This section, “Attitudes and Misconceptions,” identifies some of the major trends in thinking that are holding back

the sanitation and wastewater management sector from making real progress. This thinking is prevalent among leaders and practitioners at all levels, and for various reasons. Perhaps these ways of thinking were learned from previous leaders or through experiences. Attitudes and beliefs can be contagious though, spreading either positive or negative thinking. Any kind of thinking that prevents progress deserves to be challenged. Are the prevailing ideas based on reality and truth? If so, why? And the key question to make any genuine progress is: “What must be done to change either the misguided thinking itself or the realities that seem to accurately support such thinking? ” Business as usual approach Keep the same attitudes. Keep following the same misconceptions. Keep believing nothing will change because the challenges are too great. OR Business unusual approach Adopt new attitudes. Realize that myths are not based on truths. Realize misconceptions are based on wrong or incomplete information or orientation. Believe that change is possible with a new outlook on the sector and begin sharing this new outlook within the workplace, with the public, and partners in development.

One Major Attitude Problem Major Misconceptions Making Business Sense

There is a major debate within the water sector as a whole that presents two attitudes, which determine two different directions to proceed from. There are those who argue that water is a social good—that all people have a right to water because it comes from nature. There are others who oppose and argue that water is an economic good—that water brings value to homes and businesses, involving costs that must be covered. Perhaps this debate is best summarized by an example: Utility customer: “My water bill is too high; besides, why should I pay for water when it comes from the sky?” Utility employee: “Yes, sir, you are right. The water that falls from the sky is free and you are welcome to collect it or go out to the reservoir and take all you want. But, if you want to have safe water delivered to your house—available every time you turn on the faucet—then you will have to pay us to store, transport, treat, pump, and send it through the pipes.” Like water systems, sanitation and wastewater systems can become subjects of this kind of debate. For example, people have the right to a clean and safe environment, and therefore, the government must provide sanitation and wastewater treatment for free. The social good of these services is providing people clean conditions. The economic good is saving people from costly, unnecessary diseases and being able to attend school or work, in addition to averting wide-scale health epidemics. The Asian Development Bank’s (ADB) water policy views water as both a social and economic good. This is ADB's approved policy. Drinking water as a food/medicine, which should be bottled at treatment plants, is the position of an ADB staff in a think piece which has not been peer reviewed or accepted as an ADB position. Access to water is now recognized as a human right in many countries. ADB advocates that governments and utilities ask people to pay for the cost of delivering water services, not the cost of water as a resource. These services have high costs, and they need to be shared by the consumers. Otherwise, the services cannot be effective and sustainable. On the cover of the book “Asian Water Supplies—Reaching the Urban Poor” by Arthur McIntosh, 1 is a picture of a household maid in Manila who pays 900 pesos (P) monthly for water from itinerant vendors while her employer, who lives in a large home, pays only P200 a month. This disparity led Mr. McIntosh to write a section in his book about “Myths, Misconceptions, and Realities” in the water sector. One of the myths is that the poor cannot afford to pay for piped water supplies and will not pay for piped water. Separate research by ADB on water costs in 17 Asian cities supports the reality that the poor pay more—up to 10 times more—for water from private water vendors than what people pay for piped water utilities. Business as usual approach
Continue the debate over water as either a social or economic good.

OR

Business unusual approach
Agree to disagree on the debate. Water is both a social and economic good. Agree to solutions that will accomplish three goals: 1) expand sanitation coverage to poor, unserviced areas; 2) contribute to the sustainability and efficiency of utilities and facilities; and 3) contribute to the financial viability of utilities.

________________________________
1 Arthur McIntosh, Asian Water Supplies: Reaching the Urban Poor , Asian Development Bank , 2003, ISBN: 971-561-380-2.

Some major misconceptions about sanitation and wastewater treatment prevent progress.

Major Misconception #1: Infrastructure is too costly to implement.
We often tell ourselves that sanitation and wastewater projects are too expensive to implement. Sanitation and wastewater treatment expansion is expensive—that is true. Comparatively, we need five times the financing as water supply projects do but that does not negate the need. Let us consider the point that the World Bank’s John Briscoe makes in his article “When the Cup is Half Full”: “In just the first 10 weeks of the cholera epidemic in Peru, losses from reduced agricultural exports and tourism were estimated at 1 billion dollars ($), or more than three times the amount invested in water and sanitation services in the whole country during the 1980s.” The cholera epidemic that Briscoe refers to occurred in early 1991, beginning with a number of cases of cholera reported in the coastal areas of Peru. Within a few weeks, the disease spread throughout Peru and subsequently into numerous countries in the region. The suspected origin of the 1991-1992 cholera epidemic was the bilge water of a Chinese freighter in Lima, Peru. From there, the following incidents were recorded: First cases reported near fish processing plant in Lima harbor; 12,000 cases reported in Peru within 2 weeks; Rate of new cases reportedly increased to 2,500 per day within 12 weeks ; Cholera extended to all neighboring countries within 6 months; Cholera later also spread to Central America; Public health and economic impacts of the cholera epidemic were dramatic as shown in the statistics below: 506,000 cholera cases reported in Peru (942,000 in Latin America); 2,900 deaths (8,622 in Latin America); and $1 billion lost in (fish and shrimp) exports and tourism. This represents about three times the investment in water supply and sanitation infrastructure in Peru during the previous 10 years Peru’s case of cholera epidemic illustrates how not investing in sanitation and wastewater can be a very costly omission. They are not only investments that have an immediate impact on our environment, but also provide a significant amount of prevention against future health and economic catastrophes. Business as usual approach
It is too expensive to invest in sanitation and wastewater treatment.

Business unusual approach
First, commit to invest in these sectors and find necessary financing. Not doing so could be more expensive. For example, loss of productivity due to water and sanitation-related illnesses and potential outbreaks may result in additional healthcare costs. Second, prior to investing in sanitation and wastewater treatment projects, assess where alternative approaches to major infrastructure may be more suitable and sufficient. Last, where new infrastructure truly is needed, projects are always accompanied by "soft" or social-based components that are fully resourced to make the infrastructure sustainable.

OR

Major Misconception #2: People are not willing to pay for the services they get.
Because the costs of living in unclean environments are the costs of diseases—additional outlays for medical services and medicine, inability to work and earn money—people will protect their health and pay for that protection. Oftentimes though, people resist the idea of paying for sanitation and wastewater treatment because they do not understand the three-way relationship between a lack of these services, their environment, and their personal health. Most often, they may only understand the relationship between the lack of these services and their immediate environment. A sense of smell and sight is often all that is needed to know that the waste we produce is having an effect on our environment. But it is another thing to know how that waste in the environment is seeping into groundwater and contaminating water supplies that people are using and, consequently, getting ill from, for example. The poor can pay—and will be willing to pay—if they understand how a healthy environment will save them money on medicine and be able to earn more money by being healthy. We should, however, ask ourselves what we are asking the poor to pay for: is it an elegant solution that far exceeds their ability to pay, or a solution that they can afford? Business as usual approach
People are not willing to pay for sanitation and wastewater treatment, so we cannot consider charging for these services or raising existing tariffs to finance our projects or operations and the maintenance of services and facilities.

Business unusual approach
Raise the public's awareness about the need for sanitation and wastewater treatment as prevention against dangerous diseases and harmful environments that are risks to their health and ability to earn. With greater public understanding, people will agree to pay for services that save them money by protecting their health and income.

OR

Major Misconception #3: The real need is for more infrastructure to solve the health and environmental problems caused by a lack of sanitation and wastewater treatment facilities.
Because sanitation and wastewater treatment expansion is expensive—five times the amount needed for water supply projects—why are we depending so much on infrastructure for a solution? Over the last 50 years, development assistance has clearly preferred the “hard” approach—or infrastructure—to solve water and wastewater challenges. Infrastructure alone, however, has failed much of the developing world. Yet, “soft” approaches—awareness, capacity development, and non-large infrastructure investments—are not taken seriously and invested in. The soft solutions are perceived and treated as inferior to infrastructure. Infrastructure does not run itself though. People run infrastructure. They use it and their skills are needed to maintain it. Perhaps, infrastructure projects would prove to be more effective and sustainable, as evidenced in the ways that the community adopts the infrastructure, takes care of it and see that it lasts if soft approaches were incorporated as valuable or invaluable— components of infrastructure projects. Similar to the debate over whether water is a social or economic good, the debate here is between engineers and social scientists. Engineers, believing in the goodness of their field, often tend to concentrate on solving a problem by building infrastructure capacity. Social scientists and managers, also believing in the goodness of their fields, think about solving a problem by building human capacity.

Major Misconception #4: That international experts are the best minds to resolve our problems.
Successful outcomes depend, to a very large extent, on commitment by all stakeholders, including government, civil society, nongovernment organizations (NGOs), the development community, and the private sector. Commitment comes from understanding the problem and agreeing to the solution. If you have been involved in overseas development projects, you are familiar with the “top-down” approach: a development agency studies the situation and recommends a solution to government. All too often, a choice is made with little or no input from end users and civil society. Sometimes, the development agency mandates a particular solution even when the government may not totally agree. What happens? There is no commitment or ownership by either the central government or at the local level. The project eventually takes place but, to no surprise, the intended benefits do not fully materialize. Years pass and the infrastructure fails due to lack of care and maintenance. This is a primary example of continuing to do business as usual although the intended results are never achieved. Development agency representatives and international consultants do have the international experience. Outside experts can bring a fresh perspective and a wealth of information about approaches around the world. Outside experts are also independent and not part of the hierarchy, so their opinions usually will not be colored by local influences. However, in order for their suggested solutions and recommendations to be better suited to local situations, they have to work hand-in-hand with internal experts. So rather than reject their ideas immediately, why not think about how you could modify them to work in your local context? If development agency representatives and consultants are external experts, you are the internal experts! They need your knowledge and active participation. Yet, both sides must seek and offer this to one another. Consider the following two scenarios of the same situation. They illustrate how working with a development agency representative or consultant is usually handled (business as usual) and how it should be handled (business unusual). There is a meeting between a development agency representative, an international consultant, and the head of a government planning office in a developing country. A new project is beginning, and it aims to reorganize the agency so that it can better achieve its strategic plan. Here are two scenarios to that initial meeting to get the reorganization proposal report underway. Business as usual approach
1. Accept a "top-down approach" of development agencies in development and implementation projects. 2. Reject recommendations of international experts on the grounds that they are "outsiders" and do not have anything to contribute.

Business unusual approach OR
1. Demand to be true partners in development. 2. Work hand-in-hand with international experts.

A successful business owner or manager will identify those attitudes, myths, and misconceptions that are holding back progress. The owner or manager will try to understand where these ways of thinking come from and how to overcome them. Perhaps, it is not by denying some truth that the thinking may hold, but rather by building a consensus on how to move forward. Business as usual approach
Keep the same attitudes. Believe the same myths. Keep following the same misconceptions. Keep believing nothing will change because the challenges are too great.

Business unusual approach
Adopt new attitudes. Realize that certain long-standing beliefs may actually be misconceptions, which come from incomplete information or orientation. Believe that change is possible with a new outlook on the sector and begin sharing this new outlook within the workplace, with the public, and with partners in development.

Continue the debate over water as either a social or economic good.

Agree to disagree on the debate. Water is both a social and economic good. Agree to solutions that will accomplish three goals: 1. expand sanitation coverage to poor, unserviced areas; 2. contribute to the sustainability and efficiency of utilities and facilities; and 3. contribute to the financial viability of utilities.

People are not willing to pay for sanitation and wastewater treatment, so we cannot consider charging for these services or raising existing tariffs to finance our projects or operations and the maintenance of services and facilities.

OR

Raise the public's awareness about the need for sanitation and wastewater treatment as prevention against dangerous diseases and harmful environments that are risks to their health and ability to earn. With greater public understanding, people will agree to pay for services that save them money by protecting their health and income. A part of raising awareness also requires understanding the situation of the poor and those behaviors that hold back progress.

It is too expensive to invest in sanitation and wastewater treatment.

First, commit to invest in these sectors and find necessary financing. Not doing so could be more expensive. For example, the loss of productivity due to water and sanitation-related illnesses and potential outbreaks may result in additional health-care costs. Second, prior to investing in sanitation and wastewater treatment projects, assess where alternative approaches to major infrastructure may be more suitable and sufficient. Last, where new infrastructure truly is needed, projects are always accompanied by "soft" or social-based components that are fully resourced to make the infrastructure sustainable. This requires the commitment of everyone to appreciate all professions and perspectives involved, including ideas from nontraditional places—civil society and community groups—that are sometimes excluded from the decision-making process.

Business as usual approach
Infrastructure and facilities are the solution.

Business unusual approach
Prior to investing in sanitation and wastewater treatment projects, assess where soft approaches may be sufficient. Where new infrastructure is truly needed, projects are always accompanied by soft components that are fully resourced.

OR
The development agency representative or international consultant takes charge of the project process, and the government obliges because, after all, "they are the development experts and we are busy."

The government asserts itself and seeks collaboration and equal participation in the process, whether it is paper research, gathering perspectives from local governments and communities, or advising the development agency representative or consultant.

Actioning Policy
This section calls our attention to the age-long problem in many developing countries, where good policies are crafted but not implemented. And where they are implemented, they are not implemented strictly. For countries with no policies in place and are contemplating to formulate them, this is a reminder that having the policy is not enough; we have to work on its implementation. This chapter provides a glimpse of the work involved in this undertaking. Let us first look at the traditional set-up-who formulates the policies and how? Business as usual approach
We create legal and institutional frameworks and policies now, and consider how to fund and pursue their implementation later.

Business unusual approach
We consider the funding requirements and capacities of implementing agencies as we create our legal and institutional frameworks and policies. Where these are already in place, we begin the work of finding adequate funding for its proper implementation, including developing the capacity of institutions and people to implement them.

OR

Centralized: "Top-Down", and Ineffective at "The Bottom" Formulating a Sanitation and Wastewater Policy Regulation: It Follows Policy Formulation Standards Financing and Where Regulation Comes In Planning Autonomous Utilities and How Regulation Helps Capacity Development: Its Many Facets Making Business Sense-A Summary

For many years, the governments of many developing countries have operated on a very centralized model—with the central or national government formulating policies with little or no involvement from those who will play critical roles in its implementation. This model of central government-driven policy formulation is becoming less and less effective. Why? The challenges of providing water and wastewater services are mounting as populations grow—especially in major cities where people migrate to find work. Each problem needs a specific solution and the “onesize-fits-all” concept no longer works. With decentralization already in place or taking place in most developing countries, the need to match the policy with the required resources to implement it is crucial. Fixing problems like these is usually a matter of sector reforms: revisiting policies and frameworks and clarifying roles and responsibilities of major players. Often, policies are still relevant. The problem is that they are not implemented properly. Either the implementing rules and regulations are not there or the institutions responsible for implementing them do not perform their roles nor have the capacity to implement them.

Decentralization: Time to Take It Seriously
In a decentralized mode, the two complementing roles of policy formulation and implementation have to be played by the central and local governments. It is not a case of one or the other. It should be both. In fact, for policy implementation, more and more responsibilities should be delegated to local governments along with the powers to collect and spend the required resources. Why? Because a national policy is only effective if its implementation is prepared for specific local conditions. Local governments are closer to the people and know better what works and what does not work in the field.

Business as usual approach
Maintain a centralized approach and continue to experience decision-making that tend to be slower paced, and nonresponsive to the actual needs on the ground.

Business unusual approach OR
Undertake reforms that delegate different kinds of decision-making to local governments to ensure that progress happens quickly, and specific local conditions are taken into account.

