Cities are growing at unprecedented rates, with over two thirds of the world population projected to live in urban areas by 2050 (UN DESA 2018), and city governments struggle to keep up with the increasing demand for urban services, including sanitation. This unplanned growth and the resulting dense informal housing hinder the provision of such services. Burgeoning informal settlements are characterized by poor political representation and challenging physical and topographical conditions, such as inaccessibility, rocky soil, high water tables and periodic flooding, which make the provision of basic services especially difficult. Cities require sanitation approaches for such settings which can complement, or precede the arrival of, traditional sewers and conventional on-site solutions, and thus contribute to the realization of the sanitation-related Sustainable Development Goals (SDGs). This thinking underpins the core principles of Citywide Inclusive Sanitation (CWIS) – encouraging cities to think about a diversity of technical solutions that provide services along the whole sanitation service chain, combining different approaches to better respond to the challenging realities faced by cities.
citywide inclusive sanitation
With a population exceeding 3 million, only 10% of Addis residents are connected to the sewerage system and an estimated 10% continue to practice open defecation. As a result, in 2007 the Addis Ababa Water Supply and Sewerage Authority (AAWSA) began a pilot to build approximately 200 shared sanitation facilities. After the pilot’s success, AAWSA took the next bold step of aiming to build 3,000 shared sanitation facilities, more than 600 of which have been successfully completed since 2016. These shared sanitation facilities include public facilities serving high-traffic urban areas and communal latrines shared between clusters of households in low-income communities.
Although the utility AAWSA has over a decade of experience in designing and implementing public and communal latrines, the learning continues as they maintain an adaptive learning mindset and as they integrate innovation in this aspect of their work. Below we present some key learnings from their decade’s journey of providing improved sanitation services for the population of Addis.
Martin Gambrill, Lead Water Supply & Sanitation Specialist, World Bank
Rebecca Jean Gilsdorf, Water Supply & Sanitation Specialist, World Bank
Ndeye Awa Diagne, Young Professional, World Bank
Today when you go to the toilet, be it in someone’s basic latrine in a rural village you might be visiting, in a public toilet where you work, or on a comfortable water-flushed ‘loo’ at home, take a moment to think about those not as fortunate as yourself.
As you sit (or squat) and contemplate, consider these three hard truths about sanitation:
Ms. Tettey wakes her children up at 3.30 am every morning to be able to make it to the front of the line at the nearest public toilet block, located about 150 meters from her house in Accra’s La Dade Kotopon Municipal Assembly. Like many residents of low-income informal settlements in Greater Accra, the Tettey family rents a single room in a compound house with about ten other families. The 2008 Ghana Living Standards Survey reports that 79% of Ghanaians live in compound houses consisting of several households built around a common open area or yard that share basic utilities like water, electricity and sanitation, where available. The use of shared toilets was the only alternative the Tetteh family had to open defecation when at home. During the day, the adults tried to take advantage of the public toilets near the market where Mrs. Tettey works, and the children were encouraged to use the toilets at their school before coming home. The Tetteys are among the 80 percent of Ghana’s population that lack access to ‘improved’ or safely managed sanitation.
An improved sanitation facility is defined as one that hygienically separates human excreta from human contact. The Sustainable Development Goals (SDGs) currently exclude shared toilets from their definition of safely managed sanitation. Likewise, to meet the WHO/UNICEF Joint Monitoring Program (JMP)’s definition of improved sanitation, toilets must be used by only one household, and they should meet certain design standards that prevent human contact with faeces. These definitions are driven by concerns that an increased number of users, among other factors, reduces the overall levels of hygiene and cleanliness of facilities and decreases their safety, thereby limiting access for women, children, and the elderly, and precluding achievement of the health, social and environmental benefits of having adequate sanitation.
Poor sanitation is the all too familiar story in many expanding African cities and Mozambique’s capital city Maputo is no exception. In fact, over half of the country’s urban population lack access to even basic sanitation. With an estimated 668 million city dwellers around the world not having access to safe sanitation, overcoming sanitation challenges in cities like Maputo will go a long way towards achieving the Sustainable Development Goal for safe sanitation (SDG 6.2).
An Introduction to Shared Sanitation
How many people can share a toilet? This question might sound like the start of a joke but it’s actually a serious issue for many across the world. That’s because an estimated 20 percent of the global population do not have their own toilets.
In urban areas, almost one person in ten uses a shared household toilet, i.e., a toilet shared with at least one neighboring household. But sometimes no one in the neighborhood owns a private toilet, so some of these families instead have no choice but to use community toilets - that are locally available and used by anyone who lives nearby. In such cases, hundreds of people might be using the same block of community toilets. Now let’s think about the other toilets we all use – when we’re out shopping or running errands, when we’re at work or school, or when we’re in transit. These public toilets might be used by hundreds or thousands of different people at different times of day.
Many of us go through the day without giving much thought to this. But for hundreds of millions of people worldwide who do not own their own toilet, these are daily realities. Additionally, even for households who have their own toilet, when they are outside of the home, they still need access to improved sanitation facilities. The illustration below depicts a day in the life of the Mijini family (Mijini means urban in Swahili). The Mijini ’s sanitation situation is great in their home, as they have an individual household toilet, but it’s underwhelming and even dangerous once they leave home for their day. Their experience is not unique, particularly in low- and middle-income countries.
Beatrice Montesi, GAIN
Martin P. Gambrill, The World Bank
Rebecca Jean Gilsdorf, The World Bank
Crowded slums, poor sanitation and unhealthy diets. It’s a potent cocktail and for too many families across the world, a daily reality. Right now, an estimated one billion people live in slums and that number is expected to double by 2030. Slums are where the many deprivations facing the urban poor collide, including lack of access to clean drinking water, sanitation, safe and nutritious foods, sufficient living space, durable housing and secure tenure (UN Habitat). They’re where human waste is routinely emptied into streets, canals, and garbage dumps. And where overcrowding and low rates of immunization and breastfeeding combine to exacerbate the already perilous problems children face.
Children growing up in these surroundings are at a higher risk of death and disease and are more likely to be chronically malnourished (Ezeh et al. 2017). For example, forthcoming World Bank research from Bangladesh shows that children living in slums are 50 percent more likely to be stunted than children living in other urban areas. This doesn’t just have implications for today - , and face a higher risk of chronic disease as they grow older. Tragically, these effects are often passed on to offspring, trapping families in poverty and malnutrition for generations, as per findings in a forthcoming World Bank report called Uncharted Waters.
The Bill & Melinda Gates Foundation – Jan Willem Rosenboom
The University of Leeds – Barbara Evans
Emory University – Christine Moe & Eduardo Perez
The World Bank – Sophie Trémolet, Valérie Sturm, Clémentine Stip
WaterAid – Andrés Hueso
Plan International – Darren Saywell
A successful city is economically and culturally vibrant, healthy, safe, clean and attractive to business and tourism, and provides quality of life to its citizens. This vision is appealing but remains hard to realize as developing cities have to cope with changing demographics and climate with limited financial and human resources. The sustainable development goals have given a new impetus for cities to be inclusive, safe, resilient and sustainable (SDG11), ensure citizens’ health and wellbeing (SDG3) and secure access to sustainable water and sanitation services (SDG6).
World Toilet Day on November 19th is the opportunity to remind ourselves of a few facts and propose a set of guiding principles for a renewed and revitalized urban sanitation agenda.