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Building Demand for Sanitation A 2015 Portfolio Update and Overview Water, Sanitation, and Hygiene Strategy

June 2015

ACKNOWLEDGMENTSWe would like to thank all participants for their active engagement during the workshop as well as for their contributions to this report in the months following the Hanoi meeting. A special word of thanks to the staff of East Meets West (EMW, now Thrive Networks), the World Bank Water and Sanitation Program (WSP) and the National University of Civil Engineering for their assistance with organizing field trips and other local preparations:

Quang Vinh Nguyen, Country Coordinator WSP Vietnam

Hang Diem Nguyen, WSP Vietnam

Hoa Thi Hoang, World Bank Vietnam

Minh Chau Nguyen, EMW Vietnam

Hanh Nguyen, EMW Vietnam

Dang Thi Thanh Huyen, National University of Civil Engineering, Vietnam

This year as in previous years, many participants took on a presentation or facilitation role and we are grateful to: Ada Oko-Williams from WaterAid, Theodora Adomako-Adjei from CWSA, Chander Badloe, Lizette Burgers, Ann Thomas and Aiden Cronin from UNICEF, Anthony Waterkeyn from Africa Ahead, Akramul Islam from BRAC, Ingeborg Krukkert from IRCWash, Susanna Smets and Joep Verhagen from WSP, Dean Spears and Sangita Vyas from r.i.c.e., Mushfiq Mubarak from IPA, Minh Chau Nguyen from EMW, Jonny Crocker from the

Water Institute at UNC, Steven Sugden from Water for People, Daniel Asamani from PLAN International, Maria Laura Alzua from University of La Plata and Radu Ban of the Bill & Melinda Gates Foundation.

A special thanks to Dr. Viet Anh from Hanoi University for taking care of government liaison as well as arranging field visit permits and visitor visas.

Also many thanks to Sarah Herr from the Bill & Melinda Gates Foundation for travel and logistical support throughout the workshop (not to mention the period leading up to it).

Overall organization and facilitation was in the capable hands of Pete Cranston and Pippa Scott, with remote support from Nancy White.

Peter Feldman tirelessly supported the organization and documentation of the workshop; he drafted the program, engaged and corresponded with participants and wrote the first drafts of this report. We owe him an enormous debt of gratitude for his creativity, energy and persistence.

Photos:

Cover: Women review a map during a meeting to discuss sanitation and safety issues in the NTPC Subhas camp (Delhi, India, August 2014).

This Page: Nguyen Van Phuc and his family stand next to their newly constructed hygienic latrine behind their house in Long Hung commune (Chau Thanh district, Tien Giang province, Vietnam, 2014).

www.gatesfoundation.org

PREFACE 4

INTRODUCTION 5

Evolution of the Foundation’s WSH Program 5

Building Demand for Sanitation Portfolio 7

Grant-making Approaches 8

Outcome Investing 8

Payment by Results 8

Contributing to WSH Sector Evidence Base 10

Focus on Learning 10

PORTFOLIO PROGRESS 11

Introduction 11

Grant & Project Summaries 14

Product Development Projects 14

Research and Knowledge Sharing Projects 19

Integrated Implementation and Research Projects 25

SUMMARY AND DISCUSSION OF WHAT’S WORKING 40

Reaching the Poorest at Scale 40

Ensuring Political Support and Government Capacity 42

Improving Sanitation Business Models 42

Making Sanitation More Affordable 42

Integrating Supply-Side and Demand-Generating Projects 43

Fecal Sludge Management Solutions 43

Health Implications of Poor Sanitation 43

KNOWLEDGE MANAGEMENT AND RESEARCH NEEDS 45

Improvements in Learning and Knowledge Management 45

Curation 45

Connect 46

Learning Events 46

BDS Processes 46

Learning about Learning 47

Sharing Experience and Learning at the 2015 Hanoi Convening 47

Unanticipated Outcomes 47 Learning about Learning During the Convening 47

THE WAY FORWARD 48

Foundation Vision 48

Next Steps for the BDS Portfolio 48

APPENDIX 49

Footnotes 49

Participant Details 52

Notes 54

Table of Contents

4 | Building Demand for Sanitation

PrefaceIn January 2015, Foundation staff, grantees and sanitation sector experts converged on Hanoi, Vietnam for a series of important meetings. The first of these, the 5-day Fecal Sludge Management III conference, focused on technical aspects of a critical challenge—how to manage, treat, reuse, and dispose of waste which is accumulating at an increasing pace in ‘onsite’ sanitation facilities throughout the world, particularly in developing countries. The conference provided an opportunity for experts from many fields and organizations to exchange ideas on preventing fecal sludge from entering into the environment, and ideally, how we might convert this waste into products, energy, or fertilizers which will generate revenue and increase people’s standard of living.

The second meeting brought together Foundation grantees from all initiatives across our Water, Sanitation, and Hygiene (WSH) strategy—Transformative Technologies; Urban Sanitation Markets; Building Demand for Sanitation; Policy, Advocacy and Communications; and Measurement, Learning and Evaluation. Normally, most of these grantees don’t come into contact with each other, as they are working on distinctly different parts of the Foundation’s sanitation effort. However, in this first-of-its-kind convening we spent a very productive and enlightening day discussing matters of interest to us all. Based on the success of this event, we hope to continue to promote exchanges between sanitation grantees and other colleagues as the Foundation’s WSH program matures.

The final meeting was a four-day event attended by all the Building Demand for Sanitation (BDS) grantees as well as some of the Measurement, Learning and Evaluation (MLE) grantees. This was the fourth such meeting of the BDS portfolio partners,1 during which grantees and Foundation staff take stock of progress, discuss challenges, and propose new ideas. Many of the BDS grants have now either been completed, are nearing completion, or have entered a new phase. There was obviously a lot to talk about, given the maturity of the projects and research efforts.

The challenges facing the Foundation’s sanitation partners and our other colleagues working in the sector are enormous. Forty percent of the world’s population (2.5 billion people) practice OD or lack improved sanitation facilities; the consequences of this for human health and the environment are staggering. Poor sanitation contributes to about 700,000 child deaths from diarrhea each year, sanitation-related environmental enteropathy impedes child development and is linked to stunting and a reduced effectiveness of vaccines. Poor sanitation robs women and girls of their dignity and safety, and inflicts significant economic losses on national economies. In India alone, economic losses from poor sanitation are estimated to be $54 billion a year.2

The year is 2015—the target for achieving the Millennium Development Goals (MDGs). As of 2014, the global MDG for water supply (88% coverage) had been achieved—which is very encouraging news. However, there are still 76 countries who have not yet reached the water MDG—including 45 which are not on track to meet it by the close of 2015.3

On the other hand, the sanitation MDG (75% coverage) will likely not be achieved. Overall, sanitation coverage in developing countries increased 21 percentage points since 1990 (a larger increase in coverage than for water supply)—which is a worthy accomplishment. However, at least 108 countries are still shy of the MDG, and 79 of these countries are off track for reaching the sanitation MDG. Compounding this challenge is the fact that it will become increasingly difficult to reach those who still lack access to improved sanitation; the progress achieved so far has been more concentrated in urban and easily-accessible areas, and among the wealthier socioeconomic strata. The majority of those who have been left behind are poor and/or lack easy access to sanitation markets and services.4 In addition to the challenges just meeting the MDG targets (measured as access to improved sanitation), there is a growing body of evidence demonstrating that the actual use of facilities is not guaranteed even where access exists.

In spite of these challenges, or perhaps because of them, the Foundation’s partners are a determined, resilient, and innovative group of professionals who consistently see opportunities and synergies rather than focusing on constraints and roadblocks. The Hanoi BDS workshop offered us another opportunity to focus our attention on what we’ve learned and how we can use that knowledge to accelerate global progress towards achieving universal sanitation.

The report that follows attempts to outline what the Foundation and its BDS partners are doing to help meet these challenges and move the world towards universal sanitation. Naturally, it is impossible to capture everything that these individuals and organizations are accomplishing. However, I hope that readers will be inspired by it, and if particularly interested in certain topics, projects or organizations—they can use the contact information provided to find out more.

Jan Willem Rosenboom

June 30, 2015.

Building Demand for Sanitation | 5

Introduction

EVOLUTION OF THE FOUNDATION’S WATER, SANITATION AND HYGIENE (WSH) PROGRAM The Water, Sanitation and Hygiene program of the Bill & Melinda Gates Foundation was launched in mid-2005 as a “Learning Initiative,” eventually becoming a full-fledged program under the Global Development Division in early 2010. The Foundation’s efforts in the WSH sector are now nearly a decade old, and during that time it has undertaken a wide range of efforts involving research, experimentation, reflection, advocacy, and field implementation.

The early stages of the Foundation’s WSH effort explored a broad menu of water, sanitation, and hygiene challenges facing the developing world. Research efforts, landscaping studies, and pilot projects were important parts of the Foundation’s early WSH investments, although some large-scale projects also got their start during this period (e.g., IRC’s Triple S and WSP’s TSSM projects). Through these initiatives, and by listening to and learning from many global leaders in the WSH sector, the Foundation ultimately determined that its impact would be greatest if it focused on achieving catalytic change in sanitation services for the poor—an area that has long been recognized as important by the global development community, but one which traditionally had received far less investment than water supply services.

Through external consultations and internal analysis, the Foundation believed that the sanitation crisis in the developing

world had two fundamental elements: (i) 2.5 billion people, mainly in rural areas, lacked access to “improved” sanitation, meaning they practiced OD, or used unimproved pit toilets; (ii) 2.1 billion people in urban areas—many of whom were considered to already have “improved” sanitation —were capturing their waste on site—but nearly all of this waste was eventually being released into the environment without treatment. Importantly, the second failure was much less widely recognized within the WSH sector than the first. In other words, the WSH strategy identified and tried to address needs and opportunities along the entire sanitation ‘value chain’ (see graphic below).

Further, the Foundation also concluded it was unrealistic to expect that piped sanitation would (within a reasonable time frame) be able to reach the majority of the poor. To serve the poor, the Foundation believed it should focus on sustainable non-piped sanitation services. The ‘theory of change’ for generating widespread impact from this new program direction was based on the need to overcome three main challenges:

• Many people exhibited low demand for sanitation, even if they valued improved health.

• In terms of sanitation supply, fecal sludge (FS) extraction, transport, treatment, and disposal remained costly and difficult.

• The policy environment showed limited government capacity to select effective solutions.

Sanitation Value Chain


The Foundation thus determined it would contribute to meeting and overcoming these challenges through three main grant-making initiatives:

1) Ending Open Defecation (OD) – This approach combined several key elements: a) community-led demand stimulation; b) marketing affordable, desirable sanitation products and services by local entrepreneurs; c) strengthened enabling environment; d) capacity building for local governments; and, e) effective monitoring and evaluation.

2) Improving Sanitation Tools and Technologies – Development of new tools and technologies with the goal of supporting scalable business models and technologies across the sanitation value chain. Three main sub-initiatives would be: (i) Next generation latrine; (ii) Waste extracting and transport; (iii) Waste treatment and reuse.

3) More Effective Policy and Advocacy – Advocacy work to disseminate successful approaches to sanitation and encourage changes in policy and funding priorities necessary to accelerate access to sustainable sanitation.

The Foundation’s present-day WSH program has grown out of the work done under these three initiatives. Along the way, the program structure has periodically been modified to incorporate lessons learned through the various research and implementation initiatives. The current WSH program structure has three principal, inter-related initiatives, and two cross-cutting initiatives, as shown below.

These five initiatives reflect the Foundation’s current WSH priorities, showing our understanding of where the Foundation can have the greatest impact in a complex, diverse, and large sector.

TRANSFORMATIVE TECHNOLOGIES URBAN SANITATION MARKETS BUILDING DEMAND FOR SANITATION

• Applied Research• Innovation• Prototyping

• Market Research• Identify or create new markets• Promote uptake of service in low-

income urban areas• Field Testing• Commercialization

• Increase adoption of evidence-based practices

• Contribute to at least 30 million people living in OD Free (ODF) communities

POLICY, ADVOCACY & COMMUNICATIONS

• Encourage donors and implementers to invest in non-sewered sanitation• Improve sanitation policies for the poor• Foster effective regulatory environments

MEASUREMENT & EVALUATION • Efforts of the sanitation field are supported by strong measurement and evaluation



BUILDING DEMAND FOR SANITATION PORTFOLIO The Sustainable Development Goals (SDGs) being proposed for ‘post 2015’ focus on achieving, among other things, universal access to sanitation. Though the timeline for some of these new development targets may extend to 2040, governments and implementing partners will still need to accelerate the pace of progress in sanitation programs. Without accelerating the pace, some countries will not achieve universal access to sanitation until the 23rd century.

The core focus of the BDS portfolio is to help increase the efficiency and effectiveness of sanitation programs—in other words, to help ‘pick up the pace’ of sanitation improvement (and ensure the improvements are sustained). Based on sector research and the Foundation’s findings over the past 10 years, we believe these factors include:

• Promoting community-wide adoption (achieving open-defecation-free status, or nearly so)

• Reaching the poorest and most marginalized groups

• Establishing an adequate supply of affordable (and aspirational) sanitation goods and services

• Providing access to affordable financing and credit, especially for the poor

• Integrating demand-led and supply-side interventions for optimal mutual benefit

To operate effectively at scale, governments and the WASH sector in general must be supported by an ‘enabling environment’ that can accelerate the process. The factors which we believe are most critical to this include:

• Building capacity in governments and implementing agencies, and strengthening their ownership, investment, and leadership

• Improving sector monitoring, verification and reporting systems

• Establishing solid evidence on what works (and what doesn’t), and advocating for wide-spread adoption of the best approaches

The Foundation has established long-term and intermediate targets for the BDS portfolio which will continue to help align its investment, and provide benchmarks against which progress can be measured.

Progress on these accelerating factors will be difficult without improving the capture and transfer of sector knowledge. Many WASH sector organizations have realized that, and in the past several years a number of agencies have sharpened their focus on knowledge management, including the Foundation. The chapter on Knowledge Management and Research Needs provides further information on the Foundation’s WSH knowledge management effort.

Each of the BDS grantees are working hard to meet the challenges facing the sanitation sector (and have made great progress). Their accomplishments and more importantly, the key lessons learned from their work—are highlighted in the chapter titled Grant and Project Summaries.

3-5 YEAR BDS GOALS 12-18 MONTH RESULTS

30 million people in rural and urban areas demand, use and form social norms for sanitation via replicable models

Carry out at least 4 demand-generating, integrated communications and consumer awareness campaigns in urban environments

Contribute to over 5 million people in rural communities using improved sanitation services

The evidence base for building sanitation demand is strengthened and used to drive best practices and deliver improved services

Portfolio-generated information is readily available through the BDS Knowledge Management Initiative

Evidence from completed CLTS and sanitation marketing grants is effectively disseminated through appropriate channels

Field-based research efforts constructively influence key implementation agencies

In India, two rural states (Bihar and Uttar Pradesh) adapt the implementation of national sanitation programs, with assistance from State and Federal-level Technical Support Units


GRANT-MAKING APPROACHESThere are three features of BDS portfolio grants that are important to mention; two of these are used widely across the Foundation, and one is more specific to the BDS portfolio. The first two features discussed below relate to i) how grants are designed; and ii) the structure of grant payments.

Outcome InvestingThis is an approach to grant making that establishes up-front a clear vision of what a successful outcome to the project would be, and then translates that vision into measurable outcome (or sometimes output) indicators. This clarity of purpose then guides the development of the grant agreement. Outcome investing emphasizes:

• Aligning an investment around the intended impact of a project, rather than its activities or outputs;

• Translating project impacts into a number of specific, measurable outcomes that will serve as proxies for impact;

• Agreeing on a transparent and robust approach to measuring project outcomes as part of routine project monitoring. In some cases, independent third party verification of project results is included as part of the measurement approach.

The main benefit of outcome investing is that it creates clarity of purpose—aligning a grantee and the Foundation around a shared vision of success. From the Foundation’s point of view, the advantage is that monitoring (and reporting) focus mostly on outcomes, making it easier to understand whether the investment is paying off in terms of achieving the desired impact. From the grantee’s perspective, this approach empowers them to devise the best ways of delivering results—giving them the flexibility to adapt or change their project activities or approaches as required.

Payment by ResultsA special case of outcome investing is where payments to the grantee are actually linked to achieving specific outcomes. There are several ways of doing this, with varying degrees of linkage. On one end of the spectrum, all grant payments can be linked to achieving results or outcomes. The East Meets West grant for the CHOBA project in Vietnam and Cambodia is an example of this; payments to EMW are made (largely) based upon the number of toilets sold by the Vietnam Women’s Union (there also are other qualifying factors taken into account). This approach has enabled EMW and their partners to experiment with their approach until it ‘clicked’ and started delivering results at scale. If the project had been more rigidly designed around specific activities and output deliverables, EMW and its partners might not have hit upon the highly effective approach they are currently using (an approach with which EMW is now exceeding the original targets).

Another approach to outcome investing involves establishing a baseline “satisfactory performance” project performance level, and then linking “incentive payments” to outcomes which exceed this. In this situation, the Foundation provides an agreed-upon base amount of financing for the project, and then pays the grantee an additional amount(s) if performance exceeds expectations. The grant to International Development Enterprises (iDE) for the Sanitation Marketing Scale-Up project in Cambodia was designed this way, as well as Foundation support for the WASH II program being carried out by BRAC in Bangladesh.

Community Health Club members in Rwanda displaying their certificates.



GRANTEE ATTRIBUTES GRANT FEATURES RISK SHARING AND EXAMPLES

Strong on research but relatively weak on policy influence

Agreement with grantee that the vision of success is policy influence and not (just) completion of research Funding based on activities

None

Example: r i c e

Weak on research but relatively strong on policy influence

Allowing the grantee the flexibility to develop a research proposal with suitable partners If research results successfully influence policymakers, grant payout increases

Limited Payments upfront for each outcome, but follow-up payments conditional on reaching previous outcome

Example: WSA Dakar (not known in BDS portfolio)

New to the sector and developing business model

While developing business model, payments based on activities; switching to outcome payments later as model becomes clear

Limited Paying for outcomes only in the second half of the grant

Example: PSI Bihar (3SI grant)

Has developed a business model and is using the grant to reach scale

Clearly defined outcomes and expected value for money, with modest incentives for reaching stretch goals

Moderate Part of the budget is represented by incentive payments for excellent targets, and hence is at risk

Example: iDE Cambodia

Has an excellent field presence, has worked at scale, and has experience with outcome investing

Cash on delivery applied to all service delivery targets, not just stretch goals Highly incentivized to innovate to optimize impact

High In the example, 80% of budget is paid for outcomes upon delivery An additional 12% of payments are linked to ‘stretch’ goals

Example: EMW Vietnam

These outcome investing approaches provide greater flexibility to grantees in terms of project design and management, as well as meaningful financial incentives to outperform expectations. For the Foundation, outcome investing helps to reduce its financial risk in the case of under-performance, and helps keep its grant relationships focused on results and impact. In summary, outcome investing and payment by results has helped lead to:

• Shared vision of success between the Foundation and grantees, and a shared sense of risk and reward;

• Greater flexibility in project implementation for grantees, which in turn encourages innovation and rewards ambition;

• Shift in grant management focus from verification of activities and expenditures to verification of results;

• Project monitoring has become more effective and better-focused.

The table below provides some additional examples and further details on how the Foundation has used outcome investing in the BDS portfolio:

Young women discussing hygiene and menstrual management, Bangladesh.


Contributing to WSH Sector Evidence BaseAs discussed above, as the Foundation was determining whether and how to invest in the WASH sector, it became clear that there was a lack of rigorous evidence5 on what was working (and what was not) regarding sustainable sanitation delivery models at scale. In response to this, the Foundation has endeavored to invest in learning and research to the extent practicable under the BDS portfolio. This research has been (and continues to be) conducted either as standalone investments (e.g., the Innovations for Poverty Action research on the “migration of sanitation demand” in Bangladesh), or as an integral part of an implementation program (e.g., the testing of CLTS facilitation approaches by Plan International and the University of North Carolina in Ghana, Ethiopia and Kenya, or the work on strengthening large-scale CLTS and sanitation marketing by WaterAid in Nigeria).

This lack of rigorous evidence in the WASH sector has meant that many key programming decisions are (or have been) made based upon incomplete or inconclusive information—not so much in terms of what will have the greatest impact on health, but particularly how to best influence sanitation and hygiene behavior, or how to design and promote adoption of new sanitation technologies. Combining implementation and evidence-gathering has become one of the defining characteristics of the BDS portfolio. This has led to productive partnerships between implementers and researchers (Plan and UNC; iDE and IDInsight; WaterAid and IPA as well as EDePo6). The partnerships between implementing agencies and research institutions have not always been easy for the grantees to establish, but once accomplished they have generally proven very beneficial for all involved.

Broadly speaking, the Foundation invests in research to help us (and others) find out “what works” in delivering sanitation and thus make more informed decisions about what kinds of programming to fund.

Should we support programs that link sanitation to micro-finance? Conditional cash transfer programs? CLTS programs that are implemented through partnership with teachers? Our hope is that by integrating learning initiatives (research) with implementation projects we will learn more about what works, and why it works. This information has been, and will continue to be fed into our own grantmaking efforts as well as shared with Governments and other organizations involved with WSH sector implementation.

Another goal of WSH research is to enable the Foundation to reflect on the value for money achieved by particular investments, and to share this information with others. For example—how cost effective are investments in sanitation? How could they be made more cost effective? How do investments in sanitation compare to other types of investments that compete as priorities within Governments and donor institutions?

Focus on Learning A theme that connects different stages of the BDS strategy—and that has stayed constant throughout, independent of changes to the initiative priorities- has been a focus on learning. The previous section talked about the research and learning driven by specific questions. Apart from that important programmatic learning, there is another level of learning focused on clearly identifying, sharing and applying what we learn, leading over time to better results in the sector. The report from the 2013 BDS convening in Cambodia put it nicely:

“ To enable progress on [factors that accelerate the delivery of cost-effective sanitation at scale], they must be underpinned or supported by improved knowledge management and dissemination, noting that the type of knowledge which is most impactful is that which is highly accessible, as well as that which is capable of being put to practical application in ongoing or upcoming programs.”

Stepping back and reflecting on what we are learning as a sector has been one of the functions of the annual convenings. Those started in late 2011 in Kenya (focusing on metrics and measurement of progress monitoring), followed by the meetings in Cambodia (2013, “Learning what works”), Kenya (2014, “Knowledge management”) and Vietnam in 2015 which is the subject of this report.

In the Hanoi convening the program included even more specific activities than in previous years designed to encourage reflection, surface ideas and insights. In response, there have been very enthusiastic reactions from participants about the opportunities to learn and share after the convening (such as the exchange visits that will take place later in the year).

Participants engaged in a “Fishbowl discussion” on financing and subsidies.


Portfolio Progress

INTRODUCTIONBDS grantees are carrying out a range of interventions and research efforts focused on sanitation demand creation, market establishment, systems strengthening (enabling environment), reaching and empowering marginalized groups, and understanding and improving behavior change approaches. In contrast to the situation in 2013 (when the previous portfolio report was issued), most of the grant-supported activities are now well underway, nearing completion, or fully completed.

Preliminary or mid-project results are available, as well as the final outcomes from a few grantees.

The table below provides a quick overview of the current and recently completed BDS portfolio projects, and their overall focus. The narrative sections which follow the table provide more detail on each project, with highlights of their key contributions and lessons learned.

GRANTEE PROJECT NAME LOCATION STATUS FOCUS

PRODUCT DEVELOPMENT GRANTS

American Standard Brands (ASB)

Designing Sanitation Products for Sub-Saharan Africa

New markets in Sub-Saharan Africa

Ongoing(follow up on the earlier grant that developed the original SaTo pan)

Develop new low-cost toilet pan products that are adopted for use in one or more rural markets in Africa and Asia

Fundacion In Terris (FIT) The Earth Auger Ecuador Ongoing

Develop an ecological dry toilet that meets customers’ aspirations; goal of product commercialization by 2016

World Bank Water and Sanitation Program (WSP) and International Finance Corp (IFC)

Selling Sanitation Kenya CompletedSupport private sector to expand access to products that meet BoP consumer needs, and help create demand

RESEARCH AND KNOWLEDGE SHARING GRANTS

Center for Distributive, Labor, and Social Studies (CEDLAS), University of La Plata, Argentina; UNICEF Mali

Evaluation of the Impact of a Rural CLTS Programme

Mali CompletedRCT to assess effects of a CLTS program on child health, welfare, and household sanitation behavior in rural Mali

Eawag; USAID7

Determining the effectiveness and mode of operation of CLTS

Cambodia, Ghana, Lao PDR, Mozambique

Starting

RCT in Ghana to analyze behavior change approaches used by CLTS as well as ODF adoption process by communities Preceded by an evaluation of completed CLTS projects in 3 countries



RESEARCH AND KNOWLEDGE SHARING GRANTS

Environment and Population Research Centre of Bangladesh (EPRC)

Improving Rural Total Sanitation through Empowered Female Local Government Members

Bangladesh Ongoing

To learn whether female Local Government members, working with women’s groups, can establish effective sanitation improvements at scale

Institute for Development Studies (IDS)

CLTS Knowledge Hub Global

Completed (Continuing Funding from SIDA)

Promote learning and knowledge management for CLTS; expand and strengthen its application

Innovations for Poverty Action (IPA)

Inter-Linkages in Sanitation Demand Across Households

Bangladesh Ending

RCT to study effectiveness of demand generation, supply-side marketing, and sanitation subsidies Investigate influence of sanitation decisions on decisions by others in a social network

IPA Does Sanitation Behavior Migrate? Bangladesh Ongoing

Study of how sanitation interventions affect the behavior of seasonal migrants, and how sanitation in towns affects migrants’ home villages on their return

Research Institute for Compassionate Economics (r i c e )

SQUAT Report/Switching Study

India and other countries Ongoing

1 Analysis of large country data sets (starting with India) showing strong correlation between OD and stunting, and reductions in stunting with reductions in OD

2 Study of sanitation behavior in 5 states in India showing widespread OD by latrine owners Evidence linking OD and culture, explaining preference for OD

INTEGRATED IMPLEMENTATION AND LEARNING INITIATIVES

Africa Ahead

Community-Based Environmental Health Promotion Programme

Rwanda Ongoing

RCT to test effectiveness of Community Health Clubs (CHC) as a social mobilization and behavior change approach The grant makes uses of the fact that Rwanda is establishing CHCs in all villages, over a period of a few years

BRAC

Innovations in Sustainable Sanitation in Bangladesh

Bangladesh Ongoing

Increasing sanitation coverage at scale -with a special emphasis on reaching the hardcore poor- as well as innovation and replication components

Central India Initiative (CInI)

Integrated Water and Sanitation Model for Rural India

India: Gujarat and Jharkhand Ongoing

Sanitation promotion and sustainable sanitation technology for rural households, as part of livelihood projects aimed at alleviating poverty among tribal communities

Community Water and Sanitation Agency of Ghana (CWSA)

Fecal Sludge Management Study Ghana Ongoing

A study of fecal sludge management approaches in villages and small towns, to inform national FSM policy development




INTEGRATED IMPLEMENTATION AND LEARNING INITIATIVES

East Meets West Foundation8 (EMW) CHOBA Vietnam,

Cambodia Ongoing

Sanitation financing, hygiene education, and marketing in a project driven by financial transfers and incentives payments, to promote sanitation improvement in rural Vietnam and Cambodia, especially among the poorest

International Development Enterprises (iDE)

Sanitation Marketing Scale-Up Project (SMSU)

Cambodia

Completed (continuing with funding from other sources)

Brought commercial sales of moderately-priced latrines to scale Demonstrated market-based approaches can significantly increase sanitation coverage in Cambodia, also among the poor Learning efforts included testing of financing models, consumer price sensitivity and replication in other countries

Plan International with University of North Carolina (Plan/UNC)

Testing Modified CLTS for Scalability

Ethiopia, Ghana, Kenya Ongoing

How to scale up CLTS while maintaining quality and containing costs Research around testing impact of different internal actors (natural leaders, teachers, and district officials) Learning component includes case studies, literature review, and dissemination

Population Services International (PSI)

Supporting Sustainable Sanitation Improvements through Supply-side (3SI) strengthening

India (Bihar) Ongoing

Develop sustainable sanitation business models and products that match consumer expectations Demonstrate innovative financing approaches to increase coverage, and conduct multi-media campaigns for sales and marketing

Population Services International (PSI)

Project Prasaadhan: rural pit emptying

India (Bihar) OngoingDevelop and test business models to promote rural FSM practices (focusing on pit latrine emptying)

Rajiv Gandhi Mahila Vikas Pariyojana (RGMVP)

Women’s Empowerment and Poverty Reduction in Uttar Pradesh

India (Uttar Pradesh) Ongoing

Organize women into Self-Help Groups as agents of change in sanitation, hygiene, and other social and economic spheres Conduct research on effectiveness of different implementation approaches

UNICEF

Scaling-up and Strengthening Community Approaches to Total Sanitation

Indonesia, Malawi Ongoing

Increase access to sanitation through strengthening government sanitation programs at scale; analyze program innovations and strategies; distil l lessons learned and transmit learning to other Asian and African countries

WaterAidSustainable Total Sanitation in Nigeria

Nigeria: Jigawa, Ekiti and Enugu Ongoing

To improve the effectiveness, efficiency, inclusion and sustainability of total sanitation approaches in 3 States, and contribute to wider national and regional good practice Research impact of varied combinations of CLTS and marketing approaches


American Standard BrandsFocus and Objectives: This project is an extension of the Foundation’s previous partnership with American Standard Brands (ASB),9 under which ASB developed a prefabricated toilet pan in Bangladesh that was hygienic, easy to install and clean, and was economically mass-produced. The “Sato Pan” improved upon existing pan designs that were available on the open market, and in so doing, provided an affordable, attractive and hygienic alternative for consumers. Over 700,000 Sato Pans are now in use in Bangladesh, of which roughly 500,000 were donated by ASB to partner NGOs BRAC, Water for People, Save the Children, and WaterAid. About 200,000 units have been sold to consumers through the open market by the manufacturer, RFL Plastics. The retail price of the pan in rural Bangladesh is around $1.75, which is within a price range that most consumers can afford. This price point allows for profit-taking throughout the supply chain, providing a sustainable business model. The product is considered both a programmatic and a commercial success and introduction into other countries (Timor Leste, Vanuatu, possibly India) has happened independent of project activities.

Under this new partnership, ASB will introduce improved sanitation products at scale via market-based approaches in one or more sub-Saharan African markets over a 2-year period. The products will be variants of the Sato Pan developed in Bangladesh. ASB will establish local production and marketing efforts, so as to help generate sanitation demand as well as contributing to livelihoods opportunities.

Project targets include: A ‘deep dive’ sanitation demand and supply analysis (completed), followed by product development prototyping,

Designing Sanitation Products for Sub-Saharan AfricaGrantee: American Standard BrandsPartners: UNICEF, Water for People,

Cresstanks Ltd and othersLocation: Uganda, Kenya, RwandaDates: May 2013 – December 2015 Information: Jim McHale mchalej@AmericanStandard com

field trials, and refinement of products for market. Once these steps are completed—the final product(s) will be manufactured and marketed if warranted by a solid business case.

Accomplishments to Date: The ‘original’ Sato Pan as developed in Bangladesh consisted of one basic pan design, with a flapper door to keep the pit contents sealed from the environment. A ‘collection box’ was also manufactured which served to adapt the pan for offset pit installations. The original Sato works best when installed in a concrete slab. The concepts to be tested in Africa include the original design, plus three new variations: a ‘wide flange’ model for installation in wooden or earthen structures; a ‘stool’ model for seated use; and an ‘integral slab’ model. A new trap door design, which is more lightly counterweighted and opens to a steeper angle to minimize water usage has also been developed. Each of these models mentioned above can be fitted with either of the two trap door varieties. The new concepts are also fitted with a “pull string” for manual opening of the trap door. This was deemed necessary to allow for the passage of paper, leaves,

Grant & Project Summaries

PRODUCT DEVELOPMENT PROJECTS



etc., that might be used as wiping materials and would be too light in weight to cause the trap door open on its own.

Production tooling for the wide flange pan (“Pan 2”) and the new door (“Door 2”) have been produced with manufacturing partner, Cresstanks, located in Kampala, Uganda. This new product will become commercially available in Uganda and other neighboring markets in 2015. The retail price point is expected to be below $5 USD.

Key Learnings from Project: Field trials of the stool and integral slab concepts are underway in Rwanda with assistance from the local UNICEF office. Additional field trials are being planned for Uganda and Kenya, again with assistance from UNICEF. Early feedback from users has been very positive, with odor reduction and “cleanliness” being cited as the most significant benefits. One specific learning has been the unexpectedly high acceptance of the stool version in Rwanda. General opinion at the onset of the project was that the Sub-Saharan African consumer preferred squatting toilets and would not accept seated options. This thinking was generally confirmed in the initial field research interviews in Zambia and Kenya. However, in the relatively small sample of 15 families

participating in the Rwanda field trials the seated version was preferred nearly 2:1. Three households that had originally selected the integral slab version requested to switch to the stool when seeing both products side by side. Although the stool concept was originally designed for the functional purpose of lifting the moving trap door mechanism up and away from the opening to the pit, it appears that it could be viewed as a more aspirational, perhaps premium product for this market.

Next steps for the project will be to:

1. Conduct field trials in Rwanda, Uganda, and Kenya and collect user feedback.

2. Launch the large flange product on a commercial basis in Uganda to determine price point, distribution strategy, marketing plan, and other critical aspects of the business model.

3. Evaluate user feedback and determine whether to commercialize additional models.

A prototype of the new American Standard plastic slab with SaTo pan fitted in an existing latrine in Rwanda.


The “Earth Auger”, Testing and Introducing in Latin America’s Market a New Technology on Decentralized SanitationGrantee: Fundacion In Terris (FIT)Partner: Critical Practices LLCLocation: Ecuador Dates: July 2013 – December 2015 Information:Marcos Fioravanti mtfioravanti@gmail com Charles (Chuck) Henry critical practices@gmail com

Fundacion In Terris This project is developing an ecological, dry toilet that meets customers’ aspirations—with a goal of product commercialization by 2016. The Earth Auger (El Taladro de la Tierra) is a urine-diverting dry toilet whose key innovations include a pedal-operated dry-flush mechanism, and an automated composting system. When the pedal is operated the feces, cleansing paper and automatically-added sawdust are mechanically moved along through a pipe with an auger inside. Successive “flushes” mix and aerate the materials while moving them through to a storage bag at the end of the pipe, where the mixture is retained for further dehydration and pathogen die-off prior to being used as a soil amendment. Urine is harvested separately, mixed with any wash water and drained, preferably to a nearby garden. In mass production the units (without superstructure) are expected to cost between US$150 and US$300.

Project targets include:• Demonstration and testing of mass-produced Earth Auger

prototypes in sufficient numbers to assess the toilet’s functioning and acceptability by users, as well as the microbiological quality and the use of the final product (e.g., as fertilizer).

• Improve design and production, to increase product quality and decrease manufacturing costs.

• Develop a business plan for production, marketing, assembly and distribution that is sustainable and competitive for Ecuador.

Accomplishments to Date: • 86 demonstration Earth Augers installed; over 50 additional

installations expected in first quarter of 2015.

• Arrangements for micro-financing household toilet purchases should reduce cost for the user to $225-$565 (with the higher amount including the superstructure), paid back at $10-$24 per month over a 2-year repayment period (equivalent to a cost of $0.07 to $0.17 per user per day for a family of five).

• Several State & County Governments are interested in the toilet; approval for the design by National Ministry of Environment.

Key Learnings to Date: Early products, which were partly hand-built, had reliability and user acceptance issues and a relatively high cost. Project targets were adjusted to provide more time for design improvements and collect in-depth performance data and user feedback. The business plan is currently under development, and the project has been extended until end of 2015. Commercialization goals are focused on the Ecuadorian market. Lessons learnt:

• The discovery that it is possible to have plastic components manufactured without paying the full cost for a mold (but instead paying mold “rental charges” to the manufacturer) transformed manufacturing options allowing the project to stop using the low-quality hand built components.

• Testing early products at small scale and collecting user feedback is necessary before scaling up production.

• Business models need to be based on local field data. In the absence of reliable data, crafting a sound business plan takes significant investment of time, effort and resources.

Next Steps: Further efficiencies will be sought along the supply chain to ensure sustainability, along with finding additional ways to reduce the unit’s retail cost. As the demonstration model moves towards production, FIT will increasingly focus on building demand for the units by increasing the product’s aspirational features as well as further cost reductions. FIT will use crowdsourcing to speed up development of solutions and identify design and manufacturing improvements. From a user protection perspective, FIT will be seeking improved methods for increasing (and measuring) pathogen die-off during the composting process, and to ensure the safety of land application of mature compost products. FIT also will collect data regarding users’ experience including the toilet itself, as well as any benefits gained from composting.



Selling Sanitation—Catalyzing the Market for Household Sanitation in AfricaGrantees: IFC and WSPPartners: Numerous government, private

sector, and financing organizationsLocation: Kenya Dates: 2012 – 2014Information: IFC Website and Project VideoYolande Coombes (WSP) ycoombes@worldbank org

International Finance Corporation & Water and Sanitation Program-AfricaAlthough half of Kenya’s base-of-pyramid (BoP) consumers already have the desire to invest in sanitation for their homes, the available options are complex to purchase and generally of poor quality. Sanitation products are not standardized, and sanitation businesses are not seeking new customers. To improve on this situation, the Selling Sanitation project10 has worked with businesses to develop affordable and desirable sanitation products, with Government and financing organizations to help establish a sustainable market for sanitation services, and with outreach organizations to increase consumer demand and to help end OD through CLTS campaigns, as well as to improve other hygiene-related behaviors such as hand washing. This is in line with and supportive of the Government of Kenya’s vision to achieve universal access to sanitation by 2030. The project’s Foundation funding officially ended in 2014, but WSP is continuing its work on this with other sources of financing.

Project targets include: The overall IFC/WSP project target is to sell 1.5 million of the latrine slabs by 2020, including sales from expansion countries outside of Kenya. Selling Sanitation has already led to two partner investments of approximately $500,000. As a result, one manufacturer, Silafrica, has developed the manufacturing capacity to produce over 10,000 units per month. The final product design is fixed and distribution began in August 2014, with 1,000 durable plastic slabs sold even before the launch of the main demand creation campaign which began in November 2014. Selling Sanitation also catalyzed the signing of a distribution agreement between Silafrica and Equity Bank to leverage their extensive BoP presence (Equity Bank provides 56% of all Kenyan bank accounts).

Although these are still only early results in Kenya, there is already interest in replication from both the public and

private sector sides elsewhere in East Africa, such as Uganda, Tanzania and Ethiopia. Manufacturers involved in Kenya are well-positioned to expand to access the larger regional market, as several have factories in other East African countries and distribution networks spanning sub-Saharan Africa.

Accomplishments to Date: Through in-depth market research, and in partnership with manufacturers, the project used the Human Centered Design approach to develop a range of hygienic, aspirational plastic latrine slabs that are manufactured locally in Kenya (see photo). The slabs range in price from $17 to $55 (ex-factory), can be easily transported and stored, are easy to move to a new pit once the old one is full and provide an attractive and durable alternative to the built-to-order concrete products that had dominated the Kenyan marketplace.

The project has also worked at the policy level to integrate market-based approaches into the Kenya Environmental Sanitation Policy and Strategy, as well as the National Sanitation Bill. In addition, the project helped establish working partnerships between NGOs, Government, and other agencies to pool resources for more effective and cost-efficient behavior change and capacity-building campaigns.

Improving consumer access to affordable credit is another area of project engagement. The project is working with MFIs and other partners to support development and testing of workable financing mechanisms that can enable more consumers gain access to new products. Mechanisms may include existing water,

Plastic latrine slabs like this one are now manufactured and sold in Kenya.


sanitation or housing MFI consumer loans, or working capital loans to private partners who can pass on terms of credit to consumers.

