems should be developed tion. Dependence on taxes to meet operating costs and incorporated into City Sanitation Plans as a should be phased out. tool for determining progress. For a copy of the EAP Urban Sanitation Review, supporting country studies that include more detailed country-specific recommendations, and an info- graphic, please visit: www.worldbank.org/eap/urbansanitationreview.