2009

Water Sanitation:
Contemporary Issues and Solutions

Evan DeFilippis

[University of Oklahoma] 5/8/2009

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Table of Contents

FIGURE INDEX ........................................................................................................................... 4 TABLE INDEX ............................................................................................................................. 4 1. INTRODUCTION..................................................................................................................... 5 2. DEFINITION OF SANITATION ........................................................................................... 7 3. TYPES OF TECHNOLOGIES ............................................................................................. 10 3.1 OFF-SITE SANITATION TECHNOLOGIES ................................................................................. 10 3.1.1. Conventional Sewerage System.................................................................................... 10 3.1.2. Simplified Sewerage System ......................................................................................... 11 3.2 ON-SITE SANITATION TECHNOLOGIES (LATRINES)............................................................... 12 3.2.1. Dry Latrines ................................................................................................................. 12 3.2.1.1. Simple Pit Latrine .................................................................................................. 12 3.2.1.1.1. Advantages ...................................................................................................... 13 3.2.1.1.2. Disadvantages .................................................................................................. 14 3.2.1.1.3. Additional Barriers to Implementation ............................................................ 16 3.2.1.2. Ventilated Improved Pit Latrine ............................................................................ 17 3.2.1.2.1. Advantages ...................................................................................................... 18 3.2.1.2.2. Disadvantages .................................................................................................. 18 3.2.1.3. Double Ventilated Improved Pit Latrine................................................................ 20 3.2.1.3.1. Advantages ...................................................................................................... 20 3.2.1.3.2. Disadvantages .................................................................................................. 21 3.2.1.4. The Dry Urine Diversion Toilet............................................................................. 22 3.2.1.4.1. Advantages ...................................................................................................... 23 3.2.1.4.2. Disadvantages .................................................................................................. 23 3.2.2. Wet Latrines ................................................................................................................. 25 3.2.2.1 Pour-Flush Latrines................................................................................................. 25 3.2.2.1.1. Advantages ...................................................................................................... 25 3.2.2.1.2. Disadvantages .................................................................................................. 26 3.2.2.2 Aqua Privy .............................................................................................................. 27 3.2.2.2.1. Advantages ...................................................................................................... 27 3.2.2.2.2. Disadvantages .................................................................................................. 27 3.2.3. Ecological Latrines ...................................................................................................... 29 3.2.3.1. Advantages ......................................................................................................... 31 3.2.3.2. Disadvantages ..................................................................................................... 32 3.3. OTHER SYSTEMS .................................................................................................................. 38 3.3.1. Septic Tanks.................................................................................................................. 38 3.3.2. Greywater management ............................................................................................... 39

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4. CHOOSING APPROPRIATE TECHNOLOGY: BARRIERS AND CONSIDERATIONS .................................................................................................................. 40 4.1. Unplanned, High-Density Urban Settlements ................................................................. 42 4.1.1. Technical challenges ................................................................................................. 43 4.1.1.1 Case Study: TTC Bustee, Dhaka, Bangladesh ................................................... 45 4.1.2. Financial Challenges ................................................................................................. 47 4.1.3. Institutional Challenges ............................................................................................ 48 4.2. Planned, High-Density Urban Settlements ..................................................................... 50 4.2.1. Technical Challenges ................................................................................................ 50 4.2.1. Financial Challenges ................................................................................................. 51 4.1.3. Institutional Challenges ............................................................................................ 51 4.3. Peri-urban Settlements .................................................................................................... 52 4.3.1. Technical Challenges ................................................................................................ 52 4.3.2. Financial Challenges ................................................................................................. 53 4.3.3. Institutional Challenges ............................................................................................ 56 4.4. Rural Settlements............................................................................................................. 57 4.4.1. Technical Challenges ................................................................................................ 57 4.4.2. Financial Challenges ................................................................................................. 57 4.4.3. Institutional Challenges ............................................................................................ 58 4.5. General Factors to Consider .......................................................................................... 59 4.5.1. Typical Community Factors ..................................................................................... 59 4.5.2. Typical Environmental Factors ................................................................................. 61 5. CONCLUSION ....................................................................................................................... 62 6. REFERENCES........................................................................................................................ 64

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Figure Index
Figure 1. Simple Pit Latrine . ........................................................................................................ 13 Figure 2. Ventilated Improved Pit Latrine . .................................................................................. 18 Figure 3. Double Ventilated Improved Pit Latrine . ..................................................................... 20 Figure 4. Dry Urine Diversion Toilet . ......................................................................................... 22 Figure 5. Pour-Flush Latrine . ....................................................................................................... 25 Figure 6. Organic/Nutrient Loop Mechanism of Ecosan . ............................................................ 31 Figure 7. Treatment and Utilization Options with Ecosan .......................................................... 34 Figure 8. Two NGO Loan Success Stories .................................................................................. 55 Figure 9. Willingness-to-Pay Survey ........................................................................................... 55