Key Learnings from project: Through consumer and market research, the project has learned that

• Sanitation customers were dissatisfied with available product choices and were interested in latrine construction and upgrades if costs were reasonable

• Consumers did not know of options between traditional and high-end concrete slabs; the aspirational high-end options were financially out-of-reach for many, including BoP customers

• Available slab products were not designed to fit consumer needs and preferences

• Little to no market testing of plastic sanitation products had been done because onsite sanitation was still seen as a low priority and high risk market

• Misinformation about improved latrines led manufacturers to design plastic products that did not fully achieve health benefits for consumers

• The market for latrine slabs in rural and peri-urban Kenya was estimated at 1.6 billion KES (USD 19 million) in 2014

Next Steps: The project will focus on expanding the market for the plastic slabs and going ‘the last mile’ to reach more consumers. Efforts will include helping the private sector to identify optimal distribution channels, including engaging with local masons and artisans, marketing to communities who have been triggered through CLTS, and utilizing new marketing channels. The project also will seek to address the complexity of purchasing and financing by establishing partnerships with formal MFIs, Savings and Credit Cooperative Organizations, and local micro-savings groups. Finally, an evaluation of the impact of the plastic latrine slabs is planned to begin with a baseline study starting in March 2015.



Evaluation of the Impact of a Rural CLTS ProgramInstitution: Center for Distributive, Labor, and

Social Studies (CEDLAS), National University of La Plata

Researcher: Dr Maria Laura Alzua et al Location: Mali (Koulikoro Region)Dates: April 2011 – May 2013Information: M L Alzua, CEDLAS malzua@depeco econo unlp edu ar

RESEARCH AND KNOWLEDGE SHARING PROJECTS

CEDLAS and UNICEF Research Focus and Objectives: This research effort was conducted as a learning exercise within a large CLTS program being implemented by UNICEF in rural Mali. The study was designed to assess the effects of a CLTS program on sanitation and defecation practices, child health, and other household and community attributes.11

Methodology: A randomized, controlled trial (RCT) was conducted with half of the 121 eligible communities randomly assigned to receive the CLTS intervention. The study investigated the intervention’s effects upon sanitation adoption and defecation behavior, child health and nutritional status, labor supply, schooling and women’s safety. Also investigated were what the drivers of collective action related to latrine adoption were, and to assess any effects related to social structure.

Key Findings to Date: The study showed that there was a significant increase in access to private latrines, improved quality of latrines, and a reduction in OD. Specifically,

• Access to private latrines nearly doubled among households in CLTS villages, going from 35% to 65% on average.

• Adult OD rates fell by 70%; among children (aged 5-10) by 46%; and among children under five by 50%

• Children too young to use latrines were more likely to use a potty in CLTS villages (51% vs. 15%)

CLTS intervention households also had cleaner latrines and improved hygiene:

• Households were three times more likely to have soap and 5 times more likely to have water (for handwashing)

• Latrines were more than twice as likely to have a pit cover, and 20% less likely to have flies inside the latrine

Perhaps the most significant findings were related to child health and nutrition in the intervention areas. There was a positive, significant impact on child growth patterns: children under five years in CLTS villages were found to be taller (+0.18 height-for-age Z-score). Stunting was reduced by 17%, and severe stunting in children under 2 years was lower by 23%. There also was a 57% reduction in diarrhea-related under-five mortality in CLTS villages. There was no statistically significant impact on child diarrheal disease or respiratory illness. However, there were significant reductions in bloody stool incidence.


In terms of social effects, there were significant differences in prosocial12 behaviors such as cooperation and community empowerment in CLTS intervention areas. Increased feelings of privacy and safety were reported by women.

An unexpected finding was that no significant change in the amount of diarrheal disease was found, yet there was a significant impact on child growth. There also was no change in the bacteriological quality of water in the intervention areas. The findings suggest that improved sanitation works to prevent child malnutrition; the mechanism may be that lower OD rates in CLTS communities led to lower prevalence of non-diarrheal but fecally-transmitted pathogens such as soil-transmitted helminths, (Ascaris, hook-worm) and/or lower prevalence of environmental enteropathy.

A reduction in the prevalence of diarrheal diseases may require stronger adoption of hand-washing with soap, improved food hygiene, as well as improved access to safe water.

The findings of this research were presented at several international public health conferences in 2014; the health impact results will be published in an international journal. The results also will be presented and discussed with the Malian government.

Next steps: Future research will look further into the role of social networks on latrine adoption and OD practices, conduct a cost-benefit analysis, and perform a comparative analysis using data from India, Indonesia, Tanzania and Mali.

Determining the Effectiveness and Mode of Operation of CLTSInstitution: EawagResearcher: Drs Hans-Joachim Mosler and

Miriam HarterPartners: USAID and Plan InternationalLocation: Ghana, Cambodia, Lao PDR, and

MozambiqueDates: November 2014 to October 2017 Information: Miriam Harter miriam harter@eawag ch Hans Mosler mosler@eawag ch

Eawag (Swiss Federal Institute of Aquatic Science and Technology) Research Focus: To analyze the behavior change approaches used by CLTS and community ODF adoption processes. The research will attempt to determine how different elements of CLTS affect behavior, and whether there are elements which have counter-effects on individuals or social systems. The study will identify the psychological determinants of behavior change triggered by the CLTS activities. In addition, the study seeks to identify which are the best combination of CLTS elements to attain an ODF community, and to unpack the ODF adoption process including assessing which community members are ending OD first, who is doing so last, and why. Finally, the identified combinations of CLTS elements will be compared to a data-driven behavior change strategy.

Methodology: Pre-surveys will be conducted in 3 countries (Cambodia, Lao PDR, and Mozambique) where CLTS has been implemented (600 households in each country). The main study to follow will be conducted in Ghana, as the research component of a large CLTS implementation program funded by USAID. The study includes face-to-face interviews in 3,125 randomly selected households using quantitative, structured interviews on three key behaviors: OD, latrine construction, and latrine use; as well as behavioral determinants. Spot checks will be conducted regarding OD within households and at the village level.

The pre-surveys started in March 2015, and the main research in Ghana will follow—starting with a baseline survey in October 2015.

Household interviews in rural Cambodia



A community gathering in Bangladesh

Environment and Population Research Centre of Bangladesh (EPRC)Research Focus: The importance of institutions in addressing long-term development challenges is well accepted, though there is a lack of empirical evidence on their effectiveness. In particular, there is little information available regarding the roles played by female leadership in bringing about societal changes such as sanitation and hygiene improvement.

Although Bangladesh has made great strides since 1990 in latrine coverage, nearly 45% of the rural population still lack access to sanitary latrines. Lack of local leadership has been shown to be an important factor influencing the adoption and sustained use of latrines and related behavior change.13 EPRC is studying whether female Local Government members (FLGMs), working together with Cluster Women’s Groups (CWGs), can effectively promote sanitation, including ownership and use of improved latrines and related hygiene practices. The FLGMs are members of the Union Parishad14 (Council); each UP has three elected female representatives that serve on the 12-member body. Government policy stipulates that FLGMs should chair at least one third of the Council’s standing committees which in turn make recommendations for UP Council approval.

The knowledge gained hopefully will serve other rural populations in Bangladesh as well as other developing countries. Many if not most countries have also been promoting a greater role for local government in sanitation campaigns. Attention to gender and poverty issues is often acknowledged as a necessary component, but empirical evidence and practical guidance on how to do this effectively has been lacking.

Improving Rural Effective Total Sanitation through Empowered Female Local Government MembersInstitution: Environment and Population

Research CentreResearcher: Dr Bilqis HoquePartner: Jagoroni Chakra Foundation (JCF)Location: Bangladesh (Comilla and Dinajpur

Upazilas)Dates: May 2012 – Apr 2015Information: Bilqis Hoque bilqisdhaka@yahoo com eprchq@yahoo comWebsite: www eprcbd org

Methodology: The study involves a RCT in 32 intervention and 32 control Union Parishads. The implementation aspect of the study involves supporting FLGMs to work with CWGs in order to carry out sanitation and hygiene education interventions, as well as to promote hygiene and sanitation within the context of the UP itself.

Key Findings to Date: Monitoring of intervention communities indicates that FLGM and CWG-led hygiene promotion efforts have resulted in significant changes over baseline conditions. These changes include:

• Rates of access to sanitary latrines increased to nearly 97% from a baseline of around 80% (over a 2-year span). This exceeded the project target to increase access by 10 percentage points.

• Observed presence of hand washing agents improved significantly.

• About 40% of FLGMs showed good potential for coordinating sanitation at the UP level

• Three out of 10 “Best Practice” fact sheets recently developed for Local Government were prepared by intervention FLGMs and their UP Chairmen.

• The National Institute of Local Government agreed to recommend FLGMs be considered as Chairs of the UP WASH Standing Committees.

Discussion of Findings: Results so far suggest that working with FLGMs improved their overall capacity as UP members and they played important roles in promoting sanitation in their Union Parishads, including both schools and communities. With CWG assistance, FLGMs demonstrated the potential to lead the drive to achieve total sanitation at the local level, in line with national sanitation policy.


There have been challenges to the project which are worth considering. One hinged around incentives—as this project offered no financial or other incentives for community members (e.g., latrine subsidies; meeting attendance costs) which differed from some other major national projects. This resulted in constraints to a number of FLGMs who faced difficulties in building community participation. In addition, national elections were followed by a prolonged period of unrest which influenced UP budgets and the ability to carry out project work; the project timeline had to be extended to accommodate this.

Though most communities readily accepted FLGMs in their role as promoters of improved sanitation, this stronger leadership by FLGMs led to occasional tensions between

Networking and Action Learning to Support CLTS (CLTS Knowledge Hub)Institution: Institute of Development StudiesResearcher: Prof Robert ChambersLocation: GlobalDates: Feb 2012 – Sept 2014Information: Robert Chambers R Chambers@ids ac ukPetra Bongartz P Bongartz@ids ac ukwww communityledtotalsanitation org

Institute for Development Studies (IDS)Focus and Objectives: Promote learning and management of knowledge about the CLTS approach; expand and strengthen its application, quality and scale.

Key activities: Convened learning workshops with practitioners, documented and published lessons learned, maintained the CLTS website, published a periodic newsletter with programmatic updates, and engaged in action learning and networking with CLTS practitioners.

From a technical perspective, the Knowledge Hub also promoted equity and inclusion in sanitation programs, sustainability of the approach, and enhanced monitoring and verification. The Hub also carried out important policy and advocacy work with leading organizations and key government bodies.

Next Steps: The Foundation’s project is now completed, but IDS has secured new sources of funding and continues to expand its services to the CLTS practitioner community in order to broaden, improve and strengthen CLTS at scale. A recent innovation was the establishment of a new publication series called “Frontiers of CLTS: Innovations and Insights”. The Knowledge Hub continues to focus on policy engagement in India, recognizing that India’s sanitation situation is a major challenge in the sector. IDS will continue to engage with the Government of India in an attempt to understand and constructively influence policy and practice there. For example, IDS has taken part in initiatives and discussions leading to new national guidelines for the Swachh Bharat Mission (India’s national sanitation program), and is tracking developments regarding the proposed guidelines for Rapid Action Learning Units.

A particular focus for the Hub are the second and third generation challenges that have arisen now that CLTS is being implemented at scale, and in many cases by Government. Sustainability is one of the central challenges that encompasses many other issues such as equity and inclusion; integration of sanitation technology design and marketing; post ODF follow up; monitoring; and ODF verification. In 2015, the Hub will host a write-shop on sustainability which will result in a publication. The Hub is also engaged in learning more about adaptations of CLTS in urban settings, and plans to conduct research, hold thematic workshops, and prepare papers on this topic during 2015-16.

male and female UP members regarding their roles and responsibilities. As female members’ capacity and confidence increased, they sought greater and more equitable participation in the governance process. Overall this trend is positive, though further evolution will likely need to take place regarding the roles and responsibilities of FLGMs and CWGs in the context of UP governance.

Finally, the lack of affordable pit de-sludging services and treatment/disposal options are of increasing concern, especially as latrine use rises. Pit wastes continue to be disposed untreated into water bodies.



Innovations for Poverty Action (IPA)Research Focus: This study by researchers at IPA15 seeks to answer two related questions: do rural sanitation campaigns impact migrant (worker) behaviors when they move to cities and towns? Conversely, do migrant workers bring back sanitation habits acquired in cities and towns to their home villages?

Methodology: Two sets of experiments were conducted:

1. Sanitation campaigns16 were randomly assigned to rural villages, and the sanitation behaviors of migrants from those villages were tracked when they moved to cities and towns.

2. Incentives to seasonally migrate were randomly assigned to rural residents,17 encouraging them to move to cities and towns for work during the slack season. The sanitation behaviors of returning migrants were tracked, both at their destination and at their origin.

Discussion of Findings: The study still has at least one more round of data collection to go, so results are preliminary at this point. For Experiment 1 (effects of sanitation campaigns on the sanitation practices of migrants) the following results were observed:

• Sanitation campaigns decrease OD among migrants

• Migrants from households who invested in latrines (through randomized subsidies) are less likely to practice OD at their destination

For Experiment 2 (effects of migration on sanitation behavior of returning migrants):

• Adults who migrate are much more likely to practice OD when they return home if they migrated to high-OD destinations (such as small towns). Adults who migrate to a low OD area (such as a city) show no difference in OD behavior against the control group.

Does Sanitation Behavior Migrate?Institution: Innovations for Poverty ActionResearcher: Dr Ahmed Mushfiq MobarakLocation: BangladeshDates: Sep 2013 – Sep 2015Information: A Mushfiq Mobarak ahmed mobarak@yale edu

Next steps: The research continues and once data collection is complete, findings will be published. Any implications for program design or implementation will be considered jointly with implementing organizations.

Previous research: IPA conducted an earlier study (2011-13) in Bangladesh entitled Inter-Linkages in Sanitation Demand across Households, in partnership with WaterAid Bangladesh and Village Education Resource Center (VERC). The research was conducted in rural areas of Tanore Upazila (located about 265 km northwest of Dhaka).

The research (an RCT conducted in 380 villages) focused on testing the effectiveness of different types of sanitation interventions intended to increase hygienic latrine ownership. Key questions addressed:

• Is demand generation necessary or sufficient?

• Is a supply-side push necessary or sufficient?

• Are subsidies necessary?

• Who should you subsidize? How should you subsidize?

The demand-generating approach, referred to as the ‘latrine promotion program’ (LPP) was a version of CLTS carried out by VERC. The supply program (latrine supply agent or LSA) was a respected community member with knowledge of sanitation technology. The subsidy program was run as a lottery among poorer households, and if awarded would cover about 75% of hygienic latrine cost.

Result of previous research: CLTS or latrine supply alone did not lead to large changes

in latrine ownership relative to the control group. CLTS + subsidy had the biggest

impact (and even households that did not win the subsidy showed a big increase).


Effect on latrine ownership was greatest for the subsidy treatment-eligible households were 16% more likely than those in control villages to own a latrine (averaging for those who both won and lost the subsidy lottery). Households in the LPP + Subsidy treatment group were 14% more likely to have latrines than in the LPP only group. Even subsidy lottery ‘losers’ were 7% more likely to own latrines (than control villages), indicating that sanitation investment decisions made by one household were influenced by those made by another. This is an important finding, because program implementers have often made the assumption that providing a subsidy to some discourages others from investing in a toilet. In this study, this was not the case. The LPP-only group had the lowest increase in latrine ownership (around 6%).

The small effects of the LPP Only and Supply Only treatments suggest that lack of information about the benefits of improved

sanitation or lack of access to markets for toilet components are not the key deterrents to sanitation investments in this setting. Instead, the results suggest that financial constraints are an important limiting factor. Asking community members to make a joint investment commitment is a good idea, but study results suggest this should be accompanied by subsidies targeted to the poorest members of the community. Further analysis of the data from this study will further investigate the links between subsidies and investment decisions by others. Shame, aspiration or changing social norms could all be at play in this case (do richer households buy a latrine after the poorer households receive a subsidy because they are ashamed of remaining without toilet? Or are poorer households investing because they aspire to be like their richer neighbors? Or does the provision of a large number of subsidies help change social norms in the community?). Further results and any implications for programs will be published as they become available.

Sanitation Quality, Use, Access, and Trends (SQUAT Report); and Switching StudyInstitution: Research Institute for

Compassionate EconomicsResearchers: Dr Dean Spears, Sangita Vyas,

and othersLocation: India (5 states)Dates: March 2013 – August 2015Information: Dean Spears dean@riceinstitute org Sangita Vyas sangita@riceinstitute org http://riceinstitute org/research/

Research Institute for Compassionate Economics (r.i.c.e.)Research Focus: These related studies examined the drivers of OD in India, including links between OD and culture, and the reasons why people use or do not use latrines.

Methodology: For the SQUAT Report, 3,200 households in 13 districts were sampled in 5 states.18 The sampled states are home to one third of the global OD population. The data were analyzed quantitatively. The Switching Study19 was a semi-quantitative survey using structured interviews (100 conducted) across Gujarat, Haryana, Uttar Pradesh and the Nepali terai.

Discussion of Findings: India with its very high OD rate is an outlier compared to other Asian and South Asian countries. Simple latrines are unpopular in India, especially in the northern plains states, though they have gained popularity in many other countries in the region and in Africa. Comparing India to other countries, India’s higher OD rate does not appear to be correlated with income, poverty, education, or access to water. Importantly, access to sanitation is not really the answer—even households with latrines still have members which practice OD—as many as 40% or more of rural household members with latrines may still OD.

Another important finding is that Government-constructed or supported latrines are less likely to be used than private latrines. One reason is that private latrines typically have much larger-capacity pits which require much less frequent emptying.

Figure 1: Males from HHs with latrines who practice OD (SQUAT survey results).



OD practices and low preference for latrines appears linked to cultural beliefs about ‘purity’ and ‘pollution’. The presence of a latrine in the home is seen as ‘polluting’, whereas OD is seen as pleasant, invigorating, and a healthy lifestyle practice. Latrine use is also associated with weakness—they are built for the convenience of sick people, the elderly, young children, and women who recently delivered a baby; i.e., people who would have a hard time walking long distances to defecate. Relatively few interviewees expressed interest in having a latrine, when given a choice of other consumer goods.

Moreover, higher-caste members do not prefer simple pit latrines because they require more frequent emptying (and contact with pit emptiers, who are seen as polluting). At the same time, lower-caste members want to distance themselves from manual scavenging and pit emptying as symbols of the past and of oppression.

These findings help explain the high rate of OD, the preference for private over Government latrines, and the difficulty of promoting latrines in areas with limited space around the household. Therefore, solving the OD problem in India will

require much stronger attention to drivers of behavior, which include religious and cultural values, among other challenges.

Next steps: The preference for very large latrine pits and related cultural preferences will be key issues to address in any sanitation campaign. These policy issues should be discussed with local, state and national government.

New questions being considered in ongoing research include analysis of cultural links to the Infant Mortality Rate, and possible links between sanitation and anemia.

Previous research: R.i.c.e. has carried out a number of studies on the correlation between stunting and OD—starting with the Indian question (why are children in India shorter, on average, than children in sub-Saharan Africa who are poorer, on average?) as well as performing similar analyses on other country data sets. The findings demonstrate strong correlations between stunting and the percent of households who engage in OD. These results, and numerous related research studies, can be found on the r.i.c.e. website.

Community-Based Environmental Health Promotion Programme in RwandaGrantee: Africa AheadPartners: Ministry of Health Location: Rwanda (Rusizi District)Dates: October 2013 - December 2016Information: Anthony Waterkeyn anthony@africaahead com

Africa Ahead Description and Approach: This project tests the effectiveness of different approaches of Community Health Clubs (CHC); the evaluation seeks to distinguish between two levels of intervention: the ‘Classic’ CHC approach and a ‘Lite’ version. The ‘Classic CHC’ model claims to achieve high levels of hygiene behavior change together with holistic preventative health outcomes (that includes ODF, demand for improved sanitation, and hand-washing) together with significantly strengthened social cohesion and the empowerment of women. The research will employ an RCT to test the effectiveness of the two different

intensities of CHC interventions. The ‘Lite’ version is more in line with the PHAST20 method of health and hygiene education. The CHC model was adopted for the Rwandan Community-Based Environmental Health Promotion Programme (CBEHPP) because previous research had demonstrated CHCs capable of achieving high levels of cost-effective behavior change. This project randomly selected 150 villages and is delivering the ‘Classic’ (20-module) version of CHC trainings to 50 villages; 50 villages are receiving the ‘Lite’ version, and the rest are control villages. (All Lite and Control villages will receive ‘Classic’ CHC training after the RCT is completed in early 2016).

Accomplishments to Date: After six months of intervention, field monitoring indicates participating households (8,420) have made significant gains with an average 41% improvement in hygiene behaviors across 14 water and home hygiene indicators. Anecdotal evidence suggests district and sub-district leadership are becoming engaged with the CHCs and are taking responsibility for supporting their preventative health and hygiene efforts. Some CHCs are forming village-based enterprises, registering as cooperatives, and opening bank accounts. Such promising developments will continue to be monitored and supported. The evaluation’s RCT results will not be available until the beginning of 2016. In the meantime, impressed with the results to date, the MoH has called for a scale-up of CHCs nationally.

INTEGRATED IMPLEMENTATION AND RESEARCH PROJECTS


Innovations in Sustainable Sanitation in BangladeshGrantee: BRACPartner: IRC Location: Bangladesh Dates: Oct 2011 – August 2015Information: Md Akramul Islam Ingeborg Krukkert akramul mi@brac net krukkert@ircwash orghttp://wash brac net/ www ircwash org/home

BRACDescription and Approach: This grant supports BRAC’s WASH II program, which covers half the country’s upazilas21 and whose overall targets included reaching 51 million people. The Foundation sought to reach at least 1.2 million persons with the funds it provided; as of December 2014, BRAC had reached nearly 4.5 million (who have obtained new or upgraded latrines). The project used a community-based integrated approach and also provided financial subsidies for the ultra-poor,22 and loans for poor households. The project sought to increase sanitation coverage as well as sustaining it by strengthening demand, supply, finance, and enabling environment. Foundation-specific components included reaching the poorest; emptying pit latrines and producing organic compost from the composted waste; adoption of the approach by government and other NGOs, cost analysis (WashCost); and using smart phones for monitoring. Additional support for BRAC’s WASH II program (and for the earlier WASH I program) was provided by the Dutch government (DGIS).

The BRAC project aimed to bring sanitation services to at least 1 million people in the existing 152 upazilas, and at least 225,000 people in five new upazilas. In addition, targets were specified for sustainable sanitation use (measured six months after implementation); the design of a “waste to energy” component focused on handling waste from latrine pits; and the replication of WASH II project approaches by others. In fact, the project (which will finish later this year) exceeded “satisfactory” project target levels on almost every key indicator (reaching “excellent” on many), according to an independent verification study completed as part of the BDS grant incentive payment scheme.

Some of the result areas have been supported by BRAC’s knowledge partner, IRC. IRC was jointly en-gaged by the Dutch government and the Foundation to focus on qualitative monitoring, strengthening the sanitation supply chain, hygiene

promotion, and documentation and learning. IRC also was coordinating action research to address some of the key challenges identified in phase one of BRAC WASH, including low-cost sanitation technologies for high water table areas, business models for turning waste into energy, composting options for pit contents, and ways to simplify monitoring and reporting processes.

Project objectives included:

• Improved understanding of what it takes to reach the hardcore poor and greater effectiveness reaching them through the project;

• Improved understanding of long term sustainability and factors influencing it;

• Pilot-scale “sustainability” efforts to identify new solutions for pit emptying, including micro-production of organic fertilizer and producing energy from fecal sludge combined with agriculture waste;23

• Availability of low cost latrine options for use in challenging areas;

• Adoption of components of the project model by local government and other agencies (e.g., use of twin pit latrines, copying of “sustainability” pilots).

Accomplishments to Date: Over the past eight years BRAC WASH has set new standards for large-scale interventions in low-income rural communities. BRAC has combined mass mobilization, community participation and leadership, and behavior change campaigns—facilitated by well-organized management strategies. BRAC also made substantial progress in monitoring hygiene practices at scale and in developing a unified monitoring platform for key program data including finance.

Private business supplying latrine components to rural customers.



GOALS ACCOMPLISHED TO DATE

1,225,000 persons with sanitation services in 157 Upazilas

4,004,425 persons with new latrines;

452,715 persons with repaired latrines

95% sustained access in target areas (baseline of 51%)

98% sustained access

Selection of poor & ultra poor: 600,000

650,514 households

Grant support to ultra poor: 132,177

145,529 households

Loan support to poor: 14,880

14,880 households

Rural Sanitation Centers (RSCs): 53

5324

Entrepreneurs to market organic fertilizer: 8

2

Low-cost sanitation optionsAction research completed; report due in 2015

Pit composting options874,000 twin pit latrines in use in 157 Upazilas

Menstrual hygiene management

Over 12 million cluster meetings with women’s groups; over 2 million cluster meetings with adolescent girls25

Health volunteers sold over 1 million bars of soap; 1 1 million sanitary napkin packets

Adoption of project model components by local government and other agencies

Twin pit latrine model adopted by government agencies, RSCs and NGOs at community level

Key Learnings from project:

• Integrated approach to hygiene, sanitation and water can deliver long-term change. However, sustained behavior change requires time, patience and frequent interpersonal and gender-targeted communication.

• Availability of water is crucial for maintaining hygienic behavior.

• Strong staffing commitment to hygiene behavior change was a key to success—BRAC trained over 8,000 staff to improve their communication skills.

• Strong political commitment, government support, and collaboration with NGOs, CSOs, and other partners played a crucial role in the project’s success.

• Grants given to ultra-poor only after coverage reached 60% (demonstrating community commitment).

• BRAC target was 90% coverage (achievement was 98%). This high coverage figure was reached across all economic strata, and did not exclude the poor or ultra-poor (90% of all toilets resulting from the project reached ultra poor or poor households).

Next Steps: The Foundation’s project is almost completed, but reaching the ‘last mile’ still remains a priority, along with sustaining gains made during the project. This goes especially for the ultra-poor, who often find it expensive to maintain hygienic behaviors. Also, further research is needed to develop low-cost and sustainable sanitation technologies for challenging hydrogeologic conditions.

Principal accomplishments include:


Ghana: Sanitation and Hygiene in Small Towns and Rural Areas Grantee: CWSAPartners: AFD and EIB Location: Ghana Dates: June 2014 - December 2018Information: Theodora Adomako-Adjei Adomakoadjeit@yahoo com

Community Water and Sanitation Agency of Ghana (CWSA)Description and Approach: This project was originally designed to establish an innovations unit at CWSA, to support a €80 million sanitation and water supply program for small towns and rural areas, financed through loans from the French government (AFD) and the European Investment Bank (EIB). The Foundation grant was restructured when the loan was canceled; however, the planned feasibility study of technical options for Fecal Sludge Management (FSM) in small towns and rural areas has moved forward. Possible next steps depend on the results of the study.

Project Goals and Accomplishments: The FSM study is underway and should provide an overview of existing public and private options used by households, institutions and public facilities. The study includes a review of national policy and strategy, as well as management, business, and operating models for fecal sludge collection, transportation, treatment and disposal or re-use. The results are expected in the first half of 2015 and will be used by CWSA to pilot sanitation options and associated FSM practices for institutions (such as schools and clinics) and public places (such as markets and bus stops). A national FSM strategy will be developed on the basis of the study and pilot results.

Residents walk by an open sewer in a slum (Accra, Ghana, January 2014).



Community Hygiene Output Based Aid (CHOBA) Grantee: East Meets West FoundationPartner: Water and Sanitation Reference Center;

Mekong Development Research InstituteLocation: Vietnam and Cambodia Dates: May 2012 – June 2016Information: Jeff Albert jeff albert@thrivenetworks org http://thrivenetworks org/impact/case-studies

East Meets West Foundation (EMW)26

Description and Approach: This project merges sanitation financing, hygiene education, marketing, financial transfers and rewards, and output-based aid in an effort to deliver hygienic latrines and septic systems in rural Vietnam and Cambodia, with a strong emphasis on low-income households. CHOBA is designed to address two challenges: first, it seeks to accelerate the climb up the sanitation ladder; and second, it focuses explicitly on the poorest 40% of the rural population. With these challenges in mind, standard CLTS approaches are not applicable.

In Vietnam, the main implementing organization is the Vietnam Women’s Union (VWU), a government-affiliated mass membership organization whose provincial chapters field 2,500 volunteers to promote hygiene behavior change and motivate the construction of sanitary latrines. Critically, these VWU motivators connect target households with sanitation hardware providers and construction contractors while also facilitating access to consumer credit. Both EMW and the VWU are compensated for the development and management expenses only after producing well-defined outputs: hygienic latrines built and used by poor households. VWU motivators in turn earn modest financial rewards for each poor household that elects to purchase a latrine. In Cambodia, these facilitation functions are assumed largely by Village Chiefs, Village Commune Councils, and the Provincial Departments of Rural Development (PDRDs).

Another program element intended to incentivize household action are 1) a “consumer rebate” following verification of a properly built hygienic latrine and evidence of usage; and 2) conditional cash transfers to local government authorities when communities reach certain sanitation coverage targets.

Key Learnings: A well-structured results-based payment approach can change the mind-set of field workers who, even when well-intentioned,

tend to go for the ‘low hanging fruit’ (i.e., better-off households who can more easily afford to build latrines). Under the OBA system, field workers provide more help to poor households and get more effective penetration of the lowest quintiles. In 2014 the project reached an average of nearly 7,800 low-income households per month (Vietnam and Cambodia combined) with peak monthly latrine output surpassing 11,300.

An accurate monitoring and verification system needs to be an integral part of the project to ensure incentive payments are fairly distributed, and to reach the poorest income strata.

GOALS ACCOMPLISHED TO DATE

110,825 poor households in Vietnam and 50,558 in Cambodia install and use hygienic latrines

85,926 poor households in Vietnam and 42,023 in Cambodia mobilized as of February 2015

Target communes reach 30% increase in sanitation coverage from baseline, and 95% coverage in about 71 communes

37 communes reach at least 30% increase in coverage; 95% coverage in 1 commune in Vietnam

Improved hygiene behavior in target communes

Hygiene promoted by VWU as part of national campaign (“clean house, clean community and clean nation”) Hygiene messages communicated in various meetings with beneficiaries In Cambodia

Set up monitoring, evaluation and learning (MEL) systems

MEL systems set up as planned Baseline data in Vietnam for 1 million households, and about 220,000 households in Cambodia Information used to perform analysis and refine approach Data collection by tablet, directly populating a database “in the cloud” with extensive information and analytical capacity

Conduct research to evaluate EMW's approach and to provide evidence for large-scale replication

RCT on effects of consumer rebates and CCT is ongoing in Vietnam Mid-term survey conducted end of 2013 Final survey (Hai Duong) conducted January 2015; Tien Giang survey scheduled March 2015 In Cambodia, research underway on OBA incentives and sanitation marketing

Project Goals and Accomplishments:


Sanitation Marketing Scale-Up Project (SMSU) Grantee: International Development EnterprisesPartner: Cambodian Government, PATH, WSP,

IDinsight, WSP, 17 TriggersLocation: Cambodia (60 districts in 7 provinces)Dates: October 2011 – October 2014Information: Yi Wei ywei@ide-cambodia orghttp://www ide-cambodia org/

Moreover, a range of incentive types may be needed for different stakeholders (e.g., household rebates, incentive for volunteers, and conditional cash transfers for communes—that are focused on both reaching the poor and improving coverage). Different approaches may be needed even for the extremely poor.

Government buy-in and commitment are critical for scaling up. Incentive and management payments to government authorities may require fine-tuning; indeed, CHOBA’s had to be restructured early on during implementation to make sure they were more effective at engaging government. Also important for scalability is the way verification is set up, and trade-offs between accuracy and cost may need to be made (at larger scale of implementation, it will be difficult and costly to verify all applications made, the way they are now).

RCT results have so far confirmed that CHOBA incentives effectively encourage poor households to climb the sanitation ladder and install hygienic latrines. Results also indicate consumer rebates have a greater impact on sanitation improvements than CCTs (which are paid to the community). Final surveys will provide further evidence for these analyses.

Overall, results-based payments have helped increase project effectiveness and sharpened its focus on reaching the poor. However, it has taken time to build the capacity and trust required to implement this relatively complex programmatic approach.

CHOBA has demonstrated that there is indeed considerable consumer demand for household sanitation in both Vietnam and Cambodia, though financing remains a significant issue. Most sanitation investments in Cambodia tend to be financed by family savings and loans from friends and relatives. In Vietnam, however, access to affordable credit from microfinance institutions appears to play a major role in moving poor households up the sanitation ladder.

Remaining challenges: Reducing operational costs (and in particular the costs of latrine hardware components and construction) as well as finding ways to more accurately measure hygiene (and other types of) behavior change are two areas of focus. Strategically, EMW is actively seeking to transition the OBA approach from a donor-supported model to one that is self-sustaining.

Next steps: The final phase of the project will focus on CCT implementation and transitions to commercialization. EMW also is piloting a commercialization model that seeks to address the challenges of transitioning to a self-financing model, as well as maintaining the high output achieved by the VMU during the project.

International Development Enterprises (iDE)Description and Approach: The SMSU project set out to determine whether commercial sales of latrines through private businesses and sales agents could be scaled up and also reach the poor. SMSU follows on an earlier program that, among other activities, developed the “Easy Latrine” for the rural Cambodian market. The award-winning Easy Latrine was developed through a ‘Human Centered Design” approach and made a number of significant breakthroughs, chief among which was it provided an aspirational model that was convenient, desirable, and affordable for a rural household, and attractive for local enterprises to produce and sell. iDE’s role was to improve the consumer sanitation experience by streamlining the supply chain, developing a direct sales team, and engaging local government. This disrupted the formerly fragmented market in which households had to exert significant effort to procure a desired sanitation solution, and businesses were only catering to wealthy households.

SMSU also set ambitious project targets, and had met or exceeded most of them, demonstrating that a market-based approach can effectively increase sanitation coverage in Cambodia at almost seven times the typical background rate.27 The project collected strong evidence that providing access to affordable financing options at the point of sale increases sales (by a factor of 4). Training businesses and sales agents to conduct effective marketing and direct sales has helped to close deals at the household level.

Key Learnings: Rural Cambodian households are willing and able to purchase a desirable sanitation solution at market price without subsidy, and at scale. Moreover, businesses are willing to invest in the sanitation market and cater to low-income rural households. Microfinance, if available to latrine purchasers, was shown to have the potential to increase market demand four-fold. However, MFIs have so far been reluctant to expand their services for household sanitation loans.



Direct sales in communities worked well as a means of reaching the rural poor. However, most private businesses were reluctant to hire and manage a sales team, so iDE has taken on a greater role of supporting sales.

Remaining Challenges: Ensuring access to an adequate supply of latrines and microfinance has been a constraint. Therefore, iDE is focusing on “unblocking” the supply chain and exploring whether an in-house microfinance capacity would be an effective way to alleviate this problem. iDE has also sought ways to establish effective, targeted financial subsidies for the poor to increase sales (in partnership with East Meets West/CHOBA project).

Affordably and sustainably addressing sanitation needs in challenging environments (e.g., flood-prone areas, collapsing soils) continues to be a concern in Cambodia, as well as in many other countries. Fecal sludge management, especially in the rural context, remains a challenge, especially in the context of financial viability.

Next Steps: The SMSU Project has been completed; however, iDE will continue the program with other sources of support, aiming to increase rural sanitation coverage from the current 45% to 74% in three years. Work will continue on scaling up microcredit for latrines, developing and marketing low-cost superstructures, bundling latrines sales with sales of household water filters and hand hygiene products, and testing further smart subsidy interventions.

KEY MILESTONES BASELINE28 TARGET(SATISFACTORY LEVEL)

TARGET(EXCELLENT LEVEL) ACHIEVEMENT

70,000 latrines purchased from project-connected enterprises N/A 70,000 140,000 141,030

45,000 latrines purchased in target districts from enterprises not connected to the project

N/A 45,000 N/A 90,138

41% total latrine coverage in target districts 29% 41% 60% 45%

10,500 latrines purchased by poor households from project-connected enterprises and/or through project-connected finance mechanisms

N/A 10,500 42,000 30,191

90 enterprises profitably serving rural households with affordable sanitary latrines

N/A 90 N/A 12429

Project Goals and Accomplishments:

Figure 2: Sanitation marketing is taking off in Cambodia

Accomplishments to Date: The project set and has met or exceeded most of its original targets (see Table above).


Testing CLTS Approaches for Scalability (TCAS)Grantee: Plan International USA Partner: University of North CarolinaLocation: Ghana, Ethiopia, Kenya Dates: October 2011 – September 2015Information: Darren Saywell Darren Saywell@planusa org Jonny Crocker jonny crocker@unc edu http://www planusa org/content2675015http://waterinstitute unc edu/clts/

Plan International and University of North Carolina (Plan/UNC) Description and Approach: The TCAS project aims to learn, capture and share reliable and unbiased information on CLTS approaches and scalability. TCAS is exploring how to overcome selected implementation challenges while maintaining quality and containing costs. A key aspect of this is to experiment with the roles of different ‘local actors’ in three focus countries: natural leaders in Ghana, teachers in Ethiopia, and district officials in Kenya. A range of research and learning activities also are integrated into the project, including seven CLTS case studies, a global review of literature on the effectiveness of CLTS, and detailed evaluations of the three country-level efforts. Local, regional, and global learning and dissemination events are planned to ensure that TCAS’ findings reach a wide range of stakeholders.

Accomplishments to Date: The early phase of the project included desk-based reviews (led by UNC researchers) to systematically review the formal (peer-reviewed) and informal (grey) literature on the effectiveness and impact of CLTS programs. A key finding of the review of formal literature is that there is very little of it—an extensive search yielded only 18 peer-reviewed articles dealing with CLTS or total sanitation approaches. The findings of this review included:

• The focus was mainly on project impacts, although study designs were often inappropriate for the types of conclusions drawn

• Generally, CLTS was found to have a positive impact on latrine access and usage

• Children identified as effective behavior change agents for peers in schools

• Natural leaders, teachers, and local government actors identified as community change agents, but no rigorous evidence was provided on their actual effectiveness

• More rigorous evaluations of CLTS impact are needed, including on the effectiveness of the various techniques used by CLTS on long-term behavior change

The search for informal literature on CLTS turned up more than six times as much documentation—115 relevant reports were found, mainly on projects (often in the form of case studies) produced by international NGOs and international organizations like WSP and IDS. The informal literature review found that:

• Generally, CLTS case studies were done on ‘successful projects’

• Methodology was less rigorous than those documented in formal literature

• Focus was on project processes and implementation (not impacts)

• Structured post-triggering follow-up activities helped communities eliminate OD. Visits by ‘outsiders’ were considered most effective.

• Natural leaders, teachers, and local government actors identified as change agents, but no rigorous evidence on their impact on CLTS (same finding as for formal literature)

• Children and women often cited as most effective natural leaders; teachers mainly mentioned in only in the context of “school-led” CLTS projects

• Greater rigor and consistency is needed in project monitoring and evaluation methods (so as to generate better data on project performance)

The project’s integrated implementation and research phase

At the convening, posters and drawings were used to highlight progress and setbacks.



was informed by the literature review phase, and was designed to provide rigorous evidence with regards to the effectiveness of natural leaders, teachers, and local government in CLTS campaigns. Implementation is mostly completed in the three target countries, and evaluation of those efforts is currently underway. Preliminary findings from Ethiopia (where teacher-facilitated CLTS was the focus of the research) suggest the following:

• Teachers may be more appropriate in supporting roles, rather than leading

• Kebele (village cluster) administrators seemed to be the most important actors (an unexpected finding)

• CLTS seems to work best in settings where baseline latrine access is low and OD is high

Preliminary findings from three regions in Ghana (where training CLTS natural leaders was the focus of the research) suggest the following:

• CLTS facilitation intensity varied between regions and throughout the year

• Intensive Natural Leader training required about 50% more facilitation time

• Natural Leader training had positive impacts in all 3 regions

• Natural leader training impact was greatest in Ghana’s Upper West region, possibly because

o Upper West is more remote, with low expectation of sanitation subsidies

o Communities are smaller, more homogenous and cohesive

o There is little to no reliance on communal or shared latrines

Figure 3: Household Sanitation Access & Practices after 18 months of CLTS

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Dig & Bury Communal Latrtine

Shared Latrine

Private Latrine

Overall results in Ghana showed a rise of about 25% in use of private and shared latrines, and a drop of 22% in OD. In Upper West, the share of private and shared latrines rose from about 17% to 65%, an increase of about 48%.

