The importance of sanitation: How to bring about change

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WASH 2011 training program: Ben Fawcett, International WaterCentre

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The importance of sanitation: How to bring about change

  1. 1. Sanitation is important: how can you bring about change? <ul><li>Sanitation is important: how can you bring about change? </li></ul>Ben Fawcett Lecturer at the International WaterCentre, Brisbane
  2. 2. Why is sanitation important? <ul><li>Health impacts of inadequate sanitation: </li></ul><ul><li>Diarrhoea: 1.5m children die every year </li></ul><ul><li>Polio </li></ul><ul><li>Hepatitis A </li></ul><ul><li>Typhoid </li></ul><ul><li>Trachoma </li></ul>Sanitation is important: how can you bring about change?
  3. 3. Trachoma Sanitation is important: how can you bring about change?
  4. 4. Why is sanitation important? <ul><li>Health impacts of inadequate sanitation: </li></ul><ul><li>Diarrhoea: 1.5m children die every year </li></ul><ul><li>Polio </li></ul><ul><li>Hepatitis A </li></ul><ul><li>Typhoid </li></ul><ul><li>Trachoma </li></ul><ul><li>Bilharzia (schistosomiasis) </li></ul><ul><li>Hookworm / roundworm / whip-worm </li></ul>Sanitation is important: how can you bring about change?
  5. 5. Roundworm Sanitation is important: how can you bring about change?
  6. 6. Why is sanitation important? <ul><li>Health impacts of inadequate sanitation: </li></ul><ul><li>Diarrhoea: 1.5m children die every year </li></ul><ul><li>Polio </li></ul><ul><li>Hepatitis A </li></ul><ul><li>Typhoid </li></ul><ul><li>Trachoma </li></ul><ul><li>Bilharzia (schistosomiasis) </li></ul><ul><li>Hookworm / roundworm / whip-worm </li></ul><ul><li>Tropical enteropathy </li></ul><ul><li>Any more? </li></ul>Sanitation is important: how can you bring about change?
  7. 7. Sanitation is important: how can you bring about change? Neglect of sanitation in health financing
  8. 8. Why is sanitation important? <ul><li>Some social impacts of poor services : </li></ul><ul><li>200m women in India are obliged to wait throughout daylight hours </li></ul><ul><li>Girls drop out of schools without toilets, on reaching puberty </li></ul><ul><li>Huge numbers of people are still expected to handle other people’s shit </li></ul>Sanitation is important: how can you bring about change?
  9. 9. ‘ Manual scavenging’ Sanitation is important: how can you bring about change?
  10. 10. Why is sanitation important? <ul><li>Some social impacts of poor services : </li></ul><ul><li>200m women in India are obliged to wait throughout daylight hours </li></ul><ul><li>Girls drop out of schools without toilets, on reaching puberty </li></ul><ul><li>Huge numbers of people are still expected to handle other people’s shit </li></ul><ul><li>Adolescent girls have nowhere private to deal with menstrual hygiene </li></ul><ul><li>Any more? </li></ul>Sanitation is important: how can you bring about change?
  11. 11. Why is sanitation important? <ul><li>All this results in: </li></ul><ul><li>morbidity and mortality </li></ul><ul><li>poor child development </li></ul><ul><li>and terrible indignity </li></ul><ul><li>for huge numbers of people. </li></ul>Sanitation is important: how can you bring about change?
  12. 12. ‘ Clean toilets; not having to lift raw sewage and dump it into the Mwengenye River [which we also use for bathing and cleaning]; bathing spaces with warm water for the elderly and young children; water to clean clothes and homes; roads that are not always filled with [human and animal] wastes; roads, homes and toilets that don’t flood in the rainy months – that is what I think is appropriate sanitation .’ Margaret Wangui, Maili Saba, Nairobi What should sanitation comprise?
  13. 13. What should sanitation comprise? <ul><li>Safe, private, hygienic and convenient facilities for defecation – TOILETS not latrines </li></ul><ul><li>Appropriate services for safe disposal of faeces </li></ul><ul><li>Accessible, appropriate bathing and laundry facilities, with a reliable water supply </li></ul><ul><li>Facilities that are accessible for all </li></ul><ul><li>An environment that is clean and healthy </li></ul><ul><li>There is clear demand for all this, particularly in poor urban areas. </li></ul>Sanitation is important: how can you bring about change?
