Recently I was in Botswana giving a course on planning for wastewater and sanitation management for the Department of Water Affairs (DWA) who has recently taken over the mandate for provision of these services. It became very obvious during the week that the participants were interested in managing conventional centralized wastewater systems and did not see a place for decentralized or on-site services in their mandate. In fact, there seems to be no clear institutional mandate for non-centralized services. Previously DWA had responsibility solely for water provision. So perhaps it is not surprising that they see their new sanitation responsibilities purely from the "how do we clean the water" perspective.

This perspective is not at all unusual in the sector which is generally referred to as the water and sanitation sector. The water-sanitation connection is deeply ingrained in the sector. Engineers are trained on technologies based on centralized sewerage and politicians promote these big investments as "state-of-the-art" solutions for their populations. The trouble comes of course when we start to realize that the vast majority of the world’s population does not have access to water-based sanitation and that the costs of building and maintaining such systems are prohibitive to providing sanitation for all. On-site and dry solutions are and will continue to be a critical part of providing the health and environmental benefits of universal sanitation.

Often responsibilities for sanitation get divided up based on desired out-comes, e.g.  health, water or environmental protection. However, this often leads to one-sided thinking on solutions. Such is the case in Botswana where the DWA aims to "promote water conservation through the reuse of treated wastewater" without considering that dry toilets can also conserve water. Housing sanitation in health departments can have the opposite affect with the focus being on pathogen control to the exclusion of reuse potentials. If the contents of pit latrines and septic tanks are classified as solid waste rather than wastewater, responsibility for on-site sanitation can end up with the waste management department who are often not invited into wastewater sector discussions. Determining the proper home for sanitation has major consequences for what type of system is promoted for use and on the potential for treating the waste flows as resources.

So the challenge is how do we find a proper home for sanitation that covers service provision for all (not just those with flush toilets) and at the same time provides opportunities for resource recovery?
A number of Swedish utilities (e.g. Roslagsvatten) have now taken over responsibilities for both wastewater and solid waste which gives them the flexibility take a holistic perspective in handling "waste fractions". Another example is Telge in Södertälje which has collaborated with the Swedish Farmer Association in development of their black water treatment, allowing for out of the box thinking and more possibilities for recycling.  Both have created a home for sanitation by working in wider collaborations than the typical institutional silos of the water-sanitation sector. Perhaps we can share some of these experiences with our colleagues in Botswana?

A year and a half ago I wrote my first sanitation blog on the cholera crisis in Haiti. Today the epidemic is on-going and getting worse. This month the Pan American Health Organization estimated the disease could strike 200,000-250,000 Haitian this year. More than 7,000 have already died from the disease. Efforts to control the outbreak have been patchwork and investments slim as aid organization are beginning to leave. The solution is of course investment in adequate sanitation and water systems, estimated at a price of US$1 billion. This is small portion of the billions that were pledged to Haiti following the earthquake, but contributions have flagged as attention from the crisis fades.

Unfortunately, this situation is typical. It often takes a tragedy or a crisis for a problem to make the headlines and stimulate action to correct the situation. Yet what about the quiet tragedies that happen on a daily basis which no one seems to notice? When news becomes old or repetitive we tune it out. How many of you have heard the statistics on children mortality linked to lack of proper sanitation (millions of deaths per year) so often that you hardly react to it anymore?

One of the major challenges in the sanitation sector is making it a priority issue - for households as well as politicians. I am convinced that part of the solution will be finding a way to bring sanitation issues into the limelight on a more regular basis. Getting more press coverage does not always need to be negative. Many organizations in the sector are already using media tactics. Football stars support WASH campaigns (for water, sanitation & hygiene) around the world and this month the Bollywood actress, Vidya Balan, was named India's sanitation brand ambassador. Another Indian woman made the news when she threatened to divorce her newly-wed husband because he lacked a toilet. In March this year, she received a cash reward and the "Sulabh Sanitation Award" by the Union Minster for Rural Development.

People need to hear the sanitation news - both the bad and good. The only way to break a taboo is by talking about it. This can be done at high levels, like the Ministerial delegations that were assembled by the global partnership Sanitation and Water for All (SWA) last month to raise spending commitments for improved sanitation and water. Yet, it can also be done at a grass-roots level through local media, editorials, social-networking sites, and sharing stories at a personal level. We need to keep reminding ourselves of the importance of sanitation so that it is not quietly forgotten.

Maybe you have a catchy slogan to help get the issue stuck in people's heads?  The Sanitation Drive to 2015 seeks to support and inspire people to take action towards achieving the sanitation MDG. They need a slogan - submit your idea on their website (http://www.sanitationdrive2015.org/).

