Urban dwellers in general enjoy better health and higher incomes than rural inhabitants. Yet, the squalid sanitary conditions of many high-density, low-income informal settlements forfeit the urban advantage. In the urban slums where dwellings lack toilets and where water and waste management is unreliable or ineffective; daily life becomes cumbersome, inconvenient and undignified. Children suffer the consequences through debilitating diarrheal disease.

The high cost for society induced by the lack of sanitation has been diligently calculated and the corresponding social and economic benefits of investing in sanitation quantified by the WSP Economics of Sanitation Program (1).

For actually putting resources into sanitation, you however need to resolve; who is to pay? How much? For what? And how? A welcome contribution to this challenge is the recent IRC report Sanitation Financing Models for the Urban Poor (2) which sorts out the variegated institutional arrangements to finance different urban sanitation options. The report reviews the ways in which the private citizens and others (e.g. national and local government, NGOs, external donors) have (co-) financed different sanitation solutions, with their respective advantages and disadvantages. Naturally, there is not one solution, nor need there be. There are many modalities which can be made to work better, including through more systematic sharing of lessons learned in the sanitation sector.

A more specific finding worth highlighting in relation to the urban poor is that the pay-per-use, being the most common way to finance (recurrent costs of) public or communal toilets in low-income areas, will never be able to make away with open defecation. The poorest people will never be able to pay to use a toilet, and certainly not for all household members and at all times. While paying for each visit may be suitable for busy commercial areas, for low-income more residential areas, an alternative to the pay-per-use could be a monthly flat rate for the use of toilets as well as washing and laundry facilities.

The monthly subscription model is reportedly preferred by SPARC, an Indian NGO that has supported community-designed, built and managed toilet blocks serving hundreds of thousands of poor urban dwellers. Their experience also highlights the contentious issue of securing land for communal facilities (3) and the importance of working closely with communities and supporting their incremental organization - including the power of women's groups, as well as "the art of gentle negotiation" - in order to get reluctant urban governments involved (4).

In crowded slum areas, individual household toilets are often not an option because of lack of space, house ownership or sheer poverty. Shared facilities may in such situation be the most viable way forward. However, where densities are lower, household installations may be plausible for providing basic sanitation for the urban poor.

In Durban - now a renowned success story on extending sanitation and water services to all - the municipality pays parts of the cost of installing urine diverting toilets and hygiene promotion (5). With a grant from the Gates Foundation, nutrients are being extracted from the urine as a way of turning waste into a resource (6). If business plans become successful, this could provide a much-needed financial incentive to help increase sanitation coverage. In any case, there is the potential of closing the urban nutrient cycle.

Different sanitation technologies and institutional arrangements have different requirements in terms of land, money and water availability. (Urban) sanitation blogger Duncan Mara (7) is concerned about the relative costs of different solutions, and often argues for the cost-effectiveness of condominial sewerage for high-density periurban areas (Mara & Alabaster). These systems, a form of simplified sewerage based on the sharing of smaller-diameter piping at relatively flat gradients, are considerably cheaper than conventional sewers. Still, the condominial systems rely on water and sanitation cooperatives and thus the ability of communities to organize to manage shared facilities. And, all sewerage engineering needs to be correctly done.

Urban sanitation systems are complex, and without appreciating the whole, certain parts are easily neglected. The report on Sanitation Financing Models (2) found that the costs for excreta transport and final disposal were not given sufficient attention in the planning and budgeting. Needless to say, without all its parts coming together, the system will not serve its users well.

With great humility to the task, we need to mobilize funds, expertise and urban land along with the insights, engagements and priorities of low-income communities. Rather than allowing 'cholera' to be dubbed 'the best of all sanitary reformers' - governments should take a resolute lead in this collective concern for the health and dignity of its citizens. 

References

1. WSP (2012) "Economics of Sanitation Initiative" Water and Sanitation Program
2. Sijbesma, C. (2011)Sanitation financing models for the urban poor. IRC International Water and Sanitation Centre, The Hague.
3. Making Urban Sanitation Safe and Fair. World Water Week Side Event 2011-08-21, convened by SHARE Consortium, International Institute for Environment and Development (IIED), Shack/Slum Dwellers International (SDI), London School of Hygiene and Tropical Medicine (LSHTM) and WaterAid
4. Burra, S., Patel, S. and Kerr, T. (2003) Community-designed, built and managed toilet blocks in Indian cities. Environment and Urbanization. 15(2):11-32.
5. Gounden, T., B. Pfaff, et al. (2006). Provision of Free Sustainable Basic Sanitation: The Durban Experience. 32nd WEDC International Conference. Colombo, Sri Lanka, WEDC: 4.
6. Frederikse, J. (2011) "South Africa: Harvesting nutrients that are flushed away." all.Africa.com, 28 June 2011.
7. Mara, D. (2012) "S a n i t a t i o n. Personal and fairly maverick views on how international sanitation targets can be achieved."
8. Mara, D. and Alabaster, G. (2008) A new paradigm for low-cost urban water supplies and sanitation in developing countries. Water Policy. 10:119-129.