  14. 14. The present situation <ul><li>The JMP data suggest that: </li></ul><ul><li>48% of people (2.6bn) in developing countries have no improved sanitation </li></ul><ul><li>32% of urban residents in developing countries lack sanitation </li></ul><ul><li>56% (170m) of those in urban sub-Saharan Africa lack sanitation </li></ul><ul><li>But a UN-HABITAT survey suggests that nearly 50% of urban populations are without toilets </li></ul>Sanitation is important: how can you bring about change?
  15. 15. The present situation Sanitation is important: how can you bring about change? At least 1.2 billion people are obliged to defecate in the open every day
  16. 16. Slums Sanitation is important: how can you bring about change?
  17. 17. Sanitation is important: how can you bring about change? Slums
  18. 18. What must we do? <ul><li>Emphasise excreta-related diseases; shit is the problem </li></ul>Sanitation is important: how can you bring about change?
  19. 19. Sanitation is important: how can you bring about change? John Snow, Henry Whitehead, cholera in Soho
  20. 20. Faeces Fluids Fields Flies Fingers Food New host Sanitation Water quality Water quantity Hand washing The F-diagram: faecal-oral diseases Sanitation is important: how can you bring about change?
  21. 21. Faeces Fluids Fields Flies Fingers Food New host Sanitation Water quality Water quantity Hand washing The F-diagram: faecal-oral diseases Sanitation is important: how can you bring about change?
  22. 22. Faeces Fluids Fields Flies Fingers Food New host Sanitation Water quality Water quantity Hand washing The F-diagram: faecal-oral diseases Sanitation is important: how can you bring about change?
  23. 23. What must we do? <ul><li>Emphasise excreta-related diseases; shit is the problem </li></ul><ul><li>Agree that public health is a governmental responsibility , that sanitation is a key component, & persuade governments of this </li></ul>Sanitation is important: how can you bring about change?
  24. 24. Urban contrasts Sanitation is important: how can you bring about change?
  25. 25. What must we do? <ul><li>Emphasise excreta-related diseases; shit is the problem </li></ul><ul><li>Agree that public health is a governmental responsibility , that sanitation is a key component, & persuade governments of this </li></ul><ul><li>Demonstrate the cost-effectiveness of improved sanitation </li></ul>Sanitation is important: how can you bring about change?
  26. 26. Costs and benefits <ul><li>Benefit:cost ratio of universal (ie not just 50% of those unserved) basic sanitation by 2015 is at least 11.2 (Hutton et al 2006). </li></ul><ul><li>Estimated annual cost (2005-15) = US$14.5bn </li></ul><ul><li>[Annual military expenditure in all developing countries = US$201bn; </li></ul><ul><li>global military expenditure = US$1559bn] </li></ul>Sanitation is important: how can you bring about change?
  27. 27. Costs and benefits <ul><li>Benefit:cost ratio of universal (ie not just 50% of those unserved) basic sanitation by 2015 is at least 11.2 (Hutton et al 2006). </li></ul><ul><li>Estimated annual cost (2005-15) = US$14.5bn </li></ul><ul><li>The WSP ESI project estimates the economic impact of inadequate sanitation at US$54bn/yr in India, US$6.3bn/yr in Indonesia and US$2.9bn/yr in Cambodia, Laos, the Philippines and Vietnam. </li></ul><ul><li>In India 54% of the impact is from premature mortality. </li></ul><ul><li>Total global impact is at least US$150-200bn/yr. </li></ul>Sanitation is important: how can you bring about change?
  28. 28. What must we do? <ul><li>Emphasise excreta-related diseases; shit is the problem </li></ul><ul><li>Agree that public health is a governmental responsibility , that sanitation is a key component, and persuade governments of this </li></ul><ul><li>Demonstrate the cost-effectiveness of improved sanitation </li></ul><ul><li>Provide locally appropriate solutions for everybody </li></ul><ul><li>Emphasise work in slums </li></ul>Sanitation is important: how can you bring about change?