On March 6th of this year the Joint Monitoring program of UNICEF and the World Health Organization announced that the world has met the MDG target of halving the proportion of people without sustainable access to safe drinking water. Yet, the same report highlights that the world is still far from meeting the sanitation target and is unlikely to do so by 2015. According to the report, only 63% of the world has access to improved sanitation, well below the target goal of 75%. Without a significant change in the rate that sanitation in delivered, it will take until 2026 until the sanitation target is met.

So the pressure is on to find solutions and new approaches. In fact, that is the theme of the World Water Forum held in Marseille. The conference organizers have started a webpage where people can post their solutions and even gather votes and feedback (http://www.solutionsforwater.org/. The solutions for sanitation include, increasing the capacity of system operators, backing the human right to sanitation, planted wetlands for biomass production, public education and awareness-raising, empowering young people as change leaders, strengthening women’s roles, decentralized treatment options, and pro-poor financing schemes. Nearly 150 sanitation solutions have been submitted. What is striking about the list is how few of the solutions are technology-based. The majority have to do with providing an “enabling environment” for positive behavior change, pro-active politics and increased affordability. Where there are technical solutions, they tend to focus on the potential for reuse of water and nutrients or gaining energy through biogas or biofuel.

To me the message in this is quite strong - sanitation does not stand alone. The solutions to reaching global sanitation coverage must be integrated into the web of society and its use of resources. Sanitation is not a “thing” that can be packaged and sold like the latest cell phone or pills to cure malaria. It is essentially about hygiene habits and attitudes towards cleanliness. It is a state of being that is created through education and behavior change. Yet, it is also about the management of physical waste streams; waste that is increasingly recognized as a potential resource. The solution to global sanitation thus lies in fostering the values of sanitation and linking it directly to economic gains.

There are of course huge challenges remaining in how to do this on a global scale. But like many changes, it can also start small - with individual changes. It starts with the education of our children; teaching them to appreciate a clean restroom, to pick up trash, to use the toilet properly. It starts with consumers using biogas from wastewater treatment and demanding produce fertilized with recycled nutrients. It starts with citizens pushing their representatives for more closed-loop options that increase resource efficiency in waste management, and supporting the export of these ideas to the areas that need them most. It starts with a global movement and dialogue about the value of sanitation.

The World Water Week in Stockholm this year focused on one of the increasing challenges for sanitation and water service delivery - urbanization. The global population is now more than half urban and cities are growing at a tremendous rate, especially in the developing world and in the small and medium-sized towns. This rapid urbanization process poses many challenges for those trying to provide services. First and quite simply, the increasing human density corresponds to increasing quantities of waste. This of course leads to environmental degradation, water pollution and a multitude of related health and livelihood impacts. Urbanization exacerbates the need for improved sanitation. Secondly, cities are often experiencing population growth that far exceeds their absorptive capacity in terms of shelter, water, sanitation infrastructure, public health services, employment, education, food supplies and environmental protection - a striking new challenge that has arisen within the span of a lifetime. The service backlog thus gives rise to an increasing number of slums and informal areas lacking adequate sanitation services.

There are a number of recent initiatives moving the focus of urban sanitation to the spotlight. For example, the City Sanitation Strategies in Indonesia that have developed over the last 5 years focusing on city-wide operational which transformed the sector. Increasingly investors such as the World Bank, Gates Foundation, African Water Facilities and European Union are financing urban solutions. The urban environment is challenging, but also leading to innovations in service delivery and financing, like the private entrepreneurs supported through Water & Sanitation for the Urban Poor (WUSP).

In our attempts to come to grips with the scale of the urban challenges there is increasing recognition that the term "urban" hides a complex mix of heterogeneous contexts. There is amazing diversity in the level of service provision within cities, from high income-high water consumption areas connected to sewerage systems, to proper toilets without proper waste management, to nothing at all. Although statistics usually show urban areas as having greater access to sanitation services, this can be misleading. In the case of urban slum dwellers, proximity doesn’t mean access to improved services. At the World Water Week, sector professionals were increasing recognizing that this spatial diversity needs to be taken into account when planning, designing and monitoring for urban sanitation.