Research in Kenya is still under way and the findings will be analyzed in the coming months. Early findings suggest that the training and engagement of local government officials appears to have improved budget allocations for sanitation, and possibly individual performance. Financial flow systems are critically important and can create bottlenecks to scaling.

Next steps: The project is scheduled to be completed during 2015. The focus of remaining activities will include a deeper analysis of cost effectiveness data, completion of the Kenya research, developing final conclusions and findings, carrying out learning events, and other information dissemination efforts.


Supporting Sustainable Sanitation Improvements through Supply-Side Strengthening (3SI)Grantee: Population Services International Partners: Monitor Deloitte, Water for PeopleLocation: India (Bihar State)Dates: July 2012 – June 2017Information:Shankar Narayan shankara@psi org in http://www psi org/publication/getting-to-know-psis-market-based-sanitation-work-in-india/http://www inclusive-markets org/sanitation

Population Services International (PSI) Description and Approach: The 3SI project will demonstrate the potential for market-based solutions to increase access to improved toilet facilities among the poor in Bihar through a mix of private and public sector support. Market research was conducted to analyze consumer needs, aspirations and ability to pay. In addition, the project studied the private sector to assess its existing capacity and needs, and to develop more effective business models and toilet designs. The project also will demonstrate innovative financing approaches to increase coverage, as well as helping generate demand through multi-media sales and marketing campaigns.

Accomplishments to Date: Market research30 has shown that latent demand for toilets exists—84% of households expressed a desired to own a toilet, and 38% had already researched the options. However, the lack of affordable, aspirational products remains a major market constraint in Bihar, as elsewhere. Analysis of the current household toilet designs suggests it might be possible to reduce toilet cost further by improving design and other efficiencies.

Financing is also a significant constraint, as households rarely have sufficient cash on hand for a toilet purchase, and there are other products and services which are in higher demand. Availability of affordable credit and targeted subsidies to the poor would facilitate sales, especially to base of pyramid (BoP) consumers. Existing Government of India sanitation financing schemes could help in this regard, especially if the Government scheme could be integrated with an improved sanitation marketplace and more efficient targeting of the poor.

Additional learnings from project include:

• Demand for sanitation in Bihar is driven by convenience,

privacy and other social-status concerns. Health is not an important driver.

• Consumers want a high quality product that does not require frequent emptying. However, existing models usually cost the equivalent of $400 or more, and may require engaging with multiple businesses/providers.

• Availability of affordable credit can help move consumers; however, lowest quintiles may require partial to full subsidies.

• The ideal envisioned solution was a ‘Turnkey Service Provider’ model, however a lighter-touch model based around Cement Ring Manufacturers (where enterprises provide substructure and toilet components to consumers) is proving to be more appropriate (primarily because it lowers costs).

To date, around 9,400 toilets have been sold by sanitation enterprises, with over 84,000 households visited. One third of the toilets sold were to BoP customers, and roughly 5% were sold with loans.

Next Steps: Developing a platform for sanitation loans through MFI partners; creating an enabling environment for customers to get access to subsidies; and an increased focus on demand generation through Behavior Change Communication campaigns.

Proud owner in front of her newly completed latrine.



Women’s Empowerment and Poverty Reduction ProjectGrantee: Rajiv Gandhi Mahila Vikas Pariyojana (RGMVP) Partners: Shramik Bharti and International Center for Research on WomenLocation: India (Uttar Pradesh State)Dates: Oct 2012 – June 2015Information: Krapal Singh ksyadav@rgmvp org http://www rgmvp org/programmes-health asp?lk=pr3Twitter: @RGMVP

Rajiv Gandhi Mahila Vikas Pariyojana (RGMVP)Description and Approach: The project aims to increase the number of poor women organized into Self-Help Groups (SHGs) and SHG federations, and to test efficacy of community institutions to promote improved sanitation and hygiene practices in parts of Sultanpur and Amethi Districts in Uttar Pradesh. Learning questions being addressed include:

• Does building of social capital through SHGs improve hygiene and sanitation outcomes in the community?

• Do expedited SHG models and their sanitation interventions lead to similar outcomes as the full-scope, phased SHG (Model 1 below)?

• How do these compare with the normal Government sanitation promotion approach?

• What is the cost effectiveness of these models?

The four ‘models’ being tested are:

1. RGMVP sanitation interventions as part of larger package of community strengthening with mature SHGs

2. RGMVP sanitation interventions delivered simultaneously with SHG formations in new villages

3. Standalone sanitation interventions by Shramik Bharti in villages where no SHGs are present

4. Control villages with interventions under the Government of India’s sanitation campaign

Each model is tested in 40 selected villages (160 total) selected randomly from the two target districts. The target area’s baseline survey highlights the extent of the sanitation challenge being faced:

• 97% of population reported engaging in OD

• Average time to reach OD site from home is 30 minutes

• Toilets available at only 9.4% of households.

• 85% of women do not have hygienic menstrual hygiene practices31

Accomplishments to Date: Historically, RGMVP has organized over 1.4 million poor households into over 120,000 SHGs, as well as forming over 150 “Block Organizations” and over 5,000 Village Organizations across 42 districts. These bodies address issues related to health, collective social action, human rights, and access to credit. The research effort is being implemented in 160 villages out of over 50,000 villages where RGMVP has a presence.

During the project, RGMVP or their community partners have:

• Delivered over 300 WASH training sessions

• Delivered over 200 sessions on menstrual hygiene management (MHM)

• Organized and trained 63 Young Women’s SHGs

• Renovated 786 defunct toilets, and constructed 132 new toilets using SHG funds

• Facilitated 537 new toilets ‘sanctioned for construction’ by Government scheme

Preliminary results monitoring indicates that over 1000 women in 44 villages have improved MHM practices; improved WASH hygiene practices are also reported (hand washing with soap; improved water handling, and household water treatment). Young Women SHGs also have taken on key roles in spreading sanitation awareness and adopting and spreading behavior change in sanitation and hygiene practices.

Next Steps: The project continues to implement the various SHG models and will carry out end line surveys and data analysis during April to June 2015. Some of the key challenges the project will continue to seek to overcome:

• Extreme poverty of many residents in the target areas

• Trying to change behavior over a relatively short span of time

• Lack of awareness about Government sanitation programs

• Constraints on the supply side in meeting increased demand for sanitation

• Lack of land (space) required to construct a latrine at many households


Scaling Up and Strengthening Community Approaches to Total SanitationGrantee: UNICEFPartners: Government and civil society PartnersLocation: Indonesia and MalawiDates: November 2012 – November 2016Information:Global: Lizette Burgers lburgers@unicef orgAfrica: Ann Thomas athomas@unicef orgAsia: Chander Badloe cbadloe@unicef org

UNICEFDescription and Approach: UNICEF supports implementation of CLTS or CATS programs in a large number of countries globally, mostly in Africa and Asia. This project is designed to support CATS innovations and implementation strategies in two countries—Malawi and Indonesia—and to distil and disseminate lessons learned to other UNICEF country programs in Africa and Asia. Among other goals, the project seeks to meet ambitious ODF ‘hit rates, 32 of 66% and a ‘reach’ target of 85%.

Accomplishments to Date: In Indonesia, access to improved sanitation facilities currently stands at 59% of the population, which is significantly short of the MDG target of 86 percent. An estimated 54 million people still practice OD, or about one quarter of the population. On a country basis, this is second only to the size of the population practicing OD in India.33 UNICEF is supporting Indonesia’s national “STBM”34 campaign to help accelerate sanitation progress. A number of key steps have been taken to systematize STBM, including a Knowledge, Attitudes, and Practice (KAP) survey, a review of existing evidence, development of STBM training materials, establishment of a knowledge management framework, and undertaking Joint Technical Reviews with the Government of Indonesia. New alliances have been built to make sanitation and hygiene communications more effective; and the use of social media has been expanded. However, though the enabling environment in Indonesia is supportive, a number of key challenges remain. Progress achieved against project targets has been off track in terms of number of new latrines constructed. Other challenges include lack of partner implementation capacity, low hit rate of ODF villages, continued fragmentation of the sanitation sector, and impediments to sharing and disseminating lessons learned.

Malawi declared, in its 2011 national sanitation strategy, that 2015 was the year it would achieve 100% ODF. This would be an astonishing achievement, since (as of 2012) Malawi’s national improved sanitation usage rate was only 10%.35 This challenge is in part what led UNICEF to select Malawi as one of the focus countries for this project. UNICEF is supporting the national ODF Task Force, and among other activities has helped to improve the national sanitation monitoring system. The project also is strengthening the supply side through latrine construction and business management training, and a marketing campaign carried out in partnership with PSI. However, cumulative progress has been slower than expected. New ODF communities number 446 (representing over 45,000 households). But the ODF ‘hit rate’ is only 30% after 6 months. Positive examples do exist, including one Traditional Area that has attained ODF and which serves as a constructive role model.

Regionally, UNICEF is engaged in a number of monitoring and learning efforts as part of this project—including:

• Online Sanitation Monitoring Toolkit (published at www.sanitationmonitoringtoolkit.com).

• Supporting Kenya, Mozambique, and Madagascar on CATS reviews and tools development

• Preparing CLTS reviews and case studies

• Learning projects including use of Social Norms Theory, small town approaches to CLTS, regional sanitation supply chains research, and reviews of School Led Total Sanitation

• Learning, and dissemination events

Next Steps: In Indonesia, UNICEF will improve communications and advocacy; promote stronger M&E, assess the potential for more intensive supply-side work, and improve post-triggering data capture and analysis. UNICEF also will increase its focus on accelerating progress in weaker-performing districts.

In Malawi, UNICEF will continue to work with PSI to help strengthen sanitation marketing campaigns, and will increase its focus on strengthening local government leadership of sanitation campaigns.

Across both country programs, UNICEF is focusing on bringing intent to the learning focus and not giving in to “focusing on the numbers” in light of the missed targets. In the long run, unlocking insights into what makes for successful program delivery at scale will be more useful than just delivering against a coverage target.



Sustainable Total Sanitation in NigeriaGrantee: WaterAidPartners: Local Government Authorities; CSOsLocation: Nigeria (Ekiti, Enugu, Jigawa states)Dates: July 2012 – June 2016Information:Ada Oko-Williams adaoko-williams@wateraid orgEphraim Danladi ephraimdanladi@wateraid orgErik Harvey erikharvey@wateraid org Sarah Dobsevage sdobsevage@wateraidamerica org

WaterAid Description and Approach: The project seeks to improve the effectiveness, efficiency, inclusion and sustainability of total sanitation approaches in Jigawa, Ekiti and Enugu States of Nigeria (targeting 625,000 people), and through the learning so generated contribute to wider national and regional good practice. The project encompasses components of implementation, action learning and research, and advocacy.

Accomplishments to Date: To date, 76% of the 382 target communities have been triggered and are undergoing follow-up monitoring. Both demand-side and supply-side research efforts have been completed, and the results are being incorporated into project plans. New community monitoring approaches also have emerged. The CLTS approach has been reviewed; community monitoring forms for effective follow up (towards achieving ODF in triggered communities) also have been developed.

Demand-side research has shown that rural households are increasingly exposed to urban lifestyles and upwardly mobile; there is reasonable access to cash and modern building materials. Yet OD is still a widespread practice. Households express dissatisfaction with this situation, often including their current sanitation facilities—which points to potentially large opportunities for sanitation marketing enterprises. There is little expressed household interest in low-quality latrine investments; but rather a preference to wait and build an ‘ideal’ facility. In terms of motivating forces—external pressure from, and enforcement of local ordinances by village leaders seem to be effective for motivating toilet construction. There is also a positive effect from families returning home from abroad that prompts home improvement projects including household

latrines. On the other hand, the fact that there is no shame in OD means that there is no “internal” personal or family pressure to improve.

Supply-side research has found the latrine purchasing process (through multiple artisans) to be complex, and it is difficult for home owners to estimate the cost of the complete product. Though an extensive rural marketplace infrastructure exists, sanitation hardware retailers and concrete block producers operate in a fragmented manner, and labor must be procured separately. In addition, quality of the finished product varies greatly. Testing of improved sanitation products has been conducted in Ekiti and Enugu States and WaterAid has taken feedback from this process into account when establishing the sanitation marketing approach and when developing sanitation products that appeal to consumers.

Next Steps: WaterAid is continuing its work to rationalize and strengthen the sanitation marketplace, and to integrate these supply-side efforts with demand generation. As part of this effort, WaterAid is trying to improve information about sanitation products and increase transparency regarding pricing, and increasing access to affordable credit and finding other suitable mechanisms for improving financing of sanitation for the poor. Other challenges to be addressed include designing sanitation communication campaigns which can tackle the changing demand situation in communities in an iterative and flexible manner.

A pour-flush latrine with offset pit under construction.


Scaling Up Rural SanitationGrantee: Water and Sanitation ProgramPartners: Governments, civil society, and private sector partnersLocation: India, Indonesia, and Tanzania (plus 10 expansion countries)Dates: 2007 – PresentInformation:Craig Kullman ckullman@worldbank org Yolande Coombes ycoombes@worldbank org Susanna Smets ssmets@worldbank org Joep Verhagen jverhagen@worldbank org http://www wsp org/global-initiatives/global-scaling-sanitation-project

WSP Description and Approach: The World Bank’s Water and Sanitation Program (WSP) has been working with the Foundation since the latter’s WSH effort was still a ‘learning initiative’; WSP’s role has evolved considerably as the Foundation’s engagement with the WSH sector has changed and grown over the years. However, WSP’s core strengths in addressing strategic-level issues with governments as well as advancing innovative implementation approaches in the field have remained central to WSP’s relationship with the Foundation’s WSH program.

WSP’s Scaling Up Rural Sanitation (SURS) business area is an outgrowth of that evolution, and WSP’s mandate is to support governments to catalyze systematic changes for reaching scale in rural sanitation programs at the country level. The geographic focus of WSP engagement has grown rapidly from its initial Total Sanitation and Sanitation Marketing (TSSM) project in India, Indonesia, and Tanzania—to a global learning program covering 13 countries in four regions, including Bangladesh, Cambodia, Ethiopia, Kenya, Lao PDR, Niger, Pakistan, Senegal, the Philippines, Uganda, and Vietnam. Under WSP’s business area “Sustainable Services through Domestic Private Sector Participation”, WSP has worked with governments in some of those as well as additional countries to catalyze private sector service delivery on rural sanitation, such as Bangladesh, Nicaragua, Niger and Peru.

The theory of change involves working on 4 key areas in order to accelerate the pace of sanitation program scale-up:

• Generating demand for improved sanitation at scale

• Strengthening supply of sanitation products at scale

• Strengthening the enabling environment

• Learning and knowledge management

Translating these four strategic pillars into project activities has broadly meant that WSP’s service delivery model has involved the following:

• Problem identification (multi-sector, results-focused)

• Design (utilizing the best ideas and evidence available)

• Implementation and iterative improvement (technical assistance, capacity building, and operational learning)

• Evaluation and learning (sharing knowledge from successes and failures; new products and tools; and promoting south-to-south learning)

Accomplishments to Date: Governments in the original 3 focus countries plus 10 expansion countries have now increased their access to improved sanitation to an aggregate total of over 20 million persons. In addition, the initiative has contributed to ending OD by an additional 19 million persons. While it is not possible to summarize this level of effort in a page or two, some key examples of learning shared at the recent Grantee workshop in Hanoi in 2015 follow below.

It can be a ‘long road’ from fragmented implementation to coherent national sanitation programs. WSP support to the Government of Indonesia began in East Java (rural population of 20 million) in 2007, and based on lessons from failure and success, by 2014 the Government is now implementing a national rural sanitation program (120 million people), supported through a large scale World Bank financed program designed based on lessons from WSP technical assistance.

Specific key learnings from Indonesia are relevant to many country settings, and include:

• A heavy investment in institutional capacity building can pay big dividends over the long term. WSP anchored its capacity building efforts in the existing (pre-service) government training system, helped government develop an accredited training program for in-service professional staff, as well as on-line training as a supporting mechanism. Implementation Guidelines for the Government’s national program were supported, help harmonize implementation and form the backbone of the capacity building program.

• Supporting a process to move from patchwork financing and project delivery, to bringing different sources of finance together for a program that covers all communities in a phased manner in targeted districts.



• Supporting Government monitoring systems and their national scale-up and usage, rather than developing project-based systems.

WSP’s engagement with the sanitation marketplace in Indonesia also has evolved from analyzing sanitation markets and developing new products and services—to operating at a more strategic level. This evolution has taken many years, but has led to a scale-up of the sanitation marketing effort:

1. Filling gaps: Developing and testing new products and business models

2. Promoting business models: Training sanitation entrepreneurs on the ‘one-stop shop approach’

3. Starting an industrial network: Coaching businesses, establishing certification processes, and facilitating access to capital

4. Growth and sustainability: Supporting the network, which has taken shape as a national business association, while it coaches and collaborates with actors throughout the sanitation value chain, and moves to a franchise model to aggregate value-adding services to its members

Another lesson learned is from India, with the Government’s focus on toilet construction, instead of sanitation behaviors WSP has supported central and state government to make a critical shift in thinking to focus on monitoring outcomes, which is critical in an environment where massive resources are being channeled for toilet construction subsidies. The application of a third party mobile monitoring system and its scale-up at national level is transformational in ensuring a focus on results. WSP as part of the World Bank team is supporting the design of a new large-scale rural sanitation loan, originally targeting at least eight lagging states, but recently expanded to cover the whole country, ensuring a focus on results in behavior change.

Cambodia provides another example of the ‘long road’ from fragmentation to harmonized national programs, led by government. With many active sanitation partners, and a lack of harmonized program approaches or financial flow mechanisms, the sanitation sector started out as on the left side of the diagram—with a smorgasbord of actors, approaches, and implementation systems. The Government of Cambodia, together with WSP and sanitation sector partners are actively working towards the situation depicted on the right side of the diagram: a national rural sanitation program led by

government, with decentralized engagement at district level; harmonization of program and financing approaches; increased resource mobilization; and leveraging of national, sub-national and development partner funds.

Next Steps: WSP is actively engaged in the ‘post-2015’ process of establishing global new water, sanitation and hygiene targets—and universal access will likely comprise the core of these new goals. With 2.5 billion people in need of access to sanitation (over 70% of them in rural areas), there is still plenty of work ahead for the entire sector. WSP will continue to work with the Foundation and other partners to 1) Eliminate OD by 2025; 2) reform sanitation policies and accelerate progress towards achieving universal access by 2030; and 3) increase its focus on the elimination of inequalities in access. WSP will carry out two core activities to help governments achieve greater equity in rural sanitation:

• Integrate sanitation into existing nationwide poverty alleviation, health and nutrition programs that target poor households. Key to this will be working with country-led programs that are providing publicly financed subsidies to the poorest to meet other social needs, to learn how subsidies for sanitation can be integrated into these programs without distorting the market.

• Identify opportunities to work with local financial institutions to extend financing to the extreme poor, leveraging subsidies when possible.

Figure 4: From Fragmentation to National Program: Empowering Government at Different Levels while Building on Strength of all Players


Summary and Discussion of What’s Working

CHALLENGES IN GENERATING DEMAND FOR SANITATION

Programs focused on creating demand for sanitation face daunting challenges, depending on the context. These may include:

• Lack of access to easy and affordable credit

• Lack of aspirational and affordable latrine options

• Consumer desire for higher-end options and lack of interest in simple, home-built latrines

• Complicated process to procure a latrine (multiple businesses or persons involved)

• Lack of marketing and sales capacity in the private sanitation sector

• Cultural preferences which favor OD (e g , in India)

• Poor quality implementation (e g , of CLTS triggering or mobilizing)

• Low capacity of implementing agency(ies) and poor coordination

• Heterogeneous population; lack of communal cohesion; conflict; seasonal migration

• Proximity to subsidized programs; expectations of hand-outs at the community level

• Lack of land or space around the home to build a latrine

• Occupants don’t own land (and landlord unwilling to install a latrine)

• Collapsing soils and other physical challenges

• Lack of support from village leaders and/or local Government

Ten issues were identified during the 2013 Sanitation Partners’ Workshop as being of critical importance to effectively and sustainably scale up sanitation programming. How have the partners working on projects within the BDS portfolio been contributing to progress on these issues?

Reaching the poorest at scale.It is the poorest who most lack sanitation services and who are disproportionately affected by the health problems stemming from unhygienic environments. To reach the poorest more efficiently, several sub-issues were identified: the need for continued innovations in demand generation including CLTS; pro-poor credit and marketing schemes; and financial support mechanisms for the poor which do not distort the sanitation marketplace.

Demand Generation.Progress is being made in a number of key areas, including ongoing investigations on how CLTS campaigns can be made more effective, sustainable, and cost efficient. PLAN and UNC are working to better understand the relative impact of different internal actors on CLTS impact; WSP and others are working on harmonizing national approaches and making campaigns more systematic; IDS36 and others are continuing to promote at-scale approaches; future BDS work also will look at identifying drivers of demand in, and effective approaches for, peri-urban and urban environments.

A key challenge with CLTS has been the uneven ODF ‘hit rate’ achieved within and across countries. UNICEF has challenged itself in Malawi and Indonesia with an ambitious project target of 66% ODF communities (per total triggered), with a ‘reach’ target of 85%. The project has more than one year to go, but so far it has proven challenging to achieve those high hit rates. On the other hand, UNICEF’s CLTS program in Mali was able to achieve a hit rate of 97% ODF in the 60 communities that were part of the RCT on CLTS impacts conducted there by CEDLAS. The Mali campaign had a strong focus on post-triggering follow up (weekly visits for 3 to 4 months), which may be part of the reason why this hit rate (and other performance indicators) were so high. While the benefits of intensive post-triggering



follow up are well noted, being able to scale this intensive approach up in a cost-effective manner remains a challenge. The EAWAG-USAID research in Ghana may shed light on the question whether it is possible to design a CLTS-type approach that routinely results in a higher hit rate (which, if this could be done, would lower the cost of attaining ODF).

The Foundation and others are also considering the drawbacks to monitoring primarily “ODF” achievements in CLTS programs. While ODF communities certainly represent a desirable endpoint for CLTS campaigns (and other sanitation campaigns as well) – this metric also results in a binary situation whereby CLTS either ‘succeeds’ (ODF status achieved) or ‘fails’ (ODF not attained). In the latter case there may still be a significant decrease in OD and increase in the access to and use of latrines. The Foundation is already exploring how to accomplish this more nuanced type of monitoring of CLTS performance with help from UNICEF in Indonesia.

Other methods of demand generation are also moving forward. BRAC is using an ‘integrated approach’ to demand generation and hygiene behavior change communication which involves forming, training and supporting village WASH committees, and uses PRA37 techniques (among others) to promote effective WASH improvements. By the very nature of BRAC’s size in Bangladesh, their WASH II program (which the Foundation is supporting) is operating at scale and already reaches many parts of the country. WASH II includes financial incentives for the ultra-poor, and credit financing schemes for the poor.

East Meets West and iDE have made excellent progress generating demand through sanitation marketing efforts. In Vietnam, EMW has used an output-based aid approach to strongly incentivize the implementing agency (Vietnam Women’s Union) to reach the poor with improved sanitation options. Credit and other financial awards are used at various levels in the project to help drive results and enable the poorest to purchase aspirational sanitation systems. In Cambodia, iDE has also reached the poor with improved sanitation through sanitation marketing campaigns backed by affordable financing schemes. However, they have found that microfinance institutions are unwilling to scale up loan portfolios for household sanitation purchases. Also, iDE has found that sanitation-oriented businesses are often reluctant to invest in and manage the direct sales teams required to reach customers at the community level.

New implementation research on sanitation demand generation and behavior change will be conducted on the effectiveness and cost of the Community Health Club model being advocated by Africa Ahead. The integrated research and implementation effort will assess whether a less intensive CHC approach can still deliver results (which would be a more scalable model).

Sanitation financing (including credit schemes, subsidies, and

other interventions) is another important factor to consider in sanitation demand generation. Another factor to consider in sanitation demand generation is the effect and importance of credit schemes, subsides, and other financial interventions. Experience suggests that households are willing investors in on-site sanitation and often pay the bulk of sanitation hardware costs. Toilets are aspirational products and many consumers, including the poor, want higher-quality sanitation products. However, cash flow issues can impede the poor from acting on these decisions. Household sanitation investments also must compete with other spending priorities such as education, health care, communi-cation, transportation, and entertainment.

Subsidies have long been a controversial matter in the sector, with some agencies and experts arguing that subsidies distort the market, confuse the behavior change progress at the community and house-hold level, and create an undesirable dependency on external agencies. Observations made by WaterAid and VERC in Bangladesh in the late 1990s led to the conclusion that hardware subsidies were part of the problem rather than the solution; this in turn led to the development of CLTS as a method of putting communities back in charge of their sanitation decisions.38 Yet more recent research carried out by IPA in Bangladesh39 suggests that generating demand (through CLTS) may have little overall effect on ownership of hygienic latrines without some type of financing being made available. The seeming contradiction raised by these two studies, though they are separated in time by well over a decade,

Volunteers are selected to help organize the village to build latrines during a

Community-Led Total Sanitation (CLTS) triggering session at the Maparanhanga

village (Mozambique, September, 2009).


is indicative of the fact that this issue is still of major concern to sanitation-focused organizations and communities alike.

The modalities employed by agencies using hardware subsidies highlighted in the 2003 publication by Kar and IDS were problematic for a variety of reasons:

• Approaches were not harmonized among agencies and varied considerably.

• Subsidies were often captured by the better-off and did not reach the poorest; little targeting of the poorest took place.

• Poorest households could not afford the required cash investment needed to construct functioning toilets where subsidies took the form of in-kind sanitation hardware components.

• Subsidy funds are usually limited and not sufficient to provide a subsidy to everybody who qualifies for one. This can lead to capture of subsidies by the fastest movers and confusion among those who are left behind.

• Progress was generally measured in terms of the number of toilets built, rather than behavior change (use) or reduction in (or end to) OD.

Additional research and experimentation since the early 2000s has led to greater understanding of how to apply sanitation credit and subsidy schemes in a manner that does not distort markets or create dis-incentives at the household or community level. Some of the contributions that BDS grantees have recently made in this regard include:

• East Meets West in Vietnam found that households would postpone sanitation investment until they had sufficient funding to pay for the type of facility they wanted. In such situations, offering affordable financing to households can act as a catalyst for investment decisions.

• iDE Cambodia, with PATH, saw a 400% increase in demand for Easy Latrines sold at market price when financing was made available. However, MFIs do not appear prepared to scale up this type of consumer loan program, in spite of the 100% repayment rate suggesting that the poor are not risky as creditors had thought.40

• CInI, who work in some of India’s most challenging areas, acts as a financial intermediary to help make Government financing delivery systems more efficient. CInI provides up-front payments to households who want to build toilets; after those toilets are built, households apply for the Government subsidy. When households receive the subsidy, they pay CInI back.

• BRAC in Bangladesh are targeting sanitation subsidies to the ultra-poor, using a clear set of criteria applied during a community census (the recent outcome verification study suggested that BRAC should update household classifications

on a regular basis, as people move out of –but also move into- poverty over time).

• PSI in India’s Bihar State found that households rarely have sufficient cash on hand for a toilet purchase, and other products and services are in greater demand. Affordable credit and targeted subsidies to the poor would facilitate sales to base of pyramid (BoP) consumers; they are exploring how to use existing Government of India financing schemes into a more efficient sanitation marketplace and with better targeting of the poor.

• WSP and IFC in Kenya are working with MFIs to develop and test financing mechanisms that can enable more consumers gain access to new products. Mechanisms may include water, sanitation or housing loans, or working capital loans to sanitation entrepreneurs who can in turn pass on terms of credit to consumers.

These findings point to better ways of supporting sanitation investment, especially by poor households, than those used in the subsidy and hardware-driven programs of the 1990s and early 2000s. Where findings can be translated into clear program- or policy guidance, BDS grantees will be strongly encouraged to publish and share such guidance. Effective uptake in the sector should then lead to adaptation of these improvements to new countries and environments, for further replication and scaling.

Ensuring political support and Government capacity still requires attention—particularly regarding policy harmonization, operational planning, sector coordination, financial contributions, and efficiency of expenditure. Capacity building efforts also must be better coordinated and institutionalized. There has been a lot of progress on this in the past ten years, but there is still a long way to go. Experience from BDS grantees (especially WSP) suggests that these tasks can be accomplished, but that it will take time, significant levels of investment, and a government prepared to lead.

Improving sanitation business models requires new and better sales approaches, simplifying the purchase process, and improving the range and type of products and services sold. These innovations need to continue, and the most effective models scaled up. BDS partners have been making great strides in this arena, including at-scale efforts by iDE’s SMSU project in Cambodia,41 PSI’s 3SI project in Bihar, WSP & IFC’s Selling Sanitation project in Kenya, and others.

Making sanitation more affordable. The cost of hygienic toilets that appeal to consumers has been brought down in many places, but are still generally out of the reach of the poorest. BDS partners who are working on making sanitation options less expensive include:



• American Standard Brands whose Bangladesh-based “Sato Pan” project improved upon the design of inexpensive but poor-quality pour-flush pans sold there. Having succeeded with at-scale sales in Bangladesh (over 700,000 sold), the Foundation is now supporting ASB to develop and trial similar and new types of pans in Sub-Saharan Africa, in partnership with iDE.

• WSP & IFC used Human Centered Design to develop a range of plastic latrine slabs which are affordable ($17 - $55, ex-factory), can be easily transported and stored, and which are an attractive and durable alternative to masonry products. Over 620,000 units have already been sold.

• iDE Cambodia, also using Human Centered Design, developed the Easy Latrine (prior to the Foundation-supported SMSU project). The Easy Latrine, priced at around $50, cost a fraction of what consumers typically paid for made-to-order masonry latrines. Over 140,000 have been sold through the SMSU project.

• PSI in Bihar found that existing toilet options cost $400 or more, and were complex to purchase. Design and production efficiencies have brought this price down significantly, but additional cost efficiencies are still being sought. Over 6,000 of these lower-cost toilets have been sold by sanitation enterprises trained and supported by the project.

Integrating supply-side and demand-generating projects has the potential to ensure sustainable sanitation outcomes. Supply-side and demand-generating approaches each face challenges (e.g., CLTS campaigns at scale often fail to result in hygienic, user-friendly sanitation facilities; and

sanitation marketing at scale may only reach early adopters and the better off, without reaching ODF). On-going work under the BDS portfolio will need to strengthen efforts to integrate these two powerful, yet distinct programmatic approaches—which in the past have typically worked in relative isolation from each other. BRAC, iDE, WSP, and East Meets West have made great strides by improving the supply of affordable sanitation options, reaching the poor through targeted sanitation financing supports, as well as promoting adoption of sanitation throughout entire communities. WaterAid is also working on this challenging problem in Nigeria.

Fecal sludge management solutions are needed now, or in the near future, for the solids accumulating in on-site sanitation. Additional work is needed to establish pit emptying services that are hygienic, environmentally sound, and affordable, as well as improving sanitation services such as repair, maintenance, and upgrades. Water for People, in partnership with PSI, are working to develop more efficient ways of emptying fecal sludge in slums and poor communities. The Foundation’s Urban Sanitation Markets (USM) and Transformative Technologies (TT) portfolios are also working extensively on the FSM issue, from a markets/business model and technology development perspective respectively.

Health implications of poor sanitation. Research conducted by the Research Institute for Compassionate Economics (r.i.c.e.) has demonstrated a strong correlation between OD and stunting in India and several other countries in Asia and Africa. This information has been incredibly helpful to the WASH sector (e.g. in arguing for more attention and investment, given the broad impacts on health) but arguably the biggest impact so far has been on the nutrition sector. Large funders and implementers (such as USAID and UNICEF) have begun to consider integrated Nutrition and WASH programs. The CEDLAS study of UNICEF’s CLTS program in Mali demonstrated how decreases in OD can lead to reduced stunting and other positive health outcomes. At the same time, Emory University’s study of the Indian Government’s Total Sanitation Campaign in Orissa State found increased latrine coverage but did not identify any reduction in the reported prevalence of diarrheal diseases in children. The findings of these three research efforts highlight the challenges in understanding the health impacts of WASH interventions, and the significant remaining unknowns.

The results of the two impact evaluations (Orissa and Mali) are particularly interesting, as their results seem quite different. In Mali, a focused and well-orchestrated CLTS campaign with strong Government support was found to reduce adult OD rates by 70% (child OD fell by 46%), and access to latrines in-creased from 35% to 65%. CLTS intervention households also had cleaner latrines and improved hygiene. It also is worth noting that the early phase of the research (i.e., baseline study) was

Early consumer testing of ASB products in Africa showed a ‘sitting option’ for

latrines to be popular in some countries.


used to help the field implementers to focus their CLTS effort on the most critical aspects of the intervention, to improve their mobilization strategy, and to sharpen their monitoring program.

The most significant health findings from Mali were that stunting was reduced by 17%, and severe stunting in children under 2 years was reduced by 23%. There also was a 57% reduction in diarrhea-related under-five mortality. However, there was no significant impact on child diarrheal disease morbidity or respiratory illness.

Interpreting the results of the Mali study, the following were concluded:

• The Mali implementation team used the research opportunity to improve their overall program implementation.42

• A highly successful CLTS campaign (96% of communities declared ODF) led to reduced stunting and other positive health effects in children within a period of less than two years.

• There was no significant impact on child diarrheal disease morbidity.

• The intervention had no discernable impact on household water quality, hand hygiene, or the cleanliness around houses. The impact on children’s health was not through these pathways.

• Health impact appears to have resulted from increased (individual) latrine use and reduced OD.

• There was no indication that access to sanitation was declining over time.

In Orissa, access to latrines increased dramatically—from less than 10% to around 63% in the intervention area. However, there were no observed changes in diarrheal disease morbidity

among children, or impacts on stunting. And while the outcome in terms of increased sanitation coverage was dramatic, no communities achieved ODF status, and latrine usage was only around 36% by the end of the effort. Intervention area hand hygiene did not noticeably improve, nor did household water quality.43 Why did this intervention, which was at least partially successful in reducing OD and increasing access to latrines, not result in any detectable child health improvements? Possible reasons for this include:

• The level of latrine coverage and/or latrine use achieved were too low to have a significant health impact.

• The intervention did not impact enough transmission pathways (e.g., hands after defecation, child feces) or sources of exposure.

• Environmental pathogens were persistent, and the 21-month follow up period was too short to see any impact.

• The intervention did not adequately contain excreta.

Comparing the outcomes of these two research studies, two of the main conclusions that can be drawn are:

• Sanitation interventions need to achieve very high use of improved sanitation (as opposed to high coverage) to produce better health outcomes. Striving to achieve ODF status (or nearly so) is important.

• As multiple routes of exposure to pathogens exist, improving hygiene behavior, drinking water quality, and management of child feces are critically important for WASH interventions.

The BDS program and its research partners will continue to work on interpreting these findings, and disseminating the results. With reference to the Orissa study, future work will include studies to assess the determinants of latrine uptake and use; microbial source tracking, and dissemination of the findings in India and discussion of their policy implications.


Knowledge Management and Research Needs

IMPROVEMENTS IN LEARNING AND KNOWLEDGE MANAGEMENTThe BDS portfolio has invested in an 18-month Knowledge Sharing and Learning project. In this section we recap on the BDS Knowledge Management (KM) work-stream and describe how the project contributed to the 2015 annual convening which aimed to integrate Knowledge and Learning activities throughout the event. Designed after consultations with grantees in 2014, the BDS KM project has six activity areas, addressing the two principal aims in the project’s Terms of Reference:

1. Improve BDS portfolio’s knowledge sharing and uptake of effective approaches by grantees;

2. Improve management of, and access to, WSH information.

Curation

A key requirement from the 2014 consultation was to “increase the signal to noise ratio” of content that floods across desks and email inboxes. A related grantee recommendation was for a curated, online collection of WSH/BDS relevant material, formally organized as in a traditional database, and with features such as user ratings to make the material more accessible and dynamic. Accordingly two sets of activities focus on content curation.

Curated Updates

Two curators from grantee organizations were engaged to review and select a small number of current WSH documents, accompanied by a one or two sentence synthesis of each. The monthly email digest goes to all grantees, and others who are recommended or ask to join the list. Driven by peer recommendations the list had grown to 130 recipients by the sixth issue (January 2015). Platform statistics show that the mailing’s open and ‘click’ rates are consistently higher than the industry (not-for-profit) average. The generally positive reactions from recipients were confirmed at the 2015 convening, although non-recipients questioned the value of ‘yet another information service’. Following the convening feedback the remaining issues will be slightly shorter (four rather than five recommendations), bias grantees own publications, maintain the focus on relevant themes, and increase multimedia content. While the case is demonstrated that a useful service can be

provided economically (approximately 4-5 person days per month) such a curation service depends on recommendations from within the recipient network, which are not coming forward sufficiently; another constraint is the paywall barrier blocking access to many current publications.

Curated Repository

This stream aims to provide a working prototype of a curated database of core WSH digital content, comprising both Foundation and other information. A prototype was prepared for demonstration at the 2015 convening, to gauge reactions and enroll grantees interested in testing the prototype. The prototype uses the Mendeley platform. Before opting for a discrete repository the project reviewed the major existing WASH databases against criteria including the utility of their classification and search capabilities; the transparency of their curation processes; facilities to upload documents; user ranking and comment functions; and whether the material could be accessed offline. The well-structured WSSCC database was judged the closest match to BDS grantee focus in terms of content but none of those reviewed provided offline capabilities. After a review of the options, Mendeley.com was chosen as the easiest to use and well featured of the platforms that could be accessed across systems (Windows, Android, iOS) and devices (tablets, phones lap- or desktop computers) with automatic on- and offline synchronization of content.


The content in the prototype is a sample selection of 60 current and influential content items uploaded into a Mendeley group and tagged according to a classification structure developed in consultation with the BDS KM Technical Advisory Group. The sample comprises both materials produced by the Foundation’s programs and other publicly available material. Questions about how a more comprehensive collection could be chosen and what processes could be established to maintain and update it will need to be addressed if a workable model of a curated database can be demonstrated. It would be a sizeable task, since there is currently no easily identifiable and accessible collection of Foundation WASH materials.

The prototype will be tested by a group of volunteers over the next three months.

ConnectThe target is to increase engagement and knowledge sharing between grantees using digital platforms. These include public social networks like LinkedIn and Twitter; specialist, public online communities such as SuSanA.org, the WSSCC LinkedIn group44; and platforms private to the grantees. The latter are intended to encourage more open conversations than might occur in a fully public space. We are currently using Dgroups.org for an email list and a private blog space.45 An objective of the first phase of the KM project was to build a greater sense of a BDS identity within the grantee network. While the visibility of (and appreciation for) the KM activities within BDS has grown during the project, developing a strong sense of a BDS community would take longer than the 18-month project timespan. We will continue using private spaces to encourage exchanges between grantees and we will also be engaging more actively in KM activities on the public SuSanA.org platform as we transition to the end of the KM project.

Learning EventsThis work-stream aims to focus on and harvest the knowledge sharing and learning that occur during events, both face-to-face and online, experimenting with different ways to improve learning and knowledge sharing within the BDS portfolio. “Designing effective learning events” was the theme of one of two sessions at the 2015 convening which specifically focused on KM.

“Reflection and Learning are allocated small amounts of time” was the unsurprising conclusion of our initial exercise with workshop participants. A subsequent exercise revealed that the majority of grantees still don’t engage with each other between convenings, a huge lost opportunity. The session also focused on surfacing examples of good practice in shared learning. Following examples from two participants about how difficult it is to share learning unless it is face to face, we zeroed in on stories as one of the most effective ways to capture attention,

WHAT MAKES A GOOD LEARNING EVENT?

