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Better together: Toilets and nutrition

Martin Gambrill's picture
​Studies show children grow taller and perform better
on cognitive tests in communities where residents have
access to improved sanitation and do not defecate
in the open. Photo credit: World Bank

Building urban sewerage infrastructure – but where is the sewage?

Isabel Blackett's picture

The World Bank at World Water Week 2015

Sewage is wastewater which contains human excreta (feces and urine), laundry waste, and often kitchen, bathing and other forms of waste water too. It is highly pathogenic, meaning that it contains many disease causing organisms.

Globally around two-thirds of the World’s urban dwellers rely on on-site (on-plot) sanitation. At the same time there is an increasing trend towards replacing on-site sanitation with traditional sewerage systems. Millions of dollars are spent on building sewers and sewage treatment plants while the complementary investments in household sewer connections and toilets are often neglected. What will those municipal investments in sewage treatment achieve without house connections?

Six steps to a successful sanitation campaign

Suvojit Chattopadhyay's picture

new latrineInadequate sanitation costs India $54 billion a year. To that, add the challenge of juggling our nationalistic aspirations of superpowerdom with the ignominy of housing the largest share of human population that defecates in the open.  In light of this, here are six steps to a success sanitation campaign.

Amid many reports that the Swachh Bharat Abhiyan (SBA) is failing, we need a dose of optimism. While SBA might be failing, it certainly isn’t the first, nor will it be the last state-led sanitation programme to fail in India. Our large schemes to tackle this challenge have, more often than not, ended up as models of just what one should avoid doing if they are serious about bringing about total sanitation.
It is now widely acknowledged that conventional approaches are not working: those that set up a false dichotomy between construction and behaviour change; those that are content with pit latrines as opposed to functional toilets; those that use reductionist conceptions such as communities being open defecation free rather than focusing on personal and environmental sanitation and hygiene as a whole; and those that settle for incremental coverage instead of full coverage from the start.
However, it’s not that there are no success stories within India or in our immediate neighbourhood. For one, the experiences of locally-embedded NGOs that have taken their interventions to scale can be highly instructive. There have also been state-led successes in Maharashtra and Himachal Pradesh that can offer valuable lessons. So what could some key design elements in a sanitation programme be?

Sesame Street, World Bank apply behavioral and educational insight to scale up sanitation and hygiene

Stephen Sobhani's picture
Sesame Street’s Global Health Ambassador
Raya and math expert Count von Count at
World Bank HQ. Characters © Sesame
Workshop. All rights reserved. Photo
​© Simone D. McCourtie/World Bank

Stephen Sobhani, Sesame Workshop's Vice President, International, and Junaid Ahmad, World Bank Group Senior Director for Water, wrote a blog for The Huffington Post. Read an excerpt below and continue reading on The Huffington Post.

A bright, green global ambassador for life-saving hygiene habits from Sesame Street -- the world's largest informal educator of children. Unprecedented investments in water and sanitation from the World Bank Group -- the world's largest development financier. What do Sesame Street and the World Bank Group have in common? Far more than you think...

The false dichotomy among sanitation-for-all advocates

Suvojit Chattopadhyay's picture

The sanitation debate has suffered from a seemingly irreconcilable dichotomy when it comes to identifying the best approach towards sanitation for all.

A good way of blocking progress in an argument is to present two aspects of a whole as a dichotomy. The sanitation debate, in recent years, has suffered from a seemingly irreconcilable dichotomy when it comes to identifying the best approach towards sanitation for all. This is the one that pits subsidies against motivation and correspondingly, construction against behaviour change communication. And yet, in a comprehensive and prudent programme design, there is no need for these ideas to be opposed to each other. I call this then, the false dichotomy in the world of sanitation advocates.

The current sanitation programme in India has at its centre a subsidy and incentive for individual households constructing toilets. This is a programme that has clearly not worked, irrespective of the minister or bureaucrat at the helm of affairs. India holds the ignominious record of having the largest number of people defecating in the open. At the same time, the popularity of the community-led total sanitation (CLTS) approach has risen. This approach depends on using shame and motivate as a call to action to build basic pit latrines (rejecting subsidies completely) and has worked in multiple countries around the world, as well as in certain states in India.