In many ways meeting the urban challenge requires a paradigm shift in how we view the urban context and how we design urban sanitation services. The heterogeneous nature of the problem means that the solutions will also have to be heterogeneous. Instead of rolling out a single standard of city-wide services, meeting the needs of ALL city dwellers will mean adapting technology, management and financing structures that are matched to the urban context in which they are living. Matching services to specific contexts and social demographics will mean looking at a multitude of solutions and integrating them along the entire chain of environmental service delivery (including solid waste and drainage). Future city-wide planning may need to allow different standards and options at different levels of the city. One way of doing this is to start looking at the functions that services provide instead of focusing on specific technologies. This will open the door for innovation and critical linkages to complementary services. We need to start thinking out of the box, adapting solutions to specific urban contexts (http://susana.org/lang-en/library?view=ccbktypeitem&type=2&id=1019), and taking action at a variety of levels within the urban context. The urban challenge is also an exciting opportunity for a paradigm shift within the sanitation sector - as long as we remember that this transition requires advocacy and our active engagement at both local and global levels (see my news stream entry from 16th July).

It is standard procedure for international sanitation researchers to quote the vast statistics of how many people lack access to improved sanitation services and criticize the lack of resources and attention paid to the sector in general. There are calls for greater action, the "Sustainable Sanitation: Five-Year Drive to 2015", greater publicity and change. Yet, forward process often seems incremental and sometimes non-existent. I was in Botswana last week for a scoping trip regarding new approaches for more sustainable sanitation and was struck again by how entrenched conventional wastewater ideas are with practitioners and decision-makers in the sector. This is not only the case in Botswana, it is the same scenario in Sweden. What is it that is creating such inertia in the sector and how do we start transitioning towards more sustainable options?

A recent report from the Sanitation Global Practice Team of the Water and Sanitation Program and the World Bank looked to political-economy as one way to why sanitation is not given adequate priority and why interventions often do not reach the poorest populations . The study looked into the social, political and economic processes determining the extent and nature of sanitation investment and service provision. What it found was that cultural and historical contexts are significant determiners of sanitation investment. In other words, social taboos and fractured or hierarchical politics lower political motivation to prioritize resources for sanitation. And when there are resources for sanitation, there is a strong preference for highly visible, big infrastructure investments. This can be explained in part by the technical bias of engineers, who have all been trained in sewerage systems; desires to gain power and prestige from big infrastructure, and perhaps ignorance that other options exist.
 

Looking closely at these causes for inertia can give us some tips on how to overcome them. Diversifying the education of sanitary engineers is needed, but will hardly give short-term results. Perhaps there is a way to design sustainable sanitation investment that is even more visible and nice-looking as the conventional sewerage so as to tempt politicians and voters. Here generating public demand and communication can lead to higher visibility and political incentives for sanitation investment. Linking fractured water and sanitation sectors and creating cross-sectorial bridges in political hierarchies is also crucial. In this way, sanitation can find an institutional home with a mandate, capacity and resources to create change.
 

At the same time we need to consider how to build pressure for leapfrogging the sector into more sustainable regimes. There are several ways to do this, either through international cooperation or through internal change. Swedish actors are well-positioned to create this change either abroad or at home. Partner driven cooperation or direct investment for sustainable approaches with foreign partners is one approach. Swedes are good at working across sectors and can provide needed institutional and technical support. Expanding the education of sanitary engineers through courses taught in Sweden or abroad is another. On the home front, a global movement can be started right here by aligning our own thinking and sanitation systems for sustainability. These ideas can eventually be exported to the rest of the world. Finally, we need to remember that in spite of challenges, individual champions can and do make a difference.

In February of this year Sierra Leone announced its 1000 open-defecation free village at the same time as organizations in Niger are geared up for a campaign to produce similar results there (IRIN, 2011). Only 2% of the population in Niger has access to adequate sanitation and a majority of people use no toilet at all, defecating in the open and giving pathogens ample opportunity to spread. Organizations such as Plan Niger and UNICEF are working to change this, using a well-known method for driving behavior change, Community-Led Total Sanitation (CLTS). The techniques used in CLTS focus on building feelings of disgust and shame related to open defecation – thus motivating people to stop open defecation and use a toilet.

The popularity of CLTS is derived from the realization within the sanitation community that simply building better sanitation facilities may not be enough to get people to use them. One of the biggest stumbling blocks for improving the sanitation and corresponding health situation around the world is that it means changing the hygiene and defecation practices of individuals. Humans are creatures of habit and motivating change can be an extremely difficult task (ask anyone who has tried to break a bad habit), perhaps especially when it has to do with a taboo subject such as sanitation. The tactics of CLTS have meet with some success in Asia and Africa, yet in other areas they have been criticized as manipulative and inappropriate for the local culture. But at least one thing is sure – stronger drivers than a shiny toilet are needed to get people to change.