• Being outside our familiar context helps to challenge your thoughts and ideology

• Exposure to a good example helps to define strategy

• Ensure the right people and mix of people participate in the learning process

• “Seeing is believing”

• Learning is a journey which takes time and needs space for reflection

• Learning comes through ‘friction’, dig below the surface and be open and frank about failures

Figure 5: Ideas generated by participants during the “learning events” session

bring alive learning points and leave behind hooks for memory, often provided by the Punch Line – or what is the point of your story? In the session participants reflected on and shared examples – stories of successful learning experiences or events. In plenary we summarized some of the critical success factors.

Participants were then invited to apply for small grants in support of learning exchange visits between grantees whose aim is both the continue the kind of deep-dive knowledge exchange that occurs during face-to-face events like convenings and to reflect openly about learning and sharing processes. Five blogs from a recent visit by the KM team to East Meets West46 and a Learning Workshop at WEDC conference were presented as an example of an open reflective learning journal, using digital media to en-liven the material.

BDS ProcessesThe aim of this stream is to help in the development of a Learning Culture within BDS, working with BDS program staff to advance and model a way of working that maximizes opportunities for learning and knowledge sharing across the portfolio. One of the central arguments of the BDSKM program is that, in common with other development sectors, there is an over-emphasis on knowledge products and outputs, and not enough emphasis on the reflection and learning processes that produce sustainable change within projects and organizations.47 This work stream is central to such a reorientation. BDS management has been testing out different ways to encourage and model processes that encourage reflection and learning, including quarterly ‘open-agenda’ regional teleconferences with grantees and the posting of questions about long-standing ‘knotty problems’ on the Dgroups email group. As described below, BDS management extended this approach into the 2015 convening, leading activities designed to encourage reflection and sharing.



Learning about Learning This overarching workstream aims to encourage reflections on the learning process during the project and to develop recommendations on how to create and foster a stronger learning environment. The approach is to constantly ask questions and communicate about learning and exchange processes. The most complete model to date is the set of blogs referred to above from the 2014 exploration of the East Meets West program but it was also a central theme of the 2015 convening.

SHARING EXPERIENCE AND LEARNING AT THE 2015 HANOI CONVENINGKnowledge and Learning were central to the design of the convening, which aimed to enable grantees

• To share, “the most exciting new and emerging results from (their) work;

• To have “open and candid conversation amongst grantees and between grantees and Foundation staff”;

• To “examine important technical issues and challenges of mutual interest (and to seek solutions with fresh points of view)”;

• And to “identify opportunities for knowledge sharing, research, and other types of follow-up”.

Annual convenings are, of course, Learning Events and the BDS KM team worked with the Foundation team to construct an agenda which maximized opportunities for learning and knowledge sharing. The agenda was designed to balance different modes of knowledge sharing and learning, including:

• Sharing information and updates from projects using posters48, with a whole afternoon for grantees to review and engage with each other around the posters

• Field visits and session to share learning and a 90-minute reflection session on the following morning

• Traditional presentation sessions, tightly chaired, to provide ‘TED’ style rapid, detailed input, with time for Q&A (two topics)

• Fishbowl format discussions for whole-group conversations about two key topics, Rural Sanitation Financing and Subsidies and Rural Hygiene and Sanitation Behavior Change (see also this blog on the fishbowl formats49)

UNANTICIPATED OUTCOMESHigh on the list of priorities that emerged from the January 2014 grantee consultation was ‘learning from failure’. For the Hanoi convening we were keen to explore how organizations and projects respond to unanticipated outcomes, which included runaway successes as well as failures. We were aware of the sensitivity involved in sharing publicly stories of failure, especially in a workshop organized by the donor organization. So we structured the session to encourage and allow frank exchanges within small groups. Participants were asked to tell a story about a situation where there was an unanticipated outcome, involving success or failure. The groups then had to share only one story in plenary, along with the lessons learned from the whole collection of stories. While photos of the flipcharts recording the lessons are available from the KM OneDrive50 we believe that sharing and story-telling with others was the more important process, which intended to normalize the idea that failures are common, sharing is useful and valuable learning can emerge from that sharing.

LEARNING ABOUT LEARNING DURING THE CONVENING Building on that work we introduced activities to encourage reflection and sharing between participants, based on the ‘art form conversations’ methodology51, at key moments during the event, including at the end of the day, before lunch-breaks and also as part of agenda sessions. This spirit continued after the event, with at least five blogs reflecting on the convening published soon after the event, as well as notes being shared and circulated among some of the grantees.

Participants discussed project updates using poster presentations.


The Way Forward

FOUNDATION VISION The Foundation’s vision for the WSH sector is simple but ambitious: the adoption and use of sustainable sanitation services for all. To contribute to this outcome, we make investments, forge partnerships, and advocate for opportunities that have the potential to make quality sanitation technologies and services safe and affordable for everyone. The Foundation’s co-chairs are ‘bullish’ on sanitation and see the Foundation’s role as a sector catalyst to make high-risk (and potentially high-impact) investments that would not otherwise happen.

As explained earlier, the WSH program has evolved since its inception as a learning initiative in 2005 to focus on two fundamental challenges:

1. Expanding and improving sanitation without central sewers, because this is (and will be) the most common type of sanitation service used by the poor;

2. Making sanitation safe and sustainable by establishing more effective fecal waste management systems.

Our strategic focus is on the science, technologies, market approaches, processes, and tools that will transform these aspects of the sanitation sector. We believe the focus on non-piped sanitation makes good sense, because establishing water-based sewage systems and wastewater treatment plants will be too costly for the foreseeable future in most developing market scenarios. Along with the focus on transforming on-site sanitation, the WSH program as a whole has tilted towards urban sanitation. Development of new on-site sanitation approaches and technologies could accelerate the adoption of improved sanitation services—and the Foundation believes that improved products and services will first become economical in more densely populated urban environments. Further supporting our focus on urban areas is the fact that the population of urban residents lacking sanitation has increased by nearly 40% since 1990, whereas the rural population lacking sanitation has dropped by 18% over the same time period.52

Note that this does not mean the Foundation considers rural sanitation a low priority for the sector. With over 70% of those lacking adequate sanitation living in rural areas and an even greater majority of the deaths from diarrheal disease occurring in rural areas, rural sanitation is central to meeting global WSH and related health, nutrition, and education targets. We are acutely aware that rural residents who lack improved sanitation outnumber their urban area counterparts by one billion.

The BDS portfolio’s contribution to the Foundation’s overall vision for the WSH sector focuses on several key aspects of the challenge:

• Strengthening individual and collective demand for sanitation

• Working to sustainably end OD and promoting adoption of improved sanitation services

• Increasing the use of evidence-based practices

The BDS program also hopes to substantially impact sector progress on the ground:

• Contribute to at least 30 million people living in Open Defecation Free (ODF) communities

• Increase adoption of evidence-based practices in rural and urban sanitation

• Explore better ways to drive adoption of hygienic sanitation practices

BDS grantees have made great strides in addressing the need to strengthen both rural and urban demand generation and the effective collection and use of program evidence; these accomplishments (and ongoing work) were summarized in the Portfolio Progress section above. As the Foundation shifts more of its implementation resources to urban environments, we expect to make no major new investments in BDS implementation grants, though we will continue our focus on BDS learning and research, knowledge management, and integrating BDS learning with Urban Sanitation Markets and Transformative Technology initiatives.



NEXT STEPS FOR THE BDS PORTFOLIODuring 2015 and beyond, the Foundation will continue to pursue ways of accelerating the scale-up of sanitation demand-generating approaches and programs. Many of the projects mentioned in this report are ongoing, and results from those efforts are still forthcoming. However, some projects have been completed, and there are preliminary results from several of the ongoing efforts. The BDS Knowledge Management initiative will gain prominence as the Foundation seeks to share information within the portfolio, and disseminate it to other agencies, experts, and countries. New projects which have recently, or are soon to come on line—should benefit from the greater focus on KM and the lessons learned by mature and completed projects. The Foundation also will increasingly seek ways of integrating the knowledge generated by the BDS portfolio with its other sanitation initiatives, especially the Urban Sanitation Markets effort.

India is already an important focus of the BDS effort, and this will only increase in the future. New investment in India will grow substantially from 2015, and will be supported by a dedicated WSH team based at the Foundation’s office in New Delhi. Efforts to reach the marginalized (i.e., through the work of RGMVP, CInI, and others) and improve market and Government sanitation program efficiencies (PSI, CInI) will continue, with more results from these projects expected during 2015-16. R.i.c.e. will continue and expand its research efforts on the Indian sanitation challenge; furthering its work on latrine preferences and related cultural influences include analysis of cultural links to the Infant Mortality Rate, and possible links between sanitation and anemia. R.i.c.e (and others) also will support the Government of India to examine the growing body of sanitation program evidence and address these issues at the policy level.

Work in Bangladesh will continue, with the EPRC research project on the effectiveness of female local Government members set to deliver results later in 2015. Innovations for Poverty Action will continue its research (led by Mushfiq Mobarak) on the effectiveness of different sanitation behavior change tools and approaches. BRAC plans to continue expanding its work on rural WASH (independent of foundation funding) and discussions about a partnership with the foundation WSH team to start tackling sanitation for the urban poor are ongoing.

New investments currently under development demonstrate a continued focus on generating, disseminating and applying

evidence. Work underway with WHO includes the development of official Guidelines on Sanitation and Health, as well as the development of new monitoring guidelines and tools for application by the Joint Monitoring Program (JMP) once the new Sustainable Development Goals (SDG) have been adopted (the SDGs are expected to include a much stronger focus on the full sanitation chain, including fecal sludge management and treatment, than the MDGs did). Also in support of the SDGs is the work ongoing at the Water Institute at the University of North Carolina: a proof of concept on how to estimate the amount of untreated human waste which is returned to the environment at the country level.

The BDS initiative remains focused on developing a better understanding of demand for sanitation, including CLTS as a demand generation method that has been widely adopted by governments and organizations. A new research effort on CLTS will be carried out by Eawag, focusing on how the various aspects of this method work in terms of the behavior change mechanisms at work, and the relative effectiveness of its various components. Plan and UNC will complete their detailed assessment of the effectiveness of internal actors in the CLTS process, as well as conducting an analysis of cost effectiveness. Plan and UNC also will carry out a number of internal and external learning and dissemination efforts as the project winds up later in 2015.

The BDS effort also will continue its efforts to integrate with other parts of the Foundation’s WSH program, namely the Urban Sanitation Markets (USM) and Transformative Technologies (TT) initiatives. Sanitation market interventions and product development efforts being carried out by Fundacion In Terris, IFC & WSP Africa, American Standard Brands, iDE, PSI, and CInI are all making important contributions that should provide useful products, implementation “business models” and insights that are relevant for both rural and urban settings, and which hopefully can be carried forward to scale.

Related to this “blurring of the lines” between the different WSH initiatives is a new direction which the BDS initiative will add to its currently strongly rural focus: to develop a better understanding of the urban environment, including questions of demand generation and service provision. Starting from 2015, this focus will be further developed and will progressively become part of the results reported by the BDS initiative.


Appendix

FOOTNOTES1 Previous meetings were held in Nairobi (2012), Phnom Penh (2013), and

Nairobi (2014). The BDS portfolio was called “Sanitation Delivery Models” until 2013.

2 Economic Impacts of Inadequate Sanitation in India; Water and Sanitation Program (2011).

3 Progress on Drinking Water and Sanitation, 2014 Update. WHO and UNICEF, 2014.

4 Ibid.

5 Rigorous evidence not only tells us what happens as the result of a specific intervention, it also tells us what would have happened in the absence of the intervention. This allows researchers to make strong causal connections (“result “X” happened because of activity A”). For increased confidence in the results, such research requires a control group (which does not receive the project intervention), randomized assignments of who will receive the project intervention, and a carefully computed (often large) sample size.

6 The Centre for the Evaluation of Development Policies.

7 This research project also includes a significant, at-scale implementation component (supported by USAID).

8 Also known as “Thrive Networks”.

9 ASB is now part of the Lixil Corporation of Japan.

10 Selling Sanitation partners include: Manufacturers SIL Africa Limited and Kentainers Limited; Kenya Ministry of Public Health and Sanitation, AMREF, FHI 360, KWAHO, Plan International Kenya, PSK, Red Cross, SNV, WSSCC, World Vision, and UNICEF.

11 Collaborators: A.J. Pickering, Stanford University; H. Djebbari, Aix-Marseille University; J.C. Cardenas, University of the Andes; and M.A. Lopera, Université Laval. Implementers: N. Osbert, UNICEF and M. Coulibaly, Government of Mali (National Directorate of Sanitation).

12 These are social behaviors that benefit others or society as a whole, such as helping, sharing or cooperating.

13 Long-Term Sustainability of Improved Sanitation in Rural Bangladesh. WSP Technical Paper (2011).

14 Union Parishads (Union Councils) are the lowest level of local government in Bangladesh. A Union is comprised of nine Wards or villages; the ‘UP’ has responsibility for economic and social development of the Union.

15 Co-researchers: Raymond Guiteras and Shyamal Chowdhury.

16 Campaigns comprised a latrine promotion program (a CLTS-type of approach); 75% latrine purchase subsidies for the poorest population segment; and sanitation ‘supply agents’ who helped arrange latrine purchases and help with installations.

17 The provision of incentives for seasonal migration were part of a larger and unrelated study about seasonal migration of agricultural workers to cities.

18 Bihar, Haryana, Madhya Pradesh, Rajasthan, and Uttar Pradesh states.

19 R.i.c.e. also received financial support from India Globalization Capital for the Switching Study.

20 Participatory Hygiene and Sanitation Transformation.

21 An Upazila is the second lowest tier of regional administration in Bangladesh. The structure consists of Divisions (7), Districts (64), Upazilas (488), and Union Parishads (UPs), of which there are over 4,500.

22 Households with less than 10 decimals (400 m2) of land, no productive assets, children of school-going age who are working, and no active adult male present.

23 Although tests on organic fertilizer were carried out and approvals were obtained, the efforts to establish small businesses selling it were largely abandoned as demand is very low and chemical fertilizer is heavily subsidized.

24 Including training of more than 5,600 Rural Sanitation Centre owners.

25 Monthly women’s cluster meetings comprised of women from 10 households; cluster meetings for adolescent girls from 45 households. Menstrual hygiene messages are covered during these meetings.

26 Now part of Thrive Networks.

27 SMSU saw a 16% increase in coverage in project areas over 2.5 years between the baseline and endline, meaning a 6.4% annual rate of increase in sanitation coverage. According to the WHO/UNICEF JMP Report for Water Supply and Sanitation from March 2010, the average rate of increase in sanitation for Cambodia was 0.923%. 6.4/0.923 = 6.93

28 If relevant and available.

29 By the end of Period 3, 90% of active businesses were profitable with an average operating profit of $0.26 per dollar of sales. At this time, there were 138 Active LBOs (defined as having made a sale in the previous 6 months as of Oct. 2014)

30 Conducted by Monitor Inclusive Markets (now Monitor FSG).

31 During menstruation, instead of using sanitary napkins, women use homemade pads made from old cloth. They often reuse these without proper cleaning as they feel shy to take care of these needs openly. Women also generally have no access to safe toilets or bathing spaces.



32 An imprecise term, but one generally used to mean the number of villages which achieve ODF status per the number of villages triggered using CLTS/CATS.

33 Progress on Drinking Water and Sanitation, 2014 Update (2012 data).

34 Indonesia’s Sanitasi Total Berbasis Masyarakat (STBM) campaign is comprised of 5 elements: 1. Stopping Open Defecation; 2. Handwashing with soap; 3. Household Drinking Water and Food Management; 4. Household Waste Management; and 5. Household Liquid Waste Management.

35 Progress on Drinking Water and Sanitation, 2014 Update (2012 data).

36 IDS is no longer working under a Foundation grant, but the Knowledge Hub continues to promote and document CLTS experience.

37 Participatory Rural Appraisal. PRA methods used by BRAC include transect walks and social mapping.

38 Subsidy or self-respect? Participatory total community sanitation in Bangladesh (IDS Working Paper 184). K. Kar 2003.

39 See the discussion of IPA research on “Inter-Linkages in Sanitation Demand Across Households” in Bangladesh.

40 iDE is considering ways of developing an in-house microfinance capacity to address this challenge.

41 Including the “CLEAR” sales approach introduced by PATH.

42 While the UNICEF/Government of Mali implementation team used baseline findings to improve their CLTS pro-gram, their access to these data did not in any way compromise the integrity of the RCT research methodology.

43 No significant difference between intervention and control household water quality over time; although water quality in both areas did generally improve during the course of the study.

44 Community of Practice on Sanitation and Hygiene in Developing Countries

45 http://www.bdskm.net/online-spaces/km-talks/

46 http://www.euforicservices.com/search/label/oba

47 From blog about Learning Event in Hanoi with East Meets West http://bit.ly/ZmbmTe

48 http://tinyurl.com/mup6tuw

49 http://bit.ly/1BQETEe

50 See http://1drv.ms/19sgwCl

51 Described in this post-convening blogpost http://bit.ly/1LjO3PN

52 Joint Monitoring Program (2014).


FIRST LAST ORGANIZATION EMAIL LOCATION (PROJECT)

1 Anthony Waterkyn Africa Ahead anthony@africaahead com South Africa (Rwanda)

2 Jim McHale American Standard Brands mchalej@americanstandard com USA (Bangladesh, Uganda)

3 Radu Ban Bill & Melinda Gates Foundation radu ban@gatesfoundation org Seattle, USA

4 Stephanie Drozer Bill & Melinda Gates Foundation stephanie drozer@gatesfoundation org Seattle, USA

5 Sarah Herr Bill & Melinda Gates Foundation sarah herr@gatesfoundation org Seattle, USA

6 Jan Willem Rosenboom Bill & Melinda Gates Foundation

janwillem rosenboom@gatesfoundation org Seattle, USA

7 Akramul Islam BRAC akramul mi@brac net Bangladesh

8 Milan Kantu Barua BRAC milan kb@brac net Bangladesh

9 Maria Laura AlzuaCEDLAS- Universidad Nacional de La Plata, Argentina

malzua@cedlas org Argentina (Mali)

10 Vartika Jaini Collectives for Integrated Livelihood Initiatives vartika j@cinicell org Delhi, India

11 Theodora Adomako-Adjei Community Water and Sanitation Agency adomakoadjeit@yahoo com Accra, Ghana

12 Chuck Henry Critical Practices LLC critical practices@gmail com USA (Ecuador)

13 Hans Mossler EAWAG mosler@eawag ch Switzerland (Ghana)

14 Pete Cranston Euforic Services pete euforic@gmail com UK

15 Peter Feldman Euforic Services pfeldman@fastmail fm Seattle, USA

16 Pippa Scott Euforic Services pippa scott@gmail com UK

17 Marcos Fioravanti Fundacion in Terris mtfioravanti@gmail com Quito, Ecuador

18 Juan Pablo Arguello Yepez Fundacion in Terris juan arguello yapez@gmail com Quito, Ecuador

19 Yi Wei iDE ywei@ide-cambodia org Phnom Penh, Cambodia

20 Eric Baetens International Water and Sanitation Centre (IRC) baetens@ircwash org The Hague, Netherlands

21 Ingeborg Krukkert International Water and Sanitation Centre (IRC) krukkert@ircwash org Netherlands

(Bangladesh)

22 Fisseha Atalie Plan Ethiopia Fisseha Atalie@plan-international org Addis Ababa, Ethiopia

23 Daniel Asamani Plan Ghana Daniel Asamani@plan-international org Accra, Ghana

24 Mulugeta Balecha Plan International USA Mulugeta Balecha@planusa org Washington DC, USA

PARTICIPANT DETAILS



FIRST LAST ORGANIZATION EMAIL LOCATION (PROJECT)

25 Rosalyn Okwiri Plan Kenya roselyn okwiri@plan-international org Nairobi, Kenya

26 Shankar Narayan PSI s i shankarnarayanan@gmail com Delhi, India

27 Dean Spears r i c e dean@riceinstitute org Uttar Pradesh, India

28 Sangita Vyas r i c e sangita@riceinstitute org Uttar Pradesh, India

29 Divyang Waghela Sir Ratan TATA Trust dwaghela@tatatrusts org India

30 Krapal Singh Rajiv Gandhi Mahila Vikas Pariyojana (RGMVP) ksyadav@rgmvp org Delhi, India

31 Arno Rosemarin Susanna arno rosemarin@sei-international org Stockholm, Sweden

32 Jonny Crocker The Water Institute at UNC jonny crocker@unc edu Chapel Hill, NC, USA

33 Nguyen Hong Hanh Thrive Networks hanh nguyen1@eastmeetswest org Hanoi, Vietnam

34 Kim Hor Thrive Networks horkim@eastmeetswest org Hanoi, Vietnam

35 Minh Chau Nguyen Thrive Networks minhchau nguyen@thrivenetworks org Hanoi, Vietnam

36 Nguyen Quang Quynh Thrive Networks quynh nguyen@eastmeetswest org Hanoi, Vietnam

37 Hien Vo Thrive Networks hien vo@eastmeetswest org Hanoi, Vietnam

38 Lalit Patra UNICEF Viet Nam lpatra@unicef org Hanoi, Vietnam

39 Lizette Burgers UNICEF Headquarters lburgers@unicef org New York, NY, USA

40 Aidan Cronin UNICEF Indonesia acronin@unicef org Jakarta, Indonesia

41 Paulos Workneh UNICEF Malawi pworkneh@unicef org Lilongwe, Malawi

42 Chander Badloe UNICEF RO Bangkok cbadloe@unicef org Bangkok, Thailand

43 Ann Thomas UNICEF RO Kenya anthomas@unicef org Nairobi, Kenya

44 Bilqis Hoque Uttara University and EPRC bilqisdhaka@yahoo com Dhaka, Bangladesh

45 Steve Sugden Water for People ssugden@waterforpeople org UK

46 Ephraim Danladi WaterAid Nigeria (replace Mimi) EphraimDanladi@wateraid org Abuja, Nigeria

47 Ada Oko-Williams WaterAid UK AdaOko-Williams@wateraid org UK (Nigeria)

48 Viet-Anh Nguyen World Bank vietanhctn@gmail com Hanoi, Vietnam

49 Susanna Smets WSP East Asia and the Pacific ssmets@worldbank org Phnom Penh, Cambodia

50 Virak Chan WSP Cambodia vchan1@worldbank org Phnom Penh, Cambodia

51 Joep Verhagen WSP India jverhagen@worldbank org Delhi, India

52 Mushfiq Mobarak Yale University ahmed mobarak@yale edu USA (Bangladesh)


NOTES

Guided by the belief that every life has equal value, the Bill & Melinda Gates Foundation works to help all people lead healthy, productive lives In developing countries, it focuses on improving people’s health and giving them the chance to lift themselves out of hunger and extreme poverty In the United States, it seeks to ensure that all people—especially those with the fewest resources—have access to the opportunities they need to succeed in school and life Based in Seattle, Washington, the foundation is led by CEO Sue Desmond-Hellmann and Co-chair William H Gates Sr , under the direction of Bill and Melinda Gates and Warren Buffett

For additional information on the Bill & Melinda Gates Foundation, please visit our website: www.gatesfoundation.org.

© 2015 Bill & Melinda Gates Foundation. All Rights Reserved. Bill & Melinda Gates Foundation is a registered trademark in the United States and other countries.


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RESEARCH ARTICLE

Implementation and process analysis of pilot scale multi-phase anaerobic fermentation and digestion of faecal sludge in Ghana

[version 1; referees: 2 approved]Justin Shih , Ato Fanyin-Martin , Edris Taher , Kartik Chandran 1

Earth and Environmental Engineering, Columbia University, New York, NY, 10027, USAChemical Engineering,, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

AbstractIn Ghana, faecal sludge (FS) from on-site sanitation facilities isBackground.

often discharged untreated into the environment, leading to significant insults toenvironmental and human health. Anaerobic digestion offers an attractivepathway for FS treatment with the concomitant production of energy in the formof methane. Another innovative option includes separating digestion intoacidogenesis (production of volatile fatty acids (VFA)) and methanogenesis(production of methane), which could ultimately facilitate the production of anarray of biofuels and biochemicals from the VFA. This work describes thedevelopment, implementation and modeling based analysis of a novelmultiphase anaerobic fermentation-digestion process aimed at FS treatment inKumasi, Ghana.

A pilot-scale anaerobic fermentation process was implemented atMethods. the Kumasi Metropolitan Assembly’s Oti Sanitary Landfill Site at AdanseDompoase. The process consisted of six 10 m reactors in series, which wereinoculated with bovine rumen and fed with fecal sludge obtained from publictoilets. The performance of the fermentation process was characterized interms of both aqueous and gaseous variables representing the conversion ofinfluent organic carbon to VFA as well as CH . Using the operating data, thefirst-ever process model for FS fermentation and digestion was developed andcalibrated, based on the activated sludge model framework.

This work represents one of the first systematicResults and Conclusions. efforts at integrated FS characterization and process modeling to enableanaerobic fermentation and digestion of FS. It is shown that owing topre-fermentation of FS in public septage holding tanks, one could employsignificantly smaller digesters (lower capital costs) or increased loadingcapabilities for FS conversion to biogas or VFA. Further, using the first-evercalibrated process model for FS fermentation and digestion presented herein,we expect improved and more mechanistically informed development andapplication of different process designs and configurations for global FSmanagement practice.

Keywordsfaecal sludge, anaerobic fermentation and digestion, volatile fatty acid,chemical oxygen demand

1 2 1 1

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Referee Status:

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version 1published06 Nov 2017

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report report

, Asian Institute ofThammarat Koottatep

Technology, Thailand, Asian Institute ofTatchai Pussayanavin

Technology, Thailand

1

, University of Science andZifu Li

Technology Beijing, China2

06 Nov 2017, :10 (doi: )First published: 1 10.12688/gatesopenres.12754.1 06 Nov 2017, :10 (doi: )Latest published: 1 10.12688/gatesopenres.12754.1

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https://orcid.org/0000-0002-1528-3897

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http://dx.doi.org/10.12688/gatesopenres.12754.1


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Kartik Chandran ( )Corresponding author: [email protected] : Data Curation, Formal Analysis, Investigation, Methodology, Validation, Visualization, Writing – Original Draft Preparation,Author roles: Shih J

Writing – Review & Editing; : Formal Analysis, Investigation; : Data Curation, Formal Analysis; :Fanyin-Martin A Taher E Chandran KConceptualization, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Supervision, Writing –Review & Editing

No competing interests were disclosed.Competing interests: Shih J, Fanyin-Martin A, Taher E and Chandran K. How to cite this article: Implementation and process analysis of pilot scale multi-phase

Gates Open Research 2017, :10 (doi: anaerobic fermentation and digestion of faecal sludge in Ghana [version 1; referees: 2 approved] 1)10.12688/gatesopenres.12754.1

© 2017 Shih J . This is an open access article distributed under the terms of the , whichCopyright: et al Creative Commons Attribution Licencepermits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Bill and Melinda Gates Foundation [OPP1019896].Grant information: 06 Nov 2017, :10 (doi: ) First published: 1 10.12688/gatesopenres.12754.1

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IntroductionIn Ghana, faecal sludge (FS) from on-site sanitation facili-ties is often discharged untreated into drainage ditches, inland waters, and the Atlantic Ocean, leading to deteriorating water quality and increasing the spread of gastro-intestinal infections (Cofie et al., 2006). While conventional wastewater treatment (primary, secondary, and tertiary) has proven to be effective in developed countries, the associated high energy demands with such treatment models may be cost prohibitive for developing countries to sustain (Murray & Buckley, 2010). One promising strategy for sustained FS treatment is to consider any potential end uses of FS that can offer incentives through resource recov-ery (Diener et al., 2014). Anaerobic digestion offers an attractive pathway for FS treatment with the concomitant production of energy in the form of methane. Another innovative option includes separating digestion into acidogenesis (production of volatile fatty acids (VFA)) and methanogenesis (production of methane), thereby facilitating the production of an array of biofuels and biochemicals from the VFA (Chandran, 2014).

In order to determine the feasibility of these treatment technolo-gies, numerous FS characterization studies have been performed in the last two decades (Bassan et al., 2013; Kengne et al., 2011; Koottatep et al., 2005), including those specifically evaluated in Ghana (Cofie et al., 2006; Strauss et al., 1997). These studies provide a baseline of FS characteristics, often focusing on chemical oxygen demand (COD), biochemical oxygen demand, solids (total solids, total volatile solids, total suspended solids, or volatile suspended solids), COD fractionation (Lopez-Vazquez et al., 2014), pH, or ammonia-nitrogen. However, there is a general lack of FS characterization beyond conventional parameters.

This absence of more detailed characterization presents a chal-lenge for determining clear design guidelines for resource or energy recovery. For example, in Ghana, anaerobic digesters accepting FS are typically sized for a solids retention time (SRT) of 15–60 days for pathogen reduction (Bensah & Brew-Hammond, 2010). In the United States, the design SRT of sewage sludge digesters for biosolids treatment is dependent on the desired biosolids Class (USEPA, 2006), but is usually higher than 20 days for single stage mesophilic digesters (Song et al., 2004) to meet pathogen and volatile solids reduction require-ments. However, if methane production and hygienization are concurrent project goals, it may not be necessary for them to occur in the same process (Astals et al., 2012). Rather, by pair-ing individual goals with specific processes as part of a multi-stage system, the improvements in efficiency may result in more efficient, lower cost systems.

Given that initial capital cost is a key limiting factor to biogas dissemination, especially in developing nations (Bensah & Brew-Hammond, 2010), any reductions in anaerobic digester sizing (where applicable) may assist in more efficient FS management and improved systems for biogas production and usage. Smaller digesters also open up opportunities for installa-tion in dense urban areas with space limitations. By determining the optimal SRT for recovery of specific end products, process

designers and engineers can perform a more accurate cost benefit analysis for resource recovery in specific systems. Accordingly, this work describes the process development, implementation and modeling based process analysis of a novel multi-phase anaerobic fermentation-digestion process aimed at FS processing in Kumasi, Ghana.

MethodsStudy background and facility layoutIn partnership with the Kumasi Metropolitan Assembly, pilot-scale anaerobic fermentation and digestion of FS was con-ducted at the Kumasi Metropolitan Assembly’s Oti Sanitary Landfill Site at Adanse Dompoase (Dompoase), the disposal point for FS from Kumasi and bordering neighborhoods. FS from septic tanks, aqua privies, latrines, or unsewered public toilets (Cofie et al., 2006; Kuffour et al., 2013) is regularly collected by vacuum trucks and discharged into a series of waste stabili-zation ponds. FS from public toilets was exclusively used in this study since it represents the largest toilet usage category (34.6% of Ghanaians) as reported by the 2010 Ghana Census (Ghana Statistical Service, 2012). Public toilet FS includes both wet (utilizing water for flushing) and dry (not utilizing flush water) toilet blocks.

The multi-phase anaerobic fermentation-digestion process consisted of six, 10 m3 concrete anaerobic reactors in series (labeled R1- R6 in Figure 1). The anaerobic reactors were bur-ied and operated unheated with an average liquid temperature of 28°C. Two sample ports each were installed on R1, R2, R4, and R6 for initial inoculation, mixing, and liquid sampling. FS was received from vacuum trucks in batches of 5–10 m3 and fed in turn into a 1.2 m × 1.2 m receiving box (0.3 m depth) through a 1 cm metal screen, which typically retained clothing material, condoms, plastic bags, and plastic wrappers. The variable batch volume was due to the maximum capacity and the load volume carried by the specific trucks, which varied by delivery. After FS was received, it was pumped into a 10 m3 holding tank (round, 2.4 meters tall) at grade before gravity fed into the first reactor in the series of six reactors (Figure 1). The 10 m3 holding tank allowed for a defined volume to be loaded into the system.

Loading periods – fed batch loadingThe monitoring data for this study was separated into two distinctive loading periods: Loading Period One (days 1–70), beginning on April 22, 2013, and loading Period Two (days 71–156). Period One had an average daily loading volume of 2,806±3,484 L, resulting in an average hydraulic retention time (HRT) of 3.6 days per reactor. Period Two had an average daily loading volume of 4,413±1,540 L, resulting in an average HRT of 2.3 days per reactor. In general, Period Two had higher overall loading volumes and less loading volume variability (Figure S1), due to more consistent loading days throughout the week (6.4 days per week vs. 3.5 days per week, on average over the two respective loading periods). Period One was also character-ized by higher precipitation than Period Two, which in combina-tion with unpaved roads led to difficulties in receiving influent at the site, which resulted in increased loading volumes to compensate during Period One.

Page 3 of 16


Figure 1. Layout of the faecal sludge anaerobic fermentation and digestion facility in Kumasi, Ghana.

During Period One, the sample ports extended until 73 cm from the bottom of the reactor, and the 2” mixing pipes extended to the bottom of the reactor. However, due to increased clogging of gas sample lines, these sample ports were shortened to the elevation of the reactor shoulder for Period Two. This allowed the discharge pipe to direct FS towards the foam breakers, potentially preventing solids accumulation that was passing through the foam breakers and clogging the gas sample lines.

Before the start of both Period One and Period Two, FS was transferred between the two rows of reactors to allow for physical removal of any rumen, settled solids, and upper crust layer from the active liquid stream. This ensured that any organic contributions during the Loading Periods were due to incoming FS and not any previous solids accumulation.

Start-up and process operation and monitoringThe inoculation and start-up period spanned 144 days (pre-Day 1 to pre-Day 144), beginning on November 29th, 2012. Bovine rumen was used to inoculate the reactors. Rumen is a well- documented inoculum for anaerobic digestion (Hu & Yu, 2005; Lopes et al., 2004) and was sufficiently available from the Kumasi Abattoir. On pre-Day 1, R1 was loaded with 8,500 L of FS and inoculated with 1,500 L of bovine rumen (separated from blood and carcass). All reactors were filled with FS on pre-Day 51, and additional rumen (1,500 L per reactor) was loaded through the sample ports into R1, R2, R4, and R6 on pre-Day 71. FS load-ing was ramped-up starting from 1,000 L/day (on pre-Day 91),

increasing to 2,500 L/day (on pre-Day 106), and finally reaching 4,000 L/day (on pre-Day 131).

The reactors were mixed five days a week during Period One and seven days a week during Period Two by pump circulation with a gasoline powered 2” centrifugal pump (standard trash pump) at 340 L/min for 16 minutes per day (clockwise for 8 minutes and counter-clockwise for 8 minutes). On sampling days, the first operation performed was gas flow measurement and gas analysis through the gas sample ports installed onto R1, R2, R4, and R6. Plastic flexible tubing was used to connect the sample port to an inverted graduated cylinder, allowing for gas flow measurement through the volume displacement method. Starting from Day 85, a GFM416 gas analyzer (Gas Data Ltd., Coventry, UK) was used to measure CH

4, CO

2, and H

2S in the off gas.

Reactor samples were taken twice a week from R1, R2, R4, and R6 through the sample ports immediately after reactor mixing. A 237 mL Bacon Bomb sampler (Clarkson Laboratory and Supply Inc., Chula Vista, CA) was lowered through the sample port to take one sample 20 cm from the bottom of the reactor and one sample 30 cm above the first sample from both sample ports. These four samples were mixed together in a 1 liter plastic container and stored in a cooler until transport to the lab.

Laboratory analysis of reactor samples was performed at Kwame Nkrumah University of Science and Technology in Kumasi, Ghana. Total chemical oxygen demand (tCOD, HACH

Page 4 of 16


Method 8000) and total volatile fatty acids (VFA, HACH Method 8196) were tested twice a week, while total suspended solids (TSS, US EPA Method 160.2), volatile suspended solids (VSS, US EPA Method 160.4), alkalinity (US EPA Method 310.1), pH (US EPA Method 150.1), and ammonia-nitrogen (NH

3-N, US EPA Method 350.3) were tested once a week. Related

methods pertaining to analysis of wastewater-related samples can also be found readily at https://www.epa.gov/cwa-methods.

Process modelingThe pilot facility was dynamically simulated using BioWin 4 (EnviroSim, Oakville, CA) through input of measured influent loads and calibration with measured reactor results. The Biowin setup consisted of six anaerobic digester modules in series each defined with a 10,000 liter volume, depth of 1.8 meters and head space volume of 1,500 L under 103 kPa to represent field reactors. Daily loading volumes, tCOD, pH, alkalinity, and inorganic suspended solids (ISS) were directly inputted from measured influent values. A total kjeldahl nitrogen (TKN)/COD ratio of 0.16 TKN/COD was determined by calculating a ratio of NH

3-N/COD and scaling by 33% to balance nitrogen in the

influent, and a total phosphorus (TP)/COD ratio of 0.04 was determined from measured phosphorus in Kumasi FS. Nitrate N and dissolved oxygen were left as 0 mgN/L and 0 mg/L, respectively, given the anaerobic conditions of toilet systems, and calcium and magnesium were left as default values of 80 mg/L and 15 mg/L. Finally, given that FS vacuum trucks often do not remove all settled material from toilet systems, “settled” wastewater COD fractionation values were used as initial values.

The calibration methodology focused on identifying and limit-ing model adjustments to a minimal number of significant, justi-fiable parameters. Throughout the calibration, central composite response surface designs were created using Minitab 17 (State College, PA) to evaluate the significance of variables, determine optimal variable inputs (through the response optimizer tool) and minimize the number of model runs required to evaluate mul-tiple variables. Optimal variable inputs were evaluated by their composite desirability, which is calculated as the weighted geometric mean of individual desired responses (measured from 0 to 1, 1 as ideal). Given the number of variables and reactors, model development was based on average simulated and average observed values over both loading periods.

The calibration process was conducted through a chronologi-cal series of hypotheses that primarily focused on VFA concen-trations and gas production. VFA and gas production serve as benchmarks that characterize the stage or degree of anaerobic digestion, and they are also the target end products for this study. tCOD, % CH

4, and % CO

2 were also directly used for model

calibration. All considered variables are documented through the following calibration phases (Figure 2):

Calibration Phase 1: COD influent parameters were the first to be adjusted due to COD fractionation reference values as well as expected microbial populations inherent in FS. A soluble unbio-degradable fraction (Fus) of 0.09 and particulate unbiodegrada-ble fraction (Fup) of 0.47 was used (Dangol et al., 2013) from a

previous FS study. A full factorial central composite response surface design was created in Minitab for the following influent parameters and factor ranges: readily biodegradable (including acetate) g COD/ g total COD (Fbs, 0.05–0.2); ordinary het-erotrophic organisms (OHO) COD fraction g COD/ g total COD (FZbh, 0.1–0.5); acetoclastic methanogen COD fraction g COD/ g total COD (FZbam, 0.0001–0.005); and hydrogenotrophic metha-nogen COD fraction g COD/ g total COD (FZbhm, 0.0001–0.005).

Calibration Phase 2: Given that Biowin simulates the anaero-bic digester modules as completely mixed reactors, increased reactor sizes for R1 and R2 were explored in addition to influent parameters to simulate longer solids retention time in the upstream reactors. A half factorial central composite response surface design was created for the following influent parameters and factor ranges: Fbs (0.03–0.27), FZbh (0.01–0.1), FZbam (0.0001–0.01), FZbhm (0.0001–0.01), R1 volume (10,000–30,000 L), and R2 volume (10,000–30,000 L).

Calibration Phase 3: Reaction rates were considered next, focusing on the key aspects of anaerobic digestion: hydrolysis, acidogenesis, acetogenesis, and methanogenesis. A half facto-rial central composite response surface design was created for the following reaction rates and factor ranges: hydrolysis rate (0.36–3.84), maximum specific growth rate of OHO (0.07–3.13), maximum specific growth rate of acetogens (0.07–0.43), maximum specific growth rate of acetoclastic methanogens (0.07–0.53), and maximum specific growth rate of hydrogenotrophic methanogens (0.07–2.73) on VFA and gas production. Note: Biowin utilizes a 0.2 anaerobic hydrolysis factor to account for reduced hydrolysis rates under anaerobic conditions. To further explore the extent of reaction rate adjustments, local rate parameters were grouped into R1–R2 and R3–R6 due to the hydraulic connection locations, as well as the solids distribution profile.

Calibration Phase 4: Volume-less point clarifiers were added to recirculate solids within each reactor to simulate the observed solids concentrations therein. The point clarifiers allow solids to be concentrated or diluted depending on the flow split ratio and solids removal percentage. These point clarifier settings were iteratively adjusted to calibrate tCOD concentrations.