Table Index
Table 1. Dry Latrine Comparisons................................................................................................ 24 Table 2. Wet Latrine Comparisons ............................................................................................... 28 Table 3. Septic Tank Synopsis...................................................................................................... 38 Table 4. Unplanned Urban Settlement Overview ......................................................................... 43 Table 5. Planned Urban Settlement Overview.............................................................................. 50 Table 6. Peri-urban Settlements Overview ................................................................................... 52

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1. Introduction
O ver a third of th e w orld‘s p o p uatio n , 2 .6 b illio n in div id u a ls , ck a cces s to basic l la sanitation (1). The vast majority of these individuals live in peri-urban areas across South Asia, East Asia, and sub-Saharan Africa (2). Even those served in areas of Asia and Africa are not utilizing the sanitation systems in place, instead dumping wastewater directly into rivers and freshwater bodies. In Asia, only half of the individuals with sanitation technology have a sewage system, the others are forced to rely on unsustainable latrines and septic tanks (3). The consequences for those who do not have access to sanitation are startling: over 2 million individuals, most of whom are children under the age 5, die every year due to preventable diarrheal diseases. In fact, over 60% of all infant deaths are linked to infectious diseases that arise from inadequate sanitation (4). For these individuals and many others, access to improved sanitation is a pivotal concern. The consequences of inadequate sanitation extend far beyond disease-related outcomes: poor sanitation is the lynchpin behind poverty, causing an estimated $750 million (US?) in productivity losses each year. Additionally, poor sanitation hampers education efforts worldwide as potential students are forced to tend to the sick or are sick themselves, rivers and backyards are turned into open sewers as feces have no mechanism of disposal, and nearly a quarter of infectious disease plaguing developing populations are attributable to poor sanitation (3). Despite global efforts by the United Nations, through its Millennium Development Goals, and other international agencies with similar agendas, successful sanitation is fraught with challenges of misinformation, bureaucracy, and poor host-country receptivity which impede fruitful implementation (3). C o n v tio nal s olu tion s , typ ifi d by ―flu shan d forget‖ tech n oogie s , en e l

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rely on the notion that fecal material exists only as waste, and are forced to rely on an incredible amount of money and water in disposing excreta. Toilets and water-based sewage systems that rely on this concept are neither economically nor environmentally viable in many parts of the developing world (4). Therefore, the need for alternative and environmentally sound sanitation strategies is abundant. To keep pace with UN Millennium Development Goals, an additional 1.6 billion individuals must be provided with basic sanitation by 2015 in order to halve the number of people without access to water sanitation (5). With current sanitation improvement rates, the United Nations is projected to fall short of this goal by 550 million people (6). With the extraordinary task of universal water sanitation in mind, the goals of this paper are to (a) investigate the advantages and disadvantages of technologies that are valuable in addressing the sanitation problem, (b) examine the challenges to successful implementation, and (c) articulate technological and political strategies to overcome common obstacles.

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2. Definition of Sanitation
Sanitation refers to a host of strategies utilized to manage human excreta and greywater as well as solid and industrial waste (7). A distinction must be made between sanitation and disinfection: sanitation refers to a quality of cleanliness brought on by an improvement of conditions related to waste disposal, while disinfection refers to the reduction in pathogenic load of a particular substance (8). In this respect, sanitation focuses on the prevention of contamination while disinfection refers to the treatment of contaminated substances, such as water. Although this semantic distinction is acknowledged in literature, it is not acknowledged in p olicy an d th u sm any o f th e ‗san itation‘ tech nologie s d is cu sed in th is paper will a ls ob e s disinfecting technologies. This paper will focus on sanitation technologies and their economic, environmental, and public health implications for the developing world. With this in mind, sanitation projects can be divided into two distinct categories: on-site and off-site sanitation (14). Off-site sanitation refers to an economically intensive sanitation system that consists of sewer networks, runoff drains, and a centralized wastewater treatment plant (9). Off-site sanitation is appropriate for industrialized countries because it is convenient to use and the users are not responsible for the maintenance and operation of the system (10). Off-site sanitation also excels in the removal of pathogenic bacteria, organic material, and nutrients from waste. Unfortunately, the creation of extensive sewer systems necessary for off-site sanitation requires significant time and economic investment which are not readily available in developing countries that are in desperate need of prompt, short-term relief (11). Furthermore, off-site sanitation fails to serve remote rural areas in developing countries where population is dispersed and thus inaccessible by the limited reach of sewer systems (12). Government investment in such technologies is also required, which can become an onerous burden to those countries already