How Transformational Changes in Rural Sanitation Service Delivery in Indonesia Accelerated Access

Deviariandy Setiawan's picture
Open Defecation Free declaration billboard 
in Madiun city, East Java Province, Indonesia
Photo credit: Edy Basuki, East Java Health Office

Back in 2009, Ratih Purwindah, a 25-year-old newly appointed sanitation district facilitator, was not invited to sit in the car to travel with delegates from Indonesia’s Ngawi District to participate in the East Java province rural sanitation review meeting. Instead, Ratih was asked to take a bus the 180 km to Surabaya, even though there were vacant seats in the delegation’s car. She also did not get a desk at the district’s office. Five years onwards, this has changed and Ratih is now the provincial coordinator for the government’s sanitation program in Central Java. District sanitation facilitators working with her are recognized and empowered within District Health offices.  Ratih’s personal journey is a testament to the systemic changes that have taken place in Indonesia. With a focus on district-wide sanitation service delivery, Indonesia is accelerating access from below 1% to 2-3% a year and catching up to achieve the sanitation MDG. 

Why Choosing the Preferred Sanitation Solution Should Be More Like Grocery Shopping

Guy Hutton's picture

When we go to the supermarket, our decision-making is considerably aided by having the price, ingredients and source of goods clearly labeled. This allows us to rapidly compare the characteristics, perceived benefits, and price of different products to make what is usually an informed and instantaneous purchase decision. 

When it comes to making investment choices for public programs, we do not traditionally have the same luxury of information. The full benefits and costs of those interventions, including the long-term costs to maintain and operate a service, are rarely understood or taken into account in the decision. As a result, public decisions are usually made based on the most visible costs (capital investment required from the public budget), historical choices and the political process. 

Sanitation For All: Ignore Quality at Your Own Peril

Suvojit Chattopadhyay's picture

The excellently named Research Institute for Compassionate Economics (R.I.C.E) recently published an equally excellently named survey – the SQUAT (Sanitation Quality, Use, Access and Trends) survey. Based on the findings of this survey conducted in five north Indian states, R.I.C.E calls for a latrine use revolution - since the bottleneck is not the non-availability of a latrine (since even those with a government latrine are not using them), nor is it lack of funds (since far poorer countries and communities have built and used latrine). It is an issue of messaging around hygiene, towards which we need to set our firm focus.

My first job in the development sector was with an NGO, Gram Vikas in Odisha and my experience there has shaped many of my core beliefs about working in this sector. At the core of Gram Vikas' work was the conviction that the 'poor can and will pay for quality services'. So when I think toilets (not latrines – and there is a key difference in the definition), I often use the 'quality' lens and make the argument about how the usage of physical facilities installed by projects has a direct link with what community perception of what counts as good quality. This also has a strong link with the extent to which they feel a sense of ownership for the facility.

Loyabi’s Story: Where There is a Will, There is a Way

Santanu Lahiri's picture

The author captured the story of Loyabi, in Chhaor Union Parishad. This is her story of how she provided her family with access to better Mariam, Loyabi's daughter, studies in Grade IXsanitation and improved their futures.

“I will teach my children how to read and write regardless of my difficulties in doing so.”

My name is Loyabi and I come from a very poor family of Mahadanga village in Chhaor Union Parishad. I was married to Abul Hassan, a man from my own village, at the age of 15. For several years our poverty did not prevent us from being happy. We were blessed with two daughters and two sons. However, when my husband was diagnosed with gallstones, I found I had to raise Taka 50,000/- ($630) for his operation.

We had no land of our own and lived on common land. I was able to collect some money by asking for assistance in different villages. I worked as a mid-wife for humans as well as cattle, bathed dead bodies before their burial and somehow put together the required amount of money to get my husband’s operation done.

Cleaning Up One of the World’s Most Polluted Places

Guy Hutton's picture

For users of water-based sanitation, most of us give little thought to what happens after we hear the sound of the toilet flushing. Wooooosh -- out of sight, out of mind.

Certainly, there is massive benefit to be derived from owning and using a functioning toilet.

But what if you were told that there is nothing at the end of the sewage pipe that actually deals with what flows down the toilet? What if you learned that every flush pollutes the environment, and that combined with the chemicals, heavy metals and nutrients from industrial pollution and agricultural run-off, the improperly treated waste was turning rivers, lakes and estuaries into dead zones? Would you think twice next time you flushed?