Calibration Phase 5: After determining which COD fractiona-tion values, influent microbial groups, and reaction rates signifi-cantly affected VFA and gas production, these variables (along with point clarifiers) were simultaneously considered for cali-bration. Additionally, the simulated microbial population ratios in R4 and R6 were considered as reference values for the influent conditions to reflect a microbial distribution where methanogenesis is active and stable.

Calibration Phase 6: Several alternatives were investigated to calibrate the % CH

4 and % CO

2 content in the off gas, including:

lowering the hydrogenotrophic methanogen growth rate (along with increasing the acetoclastic methanogenic maximum specific growth rate to compensate for lower gas production), increas-ing the hydrolysis rate (to promote subsequent CO

2 production

during fermentation), lowering the readily biodegradable COD

Page 5 of 16


https://www.epa.gov/cwa-methods

Figure 2. Model development chronology. COD, chemical oxygen demand.

content in the influent to reduce initial gas production spikes in upstream reactors, increasing the gas-liquid mass transfer coefficient for CO

2, and finally increasing the stoichiometric CO

2

yield (moles of CO2 produced per mole of acetate formed) for

OHO.

For the final model configuration, each parameter per reactor was evaluated (using Microsoft Excel 2010) by determining the root mean square error, as well as the Nash-Sutcliffe coefficient to consider the observed data variance.

Gas production efficiencyGas production efficiency per reactor (E

gas) was calculated with

Eq. 1, where Qr is the gas production rate (mL off gas/day), HRT

r

is the HRT per reactor, and CODr is the tCOD (g) loaded into the

reactor.

rgas

HRTE r

r

Q

COD

×=

(Eq. 1)

Statistical analysisProcess modeling was conducted using BioWin 4 (EnviroSim, Oakville, CA). Minitab 17 (State College, PA) was employed to evaluate the significance of variables, determine optimal vari-able inputs (through the response optimizer tool) and optimize the number of model runs required to evaluate multiple variables. Added statistical analysis was conducted using built-in subroutines in Microsoft Excel 2010.

Page 6 of 16


Results and discussionFaecal sludge characterizationThe observed high variability of tCOD and TSS in influent loads (Table 1), stable pH of 8.1±0.3 and 7.9±0.2 (Period One and Two, respectively), and average NH

3-N of 2039±1248 and

963±1,253 ppm (Period One and Two, respectively) were all consistent with previous FS characterization studies (Bassan et al., 2013; Cofie et al., 2006; Kengne et al., 2011). Despite the high variability of tCOD, average influent VFA remained rela-tively low at 1151±839 and 1646±1214 mgCOD/L, and average alkalinity was measured as 170±94 and 141±73 mmol/L (Period One and Two, respectively), which is higher than observed in sewage (80 mmol/L, Forster-Carneiro et al., 2010). All of these measured parameters suggest that FS is partially degraded with low acidogenesis and some buffering capacity, which is to be expected given that the emptying frequency of FS varies from “weeks to years” (Niwagaba et al., 2014).

tCOD concentrations in the influent FS were statistically higher (p=0.012) in Period Two (31,354±22,740 mg/L) than in Period One (14,549±10,863 mg/L). Influent total solids (TS) in Period One averaged 16,255±13,691 (n=16), while in Period Two they averaged 25,390±27,695 (n=13). One potential expla-nation for the differences in tCOD is that increased precipitation during Period One may have caused stormwater runoff to enter toilet systems and dilute the FS. Another supposition is that water is more available during the rainy season, and that FS truck operators are more willing to use water to aid in FS extraction from toilet systems. Although a previous study in Ouagadougou, Burkina Faso, did not find significant differences in FS sampled during the dry and rainy seasons (Bassan et al., 2013), tCOD concentrations in Ouagadougou for latrines and septic tanks (10725±9508 mg/L) were also on average lower than in Kumasi. Given that FS is highly variable even within a community or township, it is difficult to discern the exact explanation for the differences across countries. Any planned FS treatment facility would greatly benefit from local FS characterization.

Inoculation and reactor performanceInoculation and start-up of the pilot reactors occurred over a total of 131 days. Any rumen addition or increase to the FS load-ing rate was followed by weeks of observation to prevent over accumulation of VFA and subsequent inhibition of methano-genesis (Wang et al., 2009). However, throughout this entire start-up period, VFA averaged 427±305, 318±154, 286±119, and 268±129 mgCOD/L in R1, R2, R4, and R6, respectively (Figure S2). Gas production was highest in the first reactor, averaging 0.070±0.065, 0.043±0.037, 0.029±0.016, and 0.018±0.011 m3/hr in R1, R2, R4, and R6, respectively (Figure S3). Additionally, the highest gas production values were not observed until higher FS loading rates. The lack of VFA accumulation in all reactors and generally limited gas production in downstream reactors suggest that the inoculation and ramp-up loading could have been implemented in a shorter time period.

Similar VFA and gas production trends were also observed during full operation of the reactors. While it was expected that VFA concentrations would be maximal in the upstream anaerobic

reactors owing to higher fermentation kinetics relative to metha-nogenesis kinetics (Metcalf & Eddy, 2003), VFA concentra-tions were actually highest in the influent and steadily decreased across the reactors. Gas production followed a similar trend, with maximal values in the first reactor decreasing to the last reac-tor. % CH

4 and % CO

2 remained consistent across the reactors.

% CH4 averaged 63.5±2.1%, 64.3±2.1%, 63.6±2.0%, 64.2±2.3%,

62.8±1.8% and 63.2±2.0% and % CO2 averaged 24.4±2.6%,

24.3±1.8%, 21.9±1.9%, 24.0±1.9%, 23.2±2.5% and 24.3±2.1% in R1–R6, respectively. H

2S (ppm) varied in the reactors, averaging

2159±474, 2444±299, 2795±442, 2791±305, 3012±460 and 2766±354 in R1–R6, respectively.

Given that the reactors in Kumasi, like many anaerobic digesters in the developing world, were unmixed, a generally decreasing solids distribution across successive reactors was observed in terms of COD, TSS, and VSS concentrations. Elevated concen-trations in R2 may have been caused by conveyance of solids through localized flow paths at the bottom of R1 (Figure 1), while the mid-level connections between R2–R6 encouraged settling in the reactors. Unmixed systems will inevitably be affected by the hydraulic conditions of the system, which presents a challenge in developing general performance guidelines. Accumulated solids may also eventually decrease the overall working volume of the reactor and should be addressed to improve process efficiency.

Despite the potential impacts to gas production at the pilot facil-ity, solids accumulation was not likely the governing factor. While a baseline level of gas production may be expected from retained solids, gas production in upstream reactors was still observed to drop down to very low levels, suggesting that retained solids do not considerably contribute to gas production in a sus-tained way. Rather, the fluctuating, yet considerable gas produc-tion in upstream reactors was due to the influent FS loads. The measured performance of this pilot facility represents one of the first efforts to document the fermentation and digestion of actual FS loads delivered by vacuum truck, allowing for an accurate consideration of the effect of FS variability. The processing modeling analysis presented next offers further insights into the measured trends in VFA and gas production from the FS treatment process.

Process model calibrationSpecifically, the following influent substrate fraction (Fbs) and biomass fractions (FZbh, and FZbam) were found to statistically significantly impact (p<0.05) VFA and gas production in all reac-tors, while the biomass fraction, FZbhm, significantly impacted for R1-R2 VFA and R1 gas production. Through adjustment of these parameters, it was found that Biowin either under- simulated VFA in downstream reactors or under-simulated gas production in upstream reactors. When increased R1 and R2 reactor volumes were explored to simulate solids accumula-tion through increased retention times (thus increasing gas pro-duction), both R1 and R2 volumes were found to be significant (p<0.05) for VFA and gas production, with the exception of gas production in R4. While Minitab’s response optimizer tool yielded numerous combinations of inputs for successfully simu-lating VFA and gas production, the ability to control R1 and R2

Page 7 of 16


Tab

le 1

. Mea

sure

d d

ata

for

Per

iod

On

e an

d T

wo

. CO

D, c

hem

ical

oxy

gen

dem

and;

VFA

, vol

atile

fatty

aci

ds.

Tota

l CO

D (

mg

/L)

Tota

l Su

spen

ded

So

lids

(mg

/L)

Vola

tile

Su

spen

ded

So

lids

(mg

/L)

Tota

l VFA

(m

gC

OD

/L)

Per

iod

On

eP

erio

d T

wo

Per

iod

On

eP

erio

d T

wo

Per

iod

On

eP

erio

d T

wo

Per

iod

On

eP

erio

d T

wo

Avg

±SD

(n)

Avg

±SD

(n)

Avg

±SD

(n)

Avg

±SD

(n)

Avg

±SD

(n)

Avg

±SD

(n)

Avg

±SD

(n)

Avg

±SD

(n)

Influ

ent

1454

9±10

863

(16)

3135

4±22

740

(16)

1358

0±14

553

(16)

1804

4±19

463

(14)

1105

8±11

755

(16)

1440

0±15

179

(14)

1151

±83

9 (1

8)16

46±

1214

(21)

R1

1274

9±68

79 (1

6)23

094±

2330

6 (1

8)76

48±

2235

(9)

1972

3±13

610

(13)

5903

±14

34 (9

)14

813±

1050

8 (1

3)80

8±34

3 (1

8)10

49±

551

(23)

R2

1528

2±83

23 (1

6)19

432±

1947

2 (1

6)10

626±

3756

(9)

1916

5±11

195

(13)

8099

±27

59 (9

)14

853±

8258

(13)

733±

269

(18)

936±

461

(23)

R3

R4

1088

2±98

37 (1

6)15

440±

1566

1 (1

8)68

69±

6112

(9)

1225

8±76

05 (1

3)53

04±

4468

(9)

9331

±55

87 (1

3)54

2±26

7 (1

8)64

2±20

6 (2

3)

R5

R6

6761

±62

52 (1

6)76

84±

2876

(16)

2340

±14

94 (9

)72

00±

7173

(13)

1972

±11

53 (9

)55

92±

5204

(13)

514±

180

(18)

652±

278

(23)

Off

Gas

Flo

w R

ate

(m3/

hr)

pH

Alk

alin

ity

(mm

ol/L

)N

H3-

N (

pp

m)

Per

iod

On

eP

erio

d T

wo

Per

iod

On

eP

erio

d T

wo

Per

iod

On

eP

erio

d T

wo

Per

iod

On

eP

erio

d T

wo

Avg

±SD

(n)

Avg

±SD

(n)

Avg

±SD

(n)

Avg

±SD

(n)

Avg

±SD

(n)

Avg

±SD

(n)

Avg

±SD

(n)

Avg

±SD

(n)

Influ

ent

8.09

±0.

33 (8

)7.

93±

0.16

(7)

170±

94 (8

)14

1±73

(7)

2039

±12

48 (1

1)96

3±12

53 (5

)

R1

0.08

3±0.

070

(15)

0.20

9±0.

170

(23)

8.28

±0.

15 (5

)7.

91±

0.27

(8)

136±

38 (5

)13

3±85

(8)

1728

±77

4 (8

)10

78±

931

(6)

R2

0.05

7±0.

039

(18)

0.14

4±0.

097

(22)

8.24

±0.

10 (5

)7.

90±

0.30

(8)

162±

25 (5

)14

0±59

(8)

1681

±57

9 (8

)12

10±

963

(6)

R3

0.06

1±0.

051

(13)

R4

0.02

3±0.

017

(17)

0.04

6±0.

050

(23)

8.21

±0.

11 (5

)8.

00±

0.26

(8)

112±

32 (5

)12

1±36

(8)

1310

±53

7 (8

)97

9±61

9 (6

)

R5

0.02

5±0.

011

(13)

R6

0.00

6±0.

005

(15)

0.01

5±0.

014

(23)

8.21

±0.

15 (5

)7.

99±

0.22

(8)

98±

28 (5

)11

5±34

(8)

1244

±57

5 (8

)91

5±55

1 (6

)

Page 8 of 16


volumes resulted in highly heterogeneous options that did not provide insight into the distinguishing characteristics of FS or FS fermentation and digestion. Reactors volumes were subsequently left at 10,000 L to explore additional calibration options.

When hydrolysis, acidogenesis, acetogenesis, and methanogen-esis reaction rates were adjusted for the system, Biowin con-tinued to either under-simulate VFA in downstream reactors or under-simulate gas production in upstream reactors. The hydroly-sis rate, maximum specific growth rate of OHO, and the maximum specific growth rate of acetoclastic methanogens significantly affected VFA and gas production, while the maximum specific growth rate for acetogens and the maximum specific growth rate for hydrogenotrophic methanogens (for gas production in R4 and R6) were not significant (p>0.05). While separate rate adjustments for R1–R2 allowed for increased congruence of simulated and observed VFA and gas production, reactions rates were ultimately left as global values for the entire system due to the lack of sufficient justification for rate differences among reactors.

The solids distribution in the system was addressed by pairing the reactors with point clarifiers, which allowed for direct control of the solids concentration in each reactor. Given that Biowin’s anaerobic digester modules are complete-mix reactors, simu-lated tCOD concentrations were initially high in downstream reactors. Point clarifiers were added to R2, R4 and R6, and additional point clarifiers were eventually added to R3 and R5 in the final model configuration (Figure 3).

When the un-adjusted microbial population ratios were explored for R4 and R6, it was found that the concentration of OHO were roughly 2–3 times the amount of acetoclastic methano-gens, which were in-turn roughly 3 times the amount of hydrog-enotrophic methanogens. Hydrogenotrophic methanogens were found to be 10–20 times the amount of acetogens. Once the influ-ent concentrations of these microbial groups along with COD fractionation values and reaction rates were considered together, congruence of VFA and gas production was obtained without adjusting local rate parameters. The best configuration from this phase retained default values for the hydrolysis rate (2.1 day-1), fermentation rate (1.6 day-1) and hydrogenotrophic methano-genesis rate (1.4 day-1), and largely focused on adjusting FZbh, FZbam and the acetoclastic methanogenesis rate.

The final model consideration was the % CH4 and % CO

2 in the

off gas, which Biowin was initially over-simulating and under-simulating, respectively. While COD fractionation values and

reactions rates were re-evaluated for gas composition, any adjust-ments negatively affected VFA and gas production congruence. Another strategy was to increase the gas-liquid mass transfer coefficient (kL) for CO

2 to promote gaseous CO

2, but this did

not have detectable effect on % CO2 in the off gas. In order to

better match the gas composition, the stoichiometric CO2 yield

(moles of CO2 produced per mole of acetate formed) for OHO was

ultimately increased. Due to acetoclastic methanogen dominance over hydrogenotrophic methanogens, a higher amount of acetate may be required in the system, thus increasing the stoichiomet-ric yield above the Biowin default. It was found that an increase from the default 0.7 to 1.2 moles CO

2/moles acetate successfully

brought the simulated % CH4 and % CO

2 in range with measured

values.

Final model configuration and performanceThe calibrated model ultimately focused on the following influent parameters (all expressed as g COD/ g total COD): Fbs (0.09), Fus (0.09), Fup (0.47), FZbh (0.05), and FZbam (0.015). The acetoclastic methanogen maximum specific growth rate (0.1/day) and stoichiometric CO

2 yield for OHO (1.2 moles

CO2/moles acetate) were also adjusted from default values. Point clarifiers were implemented on R2–R6 with 25% solids removal and underflow ratios of 0.2, 0.35, 0.5, 0.625 and 0.75 for R2–R6, respectively.

Fbs was decreased from 0.27 to 0.09 g COD/ g total COD due to prior fermentation and digestion within the toilet systems. Accordingly, Fus and Fup were increased from 0.08 to 0.09 and 0.08 to 0.47 g COD/ g total COD, respectively, to represent higher concentrations of remaining unbiodegradable content. FZbh were increased from 0.01 to 0.05 OHO COD/total COD and FZbam (acetoclastic methanogens) from 0.0001 to 0.015 aceto-clastic methanogen COD/total COD to reflect the high micro-bial concentrations inherent in FS, as demonstrated by maximal gas production in upstream reactors. While the influent concen-trations of acetogens and hydrogenotrophic methanogen con-centrations were adjusted in previous stages, due to their minor effects on VFA and gas production, they remained as default values. The acetoclastic methanogenesis maximum specific growth rate was decreased from 0.3 to 0.1 day-1 due to the background methanogen population in the reactors, as well as potential ammonia inhibition of methanogenesis (Yenigün & Demirel, 2013).

Figure 4 and Figure 5 demonstrate congruence between simu-lated and observed output for VFA and gas production. The other parameters are documented in Figure S4–Figure S9. Table S1

Figure 3. Final model configuration.

Page 9 of 16


Figure 4. Total VFA, simulated and observed.

Figure 5. Off gas flow rate, simulated and observed.

Page 10 of 16


documents the root mean square error and Nash-Sutcliffe coef-ficient for all parameters per reactor. While the Nash-Sutcliffe coefficients were close to 0 for TSS, VSS, tCOD (Reactors 1, 2, 4) and gas production (Reactors 1, 2, 4), the VFA coefficient ranged from -2 to -6. Given the variability in COD loading, Biowin simulated equivalent peaks in VFA, causing a higher residual variance than the observed data variance. While these values demonstrate that the model does not perfectly simulate all observed values, the model calibration process still resulted in overall congruity and allows for an evaluation of VFA and gas production potential.

Given the antecedent retention time in public toilet systems and subsequent methanogen population in FS, average influent VFA concentrations were less than 2,000 mg COD/L. Addition-ally, any further fermentation/digestion was shown to decrease VFA concentrations in the reactors. While these concentrations are lower in comparison to the potential of other feedstocks (Chang et al., 2010), VFA can be harvested directly from FS without additional fermentation. Finally, given the variability of toilet systems, there is potential for producing higher concen-trations of VFA from less stabilized sources, such as toilet systems that are emptied more frequently or toilet systems with lower water content and higher organic concentrations.

Gas production efficiency (mL off gas/g tCOD loaded) was calculated to be maximal in R1 and subsequently decreasing through R6 for both Period One and Two. In addition, gas pro-duction efficiency in Period Two (14.0±2.0, 10.9±1.2, 10.4±1.4, 9.6±1.5, 8.5±1.6, and 7.3±1.7 mL off gas/g tCOD loaded in R1–R6, respectively) was significantly higher in all reactors than efficiency in Period One (11.2±2.7, 8.5±1.6, 7.6±1.5, 6.5±1.5, 5.6±1.5, and 4.6±1.5 mL off gas/g tCOD loaded in R1–R6, respec-tively). Period Two, which had more consistent loading volumes,

had roughly 15% more gas production after 14 days (140 vs 122 mL off gas/g tCOD loaded). The 75th percentile of cumula-tive gas production for Period One and Two were obtained in 14 of 22 days and 9 of 14 days respectively (Figure 6). These effi-ciencies were in range with a biomethane potential study in China, which found that FS produced 87 ml gas/g FS at 30°C (Song et al., 2011). Period Two had a 1.23 tCOD/TS ratio, resulting in roughly 172 mL off gas/ g dry FS after 14 days. However, given the vari-ability of FS beyond tCOD or TS, it is expected that biometh-ane potential studies would also yield variable results. When comparing with sewage sludge, one study in Sweden reported 271 m3/ton VS loaded (271 mL/g VS), which at 76% VS/TS, is 206 mL/g dry sewage sludge (Davidsson et al., 2008). While it is difficult to directly juxtapose these two waste streams consider-ing the variability in each, the gas production efficiency of FS is comparable and has sufficient potential for further consideration.

This study presents one of the first calibrated FS fermenta-tion and digestion process models. By exploring characteriza-tion of FS beyond tCOD and investigating reactor performance beyond conventional process indicators (pH, alkalinity, gas pro-duction, etc.), a more detailed and complete understanding is formed. FS, though often guided by wastewater or sewage sludge literature, is a very different feedstock. FS composition is highly variable, contains limited readily biodegradable COD due to prior degradation, and also harbors considerable OHO and methanogen concentrations. These singular characteristics have far-reaching implications for FS treatment design, which cur-rently (erroneously) still relies on typical guidelines such as 20 day SRT for anaerobic processes at 30°C (Metcalf & Eddy, 2003). Non-idealities such as settling also need to be considered for FS treatment process optimization, especially for highly concen-trated FS. In order to effectively plan and evaluate these systems, all of these factors must be examined on a case by case basis.

Figure 6. Cumulative gas production per COD loaded. COD, chemical oxygen demand; HRT, hydraulic retention time.

Page 11 of 16


ConclusionsThis work documents the start-up and operation of a pilot scale FS anaerobic fermentation and digestion system that processed FS from vacuum trucks in Kumasi, Ghana over a five month period. By utilizing measured field data from the pilot plant, this work details one of the first systematic efforts at integrated FS characterization and process modeling to enable anaerobic fermentation and digestion of FS. In addition to recording con-ventional process parameters for FS characterization, COD fractionation and existing microbial concentrations were also explored. In sum, it is shown that owing to pre-fermentation and digestion of FS in toilet systems, maximal VFA and gas produc-tion are expected at SRT values less than five days. While treat-ment modules such as biogas settlers are effective at maximizing gas production per COD load due to extended SRT (months or years) until desludging, these modules eventually become accu-mulated with digested sludge with lower gas production efficiency. There is potential for smaller digester units with lower SRT (for gas production) to be paired with a subsequent treatment step for potentially more cost effective hygienization, such as drying beds or infiltration based methods. This calibrated FS process model, along with the documented calibration approach, allows for future research into the expansion of biogas production from varying

FS streams, as well as additional recovery of even higher-value resource outputs.

Data availabilityMonitoring data during start-up and full operation are available on OSF: http://doi.org/10.17605/OSF.IO/WGRDX (Chandran, 2017). Data are available under the terms of the Creative Commons Zero “No rights reserved” data waiver (CC0 1.0 Public domain dedication).

Competing interestsNo competing interests were disclosed.

Grant informationBill and Melinda Gates Foundation [OPP1019896].

AcknowledgmentsSupport from the overall project team and the Kumasi Metropoli-tan Assembly and Waste Enterprisers is gratefully acknowledged. This work was presented at the 3rd International Faecal Sludge Management Conference on January 20, 2015 (presentation available at https://osf.io/nym3z/).

Supplementary materialSupplementary File 1: File containing Table S1 (Statistical model evaluation); Figure S1 (Influent loading volumes); Figure S2 (Total volatile fatty acids, inoculation and ramp-up); Figure S3 (Off-gas flow rate, inoculation and ramp-up); Figure S4 (Total chemical oxygen demand, simulated and observed); Figure S5 (Total suspended solids, simulated and observed); Figure S6 (Volatile suspended solids, simu-lated and observed); Figure S7 (% CH

4 and % CO

2, simulated and observed); Figure S8 (pH, simulated and observed); Figure S9 (Alkalinity,

simulated and observed).

Click here to access the data.

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THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

May 2015

Prepared for the Sanitation Research Fund for Africa (SRFA) Project of the Water Research Commission and the Bill and Melinda Gates Foundation

WRC Report No. KV 340/15

ISBN 978-1-4312-0685-8

DISCLAIMER

This report was compiled from country reports submitted by research teams involved in the Sanitation Research Fund for Africa (SRFA) Project. This report has been reviewed by the Water Research Commission (WRC) and approved for publication. Approval does not signify that the contents necessarily reflect the views and policies of the WRC nor does mention of trade names or commercial products constitute endorsement or recommendation for use. Further, the WRC, Bill and Melinda Gates Foundation and the service provider take no responsibility for any inaccuracies or undisclosed sources from these country reports.

© Water Research Commission

The publication of this report emanates from a project entitled The Status of Faecal Sludge Management in Eight Southern and East African Countries (WRC Report No. K8/1100/11)

WRC Report No. KV 340/15 ISBN 978-1-4312-0685-8

191 Anderson StreetNorthcliff2195Tel: 27 (0) 11 476 5915Fax: 0866498600Cell number: 27 (0)834606832E-mail: [email protected]


01


Background

Sub-Saharan Africa still lags behind in achieving the Millennium Development Goals for sanitation. In 2012, 644 million people in sub-Saharan Africa, that is 70% of the population, used an unimproved toilet facility or resorted to open defecation (WHO/UNICEF, 2014). The percentage for open defecation has dropped by 11% in the period 1990-2012, but the number of people defecating in the open is still increasing in 26 of 44 countries in sub-Saharan Africa.

The statistics of projected growth in population and the rate of urbanisation mean that sub-Saharan cities have an ever increasing population to serve with water and sanitation. As most of the urban poor rely on on-site sanitation, these statistics present a growing challenge for faecal sludge management.

Reported daily collections of faecal sludge show that only a fraction of the estimated volume of faecal sludge to be collected and disposed of daily reaches safe disposal sites. The rest is either used in agriculture or aquaculture or discharged indiscriminately into lanes, drainage ditches, inland waters, estuaries and the sea, or onto open urban spaces, posing a serious health risk.

Managing faecal sludge that reaches safe or legal treatment or disposal sites has its own challenges. Research from around the world indicates that faecal sludge varies widely in physico-chemical characteristics, even within the same city, making management of this waste stream more challenging than wastewater.

Despite the seriousness of the health risk, the management of faecal sludge from on-site sanitation systems does not get the attention it deserves. Development goals focus primarily on providing sanitation facilities and often overlook the need for cost-effective processes to collect, transport, treat and re-use the faecal sludge that accumulates in them, and the operation and maintenance needed to keep the toilets in an acceptable condition.

The Water Research Commission of South Africa has commissioned several projects over the years to solve challenges along the faecal sludge value chain, but further research on faecal sludge management is still urgently needed. For example, there is a general lack of scientific knowledge of how pit toilets work and how fast they fill up. Most disposal and treatment solutions are still in pilot or testing stage, making it difficult for local authorities and private pit emptying service providers to make informed decisions. Moreover, there is a general lack of reliable information in sub-Saharan Africa on the actual numbers of each of the different types of toilets or toilet practices out there and the condition in which they are in.

The Sanitation Research Fund for Africa (SRFA) Project

In 2012, the Water Research Commission, together with the Bill and Melinda Gates Foundation, took a strategic decision to develop capacity in Africa to deal with faecal sludge management. This initiative, known as the Sanitation Research Fund for Africa (SRFA) Project, provides an exclusive research and development grant of up to US$200 000 to African institutions and organisations.

12 African institutions and organisations from eight Southern and East African countries were awarded research grants:

a. East Africa: Kenya, Ethiopia and Malawi (2 research teams)

b. Central Africa: Uganda (2 research teams)

c. Southern Africa: Botswana, South Africa (3 research teams), Zimbabwe and Zambia

Executive Summary

02


The Project comprises two focus areas:

a. The physical and chemical processes occurring in “dry” pit toilets and their contribution to the physico-chemical characteristics of faecal sludge, the level of pathogens and pit filling rates.

b. Technology for desludging, transporting, treating and disposing of faecal sludge, which would benefit people and the environment.

The first task of the research teams was to research the baseline conditions of faecal sludge management in their respective countries. This report presents a consolidated review of their findings, which cover the sanitation policy environment and faecal sludge management practices in these eight Southern and East African countries.

Summary of findings

General state of sanitation

The challenges that these countries experience with faecal sludge management in urban and peri-urban areas are similar, but the general state of sanitation differs considerably as figures from the latest WHO/UNICEF report (2014) indicate.

Substantial progress has been made in access to sanitation since 1990; yet only South Africa and Botswana serve more than 50% of the population with an improved sanitation facility.

The figures for toilet facilities are based on infrastructure projects; they give no indication in what condition these toilets are or how the wastewater and faecal sludge that they collect are managed.

The enabling framework

Since the 1970s, sanitation programmes focussed mainly on infrastructure development to eradicate open defecation and bucket latrines. (See details of South Africa's bucket eradication programme in the sub-sections on South Africa.)

Sanitation legislation, policy and strategy reflect this drive for infrastructure development. What would happen when the pits were full, were not a concern at the time. As a result, faecal sludge management is largely absent in policy and legislation as the country profiles in the report will illustrate.

The responsibility for sanitation is vested in a range of government ministries and agencies. In most of the countries studied, these ministries include the Departments of Water Affairs, Environmental Affairs, Local

1government, Health and Education.

In most of the countries, institutional arrangements are complex and fragmented. The structure of local authorities and the delineation between urban and rural jurisdiction vary considerably between the eight countries. In the majority of the countries, implementation is the responsibility of the local authority. Limited capacity, inadequate by-laws and enforcement, action plans and budgets hamper effective faecal sludge management.

In some countries, the distinction between urban and rural sanitation has turned peri-urban sanitation into a no-man's land in terms of policy and legislation - see the Zimbabwe profile.

There are exceptions: in an attempt to consolidate the sector, Botswana, for example, rationalised water and sanitation services under a single state-owned utility in 2009.

National budgets allocate significantly more to water than to sanitation. To meet the Millennium Development Goal for sanitation, sub-Saharan Africa needs to invest an estimated 0.6 percent of its gross domestic product (GDP) annually on sanitation. Five of the eight countries (Ethiopia, Kenya, Malawi, Zambia and Zimbabwe) spent less than 0.6%, according to an AICD DH/MICS Survey Database of 2007 (Morella et al., 2008).

1Each country has its own name for these Ministries.03

The focus of these limited budgets is on the provision of sanitation facilities, and less on operation and maintenance. As a result, local authorities do not have enough budgeted funds for faecal sludge management.

2Water and sanitation made up an average of 6.48% of donor spending in Africa in 2012 . Donor funding and other aid to sanitation goes mainly to infrastructure development and health and hygiene education. 80% of aid flows in the water sector were extended in the form of projects (mainly investment projects). Projects for large systems are still predominant and accounted for 41% of total contributions to the water and sanitation sector in 2010-11.

Faecal sludge management in practice

Many issues regarding faecal sludge management have not been resolved yet; as a result there are no common standards and best practices for on-site sanitation:

Pit latrines

Pit latrines are by far the most common on-site facility in informal urban and peri-urban settlements and rural areas.

Only three of the eight countries developed a minimum standard for a sanitation facility: Botswana (the double vaulted VIP latrine), South Africa (the VIP latrine) and Zimbabwe (the Blair VIP latrine).

In Botswana, South Africa and Zimbabwe, there has been large infrastructure programmes to supply sanitation that meets the basic standard.

The wide variety of pit latrine technologies and sludge characteristics in the countries studied makes management of these systems difficult. For example, many pit toilets that the research teams encountered had no slab covering to access the sludge, unlike in South Africa where it is a requirement.

It is commonly acknowledged that pit latrines could contaminate groundwater in certain circumstances. Yet, the literature gives disparate guidelines on the safe distance between a pit latrine and a water source.

Alternative improved options, such as the pour flush, urine-diverting toilet and other eco-sanitation types have been mainly confined to small-scale donor-funded projects. An exception is the eThekwini urine diversion dehydration toilet (UDDT) project. Several research reports mention that the social acceptability of handling and re-using dried or treated faecal sludge or urine on-site remains a challenge.

Operation and maintenance

Pit latrines, even if it is a VIP that is not full yet, continue to be an unpleasant solution due to odour, flies and safety. In practice, eco-san alternatives such as UDDT do not seem to resolve the issue of odour and flies.

The literature on faecal sludge management abounds with pictures of dirty and blocked toilets, but it does not indicate to what extent this problem is an engineering problem or an operation and maintenance problem. When users do not clean up their own urine and faeces spills on the seat and the floor, or faeces sticking to the inside of the bowl, someone has to clean up behind them. If no-one takes this responsibility, and disinfectant and cleaning materials are unaffordable or absent, any toilet, whether waterborne or a pit latrine, will smell and become unhygienic to use. In cities such as Kampala, Uganda, where most pit latrines are communal or shared among households, the problem is exacerbated.

All over the world, from households to public spaces, thousands and thousands, probably millions of cleaners, mostly women, have to clean toilets after they have been used.

Nowhere in the literature have we seen this problem, which is also a gender one, being addressed directly.

The country reports do not make a link between open defecation and dysfunctional or unhygienic toilets. It is likely that open defecation will continue to be practised in Africa as long as there are toilets that are dysfunctional or unhygienic.

2http://webnet.oecd.org/dcdgraphs/CPA_recipient/


04

Also, the reports emphasise that all aspects of the sanitation value chain are affected if solid waste is indiscriminately disposed of into toilets. If solid waste is not regularly removed from peri-urban and urban settlements, some of it end up in toilets.

Full pits

The rate at which pits fill up in a particular country is a function of many variables, such as pit size, soil quality, groundwater level, the number of people who share the latrine, anal cleansing practices and solid waste dumped into the pit. It is therefore difficult to plan a pit-emptying programme that would fit all scenarios. Emptying on demand seems to be the common approach.

Full pits are either emptied or replaced. Where there is space available and soil conditions are favourable, the common practice is to replace the pit.

Sludge removal

Sludge removal technologies are either mechanised or manual, or mixed. Vacuum trucks are the most common mechanised pit-emptying technology. In many low income areas, the plots or the top structures of latrines are not accessible to vacuum trucks and these residents have no choice but to resort to manual removal. In some instances, faecal sludge can only be accessed by removing the toilet or other structural components. Also, vacuum trucks struggle to deal with thick sludge and solid waste found in the pits.

Mechanised pit emptying is expensive and low income residents can't afford vacuum trucks, unless the service is subsidised by the local authority, which the local authority, in turn, cannot sustain.

Innovative pit emptying technologies seldom survive the pilot stage due to a lack of institutional support, maintenance issues such as a spare part that has to be imported or inadequate fees to cover costs.

Manual emptying is still common in areas where people cannot afford the mechanised service or where the mechanised service has broken down or cannot access the pit.

While there seems to be no lack of manual pit emptying entrepreneurs, they lack business skills and the financing to add some mechanised support to their operations. See the eThekwini project in the South Africa profile for an example of a large-scale manual emptying programme. Also, most mechanised options for manual operators have not scaled up beyond the pilot phase as a result of unforeseen mechanical problems or costs. The work conditions of manual emptiers are unpleasant and unsafe, because occupational health and safety measures are mostly absent.

Sludge disposal, treatment and re-use

Inadequate treatment and re-use of faecal sludge seems to be a common problem of most urban local authorities. The country reports mention lack of institutional support, funds and skills.

Most city wastewater treatment plants receive faecal sludge where it is co-treated with wastewater. Shock loads are a risk, but in some African cities, the wastewater treatment plants are dysfunctional irrespective of whether they receive faecal sludge or not. The effect of large quantities of faecal sludge on activated sludge plants still has to be studied further. Various new technologies to treat faecal sludge, such as deep row entrenchment, are being introduced, but there is no single solution yet.

In some countries, treatment plants in the major cities are being upgraded to make provision for faecal sludge. For example, the city of Kampala is currently building two faecal sludge treatment plants with a capacity of 200 m³/day each, one at Lubigi and another one at Nalukolongo. A donor-funded project, FaME, will be piloting the use of faecal sludge to fuel brick kilns at the Lubigi plant in Kampala.

In the absence of proper regulation and law enforcement, manual emptiers tend to dump their sludge loads as fast as possible and where it is the most convenient, creating a hazard to the environment.

So far, there has not been much success with the on-site treatment and re-use of faecal sludge in the eight countries studied. Eco-san facilities, such as the urine diversion dehydration toilets (UDDTs) and Arborloos, have had slow uptake for various reasons. Residents don't like to handle faecal sludge or they don't perceive these toilets as an improved sanitation facility, because they still have a smell nuisance.


05

The commercial re-use of faecal sludge takes place on a small scale, but there are some successful and innovative pilots, for example the biogas projects of the Umande Trust in Nairobi and the Dream Team in Zambia.

Considerations for the future

Faecal sludge is a valuable resource that is still largely unexplored. It is evident that challenges and the areas to be addressed listed above call for an integrated management solution that can turn faecal sludge from waste to resource on a large scale.

It is essential that the sanitation managers of local authorities and utilities meet regularly at a sub-Saharan forum to share success stories and lessons learnt. It is also essential that the required budgets, skills and technology are harnessed to solve the faecal sludge problem of African cities effectively.

Possible focus areas:

WASH campaigns that include educating children and adults (males and females) to be responsible and hygienic toilet users and cleaners.

Solid waste removal services to informal settlements. Privatising re-cycling services might work.

A cost effective and safe alternative for the pit to solve the problems with pit-emptying and potential groundwater contamination.

Research and development of financially viable and scalable solutions for the treatment and re-use of faecal sludge. The cost-benefit calculation must reverse the money flow, i.e. pay toilet owners or collectors in money or by-products for faecal sludge.

Supportive policy and legislation, and micro financing for the private sector to invest in these solutions.


06

Executive summary

Table of Contents

List of Tables

List of Figures

Acknowledgements

1. Introduction

1.1 The challenge of feacal sludge management in sub-Saharan Africa

1.2 The Water Research Commission (WRC) of South Africa

1.3 The Sanitation Research Fund for Africa (SRFA) Project

1.4 The scope of this report

2. Methodology

3. Definitions

3.1 Feacal sludge management

3.1.1 Feacal sludge

3.1.2 Feacal sludge as a health hazard

3.1.3 Feacal sludge management

3.1.4 Collection and discharge

3.1.5 Treatment and re-use

3.2 The sanitation ladder

3.3 On-site sanitation

3.3.1 On-site sanitation facilities

3.3.2 Unimproved on-site facilities

3.3.3 Improved on-site facilities

4. The socio-economic context

4.1 Overview

4.2 Donor aid for sanitation

5. The sanitation policy environment

5.1 Botswana

5.1.1 Brief history of sanitation development

5.1.2 Policy and legislation

5.1.3 Institutional arrangements

5.2 Ethiopia

5.3 Kenya



Table of Contents

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5.4 Malawi



5.5 South Africa



5.6 Uganda

5.7 Zambia



5.8 Zimbabwe



6. Dashboard of progress in sanitation

6.1 In sub-Saharan Africa from 1990 to 2012

6.2 In eight Southern and East African countries

7. Country profiles

7.1 Botswana

7.1.1 Main issues

7.1.2 Types of on-site facilities

7.1.3 Faecal sludge management practices

7.2 Ethiopia

7.2.1 Main issues



7.3 Kenya

7.3.1 Main issues

7.3.2 Types of on-site sanitation

7.3.3 Faecal sludge collection and disposal practices

7.3.4 Treatment and re-use practices

7.4 Malawi

7.4.1 Main issues



7.5 South Africa

7.5.1 Main issues


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7.5.4 eThekwini Metro

7.6 Uganda

7.6.1 Main issues




7.7 Zambia

7.7.1 Main issues



7.8 Zimbabwe

7.8.1 Main issues



8. Conclusions

8.1 Policy and legislation

8.2 Responsibilities, capacity and funding

8.3 Standards for on-site sanitation facilities

8.4 The sanitation value chain

8.4.1 Full pits

8.4.2 On-site disposal

8.4.3 Pit-emptying and transportation

8.4.4 Treatment, disposal and re-use

9. References


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Figure 1: Some of WRC research reports on faecal sludge management

Figure 2: The eight Southern and East African countries that received SRFA grants

Figure 3: Some of the technologies being piloted in the SRFA Project

Figure 4: The sanitation ladder

Figure 5: The BOTVIP and the South African VIP

Figure 6: Breakdown of aid to water and sanitation projects

Figure 7: Progress in sanitation in sub-Saharan Africa

Figure 8: The general state of sanitation in the 8 participating countries

Figure 9: Research team from Ethiopia sampling a pit toilet

Figure 10: Overview of available treatments and disposal methods of faecal sludge in South Africa

Figure 11: Dewatering technologies employed in South Africa (dry mass % as base)

Figure 12: Tertiary treatment and additional stabilisation technologies employed in South Africa (dry mass % as base)

Figure 13: The sanitation value chain

Figure 14: Unsafe faecal sludge disposal in Dakar (2012)

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Table 1: Overview of economic and political indicators in eight Southern and East African countries

Table 2: Institutional roles and relationships in water and sanitation in Kenya

Table 3: Legislation on public health, environmental protection and occupation safety in Malawi

Table 4: Major policies and legislation that relate to sanitation in Uganda

Table 5: Milestones in the water and sanitation sector in Zimbabwe

Table 6: Sanitation in eight Southern and East African countries

List of Tables

List of Figures


10

The Bill and Melinda Gates Foundation is acknowledged for its grant to the Sanitation Research Fund for Africa (SRFA) Project, from which the information in this document is sourced.