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plagued with economic troubles (11). Clearly, nuanced approaches are necessary to address sanitation issues in the developing world, and thus off-site sanitation will not be addressed extensively in this paper. On-site sanitation refers to the actions related to the treatment and disposal of waste water that cannot be carried out by a sewage system or any other off-site systems because the population of interest has particular concerns that cannot be addressed with such systems (11). Specifically, on-site sanitation can refer either to a micro form of sanitation whereby each individual house within a community utilizes the soil as an instrument of sanitation, or it can refer to community-based sanitation where multiple houses form an interlinking network that is connected to a central treatment system (13). Examples of on-site sanitation include, among other technologies, latrines, toilets, and natural treatment systems, which will all be discussed in depth in subsequent sections. The ultimate objective of sanitation projects should be the protection of public health through the prevention of illnesses such as diarrhea while preserving the environment through the reuse and recovery of resources such as soil, water, and energy (14). An effective sanitation system should contain the following components: 1. A sanitary environment for urination and defecation 2. A mechanism by which waste and greywater can be collected and disposed of; although it is ideal for a sanitation program to reuse treated waste for agricultural projects

The protection of the environment is a goal of sanitation that cannot be understated: the frequent disposal of waste in developing countries is collapsing ecosystems, poisoning water and

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food supplies, spreading bacteria, facilitating the growth of insect vectors such as mosquitoes which catalyze disease spread, and adulterating the intrinsic beauty of the natural world (4). Designing a sanitation system that can effectively address these concerns can ameliorate not only public health and environmental issues but can also enable the recovery of domestic economies by revitalizing labor sources previously diminished by water-borne diseases and other related conditions.

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3. Types of Technologies 3.1 Off-Site Sanitation Technologies

3.1.1. Conventional Sewerage System

Conventional sewerage is a resource- and fiscally-intensive system that utilizes a network of pipes to transport waste from latrines to a designated disposal point. Each pipe which connects to a house typically contains an inspection chamber to clear any blockages resulting from frequent use. Manholes are installed at regular intervals throughout the transport process so that maintenance can be done to specific locations in need of repair (15). Once the waste is transported to the main sewer, the sludge byproduct is transferred to a treatment facility in order to prevent pathogenic build-up. In parts of the developing world, waste is currently being emptied into rivers, and a sewerage system provides an alternative to this process (16). Sewerage systems are most practical in heavily urbanized areas which have the funds to support the construction of such financially-demanding systems, although there are modified variations that cater to less lucrative locations. These systems also have the unfortunate disadvantage of using high amounts of water to facilitate the flushing process and fail to harness the agricultural potential of waste (17).

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3.1.2. Simplified Sewerage System

Simplified sewerage is an attempt to address many of the financial concerns prompted by the conventional system. The simplified sewerage system has shallower pipes, reducing excavation and pumping costs, and the smaller pipes help to save on material costs. It also replaces manholes with inspection chambers which are easier to design and construct, decreasing material costs and increasing construction expediency. A simplified sewerage system is advantageous for communities that can afford to allocate a sum of money to sanitation, but at the same time have high-density populations and small streets not conducive to conventional sewerage systems (18).

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3.2 On-Site Sanitation Technologies (Latrines)
A latrine is a structure used to store (and sometimes process) solid waste and urine, often decomposing waste into safer, environmentally-friendly byproducts. Latrines are the most commonly used sanitation system in the world, used prevalently in developing countries in rural and low-income urban areas. Latrines allow hygienic and environmentally-safe disposal of waste that would otherwise be discharged into waterways, devastating local aquatic flora and fauna (10). Latrines are also vital in the developing world where conventional off-site systems are unable to accommodate particular geographical and economic needs of a host country. Although many variations of latrines exist, some variations being more suitable in particular regions than others, they all provide cheap, easily-maintained alternatives to open defecation (3).

3.2.1. Dry Latrines

3.2.1.1. Simple Pit Latrine A simple pit latrine (see Figure 1) can be simply defined as a hole in the ground, over two meters in depth, used to collect and store waste (13). Optimally, these rudimentary forms of latrines should be created away from water tables so that the waste does not contaminate soil or underground water supplies (12). A more sophisticated version of the simple pit latrine involves the installation of a concrete or wooden floor plate over the hole which is used to ease squatting and to insulate the hole from surface water that may enter from external sources (3). Depending on user preference, the latrine can be customized to include a seat and footrest as well as a lid to cover the hole after use. The hole of the latrine should be lined with a sufficiently strong material to prevent surrounding soil from collapsing around the pit (14). The lining should be

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porous enough to allow urine access to the surrounding soil but strong enough to prevent feces from contaminating soil walls (4). For privacy and security, an overarching structure is necessary to enclose the latrine from external observation. This superstructure should be situated far from food and water sources and nearby houses (19).

