Rochester institute of technology
kate gleason college of engineering
Department of Industrial and Systems Engineering
“A Systematic Review To Identify The Factors Preventing The Adoption and Development Of Global Sanitation in Rural Environments” /
Pedro Cruz Diloné /
ME Sustainable Engineering Capstone Project 2013 /
A Systematic Review To Identify The Factors Preventing The Adoption and Development Of Global Sanitation in Rural Environments | Cruz Diloné, Pedro /
2013 /
Contents
List of Figures
List of Tables
Abstract
Definitions
1.Project Background
1.1Objectives
1.2Scope
2.Methodology
3.Discussion
3.1Review of Sanitation Programs
3.1.1Community-Led Total Sanitation (CLTS), Asia (India, Pakistan, Cambodia, Nepal, Bangladesh) & Africa (Kenya, Congo, Uganda, Ethiopia, Tanzania, Kenya, Zambia)
3.1.2IDE, Cambodia
3.1.3Lien Aid, Cambodia
3.1.4RILES Composting Toilets, Mexico, Nicaragua, China
3.1.5Orangi Pilot Project - Research And Training Institute (OPP-RTI), Pakistan
3.1.6Sustainable Organic Integrated Livelihoods (SOIL), Haiti
3.2Identifying the barriers
3.2.1Sociocultural factors
3.2.2Socioeconomic factors
4.Results
5.Recommendations
5.1Current infrastructure
5.2Availability of economical resources for improvement of sanitation
5.3Availability of financing options accommodated to different social statuses.
5.4Interaction with gender and age
5.5Interaction with religious and folkloric beliefs
5.6Environmental analysis
5.7Technical skills
5.8Perception of sanitation
5.9Perception of human excreta
6.Future Work
7.References
8.Literature Reviewed
List of Figures
Figure 1. Proportion of population using improved sanitation facilities worldwide.
Figure 2. Defecation mapping as part of the workshops developed by CTLS to illustrate the places where people practice open defecation.
Figure 3. Schematic of the use of a water sealed latrine in a squat slab.
Figure 4. Users and schematics for IDE’s Easy Latrine.
Figure 5. Diagram of a Clivus Multrum composting toilet.
Figure 6. Outside (left) and inside (right) view of a Composting Toilet in Mexico.
Figure 7. Left is a household toilet installed in the Orangi village, and right are villagers installing the sewer lanes in a road.
Figure 8. Arborloo (top left), Humanure (top right) and UDT (bottom center).
Figure 9. Summary chart showing the proportion of each category of all factors identified
List of Tables
Table 1.OPP’s Cummulative Construction andPeople’s Investment in Low Cost Sanitation
Table 2. Summary of common factors determined by the Systematic Review
Abstract
Annually, 1.8 million people die from diarrheal diseases, 90% of these are children under the age of 5, especially in developing countries. Sanitation is one of the most effective and least expensive ways to prevent diarrhea and other life-threatening illness. Even when a variety of existing sanitation methods and technology is available, they are not adequately addressing the barriers to adoption of around 40% of the world population without a toilet.A systematic review wasperformed for the critical assessment and evaluation of an extensive pool of dataconcerning this topic; a total of 53 documents were reviewed and particular information was extracted.Although many studies and reports have studied the barriers preventing the adoption of sanitation on a country or regional basis, no thorough research regarding these barriers from a global perspective was found. During this research it was observed that the slow expansion of sanitation coverage is not for lack of attention, but rather to unaddressed social, economic, technical and environmental barriers. Design guidelines and strategies are proposed toprovide the baseline for an affordable and functional hardware that addresses user needs while being culturally appropriate and locally responsible.
Definitions
The following is a list of terms used in this report that, due to the wideness of interpretation and usage, are redefined to fit the context of this research.
- Sustainability:endurance of humans on planet Earth through the reconciliation ofthe environment,socialequity andeconomic demands (3 E’s, 2005 World Summit on Social Development)
- Sanitation:refers to the combination of hardware and methods that addresses the safe disposal of urine and feces.
- Improved sanitation: refers to the management of human wastethat “hygienically separates excreta from human contact”.(WHO-UNICEF/JMP, 2010)
- Sanitation ladder: is a monitoring tool used to qualify the progress towards the improved sanitationsystems. It provides users with a step-by-step framework of different technologies that have gradual levels of improvement.
- Diarrhealdiseases:is defined by theWorld Health Organizationas having three or more loose or liquid stools per day, or as having more stools than is normal for that person. It is usually a consequence of the presence of specific bacteria, viruses and parasitic organisms. Infection can occurfrom person to person as a result of poor hygiene during food and beverage handling.
- Open defecation: the practice of releasing ones human excreta in the open environment.
- Flying toilet: the practice of releasing ones human excreta inside a plastic bag, which is then thrown “away” from the vicinity.