The research teams involved in the SRFA Project are also acknowledged:


Acknowledgements

University of Malawi

The Polytechnic

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1.1 The challenge of faecal sludge management in sub-Saharan Africa

Sub-Saharan Africa still lags behind in achieving the Millennium Development Goals for sanitation. In 2012, 644 million people in sub-Saharan Africa, that is 70% of the population, used an unimproved toilet facility or resorted to open defecation (WHO/UNICEF, 2014).

On-site sanitation systems, such as septic tanks, pit latrines of different types and bucket latrines, prevail in both rural and urban areas in sub-Saharan Africa. In fact, in most cities in developing countries, on-site sanitation facilities make up the majority of toilet facilities, because off-site (sewered) sanitation is not feasible or affordable (Koné & Strauss, 2004).

Reported daily collections of faecal sludge show that only a fraction of the estimated volume of faecal sludge to be collected and disposed of daily reaches safe disposal sites (Koné & Strauss, 2004). The rest is either used in agriculture or aquaculture or discharged indiscriminately into lanes, drainage ditches, inland waters, estuaries and the sea, or onto open urban spaces, posing a serious health risk (Klingel et al., 2002).

The causes for the unrecorded and clandestine disposal of faecal sludge are multiple: long haulage distances to treatment sites, non-affordability, the difficulty for mechanical and manual pit emptying services to gain access to toilets in densely-populated areas and the dumping of solid waste into toilets (Ingallinella et al., 2002; Ahmed & Rahman, 2003; Koné & Strauss, 2004; Koottatep et al., 2012; Bakare, 2014).

Managing faecal sludge that reaches safe or legal treatment or disposal sites has its own challenges. Research from around the world indicates that faecal sludge varies widely in physico-chemical characteristics, even within the same city, making management of this waste stream more challenging than wastewater (Ingallinella et al., 2002; Ahmed & Rahman, 2003; Koottatep et al., 2012; Bakare, 2014).

Given the high volumes of sludge produced, and the large number of on-site sanitation technologies, one would expect most developing countries to have faecal sludge management policies and legislation in place. However, this is not the case. Most African countries do not have guidelines for the management of faecal sludge from on-site sanitation systems, except for the guiding documents developed by the Department of Water and Sanitation in Developing Countries (Sandec) at the Swiss Federal Institute of Aquatic Science and Technology (Eawag) (Klingel et al., 2002).

Research on faecal sludge management is still scant. For example, there is a general lack of scientific knowledge of how pit toilets work and how fast they fill up. Most disposal and treatment solutions are still in pilot or testing stage, making it difficult for local authorities and private pit emptying service providers to make informed decisions. Moreover, there is a general lack of reliable information in sub-Saharan Africa on the actual numbers of each of the different types of toilets or toilet practices out there and the condition in which they are.

1. Introduction

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1.2 The Water Research Commission (WRC) of South Africa

The WRC, the primary water and wastewater research funding organisation in South Africa, has commissioned several projects over the years to solve challenges along the faecal sludge value chain.

In the early 2000s, as a result of the rapid upscaling of dry sanitation technologies in South Africa, the eThekwini Municipality, with the city of Durban at its core, was confronted with the challenge of emptying thousands of pit latrines. The municipality required critical know-how in faecal sludge management. It was evident to the WRC that research and development on faecal sludge management was urgent and of strategic importance. The organisation therefore decided to fund a series of research and development projects to support municipalities with this task.

The research funded by the WRC investigated faecal sludge management with reference to ventilated improved pit latrines (VIPs), the South African basic level of improved sanitation. A series of three volumes was produced:

1. Understanding sludge accumulation in VIPs and strategies for emptying full pits (Still and Foxon, 2012);

2. A scientific understanding of sludge build up and accumulation in pit latrines (Still and Foxon, 2012); and

3. The development of pit emptying technologies (Still and O’Riordan, 2012).

Over the years, the WRC has continued to commission several research projects to investigate and evaluate options for on-site sanitation systems and faecal sludge treatment technologies. Solutions that stimulate sludge beneficiation, entrepreneurship and job creation are encouraged.

An example of this is the social franchising concept piloted in the Eastern Cape to run the operation and maintenance of the water and sanitation facilities of 400 schools in the Eastern Cape (Wall & Ive, 2013). The improvement of sanitation facilities within the pilot area was so successful that the Department of Education requested that the programme be extended to a further 1,000 schools in the Eastern Cape. The WRC, through a partnership with the African Development Bank, has also recently embarked on a project to upscale the social franchising concept and incorporate innovative technologies into the faecal sludge management chain.

A new programme, in partnership with the Department of Science and Technology and the Bill and Melinda Gates Foundation (BMGF), will pilot the next generation of toilet technologies in South Africa, using innovative processes to transform faecal sludge into products that have commercial value (WIN-SA, 2014).

Figure 1. Some of the WRC research reports on faecal sludge management

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Figure 2. The eight Southern and East African countries that received

SRFA grants


1.3 The Sanitation Research Fund for Africa (SRFA) Project

The WRC is well aware of the strategic importance to develop human capacity to solve the challenges of faecal sludge management in Africa. A strategic partnership was formed with the BMGF Water, Sanitation and Hygiene Programme to fund solutions and develop capacity in this regard in sub-Saharan Africa.

This initiative, known as the Sanitation Research Fund for Africa (SRFA) Project, provides an exclusive grant of up to US$200 000 to African institutions and organisations.

In 2013, an open request for proposals was issued. 12 African institutions and organisations from eight Southern and Eastern African countries were awarded research grants:

a. East Africa: Kenya, Ethiopia and Malawi (2 research teams)

b. Central Africa: Uganda (2 research teams)

c. Southern Africa: Botswana, South Africa (3 research teams), Zimbabwe and Zambia

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No more than two research grants were awarded per country. South Africa was the exception, because the WRC provided the funding to two universities.

The WRC's research funding model was applied to the grantee projects: payment based on deliverables and a peer review of project progress through a Reference Group, consisting of the world's leading sanitation experts. The funding makes provision for capital expenses and capacity and competency development in the form of post-graduate studies.

The Project is divided into two focus areas:

1. The physical and chemical processes occurring in “dry” pit toilets and their contribution to the physico-chemical characteristics of faecal sludge, the level of pathogens and pit filling rates (six research teams). The pit characterisation studies aim to expand the knowledge base that the WRC developed with reference to eThekwini to different user habits and local conditions. The results will assist designers and operators of desludging and treatment technologies, and also inform management plans and policies around faecal sludge management.

2. Technology for desludging, transporting, treating and disposing of faecal sludge, which would benefit people and the environment (another six research teams). The treatment processes that the research teams are investigating include solar pasteurisation and hybrid anaerobic technologies (combined with pasteurisation or co-digestion). It is envisaged that the end-products from the treatment processes will be sterile and hold some monetary value, the proceeds of which can be channelled back into the faecal management chain, in particular the operation and maintenance of on-site sanitation technologies (WIN-SA, 2014).

Decentralised anaerobic plant for pit emptiers to reduce transportation costs

(Photo: Water for People, Uganda)

Solar pasteurising unit for on-site faecal sludge treatment (Photo: ATL-Hydro, South Africa).

Figure 3: Some of the technologies being piloted in the SRFA Project.

The Project provides a mechanism for African researchers to showcase their abilities and develop solutions customised to their environment and the available resources. It also provides an opportunity for African researchers and developers to gain more experience in research-related project management and to learn from a peer review of their work by an international panel of sanitation experts.

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1.4 The scope of this report

The first task of the research teams was to research the baseline conditions of faecal sludge management in their respective countries. This report presents a consolidated review of their findings, which cover the sanitation policy environment and faecal sludge management practices in these eight Southern and Eastern African countries.

The report comprises the following subsections:

1. Scope of the report

2. Methodology – the methods used to source and collate the information that the reader will find in this report

3. Definitions

4. The economic context


6. A dashboard of the status of sanitation in eight Southern and East African countries

7. A short profile of the individual countries:

i. Main issues

ii. On-site facilities

iii. Faecal sludge management practices

8. Conclusions

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The country studies used mainly two types of research methods:

1. Desk research to report on faecal sludge management in sanitation policy and legislation, and institutional arrangements; and

2. Primary research in the form of field visits, surveys, in-depth interviews and focus groups to report on faecal sludge management practices in specific areas of the capital or main cities of the country.

Some reports also relied on desk research to report on faecal sludge management practices in general in that country.

The research institutions, the coverage of findings on faecal sludge management practices and their research methodologies are summarised below:

Botswana

University of Botswana

Coverage: The whole country

Method: Desk research

Ethiopia

Jimma University and Ministry of Water and Energy

Coverage: Addis Ababa

Method: Household survey: 40 households from 2 districts in 5 sub-cities – randomly selected

Kenya

Egerton University

Coverage: Major urban areas: Nairobi, Kisumo, Mombasa

Method: Desk research

Malawi

University of Malawi

Coverage: Ntopwa settlement in Blantyre

Method: Household survey: 221 households, randomly selected

South Africa

ATL Hydro: Coverage – national; methodology – desk research

Rhodes University: Coverage – Eastern Cape municipalities; methodology – desk research

University of North West: Coverage – North West Province; method – interviews with municipal officials (no numbers) and 43 residents in 10 municipalities

Uganda

Makarere University: Coverage – mainly Kampala; method – desk research

Water for People: Coverage – national; method – desk research and seven stakeholder interviews

2. Methodology

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Zambia

University of Zambia

Coverage: Lusaka only

Method: Desk study: one stakeholder workshop and four community Focus Group Discussions (one in each of the four selected study areas) — latrine surveys (25 in each of the study areas and administration of a total of 115 household questionnaires on sludge handling and utilisation in the four study sites)

Zimbabwe

Chinhoyi University

Coverage: Eight urban centres, including the cities of Harare and Buluwayo

Method: Site visits and field observations; interviews and focus group discussions with local officials, NGO staff and community members (no numbers)

The country reports were supplemented with information from the following sources (see references):

The websites and reports of local water management institutions and research organisations.

Websites and reports of international organisations, such as OECD, WaterAid, USAID, UNICEF and the World Health Organisation (WHO).

Statistics from WHO/UNICEF and the World Bank.

In the next chapter, the basic definitions are presented to provide the reader with a better understanding of terminology and the concepts presented later in the report.

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33.1 Faecal sludge management

3.1.1 Faecal sludge

For the purpose of this report, faecal sludge will be defined as human excreta that is disposed of in facilities located on a housing plot (on-site sanitation facilities) and in fields, forests, bodies of water or other open spaces (open defecation) (EAWAG/SANDEC, 2008). EAWAG/SANDEC (2008) also uses the following technical definition: "Faecal sludge is the general term for undigested or partially digested slurry or solids resulting from storage or treatment of black water or excreta".

This report does not consider sludge from septic tanks as faecal sludge as it is biochemically more stable due to longer storage periods than sludge from dry sanitation installations. On the other hand, sludge from septic tanks is often collected and treated together with faecal sludge. In this instance, the report will mention sludge from septic tanks.

3.1.2 Faecal sludge as a health hazard

In many developing countries, increasing urbanisation has led to a backlog in services, such as housing, water and sanitation. As a result, large informal settlements or slum areas with inadequate water and sanitation services have become typical of cities in developing countries. Large quantities of faecal sludge accumulate in these areas, which may have the following negative effects on the urban environment and on public health (Klingel et al., 2002):

Environmental pollution is caused by effluents of not regularly de-sludged on-site sanitation facilities;

Large amounts of faecal sludge removed from sanitation facilities are dumped indiscriminately into the environment due to a lack of disposal facilities;

Faecal sludge is used in unhygienic ways in agriculture because no sludge treatment is available.

Proper management of faecal sludge can avoid these problems.

3.1.3 Faecal sludge management

According to EAWAG/SANDEC (2008), faecal sludge management comprises the following aspects:

Legislation, policy and strategy to set objectives and criteria

Implementation

Collection

Treatment

Re-use and disposal

Responsibilities, communication and coordination; financial arrangements, timeframe

3. DefinitionsThe report uses the following definitions of key terms and technologies:

3 Faecal sludge management as defined by Klingel, Montangero, Konè and Strauss (2002).19


3.1.4 Collection and discharge

Collection is either manual or mechanised. The most basic manual collection method involves climbing into a pit with shovels and buckets and hoisting the sludge up and into some container. Safety equipment is typically absent. More advanced methods involve some mechanised apparatus that pumps the sludge out of the pit. The sludge gulper, the diaphragm pump, the motorised pit screw auger, the nibbler and MAPET are innovations that have been used in pilot studies (Strande et al., 2014).

Vehicle-mounted mechanised methods include the following:

The conventional vacuum tanker is often the favoured technology when able to access the housing plot and the pit, because there is minimal contact with the pit contents and it is more efficient in evacuating sludge than its alternatives (Eales, 2005). A hose connects the pit contents to a truck-mounted tank (1–10 m³ in capacity) and a vacuum pump is connected to the tank (Klingel et al., 2002). Large trucks often have difficulty accessing pit latrines or septic tanks in areas with narrow or non-driveable roads.

In 1997, with the sponsorship of UN-HABITAT, the Vacutug was developed and piloted in Nairobi, Kenya. The aim was to develop a pit latrine exhauster that was suitable for areas that are inaccessible to vacuum trucks. The simple design consists of a small gasoline engine, a 500-litre tank and a 4 m PVC hose that can suck up to 1700 litres of sludge per minute. The vacuum can be reversed to discharge the faecal sludge at a centralised facility or collection point. The Vacutug requires two operators and can move at speeds of up to 5 km per hour. Ideally, the point of discharge should be within 1 km of the service area. Since then, four further versions were developed, but there was no reference to their use in the countries studied.

Discharging practices include adding the faecal sludge to the urban wastewater stream for co-treatment in wastewater treatment plants, sea outfalls, burial onsite, disposal at landfill sites, agroforestry, and taking the sludge to a point where it is treated for re-use.


Klingel and co-authors (2002) identified a list of faecal sludge treatment processes that the authors considered potentially suitable for developing countries. These are:

Solids-liquid separation;

Settling/thickening tanks or ponds (non-mechanised, batch-operated);

Unplanted drying beds;

Constructed wetlands;

Pond treatment of faecal sludge supernatants or percolates;

Combined composting with organic solid waste; and

Anaerobic digestion with biogas utilization.

New treatment technologies still being experimented on or in pilot stage include :

Pyrolysis – the thermal decomposition of human solid waste in an oxygen-free environment to produce biochar;

Electrolysis – using electrical currents to break down the chemicals in human liquid-waste;

Pasteurisation – a heat treating process which thermally sterilises human waste;

Plasma gasification – using microwave technology to gasify human waste; and

On-site membrane technology to purify liquid waste through filtration.

According to Sudhir Pillay of the WRC, despite 10 years of further research, there is currently still no definite conclusion as to which treatment method is the most suitable as the physico-chemical properties of faecal sludge is highly variable and most solutions have not been demonstrated at scale (Personal communication, 2015).

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3.2 The sanitation ladder

In line with the approach of the World Health Organisation (WHO), this report presents sanitation statistics as a four-step ladder (WHO/UNICEF, 2013):

3.3 On-site sanitation

WHO/UNICEF (2013) group sanitation facilities as follows:

3.3.1 On-site sanitation facilities

EAWAG/SANDEC (2008) defines on-site sanitation as "a system of sanitation whose storage facilities are contained within the plot occupied by a dwelling". On-site sanitation can be classified into two main categories: wet (which requires water for flushing) and dry (which does not require water for flushing). Pit latrines, VIPs and urine diversion (UD) toilets are all forms of on-site sanitation (Tissington, 2011).

Practicing opendefecation

UNIMPROVED IMPROVED

Using an unimprovedsanitation facility

Using an improved sanitation facility

Sharing an improvedsanitation facility(public facility or sharing with two ormore households athome)

Figure 4. The sanitation ladder

4Open defecation Defecation in fields, forests, bushes, bodies of water or other open spaces, or disposal of human faeces with solid waste.

Unimproved Facilities that do not ensure hygienic separation of human excreta from human contact.Unimproved facilities include pit latrines without a slab or platform, hanging latrines and bucket latrines.

Shared Sanitation facilities of an otherwise acceptable type shared between two or more households.Shared facilities include public toilets. Only facilities that are not shared or not public are considered improved.

Improved Facilities that ensure hygienic separation of human excreta from human contact. They include:

Flush or pour-flush toilet/latrine to piped sewer system, septic tank or pit latrine;

Ventilated improved pit (VIP) latrine; Pit latrine with slab; Composting toilet.

4 Open defecation encourages the spread of faeces-related diseases, such as diarrhoea, worm infestation, typhoid, cholera and dysentery. Water pollution is also

caused by the run-off surface water from areas where people have openly defecated. 21


On-site sanitation facilities can be either unimproved or improved.

Sanitation statistics sometimes also refer to sanitation facilities as basic, safe or 'adequate'. For example, the WHO/UNICEF definition for "adequate sanitation at home" for post-2015 refers to:

Using an improved sanitation facility at home, and

Sharing this facility between five households or less.

This report refers to 'unimproved' or 'improved', but it will also use the description of the respective countries where applicable.

53.3.2 Unimproved on-site facilities

3.3.2.1 Simple pit latrines

The basic elements of a pit latrine are: a hole dug in the ground, a squatting slab and a super structure erected over it. The excreta falls into the hole where the urine and other liquids soak into the ground and solid materials are retained and decomposed in the pit.

Pit latrines are a drop-and-store sanitation system. Little or minimum operation and maintenance are required and not much focus is given to the facilities until they eventually fill up with the faecal matter and other materials dropped inside. The problem-in-waiting emerges when the pit requires emptying or replacement.

Advantages:

a better solution than open defecation,

easily constructed and cost effective,

does not require water to operate, and

the technology is simple and understandable.

Disadvantages: Simple pit latrines attract flies and create a smell nuisance, frequently collapse if not well lined, can pollute groundwater and are not easy to construct on rocky ground.

3.3.2.2 Hanging latrines

Hanging latrines are toilets built over the sea, a river, or any other body of water, into which excreta drops directly (WHO/UNICEF Joint Monitoring Programme, 2015).

3.3.2.3 Bucket latrines

Bucket latrines refer to the use of a bucket or container, usually placed in a hole under the floor, for the retention of excreta, along with anal cleaning material, which needs to be periodically removed for treatment, disposal, or use as fertiliser (WHO/UNICEF Joint Monitoring Programme, 2015).

3.3.3 Improved on-site facilities

Facilities that are classified as improved on-site sanitation include the following:

3.3.3.1 Waterborne sanitation with a septic tank

Septic tanks are watertight buried receptacles that are designed and constructed to receive waste from waterborne toilets.

3.3.3.2 Riflo septica sanitation system

Developed in Italy, and introduced to Kenya by Riflo Industries, this system is similar to a septic tank and uses micro-organisms to biodegrade toilet waste and the discharge is recyclable water. The unit is available in a wide range of sizes for domestic, commercial and industrial sanitation and costs between US$ 750 to US$ 1000 (Egerton University, 2014).

5Definitions from http://www.wssinfo.org/definitions-methods/watsan-categories/ 22

Figure 5. The BOTVIP (left) and The South African VIP (right) (Odirile et al., 2013)


3.3.3.3 Aqua-Privy

An aqua-privy functions in a similar manner to a septic tank whilst avoiding the need for a consistent water supply to operate a flush toilet. It consists of a squatting plate constructed above a small septic tank that has an integral drop pipe that is submerged into the water tank to form a water seal (Egerton University, 2014).

Regular emptying and maintaining the water level are burdensome requirements. Failure to maintain the water seal has been the main problem. This leads to intense odour release and fly and mosquito nuisance. The aqua-privy has no advantage over pour-flush, which is less expensive and easier to maintain.

3.3.3.4 VIP latrines

Ventilated improved pit (VIP) latrines can overcome the disadvantages of the simple pit latrine. The basic elements of a VIP latrine are a pit, a cover slab and ventilation pipe hole, a super structure for privacy and protection from weather, as well as a fly screen to keep the latrine free from flies and odours. See illustration below. To deal with overflow, VIP latrines are sometimes connected to a septic tank (Makerere University, 2014).

3.3.3.5 The Blair VIP latrine

The Blair VIP latrine has been developed by the Zimbabwean Blair Research Institute, now called the National Institute of Health Research.

The main disadvantages are the high costs, and the fact that the design does not seem to enable the easy emptying of pits when full.

3.3.3.6 Pour-flush Toilet

A water-seal is created by a plastic U-bend that prevents odour and flies (this system is less susceptible to building errors than the VIP system). The system only requires a few litres of water and so should not put a strain on resources (Harvey et al., 2002; Ahmed & Rahman, 2003). The Water Research Commission of South Africa, together with Partners in Development, has recently began piloting an innovative variation of the pour–flush toilet that prevents blockages from toilet paper and newspaper (Pillay, 2014).

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Flyscreen

Ventpipe

Seat Insert

Ventilation Ventilation GapGapVentilation Gap

SUPERSTRUCTURESUPERSTRUCTURESUPERSTRUCTURE

SUPERSTRUCTURESUPERSTRUCTURESUPERSTRUCTURE

FardFardCover-Cover-slabsslabs

FardCover-slabs

RingbeamRingbeamRingbeam

Removable Removable CoverslabCoverslabRemovable Coverslab

PitPitPit

Vent pipe

Fly-screen

Superstructure

Door

Slab

Pit

Pedestalwith lid

CollarCollarCollar


3.3.3.7 Urine Diverting Dry Toilet (UDDT)

A Urine Diverting Dry Toilet (UDDT) is a toilet that operates without water and has a divider so that the user, with little effort can divert the urine away from the faeces. The UDDT toilet is built in such a way that urine is collected and drained from the front area of the toilet, while faeces fall through a large chute (hole) in the back (EAWAG/SANDEC, 2008). The UDDT, unlike other sanitation systems has two outlets and two collection systems that separate the urine and the faeces in order to simplify their safe recycling and the use of their unmixed nutrient content (Kvarnström et al., 2011).

The UDDT is applicable where water is inadequate for waterborne systems and the ground condition has unstable soils, rocky ground or flooded area and generally not suitable for construction of pit latrines. Education and demonstration projects are essential in achieving good acceptance with users (EAWAG/SANDEC, 2008).

3.3.3.8 Ecological compost latrines

Two types are found in the countries studied: single-pit or single-compartment latrines (for example, Arborloo) and twin-pit or twin-compartment latrines (often called Fossa alterna).

Composting latrines are shallow vaults, into which excreta, kitchen waste and similar materials are added. The waste and excreta break down together to produce a compost which can be dug out and used as fertiliser.

The Arborloo or Eco-pit is the simplest type of ecological sanitation system. A sanitary slab and a light weight latrine super structure is placed on a shallow un-lined pit (as deep as the soil conditions allow) and when the pit is full, the slab and the super structure are moved to a new pit and the existing pit covered and a tree planted on top of the pit (Egerton University, 2014).

In a twin-compartment latrine or Fossa alterna there are two shallow vaults, one of which is used at a time. When one is nearly full, it is covered with soil and left for at least two years for the excreta and waste to decompose and for the pathogenic germs in it do die. While the first vault is closed, the second is used. When the second is nearly full, the first is opened, the compost dug out for use as fertiliser and the first vault re-used (WHO, no date).

Compost formed by the combination of urine and faeces is better, but these toilets are more likely to smell if used carelessly and they require much greater quantities of carbonaceous residues like sawdust and straw. Many of the more complex types require dry access under the toilet via a basement or cellar room (Pickford, 1995).

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4.1 Overview

The table below gives a brief overview of the eight countries' political stability, population growth, the increase in urbanisation, economic growth, gross domestic product per capita and donor involvement in sanitation.

4. The socio-economic context

Table 1. Overview of economic and political indicators in eight Southern and East African Countries

Country Population increase (1990-2011)

Increase in urban population (1990-2011)

Average GDP growth in past 5

6years

7 GDP per capita, 2013 in US$

% Donor spending on water and sanitation

8(2012)

Donor spending per capita (US$ million)

92012

Political stability

Botswana 1,47% 20% +/-5% 7,315.0 0,9% 63.2 Stable democracy

Ethiopia 1,75% 4% +/-10% 505.0 7,31% 30.6 Stable democracy Largely uncontested ruling party

Kenya 1,77% 7% +/-6% 1,245.5 7.6% 49 Unstable democracy Security threats posed by local militants

Malawi 1,64% 4% +/-4.5% 226.5 Down from 2010

5.53% 55.7 Stable democracy

South Africa 1,37% 10% +/-2.5% 6,617.9 Down from 2010

0.4% 21.8 Stable democracy

Uganda 1,95% 5% +/-5.5% 57.0 5.52% 44.8 Stable democracy

Zambia 1,71% 0% +/-7% 1,844.8 7.66% 69.3 Stable democracy

Zimbabwe 1,22% 10% +/-8% Down from 2012

953.4 7.83% 47.8 Vulnerable but stable democracy

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Sources: (CIA, 2015), (The World Bank, 2015b), (WHO/UNICEF, 2014)

The population growth (annual %) in sub-Saharan Africa was last measured at 2.53% in 2011, according to the World Bank (2015b). The statistics of projected growth in population and the rate of urbanisation mean that sub-Saharan cities have an ever increasing population to serve with water and sanitation. As most of the urban poor rely on on-site sanitation, these statistics present a growing challenge for faecal sludge management (WHO/UNICEF, 2014).

6 http://www.imf.org/external/pubs/ft/reo/2014/afr/eng/sreo1014.pdf7 GDP per capita is gross domestic product divided by midyear population. GDP is the sum of gross value added by all resident producers in the economy plus any

product taxes and minus any subsidies not included in the value of the products. It is calculated without making deductions for depreciation of fabricated assets or for

depletion and degradation of natural resources. Figures are in current US$ .8 http://webnet.oecd.org/dcdgraphs/CPA_recipient/9 http://webnet.oecd.org/dcdgraphs/CPA_recipient/

Figure 6. Breakdown of aid to water and sanitation projects

4.2 Donor aid for sanitation

Sub-Saharan Africa received 25% of total aid to the water sector. Water and sanitation made up an average of 106.48% of donor spending in Africa in 2012 .

Projections for aid until 2017 are stable. The amounts remain the same, but population increases lower the 11amount per capita (OECD, 2012). Per capita Country Programmable Aid is slightly down from the average

of 38.7 million US$ per capita in 2010-2012 to 36.9 million US$ projected for 2017.

Aid to water and sanitation is predominantly in the form of infrastructure investment projects. In 2010-2011, the distribution of Development Assistance Committee (DAC) members' bilateral flows in the water sector by aid modality was as follows (OECD-DAC, 2013):

80% of aid flows in the water sector were extended in the form of projects (mainly investment projects). Projects for large systems are still predominant and accounted for 41% of total contributions to the water and sanitation sector in 2010-2011;

6% were allocated through sector budget support mainly by the EU institutions;

6% through technical assistance;

5% through pooled contributions to specific purpose programmes managed by international organisations, e.g. Inter-American Development Bank Water and Sanitation Fund, UN-Habitat Trust Fund for Water and Sanitation, World Bank Water and Sanitation Programme;

2% through pooled contributions to basket funds.

Below is the breakdown of aid to water versus sanitation projects (2010-2011) (OECD-DAC, 2013):


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Basic sanitation and drinkingwater supply

Water resources policy,management

River development

Waste management &disposal

Water resources protection

Education & training waterand sanitation

Water supply & sanitation - large systems

41%

23%

21%

7%

3%3%

2%

Aid to water and sanitation projects

10http://webnet.oecd.org/dcdgraphs/CPA_recipient/11Country Programmable Aid (CPA) is a concept of the Organisation for Economic Co-operation and Development (OECD). It captures the flows of aid that go to the partner countries.


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Faecal sludge has recently become the focus of several donor-funded research programmes of which the SFRA Project is one. Another example is SPLASH, funded by ADA (Austria), MAEE (France), SIDA (Sweden), SDC (Switzerland) and DFID (UK) and the Bill and Melinda Gates Foundation's Water, Sanitation and Hygiene Programme. In this programme, European researchers work in collaboration with colleagues in Cameroon, Ghana, Kenya, Uganda, Rwanda, Mozambique and Senegal on all aspects of the sanitation value chain (WIN-SA, 2014).



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The overview below indicates how different aspects of faecal sludge management are addressed in policy and legislation in the eight countries. Where information was available, the section also refers to institutional arrangements.

Since the 1970s, sanitation programmes focussed mainly on infrastructure development to eradicate open defecation and bucket latrines. (See details of South Africa's bucket eradication programme in the sub-sections on South Africa.)

Only three of the eight countries developed a minimum standard for a sanitation facility: Botswana (the double vaulted VIP latrine), South Africa (the VIP latrine) and Zimbabwe (the Blair VIP latrine).

Sanitation legislation, policy and strategy reflect this drive for infrastructure development. What would happen when the pits were full, were not a concern at the time. As a result, faecal sludge management is largely absent in policy and legislation as the country profiles below will illustrate.

Policies and legislation that relate to sanitation originate from different Ministries, such as Water, Environment, Education and Health. However, local authorities, which fall under another Ministry, are in most cases responsible for implementation.

In most of the countries, institutional arrangements are complex and fragmented. The structure of local authorities and the delineation between urban and rural jurisdiction vary considerably between the eight countries. The distinction between urban and rural sanitation has turned peri-urban sanitation into a no-man's land in terms of policy and legislation - see the Zimbabwe profile below.

There are exceptions: in an attempt to consolidate the sector, Botswana, for example, rationalised water and sanitation services under a single state-owned utility in 2009.

5.1 Botswana

5.1.1 Brief history of sanitation development

5.1.1.1 Urban Sanitation Research Project (USRP)

In 1971, the government of Botswana introduced the scheme of providing latrines at subsidised costs to households in urban areas with this project. The aim of the USRP was to improve the poor sanitary conditions in growing towns and cities.

The project introduced VIP latrines in Botswana. Later, a double vault VIP latrine was adopted as the standard sanitation facility in urban areas.

A self-help approach was followed. In 1979, the City and Town Councils resolved to provide substructures for the latrine and each plot-holder was responsible for completing the super structure. All registered plot-holders were required to pay a monthly service levy to cover the costs of road maintenance, water supply, refuse collection, toilet emptying, secondary infrastructure and administration (Ghanie, 1982).

5.1.1.2 Environmental Sanitation and Protection Pilot Programme (ESPP).

By 1980, the USRP was extended. This programme was funded by UNICEF, the United States Agency for International Development (USAID) and the German KFW Development Bank.

The aim of the project was to develop, test and evaluate approaches to health education and to provide on-site sanitation technology in rural areas that is affordable and easy to understand. The ESPP was piloted for two years in six small and medium villages in Kgatleng and Southern Districts.


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During the project implementation a single vault VIP latrine was installed and was eventually adopted for use in the whole of rural Botswana (Jacks et al., 1999; DSWM, 2002). At the end of the two-year pilot project, 245 latrines were constructed.

5.1.1.3 Self-Help Environmental Sanitation Project (SHESP)

By 1984, with the help of UNICEF, the Government of Botswana initiated the second phase of the project under ESPP, known as Self-Help Environmental Sanitation Project (SHESP). The aim of the project was to address the shortcomings of ESPP in relation to health, education and project implementation and enhance community commitment to the programme. The SHESP provided pit latrines, but also acted as a social mobilisation and health education project. The SHESP, like the ESPP, was piloted in four District Councils: Southern, Kgatleng with two additional districts of Kweneng and Central. By 1988, 3500 latrines had been constructed under this programme.

By the end of 1990, the project covered approximately 80 rural settlements and the process of extending this project to the remaining district villages got underway (TAG, 2003).

5.1.1.4 The National Rural Sanitation Programme (NRSP)

In 1991, a study was commissioned to assist the Government of Botswana in designing a National Rural Sanitation Programme (NRSP) strategy for the National Development Plan 7 (NDP7), and beyond.

Between 1992 and 1997 (Brandberg, 1991), the National Rural Sanitation Programme (with support from the Swedish International Development Agency and UNICEF) provided more than 30 000 pit latrine substructures (Bolaane & Ikgopoleng, 2011; Odirile et al., 2013).


The legislative framework for sanitation services in Botswana comprises the Acts, strategies and policies listed below:

5.1.2.1 Waste Management Strategy (1998)

This strategy provides for the efficient management of waste, as well as the implementation of the Basel Convention. It promotes the health and well-being of the people of Botswana through the provision of appropriate and sustainable wastewater and sanitation management.

5.1.2.2 Policy for Wastewater and Sanitation (2001)

This policy aims to “promote the health and well-being of the people of Botswana through the provision of appropriate and sustainable wastewater / sanitation management and to introduce mechanisms for the protection and conservation of water resources” (Centre for Applied Research, 2011). The specific objectives are to:

a. Develop regulatory and legislative framework on wastewater / sanitation issues;

b. Introduce development planning concepts in wastewater / sanitation at district and national level;

c. Promote stakeholder involvement in wastewater management;

d. Introduce effective and sustainable operation and maintenance of wastewater / sanitation systems;

e. Establish basic principles for pricing and cost recovery for wastewater / sanitation facilities;

f. Establishment of national effluent discharge guidelines;

g. Establish an industrial pollution control framework based on the Polluter Pays Principle;

h. Conserve water by re-use of return flows; and

i. Promote health and sanitation education and awareness initiatives.


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This policy is being implemented under the Department of Pollution Control and Waste Management.

5.1.2.3 National Master Plan for Wastewater and Sanitation (2003)

The Botswana National Master Plan for Wastewater and Sanitation developed strategies for the implementation of the National Wastewater and Sanitation Management Policy. The Master Plan is the foundation for sanitation and wastewater management until 2030.

The Master Plan recommends (Centre for Applied Research, 2011):

a. Enactment of legislation for the wastewater and sanitation sector;

b. Upgrading of existing and development of new wastewater treatment facilities (capital investment plan up to 2030); and

c. Re-use and recycling of treated wastewater. The objective is to re-use and recycle 96% of the outflow by 2030 through agricultural re-use and reduction of losses in the treatment systems.

It comprises a set of 13 planning and technical design manuals with strategies and a budget for each village in the country.


The National Rural Sanitation Programme is delivered through a complex institutional arrangement: The Ministry of Environment Wildlife and Tourism and the Department of Waste Management and Pollution Control coordinate the programme, but it is implemented by the ten District Councils (Botswana Association of Local Authorities, 2015) under the Ministry of Local Government.

In May 2009, the Water Sector Reforms Programme came into effect to simplify institutional arrangements. The programme resulted from a study to rationalise the water sector in Botswana and ensure uniform service levels for all.

In terms of these reforms, the government of Botswana made the Water Utilities Corporation (WUC) responsible for wastewater and on-site sanitation management, in addition to water services, in the whole of Botswana. The WUC was scheduled to take over wastewater services in all the urban centres and villages in the whole country by the end of 2014 (Water Utilities Corporation, 2015).

The WUC is a parastatal organisation, wholly owned by the Botswana Government. It was established in 1970 by an Act of Parliament (Laws of Botswana Cap 74:02).


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5.2 Ethiopia

Besides legislation and policy that refer to sanitation in broad terms, the researchers from Jimma University and the Department of Water and Energy could not find legal instruments, policies, strategies and plans that specifically refer to faecal sludge or pit emptying, and its management.

Operational guidelines and clearly defined stakeholder responsibilities are also lacking (Jimma University, 2014).

Below are some examples of sanitation legislation and policy.

The Federal Democratic Republic of Ethiopia (FDRE) Constitution is the basis for all development-related policies, and legal provisions and related outcomes within the country. Article 44/1 of the Constitution gives all persons the right to live in a clean and healthy environment, while Article 92/1 of the Constitution states that the government has the duty to ensure this right. Article 92/2 of the Constitution requires that the design and implementation of development programmes and projects should not damage or destroy the environment (FDRE, 1994).

Several policies refer to environmental and personal health in relation to sanitation services and mention sanitation as a high priority:

The Environmental policy of Ethiopia (EPA, 1997).

Health policy of Ethiopia (Ministry of Health, 1993).

Ethiopian Water Resources Management Proclamation No. 197/2000 article 11 and 13 prohibits the release of untreated waste into natural water bodies.

The Ethiopian Public Health Proclamation No. 200/2000 article 12 states that “no person shall dispose solid, liquid or any other waste in a manner which contaminates the environment or affects the health of the society”.

A national hygiene and sanitation strategy (Ministry of Health, 2005) as well as protocols for hygiene and on-site sanitation (Ministry of Health, 2006) were developed by the Ethiopian Ministry of Health.

A National Water, Sanitation and Hygiene (WaSH) implementation framework was ratified by the Ministry of Health, Water and Energy, Education, and Finance and Economic Development in 2013 (FDRE, 2013).


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5.3 Kenya


Kenya has laws, policies and regulations relating to the water supply, sanitation, waste management and environment, but they are "scattered" over different government departments and institutions. Some aspects are duplicated or repeated several times in the various policies and laws (Egerton University, 2014).


Institutional arrangements are complex and duplication occurs at local level as the table below illustrates:

Roles and responsibilities are not clearly defined and often the institutions lack the capacity (technical, human resources and financial) to monitor and enforce the laws (Egerton University, 2014).

Table 2. Institutional roles and relationships in water and sanitation in Kenya

Sectors and subsectors

Institutional roles and relationships

Water supply Sewerage and related hygiene

promotion

General sanitation and

hygiene promotion

School sanitation

Urban sanitation

Sector leadership (national)

Regulation (national)

Service development and provision (national)

Service development and provision (regional)

Service development and provision (local)

Ministry of Water and Irrigation

Water Services Boards

District Water Officers

Water service providers

District Public Health Officers

Water Services Trust Fund (WSTF)

Water Services Regulatory Board

WaterServices

RegulatoryBoard

NationalWater

Conservation and PipelineCorporation

Ministry of Physical

Health and Sanitation

Ministry of Education

Local authorities


5.4 Malawi


Similar to the countries above, Malawi does not have explicit legislation on faecal sludge management. The reference to faecal sludge is by inference and obtained in different legislation on public health, environmental protection and occupation safety, as the table below illustrates:

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Table 3. Legislation on public health, environmental protection and occupation safety in Malawi

Government institution Policy or legislation Faecal sludge management (FSM)

Ministry of Irrigation and Water Development

National Sanitation Policy (2008) The mission of the policy is “to ensure that all people in Malawi own and have access to improved sanitation facilities, practise safe hygiene, and practise safe recycling of liquid and solid waste for sustainable environmental management and socio economic development”.No specific targets, responsibilities, treatment or re-use technologies, responsibilities or funding mechanisms

National Water Policy (2005) No mention of FSMEmphasize research and private-public partnerships in sanitation

National Water Development Programme (NWDP) (2011)

No mention of FSMRefers to "investments and technical assistance for sanitation and hygiene investments".

Malawi Growth and Development Strategy II (MGDs II)

No mention of FSMFocuses on thematic areas, of which one is Public Health, Sanitation, Malaria and HIV and AIDS.

Water Resources Act (2013) No mention of FSMFocuses on the establishment of river basin authorities and sub-catchment management units

Ministry of Natural Resources and Environmental Affairs

National Environmental Policy (2004)

No mention of FSMFocuses on hygiene and sanitation provision


The relationship between policy and legislation, and institutional arrangements is complex. Roles and inter-relationships are not well coordinated as the examples in the next paragraph illustrate:

The Ministry of Irrigation and Water Development, the water boards and city assemblies are responsible for water supply. The main institutions responsible for sanitation are the Ministry of Irrigation and Water Development, city assemblies and the Ministry of Health and Population. However, water supply and sanitation are also provided by civil-society organisations and international donors who set up and fund their own water and sanitation projects.


Local governments are mandated by the Local Government Act to be responsible for water and sanitation, while the Water Works Act and the National Sanitation Policy mandate the water boards to have this responsibility (Zeleza-Manda, 2009).