Figure 1. Simple Pit Latrine (23).

3.2.1.1.1. Advantages The pit latrine has the advantage of inexpensively and efficiently storing excreta, thereby satisfying the first component of effective sanitation. Besides storing excreta, the simple pit latrine has the advantage of being easy to construct, incredibly inexpensive, and versatile with regard to the reusability of its components (the slab and the privacy superstructure can be refashioned for use on other latrines) (19). Furthermore, unlike most off-site sanitation mechanisms, the simple pit latrine does not require the use of water to function which is important in water-scarce regions in the developing world (13). Also unlike off-site sanitation, the simple pit latrine requires little-to-no maintenance, and the occasional repairs necessitated by frequent use can be handled by local users (19). Research findings based on user consultation

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suggests that the pit latrine also has a high satisfaction rating with over 68% of users indicating satisfaction with the installation (21).

3.2.1.1.2. Disadvantages Unfortunately, simple pit latrines can produce disagreeable odors, as there are no mechanisms to suppress the stench of excreta. Moreover, these latrines attract flies, which are considerable nuisances to subsequent users (9). Flies can pose a substantial public health threat as well because they spread disease after feeding on feces. If the pit is wet, it can also attract mosquitoes which carry diseases such as filariasis, confirming the importance of a lid cover to seal the hole from insect penetration (22). Fortunately, the odor and insect problem is not an overwhelming nuisance, as users do not perceive them to be a substantial problem when questioned after use (21). The simple pit latrine also suffers from geographic complications: it cannot be used on rocky ground, areas susceptible to flooding, or in areas with high water levels (22). Simple pit latrines are not amenable to densely populated regions because the regular and constant demand by users would far outstrip the supply of latrines. Although comparatively the simple pit latrine is easy to maintain, the regular emptying of excreta from pits may be difficult and requires community effort (22). The mere process of em ptying th e p it‘sco n te m ay co l apse th e s urrou n d in g o il walls , in capacitatin g th e latrine. nts s Because of this, every few years new latrines must be created, forcing local people to dedicate large quantities of open land to latrine installation rather than to more economically fruitful endeavors (23). The contents of the latrine are usually emptied out by hand with a spade. This poses another public health risk because by digging, one can become infected with worms, and if the excrement is new, bacteria can be spread easily (22). The solution to this problem is to

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utilize a large tanker with a vacuum pump to lift the sludge from the latrine. Unfortunately, these tankers are not a viable technology in most parts of the developing world because they are expensive and fail to navigate through the narrow paths which are typical in densely populated urban areas (12). Another problem with the simple pit latrine concerns its potential for groundwater pollution. Groundwater may become polluted when it comes into contact with nearby latrine pipes. In urban areas, this is a significant problem due to the proliferation of shallow wells which can easily be contaminated by pit latrines. This problem is usually remedied by ensuring that all pit latrines are at least fifteen meters away from sources of water, although it can be difficult to ascertain the location of underground water sources, posing yet another problem for implementation (20). In the most rudimentary version of the simple pit latrine, the shallow hole, hookworms can breed in human excreta and migrate upwards to penetrate the feet of subsequent users. Partially as a result of these ineffective sanitation systems, over 740 individuals around the world are infested with the parasitic hookworm, which causes life-threatening anemia and intentional inflammation (24). There are also a large number of studies that suggest an association between hookworm infections and impaired learning, absence from school, and decreased economic productivity (25). This information should speak to the necessity of improved sanitation systems in the developing world: a simple improvement on a hole can save millions of lives. Fortunately, the hookworm problem is avoided with the more nuanced simple pit latrine that improves upon the single-hole system (concrete slabs, lining, a superstructure, etc.) (3).

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3.2.1.1.3. Additional Barriers to Implementation In some developing peri-urban locations, areas such as Jamaica and Indonesia, there are regulations prohibiting the construction and use of latrines in areas that exceed a certain population density. For example, in Jamaica, wherever density is higher than ten houses per acre, latrine construction is disallowed. Despite the fact that these regulations are not based on reasoned analysis or pragmatic cost-benefit examination, they pose a significant barrier to universal sanitation and must be considered when prescribing global solutions (21). It is important that countries in the developing world understand the utility of simple pit latrines, but it is equally important that policymakers accommodate the aesthetic and perceptual preferences of the host country in order to ensure maximal operation and use. There is also some host country resistance to the use of pit latrines because people can be both uncomfortable and promote the fear of falling inside the hole. This fear is particularly potent for some mothers in developing countries who prevent their children from using the latrine for fear that the child will fall. This fear, whether or not it is substantiated, contributes to open defecation which sets back public health initiatives (26).