- Project Background
One of the issues that pose considerable challenge to the 3 pillars of sustainability is the global lack of sanitation.Annually, 1.8 million people die from diarrheal diseases, 90% of these are children under the age of 5, especially in developing countries [1]. Even though diarrhea is both preventable and treatable, most parts of the world don’t have access to the methods to do so. Sanitation is one of the most effective and least expensive ways to prevent diarrhea and other life-threatening illness [2] [3] [4]. Even when a variety of existing sanitation methods and technology is available [5], they are not adequately addressing the barriers to adoption of around 40% of the world population without a toilet [6][7]. Additionally, lack of sanitation options leaves the opportunity for open defecation and “flying toilets” as remaining solutions to personal relief; these two can contaminate drinkable water, deteriorate the environment and increase pollution.
Sustainability can be defined under many different scopes. Perhaps one of the concepts most referenced is the 3 pillars of sustainability: environmental consciousness, social equity and economic demands [8]. In that same sense, Sustainable Engineering can be defined as the application of scientific knowledge to design and build technology and systems that improve human condition while caring for the environment and the integrity of the members of society.
Sustainable engineering provides tools and methods to better define and understand these barriers. This approach can be used to overcome the sanitation deficit of entire communities, thus improving health and environment, and enhancing prosperity.
1.1Objectives
This present study is a first attempt to comprehensively evaluate the approaches taken by sanitation programs in developing nations froma global perspective. The main objectives of this research are to:
- Evaluate the effectiveness of strategies, in terms of installation and sustainability of use, used by existing improved sanitation programs at a household and community levels.
- Identify and assess any existing systems (technology, education, funding) intended to upgrade the status of sanitation at a household and community levels.Particularly, which approacheshave achieved behavioral change to initiate users into the sanitation ladder.
- Distinguish and classify the factors that influence the rejection or the long term use of an introduced sanitation systemat a community scale.
The perception, practices and attitudes of people in developing countries towards defecation and sanitation globally were also explored in the literature search. The goal of this research was to develop guidelines for designingsustainable sanitation systems (equipment and strategies) specific for the developing world.
1.2Scope
This paper presents a systematicanalysis of sanitation projects and existing technology in developing countries focusing on rural settings. Publications by renowned organizations, articles from sanitation related journals, renowned web site publications by academic or experts, and publications from international organizations concerned with global factors (such as UNDP, WHO, The World Bank)were reviewed systematically.Policy development, economic feasibility and environmental analysis studies that involve sanitation were also part of the review. Water treatment and technical environmental managementwere excluded from this review. Although many studies and reports have studied the barriers preventing the adoption of sanitation on a country or regional basis, no thorough research regarding these barriers from a global perspective was found. This paper covers regions of the developing world affected by the lack of sanitation in three continents: America, Asia and Africa. As seen in Figure 1, Africa and Asia are the continents with the largest proportion of affliction overall. In the western hemisphere, Haiti (26% coverage) is the country with the least coverage of the American continent, followed by the plurinational state of Bolivia (46% coverage).
- Methodology
The method used for evaluation was a systematic review of available data. A systematic review is the critical assessment and evaluation of an extensive pool of dataconcerning a specific topic. Although typically used for health care and medical science studies, this methodological framework can be used for a qualitative assessment.
In order to identify relevant studies, electronic databases—RIT Library’s summon app, Google Scholar, Google Search, Inspec and Compendex— were searched for publications up to 2013. The general search structure for electronic databases was “sanitation”, “developing countries”, “criticism”, “failure”, “success”, “project”, or any of their synonyms. Other publications were extracted as electronic filesfrom external institutions.The term “success” is used to define projects or strategies that deliver improved sanitation continuously for over a year; otherwise it is considered a “failure”.
An analysis of selected projects and programs in different settings is provided in Section 3 of this report. This analysis was developed as a general explanation of the most common factors identified. Recommendations based on the list of factors determined and the 3 pillars of sustainability (environmental, economics and socio-cultural perspectives) are presented at the conclusion of this study.
A total of 53documents were reviewed and particular information was extracted per the objectives of this report. A number of factors organized by categories were summarized and presented in Table 2.
- Discussion
- Review of Sanitation Programs
Literature reviewed allowed the identification of notable sanitation projects around the world. The following projects and programmes were selected to illustrate the most promising results obtained throughout the research. Purposedly, each of the reviewed caseswere selected to portray different social, economic and technical circumstancesin Africa, Asia and America to allow a much comprehensiveand wider analysis.
3.1.1Community-Led Total Sanitation (CLTS), Asia (India, Pakistan, Cambodia, Nepal, Bangladesh) & Africa(Kenya, Congo, Uganda, Ethiopia, Tanzania, Kenya, Zambia)
[9] [10] CLTSis an organized movement which focuses on behavioural change of communities focusing on sanitation rather than installing hardware, specifically with the goal of stopping open defecation. “Shit” is used to describe feces and with the intention of braking cultural taboos.As a general framework, CLTS instructors will presents themselves to the town with meetings and workshops. In this workshops, activities such as defecation mapping (marking the locations where people practice open defecation), a demonstration how flies move between feces and food, and calculating the amount of feces produced by the town. Once the community is made aware of the threaths of open defecation, the instructors of the program identify community leaders to develop a plan to build the hardware that accomodates to the needs and wants of the community.Even though implementation has reached a number of countries in Africa and Asia, success in stablishing Open Defecation Free zones and/or improving sanitation has not been universally achieved. Critics have been presented regarding their approach [11][12][13] mostly due to the use of humilliation and fear in their campaigns. In conclusion, while open defecation free communities have been accomplished, improvement of sanitation has not been assured. To summarize, some causes of this ineffectiveness are:
- People building toilets for the sake of not being abused rather thanfor their own health benefits.Intimidation also results in the installation and use of unsafe structures.
