By Susan Davis, Executive Director

This blog is based on a talk I gave at the Sustainable Sanitation Alliance Meeting August 22, 2015 in Stockholm (if you prefer to watch the video – about 15 minutes – click here)

Every day, several times a day, I use a toilet. I flush and forget. I don’t have to worry about where it goes. I have soap and hot water and a towel to dry my hands. If I go to a building that is not my house, I can still usually find a clean toilet with toilet paper and a place for hand washing.

Unfortunately, billions of people don’t have improved toilets, or don’t use them, or use filthy toilets, or go back to open defecation when the latrine pits fill up. This blog is about sanitation failures, and what we can learn from them. There are many types and causes of failures. I’ll highlight information from a few of these categories:

• Implementation design and quality
• Functionality
• Coverage
• Understanding customers
• Inappropriate technology
• Monitoring and follow-up
• Sustained hygienic use
• Sustained “open defecation free” status
• Fecal sludge management

I will provide mostly snapshots, but together they make a not so pretty picture.

Failures in implementation

A recent example of poor implementation was found in Icchawar Block (India), where the official data showed 38% toilet coverage. Monitoring found only 19% of the toilets was functioning. Many toilets were damaged or construction was not completed due to delays in materials and poor quality of external contractors (Nayak & Luckose, 2015).

Failures in functionality

• In Loreto Region, Peru it was estimated that 85% of latrines are considered unusable (Calderon 2004).
• In rural Madhya Pradesh, India, 75% of individual household latrines were not functional (Nayak & Luckose, 2015).
• In Afghanistan, 45% of toilets in public schools needed extensive repair or replacement (UNICEF, 2012). Similar results were found in Bangladesh (56%), Bhutan (30-40%), India (50%), Maldives (27%), and Pakistan (43%) (UNICEF, 2012).

Failures in coverage

• We all know that the world has missed the Millennium Development Goal (MDG) target for sanitation by almost 700 million people. And that wasn’t even a goal of universal access. One in three (2.4 billion) people still lack improved sanitation facilities and one in eight people (946 million) practice open defecation (WHO & UNICEF Joint Monitoring Programme).
• In Nigeria, sanitation coverage is declining. The percentage of people with access to a toilet shared by only one family between 1990 and 2012 declined from 37% to 28% (WHO & UNICEF 2014). This means 16 million more Nigerians defecate outside today than in 1990. The way aid is distributed might have something to do with this: while Nigeria has the highest percentage of unserved population (17%) in Africa, they only receive 6.1% of aid. Compare this to Kenya, with 4.2% of the need and 9.4% of the aid (WHO, 2014).
• In many parts of the developing world, up to 4 out of 10 schools and healthcare facilities lack basic water, sanitation and hygiene facilities (WHO & UNICEF, 2015).

Failure to understand customers

We have really failed to understand customers (often called “beneficiaries”). We often don’t know what kind of toilet they want, will pay for, will use, or will maintain. Or whether they even want a toilet. The aptly named SQUAT survey in Northern India:

• Revealed a preference for open defecation: over 40% of households with a working latrine have at least one member who defecates in the open.
• Showed that most people who own a government-constructed latrine defecate in the open anyway.
• 47% of those that defecate in the open say they do so because it is pleasant, comfortable, or convenient.

Studies also show differences in men’s toilet practices vs. women’s, and the disposal of child feces.

Failures in sustained hygienic use

In a 2010 World Bank study in Bangladesh, 89.5% of sample households owned or shared a latrine that safely confined feces, but only 44% of those were clean (Hanchett et al, 2011).

In a study of school WASH programs in Kenya, toilets led to increased hand contamination. As the red arrow in the chart below indicates, there is higher hand contamination after the intervention than before. Why?

The researchers suggested these reasons:

• The number of latrines were increased without improving actual hygiene behavior change and daily provision of soap and water.
• Also, anal cleansing materials were virtually nonexistent in most Kenyan school settings and were not provided as part of the program.

Failures in understanding the danger and the value of shit

In developing countries, 90% of wastewater is discharged into rivers and streams without any treatment. (UNDP, UNEP,World Bank, & World Resources Institute, 2001). This might be an underestimate: in Indonesia, which has the fourth largest population in the world, only 1% of urban households connected to sewerage system. On average there is 36% idle capacity of wastewater treatment plants (Weitz, 2015). A recent literature review on this topic can be found here. Reuse of fecal sludge and wastewater hasn’t taken off widely.

Failing forward

So what should we have learned from all of these failures? We should have learned that we can’t generalize across the poor, rural populations, across countries, across communities, and even that there are differences in sanitation practices within families. We should have learned that to reach universal safe sanitation, we need to change our measurements of success. As I hope this blog has highlighted, sanitation is not simply about access to toilets.

One way to think about successful sustained sanitation is:

• Sustained behavior change
• Infrastructure built lasts and is replaced
• Services are sustainable

According to WaterAid (2013), successful sanitation starts with political will and leadership, but also requires:

• adequate funding;
• cooperation and coordination;
• affordable technology;
• development of sustained local capacity; and
• a long-term drive toward a cultural shift is required to raise awareness and change behavior.

This month, the era of the MDGs ends and the Sustainable Development Goals begin. It is an excellent time to put these learnings into place and “future proof” the sanitation gains achieved.

P.S. Soon after I gave this presentation, WaterAid convened a World Water Week session on Transforming the Sanitation Sector. The resources and a video are available here.