  29. 29. Slums <ul><li>45% of people in developing countries (2.57bn) currently live in towns and cities </li></ul><ul><li>By 2050 this will have risen to 67% - and more than doubled in total number to 5.33bn </li></ul>Sanitation is important: how can you bring about change?
  30. 30. Industrialised, urban LDC, urban Rural Population trends, 1950-2030 (Source: UNDESA)
  31. 31. Slums <ul><li>45% of people in developing countries (2.57bn) currently live in towns and cities </li></ul><ul><li>By 2050 this will have risen to 67% - and more than doubled in total number to 5.33bn </li></ul><ul><li>At least 1bn live in slums and this will double in 25 years </li></ul><ul><li>“… in high density settlements the potential spread of diseases … is much greater … than in rural areas.” </li></ul><ul><li>Child mortality in slums is much higher than elsewhere </li></ul><ul><li>Life without toilets and private washing spaces in slums is hugely undignified </li></ul>Sanitation is important: how can you bring about change?
  32. 32. <ul><li>Particular problems in slums: </li></ul><ul><li>High density </li></ul><ul><li>Insecurity of tenure, ‘illegality’ and lack of recognition </li></ul><ul><li>Weak local government </li></ul><ul><li>Need for creative partnerships </li></ul><ul><li>Need for innovative funding mechanisms </li></ul>Sanitation is important: how can you bring about change? Slums
  33. 33. What must we do? <ul><li>Emphasise excreta-related diseases; shit is the problem </li></ul><ul><li>Agree that public health is a governmental responsibility , that sanitation is a key component, & persuade governments of this </li></ul><ul><li>Demonstrate the cost-effectiveness of improved sanitation </li></ul><ul><li>Provide locally appropriate solutions for everybody </li></ul><ul><li>Emphasise work in slums </li></ul><ul><li>Recruit high-profile champions </li></ul>Sanitation is important: how can you bring about change?
  34. 34. Let’s have a dance for the dugong! <ul><li>http://www.youtube.com/watch?v=2J_DLHKgz14 </li></ul>
  35. 35. What must we do? <ul><li>Emphasise excreta-related diseases; shit is the problem </li></ul><ul><li>Agree that public health is a governmental responsibility , that sanitation is a key component, & persuade governments of this </li></ul><ul><li>2. Demonstrate the cost-effectiveness of improved sanitation </li></ul><ul><li>Provide locally appropriate solutions for everybody </li></ul><ul><li>3. Emphasise work in slums </li></ul><ul><li>Recruit high-profile champions </li></ul>Sanitation is important: how can you bring about change?
  36. 36. <ul><li>Campaigning for (or against?) </li></ul><ul><li>‘ excreta-related disease ’ </li></ul><ul><li>and definitely against shit </li></ul><ul><li>Do we agree the need for change? </li></ul><ul><li>How: key information, key interventions, key targets? </li></ul>Sanitation is important: how can you bring about change? Feedback
  37. 37. <ul><li>Demonstrating the cost-effectiveness of improved sanitation </li></ul><ul><li>What information? </li></ul><ul><li>Who to target? </li></ul><ul><li>How? </li></ul>Sanitation is important: how can you bring about change? Feedback
  38. 38. <ul><li>Emphasising work in slums </li></ul><ul><li>Do we agree that this is a priority? </li></ul><ul><li>How to lobby for more work? </li></ul><ul><li>How to approach the work and how to spread information? </li></ul>Sanitation is important: how can you bring about change? Feedback
  39. 39. The need for champions of sanitation <ul><li>“ Sanitation is more important than independence” Mahatma Gandhi. </li></ul><ul><li>“ A good sewer … is a far nobler and a far holier thing than the most admired Madonna ever painted” John Ruskin, 19 th century English poet, artist and social thinker. </li></ul><ul><li>Who, how to get them on board, how to use them? </li></ul>Sanitation is important: how can you bring about change?
  40. 40. [email_address] Sanitation is important: how can you bring about change?

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