The Sanitation Connection suggests the following policies to form a foundation for progress in sanitation and wastewater:

Environmental policy- commitment to national action plans, procedures for environmental monitoring, and impact assessment; Economic policy- approaches to cost recovery, subsidies and attracting private investment; Social policy- addressing poverty reduction, and promoting gender equality; Policy influencing institutional arrangements- attitudes to financial sustainability and autonomy of sector institutions, scope for involvement of private sector and nongovernment organizations (NGOs), approaches to regulation and the commitment to decentralization of management to the lowest appropriate level; and Health policy- existence of national objectives for sanitation-related health improvements, guidelines on excreta, and wastewater reuse.”2

Examples of strategies, laws, and policies
Bangladesh is seeing progress as a result of its National Sanitation Strategy, developed in 2005 by the Local Government Division of the Ministry of Local Government, Rural Development and Cooperatives. This strategy clearly sets out policies, strategies, and plans to guide the effort in a style that almost anyone can read and understand easily. Some other examples of laws and policy are: Philippine Environmental Policy: Presidential Decree No. 1151 Selections from the Philippine Environmental Code, Presidential Decree No. 1152 India—Environmental (Protection) Act, 1986 As was stated earlier, the policy is only as good as its implementation. Strict enforcement is key. It will help government create the environment whereby: the utility understands its obligations in terms of what infrastructures it must put in place and how efficient the operations of such infrastructures should be to generate the revenue required to keep it going; and the households understand and accept that there is a policy they have to comply with which has financial implications—costs they should be prepared to bear because it is their health that is at stake. Once a country decides on the roles and responsibilities for the local and national players, these roles are normally formalized in laws and regulations. Laws are often not enough: regulations are needed to provide the detailed requirements and procedures that will support implementation of the law. Again, the Water and Sanitation for All—a Practitioners Companion is instructive and provides example.

_____________________________
2 Sanitation Connection Website.

Regulation is about monitoring compliance with policy. It is common practice in many developed countries to have a regulatory agency whose mission is to protect sector stakeholders. In the role of a watchdog, such agencies act as a check and balance on a number of fronts: to ensure that the public is being served adequately and appropriately; to control water utilities, which are natural monopolies; and to ensure that a utility has the resources it needs to operate sustainably.

With the exception of a few countries in Asia, most developing countries in the region reserve regulation for only those sectors that involve the private sector, such as telecommunications and power. Because water utilities are still predominantly run publicly, regulations have misguidedly been disregarded. This is a big mistake. Publicly-run utilities need as much regulation as privately-run ones. Tariff must still be set at a level that recovers the cost to sustain operation, and performance indicators must still be agreed upon to ensure that efficiency of service is maintained. Usually, regulation concerns itself with ensuring compliance with the following standards for utility performance: Water quality- quality of potable water and wastewater discharges; Management- employee qualifications and official certification of skills; Service levels- minimum standards for service; and Tariff levels- affordability and fairness of tariffs. The regulator may also approve or disapprove tariff increases regardless of whether the utility is private or public, but most especially if utilities are privately owned. In this role, the regulator must balance the financial needs of the utility, utility sustainability, and the affordability of tariffs to consumers.

For further reading:
Regulation of the private provision of public water-related services is a comprehensive outline of “the principles believed to be essential in formulating an adequate regulatory framework for the water sector. Its focus is on the issues to be confronted in developing a regulatory structure for water-related public utilities. It reviews a vast body of recent literature on economic regulation and private sector participation in the provision of water-related goods and services as well as the experience of the countries where privatization and regulatory reforms have advanced most. The regulation of prices, product and service quality, investments and quantity is emphasized.” 3 Water and Sanitation for All – a Practitioners Companion 4 provides instructions for starting a regulatory program. Business as usual approach
Only utilities with private sector involvement need to be regulated.

Business unusual approach OR
Water utilities are natural monopolies and, whether publicly or privately run, need to be regulated. Regulators act as a check and balance measure to ensure adequacy of services and affordability of tariffs

_____________________________
3 Lee, Terence R. and Andrei Jouravlev. 1996. Regulation of the private provision of public water-related services, for the Environment

and Development Division of Economic Commission for Latin America and the Caribbean (ECLAC). 4 SIGUS – Special Interest Group in Urban Settlement-MIT.2003. directed by Reinhard Goethert, Water and Sanitation for All – a Practitioners Companion, prepared for the Water Utility Partnership.

As the steward of the water and wastewater sector, the responsibility for setting standards usually falls on the government. And this is an important element of regulation. Standards may cover:

Water quality- standards for wastewater discharges into the environment; Service levels- requirements for service provision (e.g. are desludging services made available? If yes, how often is desludging done?); and Employee qualifications- minimum qualifications or certifications for certain utility personnelusually those involved in water quality related positions.

Setting standards is only meaningful when standards are enforced to ensure compliance. Standard setting and enforcement is a new concept in many countries. It takes time and money to develop an effective system from the government side, and it takes time and money for people to understand the system and comply with the standards. That is why many governments should cooperate with citizens as they implement standard setting and enforcement. Bachmann’s paper tackles the challenges and problem areas of setting standards: “Decisions about service levels and coverage in many cities are taken primarily based on engineering requirements and the availability of capital investment subsidies from higher-level governments. There is no systematic consultation of different population groups, and end user preferences and priorities are not incorporated into the service planning and pricing process.” In two separate papers presented at a September 2005 ADB workshop, Mr. Kazimir Karimov and Dr. Dang Kim Chi address problems with water quality standards and environmental standards caused by problematic legislation.

Example 1: The Kyrgyz Republic
Mr. Kazimir Karimov’s paper, Problems of Drinking Water Quality in Kyrgyzstan: Ecological and Legal Aspects, cautions that existing legislation is not always sufficient, and improvements in legislation are often required. He gives a strong critique on the lack of qualities in the Kyrgyz Republic's legal and institutional framework: “The existing legislative base in the water sector insufficiently supports protection of waters, both surface and groundwater. The exact definitions of the purposes and tasks concerning quality of water are absent. The laws do not contain the concrete purposes and tasks connected with norms of quantity and quality of water. The laws do not provide for protection of water from pollution. The law does not define the concrete responsibility for quality of water. It does not provide for compensation of damages to water resources. “

Example 2: Wastewater Production Activities.
Dr. Dang Kim Chi’s paper, Wastewater Production Activities in Craft Villages and Some Mitigation Solutions, recognizes the impact that waste discharges can have on the environment and proposes some policy solutions for improving standards: Environmental policy: Develop appropriate policies for encouraging technology innovation in craft villages toward environment friendly technologies and products. Besides, there should be a mechanism to apply a policy of “polluter pays” in craft villages. Establish local environment management mechanisms including a clean environment group, environmental programs in the villages, environmental protection statues, penalty regulations, environmental fees and funds, etc.

Local authorities should develop regulations on environmental management and have staff who help enterprises understand how to comply with the regulations and perhaps treat their wastes before discharging to protect the environment. For craft villages, this means making close contact with each household to successfully implement solutions. Regulation and standard setting are new concepts for many countries—but they are important aspects to develop. Both help a sector improve services and hold agencies accountable for providing adequate services at a reasonable price.

Business as usual approach
The central government's role extends beyond policy making and setting regulatory guidelines in ways that interfere with the autonomy of utilities to manage and operate sustainable services. Through such a diffused range of responsibilities, the central government's understanding of the sector is limited and it does not act as confidently or decisively as it should in sectoral planning with development agencies.

Business unusual approach
The central governments take the lead in policy and guidelines formulation. Legislation and regulation adequately establishes the roles and responsibilities of sector institutions. The local governments assume a much bigger role in implementing the policy and monitoring compliance. Local governments are closest to the utility that delivers the sanitation and wastewater service and closest to the people who receive the service. Local governments are in a better position to help national government implement the policy.

OR

A policy should be properly costed out. A policy that requires every household to have a toilet, and for these toilets to be connected to a sewer system, should also consider the additional costs in comparison to just building the toilets. This policy also means building septic tanks in the case of rural or lowdensity areas, and installing sewer lines and treatment plants in the case of urban or high-density areas. Such a policy must also recognize the financial implication to all stakeholders, among them the national and local governments, utilities, and communities. The cost of installing a toilet is a cost that each household must bear. Household toilets are, after all, primarily a household responsibility. However, in rural areas in developing countries—where the level of sanitation coverage is generally very low—there may be scope for limited government subsidy on account of public health and environmental protection. This could be through sharing the cost of building septic tanks; most poor households find the cost of septic tanks unaffordable. Or in some cases, the government may even provide subsidies for household toilets. Rural water supply and sanitation projects supported by multilateral development agencies, such as ADB, the World Bank, and Japan Bank for International Cooperation, have traditionally included as components the provision of toilet bowls to households. The households though bear the cost of constructing the super structure. In urban areas, where collection and treatment systems are required, the investment requirement is certainly much more. Where utilities are managed by the private sector, regulation comes in by way of tariff structuring-the tariff should be set at a level that will allow the utility to recover capital investment and operation and maintenance costs.

Without the assurance that such regulation will be put in place, financing of sanitation and wastewater is at risk. In cases where the government considers the risk to public health serious and strict implementation is of paramount importance, but the resulting tariff would be exorbitant, the government may consider some form of subsidy. This could be by subsidizing part of the cost of the treatment plant. Even in developed countries, government has often provided financial support to communities and individuals to encourage the development of sanitation and wastewater systems. Where utilities are managed by government, usually by local governments, financing is even more challenging and so is regulation. Unlike privately-run utilities whose access to financing is usually better, government-run utilities usually lack creditworthiness or are not empowered to borrow. This is where both central and local government support have to be made available. But while they remain government-run, they should be run along commercial principles — efficiencies maximized and tariff collected, otherwise they are not sustainable. Just as privately-managed utilities are regulated, so should government-managed ones. Delivery of water and sanitation services should be delegated to autonomous and accountable service providers. They may be government or private. Particularly in the case of government-run utilities, their operation should be autonomous and they should be made accountable to their customers so that they are conscious of the need to comply with their performance standards. This is where regulation plays a key role.

Business as usual approach
Government formulates the policy and expects everybody to comply.

Business unusual approach OR
Central government initiates the formulation of policy-taking into account the cost required to implement the policy- and gets local government involved in implementing it and monitoring compliance with it.

Planning is essential to deciding priorities and allocating scarce resources to highest and best use. Here are some helpful resources: “Urban sanitation: a guide to strategic planning” Health, Dignity, and Development: What Will It Take? Toward a Strategic Sanitation Approach: Improving the Sustainability of Urban Sanitation in Developing Countries.

_____________________________
5 Tayler, K., J. Parkinson, and J. Colin, 2003. Urban sanitation : a guide to strategic planning, IT Publications, London.

http://www.irc.nl/ircdoc/title.php?titleno=27982. 6 Health, Dignity, and Development: What Will It Take? The Swedish Water House of the Swedish International Water Institute, www.siwi.org. 7 Toward a Strategic Sanitation Approach: Improving the Sustainability of Urban Sanitation in Developing Countries, Water and Sanitation Program, 1997

The legal framework of a country will often enable the formation of local utilities under three general frameworks: Public agencies, such as municipal departments; Quasi-public agencies formed and owned by the public but enjoying some autonomy; and Private companies with full autonomy. However, as Arthur McIntosh points out in his book, “Legislation is a necessary but not sufficient condition for autonomy. Governments frequently do not allow corporate bodies to exercise their autonomy, especially in terms of staffing, tariffs, and investments.” 8 Many countries are undergoing sector reform to overcome the constraints of the business-as-usual model, where control of utility services has been vested in national governments and utilities have little autonomy.

Example 1: The PRC and Ukraine
In his paper, “Developing Wastewater Services in Emerging Market Economies: the Cases of China and Ukraine,” John Bachmann summarizes the business-as-usual framework as follows: “Delivering affordable, dependable, and sustainable wastewater services is a challenge for local governments worldwide. But it is an especially tall order in emerging market economies, in which the old service norms, institutional forms and pricing policies often constrain the development of autonomous and competent wastewater service providers that can develop their systems to meet users’ needs and collect sufficient revenues to cover their costs.” Mr. Bachmann continues, “The broad outlines of the institutional arrangements in (PRC and Ukraine) are favorable to responsive, sustainable wastewater service delivery to the extent that local governments can design and implement their own programs. However, the specific roles and responsibilities of the Wastewater Service Providers are insufficiently defined, and there are few incentives for managers and staff to improve institutional performance and/or service quality. In the Chinese case, the operational environment for wastewater delivery is first and foremost undermined by the political imperatives of local government leaders…” Mr. Bachmann describes issues encountered by utilities around the world: Utilities will not be sustainable if they do not have the ability to set tariffs; hire/fire and compensate staff, purchase needed equipment and materials, finance capital improvements, etc. To empower utilities to make these kinds of decisions, they need the support of the central government. The central government usually takes a leadership role in managing the sector as a whole, particularly in three areas: Sector framework and policy; Sector capital investment and financing; and Standards. _____________________________
8 Arthur McIntosh. 2003. Asian Water Supplies: Reaching the Urban Poor, Asian Development Bank. ISBN: 971-561-380-2,

http://www.adb.org/publications/asian-water-supplies-reaching-urban-poor.

Management of utilities is a challenge. This is particularly so in publicly-run utilities. One common problem is the way in which employees are compensated and rewarded for their efforts. Typically, utilities as arms of government are subject to civil service regulations, which often include wages so low that it is hard to imagine how they can support one person, much less a family. In these cases, utilities are not able to hire well-qualified people, and suffer as a result. If utilities are to run as efficiently as they should, capacity development is an important ingredient that needs to be adequately supported. The trouble with capacity development though is that people often mistake it for just training. It is much more than that. Enabling Environment for Utilities Increased Capacity Brings Convergence Making Business Sense

Enabling Environment for Utilities
In his paper entitled, Using Capacity Factors For Multi-criteria decision-making in Sanitation Options, Dr. Cesar Pinto proposes that the following capacities are essential to sustain utilities: Institutional capacity—the body of laws and regulations, administrative agencies, and procedures for the governance of utilities; Human resources capacity—the numbers of well-qualified professionals and laborers available to a utility and the ability to provide training and development opportunities to those employees; Social capacity—the sociocultural values that underlie the way sanitation in general is perceived in society, and the abilities of civil society to participate in the development of utility systems; Industrial capacity—the supply chain that supports the hardware and service needs of the utility industry, which includes such services as the maintenance and repair of vehicles and equipment along with such hardware as machinery, tools, and spare parts; Economic and financial capacity —the markets for municipal sanitation system (MSS), financing mechanisms (bonds, credit ratings, etc.), and availability of cash to fund ongoing system operations. Environmental and natural resources capacity—the surface and groundwater supplies for drinking water systems, land and surface water discharges for wastewater treatment systems, and land and air quality for solid waste land filling and burning; Service capacity—the resultant ability of a utility to provide reliable service to its customers in terms of volume, availability, and quality.

Figure 1.

Dr. Pinto’s research postulates that these seven capacity requirements will determine the long-term success or failure of a utility system, considering the overall environment within which it operates. We may infer, then, that if any of these capacities are missing or weak, the service capacity will be reduced. Let us refer to this viewpoint as the environmental factors that sustain a utility. Now, let us step out of the overall environment and go inside a utility—into Figure 1. In her paper “Why Borrow for Capacity Development?,” Ms. Nancy Barnes opines that strong and sustainable organizations are built from 5 pillars: A management foundation (organizational structure and management processes); Effective management behaviors; Availability of expertise; Management information systems; and Application of best practices. Let us refer to this viewpoint as the management factors that sustain a utility. The following chart illustrates what Ms. Barnes means by these factors. To sustain itself, any organization needs to be well structured, with good management procedures and employees who behave appropriately, and know how to do their jobs. To manage and operate effectively, people in the organization need good information and access to knowledge of best practices.

In 2003, GTZ-Palestine and Jerusalem Water Undertaking published the organization development guidebook written by Ms. Barnes and her coauthor Abdelkarim Asa’d. The guidebook is entitled: Jerusalem Water Undertaking: A Challenging Experience in Organization Development.

Increased Capacity Brings Convergence
So, we can see that capacity development is not just training, like some people have thought. It is really a broad set of activities that inspire and build the capabilities of human capital and the operating environment. Dr. Engineer Trinh Xuan Lai’s paper, “Comprehensive approaches to develop and maintain drainage/sewerage systems in urban areas of Vietnam,” makes the following observations: “Vietnam, like many other developing countries in Asia, is facing the challenge of poor infrastructure system during its continuous reform process. Among the urgent challenges originating from speedy urbanization, the issue of old, fragmented, and deteriorated drainage/sewerage system in recent years has posed urgent challenges to its governing authorities. The shortage of resources including funding and technology; the weakness of institutional arrangements and management capacity; and lack of public awareness are major causes. To overcome these shortcomings, there should be efforts of capital investment, institutional reform, management strengthening, and community education/awareness techniques for all relevant stakeholders at all levels. They need to be integrated and activated at the same time by all stakeholders to improve the existing drainage/sewerage systems which will contribute to the nationwide target of poverty reduction and sustainable development.” As we see, Dr. Lai aptly sums up the need for broad-based capacity development, taking a holistic view. If regulation is about monitoring compliance with policy, it should also be about monitoring where weaknesses occur and where capacity development interventions should be provided. Sanitation and wastewater management is, after all, a shared responsibility of national and local government and utilities because it is about public health, which should be everybody’s business.