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3.2.1.2. Ventilated Improved Pit Latrine The ventilated pit latrine is an improvement over the simple pit latrine and seeks to eliminate odors and flies by adding a ventilation pipe which funnels odors outside of the superstructure. The structure draws in air currents from the outside and funnels them through the squat hole. Odors are then dispersed through the ventilation pipe due to the chimney effect (23). In order to maintain constant circulation, the doors of the superstructure are usually built with openings on the top and bottom to facilitate air flow. The end of the ventilation pipe is fitted with a tightly-meshed net which prevents flies from accessing the excreta and from leaving the pit, suppressing the transmission of some vector-based diseases (27). Although flies approaching the ventilated pipe from the outside are prevented from entering due to the fly-net, flies can still access feces and lay their eggs in the pit by entering through the squat hole. It is for this reason that the ventilated pit latrine must stay dark at all times. Adult flies that are born inside of the pit are programmed to fly towards the strongest source of light. By keeping the inside of the superstructure dark, adult flies are forced to gravitate to the only source of light available: the top of the ventilated pipe. Because the pipe is covered with a fly screen at the top, flies are prevented from exiting and eventually die and fall back into the depths of the pit (21).

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Figure 2. Ventilated Improved Pit Latrine (23).

3.2.1.2.1. Advantages The ventilated pit latrine retains all of the same advantages that the simple pit latrine has while also avoiding odors and curbing the spread of diseases by eliminating the nuisance of flies. These factors together are, by far, the largest variables contributing to the unpopularity of the simple pit latrine. Again, like the simple pit latrine, construction is easy and economical, use is self-evident, there is little maintenance required, and it does not require water to function (23).

3.2.1.2.2. Disadvantages The ventilated pit latrine suffers from many of the same limitations and problems that plague the simple pit latrines. Geographically, it is limited to smooth plots of land that are distanced from water sources; the pit needs to be emptied occasionally, which poses substantial health risks; and there is not a substantial reduction in the pathogenic load carried by the feces (28). It is important to note that although the ventilation aspect of the latrine is a substantial improvement over the simple pit latrine with regards to sanitation and hygiene, bacteria still reside within feces, and natural processes such as organic degradation fail to effectively remove

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this th r at. It is th u simp o rt n t that u s e are weary an d c au tio u s o f co nta ct w ith th e p it‘s e a rs contents (23).

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3.2.1.3. Double Ventilated Improved Pit Latrine The Double Ventilated Improved Pit Latrine (Double VIP) is not an entirely separate system, but rather an upgrade from the Ventilated Improved Pit Latrine (21). The Double VIP utilizes two pits so that while one pit is in use, the contents of the other pit can undergo natural degradation and draining (23). Initially individuals use only one latrine which funnels feces and urine into a single pit until it is filled up. Once the first pit is filled with feces, a layer of soil is placed on top such that the excrement can decompose into a sanitized, humus-like material. Users then switch over to the second pit and use it for at least one year so that the feces from the previous pit have adequate time to organically sanitize. A superstructure may be built over both holes or over each hole individually. Either way, the unused hole must be properly sealed to prevent external forces from accessing the feces (29).

Figure 3. Double Ventilated Improved Pit Latrine (23).3.2.1.3.1.

Advantages

The Double VIP retains all of the same advantages as the Single VIP with a couple of notable improvements. First, the lifespan of the Double VIP is longer because it requires less regular emptying. With the Single VIP the regularity of emptying sessions increases the

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sensitivity of the surrounding soil walls, increasing the probability of collapse (23). Second, the Double VIP is more hygienic because it allows time for soil to sanitize feces, while constantly keeping the user at a distance from the bacteria-laden ―o ut-of-service‖ p it. Las tly, th ebypro duct of fecal matter and soil, when given a year to coalesce, is a humus-like material that is suitable for agriculture. This compost can be utilized to facilitate plant growth when fertile soil is unavailable (19).

3.2.1.3.2. Disadvantages As should be expected, the creation of two holes and a larger superstructure to encompass those holes requires higher capital cost than the Single VIP. Furthermore, although the Double VIP is better at reducing the pathogenic load of feces, it fails to completely eradicate all negative forms of bacteria (29).

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3.2.1.4. The Dry Urine Diversion Toilet The Dry Urine Diversion Toilet is a simple toilet with two compartments which keep feces and urine separate. It operates on the principal that urine should be collected separately from feces to decrease the risk of spreading pathogens and to increase the decomposition of feces through dehydration (22). Feces are stored in a partition beneath the toilet, and users are encouraged to submit dry materials such as ash or soil into the feces compartment after use to decrease odors and the risk of flies (30). Urine is diverted into a container that can be used for agricultural activities. Both males and females have to sit down when using the toilet to insure that waste is correctly diverted into the appropriate chamber (4). Toilets can be made of ceramic, cement, plastic, or painted wood (23). There is a variation of this toilet that uses one vault instead of two. In the double-vaulted system, one vault is used while the other is left to dry. This drying process serves a sanitizing function and decreases the amount of pathogens in solid waste (23).