The Malawian government's priority with regard to funding, even in seeking donor support, remains water supply. Sanitation is neglected or at best left with non-government organisations. The only major government concern in connection with sanitation is hygiene education or treatment of sufferers in cases of disease outbreak (Zeleza-Manda, 2009).

WaterAid UK confirmed this finding. According to the organisation, the root cause of lack of progress in the sanitation sector is political neglect: sanitation “is given low priority by donor and recipient governments alike. In sub-Saharan Africa, at current rates of progress, the 2015 MDG target for sanitation will not be met until 2076” (Water Aid Malawi, 2007). In the same report, WaterAid ranks Malawi the lowest of 12 countries in prioritization of sanitation.

The quote below from The Nation illustrates this neglect.

Further evidence of the relative neglect of sanitation is apparent in Mchesi in Lilongwe. Biwi Primary School was built in 1983 with four toilet blocks for 2,300 pupils. In 1995 a community secondary school opened on the same site. The toilets were used by both schools and also by the surrounding communities, but became blocked in 2003. For five years, the schools remained without any toilet facility, forcing pupils to use the nearby woodlot, and leading to a high drop-out rate among female pupils. As the government took no action, school teachers requested public support by organizing walks to raise funds for toilet construction.

(Source: The Nation newspaper, 21 July 2008: “Two Lilongwe schools without toilets for five years”)

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125.5 South Africa


The disposal of faecal sludge is subject to regulation and control by the Department of Water Affairs in terms of the National Water Act (Act 36 of 1998) and the Environment Conservation Act (Act 73 of 1989). The current regulatory legislation that governs the handling, disposal, management and re-use of pit sludge includes the following:

Fertilisers, Farm Feeds, Agricultural Remedies and Stock Remedies Act (Act 36 of 1947)

Water Act (Act 54 of 1956)

Conservation of Agricultural Resources Act (Act 43 of 1983)

Environment Conservation Act (Act 73 of 1989)

Water Services Act (Act 108 of 1997)

National Water Act (Act 36 of 1998)

National Environmental Management Act (Act 107 of 1998)

National Health Act (Act 61 of 2003)

The acts above do not address faecal sludge directly, but they can be and have been interpreted and used to develop further policies, frameworks or guidelines for the handling, disposal, management and re-use of pit latrine sludge.

The Strategic Framework for Water Services (DWAF, 2003) includes faecal sludge, although not by name, when it defines sanitation services as:

“[...] the collection, removal, disposal or treatment of human excreta and domestic wastewater, and the collection, treatment and disposal of industrial wastewater. This includes all the organisational arrangements necessary to ensure the provision of sanitation services including, amongst others, appropriate health, hygiene and sanitation related awareness, the measurement of the quality and quantity of discharges where appropriate, and the associated billing, collection of revenue and consumer care.”

In 2006, the Department of Water Affairs (DWA) developed the 'Guidelines for the Utilisation and Disposal of Wastewater Sludge' comprising five volumes. The guidelines were developed to encourage the implementation of beneficial use of sludge (Still & Foxon, 2012). Volumes 1 and 2 were published in March 2006, Volume 5 was published in March 2008, and Volumes 3 and 4 in 2009.

The five volumes addressed the following:

Volume 1: Selection of management options (Snyman & Herselman, 2006a)

Volume 2: Requirements for the agricultural use of sludge (Snyman & Herselman, 2006b)

Volume 3: Requirements for the on-site and off-site disposal of sludge (Herselman & Snyman, 2009)

Volume 4: Requirements for the bene cial use of sludge at high loading rates (Herselman & Moodley, 2009)

Volume 5: Requirements for thermal sludge management practices and for commercial products containing sludge (Herselman et al., 2008)

However, like previous acts and the Minimum Requirements Waste Management Series, these guidelines do not include or address pit latrine sludge specifically, even though VIP latrines are considered a basic minimum level of sanitation in South Africa. Therefore, a growing need to further develop policy, guidelines and procedures for the management of pit sludge in South Africa is required so that WSAs can be properly equipped to deal effectively with full pit latrines (Still & Foxon, 2012).

12 This section is based on Snyman (2007).


The roles and responsibilities of government with regard to basic sanitation; and in particular the key role played by local government, are set out in the following Acts:

The Constitution of the Republic of South Africa (Act 108 of 1996)

The Municipal Systems Act (Act 32 of 2000)

The National Water Act (Act 36 of 1998)

The Water Services Act (Act 108 of 1997)

The Municipal Structures Act (Act 33 of 2000)

The National Environmental Management Act (Act 107 of 1998)

The Division of Revenue Bill

In terms of the institutional roles and responsibilities for sanitation service provision, the Constitution places the direct responsibility at local government level. This was then translated to authorised local government institutions (Water Services Authorities), which are either a Metro, a District municipality or a Local Municipality.

In 2000, the Department of Water Affairs and Forestry (DWAF) published the Model Water Services By-laws (DWAF, 2000) under the directive of the Water Services Act. It suggests that:

“Charges in respect of the removal or collection of conservancy tank contents, night soil or the emptying of pits will cover all the operating and maintenance costs arising from the removal of the pit contents, its transportation to a disposal site, the treatment of the contents to achieve a sanitary condition and the final disposal of any solid residues and are payable by the owner.”

From a national and provincial perspective, the responsibility was initially within DWAF from 1994 to 2001, the funding and monitoring function then moved to the Department of Provincial and Local Government in 2001 via the Municipal Infrastructure Grant funding instrument.

In 2009, the National Sanitation Programme Unit (NSPU) was moved from the Department of Water Affairs (DWA) to the Department of Human Settlements, but with DWA retaining certain responsibilities in the sector, including regulation, information management, high level planning and management of the Bulk Infrastructure Grant. At provincial level, responsibility for sanitation now rested with the Department of Human Settlements, but with certain links to the Departments of Health, Water Affairs, Education and Public Works.

In 2014, the sanitation function moved back to the Department of Water Affairs and the Department's name changed to Water and Sanitation (DHS, 2012).

The 2012 government report on the status of sanitation services in South Africa, says the following about the institutional arrangement:

" Fragmentation of responsibilities for sanitation at national, provincial and local levels results in no single national authority taking responsibility for performance monitoring of municipal service provision (including monitoring of construction of infrastructure) and unclear performance standards."

Most municipalities and Water Services Authorities do not have operation and maintenance procedures and plans for VIP toilets and it was reported that they had no budgets or plans to ensure the long-term sustainability of VIP toilets (Mjoli, 2010).

13A strategic sanitation review by the South African Local Government Association (SALGA) , found that 68 of 169 Water Services Authorities claim to empty pit latrines. Only 25 of these WSAs had a policy concerning these activities, of which 7 had this policy in draft stage.

The lack of policies and budgets could be ascribed to an interpretation of the Strategic Framework of Water Services, in terms of which VIP toilets are an interim measure for urban and peri-urban settlements to be eventually replaced by waterborne sanitation (Berner et al., 2013).


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13South African Local Government Association. Strategic sanitation review on operations, maintenance and sustainability of Ventilated Improved Pit toilets including aspects of sustainability related to the eradication of buckets within the Free State province, June 2009. http://www.salga.org.za/app/webroot/assets/files/Research_Results/SALGA%20VIP%20%20BUCKET%20STUDY%20DOC%2009%20v2%20for%20WG.pdf.


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Ministry of Water and Environment (continued)

National Water and Sewerage Corporation Statute (1995)

Provides for National Water and Sewerage Corporation (NWSC), a parastatal that provides water and sewerage services in large urban centres, and in any area in which it may be appointed to do so under the Water Statute (1995).

Water Policy (1999) No mention of faecal sludge.Same objectives set as above.

National Environmental Health Policy (2005)

No mention of faecal sludge.Provides a framework for the development of services and programmes at national and local government levels.Objectives linked to MDGs.

Ministry of Education and Sports

The Universal Primary Education Policy

This policy emphasises that all primary schools shall have health programmes, and aims at a rapid expansion of facilities, including sanitation infrastructure.

5.6 Uganda

The policy and legislative framework for the water and sanitation sector in Uganda has evolved tremendously since the late 1980s and can be described as reasonably well-developed (Makerere University, 2014). The table below summarises major policies and legislation that relate to sanitation.

Table 4: Major policies and legislation that relate to sanitation in Uganda

Ministry Policy & Legislation Relevance to sanitation

All Constitution of the Republic of Uganda (1995)

A clean and healthy environment is a basic human right.

Poverty Eradication Action Plan (PEAP) (1997-2010)

Later replaced by the National Development Plan

No mention of faecal sludge.Sets government's overall objective for the water and sanitation sector: sustainable provision of safe water within easy reach and hygienic sanitation facilities to rural and urban populations with effective use and functionality of the facilities.

The Uganda Country Strategy (2010-2015)

No mention of faecal sludge.Recognises importance of sustainable sanitation.

Ministry of Water and Environment

National Environmental Management Authority (NEMA) Statute (1995)

No mention of faecal sludge.Regulatory standards for drinking water quality, effluent.

Water Statute (1995) No mention of faecal sludge management.Provides for water and sewage authorities to be constituted.Provides for the control of pollution and the promotion of safe storage, treatment, discharge and disposal of harmful waste.

National Environment (Waste Management) Regulations, S.I.No 52/1999

NEMA to licence any person intending to transport waste or operate a waste treatment plant or disposal site. (This would include faecal sludge.)


The fact that sanitation does not appear in any of the Ministry names is telling.

The Ministry of Water and Environment is the lead agency for formulating national water and sanitation policies (Plan International, 2011). The responsibility for sanitation is shared between the Ministries listed above. In 2001, they signed a Memorandum of Understanding (MoU) on their respective responsibilities and tasks. In terms of this, the Ministry of Health took responsibility for household sanitation, the Ministry of Water and Environment for sanitation in urban areas and rural growth centres, and the Ministry of Education and Sports for school sanitation (Plan International, 2011).

Lack of skills at local government level and weak enforcement seem to be the main reasons why policies and legislation are not implemented (Musabe & Nsubuga, 2014). Musabe & Nsubuga (2014) cites the approach of the Ministry of Water and Environment as a success story in this regard. The Ministry requires that households in small towns put in place the required basic sanitation facilities as a pre-condition to accessing a water connection. Apparently, this has significantly improved latrine coverage in many of the small towns in Uganda.

The National Sanitation Working Group was created to coordinate the responsibilities split between the different Ministries. It is responsible for establishing clear budget mechanisms for sanitation to fulfil the institutional mandates in the MoU between the ministries and to coordinate between local governments and national government on policy guidance and advocacy.

Sector reforms in the period 1998-2003 included the commercialisation and modernisation of the National Water and Sewerage Corporation (NWSC) operating in cities and larger towns, as well as decentralisation and private sector participation in small towns (UN-Water/World Water Assessment Programme, 2006). Presently, the NWSC supports the faecal sludge management sector by receiving and treating faecal sludge that service providers deliver at any of the 15 designated wastewater treatment plants across the country. They charge a small fee per delivery (Musabe & Nsubuga, 2014).

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Ministry of Local Government

Local Government Act (1997) Decentralises services to local level, including giving urban councils the responsibility to provide "sanitary services for the removal and disposal of night soil (human excreta)".Weak interaction between the local authorities and faecal sludge service providers results in an unregulated service.

Ministry of Health

National Sanitation Guidelines The objective of the guidelines is to provide a guide for local authorities and to promote a standardised approach.

Public Health Act (1964) Local authorities may give notice to owners to clean or upgrade sanitation facilities in their buildings.

5.7 Zambia

In 2011, the government of the Republic of Zambia recognised the urgent need to address and remedy the water supply and sanitation situation in urban areas, specifically peri-urban settlements, by introducing the National Urban Water Supply and Sanitation Programme. The aim of this programme was to create a robust and sustainable water and sanitation health service system (MLGH, 2011). Despite these initiatives, very little has been achieved with respect to the standard of the sanitation services offered in the country (Tembo & Nyambe, 2013).

The National Urban Water and Sanitation programme budget for 2011 provides for 61% of allocation to water and 14% to sanitation with 25% going to other functions (WaterAid, 2014).


As far as could be established, no policy or piece of legislation directly refers to faecal sludge management (Tembo & Nyambe, 2013). The following pieces of policy and legislation imply faecal sludge management in Zambia:

The National Water Policy of 2007 This policy promotes the development of sustainable water resources with special regard to providing adequate quality and quantity water for all users in Zambia. Sustainable quality water implies preventing the pollution of water resources. This is relevant for faecal sludge management as the pollution of water resources might occur if pit contents are incorrectly disposed of (Tembo & Nyambe, 2013).

The National Decentralisation Policy of 2002 Through this policy, local authorities are reaffirmed as the institutions responsible for water supply and sanitation in Zambia. Local authorities are therefore responsible for all sanitation services in peri-urban areas, including faecal sludge management (Tembo & Nyambe, 2013).

Local Government Act (CAP 281) The Act mandates local authorities to maintain environmental health services, environmental conservation and prevention of pollution of water resources in Zambia (Tembo & Nyambe, 2013).

Sixth National Development Plans The Sixth National Development Plans contains a chapter on water and sanitation. This chapter's vision of the Water and Sanitation sector is “a Zambia where all users have access to water and sanitation and utilise them in an efficient and sustainable manner for wealth creation and improved livelihood by 2030”. The sector goal is furthermore to “achieve 75 percent accessibility to reliable safe water and 60 percent adequate sanitation by 2015 in order to enhance economic growth and improve the quality of life”. The vision and goal imply all aspects of adequate sanitation, including faecal sludge management (Tembo & Nyambe, 2013).

Environmental Management Act of 2011 This Act provides for the protection of the environment and the control of pollution. It prohibits the pollution of water resources with untreated wastewater or faecal sludge (Tembo & Nyambe, 2013).

Water Act (CAP 198) The Water Act provides direction to the use, diversion and allocation of water in Zambia. This act relates to faecal sludge management, because improper disposal of faecal sludge from pit latrines could pollute water bodies (Tembo & Nyambe, 2013).

The Water Supply and Sanitation Act No. 28 of 1997 The Act provides for the establishment of the National Water and Sanitation Council (NWASCO), which acts as regulator in the provision of water and sanitation services. NWASCO regulates the water utilities. As most urban and peri-urban areas in Zambia fall within the jurisdiction of the water utilities, urban pit emptying activities will therefore be regulated by NWASCO (Tembo & Nyambe, 2013).


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40

Public Health Act (CAP 295) The Public Health Act regulates public health in Zambia. All faecal sludge management services should be operated in accordance with the stipulations of this Act. However, it is common practice in the peri-urban areas of Zambia to discharge pit contents in drainage channels, especially where the emptying is done informally. This creates a health hazard (Tembo & Nyambe, 2013).


The National Rural Water Supply and Sanitation Programme (2006-2015) and the National Urban Water Supply and Sanitation Programme (2011-2030) are being rolled out under the leadership of the Ministry of Local Government and Housing.

Rural water, sanitation and hygiene service delivery is decentralised to local authorities (Government of Zambia, 2012).

Most local authorities in urban areas have created commercial utilities to provide services. 50 commercial utilities were formed by local authorities, some of which have subsequently merged. Approximately 20 local authorities still provide water and sanitation services through their Works departments. The local authorities have a particularly bad service record, with coverage levels actually declining (USAID, 2010).

5.8 Zimbabwe

According to the country report, water, sanitation and hygiene policies are coordinated by various institutions and government departments. Their specific roles on faecal and other sludge management are not clear (Bangira et al., 2014).


The table below depicts important milestones in the development of the water and sanitation sector in Zimbabwe since independence.

Table 5: Milestones in the water and sanitation sector in Zimbabwe

Date Event

1980 National Independence

1985 National Master Plan for rural water supply and sanitation

1987 National Action Committee (NAC) established

1987 Integrated Rural Water Supply and Sanitation programme launched

1999 Water Act

1999 Zimbabwe National Water Authority established

2004 Draft Water and Sanitation Policy

2008 Cholera outbreak kills more than 4000 people

2010 National Action Committee (NAC) re-launched

2011 National Sanitation and Hygiene strategy

2013 National Water Policy

Source: (GoZ, 2011)

No national policy describes the provision of sanitation services in informal settlements, or the roles and responsibilities of different agencies. No national policy or legislation also mentions faecal sludge explicitly (Bangira et al., 2014).


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5.8.2 Institutional arrangements14Institutional arrangements in the water and sanitation sector are complex as the diagram below shows :

Thus, coordination and allocation of responsibilities is often a challenge (Bangira et al., 2014).

Zimbabwe comprises 10 administrative provinces and 32 urban local authorities. Local authorities are classified and ranked according to their size and levels of development into city councils, municipalities, town councils and local boards (GoZ, 2011). These local authorities are autonomous bodies that are responsible for the administration of their areas of jurisdiction and for the provision of services and infrastructure to rate payers. They have the authority to levy rates and charges on rate payers in order to raise revenue to cover the cost of council activities (GoZ, 2011).

However, roles in sanitation management and provision between rural and urban local authorities, and local authorities and government departments, especially with respect to peri-urban areas are fuzzy (Bangira et al., 2014).

Enforcement of environmental and public health regulations relating to sanitation is often weak and ineffective. Political interference has also been an issue (Bangira et al., 2014).

The water and sanitation sector has a record of poor engagement with the private sector (Bangira et al., 2014).

Sub-economic tariffs have led to insufficient funds for normal operation, repair and maintenance. Additionally, for most local authorities, water and sanitation revenue is not ring-fenced to benefit the sector. Revenue collection mechanisms are largely unclear (Bangira et al., 2014).

14 The acronyms are not explained as the purpose of the diagram is to illustrate the complexity of institutional arrangements.

Deputy Prime MinisterInfrastructure Cluster

Provincial Level PWSSCMoTCID (Chair) Urban Councils Catchment Councils

Ministerial Committee for Water and SanitationMWRDM (Chair)

MoHCW, MoTCID, MoA, MLGRUD

National Coordination Unit (NCU)in MWRDMUNICEF (Co-chair)- supports NAC and all sub-committees

National Hygiene andSanitation Taskforce

MoHCW (Chair)

Rural WSS NAC Sub-Committee

MoTCID (Chair), MLGRUD, MoHCW, MWRDM, DDF,

ZINWA, MYDIE, MWAGCD, AGRITEX, MoF, DPP

Urban WSS NAC Sub-Committee

MLGRUD (Chair), MoHCW, MWRDM,

MoEN

WRM NAC Sub-Committee

MWRDM (Chair), ZINWA, EMA, MLGRUD,

MoE, MOA

National Action Committee (NAC) PS Level MWRDM (Chair)MoHCW, MoTCID, MoA, MLGRUD, MoF, MoEM, MoWAGCD, MIT, MAMID, MENR, MEPD

Donor GroupsWorld Bank


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Figure 7. Progress in sanitation in sub-Saharan Africa

6. Dashboard of progress in sanitation

6.1 In sub-Saharan Africa from 1990 to 2012

According to WHO and UNICEF's updated report on global trends in sanitation and drinking water of 2014 (WHO/UNICEF, 2014), progress in sanitation in sub-Saharan Africa can be depicted as follows:

1990 2012

OPEN DEFECATION

36%

25% 24%26%

14%

19%

26%

30%

UNIMPROVED SANITATION

SHARED IMPROVED SANITATION

IMPROVED SANITATION

Progress in sanitation in sub-Saharan Africa

The percentage for open defecation has dropped by 11% in the period 1990-2012, but the number of people defecating in the open is still increasing in 26 of 44 countries in sub-Saharan Africa. Of the eight countries studied in the region, Ethiopia has made the most remarkable progress during the past 25 years: open defecation declined from 92% in 1990 to 37% in 2012. The number of people in this part of Africa who are still using unimproved sanitation facilities has increased slightly. This probably indicates a shift from open defecation to an unimproved facility.


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6.2 In eight Southern and East African countries

The status of, and progress in, sanitation in the eight countries that participate in this project is summarised in the table below:

Although the figures reflect substantial progress in six of the eight Southern and East African countries, only Botswana and South Africa serve more than 50% of the population with an improved sanitation facility. Improved sanitation has come to a virtual standstill in Malawi and Zimbabwe since 1990. The only shift seems to be from open defecation to using an unimproved facility.

The figures above might also paint a rosier picture of sanitation services than the actual state of affairs. The figures state how many toilets have been built; they give no indication in what condition these toilets are or how the wastewater and faecal sludge that they collect are managed.

Country Year USE OF SANITATION FACILITIES (percentage of population)

URBAN RURAL NATIONAL Proportion of the 2012 population that gained access since 2000 (%)

Imp

rove

d

Unimproved

Imp

rove

d

Unimproved

Imp

rove

d

Unimproved

Sha

red

Un

imp

rove

d

Op

en

de

fec

atio

n

Sha

red

Un

imp

rove

d

Op

en

de

fec

atio

n

Sha

red

Un

imp

rove

d

Op

en

de

fec

atio

n

Botswana 1990 61 5 23 11 22 6 20 52 39 5 21 35 19

2000 70 6 18 6 32 8 17 43 52 7 18 23

2012 78 6 16 0 42 11 12 35 64 8 15 13

Ethiopia 1990 19 29 12 40 0 0 0 100 2 4 2 92 18

2000 22 34 17 27 6 2 7 85 8 7 9 76

2012 27 42 23 8 23 7 27 43 24 13 26 37

Kenya 1990 26 40 31 3 24 16 38 22 25 20 36 19 10

2000 29 44 24 3 26 17 38 19 27 22 35 16

2012 31 48 18 3 29 19 35 17 30 26 31 13

Malawi 1990 27 22 47 4 7 4 56 33 10 6 55 29 3

2000 25 20 52 3 8 4 66 22 10 6 65 19

2012 22 18 58 2 8 4 80 8 10 6 77 7

South Africa 1990 75 13 10 2 40 7 26 27 58 10 18 14 19

2000 78 13 7 2 49 9 21 21 65 11 14 10

2012 82 14 3 1 62 12 16 10 74 13 8 5

Uganda 1990 32 49 17 2 25 13 40 22 26 17 37 20 14

2000 32 50 16 2 29 15 40 16 30 19 36 15

2012 33 50 15 2 34 17 40 9 34 23 35 8

Zambia 1990 61 26 10 3 29 7 22 42 41 14 19 26 14

2000 59 25 14 2 31 7 29 33 41 13 24 22

2012 56 24 18 2 34 8 33 25 43 14 27 16

Zimbabwe 1990 54 46 0 0 35 18 0 47 41 26 0 33 3

2000 53 45 1 1 34 17 5 44 40 27 3 30

2012 52 44 2 2 32 16 12 40 40 27 8 25

15 Most of the figures (also for 1990 and 2000) have changed from the WHO/UNICEF 2013 update to the 2014 update. The Malawi figures in previous versions seem to have been corrected in the 2014 update.

15Table 6. Sanitation in eight Southern and East African countries (WHO/UNICEF, 2014)


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Figure 8. The general state of sanitation in the 8 participating countries (WHO/UNICEF report, 2014)

Improved Shared Unimproved Open defecation

MALAWI ETHIOPIA KENYA UGANDA ZIMBABWE ZAMBIA BOTSWANA SOUTHAFRICA

36%

Access to sanitation (% of the population)

The challenges that these countries experience with faecal sludge management in urban and peri-urban areas are similar, but the general state of sanitation differs considerably as the figure below illustrates.

16According to WaterAid (2011) , inadequate water and sanitation services are estimated to cost sub-Saharan Africa more than the whole continent receives in development aid – US$47.6 billion in 2009.

Water and sanitation health (WaSH) are being side-lined as governments concentrate on health and education, says the WaterAid report. "Meanwhile, people's lack of access to clean water and basic sanitation services is holding back social and economic development in the region, costing around 5 percent of gross domestic product (GDP) every year. The World Health Organisation (WHO) estimated the financial impact of inadequate WaSH facilities by looking at the health issues linked to poor hygiene, child mortality, waterborne tropical diseases, the time people spend collecting water; and reductions in educational achievement due to illness and girls' attendance rates at schools."

16http://www.irinnews.org/report/94241/africa-sub-saharan-sanitation-targets-two-centuries-away

7

77

6

10

37

26

13

24

13

31

26

30

8

35

23

34

25

8

27

40

16

27

14

43

13

15

8

64

5

8

13

74


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This section gives a brief overview of on-site sanitation facilities and faecal sludge management in each of the studied countries.

In summary, the country reports found the following:

1. Pit latrines are by far the most common on-site facility in informal urban and peri-urban settlements and rural areas. In Botswana, South Africa and Zimbabwe, there has been large infrastructure programmes to supply sanitation that meets the basic standard. Alternative improved options, such as the pour flush, urine-diverting toilet and other eco-sanitation types have been mainly confined to small-scale donor-funded projects. Several research reports mention that the social acceptability of handling and re-using dried or treated faecal sludge or urine on-site remains a challenge.

2. Different types of facilities are called a “pit toilet”. The lack of standardisation adds a layer of complexity to the faecal sludge management process. For example, many pit toilets that the research teams encountered had no slab covering to access the sludge, unlike in South Africa where it is a requirement. Sludge samples, in these cases, had to be obtained through the pedestal (see picture).

3. The rate at which pits fill up in a particular country is a function of many variables, such as pit size, soil quality, groundwater level, the number of people who share the latrine, anal cleansing practices and solid waste dumped into the pit. It is therefore difficult to plan a pit-emptying programme that would fit all scenarios. Emptying on demand seems to be the common approach.

7. Country profiles

Figure 9. Research team from Ethiopia sampling a pit toilet (Photo: Jimma University).


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7.1 Botswana

7.1.1 Main issues

Due to Botswana's scarce water resources, the country's population relies heavily on groundwater as a source of drinking water. The drawback of low-cost on-site sanitation facilities is however the potential pollution of groundwater resources (Odirile et al., 2013).

According to the country report (2013), most of Botswana's groundwater sources are contaminated by poor faecal sludge management. In 2000, a groundwater quality survey sampled 47 public and private wells in and around Francistown. Analyses showed that nitrate concentrations well above the maximum allowable limit of 45 mg/litre for drinking water in Botswana were frequent within the city area, often reaching values between 100 and 300 mg/litre.

Though enviro-loos were introduced to curb underground water pollution across the country, these have not functioned well. Various reports on the evaluation of these technologies show that communities prefer waterborne toilets or the VIP latrine (Odirile et al., 2013).

Pit-emptying procedures are not always effective. Pits are often inaccessible to emptying vehicles. Traffic congestion prevents efficient emptying and haulage; emptying services are usually poorly managed. As such, much of the faecal sludge produced, collected, hauled and disposed of in urban centres remains as yet unaccounted for (Odirile et al., 2013).


Pit latrines are the most commonly used form of on-site sanitation in Botswana (Odirile et al., 2013).

A double vault VIP latrine was adopted as a standard sanitation facility in urban areas.

These latrines can either be ventilated or not, and are fitted with a concrete slab. Similar to South Africa, the Government of Botswana does however, not consider a non-ventilated pit latrine to be adequate.

Pit design varies according to terrain, but research found most to be between 1.5 and 2.5 metres deep. Most of the rural BOTVIP latrine designs provide removable cover slabs (Nostrand & Wilson, 1983, as quoted in Odirile et al., 2013). These enable the pit to be maintained, repaired or emptied, if a vacuum tanker truck is available and can get access.


Although the Water Utilities Corporation (WUC) is responsible for wastewater services, there is no mention of faecal sludge management on the WUC's website. It is also evident from the latest annual report of the WUC that faecal sludge management still requires development:

Wastewater services continued to be a burden to the Corporation as they did not generate any revenue, but remained expensive to run. These services were taken over from the former operators without any applicable tariff and the Corporation continued to operate in the same fashion. In a quest to make the service self-financing, the Corporation set out to develop a cost reflective tariff which was still under development by the close of the reporting period. (Annual Report 2013/14:21)

According to the country report (Odirile et al., 2013), the following management practices are followed:

In urban areas, faecal sludge is collected by individuals in private pick-up trucks. There are no health and safety measures in place. These private emptiers use small or large vacuum tankers.

In some instances, the sludge is added to the wastewater stream or combined with wastewater at the wastewater treatment plant, where it is then treated. In other instances, faecal sludge collected from pit latrines and septic tanks is transported to the main wastewater treatment plant, dried in drying beds and sold to the public for use in gardens as manure.

In the rural areas, it is not common to remove faecal sludge. Most rural householders will close the pit and relocate their latrine when it is full. The BOTVIP components may be re-used in the new location.


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7.2 Ethiopia

The information on faecal sludge management in Ethiopia is based on a survey of 403 households in urban slums in Addis Ababa (Beyene, Hailu, Faris & Kloos, 2015). No conclusions can therefore be made about the rest of the country.

7.2.1 Main issues

Due to the fact that 80% of the residents in Addis Ababa live in urban slums (UN-Habitat, 2007), the city has many sanitation problems. 26% of the houses in the city, mostly the peri-urban areas, do not have access to any type of sanitation facilities and thus use rivers, flood ditches and open spaces (Jimma University, 2014).

Poor on-site sanitation practices ultimately expose the whole community to the risk of acquiring waterborne and environmental diseases. In Ethiopia, institutional and legal aspects regarding faecal sludge management have not yet been implemented. It is therefore urgent to establish a regulatory basis for proper faecal sludge management in the country (Jimma University, 2014).


Pit latrines are the most common type of low-cost on-site sanitation facility used in the peri-urban areas of Addis Ababa (Jimma University, 2014).

The survey found that 63.28% of the households have access to a pit latrine with a super structure, whereas 22.33% use a pit latrine without a super structure. Open defecation is practiced by 8.19% of the households. The other types of sanitation facilities used are a VIP latrine (5.21%) and a pour flush toilet (0.99%) (Jimma University, 2014).


In the peri-urban areas of Addis Ababa, most of the pit latrines are full (Jimma University, 2014). The disposal of pit latrine sludge is therefore a major concern in the city.

The City Government of Addis Ababa Water and Sewerage Authority is responsible for the provision of the city's water supply and sewerage services (Jimma University, 2014). The Authority is also responsible for the construction of shared and public sanitation facilities and sludge emptying services in peri-urban areas.

In its business process re-engineering programme, Addis Ababa Water and Sewerage Authority identifies and states that it works closely with the following key stakeholders: Municipality of Addis Ababa, Ministry of Water and Energy, Ministry of Finance and Economy, Addis Ababa Roads Authority, NGOs and Funding Agencies (World Bank, UN-HABITAT, African Development Bank), the Ethiopian Environmental Protection Authority, Addis Ababa Office of Land Administration, Addis Ababa Infrastructure and Construction Authority, Addis Ababa Health Bureau, and Oromia Regional State. The survey did not find evidence of this cooperation.

The Addis Ababa Water and Sewerage Authority mostly uses pit emptying trucks to collect and dispose of faecal sludge. Sludge from toilet facilities and septic tanks is transported and disposed of into drying beds near the Kaliti treatment plant and in Kotebe Yerer Ber.

The survey indicates that 327 of the households (88.38%) use municipal emptying services whereas 29 (7.84%) connect their on-site sanitation facilities to nearby flood ditches or rivers (Jimma University, 2014). Other faecal sludge management practices include private pit emptying (1.62%), being connected to a sewer system (1.08%), and constructing a new on-site sanitation facility (1.08%).

Among the households that use municipal or private pit emptying services only 14.6% were satisfied with the services. The availability of the services (few trucks; three-month waiting period) and high cost of the services (between US$9.30 and US$36.00) were the main reasons for the dissatisfaction. On average, the pit latrines are emptied twice a year, but, due to the severe constraints of pit emptying services, most of the households' sanitation facilities were full (Jimma University, 2014).

There were no on-site faecal sludge recovery, treatment or disposal facilities available in the peri-urban areas surveyed (Jimma University, 2014).


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7.3 Kenya

The information in the Egerton University report (2014) on faecal sludge management practices is mainly based on information from:

A survey that Losai Management Ltd (2011) conducted with funds from the BMGF in Nairobi, Mombasa and Kisumo;

Another BMGF-funded report (Chowdry & Koné, 2012), which summarises the Losai report; and

Studies by Muchiri (2009) and Sagwe (2010) in the town of Nakuru.

7.3.1 Main issues

WHO data shows that diarrheal diseases accounted for 16% of under-five mortality in Kenya in 2006 and 7% of deaths overall.

Waterborne sewerage systems are found in the cities of Nairobi, Mombasa and Kisumu, as well as in other larger municipalities, but only 14% of the country's population, living in urban areas, have access to waterborne sanitation systems (MoWi, 2007). Most of the water supply and wastewater collection, treatment and disposal systems have been deteriorating rapidly and fail to meet the water demands of the ever-increasing population.

On-site sanitation, on the other hand, is a common mode of disposing of human waste in the peri-urban and rural settlements of Kenya. The faecal sludge of urban households in Kenya that make use of on-site sanitation facilities are disposed into nearby streams, which contaminates ground- and surface water (Egerton University, 2014).

Open defecation is down but still widely practiced in rural areas: In 2012, only 3% of the population in urban Kenya practiced open defecation in comparison with 17% of the rural population (WHO/UNICEF, 2014).


In Kenya, over 70% of sanitation systems are pit latrines, because they are cheap, easy to construct and do not require water (Egerton University, 2014). No distinction is made between improved and unimproved pit latrines, but the report refers to a survey conducted in the town of Nakuru, which found that 49% of respondents used simple pit latrines (Muchiri et al., 2009, as quoted in Egerton University 2014).

The study referred to above found that 88% of households in Kisumu have access to sanitation facilities of one type or another, within their compound. In Mombasa, this is 91% whilst in Nairobi it is 85%. Of this, 43% in Kisumu, 62% in Mombasa and 56% in Nairobi, use facilities that may be categorised as safe or hygienic management of human waste (VIP latrine, septic tank, cesspool, and waterborne linked to the sewer system). The average number of users per toilet in Kisumu is 8, Mombasa 4 and Nairobi 12. Of those without access to a sanitation facility at home, 40% in Kisumu and 50% in Mombasa and a lower 20% in Nairobi, dispose of human waste in open spaces, drainage channels and other unsafe sites (Losai Management Ltd, 2011).

7.3.3 Faecal sludge collection and disposal practices

The sludge accumulation rates in pit latrines are dependent on the number of users, the type of anal cleaning material, the degree to which the pit is used for disposal of other household waste and the degree to which the pit is drained (Still, 2002). In Kenya, the average sludge accumulation rate is between 25 and 30 litres per user per year varying from as little as 10 litres to as much as 100 litres per user annually. In coastal cities such as Mombasa, pit latrines are shallow due to the high groundwater level and frequent emptying is therefore required (Egerton University, 2014).

In Nairobi, and other cities and towns, the task of emptying is mainly the role of the city and local authorities. Most local authorities however lack the specialised equipment and trucks required. In Nakuru, for example, the municipal council has since 2008 stopped providing their mechanical emptying service due to the breakdown of their exhauster truck. Spare parts are not locally available and have to be sourced abroad. As a result, the private sector is left with the responsibility of offering the service.

In 1997, with the sponsorship of UN-HABITAT, the Vacutug was developed and piloted in Nairobi, Kenya. The aim was to develop a pit-latrine exhauster that was suitable for areas that were previously inaccessible. Unfortunately, the apparatus developed some mechanical problems in the pilot phase.


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No information could be found on the UN-HABITAT website as to the current status of the Vacutug in Kenya.

Pit emptying services, whether mechanical or manual, are in high demand.

According to the Losai survey (Losai Management Ltd, 2011), there are 74 trucks operating in the 3 cities (Nairobi, Kisumu and Mombasa) while there are 43 registered operators. In Mombasa, there are operators who do not own vehicles but hire one when they get a client. The truck capacity ranges from 6,000 litres to 22,000 litres. The trucks are strategically displayed and mobile numbers for contact are printed on the trucks.

The city authorities in Nairobi, Mombasa and Kisumo require faecal sludge extraction trucks to have a licence and pay a fee. Each truck providing faecal sludge extraction is classified broadly as a sanitation truck and is required to meet certain design and fitting requirements (Chowdhry & Koné, 2012).

Manual emptying is usually done in areas that are inaccessible by mechanical trucks – usually slums and informal settlements. In Kenya, manual labour is also being used to empty out the public sanitation blocks or bio-centres (see below), which are located in low-income areas unreachable by trucks.

“Given the social stigma, illegality of the work and difficulty of performing this job, many choose to do this in the middle of the night for fear of being arrested or recognized. Some reported needing to use alcohol before starting the work in order to get through it. In Kenya, teams of five workers provide emptying services in the urban informal settlements, and lease the equipment from an umbrella group that rents the equipment to the various manual emptiers operating in the settlements" (Chowdhry & Koné, 2012, p. 46).

Eales (2005, p. 3) describes the conditions under which these pit emptiers work as follows:

“The job is generally done by men, working in teams of two to four people. Sometimes they begin by pouring paraffin into the pit to override the smell of the excreta. The three men interviewed for this study had no protective clothing, gloves, boots or face-masks. They sometimes use plastic bags over their hands. The waste is removed using a bucket on a rope, and the contents are then transferred to a 100 litre drum. Depending on the nature of the access path, the drum might have to be carried 50 or 100 metres to a handcart, which is used to wheel the waste to a disposal site. The waste is disposed of by emptying it into the sewer system (where there is no structure obstructing the manhole cover), dumping it in a stream, or transferring it to a mechanical desludger for disposal elsewhere.”

There are many pit-emptying entrepreneurs in Kenya, but they lack the necessary business management skills, such as accounting skills, to be successful. The report of Chowdhry and Koné (2012) gives financial details of these businesses, including start-up loans. These entrepreneurs are also subjected to the negative attitudes of the community towards pit emptying as a business, expensive registration procedures, and the harassment from local authorities since their activities are often classified as a nuisance (Egerton University, 2014).

Studies conducted in Kibera, a peri-urban area in Nairobi, shows that 33% of the households make use of mechanical emptying whereas 28% rely on the manual emptying of their pit latrines. Other techniques used include gravitational emptying where the content of septic tanks is directed to flow to lower water channels by means of gravity (Egerton University, 2014).

Pit emptying services are more active in the rainy season, when ingress of storm water tends to fill pits and when it is convenient to dump faecal sludge in full streams.

In Kisumu, mechanical emptying costs on average US$52 while manual emptying costs only US$30 (Chowdhry & Koné, 2012).

City authorities allow mechanical and manual operators to empty the sludge into manholes once they take it out of the pits after getting a permit. In Nairobi, they must get a permit from the Nairobi Water and Sewerage Company. Faecal sludge collection operators are required to discharge the sludge at designated tipping points that are connected to the sewage lines.

7.3.4 Treatment and re-use practices

Nairobi, Kisumo and Mombasa each has two wastewater treatment plants (Chowdhry & Koné, 2012, p. 29).

The faecal sludge from the designated tipping points in Nairobi and Kisumu mixes up with sewage and ends up in wastewater stabilization ponds. At the Kisat plant in Nairobi, faecal sludge is conditioned in cold digestion tanks and dried in sludge-drying beds before disposal.


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According to the Losai report (2011), the Mombasa plants are dysfunctional and untreated effluent (including faecal sludge) goes into the ocean.

Treated faecal sludge, when available, is sold in Kisumu and Nairobi at a price of US$1.25 to US$1.45 per ton. The main challenges with sales of treated faecal sludge in Kenya are that the product is bulky and not packaged. Logistical problems therefore arise in the transportation and distribution process. Faecal sludge from waste treatment plants is acceptable among the local residents, but they are resistant to the use of dried faecal matter from urine diversion dry toilets (Chowdhry & Koné, 2012).

However, faecal sludge re-use in Kenya does take place in what are referred to as bio-centres. The bio- centres are communal toilet and bathroom facilities that have been built by the Umande Trust, a local NGO. The toilets generate methane gas (biogas) for local residents17. More than 100 bio-centres exist in the three cities studied (Nairobi, Kisumo and Mombasa). At these bio-centres, faecal sludge generates biogas that is used for cooking purposes at the cooking facilities present at these centres. The bio-centres typically produce 12 m³ gas per day (Chowdhry & Koné, 2012).

18The Sanergy for-profit enterprise operates in a similar way. It designs and manufactures toilets with a sealable container, called Fresh Life. Local residents are their franchise partners. These operators purchase and operate the facilities. Sanergy daily collects the sealable containers and replaces them with clean, empty ones. The faecal sludge is converted at a centralised facility into organic fertiliser and biogas. Sanergy generates about US$1 250 from each toilet from the sale of by-products. The revenue is channelled back to the operators as an incentive to service the toilets (Bayrasli, 2011).