Making Business Sense
Business as usual approach
Utilities are mandated to deliver the service. Whether they have the capacity or not, they should deliver.

Business unusual approach OR
Central and local governments recognize the need to support the capacity development needs of utilities. After all, investment in dapacity development will redound to better service.

Business as usual approach
Maintain a centralized approach and continue to experience decision-making that tends to be slower paced, and nonresponsive to the actual needs on the ground. Only utilities with private sector involvement need to be regulated.

Business unusual approach
Undertake reforms that delegate different kinds of decision-making to local governments to ensure that progress happens quickly, and specific local conditions are taken into account. Water utilities are natural monopolies, and, whether publicly or privately run, need to be regulated. Regulators act as a check and balance measure to ensure the adequacy of services and affordability of tariffs. The central governments take the lead in policy and guidelines formulation. Legislation and regulation adequately establishes the roles and responsibilities of sector institutions. The local governments assume a much bigger role in implementing the policy and monitoring compliance. Local governments are closest to the utility that delivers the sanitation and wastewater service and closest to the people who receive the service. Local governments are in a better position to help the national government implement the policy. Central government initiates the formulation of policy, taking into account the cost required to implement the policy, and gets local government involved in implementing it and monitoring compliance with it. Central and local governments recognize the need to support the capacity development needs of utilities. After all, investment in capacity development will redound in better service.

The central government's role extends beyond policy making and setting regulatory guidelines in ways that interfere with the autonomy of utilities to manage and operate sustainable services. Through such a diffused range of responsibilities, the central government's understanding of the sector is limited and it does not act as confidently or decisively as it should in sectoral planning with development agencies.

OR

Government formulates the policy and expects everybody to comply.

Utilities are mandated to deliver the service. Whether they have the capacity or not, they should deliver.

In approaching problems within the water supply and sanitation sector, like many other sectors, two courses of action are always possible: the "hard way" or the "soft way." In development language, "hard approaches" or "hard components" refer to infrastructure, such as building dams, laying pipes, installing toilets, etc., and are usually the focus of government and donor strategies to improve the sector. The "soft approaches" or "soft components" refer to social aspects of a program or project that also bring about results, such as special consideration for women (gender components) or involving beneficiaries (participation components). These soft-side components are usually not the main focus of large budget, heavy infrastructure projects, but are given complementary roles. And that they do! An infrastructure project that involves the community or considers the needs of women will surely have a more relevant and lasting impact than a project that does not. And these soft components may, alone, resolve certain negative conditions without the added expense of infrastructure. It depends on the situation. This section looks at a key soft, social aspect that must be addressed when preparing for sanitation projects: hygiene awareness for behavioral change. This section also provides resources for mobilizing communities and changing adverse behaviors. It also offers a number of models for both mobilizing communities and pursuing hygiene-awareness campaigns. Whether infrastructure is called for or not does not change the fact that people also must change with the changes occurring around them. Sometimes this means a change in attitude. Other times, this means a change in action and/or behavior that may be contributing to their own problems of unclean environments, illness and disease, which are precursors to other problems related to missing school, work, and unnecessary expenses. To ensure that people change along with the changes in technology and infrastructure systems around them, they must be involved with the process from the beginning. Their involvement, however, cannot be assumed to happen spontaneously. Communities—at least those that do not take action in their own hands as a number of them do—need to be mobilized through targeted campaigns. Business as usual approach
We continue to focus on infrastructure-led development without much emphasis on community involvement and social aspects of sanitation problems.

OR

Business unusual approach
Because good hygiene practices are the first line of defense against disease, we mainstream hygiene promotion activities into all water supply and sanitation projects. These activities involve more than just education programs, but involve communities in the design, implementation, and monitoring of the project's activities. We invest in human capital as well as infrastructure.

We often assume that a lack of proper systems is the cause of disease when, in fact, it may simply be behavior. In Bolivia, a baseline study showed that the prevalence of diarrhea was highly correlated with poor hygiene behavior among mothers and caretakers, not with water source or type of sanitation. To achieve the health impacts of environmental health interventions, the concept of "behavior first" needs to be adopted. This concept requires that before initiating environmental health improvement interventions or facility construction, program planners need to identify behaviors associated with disease transmission in their target areas. And based on identified behaviors, strategies for bringing about the needed changes in those behaviors must be developed and included in the overall program planning.

Promoting Hygiene: Education and Public Awareness
To change behavior, education and public awareness activities help to, first, expose the effects of unhygienic practices and, second, introduce hygienic practices. Generally, when people understand the linkages between the cause and effects of problems, they are willing and able to act to solve them. Many of us know that we need to wash our hands, bathe regularly, and take precautions to avoid disease. When the latest flu comes around, we take additional steps to protect ourselves—steps as simple as washing our hands more frequently. We are healthier as a result. Hygiene is a key defense against disease, so why do we not promote good hygiene more? Compared to major infrastructure projects, educational programs are a lot less expensive and can have an affect in a short time. Fundamentals of Hygiene Education. In November, the Water and Sanitation Program–South Asia Region published its “Learning the Fundamentals of Hygiene Promotion - A Review of Three Large-scale Projects in India.” It offers a history of India’s efforts to promote hygiene—a history that other countries might share and be able to learn from. In the early 1990s when hygiene promotion strategies were introduced in India, there was very little to learn from international experience in the field. Most activities emphasized "providing of messages" rather than participatory processes in hygiene promotion. This trend changed around the mid-1990s and "new" approaches have been attempted in externallyfunded projects in India. These new approaches have not evolved in isolation, but have developed over projects and active learning has taken place during the project cycle. 9 From the study, the following key lessons about hygiene promotion were recorded: Foster increased use of participatory methods and tools—The creation, use, and extension of participatory methods and tools have provided good results. These help overcome resistance to deep-seated attitudes and practices and facilitate links to felt priorities. At the same time, use of mass, folk, and community media builds an effective climate for change. ________________________________
9 The Water and Sanitation Program - South Asia Region published its Learning the Fundamentals of Hygiene Promotion - A Review of

Three Large-scale Projects in India in November 2000, page 1

Facilitate communities to set their own objectives—It is essential to facilitate stakeholder analysis of design factors at conception and set goals and objectives for hygiene promotion. Hygiene promotion is more effective where communities are allowed to set their own specific objectives. It is seen that a focus on three core behaviors—washing of hands, safe disposal of excreta, and use of safe water—are enough to start hygiene and sanitation programs for maximum impact. Establish unified multidisciplinary teams to present a single organizational support "window" to communities—Institutional responsibilities need to be clear and simple. A unified multidisciplinary team can build the capacity of community-based groups and facilitate the implementation of demand-responsive projects. Dedicated NGOs have demonstrated their strengths in project-specific roles as support organizations. Provide focused and well-timed training at local levels—Training strategies need to involve all stakeholders. There is a need to avoid long gaps between training and expected performance. Include incentives to support capacity—Sound Capacity Development requires more than training; it should include good incentives and management support. Develop political will—Hygiene promotion is seen to work best where a broad political will has been generated that supports effective policies and generates popular support. Update gender strategy to ensure shared and equitable roles for men and women— Overall, women and girls are given the major burden of hygiene and sanitation—both in terms of promotional tasks and responsibility for hygiene in the home and the community. Strategies need to be more equitable and aim to ensure that men and boys take more responsibility and share in related work and tasks. Design effective monitoring and evaluation systems through facilitated stakeholder analysis and planning—These tools need to be practical and simple, defining its uses for each level in the project. Where they provide adequate precision, participatory impact tools have been useful. Structured process monitoring is useful as an internal management tool. Stakeholder involvement in designing monitoring and evaluation systems makes it more effective.”

“Environmental Sanitation Promotion: Social, Institutional, and Legal Challenges for the Rural Poor”
This paper by Dr. Md. Mosleh Uddin Sadeque and Mr.Sudhir Kumar Ghosh reports on a study to improve environmental sanitation and behavior change in rural communities in low-lying areas of Bangladesh. The goal of the study was to determine if key changes in behavior could lead to a quick resolution (less than 1 year) of problems with local sanitation. The study shows that the rural poor can quickly adopt new behaviors. As a result of such significant behavioral changes, 100% hygienic latrine installation can be achieved in one year, the study found. Four major strategies are responsible for these results: Educating, mobilizing, and enabling greater environmental awareness and protection; Presenting information to the community in a format, style, and language that they can easily understand and be attracted to; Stressing concrete solutions and providing support to the community in the forms of practical tools and assistance; knowing the positive contributions they can make to protect the environment will provide them with a sense of empowerment and motivate them to be involved; and Building partnerships with a number of key partners, including local and regional government, NGOs , business, and the media.

Once communities understand the benefits of good sanitation and wastewater management, they—on their own—can undertake projects to address sanitation and wastewater. Five different authors reported from a number of different countries in Asia—Pakistan, Nepal, Bangladesh, India, and the Water for People Approach—shared various approaches applied in a variety of locations. We see a similarity of approaches in the various models these authors put forth. The similarity is grounded from projects taking advantage of basic human nature that prefer clean, healthy, productive environments and the tested notion that has proven that people want to be involved in decisions that affect them. Many of the approaches throughout this section and chapter can be applied to rural, urban, and periurban situations. Generally, their models are based on empowering the project communities by equipping them with information they need to be able to decide. The following key points suggest how community mobilization could help prepare a strong foundation for a sustainable sanitation and wastewater program: Start by communicating with the community to understand the situation and current behaviors in using water and dealing with human waste. Create awareness of the linkages between water, sanitation, and disease to create demand for a project; understand behaviors up front and provide health and hygiene education early on—even before a building project gets underway. Involve the whole community (men and women), including the poorest, in identifying needs, considering solutions, and designing a project. Integrate the aspects needed to create a clean environment: water, sanitation, wastewater, and hygiene. Ensure that the community understands the cost to be shared.

Pakistan: A Little Mobilization Goes A Long Way After years of relying on government to solve their sanitaiton and wastewater problems—and years of not getting it—a project proved that a little motivation can move people to take development into their hands.

Nepal: People Pursuing Development The people of the Dhulikhel village, on the outskirts of Kathmandu, took advantage of a neighboring project to also secure for themselves a reliable and safe water source, and in doing so, also solved their sanitation problems.

India: Overcoming Myths, Creating Demand This models demonstrates how to create people-driven demand and successful outcomes through better resources and community participation.

Bangladesh: Partnership for Empowerment A partnership between WaterAid Bangladesh and the rural nongovernment organization (NGO) VICA has moved from traditional latrine construction to involving people, to understand their situation, and to build their commitment.

Water for People Approach: Capacity Development at the Core This program is a self-help approach that involves women working with men on local water committees to construct their drinking water and sanitation.

Model 1 — Pakistan: A Little Mobilization Goes A Long Way
Dr. Rashid Bajwa reports that many people in Pakistan “recognize the need for wastewater management and sanitation, (yet) these remain neglected issues in the majority of villages in part because people assume that the Government is responsible for funding and implementing the necessary infrastructure.” Dr. Bajwa’s paper, “Successful Approaches to Improving Wastewater Management and Sanitation in Pakistan” points out that mobilizing villagers can overcome their inertia and address critical problems. By doing just that, the National Rural Support Programme (NRSP) in Pakistan, working with donors and the Pakistan Poverty Alleviation Fund (PPAF), has successfully implemented more than 400 projects, benefiting more than 85,000 households. Over the course of the NRSP projects, an approach to community mobilization has evolved, which includes the following seven steps. In the words of Dr. Bajwa:

Step 1

Social mobilization begins when NRSP "Social Organizers" engage in dialogues with members of rural communities. These dialogues are founded on two things: first, if they form one or more Community Organizations (COs), each with members of 15 to 20 households, and second, if they pool their human and financial resources, members of rural communities can meet their development needs.

Step 2

Once a CO is formed, community members prioritize their needs, with many identifying sanitation schemes as their first priority because they understand the connection between unsanitary conditions and disease very well.

Step 3

Members of NRSP’s Physical Infrastructure and Technology Development Department —all of them qualified engineers— assess the needs identified by community members and then create a Project Digest, which identifies the technical, economic, and environmental requirements for the specific project. In an Integrated Project, this usually includes: water harvesting and storage systems; distribution systems, street paving, and installing connections to the drainage system in each household; installing sewers, building filtration, and water treatment tanks; and installing pipes to safely carry treated waste away from the village—either into the fields where it can be used as fertilizer or into a water channel.

Step 4

The next step is for NRSP and COs to sign a formal Terms of Partnership (ToP) agreement. At least 75% of the community representatives must be present in a meeting to sign this agreement. In the meeting, NRSP staff explains every detail of the project. Before they sign, everyone involved knows the specifications, contributions required from all parties, disbursement schedule for funds, implementation process and procedures, time required to complete the project, and estimated annual operation and maintenance costs. They are also aware of the roles and responsibilities of NRSP and other partners.

Step 5

CO then constitutes a Project Committee, which assumes responsibility for the overall implementation of the project, and the management, and operation of the project after its completion.

Step 6

After signing the ToP, CO opens a project bank account. NRSP disburses the grant in installments, as each stage of the work is completed. The Project Committee forwards a request to NRSP for the release of the funds in the form of a resolution signed by at least 75% of the members. NRSP’s accounting staff checks the expenditure vouchers, and the engineers check the progress and quality of the work. Before releasing the final payment, the NRSP engineer ensures that the work has been completed satisfactorily and that the best materials have been used.

Step 7

NRSP arranges training programs for the members of the committees established by COs. The members learn how to manage the construction process, how to keep records, how to procure high quality materials, and—after project completion—how to properly operate and maintain their projects. They are also encouraged to adopt participatory ways of working: holding regular meetings, ensuring attendance of at least 75% of members in meetings, and ensuring that CO members are saving regularly. Members learn how to maintain accurate records and to link the village organization with relevant organizations.” Lessons Learned Among the lessons learned using this approach, Dr. Bajwa notes that: Once people have seen how well these projects can work, they are ready to tackle other development projects that are vital to their communities. Although many rural residents are quite poor, they are willing and able to contribute funds and labor for community development. NRSP’s approach to the social aspects of organizing communities to meet their sanitation and wastewater needs reflects that of its exemplar, the Orangi Pilot Project in Karachi, Pakistan’s largest city.

Model 2 — Nepal: People Pursuing Development
According to an ADB technical assistance project to reform the water supply sector in the Kathmandu Valley, the peri-urban village of Dhulikhel has proven that people-led development can reap a number of successful outcomes. By pursuing a more reliable and safe water source, the people of Dhulikhel also solved their sanitation problems. The report tells an interesting story of pursuit and success: The people of Dhulikhel faced a water problem that was compounded by the time and effort the women spent to walk to the spout, gather water, and carry it home. At first, the people approached His Majesty’s Government of Nepal, which said, "Tomorrow." But tomorrow never came, so the people took the matter into their hands. They were aware of the work Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ) was doing in Bhaktapur, so they went to Bhaktapur and managed to elicit GTZ interest. With GTZ assistance, they found a good source of water; designed and built a pipeline to carry it 14 km to the town; and worked with people in the villages along the pipe’s length to arrange for rights-of-way—some of which were secured by building a school in the nearby village. The mayor noted that these side projects (along the pipeline) have helped build a good, familial feeling between the town and the villages nearby. When the water first came through the pipe, the townspeople celebrated. The 14-year effort bore considerable fruits. Dhulikhel has ample water. Water use has increased as women use it more for washing dishes and clothes. Every house in the town is connected to the system and most homes have toilets. As a result, gastrointestinal disease has markedly decreased. But, the most significant result was the community spirit that developed and the sure knowledge that they can solve their own problems. When asked what advice he would give to the Mayor of Kathmandu, the Mayor of Dhulikhel answered that the people must be "thirsty" to energize them to fix a water problem. Also, if people pay for a system and work hard to build it, they will be more likely to take care of it. And finally, it was public participation and a "never give up" attitude that saw them through from start to finish.”10 The Nepal case study here proves that people can solve their problems and enlisting communities is one way of scaling up to meet the Millennium Development Goals.