- Several described toilets as dirtier than the fields
- Facilitieswithout hand washing station
- People unaware of the health effects of lack of sanitation
Figure 2. Defecation mapping as part of the workshops developed by CTLS to illustrate the places where people practice open defecation.
Source:
3.1.2IDE, Cambodia
[14] [15] [16]IDE’s water sealed latrine is mostly known as the “Easy Latrines”. Water sealed latrines are pit latrines with an added bowl and pipe fictures that retain water (See Figure 3). This water barrier prevents odors and insects from coming in or out of the pit where the human waste is deposited. After each use, water is poured into the bowlto flush the excreta and replace the water barrier.
Source: "Sandec/Eawag"
IDE uses a marketingapproach in which local laborersare recruited and trained to build and install Easy Latrines as a business. Some of the local labor used has little or no experience in masonry. These local fabricators are given a $440-$500 loan to buy a complete set of molds and other equipment for building the components of the Easy Latrines. Additionally, the fabricators are given training in hygiene and sanitation promotion, latrine production, as well as business and management skills (like advertising and customer follow up).
Figure 4. Users and schematics for IDE’s Easy Latrine.
Source: IDE Cambodia Official Website.
Easy Latrines are sold at approximately $35 and includes 3 rings, one lid, a toilet base, PVC pipe and a receptacle pan for under the toilet, as seen in Figure 3. The easy latrine basically works as an alternating pit latrine, where the porcelain toilet base is designed as a pour-flush squatter (conventional defecation mode in Cambodia). The base is connected to a PVC pipe that transport the wastes into the tank formed by the 3 the ringsand the lid in order to contain the excreta. After some time, when the pit is full, the PVC pipe is then switched to a second pit, so that the excreta in the first pit is given time to compost and be emptied. The cycle repeats itself when the second pit is full. This type of pit latrine is suited for areas where the soil is permeable to allow liquids to leak without the risk of contaminating underground water sources. One of the limitations of Easy Latrines is that the owner/buyer of the latrine can choose to build the outer structure of the system which poses a threat to safety. Also, because the program is strictly unsubsidized, there is less opportunity for the poorest and vulnerable to become involved or install a latrine.
3.1.3Lien Aid, Cambodia
[17] [18] [19] [20][54] Focused on capacity building of local suppliers.Lien Aidhad a very similar approach to IDE Cambodia’s, except that they don’t train new masons from scratch but only work with the existing structure. Many of their community partners are rich businessmen or in the upper class. Their strategy is centerd in the masons;the type of latrine to market is decision of the local mason. The most commoon model is the alternative pit latrine system with a pour-flush squat slab, very similar to IDE Easy Latrine’s (See Figure 4). The program teaches and empowers the masons on the importance of doing quality work in order to gain a good reputation and thus ensure the livelihood and sustainability of his business.Projects from Lien Aid have achieved cost reductions that allows hardware to be sold at prices betweenUS$30 and $100(2009-2011), compared with the commercial model of around $300. Although local masons were taught to design their latrines to community needs, they focused on selling latrines to the niche that could pay for it. It seems like this marketing approach is a good approach to getting to the middle to higher class people to build latrines, butit doesn’t necesarilly reach the poorest parts of the community.
3.1.4RILES Composting Toilets, Mexico, Nicaragua, China
[21][22][23][45]The ReSource Institute for Low Entropy Systems (RILES) is an nonprofit organization that works towards improving and protecting public health and the environment in developing countries. Their composting toilets initiative started in the Caribbean coast of Mexico and later expanded to Nicaragua (Central America) and China. Mostly funded by UNICEF, the focus of this organization was to provide a variety of composting toilets, modeled after the commercial model of Clivus Multrum (See Figure 5), for both wealthy and poor communities who were practicing open defecation or had unstable structures for sanitation. In this type of toilet, the excreta are deposited together into a chamber with a double bottom. The compost gradually forms at the bottom during a period of time, where it can be turned and removed through an access door
.
Figure 5. Diagram of a Clivus Multrum composting toilet.
Source: Humanure Handbook, 3rd Edition. Chapter 6. P114
The composting toilets were built or manufactured with varying degrees of sophistication and prices; including dry and low-flush units.Most sofisticated facilities included urinals, hand washing stations and could be built inside the house with decorative elements. Along with the installation of hardware, local masons and users were trained on the operation of the composting unit and the applications of the products of composting. Feedback gathered from users that have installed and used these composting toilets include the increase of property value, more welcoming to tourists, enhanced vegetation, complex to maintain compost with adequate humidity, difficult to repair. The complexity of some designs required some technical skills to repair or understand the systems, which meant that there was a lack of skilled labor when repairs were needed. Additionally, material availability varied from location to location, which may be the cause why better results were achieved in Mexico compared to Nicaragua and China.