These examples of faecal sludge re-use can be regarded as success stories.

17Shimanyula, James (27 October 2014). "Biogas helping to clean up Nairobi slum". Deutsche Welle. Retrieved April 2015.

18http://saner.gy/our-work/the-sanergy-model#


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7.4 Malawi

7.4.1 Main issues

According to the USAid country report on water and sanitation in Malawi (2010), the interaction between pit latrines and shallow wells make sanitation particularly problematic in peri-urban areas in Malawi. Financial, managerial and technical capacity are severely lacking at all levels.

Between 2010 and 2030, Malawi's urban population is expected to double. The challenge to provide adequate sanitation and efficient faecal sludge management in urban areas will therefore increase (Zeleza-Manda, 2009).


Pit latrines (simple or improved), with or without a super-structure of logs or a concrete slab over the pit, are by far the most common type of on-site sanitation.

For example, a study of 220 households in the Ntopwa settlement in Blantyre (Polytechnic University of Malawi, 2013) found that 92.8% of households use pit latrines, but many of these pit latrines are shared. 54.7% of the households with latrines allow others to use their latrines free of charge. Most people in the settlement are tenants and therefore unwilling to pay for better toilets. 50% of households without a pit latrine cited lack of labour and money as the reason.

According to Zeleza-Manda (2009), the adoption of eco-san toilets in Malawi has been slow and very limited to date, except in Malawi Homeless People's Federation villages where adoption is tied to acceptance of Federation membership. For example, in Mgona, a squatter area in Lilongwe City, the eco-san toilet project,

19which is supported financially by WaterAid and Training Support for Partners , is still in its infancy, largely because adoption is a matter of conviction – and many, including government officials, are reluctant to handle faecal matter. In Mgona, fewer than 10 households have adopted the Fossa alterna, about 6 have adopted the Arborloo, while the Skyloo is totally shunned on account of its cost and lack of understanding the operation of the new technology. Even in the Federation villages, some households use ordinary pit latrines “disguised” with a Skyloo super structure. For instance, at Angelogoveya Federation Village, there are 55 pit latrines, some with Skyloo super structures. The reason for the disguise relates to the stigma of touching faecal matter (Zeleza-Manda, 2009).


7.4.3.1 Sanitation Systems

Pit Latrines

According to a survey conducted with 1 178 respondents in nine areas in Malawi's largest cities, Blantyre, Lilongwe and Mzuzu (Zeleza-Manda, 2009), full pits are common for the following reasons:

Most housing plots in all nine settlements studied have more than one household living there, and many have more than two households. One of the main ways in which housing in informal settlements has expanded has been through increasing the number of people and households living on each plot. For instance, 8% of plots have between 10 and 55 households (Zeleza-Manda, 2009).

Of those who shared toilets with other households, 14.5% shared with two households, 12.6% shared with three households and nearly 3% shared with between 15 and 55 other households. The sharing of toilets may be a major cause of early filling up. While most pit latrines are intended to last for 10 years, experience shows that most stay usable for less than 5 years (Vasquez, 2008), sometimes due to fall-ins especially in sandy soil and water-logged areas.

When full, the toilets are supposed to be emptied by special equipment provided by city authorities, but the equipment is often lacking. Blantyre has only one vehicle on the road and depends on hiring another from Luchenza township. Even if the equipment were available, high fees deter clients from low-income

20communities. For example, the cost of emptying a septic tank in Blantyre is MK10 000 (US$20) per load, while for pit latrines it is MK3 000 (US$10.5) per load. In Mzuzu, it costs MK9 000 (US$19). In Lilongwe, where the service has been privatised, pit-latrine emptying costs MK11 000.62 (US$23).

19Training Support for Partners is a process-oriented capacity building NGO registered as a trust. https://www.facebook.com/TrainingSupportForPartnersTsp201 US dollar = plus-minus 450 Malawian Kwacha


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In the absence of emptying services, and encouraged by large plot sizes, many people simply dig a new latrine when an old one is full. Plot sizes (15 m x 25 m) in planned low-income areas are designed to encourage the digging of successive pit latrines. In the yards of old houses, several pit holes line the backyard, posing continuous danger to children and groundwater (Zeleza-Manda, 2009).

According to city authorities, the major hindrance to emptying pit latrines is the illegal nature of developments and congestion that makes it difficult for vehicles to enter the areas. However, while this may be true of squatter areas, evidence shows that little or no such service is provided in areas that are planned and have access roads (Vasquez, 2008).

Ecological toilets

Because of problems with Arborloos and Fossa alterna, the Malawi Homeless People's Federation then changed to urine-diversion dry toilets (UDDTs), or Skyloos, to avoid or reduce problems of contamination and foul smells. The adoption of urine-diversion dry toilets however has yet to solve all these problems, as the urine, rather than being collected, is diverted into drains or small soak pits at the back of the super structure thereby producing a foul smell for neighbours, and possibly endangering groundwater (Zeleza-Manda, 2009).

Observations showed that some of the UDDTs did not have roofs and in the rainy seasons would get flooded, affecting the drying and composting process of faeces. Further, many households do not add ash and soil as recommended: either they use too much soil, leading to early filling up, or the soil it too sandy, leading to poor composting (Zeleza-Manda, 2009).

7.4.3.2 Re-use

The first harvest of urine diverting dry toilet or Skyloo manure in Blantyre went at a test price of MK1 000 per 50 kg bag. It was sold to the Blantyre City Parks Department. Because of the value attached to the manure, other organisations are also adopting the technology and there might be potential for the Skyloo technology to be scaled up. Zeleza-Manda (2009) cites a fertiliser manufacturer, Optichem Ltd, which has tested Skyloo faecal manure, and found it to have such high nutrient content that the company ordered 20 tons.

7.4.3.3 Non-government involvement

WaterAid in Malawi is strongly committed to addressing the issue of exclusion, to ensure that the poorest and the most vulnerable and marginalised groups, including women and children, have access to clean water and sanitation.


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7.5 South Africa

7.5.1 Main issues

Most municipalities and Water Services Authorities do not have operation and maintenance procedures and plans for VIP toilets and it was reported that they had no budgets or plans for ensuring long-term sustainability of VIP toilets (Mjoli, 2010).

In the urban areas of South Africa, faecal sludge is usually added to the wastewater stream where it is subject to co-treatment in wastewater treatment plants, as well as waste stabilisation ponds (Mjoli, 2010). The wastewater treatment plants where faecal sludge from VIP toilets is emptied into are often not equipped for proper sludge management.


The Strategic Framework for Water Services (DWAF, 2003) defines a basic level of sanitation as the provision of a facility, which is easily accessible to a household and should include the sustainable operation of the facility, including the safe removal of human waste and wastewater from the premises when appropriate and necessary, and is inclusive of the communication of good sanitation, hygiene and related practices. The definition of a basic level sanitation service has led to the adoption of the VIP toilet as the minimum acceptable level of sanitation within South Africa (Salisbury et al., 2009). South Africa's groundwater guidelines recommend that pit latrines are located at least 75 m from water sources (Still & Nash, 2002).

Based on the 2003 Strategic Framework for Water Services, the Free Basic Sanitation Implementation Strategy (DWAF, 2003) guides Water Services Authorities in “providing all citizens with free basic sanitation by 2014” and aligning their own policies with national policy.

Large-scale infrastructure programmes were subsequently implemented to build VIPs to reach this goal.

The large-scale construction of VIP toilets also followed from the active bucket eradication programme. In February 2005, the bucket sanitation backlog in formal townships was estimated at 252 254 buckets (DWAF, 2009). Former President Mbeki, in his state of the nation address of February 2006, set a target for the eradication of all pre-1994 sanitation buckets from the formal townships by December 2007.

In reality, the achievement of the minimum standard for sanitation is less favourable than official figures indicate:

In 2007, the then Department of Water and Forestry commissioned the CSIR to conduct a national audit of water and sanitation projects (SALGA, 2009). The audit reported that, of the 2,410 on-site sanitation projects, only 41% had actually been completed. Approximately 25% of on-site toilets were inadequately designed for ventilation.

68% of on-site top structures were constructed in a way that meant they could not be mobilised when the pits were full.

At 60% of the facilities, municipalities were only conducting reactive maintenance; and 40% of municipalities had inadequate maintenance capacity (SALGA, 2009; DHS, 2012).

Furthermore, the construction of VIP toilets was carried out without putting in place any plans for emptying the full pits as the national sanitation policy did not provide guidelines on how municipalities should deal with full pits.


7.5.3.1 Collection and disposal

Presently there are two options available to the owners of single pit VIP toilets when these become full. Users can either empty the full pit or construct a new toilet on an adjacent site (Bester & Austin, 2000; Thye et al., 2009; Still & Foxon, 2012).

Alternatively, if the pit is full, municipalities provide a new VIP or an agent is added to the pit contents to liquefy the sludge. Then a vacuum tanker removes as much sludge as possible.

Most municipalities and Water Services Authorities use a vacuum tanker to empty septic tanks.


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Figure 10. Overview of available treatments and disposal methods of faecal sludge in South Africa (Radford et al., 2011)

Water Services Authorities often experience problems in providing a reliable, effective and affordable mechanised service to empty pits in unplanned urban settlements, as well as rural areas as tanker trucks often cannot reach households which need to be serviced because roads are poor and paths are too narrow (Bester & Austin, 2000; Still & Foxon, 2012). Furthermore, households do not always have the funds to pay for mechanised pit emptying, using cheaper manual pit emptying methods as an alternative.

Some municipalities provide additives to slow down filling despite evidence that the additives have little effect. For example, the Alfred Nzo District Municipality treats 20 000 urban pit toilets monthly with additives (Rhodes University, 2014).

7.5.3.2 Treatment and re-use

In the urban areas of South Africa, Water Services Authorities use various treatments and disposal methods for dealing with highly concentrated pit sludge from VIP toilets. The figure below gives an overview of methods and implications.

Vacuum tanks usually dispose of faecal sludge at the municipal wastewater treatment plants. In a number of municipalities, these plants struggle to meet regulatory requirements. Part of the problem might be the vacuum tanks that discharge their sludge into the inlet structure of the wastewater treatment plant. This might cause shock loads. There seems to be little experience regarding the treatment process and there are no established strategies to deal with problems (Berner et al., 2013). See also the experience of eThekwini in this regard below.

Highly concentrated pit latrine sludge

Regularemptying?

Treatment?On-site

disposal?Nutrient re-use?

Dumping

Sewer discharge

Shock loading of wastewater

treatment plant

Environmental pollution

Raw faecal sludgeacceptable?

Deep row entrenchment

Non-ediblebiomass

Pitburial

Setling-thickeningtanks

Anaerobic,facuitative &

maturation ponds

Sludgedrying bed

Co-compostwith organicsolid waste

AgricultureAquaculture

Anaerobicdigestor

Y

YY

Y

Y

N

N N N

N


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Figure 11. Dewatering technologies employed in South Africa (dry mass % as base)

Figure 12. Tertiary treatment and additional stabilisation technologies employed in South Africa (dry mass % as base)

12The figures below (Snyman, 2007) summarise sludge treatment technologies at municipal wastewater plants in South Africa.

None17%

Drying beds36%

Aerobic digestion

3%Composting

19%

Pelletisation4%

None74%

Lagoon4%

Paddies9%

Centrifuge5%

Belt filter press29%

21 If the data for dewatering technologies is reworked to represent the number of plants rather than the dry mass percentage, the figures are significantly different. Drying beds are used at 45% of the plants followed by belt filter presses (15%), ,centrifuges (5%), paddies (9%), lagoons (4%) while 24% of the plants employ no dewatering (Snyman, 2007).


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22http://www.infrastructurene.ws/2013/01/09/tackling-durbans-sanitation-crisis-head-on/ 23Deep row entrenchment consists of digging deep trenches, filling them with sludge and

covering them with soil. Trees are then planted on top, which benefit from the organic matter

and nutrients that are slowly released from the FS (Roma et al., 2013).

Composting is used by both metropolitan city councils and plants in smaller towns while pelletisation is only employed by large metropolitan councils, which is why the mass percentage is relatively high (19%). Only 9% of the number of plants surveyed composted the sludge (Snyman, 2007).

Final disposal methods employed by the wastewater treatment plants surveyed in South Africa are still dominated by on-site disposal methods. This includes direct land application and stockpiling of the sludge on site. The beneficial use of sewage sludge includes the use of the sludge by the local municipality or farmers to generate compost, using it as the bottom layer for golf courses or using it to cultivate instant lawn. In some cases, the sludge is sold or given to a contractor in exchange for bulking agent (Snyman, 2007).

7.5.4 eThekwini Metro

7.5.4.1 From manual emptying of VIP latrines to UDDTs

The eThekwini Metro municipality in KwaZulu-Natal has initiated several bold and innovative large- 22scale projects to manage faecal sludge . These projects generated valuable lessons for other cities in

Africa and other developing countries.

eThekwini Metro comprises the city of Durban and the surrounding peri-urban and some rural areas. It has a population of just over three million. With VIP toilets as the preferred basic sanitation option in informal settlements and peri-urban areas, a sustainable pit emptying service is crucial. In 2005, the city had 100 000 VIP pit latrines in its area. The municipality made a commitment to empty pits at least once every 5 years. That meant emptying 20 000 pits per year, which was a huge challenge.

Mechanised emptying was found to be expensive; often the site could not be accessed and the process could frequently not deal with heavy sludge and solid matter found in the pits. The municipality then embarked on a large-scale manual emptying programme in collaboration with the private sector.

Cost remained an issue. At the time, the municipality charged R80 to empty a pit, but the actual cost could be up to R1 000. The municipality subsidised the balance. This was obviously not sustainable in the long term.

Therefore, the municipality had to reconsider its infrastructure solution for sanitation in previously unserved peri-urban and rural areas. A limited water supply meant that it had to be a dry sanitation system. Subsequently, the municipality embarked on a project that installed a urine diversion dehydration toilet (UDDT) and a yard tank, filled free of charge with 9 kℓ of water per month in an estimated 74 606 households in 65 areas (Roma et al., 2013).

In 2011, the eThekwini municipality conducted a survey with 17 449 householders in 65 areas. The purpose of the survey was to evaluate the use and conditions of UDDTs. 80% of households reported that they always use the UDDTs. 14% had a pit latrine in close proximity. Satisfaction with the UDDTs was disappointing: 70% reported dissatisfaction; bad smell was the most critical challenge. Interestingly, there was a correlation between dissatisfaction and households that have a pit latrine on the plot. The researchers concluded that the pit latrine's closer proximity to the house might contribute to the perception. Awareness of the economic benefit of the UDDT was found to be low. The research recommended that acceptance could be improved if users understand the importance and potential of waste as a useful resource (Roma et al., 2013).

7.5.4.2 Treatment

When a WRC study (Bhagwan et al., 2008) confirmed the municipality's experience that co-treatment of large volumes of faecal sludge with municipal wastewater in activated sludge wastewater treatment plants could lead to operational problems, eThekwini Metro started to experiment with alternative treatment options.

23Deep row entrenchment was adapted for faecal sludge (Still et al., 2012). The results were positive: Limited nitrate leaching was found in the soil and tests conducted in the area showed that surrounding groundwater bodies remained free from pollution. It also appeared that the fast growing trees took up the additional nutrients. However, environmental regulations will only allow deep row entrenchment for pit sludge disposal at pilot scale in the near future (Still et al., 2012).


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eThekwini Water and Sanitation also combined drying and pelletizing faecal sludge. The method is called LaDePa (Latrine Dehydration and Pasteurisation). The LaDePa system was developed in conjunction with the municipality's technology partner, Particle Separation Systems. The pellets can be sold and used as a fuel or as a soil amendment.

7.5.4.3 Sharing lessons learnt

eThekwini had many lessons to share from its faecal sludge management programme. The municipality set up MILE (the Municipal Institute of Learning) in Durban, South Africa, to transfer knowledge and experiences to other municipalities throughout Africa. MILE offers training courses and field visits on a regular basis with funding from the United Nations Institute for Training and Research (UNITAR) and the municipality. eThekwini Water and Sanitation also partners with municipalities throughout Africa to share knowledge and bring about improvements in service provision.

The senior management of eThekwini Water and Sanitation also interacts and shares experiences with the management of other water and sanitation organisations in low- and middle-income countries with funding provided by the Water and Sanitation Programme of the World Bank (Strande et al., 2014).


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7.6 Uganda

7.6.1 Main issues

The situation in Kampala is typical of all the urban centres of Uganda:

A large proportion of the population lives in low-income informal settlements. Due to rapid population expansion, general disregard of proper urban planning and failure to adhere to existing construction guidelines, only 10% of the city's population is connected to the sewer lines of the National Water and Sewerage Corporation (Makerere University, 2014).

According to an earlier study by Water for People (2013), there is a shortfall of 63% in the supply of pit emptying services in Kampala (Musabe & Nsubuga, 2014).

As a result, sanitation provision in Kampala is grossly deficient: most people do not have access to a hygienic toilet and large amounts of faecal waste are discharged to the environment without adequate treatment (Hutton et al., 2007).

According to Musabe & Nsubunga (2014), the main issues with sanitation services and faecal sludge management are the following:

Local authorities do not provide standard latrine designs.

Lack of price regulation for emptying services.

Lack of faecal sludge transfer stations and decentralised treatment facilities, which makes faecal sludge transport very expensive for operators.

Limited re-use of treated faecal sludge.

Lack of technical skills to develop faecal sludge management technologies and logistics.

The majority (70%) of Kampala's poor households are tenants (Günther et al., 2011). Landlords are often absent and tenants are unwilling to spend the little money they have on upgrading sanitation facilities (Musabe & Nsubuga, 2014).


The pit latrine is the simplest and most common excreta disposal system in Uganda. According to the Uganda National Household Survey (2010), 89.2% of households own pit and VIP latrines; 2.2% own flush latrine facilities and 8.7% do not own a toilet (Musabe & Nsubuga, 2014).

Most pit latrines in Kampala are communal and shared among different types of households. On average, one pit latrine is used by 30 individuals or 7 households. Günther et al. (2011) noted that only 22% of households have access to private sanitation facilities and this explains, according to them, why only 47% of the sanitation facilities are clean enough to be used properly.

In addition to human excreta, pit latrines are also used to dispose of a whole range of other products including sanitary towels, diapers, broken bottles and plastics. This may shorten the filling time of the pit latrine. 45% of latrines are abandoned after 5 years because they are full or broken down (Günther et al., 2011).

Other types of on-site facilities used in the city include (Makerere University, 2014):

1. Flying toilets: The use of polythene bags for disposal of faecal matter, which is thrown into drainage channels or any other place like rooftops and roadsides. This is common in the majority of the slums around Kampala.

2. Double storey pit latrines: These are built in swampy areas where toilet pits cannot be sunk without water filling up. The only solution they have is to build a tank-like structure on the soil surface with stairs to climb up to the seating area. These tank-like structures have an outlet at the bottom, which they can easily open and close. This outlet is normally opened when it is raining to allow the pit content to flow with the run-off. Some of these pits are lined with cement to prolong their lifespan. Some are built as VIPs and others like simple pit latrines.


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3. Eco-san toilets: Uganda has initiated several programmes to generate useful products from human faeces and improve hygiene through eco-san toilets. Some communities in Uganda have been found to be very sceptical about eco-sanitation in general and the use of faecal products as soil fertility enhancers. The unwillingness to use fertilisers from human faeces was attributed to a lack of knowledge, fear of associated health risks and cultural beliefs. The use of UDDTs is new. Acceptance is problematic, due to ash shortages. Ash is used to cover the faeces. Some of the eco-san toilets have been abandoned without using them.


The city of Kampala is characterised by illegal sanitation practices, lack of regulation and enforcement, and the limited functionality of wastewater treatment works, all of which have impacted negatively on the sanitation situation and caused contamination of water resources. The enforcement of by-laws varies considerably and public sector capacity to do this is weak. Moreover, efforts to improve urban sanitation are highly fragmented, and mandates are not fully adhered to. Consequently hygiene, the environment, and the water quality of and around Kampala are all seriously threatened by the inadequate sanitation services (Makerere University, 2014).

7.6.3.1 Practices to control odour and improve decomposition

Odour is a major problem with toilets. The practices below are quoted in the country report (Makerere University, 2014) and illustrate that people need a simple, cost effective method to control odour. Unfortunately, not all methods are effective and some inhibit natural decomposition in the pit latrines:

Effective microorganisms (EMO). This seems to still be in an experimental stage (Makerere University, 2014).

Some people throw used radio cells in pit latrines with a belief that these used cells will react with the faecal matter and reduce its volume, thus controlling the filling-up of the pit.

Others pour used motor vehicle oils into the pit latrine to control odours and flies. This probably works because the oil floats on top of the liquid part of the pit content and cuts off the supply of oxygen to maggots and other micro-organisms that need oxygen.

7.6.3.2 Pit emptying practices

The following pit emptying techniques are used in Kampala (Makerere University, 2014):

Trucks locally referred to as ‟kabuyonjo”, which are equipped to empty pit latrines by suction. The pit content is then either taken to a treatment plant or disposed of at another place convenient to the truck operator. Most trucks are imported. High costs and import tax, plus difficulty to get spare parts, create shortages and broken down trucks.

The gulper is a new pumping tool that can reach pit latrines not accessible for trucks. It is promoted by Water for People and has been used successfully in experiments.

Manual emptying.

Wetland emptying: This method is used in storeyed pit latrines located in wetlands. The faecal waste outlet is opened when it rains to allow pit content outflow to run off.

Swopping is a variation on the traditional pit-emptying practice. This method is used by people who have two pit latrines. When the one latrine gets full, the second pit latrine is opened for use. By the time the second one gets full, the faecal matter in the first pit is assumed to have stabilised with low levels of pathogens. The first pit is emptied before it is re-used, closed and the cycle continues (Makerere University, 2014).

Faecal sludge that is emptied manually is usually buried. A pit is dug near the pit latrine to be emptied and the faecal matter is put in there and then covered with soil (Makerere University, 2014). Faecal sludge that is removed from the plot through manual or mechanical means is disposed of at designated wastewater treatment plants. Operators need a licence to transport faecal sludge, but this is seldom enforced (Musabe & Nsubuga, 2014).


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Most of the wastewater treatment plants are designed for wastewater treatment and not faecal sludge. Overloading of plants has been reported at some of the plants (Musabe & Nsubuga, 2014).

The Makarere University report (2014) mentions composting and incineration as treatment methods in Kampala, but no details are given.

The city of Kampala is currently building two faecal sludge treatment plants with a capacity of 200 m³/day each, one at Lubigi and another one at Nalukolongo. A donor-funded project, FaME (one of the SPLASH projects), will be piloting the use of faecal sludge to fuel brick kilns at the Lubigi plant in Kampala (WIN-SA, 2014; EAWAG, 2014).

A study by GTZ (2010) shows that attitudes toward the re-use of faecal sludge probably also affect the success of re-use technologies. Small-scale farmers in Uganda, who cannot afford to buy commercial fertilisers, would be willing to use excreta and urine, provided they didn't have to incur transport costs. The medium scale farmers were also willing to use faeces and urine, but considered the collection process tiresome and would prefer a distribution scheme or company to do it. On the other hand, large-scale farmers did not think it was economically viable to use human waste and would prefer to use commercial fertiliser due to the high ratio of nutrients to weight. Ogwang, quoted in the Makarere University report (2014), advised that human faeces would be more acceptable as fertiliser if blended with animal waste.


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7.7 Zambia

This country report refers to on-site sanitation in Lusaka only.

7.7.1 Main issues

Most of the areas of Lusaka without sanitation services rely on groundwater (boreholes) as sources of water. Two major concerns arise. Firstly, most plot sizes are small: rarely going beyond 1000 square metres. This puts boreholes in close proximity to soakaways. Secondly, the geology of Lusaka is mostly dolomite, which has a low pollution attenuation capacity. This implies that with continued use of on-site sanitation systems, most of the city's ground water will get contaminated and the likelihood of disease outbreaks will increase (Tembo & Nyambe, 2013).


In most high density, low income urban areas of Lusaka (mostly peri-urban areas), disposal of excreta via sewerage systems is non-existing. High connection charges are often a prohibiting factor. This leaves on-site sanitation systems as the most common form of excreta disposal – 70% of the population use on site sanitation facilities. The common types are:

Septic tank systems;

Pour Flush latrines;

Improved single-pit latrines;

Ordinary Pit latrines;

Ventilated Improved Pit (VIP) latrines; and

Eco-san toilets (Urine Diversion latrines).

In most peri-urban areas, pit latrines are the most common means of excreta disposal. Where financial resources are available, an improved single-pit latrine (provided with structurally safe squatting plate and super structure) is constructed. However, the majority of pit latrines are of a very poor quality with some just comprising a hole in the ground and a basic super structure (Tembo & Nyambe, 2013).


Formal emptying of septic tanks is done by registered enterprises that use vacuum trucks or tankers. In this case, the emptying is usually at one of the city's treatment plants with Manchinchi conventional wastewater treatment plant being the most used for this purpose.

Where the septic tanks are emptied informally, unregistered individuals carry out the task. In this case, chemicals are sometimes added to the contents of the tank to fluidise it. Removal is through scooping using different types of improvised tools. The scooped out contents will then be buried in a pit specifically dug to receive the tank contents without any form of treatment. In a few cases, HTH (a commercial dry chlorine product) will be added to the contents as a way of disinfecting (Tembo & Nyambe, 2013).

Years back, the pit emptying was done by the local authority (Lusaka City Council). Unfortunately, the local authority could no longer sustain this service. The result was accumulation of solids in the tanks, which

24eventually got into the small-bore sewers. This resulted in clogging since the sewers were not designed to transport the solid component of wastewater. Consequently, overflows on the streets became common.

Recently, a Community Based Enterprise (CBE) calling itself “The Dream Team”, managed by a Water Trust in one of the settlements (Kanyama) has mobilised local residents to start a formal pit latrine desludging enterprise. They are using modified scooping tools to empty the pits. The scooped faecal matter is loaded into 60 litre barrels on push-carts. The contents are discharged at a biogas producing facility, which is managed by a Water Trust. This service is offered at a cost of about US$50 per 1 to 12 barrels scooped. For barrels between 13 and 24, the charge is US$65 (Tembo & Nyambe, 2013).

Most of the eco-san facilities in Lusaka are emptied by individuals. Emptying is usually done at night. A pit will be prepared during daytime in readiness for the vault contents. The pits are usually dug just in front of the vault doors. After the contents has been offloaded into the pit, the pit is covered with soil and the cycle is repeated.

24Simplified sewerage, also called small-bore sewerage, is a sewer system that collects all household wastewater (WC wastes and sullage) in small-diameter pipes laid at fairly flat gradients. Small-bore sewerage is prone to blockages if not managed properly. http://en.wikipedia.org/wiki/Simplified_sewerage


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7.8 Zimbabwe

7.8.1 Main issues

Historically, Zimbabwe had a dual sanitation policy: waterborne sanitation linked to a sewer system for urban areas and the indigenous Blair VIP latrine for rural areas. The Blair VIP latrine was developed by the Blair Research Institute, now called the National Institute of Health Research.

Up to about the year 2000, Zimbabwe had a robust water and sanitation sector in urban areas, with modern, highly mechanised, and well designed and functional sewer networks and wastewater treatment works. The latter consisted mainly of biological nutrient removal systems, trickling filters and waste stabilisation ponds. However, these systems are currently either totally non-functional or only partially functional, because local authorities are struggling to operate and maintain the highly mechanised and technically complex energy- demanding sanitation systems (Bangira et al., 2014).

As a result, most of the wastewater treatment plants currently simply bury sludge on site, contaminating groundwater (Bangira et al., 2014).

The rural water, sanitation and hygiene sector had an impressive record of researching and implementing rural sanitation programmes, with the Zimbabwean designed Blair Ventilated Improved Pit toilets being built in large numbers, mainly through donor-assisted funding mechanisms. The considerable donor support (up to 5 bags of cement per family) had to be matched by a large contribution from the family (bricks, labour, paying an artisan). This design did not focus on the re-use of sludge or on the emptying of pits, as one would have had to dismantle the toilet physically to easily access the pit contents (Bangira et al., 2014).

Half a million units were built, serving an estimated three million people. The programme was promoted vigorously by the Environmental Health Department of the Ministry of Health. The Blair toilet was built in households and as multi-compartment units at schools, clinics and other institutions. No consideration was made to the issue of pit emptying and faecal sludge management. A new set of toilets was simply built when the old set was full. When donor support faded, the number of units built rapidly declined. The standardised Blair VIP latrine was too expensive for most families to build themselves (Bangira et al., 2014).

Since the 1990s, years of drought, political, economic, and social upheaval brought economic challenges that 25saw high unemployment . This pushed people into the informal economy and migration from rural to urban

areas increased (Bangira et al., 2014). Following the National Land Reform Programme in 2000, there has been a rise in peri-urban and informal settlements in and around major towns and cities.

National policy stipulates that only waterborne sanitation is allowed for urban areas. But, urban centres cannot afford or sustain waterborne sanitation in these settlements. In the absence of donor support, the possible improved alternative, the Blair VIP latrine, has also become unaffordable. As a result, no sanitation (and water) services are provided in urban and peri-urban informal settlements. In cases where these services are provided, they are in the form of public latrines that are used by large numbers of people (Bangira et al., 2014).

Faecal sludge accumulates and there is no policy or formal management guidelines in place to deal with the situation (Bangira et al., 2014).

25Unemployment figures found in the literature, range from 10% (the official figure, based on a 2011 survey) to as high as 95%. None of these figures seem to be reliable.


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In the absence of formal service delivery, informal settlement dwellers dig their own unimproved pit latrines or defecate in the open.

NGOs in Zimbabwe have repeatedly ignored legislation and promoted and constructed various forms of eco-friendly on-site sanitation facilities. A case in point is the work of the Mvuramanzi Trust in the peri-urban informal settlements of Hatcliffe extension, Dzivarasekwa extension and Porta Farm since 1999. By 2002, about 1650 ecological pit latrines had been built with the intention that the pit contents (after proper storage) would be used as a soil conditioner. The Mvuramanzi Trust built Arborloos (shallow pit toilets), Fossa alterna and Skyloos (urine diversion toilets) at individual homesteads, and some urine diversion toilets at institutional premises (Bangira, et. al., 2014).


Currently there is no policy in place on the emptying of pit latrine toilets. Most of the settlements are relatively new and it appears that the pits have not yet filled up, although a crisis is looming, given that the pits may fill up soon. The current practice is that when a pit is full, the latrine is simply abandoned, and a new one is constructed adjacent to it. However, challenges due to space have been encountered given the small stand sizes (Bangira, et. al., 2014).

In the town of Chinhoyi, 115 km from Harare, the NGO Homeless People's Federation assisted a community to build Skyloo and Fossa alterna latrines. The Skyloo serves a household of six. They can use each vault (roughly 1 square metre volume) for 1 year and 6 months, after which a layer of topsoil is put on top, the vault is sealed and left to compost for a further 6 months before the contents are extracted. The community is organised into a club, which centres on the management of these latrines and disseminates educational material, besides also assisting others with no latrines to set up their own (Bangira et al., 2014).


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26 Each country has its own name for these Ministries.

Most sub-Saharan countries are characterised by high population increase rates and rapid urbanisation. An ever increasing number of people flock to informal settlements in and on the outskirts of cities and towns. Governments and local authorities specifically fail to keep up with service provision. In many cases water, sanitation and solid waste removal services do not ensure environmental sustainability.

Because there is no alternative, most people in these informal urban and peri-urban settlements make use of unimproved on-site sanitation, creating large amounts of faecal waste. Faecal sludge management is often hopelessly inadequate. As a result, large quantities of faecal sludge are discharged to the environment without treatment. This creates unhygienic living conditions and is likely to increase the outbreak of infectious diseases, such as diarrhoea, worm infestation, typhoid, cholera and dysentery.

The challenges surrounding faecal sludge management affect all aspects of the sanitation value chain.


In all the studied countries, a range of ministries has policies and acts that relate to sanitation. These policies and legislation have broad sanitation objectives; however, few mention faecal sludge management and its aspects specifically. Targets and timeframes, if set, are for sanitation facilities.

Sanitation regulation is complicated by overlapping lines of authority between different government departments (Bahri, 2012). For example, in South Africa, eThekwini Metro's successful pilot with deep-row entrenchment cannot be upscaled, because environmental legislation prohibits the large-scale use of faecal sludge in deep-row entrenchment.

Focus areas:

National policy and legislation that specifically deal with faecal sludge management.

Aligning policy and legislation across different government departments.

8.2 Responsibilities, capacity and funding

As mentioned above, the responsibility for sanitation tends to overlap between a range of government ministries and agencies. In most of the studied countries, these ministries include the Departments of Water

26Affairs, Environmental Affairs, Local government, Health and Education . However, in practice, it is usually the local authority (under different names), which is ultimately responsible for faecal sludge management. In most instances, the high-level policies and legislation do not link sufficiently to by-laws and implementation at local level.

National budgets allocate significantly more to water than to sanitation. The focus of sanitation budgets is mainly on the provision of sanitation facilities, and less on operation and maintenance. As a result, local authorities do not have enough budgeted funds for faecal sludge management. Also, capacity for implementation and law enforcement at local level seem to be generally weak.

Donor funding and other aid to sanitation go mainly to infrastructure development and health and hygiene education.

8. Conclusions


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Focus areas:

Is the responsible authority supported by the necessary by-laws and implementation strategies?

Is the responsible authority equipped with an adequate budget and capacity to manage faecal sludge efficiently and enforce by-laws?

If not, can this be addressed or should one look at an alternative responsible authority, such as an urban or a national water and sanitation utility? To what extent can faecal sludge management be privatised?

8.3 Standards for on-site sanitation facilities

Pit latrines are the most commonly used on-site facility in the studied countries. Yet, only South Africa, Botswana and Zimbabwe have a clear minimum standard for an improved pit latrine (VIP, BOTVIP and Blair VIP). Unfortunately, standards are not always applied consistently when these toilets are built.

It is commonly acknowledged that pit latrines could contaminate groundwater in certain circumstances. Yet, the literature gives disparate guidelines on the safe distance between a pit latrine and a water source (Graham & Polizzotto, 2013).

Pit latrines, even if it is a VIP that is not full yet, continue to be an unpleasant solution due to odour, flies and safety. In practice, eco-san alternatives, such as the urine diversion dehydration toilets (UDDTs) do not seem to resolve the issue of odour and flies (Roma et al., 2013).

The literature on faecal sludge management abounds with pictures of dirty and blocked toilets, but the literature does not indicate to what extent this problem is an engineering problem or an operation and maintenance problem. All over the world, from households to public spaces, thousands and thousands, probably millions, of cleaners, mostly women, have to clean toilets after they have been used. When users do not clean up their own urine and faeces spills on the seat and the floor, or faeces sticking to the inside of the bowl, someone has to clean up behind them. If no-one takes this responsibility, and disinfectant and cleaning materials are unaffordable or absent, any toilet, whether waterborne or a pit latrine, will smell and become unhygienic to use.

Nowhere in the literature have we seen this problem, which is also a gender one, being addressed directly.

The country reports do not make a link between open defecation and dysfunctional or unhygienic toilets. It is likely that open defecation will continue to be practised in Africa as long as there are toilets that are dysfunctional or unhygienic.

Focus areas:

A uniform standard for an improved pit latrine.

Clear standards on the safe distance between a pit latrine and a water source.

WASH campaigns that include educating children and adults (males and females) to be responsible and hygienic toilet users and cleaners.

The sanitation value chain


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Figure 13. The sanitation value chain (Bill & Melinda Gates Foundation, 2010)

8.4 The sanitation value chain

All along the value chain, current technology and faecal management practices present serious challenges:

8.4.1 Full pits

The time that it takes for pits to get full is a function of a number of factors that are well documented in the literature. The presence of solid waste in the pits is one of the main contributing factors. Education programmes might improve the situation, but unless the responsible authority removes solid waste regularly from informal settlements, it is unlikely that this problem will be resolved.

8.4.2 On-site disposal

On-site disposal (with or without treatment) of faecal sludge has not yet been resolved. The practice to close a full pit and dig a new one is only feasible on large stands, but this could increase the risk of groundwater contamination. On-site treatment and re-use, such as with the urine diversion dehydrating toilets, still has a long way to go to become acceptable, if ever.

8.4.3 Pit-emptying and transportation

Mechanical and manual pit emptying services remain challenging for a number of reasons, which are also well documented in the literature: exposure to pathogens, sludge remaining in the pit, access, the consistency of the sludge, mechanical problems with suction, cost, etc. Currently, if the owner of the toilet does not or cannot pay for the service, the service is not sustainable.

Some of the faecal sludge collected from pit latrines is legally added to the wastewater stream or taken to treatment facilities. Unfortunately, because of long distances to treatment facilities and cost, an unquantified but large proportion is illegally dumped in rivers, streams, the ocean or open spaces, creating a health hazard.

CAPTURE STORAGE TRANSPORT TREATMENT RE-USE


67

27Figure 14. Unsafe faecal sludge disposal in Dakar (2012)

The figure below illustrates this for Dakar, Senegal.

A

C

D

B

3 Sanitation markets in Dakar (volume of Faecal Sludge in m per year)

3Estimated annual production (2012): 1,565,911 m (-25% / +50%)Production

Collection

Opendefecation

~ 0%

Remainsin latrine

(10%)

Manual emptiers &others (family)

Mechanical emptiers

Unquantifiedbut potentially

large Faecal sludge

treatment plants

Wastewatertreatment plants

Sea outfall

Unquantified butlimited

3(620 m in 2008)

Demand toDemand tobe createdbe createdDemand tobe created

Treated dry FSfor end-use sold to local farmers

Treated dry FSfor end-use sold

to industries

Burying / unsafe disposal in the neighbourhood

UnquanitfiedUnquanitfiedUnquanitfied

3218,149 m

Pitlatrines

2%

Septic tanks58%

3On-site sanitation: ~1,017,842 m(-25% / +50%)

Semi-collective

(small-bore)5%

Sewers35%

Off-site sanitation

3~ 441,708 m(-25% /+50%)

Transport

Treatment

Disposal

Re-use

8.4.4 Treatment, disposal and re-use

The literature points out that existing faecal sludge treatment plants and wastewater treatment plants in the studied countries are often dysfunctional. Large amounts of faecal sludge exacerbate the issues that these treatment plants have to deal with.

On the other hand, the country reports cite several examples of successful pilot projects with innovative faecal sludge treatment and re-use technology, for example, the biogas projects of the Umande Trust in Nairobi and the Dream Team in Zambia.

27Source: FaME project. http://www.slideshare.net/tremoletconsulting/fame-presentation-04112014-vf


68

Faecal sludge is a valuable resource that is still largely unexplored. For the future, it will be essential to research and develop further the potential economic value of faecal sludge for biogas or fertiliser or other applications.

Focus areas:

Solid waste removal services to informal settlements. Privatising recycling services might work.

A cost effective and safe alternative for the pit to solve the problems with pit-emptying and potential groundwater contamination.

Research and development of financially viable and scalable solutions for the re-use of faecal sludge. The cost-benefit calculation must reverse the money flow, i.e. pay toilet owners or collectors in money or by-products for faecal sludge.

Supportive policy and legislation, and micro financing for the private sector to invest in these solutions.

It is evident that these challenges and the areas to be addressed listed above call for an integrated management solution that can turn faecal sludge from waste to resource on a large scale.


69

Please note that the abbreviations “s.l.” and “s.n.” stand for without place of publication and without name of publisher.

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This report emanates from country reports from the Sanitation Research Fund for Africa (SRFA) Project.

Obtainable from

Water Research Commission

Private Bag X03

GEZINA, 0031

[email protected] or download from www.wrc.org.za

For more information:

Dr. Sudhir Pillay

Water Research Commission

Marumati Building

Pretoria

South Africa

[email protected]

Other WRC reports that may be of interest:

· 1745/1/12

· 1745/2/12

· 1745/3/12

· 2381/P/15

These reports are available on www.wrc.org.za

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