Model 3 — India: Overcoming Myths, Creating Demand
In Dr. Veerashekharappa's paper, “Community Contribution for Environmental Contribution in Rural Area: Myth and Reality,” he reports the findings of a study that tests the effectiveness of the recent trend toward requiring beneficiaries to share the cost of sanitation infrastructure and user fees. The pressure to meet the sanitation target of the Millennium Development Goals (MDGs), and its heavy financing has lead the Government of India to involve the private sector, NGOs, and beneficiary communities in projects, including their planning, implementation, and some cost. Veerashekharappa studied the impact of such an approach in Karnataka, where the state implemented three major projects that were supported by multilateral and bilateral agencies. These projects required beneficiary communities to contribute 30% of the costs for an environmental sanitation component.

_____________________________
10 ADB TA Number 2998 – NEP, Urban Water Supply Reform in the Kathmandu Valley, Meeting Report - Dhulikhel Community Managed Drinking Water System, Nancy E. Barnes for Metcalf & Eddy, 1998

Key Findings: Heavy Subsidization of Community's Cost Sharing The study found that 10 of the 12 project districts were able to mobilize their share of the project costs. However, the community's share did not come solely from households. In fact, no district was able to raise the full amount from households. Instead, community leaders turned to cooperatives and contractors to subsidize shortfalls in the contributions by households. Almost 42%—and in some villages up to 80%—of the costs that beneficiary households were supposed to contribute came from outside sources. The study found that ineffective NGOs were the single greatest reason for the inadequate contributions by households. NGOs were commonly unsuccessful in convincing households about the benefits of the project. Without understanding the benefits, communities did not demand the project and, consequently, feel pressed to share in the costs. "The inefficiency of NGOs turned out to be an advantage to contractors in each village," the study found. When village households refused to pay their share of the costs, contractors who were willing to augment the shortfall in household contributions where awarded the project infrastructure contract. "Thus, there was no community participation and transparency in awarding contracts, because there was a nexus between the elite of the village and the contractor," the paper states. In the end, the contractor provided greater accessibility and volume of water to the elite areas of the village. Lessons Learned The study concludes that although "the concept of community participation through cost sharing and recovery in development projects has been theoretically establish and empirically tests in many parts of the world," it needs careful design and participation by NGOs tasked to create demand for the project.

Model 4 — Bangladesh: Partnership For Empowerment
Ms. Rokeya Ahmed’s paper addresses a major challenge: “Shifting Millions from Open Defecation to Hygienic Practices.” She discusses a successful case study of WaterAid Bangladesh and the NGO Village Education Resource Centre (VERC) partnering to help Bangladesh achieve 100% sanitation. Ms. Ahmed summarizes the background of the problem and the approach the partnership took. “The Government of Bangladesh plans to achieve total sanitation by 2010. According to a 2003 survey, average sanitation coverage is only 32%. Traditional approaches to improving sanitation have focused on latrine construction rather than on health and hygiene education. WaterAid Bangladesh and its rural partner VERC have jointly developed an integrated, empowering approach in collaboration with community people living in rural areas. VERC’s approach is based on the assumption that once the issues have been understood, communities have the commitment and ability to overcome their water and sanitation problems themselves. The approach has proven effective in establishing safe water supplies, environmental sanitation, and promoting good hygiene practices.

The approach is based on the following key principles: Integration — Safe water supply, environmental sanitation, and hygiene promotion are addressed simultaneously. Projects are appropriate, sustainable, and affordable for the community; Participation — The whole community, including the hard-core poor, are actively involved in project planning, implementation, monitoring and evaluation. Individuals in the community are trained to become trainers; the community determines the best water supply and sanitation infrastructure option and hygiene promotion education inputs are facilitated; Empowerment — People’s capacities, skills, and indigenous knowledge are recognized and valued support is provided in the form of capacity building to strengthen the ability of individuals who emerge as leaders to work as agents of change within the community; communities act as facilitating agents in their neighboring areas; empowered communities increase their confidence to analyze and voice their needs constructively to local government agencies or other development programs. Key aspects of the approach: People’s skills, abilities, and knowledge are valued; 0% subsidy for latrine construction; "Whole community" approach; Use of participatory research tools to analyze the problems; Formation of village development committees (local engineering groups); Identification of potential community leaders and involve them as community "catalysts;" Mobilization of local resources; and Involvement of local government. And the results? The Department for International Development's (DFID) assessment 11 of VERC results in areas with improved water facilities and 100% sanitation: Cases of diarrhea have fallen by 99%, dysentery by 90%, and stomach-related problems, such as intestinal worms in rural areas, by 51%; Monthly medical costs for common illnesses are 55% lower; Working days lost due to illness have fallen from 77 to 35 per year in rural areas; Schooldays lost due to illness have fallen from 16 to 7 per year in rural areas; and Expenditure on food and clothing has risen by 6%. These outcomes are phenomenal—demonstrating the power of an approach that depends on the community as project drivers and combines safe water supply, sanitation, and hygiene promotion.

Model 5 — Water for People Approach: Capacity Development at the Core
Peter Nathanson, in his paper, “Water for People’s (WFP) Approach to Building Sustainable Capacity in Sanitation and Wastewater Management: Case Studies,” explains that: ...the Water for People’s program is a self-help approach that involves women working with men on local water committees. the Program helps communities to construct their drinking water and sanitation systems by using technology that is easy for the communities to use, maintain, and repair. The Program mobilizes communities by helping organize water committees, using locally available materials, and conducting community-based training so the communities are empowered and responsible for the long-term benefits from their water and sanitation systems. ________________________________
11 Farouk A. Chowdhury, an Economic Evaluation of WaterAid Bangladesh’s Water and Sanitation programme in specified areas of

Bangladesh, December 2002, DFID Bangladesh.

Through this process, community members are educated about the technical, financial, institutional, and social elements of sustainable projects. The Program also includes health and hygiene education in the model by creating a network of community health promoters so water and sanitation systems are used properly and kept clean and free from re-contamination. In urban and peri-urban areas, the Program has had success with bringing stakeholders (community, government, utilities, and nongovernment organizations) together to develop a plan that addresses issues which have been barriers to successful projects, such as land ownership, payment for water and sanitation infrastructure and maintenance, protection of the hardware, training, and health and hygiene education.” Nathanson's paper summarizes the Program's experience in Africa, India, Latin America, and Viet Nam. Based in these experiences, Nathanson writes that the Program to expand upon a number of proven community-based resolutions: constructing culturally and technology-appropriate latrines, utilizing different designs to fit the needs of the communities, and the training on how to maintain and dispose of the waste materials properly; safely reusing gray water by utilizing the water for family gardens and pour-flush latrines; constructing and maintening of absorption pits and other low-tech on-site disposal technologies so wastewater can be safely re-introduced into the environment without impacting water supplies or creating other problems (cesspools, mosquitoes, other health hazards); implementing community-based health and hygiene education so communities and elected officials learn the importance of safe local disposal practices of human and animal wastes until proper sanitation systems can be developed by the local utility; facilitating discussions between communities and elected officials about longer-term solutions to keep wastewater from flowing untreated into rivers and streams; facilitating discussions between communities and elected officials about watershed management and river basin protection, and amplifying the link between wastewater management, and (drinking) water quality; working with communities to keep solid waste from accumulating and becoming vector attractants. To learn approaches specifically suitable for rural areas, a worthwhile starting place is with the World Bank’s November 2004 improved edition of “Rural Water Supply and Sanitation (RWSS) Toolkit for MultiSector Projects.”12 According to the Foreword, the toolkit provides “the guidelines and tools for designing, implementing, and monitoring and evaluating the RWSS components of (multi-sector, community-based RWSS) projects. The target audience includes ADB Bank staff, government officials, consultants, and other practitioners who are involved in the preparation and implementation of community-driven development programs.”

________________________________
12 The World Bank. 2004. Rural Water Supply and Sanitation Toolkit for Multi-Sector Projects, Available at:

http://www.worldbank.org/html/fpd/water/rwsstoolkit/index.htm.

Technology: Where Are Our Choices Leading Us?
The purpose of this section is not to go into great detail on the technical or scientific side; plenty of publications do that in great detail, some of which we will mention here. The purpose of this section is to gain a perspective on strategies and approaches—to consider some of the new and creative approaches that may revolutionize the sanitation and wastewater sector over the next 100 years. To gain a perspective for the future, let us gain a perspective on the past. Think of how early wastewater systems used the storm sewers to carry away waste. Because the storm sewers were already there, it was a practical solution for transporting waste. But that was 100 years ago; and perhaps, conditions that have developed in our cities since the storm sewers were first built do not make this the right solution now. Sometimes, new ideas end up changing the world dramatically. New ideas for sanitation can do the same. In 1900, you may have debated the practicality of a car, still preferring your horse and carriage. You might have considered a car impractical because there were few roads or dependable sources of fuel. You can easily see why an ordinary person in 1900 would not buy a car—too many obstacles to overcome and too many uncertainties. The horse worked just fine then. When people in 2107 look back 100 years, they may be similarly amused at the ways we are doing sanitation and wastewater now. They may wonder why we did not act sooner to handle the wastes of growing and increasingly dense populations. They may smile—as perhaps you did when you thought of a person giving up his horse—at the idea of us giving up our wastewater treatment plants and toilets for more sustainable approaches. Other sectors in developing countries have seen radical shifts in approaches and technology choices. Just look at the telephone industry. Over the last 100 years, developed countries have invested untold sums to string telephone wires from building to building. Just imagine what it took to connect almost every building in a country to the telephone system. Yet, just over the last 10 years, think of how developing countries are skipping this big effort and huge cost by implementing cellular phone technology instead. Why has sanitation not made similar significant shifts? Ecological sanitation today is at the same development stage that [airplanes] were when Louis Bleriot in 1909, a few years after Wilbur and Orville Wright’s pioneering first flight, flew his monoplane across the English Channel … Today we have thousands of [airplanes] flying the skies of the world … A key reason for its success was that governments and industry saw its potential benefits to society and invested.13 Business as usual approach
We continue to apply the same technologies and approaches that have been used in the past even though their environments have changed and their communities have grown. We solve almost every problem with proven, years-old engineering and infrastructure solutions, often according to practices and standards commonly followed in the developed world.

OR

Business unusual approach
We explore new technologies and approaches We are willing to replicate and/or upscale innovative ideas that have already been tested, and that, after thorough study, show great potential for success in our target locations We are willing to pilot test those new ideas that have not yet been tested

____________________________

13 Uno Winblad and Mayling Simpson-Hebert et al. 2004. Ecological Sanitation. Stockholm Environmental Institute. Pp. 113-114.

For further reading
The World Health Organization (WHO) is the United Nations’ specialized agency for health. Its website contains extensive information and guidelines for the provision of sanitation and wastewater management. Particularly relevant information includes the following: Guidelines for the safe use of wastewater, excreta, and greywater; Guide to the development of on-site sanitation; and Fact sheets on environmental sanitation.

The bulk of this section of the CD is spent reviewing the advantages and disadvantages of the traditional technology choices, such as toilets, as well as considering some new, innovative approaches. No matter what the choice is though, we should have in mind a strategy that guides our choices. One master strategy that gained endorsement at the G8 Summit held in 2004 at Sea Island, Georgia, USA, is the “3R Initiative: Reduce, Reuse and Recycle.” Reporting on Japan’s 3R plans, Hiroaki Takiguchi from Japan’s Ministry of Environment (Waste and Recycling Department) said Japan is using the 3R principles to achieve zero waste in Japan (3R Initiative and the Experience of Japan in Sanitation and Wastewater Management). How can that be possible—zero waste? Certainly, not through traditional technologies. Let us take a look at the ideas behind the 3Rs. Reduce: Conserve and Pretreat Reuse and Recycle Making Business Sense

Reduce: Conserve and Pretreat
Ultimately, our goal should be to reduce the impact of waste on the environment. It follows then that our goal is also to reduce the volume of waste and improve its quality. To do this, we should consider two principles: water conservation and pre-treatment. The less water people use, the less wastewater they will create. Therefore, water conservation programs can help meet the wastewater challenge. Let us consider some statistics from the American Water Works Association: “Toilets can account for almost 30% of all indoor water use, more than any other fixture or appliance. Older toilets (installed prior to 1994) use 3.5-7 gallons (13–27 liters) of water per flush and as much as 20 gallons (76 liters) per person per day. Replacing an old toilet with a new model can save the typical household 7,900-21,700 gallons (29,902–82,135 liters) of water per year, cutting both your water and wastewater bills. An average of 20% of toilets leak. Yes, these statistics are based on water used in the United States, one of the largest water-consuming countries in the world, but we can see that toilet use accounts for a significant amount of water use. By installing low-flow toilets or dry toilets (as you will read about in this section), the volume of wastewater is reduced. In addition to reducing the amount of domestic water usage, there are ways to improve the quality of wastewater that needs to be treated, particularly from industries.

Processes in some businesses use a lot of water or generate waste with a heavy load of contaminants. We can improve the quality of the wastewater discharged into the environment by requiring these businesses to pretreat contaminated water before discharging to the wastewater system, which improves the quality of wastewater that comes to a treatment plant and, in turn, improve the quality of the plant’s discharge to the environment. Where businesses are forced to pay higher tariffs because of the low quality of their wastewater, businesses may find it easier and less costly to switch to cleaner production technologies to reduce the level of contaminants generated by their processes and, thereby, pay a lower tariff rate. Some businesses can also recycle processed water to reduce the amount of water that goes into the wastewater system and on into the environment.

For Further Reading:
Pretreatment is a key program in the United States Environmental Protection Agency’s National Pollution Discharge Elimination System. For more information, go to http://cfpub.epa.gov/npdes/home.cfm?program_id=3. Read the description of the pretreatment program. CleanerProduction.com contains resources and tools for developing cleaner production programs. (http://cfpub.epa.gov/npdes/home.cfm?program_id=3). The site recommends a publication of the European Environmental Agency entitled Environmental Management Tools for SMEs: A Handbook. You can order this inexpensive handbook from: http://bookshop.eu.int/. http://www.awwa.org/Advocacy/learn/conserve/resources/Toilets.cfm

Reuse and Recycle
Technologies are being progressively developed to recycle wastewater and household greywater—the soiled water from washing and cleaning—not just for discharge but also for reuse. We should look into these new technologies carefully to ensure that the quality of the water being reused is suitable for the end user so that we do not harm public health. The World Health Organization provides Guidelines for the Safe Use of Wastewater, Excreta and Greywater.

Example 1: Australia Mr. Rajah A. Thiyagarajah’s paper entitled Sustainable Wastewater Reuse through Private Sector Participation – The Adelaide Experience showcases a successful wastewater-recycling scheme. Do not be fooled by its elite purposes—to reuse wastewater to irrigate grape vines that produce some of Australia’s finest wines. This scheme has lessons for everyone to learn from. Located in the world-renowned wine-growing region of McLaren Vale, the scheme uses effluent from one of Adelaide’s three large wastewater treatment plants to irrigate grape vines. The key results achieved from the scheme were a technically, financially, commercially, and environmentally sustainable wastewater reuse scheme; a scheme that is entirely built, financed, and operated by the private sector, providing an example of a viable reuse project with private sector participation; contribution to economic growth through increased grape production and job creation; delivery of Class B-rated reclaimed wastewater suitable for horticultural use; reduction in fertilizer requirements due to the nutrient content; and reduced effluent discharge and damage to the marine environment.

Best practices adopted that others can emulate include: Independent and competent design and tendering processes that ensure technical integrity of the scheme; Regular water quality monitoring and control to ensure environmental sustainability; A tariff structure that is affordable while ensuring the financial sustainability of the project; Commercial arrangements and agreements that allocate risk appropriately between the government, Wastewater Treatment Plant , the management company and the growers; Appropriate safety measures and practices to avoid any occupational health and safety hazards; Best irrigation practice through soil surveys, review of on-farm irrigation systems and headworks, regular soil and crop management reports, and seminars; Regular independent monitoring and audits need to be carried out; and Irrigation Management Plan that is scrutinized and monitored by various government agencies to ensure the sustainable management of the reclaimed water irrigation scheme.