Figure 4. Dry Urine Diversion Toilet (23).

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3.2.1.4.1. Advantages Because this technology encourages submitting dry materials into the base of the toilet after use, it is less prone to odors and flies than pit latrines. For this reason, it is possible that the toilet be installed within homes, which has a positive effect on individual use and acceptance. The toilet also does not require digging large pits underground to contain waste and therefore has no adverse effects on the environment via soil and water contamination (30). Perhaps most important, however, is that the toilet allows for the use of urine in agricultural endeavors and for the reintroduction of nutrients into the environment. Also unlike its predecessors, the toilet is suitable for use in high-density areas, areas with rocky terrain or poor soil, and in locations prone to flooding (23, 30).

3.2.1.4.2. Disadvantages Because the technology is somewhat sophisticated, it requires education in order to instruct users on the importance of correctly diverting forms of waste into the correct channels. In order to solve this problem, clear instructions are usually posted within the superstructure to insure that confusion does not arise. Also, because correct diversion of waste is such an important feature, seats for children are often necessary in order to accommodate different physical compositions (22). The toilet also requires more maintenance than latrines. For example, both the urine bucket, which tends to fill up quickly, and the solid-waste compartment must be frequently emptied (23).

University of Oklahoma Evan DeFilippis Table 1. Dry Latrine Comparisons DRY LATRINE COMPARISONS LATRINE Rural application Urban application

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Cost Best anal Ease of Water to cleaning construction requirement build material Simpleexcept in wet and rocky ground Simpleexcept in wet and rocky ground

Hygiene

Fertilizer production

Pit latrine

Suitable in all areas

Not in high density suburbs

Low

None

Any

Moderate

Not easily

VIP Latrine

Suitable in all areas Suitable in all areas Suitable in all areas

Not in high density suburbs

Low

None

Any

Good

Not easily

Double VIP Latrine Dry Urine Diversion Toilet

Not in high density suburbs Suitable in all urban areas

Low

Moderately None complicated.

Any

Very Good

Yes

Low

Simple

None

Any

Good

Some

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3.2.2. Wet Latrines

3.2.2.1 Pour-Flush Latrines A pour-flush latrine combines a simple pit latrine and a conventional toilet (13). The latrine is fitted with a chamber which takes in urine and feces and funnels them through a water seal, which serves the purpose of preventing odors and flies from coming back up the pipe and into the superstructure (26). Users push feces through the water seal by pouring large quantities of water, about 2-3 liters, into the chamber until the feces have been moved up and over the water seal. Much like the VIP latrine, excreta is collected in the pit while urine leaches into the soil (23).

Figure 5. Pour-Flush Latrine (23).

3.2.2.1.1. Advantages The pour-flush la trine‘s u s e of a wate r seal is a n e ffe ctiv e me chan is mto preven t o d o rsand flies (23). Additionally, the flush method is aesthetically viable because it means that excreta are removed from sight before the next user arrives. In other variations of latrines, there

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may still be fecal residue on the base of the squatting-hole which may promote resistance to use. The pour-flush latrine is also relatively cheap to build, although significant costs may be accrued through water use (26). Maintenance is also relatively nonexistent; there are no mechanical parts, so pour-flush latrines rarely require repair (31). The pour-flush latrine also accommodates for cultures that demand anal cleansing, a prominent sociocultural request (13).

3.2.2.1.2. Disadvantages One of the greatest problems with the pour-flush latrine is that it requires the constant use of water, which may be a problem in parts of the developing world that are water-scarce (26). The water trap may also become intermittently clogged, which may require excess amounts of water to be used or external force. In these instances, users are encouraged to have dry toilet paper in order to force waste through the trap. The latrine is also not suitable in cold areas as the water seal may freeze (32). Moreover, because the use of the latrine is not intuitive, it may require education before proper use (26). From a public health standpoint, the use of water to flu shfe c e dow n th e p ip ep o s a ris k fo r d iseas e spre ad : water incre ases th e v o lu m e f th e s es o p it‘s contents, escalating the spread and dissipation of bacteria (14). Furthermore, because urine leaches into the soil when it goes through the water seal, the potential for groundwater contamination exists. In order to remedy this problem, pour-flush latrines should be distanced from local water sources (26).

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3.2.2.2 Aqua Privy The Aqua Privy is essentially a septic tank attached below any toilet-like apparatus. A down-pipe funnels waste below a water seal such that both liquid and sludge are contained in the area. An overflow pipe is installed just above the water seal such that if the volume of the tank exceeds capacity, effluent overflow is directed into a soakpit or drainage trench (19). In order to ensure that odors, mosquitoes and other nuisances are minimized, the water seal must be maintained by adding water to the toilet after each visit to replace any losses. This system is contained within an overarching superstructure to provide privacy to users (23).