While many people understand the need for behavior change when it comes to open defecation, it is actually an issue for sustainable sanitation across the globe. There is growing agreement that achieving sustainable sanitation will require new innovations, even in places like Sweden where wastewater infrastructure is nearly universal (Lüthi et al., 2010). For example, future sanitation systems will need to drastically reduce water use and close the loop on nutrients. The toilets of the future may very well look and work differently than the standard flush-toilet with which we are familiar. New innovations will mean changes in the current system and will require users to adapt accordingly. The changes to the actual user interface may be large or small, but if the new systems are to achieve the ambitious health and environmental goals it will demands that people change.

school education on how to use a urine-diverting toilet (from SuSanA site, photo by Robert Gensch)

That an individual’s behavior can make a difference for all is true for more than just sanitation. In order to meet ambitious climate change policy and reduce the carbon footprint for the entire city, the City of Stockholm has started a public awareness campaign aimed at changing the inhabitants’ lifestyles and consumer behaviors. Being climate smart is rather trendy these days, yet the City is spending significant time and resources to really motivate change. However, imagine how much more effort would to needed to convince consumers, the housing market and politicians to back a change that would gradually replace all flush-toilets in Stockholm with, say dry composting toilets. There just isn’t enough incentive to change right now; just as many open-defecators in Niger see no reason to change their morning routine of visiting the nearest bush. Yet achieving sustainable sanitation for all will require that we overcome this societal inertia and find a way to motivate change in hygiene and sanitation behavior at all levels.  We need to start critically assessing our current behavioral and organizational practices in order to identify how technologies, knowledge, and policy can act as catalysts for change.  The message has to be right.

References
IRIN Humanitarian News and Analysis, 23 February 2011
Lüthi, C., Panasar, A., Schütze, T., Norström, A., McConville, J., Parkinson, J., Saywell, D., & Ingle, R. (2010). Sustainable Sanitation in Cities: A Framework for Action. Papiroz Publishing House: Rijswiik, The Netherlands.

The United Nations Convention on Climate Change (COP16) is drawing to an end and the world is still waiting for a binding agreement on climate policy. While there is still hope for an eventual deal on mitigation policies, it is time to recognize that climate change is already upon us and that additional budgets and adaptive solutions will be necessary to deal with the consequences.

Climate change increases the likelihood of extreme weather events and the resulting natural disasters. The floods in Pakistan that directly affected 20 million people this summer are a striking example. Yet, while the storms and floods make the headlines it is the after-effects that may take the greatest toil. In Pakistan, a widespread waterborne disease outbreak following the floods has so far been avoided, but the current situation in Haiti proves that sustained action must be taken in post-disaster areas to prevent the spread of disease. In October, ten months after the earthquake, cholera was detected in Haiti. As of December 4, the Haitian Ministry of Public Health & Population reported a total of 93,222 hospital visits and 2,120 deaths due to cholera. Waterborne diseases such as cholera will be one of the most significant risk factors resulting from climate-change disasters. Currently, 5000 children die a day from diarrhoeal diseases that are closely linked to lack of hygiene, clean water and proper management of human waste. In a changing world where extreme weather events destroy or compromise the functionality of our sanitation systems, these numbers are likely to be even higher.

Adapting to climate change means major changes in how vital systems, such as sanitation, in our society are managed.  If major waterborne disease outbreaks as a result of climate change are to be avoided, many nations, especially in developing countries, will need support in adapting sanitation systems to manage the source of disease, wastewater. However, to date donor spending on sanitation and water is very low. Today, Sweden spends less than 2.5% of the state’s aid budget on sanitation and water, down from 5% several years ago. If we are to overcome the challenges of climate adaptation this figure will need to be higher. Similarly, technology innovation in the sector is low and today’s sanitation systems are generally inflexible, fixed infrastructures with little variation across the globe. In the future, we will need flexible technical solutions that can be implemented quickly in post-disaster areas or adapt to prolonged droughts.

There are opportunities for Swedish actors to support this change, both by lobbying for better sanitation policy and funding, and through the development of innovative and adaptive sanitation solutions. The initiative of Peepoople (collaboration SLU and KTH) is one example of Swedish researchers testing the limits of traditional sanitation services and offering possibilities to sterilize human waste in a fast and infrastructure-free manner.  More work is needed to make sanitation systems more flexible to varying water flows resulting from climate change. Other adaption possibilities include coupling sanitation systems to the energy grid (biogas) or decoupling the centralized system to smaller treatment centres during crisis periods. Climate change may be the opportunity we have been waiting for to finally take our pioneering ideas for new sanitation systems off the shelf and put them into reality. The world is waiting.
 

by Jennifer McConville, Chalmers