Example 2: California, United States Similarly, “in California, Fetzer Vineyards processes its own wastewater with a natural filtration system. Using gravel and sand filters, a planted reed bed, and ultraviolet light to kill bacteria, the treated water is used for organically farmed vineyards and landscaping.”14 “Fecal sludge contains essential nutrients (nitrogen and phosphorus) and is potentially beneficial as fertilizers for plants. The organic carbon in the sludge, once stabilized, is also desirable as a soil conditioner because it provides improved soil structure for plant roots.”15

Example 3: New Mexico, United States The citywide scheme for Albuquerque, New Mexico, USA, also utilizes domestic and industrial wastewater for crops that humans directly consume. The Southside Water Reclamation Plant (SWRP) in Albuquerque (New Mexico, USA) purifies over 55 million gallons of mixed residential (85%) and industrial (15%) wastewater each day. Cleaned water is discharged to the Rio Grande (River), in accordance with the requirements of a National Pollutant Discharge Elimination System permit. Organic substances removed during wastewater purification are digested to produce methane gas, which is used as a fuel to generate electricity for use on-site. The remaining biomass, known as sludge or biosolids, totals 150 tons per day. Biosolids are rich in organic matter, nitrogen, and trace minerals; and the US Environmental Protection Agency (USEPA) encourages safe biosolids reuse. A 1987 master plan for managing Albuquerque wastewater biosolids recommended a two-phase program comprising dedicated land disposal and composting for beneficial reuse. Properly managed, composting qualifies as a Process to Further Reduce Pathogens under USEPA regulations, meaning that composted biosolids may be used in the production of crops even for direct human consumption. 16

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14 http://www.wineinstitute.org/communications/highlight/hom_1feb02.htm 15 United Nations Environment Program 16 City of Albuquerque

For further reading Two additional resources may be helpful in 3R decisions for your area: 1. The International Development Research Centre (IDRC) in Canada helps “developing countries use science and technology to find practical, long-term solutions to the social, economic, and environmental problems they face.” On the website, you can find an article entitled Treated Wastewater Use in Tunisia: Lessons Learned and the Road Ahead by Shobha Shetty, The World Bank, Jakarta, Indonesia. 2. International Research Center also provides valuable information about sanitation and wastewater in general and in specific, this article concerning wastewater reuse: Wastewater Reuse West Africa: Mali and Burkina Faso case studies.

Making Business Sense
Business as usual approach
We continue choosing technology that consumes large amounts of water and generates large amounts of wastewater for treatment, such as toilets, when other technology may be appropriate and less consumptive. We continue viewing wastewater as something disposable. Our wastewater management strategies are reactive in that they concentrate on merely coping with current waste volumes through storage, flushing, and disposing waste.

Reduce, reuse, and recycle (3Rs) is a general strategy. And in the specific context of the sanitation and wastewater sector, the concept of Ecosan must further be understood. Ecosan stands for ecologically and economically sustainable sanitation, "a new philosophy of dealing with what to date has been considered as merely waste and wastewater. (It is) based on the systematic reuse and recycling of nutrients, organics, and water as a hygienically safe, closed-loop, and holistic alternative to conventional solutions." Ecological sanitation is based on three fundamental principles: preventing pollution rather than attempting to control it after we pollute sanitizing urine and feces using the safe products for agricultural purposes This approach uses a cycle process—a sustainable, closed-loop system. It treats human excreta as a resource. Urine and feces are stored and processed on-site and then, if necessary, further processed off-site until they are free of disease organisms. The nutrients contained in the excreta are recycled for agricultural use. The key features of Ecosan are prevention of pollution and disease caused by human excreta management of human urine and feces as resources rather than as waste recovery and recycling of the nutrients 17 Ecosan can also be applied as an off-site concept combined with a sewer system, which has been done in Germany.

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4-5.

17 Uno Winblad and Mayling Simpson Hebert, Ecological Sanitation, Stockholm Environment Institute, http://www.sei.se/, 2004, pages

Ecosan compared to 3Rs
We can see similarities between the Ecosan approach and 3Rs in that both recognize that wastes can also be resources. Ecosan adds further emphasis to prevention than just reduce. With its closed-loop system, resources are constantly put to good reuse. Ecosan, then, finds ways to use most, if not all, components of most wastewater systems: urine, feces, and cleaning/cooking water. Is there anything left? Not much. And we can see how it might be possible to have zero waste in some places. What makes Ecosan an attractive consideration? “Sanitation practices promoted today are either based on hiding human excreta in deep pits ("drop and store") or on flushing them away and diluting them in rivers, lakes, and the sea ("flush and discharge"). Drop and store systems can be simple and relatively low cost but have drawbacks … Flush and discharge systems require large amounts of water for flushing…”18 Ecosan systems collect urine and feces separately through the use of innovative toilet designs. Urine and feces are stored for primary processing to reduce volume, weight, and pathogens. Then, the wastes are removed and processed further—either through composting or the addition of urea or lime to increase the pH level. When fully treated, the new waste resource is recycled. Of course, another component of most wastewater is the water we use in kitchens, baths, and laundries known as grey water. Managed properly, grey water can also be recycled. And let us not forget that one way to reduce waste is to prevent some things from getting into the waste stream to begin with.

Example 1: Philippines Mr. Danilo G. Lapid’s paper, Ecological Sanitation in the Philippines, reports on a program of the Center for Advanced Philippine Studies to introduce Ecosan in the Philippines. This program aims to alleviate poverty and its effects through local initiatives in urban waste management and ecological sanitation; develop and build models in waste management and sanitation that consider the social environment (private and community sector participation) while recognizing local resources constraints; and direct or redirect valuable resources to support livelihood opportunities among the poor and harness accumulated knowledge and experience to practical application. The Program has three components: The Ecosan component focuses on building Ecosan toilets in the city. The waste venture component develops livelihood and business opportunities related to Ecosan. The knowledge sharing component conducts research and publication, capacity development, information and education campaigns. Some of the results are poverty alleviation through better health and sanitation conditions, practice of urban agriculture, livelihood enhancement, and Ecosan promotion in general.

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18 IBID pages 2-4

From the Philippines’ experience with Ecosan, Lapid’s paper gives attention to the following lessons learned for future application. Social preparation.The main challenge in making Ecosan viable is its social acceptance by the target city stakeholders and partner-beneficiaries. In one case, this challenge was hurdled through effective social preparation, information and education campaigns. The concept of dry sanitation is a new and innovative approach, but Ecosan became viable because its benefits and advantages were successfully conveyed and concretely shown through knowledge sharing, capacity development and project piloting. Capacity development and ownership of program and projects. The program conducts seminars, workshops, trainings, and meetings with various sectors from the city, to the barangay, household, and the provincial levels. This is to develop a more positive attitude among all stakeholders, especially at the household level, about the concept of ecological sanitation. Political will. The Mayor of San Fernando, Hon. Mary Jane C. Ortega, first saw the applicability, advantages, and benefits of Ecosan for her city. She was, and still is, the key factor in pushing through and implementing it in the city, and now in the whole province of La Union.”

For further reading:
An excellent reference on Ecosan is Ecological Sanitation by Uno Winblad and Mayling Simpson Hebert, published in 2004 by the Stockholm Environment Institute that provides this book for download from their website. The document entitled Concepts for ecologically sustainable sanitation in formal and continuing education 20 is a valuable source book for developing Ecosan solutions. Just as the overall Ecosan philosophy and its related technologies are beginning to realize their market potential in the Philippines, Ecosan has a long way to go to earn widespread appeal. “While Ecosan clearly has the potential to become a promising alternative, for the developed and developing world alike, there is still a large gap on transmission of the relevant knowledge and Capacity Development on how to apply ecologically sustainable sanitation.” Business as usual approach
Control pollution once it is created

OR

Business unusual approach
We consider variations of standard technology that are both economically affordable and culturally acceptable, such as the two-pit flush toilet We consider sanitation solutions even in difficult locations by using innovative approaches, such as public pay-and-use toilets in slums, markets, and other heavily populated public placess

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19 And WASTE (a Dutch NGO) www.waste.nl and www.ecosan.nl. 20 Concepts for ecologically sustainable sanitation in formal and continuing education, International Hydrological Programme (IHP) of

the United Nations Educational, Scientific and Cultural Organisation (UNESCO) and Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ) GmbH, 2006.

This section looks at some of the various approaches—traditional and innovative—to improving sanitation and wastewater management for different situations: On-site disposal On-plot sanitation Simplified sewage Small-scale wastewater treatment Large-scale wastewater treatment Solid waste management This section is not intended to be a comprehensive overview of all technological approaches. Rather, it is intended to get you thinking about options.

On-site Disposal
The toilet seems like a simple enough device. But the technology has many variations. Most people consider it to be the optimal, modern, cleanest technology. It may not, however, be the most affordable, or sustainable, or practical technology choice for some areas. Example 1: India’s Sulabh Toilets In his paper “Sustainable Technologies for On-site Human Waste and Waste Water Management: Sulabh Experience,” Dr. PK Jha describes the technology of the two-pit pour flush toilet as economically affordable and culturally acceptable for most developing countries. His organization, the Sulabh International Social Service Organization, has installed more than 1.2 million such household toilets in India, which have become known locally as Sulabh toilets. The organization converts bucket privies into toilets, resulting in the liberation of over 60,000 Indians (most of whom are women) from the unsanitary and humiliating low-caste job of manually cleaning waste from privies. The former waste workers have been provided vocational training in different trades. To provide sanitation in slums, at public places, markets, etc., Sulabh is operating and maintaining over 6,000 public toilets on a pay-and-use basis in different parts of the country. For non-sewer areas, Sulabh generates biogas to be used for different purposes such as cooking, lighting, and electricity generation. The effluent of the biogas plant is reused after a simple and convenient method of treatment consisting of sedimentation, followed by passing through a sand column and activated carbon and, finally, with ultraviolet rays. Such effluent is colorless, odorless, and pathogen-free. It has biological oxygen demand of less than 10 mg/l, making it suitable for agriculture, horticulture, or cleaning of floors of public toilets or discharge in any water body. For further reading http://www.toiletsforall.org provides information on more than 26 versions of the toilet complete with drawings, layouts, materials needed, and estimated costs. The Sulabh International Museum of Toilets offers a history of the toilet. The website of the World Toilet Organization “communicates the need for better toilet standards in both the developed and developing economies of the world and provides a service platform for all toilet associations, related organizations, and committed individuals to facilitate an exchange of ideas, health, and cultural issues.”

On-plot sanitation
On-plot sanitation is when safe disposal of excreta takes place on or near the housing plot. Pit latrines and septic tanks fall into this category. It is the simplest of sanitation systems, and has been used by people for hundreds, if not thousands, of years. Simple pit latrine. “The pit latrine is relatively low cost; it consists of a superstructure which affords privacy to the user, a hole (or seat) set into a slab which covers the pit, and a pit beneath the slab into which excreta and anal cleansing materials are deposited. Pit latrines are not used in conjunction with conventional flush toilets; only a relatively small volume of water enters the pit and liquid is allowed to seep from the pit into the surrounding ground. Whilst in the pit, excreta undergo decomposition into humus-like solids, water, and gases. The important point is that because of the long storage time in the pit, disease-causing organisms (pathogens) are eventually killed.” 21 Ventilated improved pit latrine. Boas Sengi’s paper entitled Rural Coastal Sewerage Concept in Papua New Guinea says: “ADRA (Adventist Development and Relief Agency) is implementing a water and sanitation program in Papua New Guinea (PNG) to provide potable drinking water for the rural population. It is also advocating the use of Ventilated Improved Pit latrines as recommended by the Department of Health of PNG by demonstrating the latrine and providing skills and knowledge to the rural people for its construction. This aspect of the sanitation program has raised the need to elicit an appropriate sewerage management system for rural coastal population of PNG who lack proper sanitation facilities due to high water table prone areas. Septic tank. In comparison to the pit latrine, “the septic tank is relatively expensive; it comprises a sealed tank having both an inlet and an outlet into which excreta are flushed from a conventional cistern flush toilet. In the tank, solids settle out and undergo a process of anaerobic decomposition resulting in the production of water, gases, sludge, and a layer of floating scum. The effluent, which flows out of the septic tank, is commonly disposed of through absorption into the ground using a soakage pit or trench. This may require a large area of land which limits the plot size and housing density for which septic tanks are a feasible option.”

Simplified sewage
“Simplified sewerage collects all household wastewaters (WC wastes and sullage) in small-diameter pipes laid at fairly flat gradients—for example, a 100 mm diameter sewer laid at a gradient of 1 in 200 (0.5%) will serve around 200 households of five people with a wastewater flow of 80 liters per person per day. The sewers are often laid inside the housing block, or in the front garden or under the pavement (sidewalk), rather than in the center of the road as with conventional sewerage. It is suitable for existing unplanned low-income areas and new housing estates with a more regular layout. Simplified sewerage is most widely used in Brazil. It has also been used in other South American countries and some Asian countries." ___________________________
21 Sanitation Connection, http://www.sanicon.net/titles/topicintro.php3?topicId=22

Small-scale wastewater treatment
Between small villages and large cities lie thousands of communities that can apply small-scale solutions for wastewater treatment. Often they will benefit greatly from low technology and low costs. Andreas Kanzler and Gerardo Parco describe the urgent need in the Philippines to turn to low-cost, lowtechnology solutions to expedite a problem spiraling out of control. In their paper, entitled Engineered Reed Bed Treatment System as a Low-Cost Sanitation Option for the Philippines, they write: “Degradation of water quality in urban areas is mainly attributed to the indiscriminate disposal of domestic wastewater. More than 90% of the sewage generated all over the Philippines is not disposed or treated in an environmentally acceptable manner. Moreover, only 1% of the produced contaminated wastewater is being treated nationwide. This predicament is a constant threat to the local populace, the environment and an immense financial burden to the struggling economy". Decentralized Wastewater Treatment Reed bed approach Waste stabilization ponds

Decentralized Wastewater Treatment. A Pilot and Demonstration Activity, supported by

the Asian Development Bank's Cooperation Fund for the Water Sector, set out to correct the very problems that Kanzler and Parco describe above. In Central Philippines, the sublime beaches of Lilo-an, Cebu used to attract tourists. As could be expected, the coastal waters gradually blackened and lost their appeal as a result of untreated wastewater being discharged from a septic tank for a beach-side market. The horrible state of the coastline affected the economy of the numerous coastal restaurants, shops, and vendors. Like most other Philippine municipalities, Lilo-an could not afford to construct a centralized wastewater treatment system with an extensive collection system and a treatment plant. A decentralized wastewater treatment, which is far less expensive, became more suitable for this small municipality. The pilot project had two objectives: Construction of a decentralized wastewater treatment facility (WTF) at the Lilo-an public market—designed to treat approximately 60-70 cubic meters of wastewater per day, with some neighboring households connected to the WTF and new toilets installed at the public market to further increase hygienic conditions. Organization of cooperative—to collect fees from the market vendors, and operate and maintain the WTF using the collected fees.

The wastewater treatment plant was successfully completed and inaugurated in less than 1 year from the time the project began. Read more about the project’s outcomes and lessons learned.

Reed bed approach. An approach to address this crisis is the adoption of low-cost sanitation

facilities, such as an engineered reed bed treatment system, which offers low construction and maintenance costs. Engineered Reed Bed Treatment Systems are a subsurface flow, natural treatment system, which uses rhizo-degradation as the main mechanism for the removal of contaminants. The first engineered reed bed system in the Philippines to treat domestic wastewater is currently being constructed in Bayawan City, Negros Oriental with the support of the German Agency for Technical Cooperation (GTZ) in partnership with the University of the Philippines Environmental Engineering Unit and the UFZ Centre for Environmental Research Leipzig-Halle of Germany. The plant shall serve as a pilot measure to demonstrate the applicability and efficiency of engineered reed beds as a low-cost alternative technology for wastewater treatment. Aside from the intrinsic attraction of this back-to-nature approach of the reed bed approach, one major advantage of natural treatment systems is the low operational costs due to the low energy requirements in operating and maintaining the system.”