3.2.2.2.1. Advantages Odors, mosquitoes and other pests are effectively reduced due to the use of a water seal (33). The construction also does not require the use of a piped water supply, so the user can expunge waste directly into the tank. It also retains the advantages of mirroring a septic tank in many ways, but it is far cheaper to construct (23).

3.2.2.2.2. Disadvantages Unfortunately, many of the advantages accrued by the aqua privy can be utilized only if the water seal is maintained. Therefore, water must be abundant on-site in order to replace any losses after use. This can be problematic in water-stressed countries. There also needs to be absorbent, permeable land to function as a soakpit to drain effluent overflow (23). The tank also requires de-sludging every 2-3 years which can become an onerous burden (19). Although the aqua privy contains and stores sludge, it does not decrease its pathogenic load. This is because the contents of the tank are disturbed after each use, preventing waste decomposition (33).

University of Oklahoma Evan DeFilippis Table 2. Wet Latrine Comparisons

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WET LATRINE COMPARISONS LATRINE Rural application Urban application Cost to build Ease of construction Water requirement Best anal cleaning material Water Hygiene Fertilizer production

Pour-Flush Latrine

Suitable

Not Suitable

Low

Requires Significant sophisticated amount building Depends— Smaller tanks are easier to build

Good

No

Aqua Privy

Suitable in all areas

Not in high density suburbs

Low

Small amount

Water

Good

No

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3.2.3. Ecological Latrines Ecosan la trin e s(e co logical s a n it n ) operate u nder th e m a nra th a t―waste is to o atio t valu a b leto was te‖ an d are not so much a specific manifestation of technology as much as a conceptual paradigm that governs the development of future sanitation systems (see Figure 7). Ecosan latrines ensure that waste is utilized to its maximum potential by harnessing the agricultural promise of nitrogen, phosphorous and potassium which are abundant in urine and human excreta (4). Some versions of ecosan even provide a solution for greywater (14). The costs of ecosan systems are relative to the complexity and preferences of the users: systems that are incredibly functional, self-maintaining, and provide the greatest environmental benefit cost more, whereas systems that cost less require more human input and have a shorter life-span (4). Ecosan recognizes the importance of containment which is a critical step to moderate the spread of pathogens. Without containment, pathogenic material can seep back into the environment through soil and water infiltration to wreak havoc on nearby populations that consume infected substances (35). The process of pathogenic communication is self-perpetuating because individuals who are sick reintroduce infected feces into the environment which can contaminate subsequent latrine users. Ecosan ends this vicious cycle by containing and sanitizing excreta through dehydration and decomposition processes (4). In dehydration, the pathogenic load of fecal material is decreased by removing the moisture which allows bacteria to thrive. Typically, this is accomplished by adding dry materials such as ash and lime which serve the additional benefit of increasing the toxicity and pH of nearby substances to stave the continuation of bacteria, viruses, and parasites (40). In order to maintain a dry environment, most ecosan systems divert urine to a separate vault where it can be used to facilitate agriculture (37). One prominent example of this type of system is the double-

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vault urine diversion toilet which has been effectively used in China, India, Vietnam, and Mexico (40, 41). In this system, urine is diverted into a separate vault which takes, on average, 6 months for the average family to fill-up (38). Urine has even proven to be successful in ranching, as it contains proteins that are suitable for cattle consumption (39). This system produces no smell, harnesses the agricultural potential of waste, and has empirical efficacy (4). The second process that ecosan systems utilize is decomposition which makes use of inherent competition between bacteria, worms, and other organisms for carbon. Competition for carbon and other nutrients prevents pathogens from flourishing and results in a breakdown of organic material (42). Soil-composting refers to an entire category of sanitation systems that harness this approach by utilizing reinforced pits that are covered with soil and ash after each use (30). Examples of effective soil-composting toilets are the Fossa Alterna and Arbour Loo which have been used successfully in Mozambique and Zimbabwe (41). Both systems eventually make use of the sanitized excrement and newly fertilized soil to grow trees or to enhance agricultural endeavors. Specifically, the Arbour Loo system has been used in Zimbabwe to grow a range of fruit trees from which the fruit can be consumed without any negative consequences (4, 41). Countries in China and Southeast Asia have been re-using waste for agricultural purposes for centuries but fail to sanitize the waste, thereby increasing the spread of disease (42). Thus, by implementing ecosan latrines in these parts, the propagation of disease can be stemmed and environmental pollution can be suppressed (14, 42).

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Figure 6. Organic/Nutrient Loop Mechanism of Ecosan (34).