Waste stabilization ponds. In his article, The Need for Wastewater Treatment in Latin America:

A Case Study of the Use of Wastewater Stabilization Ponds in Honduras,22 Dr. Stewart Oakley reports on a case study of successful waste stabilization ponds that provides information on design, standards, and pathogen removal. Professor P.S. Navaraj advocates the approach of the Waste Stabilization Ponds (WSPs) in his paper entitled Anaerobic waste stabilization ponds: a low-cost contribution to a sustainable wastewater reuse cycle . “WSPs have been used extensively all over Tamilnadu over the last few years for the treatment of municipal and industrial wastewaters. Anaerobic WSP are single-stage, continuous-flow, anaerobic reactors operating at ambient temperatures and low volumetric organic loading as a pretreatment method. Anaerobic ponds reduce pathogenic microorganisms by sludge formation and the release of ammonia into the air. As a complete process, the anaerobic pond serves to separate solid from dissolved material as solids settle as bottom sludge, further dissolve organic material, break down biodegradable organic material, store undigested material and non-degradable solids as bottom sludge, and allow partially-treated effluent to pass out. This is a very cost-effective method.”

Larger scale wastewater management
Many of us are familiar with the approach of collecting human waste by means of a sewage collection system that transports waste to a wastewater treatment plant that treats and then discharges effluent and creates sludge. As we can remember from the lessons of history, systems like this began when communities discharged waste into the storm sewers as a practical and expedient way to deal with the waste. This basic strategy of gathering waste from households and businesses and transporting it elsewhere has not changed in nearly 200 years.

CEPT approach. In their paper entitled An Innovative Approach to Urban Wastewater Treatment in

the Developing World, Donald Harleman and Susan Murcott of the Massachusetts Institute of Technology pose questions for consideration: “Should cities of the developing world invest in the dominant municipal wastewater treatment technology of Western Europe and North America— conventional primary plus activated sludge? Or, are there alternative ‘sustainable sanitation’ approaches?” Their paper discusses these issues and makes a specific technological proposal—the adoption of recent innovations in chemically-enhanced primary treatment, known as CEPT, as the appropriate first step in urban wastewater management. What is it and why is it a superior choice? “CEPT uses small doses of coagulant salts and flocculent polymers to produce a highly efficient, single-stage treatment process that is superior not only in terms of suspended solids and organic carbon removal to conventional primary treatment alone, but also, in terms of phosphorus removal and energy consumption, to conventional primary plus activated sludge CEPT, because of enhanced settling, results in increased treatment capacity and removal efficiency. As has been demonstrated by retrofitting some of California’s largest conventional primary plants, CEPT provides a low-cost way of quickly upgrading overloaded plants. New CEPT plants can take advantage of enhanced settling to increase the surface overflow rate and reduce the number of settling tanks. When Hong Kong’s new plant switched from conventional primary to CEPT, in the design stage, the number of settling tanks was reduced to two thirds. In Mexico City, capital and operations and maintenance costs for CEPT are estimated to be about 55% of the cost of conventional primary and secondary biological treatment, including sludge handling __________________________
22 Oakley, Stewart M. Ph.D., The Need for Wastewater Treatment in Latin America 23 A Case Study of the Use of Wastewater Stabilization Ponds in Honduras, Small Flows Quarterly, Spring 2005, Volume 6, Number.

CEPT effluent, in contrast to conventional primary effluent, can be effectively disinfected. This is important in controlling public health problems caused by water supply contamination by contact with raw or inadequately treated wastewater CEPT sludge is readily dewatered and processed. The amount of CEPT sludge is generally only 10 to 15% greater than that produced by the removal of suspended solids. CEPT is an effective and appropriate first stage treatment process, it may be followed by biological treatment if the incremental effluent improvement, the risk of toxic upsets of the biological process and increased biosolids disposal can be justified and afforded. Subsequent biological treatment plants will be smaller and more efficient because of reduced organic load and increased solubility of the CEPT effluent.” 23

CEPT sparking a debate The above assertions by Harleman and Murcott precipitated a debate in the wastewater profession that is covered in the paper The Future of Chemically-Enhanced Primary Treatment: Evolution Not Revolution by Denny S. Parker, James Barnard, Glen T. Daigger, Rudy J. Tekippe, and Eric J. Wahlberg. As we can see, there are new ideas for doing a more effective job at treating urban wastewater, and there are concerns among professionals at implementing new ideas. Debates are good because they can result in a better application of a new idea.

Phased approach. Frédéric Chagnon, in Wastewater Treatment for Mega-Cities in the Developing
World24, notes that our traditional “non-phased” approaches to urban wastewater management have been characterized by the following: initial wastewater treatment held against high environmental standards; difficulty with cost recovery through user charges (no ability or willingness to pay); limited capacity of the utility to manage sanitation operations and financial systems; and only part of a city’s wastewater can be collected and treated. He proposes a different phased approach, prioritize problems to be tackled; comprehensively design sanitation infrastructure and treatment; meet environmental standards; design for future growth; staged/phase implementation; start with full wastewater collection and simple affordable treatment, build up gradually; first priority is to treat 100% of wastewater to level where disinfection is effective enough to mitigate public health problems; and subsequently implement planned/designed secondary treatment to comply with environmental regulations. In other words, when we consider meeting the urban wastewater challenge, we do not have to make it a choice of all or nothing. Staged approaches may work better and be more affordable in some places.

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24 Harleman, Donald and Murcott, Susan, An Innovative Approach to Urban Wastewater Treatment in the Developing World,

Department of Civil and Environmental Engineering Massachusetts Institute of Technology, Cambridge, MA 02139.

Solid Waste Management
Perhaps you are surprised to see the title “Solid Waste Management (SWM)” here. We have included it for this reason: if our goal is to eliminate disease and create a clean living environment, sanitation and wastewater management will definitely help, but solid waste management is also important. Sunil Kumar of the Solid Waste Management Division, National Environmental Engineering Research Institute (NEERI), Nagpur, India provides this perspective in his paper entitled Municipal Solid Waste Management in India: Present Practices and Future Challenge: SWM is a vital, ongoing, and large public service system, which needs to be efficiently provided to the community to maintain aesthetic and public health standards. Municipal agencies will have to plan and execute the system in keeping with the increasing urban areas and population. There has to be a systematic effort in the improvement in various factors like institutional arrangement, financial provisions, appropriate technology, operations management, human resource development, public participation and awareness, and policy and legal framework for an integrated SWM system. To achieve Cleanliness, which is next to Godliness, it is necessary to design and operate an efficient SWM system. Public cooperation is essential for successful operation of such a system. Finally, there is also a need do develop a methodology of research for developing interactive techniques for system’s design and operational control. Dr. Vivek Agrawal reports in his paper entitled Sustainable Waste Management: Case study of Nagpur India that: “At present, the standard of solid waste management (in India) is far from being satisfactory. The environmental and health hazards caused by the unsanitary conditions in the cities were epitomized by the episode of Plague in Surat in 1994. That triggered public interest litigation in the Supreme Court of India. Based on the recommendations of the committee set up by the apex court in that Public Interest Litigation (PIL), the Government of India has framed Municipal Solid Waste (Management and Handling) Rules 2000 under the Environmental Protection Act, 1986. One of the major requisite of these rules is to establish door-to-door garbage collection system in the cities. Nagpur, which is located in the center of India, has taken initiative in implementing MSW Rules 2000 by introducing 100% door-to-door garbage collection. It has enabled livelihood creation for 1,600 people from the most deprived segment of the society, clean environment as 75% of the total waste generated is being collected from doorstep, successful Public-Private Peoples Partnership, use of ergonomic tools for managing waste, use of appropriate technology for waste management, which also created entrepreneurship opportunities, effective recycling of waste for useful purposes, and partnership of waste producers.”

Business as usual approach
We keep reapplying technology that has not produced its intended results.

OR

Business unusual approach
We build what will be affordable, manageable, and sustainable in a community. We consider all costs and impacts before choosing an option (Life Cycle Analysis). We no longer wait for "all or nothing" solutions, but rather we implement interim solutions that have a positive effect while we develop longerterm solutions, such as the pay and use toilets in slum areas. We sort through all of the ideas and technologies and provide a decision tool to people, which helps them help themselves. Our strategies are focused on controlling waste and pollution once they have already been created. We value waste as a resource, using safe waste for agricultural purposes.

More and more, government of developing countries and international developing assistance organizations are realizing that decisions on technology choices must be made locally. Historically, the development community has implemented solutions that were proven to work in the already developed countries. This technology though has not always transferred smoothly to developing countries. This comprehensive textbook covers not only technical solutions but also approaches for operation and maintenance, monitoring and enforcement, economics and finance, standards, etc. The textbook is intended as a guide for modifying developed country approaches to suit the developing country situation. In this Internet Age, we can find an enormous amount of information about approaches to sanitation and wastewater management. But which information is reliable? How can we sort through all this information and quickly and easily find solutions to problems in our own communities? This is a big challenge.

SANEX TM
One innovative approach to sorting through the information and finding solutions is the SANEXTM Model developed by Dr. Thomas Loetscher 1 in Australia. This decision model is a tool for sanitation planning. The SANEXTM user inputs information about a community and the model responds with alternatives for providing sanitation, complete with illustrations and designs.

Sourcebook
A more basic tool is the “sanitation source book” that the Water and Sanitation Program Philippines and the Department of Interior and Local Government-German Agency for Technical Cooperation Water Program Philippines have recently published. It promotes a structured planning process with guidance and decision aids to support the process. The planning steps and decision aids cover technical and socio economic (demand-based) aspects.

Life cycle analysis
Mr. S. V. Srinivasan’s paper “Life Cycle Considerations for Selection of Wastewater Treatment Alternatives” (with coauthors E. Ravindranath and S. Rajamani) advocates the Life Cycle Analysis approach. Their paper observes that “conventional wastewater treatment using activated sludge process alone, or in combination with chemical coagulation, is energy intensive, requires a huge quantity of chemicals, and generates a huge quantity of sludge. And, we have been short-sighted when evaluating these projects solely based on treatment requirement, land availability, and capital costs. Rather, project evaluation should consider all the criteria over the life of the wastewater treatment plant including energy, chemical consumption, overall environmental impacts, and the costs/benefits associated with sludge. A Life Cycle Analysis (LCA) approach considers all of these criteria and comes up with a rational basis for decisionmaking. In the study done by these authors, a simple protocol considering the life cycle approaches helped plant designers select the appropriate treatment technologies with less environmental impact and lower operation and maintenance costs.” Historically, development agencies have not engaged in research and development in sanitation and wastewater management, leaving that largely to academic institutions. Or, agencies have supported projects that applied differing technologies. If we believe that sanitation and wastewater management technology is in its infancy, focused and effective research and development may be a very key element in making progress.

NOTE TO DEVELOPMENT AGENCIES: TRANSFERRING TECHNOLOGY
Harvey F. Ludwig’s paper “How ADB Can Improve Its Technology Transfer Operations” states: “In Thailand, there are some 50 urban sewage treatment plant projects, all of which are malfunctioning, and some 20 or 30 water supply treatment plants (rapid sand filters) which, excepting only those at Bangkok, are malfunctioning. This story is the same in all of the Developing Countries of Asia. Why is this so? Why has the assistance furnished by the international assistance agencies (IAA) not corrected this syndrome?” Dr. Ludwig recommends revisions in development agency practices so that investments are less wasteful and more meaningful, which include: “Require post-construction monitoring of performance of the systems which are built. Cease the common practice of designing systems which follow developed country design criteria and matching environmental standards, and figure out … the appropriate/affordable environmental standards and matching design criteria for the developing country. The best/cheapest way to achieve effective technology transfer is to utilize the actual project for this purpose. But (usually) the project budget has no funds for enabling the expatriate experts to use the project for technology transfer purposes. Prepare textbooks or manuals on appropriate developing country design criteria (and matching environmental standards), which can guide designers to produce a project that works. Establish graduate training programs on developing country design practices to ensure appropriate design practices (and matching environmental standards) for all types of environmentally-sensitive projects. Promote establishment of an Environmental Engineering Journal, i.e., a professional magazine in which each issue will feature projects which discuss specific examples or case studies. Send developing country staff for training not ‘observing’ with developed country organizations. Plan technology transfer projects, not in the usual way as a single event operation, but as a training series with enough time between to permit the student to absorb the lessons from each session.”

There are many techniques for dealing with sanitation and wastewater. Some of these may work, some may not, and some may work better than others. How can we decide? Then, once we decide, how can we see how we are doing and if we are accomplishing what we intend to do? Standards are a big part of the answer. Here are a number of informative resources on setting standards: The United States Environmental Protection Agency (USEPA) was formed in 1970 to work towards a cleaner, healthier environment for the American people. The extensive use of standards in the United States dates only from that time—a short 35 years ago. The history of the USEPA shows that it has established increasingly stringent standards for water and wastewater quality in the United States, and that it has been an evolutionary process. While the USEPA serves the United States—a country with extensive resources—its standards and approaches may give insight to people in developing countries. For instance, on the USEPA website, you can find effluent guidelines for wastewater. “The SPHERE initiative was launched in 1997 by a group of humanitarian nongovernment organizations and the Red Cross and Red Crescent movement, who framed a Humanitarian Charter and identified Minimum Standards to be attained in disaster assistance, in each of five key sectors (water supply and sanitation, nutrition, food aid, shelter, and health services). This process led to the publication of the first Sphere handbook in 2000.” Sphere’s Minimum standards are “rights based” meaning that in this era of globalization, Sphere focuses our work on people and what they have the right to expect from humanitarian assistance. For the humanitarian community, the Minimum Standards represent a common language, a basic curriculum for the humanitarian profession. Chapter 2 of the SPHERE Handbook covers water, hygiene, and sanitation. It contains minimum standards and indicators that may be useful in developing countries. Harvey Ludwig also offers his perspective on standards in his papers entitled Appropriate Environmental Standards in Developing Nations 25 and Appropriate Environmental Standards for Developing Countries 5.

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25 Ludwig, Harvey et al, Appropriate Environmental Standards in Developing Nations. Wat. Sci. Tech, Vol. 25 Number 9, pages 17-30, 26 Ludwig, Harvey et al, Appropriate Environmental Standards for Developing Countries, Environmental Systems Reviews, Number 35,

1992

1993

Working with a strategy that aims to reduce waste and reuse waste is cost effective, environmentally sensitive, and socially responsible. The same ideas advocated in this section are fundamental in the business world. What works and does not work in the business world is also true for the public service sectors. Some business may begin successful and promising, but eventually fail or experience down times because business owners have failed to change with the time. Services, products, and people who use them are in constant flux. When one of them fails to respond to this flux, the interdependent supply and demand nature of their relationship breaks down. When businesses do not respond to public demand and market forces, everyone loses—business owners do not get the results they need and the market does not get what it needs. Smart business owners know their market, are attentive to the changing winds of market forces and most importantly—they react! Other businesses fail because business owners are wasteful—they do not think of how they can conserve costs related to labor, materials, etc. A smart business owner maximizes resources. Yet other businesses fail because business owners fail to think for themselves—they copy other people’s ideas without thinking about whether those ideas will work in their business location. Often times, ideas need amending for them to be replicable. A smart business owner will realize this and either make adaptations to current technology or think of entirely new approaches. Our sanitation and wastewater sectors could use a large business sense when it comes to dealing with communities. We must think of the current situation and current needs. Our ideas must be attentive to the resources they demand and realize potential resources they produce. And we must think innovatively with technology, rather than indiscriminately relying on standard technology that is not a perfect fit for communities.

Business as usual approach
Maintain a centralized approach and continue to experience decision-making that tends to be slower paced, and non-responsive to the actual needs on the ground.

OR

Business unusual approach
Undertake reforms that delegate different kinds of decision-making to local governments to ensure that progress happens quickly, and specific local conditions are taken into account.

Taking Action: Business Sense Review
At this point, we have a question for you: Have you found some new ways of thinking about hygiene, sanitation, and wastewater management in this CD? We hope you can appreciate and adopt the business sense that we have tried to introduce into sanitation and wastewater sector problem solving. This section captures all the Business Unusual ideas presented in the CD sections. Throughout the course of our work in the various water subsectors, it is good to reflect on these principles to ensure we are not falling back into old, ineffectual habits of thinking and doing. Address Attitudes and Misconceptions: Gain a New "Business Unusual Outlook" on Your Sector Working the Policy: Having the policy is one thing. Implementing it is another Community Approaches: People As Part of Change Technology: Choices that Reduce, Reuse, Recycle

Address Attitudes and Misconceptions: Gain a New “Business Unusual Outlook” on Your Sector
We adopt new attitudes. We realize that certain long-standing beliefs may actually be misconceptions, which come from incomplete information or orientation. We believe that change is possible with a new outlook on the sector and begin sharing this new outlook within the workplace, with the public, and partners in development We agree to disagree on water debates. We see water is both a social and economic good and agree to solutions that will accomplish three goals: 1) expand sanitation coverage to poor, unserviced areas; 2) contribute to the sustainability and efficiency of utilities and facilities; and 3) contribute to the financial viability of utilities. We raise the public’s awareness about the need for sanitation and wastewater treatment as prevention against dangerous diseases and harmful environments that are risks to their health and ability to earn. We believe that with greater public understanding, people will agree to pay for services that save them money by protecting their health and income. We commit to invest in the sanitation and wastewater sectors and find necessary financing. Not doing so could be more expensive. For example, the loss of productivity due to water and sanitation-related illnesses and potential outbreaks may result in additional health-care costs. Prior to investing in sanitation and wastewater treatment projects, we assess where alternative approaches to major infrastructure may be more suitable and sufficient. Where new infrastructure truly is needed, we ensure that projects are always accompanied by “soft” or social-based components that are fully resourced to make the infrastructure sustainable. This requires everyone's commitment to appreciate all professions and perspectives involved, including ideas from nontraditional places—civil society and community groups—that are sometimes excluded from the decision-making process. The Government asserts itself and seeks collaboration and equal participation in the process, whether it is paper research, gathering perspectives from local governments and communities, or advising the development agency representative or consultant.

Working The Policy: Having The Policy Is One Thing; Implementing It Is Another
We undertake reforms that delegate different kinds of decision-making to local governments to ensure that progress happens quickly, and specific local conditions are taken into account. Water utilities are natural monopolies, and—whether publicly or privately run—need to be regulated. We seek regulation for a check and balance measure to ensure adequacy of services and affordability of tariffs. The central governments take the lead in policy and guidelines formulation. Legislation and regulation adequately establishes the roles and responsibilities of sector institutions. The local governments assume a much bigger role in implementing the policy and monitoring compliance since they are closest to the utility that delivers the sanitation and wastewater service and closest to the people who receive the service. Central government initiates the formulation of policy, taking into account the cost required to implement the policy, and gets local government involved in implementing it and monitoring compliance with it. Central and local governments recognize the need to support the capacity development needs of utilities. After all, investment in capacity development will redound in better service.

Community Approaches: People As Part of Change
Because good hygiene practices are the first line of defense against disease, we mainstream hygiene promotion activities into all water supply and sanitation projects. These activities involve more than just education programs, but involve communities in the design, and implementation, and monitoring of the project’s activities. We invest in human capital as well as infrastructure. Governments, NGOs, and development organizations seek the active participation of communities, building them into the main drivers of projects. We motivate our communities to seek the resolution of their sanitation problems.

Technology: Choices that Reduce, Reuse, Recycle
We explore new technologies and approaches. We are willing to replicate and/or upscale innovative ideas that have already been tested and that —after thorough study—show great potential for success in our target locations. We are willing to pilot test those new ideas that have not yet been tested . Our wastewater management strategies are proactive by concentrating on ways of reducing wastewater and recycling it for reuse, so that the impact of waste on our environment is lessened. We consider alternative technologies, not just technologies from the developed countries, because they conserve water and the production of wastewater and users can more easily adapt to them. We get tougher with polluters through incentives and penalties (higher tariffs and fines) as measures for convincing them to either produce cleaner wastewater, less wastewater, or recycled wastewater for their reuse. We consider variations of standard technology that are both economically affordable and culturally acceptable, such as the two-pit flush toilet. We consider sanitation solutions even in difficult locations by using innovative approaches, such as public pay-and-use toilets in slums, markets, and other heavily populated public places. We build what will be affordable, manageable, and sustainable in a community. We consider all costs and impacts before choosing an option (Life Cycle Analysis). We no longer wait for “all or nothing” solutions, but rather we implement interim solutions that have a positive effect while we develop longer-term solutions, such as the pay-and-use toilets in slum areas. We sort through all the ideas and technologies and provide a decision tool to people, which helps them help themselves. Our strategies focus on preventing pollution before it is created. We value waste as a resource, using safe waste for agricultural purposes. We involve communities in the decision-making process because technologies chosen must be used by them.

The challenges are great and the solutions are not simple or easy. One of the lessons from history is that the problems will not go away by themselves and must be solved sooner or later—and it will be better to solve these problems sooner to avoid potentially dire consequences and increasing costs. Doing nothing is not an option. In fact, doing nothing is a public health risk. Lack of sanitation and wastewater is linked to disease and disease traps people in poverty. However, some of the poor are not aware of the linkages between waste and disease; and even if they were aware, they may not know how to solve this problem effectively. Once people know the link between sanitation and disease—and they know how to fix this problem—they will likely take action. Public involvement and commitment on sanitation and wastewater projects is essential. Recognizably, the costs of effective sanitation and wastewater systems are significant and people are not usually willing to pay to establish them—especially when they have a tradition of on-site sanitation. Even developed countries have faced the challenge of funding these systems and resorted to a combination of government and citizen funding. The challenge in developing countries is even greater and financial assistance is essential. Still, money is not enough. Taking effective action in sanitation and wastewater requires a framework of institutions, capabilities, regulations, resources, and commitment. It takes time to develop a good framework. It takes time to build the capacity of people to manage sanitation and wastewater systems, but in many cases it is the capacity of people that is the key ingredient for a project's success. There is a risk in framework building though. While we study the sanitation situation of our country, study it again, and study it some more, the problems get worse. While governments debate laws and regulations over the years, they do their citizens a disservice. With the successful approaches and models that exist in the world today, no country needs to reinvent the wheel. Other countries can be a rich source of examples and models—as long as people do not discount these resources just because the other countries have more.

Introduction: Lessons From Near and Far, Long Ago And Recently As long as there have been creatures on the earth, there has been waste. Creatures great and small, including people, have taken care of their waste. If they had not, they would not have survived. As the centuries marched on, our world has become increasingly populated and our environment increasingly stressed. Over the last 200 years, we have found news ways to cope. This section takes a look at the lessons from history found in case studies from countries and times as far and wide as medieval London to 17 th century Philippines, when it was ruled by Spain. More recent lessons from history are also presented in this collection of country case studies. What can you learn from these countries’ experiences? United Kingdom: The Trouble With Thames Read about London's lessons with pollution, failed legislation, and epidemics on the famed Thames. United States: From Simple Sewers To National Regulation Read about the growing pains the US felt as it tried to deal with wastewater in different historical ages. Philippines: Paralysis Through Analysis? On paper, the Philippines looks to have a well-developed legal and institutional framework for its water sector. Implementing all its laws has been quite a challenge though. Chile: Characterized By Two Waves of Reforms Chilean Urban Water and Sanitation sector has been in continuous development since the middle of the 19th century. For Further Reading/ About Lesson Learned

United Kingdom : The Trouble With Thames
The United Kingdom (UK) has been dealing with wastewater issues since 1383 AD, which is over 600 years ago. Even its more modern approaches were implemented in the 1860s—almost 150 years ago. So, when we look to a developed country like the UK, we must realize that its wastewater capabilities have developed over many years and have been supported by a population with the means to pay. While we can all learn from the current practices in the developed world, we must also realize the time it takes to build a wastewater sector. Wastewater management in many developing countries is more like the UK of 50 to 100 years ago than it is like the UK of today. A Sore to the Senses Epidemics, Pollution, the Clean-up Lessons Learned

A Sore to the Senses
“There was concern about the pollution of the tidal Thames as far back as medieval times when an Act of Parliament in 1383 ordered that anyone with latrines over the Wallbrook Stream (a small tributary of the Thames in central London) would have to pay 2 shillings a year toward the cost of cleaning up the river. There was another Act in 1388 making it illegal to pollute ditches, rivers, water, and the air of London. In 1535, at the time of Henry VIII, a further Act was passed prohibiting the casting of rubbish and pollution into the Thames. However, with no means of enforcement and a growing population with no means of disposing of its waste, the Acts were rather ineffectual. The 1841 census showed that there were 270,000 houses in Central London. It is most likely that all these houses would have had cesspits, which, more often than not, overflowed. Consequently, the tidal Thames was considerably polluted. By this time, the Industrial Revolution was well under way and an increasing number of factories, slaughter houses, tanneries, and other industries grew along the banks of the river. This, together with a growing population, led to an increase in pollution from industrial wastes and overflowing cesspits. Two key events finally spelt the destruction of the Thames—the rapid increase in the use of the water closet (which dramatically increased the volume of waterborne waste) and the requirement in the Metropolitan Building Acts 1844 and 1847 that all new buildings be connected to the common sewers. This meant that more and more waste from the population of London went directly into the River untreated and by 1849 fish had disappeared from the tidal Thames. At that time, water was still being abstracted from the Thames for public consumption and cholera 27 was rife.

Epidemics, Pollution, the Clean-up
Between 1831 and 1866, there were 4 cholera epidemics during which over 35,000 people died, but it was not until the third epidemic in 1853 to 1854 that cholera was linked to the water supply. It was at this time that the cleaning up began. In 1858, a heat wave occurred and the disgusting smell from the river caused so much disruption to Members of Parliament that they hung sheets soaked in chloride of lime from the windows of the House of Commons. In addition, many tons of chalk lime, chloride of lime and carbolic acid were tipped into the Thames but with little or no effect. This became known as the year of the "Great Stink." Immediately prior to this, between 1848 and 1855, six successive commissions were set up to seek a solution to the pollution problem. In 1855, the last Commission was replaced by the Metropolitan Board of Works which considered many proposals. After much debate and acrimony, it was the plan of the board's own Chief Engineer, Joseph Bazalgette (later Sir), which was finally adopted. This scheme involved the construction of a network of sewers on both sides of the river running down to outfalls at Beckton on the north bank and Crossness on the south bank. 28 _______________________________
27 According to the Centers for Disease Control and Prevention, “Cholera is an infection of the intestines caused by bacteria in drinking

water or food. It can spread rapidly in areas without adequate treatment of sewage and drinking water. Without medical attention, cholera can cause death in a matter of hours.” 28 Dot and Ian Hart, The River Thames: Its Pollution and Clean-up, http://www.the-river-thames.co.uk/environ.htm.

Lessons Learned
Pollution worsens with the density of the population and the degree of commercial and industrial activity. Regulations and fees without effective enforcement will not work. Ample water sources and the use of the toilet will increase the amount of waterborne waste and increase pollution, unless something is done to manage the waste. “It was not until the third epidemic in 1853 to 1854 that cholera was linked to the water supply. It was at this time that the clean up began.” When people understand the connection between disease and wastewater, they will act to fix the problem. During that same decade, the “Great Stink” made conditions unlivable in London and further spurred action. Often, we do not act until matters reach crisis proportions—even when we know there is a problem to fix.

United States: From Simple Sewers To National Regulation
The growth of metropolitan areas in the United States (US) began to explode, starting in the 1840s; it continued to do so on through the turn of the century. Water systems were being implemented by cities and towns for two basic reasons: 1) for firefighting, and 2) to deliver water directly to individual homes and businesses. Per capita water usage changed dramatically: from 5 to 15 gallons (gal)/day (before the presence of municipal water systems), to volumes ranging from 75 gal/capita/day up to over 150 gal/capita/day! Once the water was easily/readily made available, the use of water closets soon came into prominence. 29 Approaches through the Ages Boston Harbor: An Example of Sore Water Lessons Learned

Approaches through the Ages
Early sewer systems in the US were developed on an as-needed basis—to get sewage (human wastes) away from the sources of water (private wells). Most systems were designed and built by common sense, with little or no guidance from trained “professionals,” for there were few such trained people in existence in those times (colonial days through the 184050s). Early 1800s—storm waters and waste. In the early 1800s, new community sewers were initially (and primarily) installed to take care of storm water; privies and “leaching” cesspools were used for human wastes. Still, a lot of human wastes from the early residents of the larger towns (following the model of their European forefathers) were unofficially put into the sewers—those wastes were either thrown out (from chamber pots) into the streets, leaked onto the ground from poorly designed/maintained privies/cesspools, or were directly deposited on the ground; wastes were then conveyed by storm water into the streets and on into the sewers.30 _______________________________
29 Jon C. Schladweiler, Tracking Down the Roots of Our Sanitary Sewers, http://www.sewerhistory.org/chronos/design_choices.htm 30 Jon C. Schladweiler, Tracking Down the Roots of Our Sanitary Sewers “Sewage Disposal," Microsoft(R) Encarta(R) 97 Encyclopedia.

(c) 1993-1996 Microsoft Corporation http://members.aol.com/erikschiff/history2.htm

Early 1900s—Wastewater treatment begins. “At the beginning of the 20th century, a few cities and industries began to recognize that the discharge of sewage directly into the streams caused health problems, and this led to the construction of sewage-treatment facilities. Because of the abundance of diluting water and the presence of sizable social and economic problems during the first half of the 20th century, few municipalities and industries provided wastewater treatment.” 31 Mid-1900s—treatment gets more technical, legal. “During the 1950s and 1960s, the US government encouraged the prevention of pollution by providing funds for the construction of municipal waste-treatment plants, water-pollution research, and technical training and assistance. New processes were developed to treat sewage, analyze wastewater, and evaluate the effects of pollution on the environment. In spite of these efforts, however, expanding population and industrial and economic growth caused the pollution and health difficulties to increase. In response to the need to coordinate efforts to protect the environment, the National Environmental Policy Act (NEPA) was signed into law on 1 January 1970. In December of that year, a new independent body, the Environmental Protection Agency (EPA) was created to bring under one roof all the pollution-control programs related to air, water, and solid wastes. In 1972, the Water Pollution Control Act (also known as the Clean Water Act) Amendments expanded the role of the federal government in water pollution control and significantly increased federal funding for the construction of waste-treatment works. Congress has also created regulatory mechanisms and established uniform effluent standards.32

Boston Harbor : An Example of Sore Water
Though Metropolitan Boston's sewer system was one of the best in the country 100 years ago, decades of neglect brought it to the brink of disaster in the early 1980s. Wastewater treatment plants built in the 1950s and 1960s were overloaded and not functioning at top capacity owing to poor maintenance. Raw sewage was discharged to the Boston Harbor making it one of the most polluted harbors in the world. Fish and lobster taken from the harbor were not safe to eat. It took a federal court order to force a clean-up of the harbor through the Massachusetts Water Resources Authority—a new quasi-municipal agency with enough autonomy to get the job done. New treatment facilities and an ocean outfall solved the problem. So now, sea life has returned to the harbor, including the whales.

Lessons Learned

Again, pollution worsens with the density of the population and the degree of commercial and industrial activity. The practice of sewage collection came after the practice of collecting storm water—so using the storm water system to collect wastes was a convenient solution. What would these early developers have done if the storm water collection system did not exist? Perhaps they would have found other ways to deal with human waste. _____________________________
31 PHILIPPINES : Water Supply and Sanitation Performance Enhancement Project, Urban Sewerage and Sanitation: 30 Years of

Experiences and Lessons, page 10. 32 IBID, page 57.

While the “solution to pollution is dilution” philosophy worked historically, it does not work in our modern world because water bodies are not always large enough to dilute pollution coming from exploding population rates and heavy industries. The US government was the prime mover in bringing wastewater collection and treatment to communities in the US in the 1950s-1960s—a short 50 years ago. Without the government support many communities would not have been able to build these systems. The US found it necessary to establish a strong regulator to set standards, enforce them, and reduce pollution—the US Environmental Protection Agency (EPA), an agency that has been in existence for only 30 years. Wastewater management is a relatively new concept—even in the developed world. The US Clean Water Act is a resource for developing countries and can also be found on the EPA website, which a rich source of information on water quality standards and enforcement procedures. Boston Harbor: lack of proper maintenance rendered wastewater treatment facilities ineffective and spoiled a harbor that once teemed with sea-life. But—owing to political opposition to raising rates—it took a federal court order to set things straight. Ignoring a problem does not make it go away, and the cost of solving a problem will only increase over time.

The Philippines: Paralysis Through Analysis?
We can see parallels in the development of the Philippine sector and the United States (US): development of regulations, standards, and incentive programs. As you review this case study though, you may find yourself wondering whether the country’s considerable efforts to study and establish the legislative and regulatory framework for wastewater management have been effective. While the frameworks are in place, the challenge remains to finance the needed improvements. Furthermore, throughout these legislative efforts, pollution has likely increased. Paralysis through analysis? This legislative review of the Philippines suggests that it is possible to spend too much time studying and getting just the right framework in place—at the expense of populations who face increasingly polluted living conditions. A Legal History The Sanitation Emphasis Some Implementation Underway Lessons Learned

A Legal History
Statutory provisions on environmental issues in the Philippine legal system date back more than 130 years. The Spanish law on waters of 1866 was extended to the Philippines in 1871 with the following provision: when an industrial establishment was found after the investigation, to have contaminated the waters with substances or properties noxious to the public health, the Governor General could suspend its operations until the owner adopted remedy. Powers to Protect. In 1935, the Philippine Constitution declared that the state, in the exercise of its inherent powers, may adopt measures to protect the health, the welfare, safety, etc. of the community. The Constitutional guarantees on the right to life, liberty, and property are not absolute. Weighed against a greater public interest, these rights have to yield to reasonable regulations.

Quality Standards Set. In 1964, through Republic Act No. 3931, the National Water and Air Pollution Control Commission (NAWAPCO) was formed to maintain reasonable standards of quality for air and water. In December 1975, Presidential Decree No. 856 established the Code on Sanitation, which dealt in detail with water supply, excreta disposal, sewerage, and drainage. Chapter XVII of the Code contained provisions for sewerage collection and disposal, as well as drainage, with implementing rules and regulations. New Agencies for the Job. In 1976, Republic Act No. 3931 was revised by Presidential Decree No 984, and NAWAPCO was replaced by the National Pollution Control Commission (NPCC). In the same year, an Inter-Agency Committee on Environmental Protection (IACEP) under the Department of Environment and Natural Resources (DENR) was created to assess the environmental situation, as well as government policies and programs on environmental protection. In 1977, IACEP recommended the creation of the National Environment Protection Council (NEPC), established under Presidential Decree No. 1121. The Council became responsible for rationalizing the functions of government agencies for an effective, coordinated, and integrated system of environmental protection, research and implementation/enforcement of environmental laws. Standards Re-set. In the late 1970s, Presidential Decree No. 1151, known as the Philippine Environmental Policy, was promulgated. The law required all agencies and instrumentalities of the national government, including government-owned and-controlled corporations, as well as private firms and entities, to prepare an environmental statement on their every action, project or undertaking that significantly affects the quality of the environment. Presidential Decree No. 1152, known as the Philippine Environmental Code , established standards for air and water quality, and guidelines for land use, natural resources, groundwater and waste management. In June 1978, Presidential Decree No. 1586 augmented the environmental statement system by providing sanctions for non-compliance with the environmental impact assessment (EIA) requirement. The scope of the system was also restricted to "environmentally critical projects to be located in environmental critical areas." This Presidential Decree, however, was not implemented until 1982. Medium Term Plans Required. In 1993, the Medium Term Philippine Development Plan (MTPDP) covering the period 1993-1998 was developed. It spelled out the development goals and objectives, strategy, policy framework, priority development programs and targets of various sectors. This initiative included a medium term plan for the water supply and sanitation sector.

The Sanitation Emphasis
Up to 1994, efforts to develop the water supply and sanitation sector focused mainly on the construction of physical facilities, primarily for water supply. In the sanitation sub-sector, more attention was given to strengthening sector policy, strategy, operational frameworks, and institutional capabilities. It was then deemed necessary that specific measures be identified through an in-depth assessment of implementation experiences, including private sector participation in water supply provision, and an analysis of emerging issues and concerns. Hence, the decision to update the medium term plan, and to formulate a sector investment plan, now referred to as the 1994 National Urban Sewerage and Sanitation Strategy Plan (NUSS). The purpose of the investment was to create a more effective institutional framework to guide policy and institutional reforms and to propose an appropriate development strategy and investment plan to improve sewerage and sanitation coverage nationally.

Sanitation Given Higher Priority. In March 1994, the National Economic Development Authority (NEDA) adopted Resolution No. 5 based on the NUSS plan. The new plan gave high priority to improved sanitation and sewerage in urban areas. In box The resolution also included the following propositions: Ensure that on-site sanitation facilities are readily adaptable to future sewerage systems All new housing developments, central business districts, and high income areas shall have low cost (simplified) sewerage systems Industrial wastes and collected municipal wastes shall be treated in accordance with DENR standards Services shall be based on demand and on willingness-to-pay criteria Utilization of external sources of assistance LGUs will be responsible for implementing sanitation and sewerage projects and programs The national government shall assist Local Government Units (LGUs), through the Central Program Support Office (CPSO) lodged with the Local Water Utilities Administration (LWUA), in institutional development, training, financial management, planning, and program management.

Some Implementation Underway
To assist LGUs in carrying out sanitation and sewerage projects, the Department of Finance (DOF) made loans available through the Land Bank of the Philippines (LBP) for the a project called “Water District Development Project (WDDP)”. Due to budgetary constraints, LWUA's role was reprogrammed to that of an advisor to the Land Bank of the Philippines. There were originally six pilot project sites for WDDP: the cities of Cagayan de Oro, Cotabato, Dagupan, Davao, and General Santos, plus the municipality of Calamba. However, General Santos City backed out from the project, leaving only five sites to proceed with the project in 1996. Due to delays in meeting loan requirements, negotiations dragged on until 1998, a local election year. After those elections, no firm commitments or interest came forth for the project, and local officials had other priorities. Moreover, the impact of the regional financial crisis that began in mid-1997 contributed to LGU decisions to drop the project. WDDP was later restructured into a broad-based environmental fund for sanitation, sewerage, drainage and the Barangay Environmental Sanitation Plan (BESP) to assist LGUs to pursue demand-driven subprojects. The restructuring required the creation of the Project Management Office at LBP. In July 1999, the revived WDDP commenced with two LGUs signing subsidiary loan agreements. To date, four LGUs are participating in the program, constructing off-site sanitation through formal drainage systems with dry weather flow interceptors and sewerage facilities.”

Lessons Learned
Philippines developed regulations, standards, and incentive programs “Sewerage management projects, even those employing alternative technology options, are very expensive. Individual users cannot be expected to shoulder the full cost of sewerage systems. The cost of urban sewerage and sanitation programs must be shared among households, business and other users, communities, local government units and the national government. The Philippine national government has been unwilling to subsidize sewerage projects. But if it intends to pursue health and environmental improvements, it is not enough to declare that sewerage and sanitation projects have the highest priority; environmental preservation has been on the government’s priority list for a long time. It is also imperative for the national government to provide grants or subsidies to share the cost of such projects. In other countries, the push for environmental projects was accompanied by substantial financing assistance from the national government. Interest and commitment generated from cities through demand-driven approaches should be key factors in deciding where to undertake very costly sanitation improvement projects.

Sewerage projects must also consider users’ ability and willingness to pay. If tariffs are based on full cost recovery plus operation and maintenance costs – as national government guidelines require – many poor households will not be able to afford a sewer connection.” Title VI of the Philippine Environmental Code calls for “achieving a rational and orderly balance between man and his environment.” It also recognizes the need for education and public information about environmental protection and research and incentives to encourage people to do the right thing. It has taken a number of years for the Philippines to study, assess and establish the legislative and regulatory framework for wastewater management—and the challenge remains to finance the needed improvements. And all the while, pollution was likely increasing. Paralysis through analysis? Sometimes, we spend too much time studying and getting just the right framework in place— at the expense of populations who face increasingly polluted living conditions.

Chile: Characterized By Two Waves Of Reforms
"Chilean Urban Water and Sanitation sector has been in continuous development since the middle of the 19th century. That is, when the first water and sewerage works started being built in the main cities of the country. The last two major institutional changes started at the end of 1970 decade and a third one is being foreseen shortly. First Wave of Reforms Second Wave of Reforms Remaining Challenges Lessons Learned

First Wave of Reforms
The first important institutional reform was made by 1977. It had as a main objective the integration in one hand of water and sanitation activities to take advantage of scale economies and to optimize and enhance the systems. The new entities were designed to work on a regional basis. Semi-autonomous utilities. Two semi-autonomous utilities were created, EMOS in the metropolitan region and ESVAL in the 5th region. Eleven regional services were also established, one in each of the remaining 11 regions of the country. EMOS integrated EAPS, Empresa de Alcantarillado de Santiago and the other public water services in the region. Regulation. A regulator body was instituted, Servicio Nacional de Obras Sanitarias (SENDOS), as a main division of the Ministry for Public Works. SENDOS was made responsible for central planning, financing and administration of the regional services and became the regulator and controller of services and utilities. SENDOS made tariff’s proposal for being presented for approval to the Ministry of Economy. However, tariffs’ level was kept low in the regions and the regional services continued receiving financial assistance from central government. EMOS and ESVAL benefited from water and sewerage integration, had some tariff increases and started to use its own financial resources for investments. System Upgrades Begin. In 1980, EMOS received a $26 million loan from the World Bank to upgrade the water system according with a $70 million investment plan. This plan included the first master plan for wastewater treatment and safe disposal in the metropolitan region. It also included a master plan to extend the sewerage system. In 1986, EMOS received a $60 million second loan from the World Bank, to be applied in a $150 million new investment plan that included the basic works for wastewater treatment. By the same period, SENDOS received a loan from IDB to upgrade regional services.

Second Wave of Reforms
Coverage continued increasing throughout the country. However, the low level of tariffs still did not allow all services and utilities to grow. By the end of the 1980s (1988-1989) a second important institutional reform was applied to the Chilean water and sanitation sector. Its main objective was to give financial stability to water and sanitation activities, while reinforcing the regulatory capacity of the government. A set of law and regulations were passed and a regulatory body, totally separated from operational activities, was created. The reform also included laws that allowed the selling of EMOS and ESVAL to the private sector. With the new orientation and the funds coming from fair tariffs, public companies started a period of enhancement and high investments. Tariff Increases. The first 5-year tariff’s period began in 1990, and considered a gradual annual rise to reach the legal limit. This meant, on the average, a total increase of about 70% in real terms—that is without taking into account adjustments for inflation. The second 5-year tariff's period started in 1995. The average tariff’s rise was now about 6% and was to be maintained until 1999. The growth of public utilities infrastructure was outstanding: Urban water and sewerage coverage reached the highest levels of Latin America. The demand for water and sanitation was increasing…, and because of the extension of water and sanitation systems to poor neighborhoods. System Improvements. The first works for wastewater treatment and safe disposal started to be built and operated by the beginning of the 1990s. EMOS and ESVAL initiated the construction of wastewater discharges interceptors (big collectors). In 1992, the first wastewater treatment plant, a pilot nonconventional plant was built in Santiago. The definitive plan for wastewater treatment in the metropolitan region was completed in 1994. In 1995, the decision of building three large plants was taken, to reach sewage treatment coverage of about 70 % within 15 years. In other regions, wastewater collectors, nonconventional wastewater treatment plans and marine outfalls for safe sewage disposal were designed, and started to be built and to be operated. Impact on Public Health Risks. Cholera was controlled in Chile as a result of emergency measures taken by the Ministry of Health. Yet, it is important to take into account the rise in sewerage coverage and the initiation of the basic works for wastewater treatment and safe disposal in the metropolitan region and in other regions. Other waterborne diseases, as typhoid, decreased from 6,700 cases in 1989 to 1,400 in 1995. The decrease of typhoid cases was even more important in the metropolitan region, from 4,100 cases in 1989 to 390 cases in 1995. Lessons Learned Building an effective water and wastewater sector can take a number of years, during which the roles and responsibilities of various players may change—with government becoming more of a regulator and less of a financier. Low tariffs mean low service because there is little money to cover operational costs, not to mention funds to expand infrastructure and, in turn, services. But, building wastewater systems may require financial contributions in addition to tariffs—from government, donor agencies, and the private sector. The private sector can play an important and effective role at providing and/or improving wastewater services. Again, we see that development of the wastewater systems contributed to reducing outbreaks of typhoid and cholera.

Remaining Challenges
Although most of the public companies are well run, some of them lack business administration capacity, and technological development. On the other hand, large infrastructure investments, yearly increasing, are required. The main investments are required for providing service to new urban population, for upgrading deteriorated systems, for building wastewater treatment plants, for developing new raw water sources, etc. Competition normally leads private companies to constant growth to survive in an always changing business environment. Public companies lack enough flexibility to face a continuous situation of advancement and renewal. Political interference could be also a menace to modern management of public companies. Thus, the sale of the public water and sanitation companies to the private sector could be an advisable government policy. By the middle of 1995, the government presented to Congress a proposal to modify the current law. The main aims of the proposal were: to join in one legal document the different laws in action; prevent power concentration (majority of shares of many sector companies in one hand); ensure that urban development is supported by water and sanitation infrastructure; and protect and introduce some forms of competitiveness.”

Lessons Learned
Building an effective water and wastewater sector can take a number of years, during which the roles and responsibilities of various players may change—with government becoming more of a regulator and less of a financier. Low tariffs mean low service because there is little money to cover operational costs, not to mention funds to expand infrastructure and, in turn, services. But, building wastewater systems may require financial contributions in addition to tariffs—from government, donor agencies, and the private sector. The private sector can play an important and effective role at providing and/or improving wastewater services. Again, we see that development of the wastewater systems contributed to reducing outbreaks of typhoid and cholera.

For Further Reading About Lessons Learned
Sanitation for the Poor: The experience of the Indian alliance of SPARC, Mahila Milan and NSDF (1984 to 2003) reports on nearly 20 years of experience implementing sanitation programs in India. Water and Sanitation Program Knowledge Network: http://www.wsp.org/ and its regional networks: East Asia and Pacific: http://www.wsp.org/07_EastAsia.asp and South Asia : http://www.wsp.org/07_SouthAsia.asp. The Development Gateway: http://home.developmentgateway.org/ ELDIS: funded by Sida, NORAD, DFID and SDC, ELDIS is one of a family of knowledge services provided by the Institute of Development Studies, Sussex http://www.eldis.org/index.htm The Sanitation Connection, a site developed by IRC and WEDC on behalf IWA, UNEP (GPA), WSP, WSSCC and WHO: http://www.sanicon.net/topics.php3 Un Habitat: Best Practices in Improving the Living Environment, http://www.bestpractices.org/ Patel, Sheela, Sanitation for the Poor: The experience of the Indian alliance of SPARC, Mahila Milan and NSDF (1984 to 2003) , SPARC (Society for the Promotion of Area Resource Centres) Mahila Milan (`women together’) and NSDF (National Slum Dwellers Federation), October 2003

Conclusion: What Lessons Remind Us
The challenges are great and the solutions are not simple or easy. One of the lessons from history is that the problems will not go away by themselves and must be solved sooner or later—and it will be better to solve these problems sooner to avoid potentially dire consequences and increasing costs . Doing nothing is not an option. In fact, doing nothing is a public health risk. Lack of sanitation and wastewater is linked to disease and disease traps people in poverty. However, some of the poor are not aware of the linkages between waste and disease; even if they were aware, they may not know how to solve this problem effectively. Once people know the link between sanitation and disease—and they know how to fix this problem—they will likely take action. Public involvement and commitment on sanitation and wastewater projects are essential. Recognizably, the costs of effective sanitation and wastewater systems are significant and people are not usually willing to pay to establish them—especially when they have a tradition of on-site sanitation. Even developed countries have faced the challenge of funding these systems and resorted to a combination of government and citizen funding. The challenge in developing countries is even greater and financial assistance is essential. Even still, money is not enough. Taking effective action in sanitation and wastewater requires a framework of institutions, capabilities, regulations, resources, and commitment. It takes time to develop a good framework. It takes time to build the capacity of people to manage sanitation and wastewater systems—but in many cases the capacity of people is the key ingredient for project success. There’s a risk in framework building, though. While we study the sanitation situation of our country, study it again, and study it some more, the problems get worse. While governments debate laws and regulations over the course of years, they do their citizens a disservice. With the successful approaches and models that exist in the world today, no country needs to reinvent the wheel. Other countries can be a rich source of examples and models—as long as people do not discount these resources just because the other countries have more resources.

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