3.2.3.1. Advantages Conventional sanitation is incredibly limited with regard to public health improvement and environmental management: flush latrines necessitate an overuse of water and often require complex sewage systems; pit latrines can contaminate nearby water supplies and decrease fertility of nearby soil; and even improvements on the simple pit latrine fail to avoid periodic flooding which spreads the infectious contents of the pit (4, 14, 15, 20). It is thus important to emphasize a conceptual shift in sanitation whereby waste is treated not as a perverse byproduct but as a potent environmental tool. Ecosan recognizes this importance and provides an effective mechanism to support environmental and public health management (see Figure 7). Despite the fact that professional naysayers insisted that Ecosan would be resisted in the developing world, innumerable case studies prove otherwise. There are several reasons that Ecosan is readily accepted: it offers a permanent solution unlike other sanitation systems which have short life-spans and need to be replaced annually; it offers economic benefit by increasing the productivity of soils and thus the supply of crops for farmers to sell; it is easy to use and the concept makes sense to people in the developing world who find it wasteful to squander the potential of excreta and urine; it has a n aesth e tic van tage o ver o ther latrines b ecause it ad d oesn ‘t

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attract flies , it d oes n ‘tsmell, an d is perceiv e d as more refined ; it p ro te ts wate r s u p p lie by c s utilizing a shallower pit; and it is relatively inexpensive, more than making up for capital costs through improved agriculture (4, 41).

3.2.3.2. Disadvantages Despite the lack of substantiation, some users resist the installation of Ecosan because they fear that it does not ameliorate smell issues (36). Furthermore, because Ecosan reuses waste, some cultures believe that the system is outmoded and disallowed by authorities (37). These barriers can be overcome by manufacturing aesthetically pleasing and high quality toilets in developing countries so that users conflate visual value with functional merit (4). Furthermore, there is concern from female users and perhaps some of the scientific community about the infiltration of menstrual blood into the Ecosan cycle. In some communities, the menstrual blood may contaminate urine and preclude its use in agriculture (40). By far the greatest criticism of Ecosan is that implementation and installation are expensive. Although this is true, it is unfair to compare Ecosan to rudimentary pit systems whose sole purpose is the avoidance of excreta. Ecosan is much more than a simple waste repository like conventional systems: it is both a toilet and a nutrient recycling system. Compared to other systems that can offer both functions, Ecosan is relatively cheaper (43). Ecosan also suffers from a status problem: communities in the developing world tend to perceive systems that use water as more sophisticated and thus tend to opt for pour-flush systems or water carriage toilets (43). Furthermore, most Ecosan systems are implemented in the poorest areas of the world (because these are the parts in most need of effective sanitation), which only contributes to the idea that Ecosan is a poorer quality system (4, 43).

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Odor is also a problem that affects some Ecosan systems. This problem is easily remedied by encouraging users to add ash or soil to the excreta after use which reduces smell. Thus, the odor problem is not a consequence of poor Ecosan construction but rather poor education among communities that are not aware of techniques that can be used to suppress odor (43). The size of Ecosan can pose a problem for acceptance. Many houses in areas of the developing world lack the space necessary to contain such systems (37). There is even more resistance by communities who do not live by fields and have no use for the agricultural benefits provided by Ecosan technologies (42). Given that economics is the most appealing, potent variable in Ecosan propagation, those living in peri-urban areas that have no need for the agricultural benefit provided by Ecosan tend to resist installation. This can be somewhat of a large problem because peri-urban areas are sprouting up all around the developing world and are in much need of environmentally-friendly sanitation solutions. Unfortunately, if users do not perceive a personal advantage that can be accrued, they will choose simpler, cheaper sanitation systems to use (38, 42). Lastly, there appears to be some resistance to the use of urine as a fertilizer. This is because most cultures believe that excreta have more potent agricultural capacity than urine, despite evidence to the contrary (42). Fortunately, this problem can be solved with proper education which instructs communities on the importance and proper use, maintenance, and transport of urine for agricultural purposes (39).

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Figure 7. Treatment and Utilization Options with Ecosan (47)

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3.2.3.3. Case Study: TTC Bustee, Dhaka, Bangladesh

The Ecosan concept was developed in 2002 in Nepal on a pilot basis with support from the World Health Organization after it became abundantly clear that access to sanitation facilities was not solving health and environmental problems experienced by communities in Nepal. This is because conventional latrines that were established in Nepal failed to effectively inhibit the spread of pathogens and increased the risk of environmental pollution (43). A current trend towards rapid urbanization in the South Asian subcontinent is wreaking havoc on sanitation endeavors as over 23% of Nepalese are expected to live in urban areas by 2016 (44). For these individuals and those living in rural areas, only 46% have access to sanitation facilities. However, the sanitation facilities that are in place require more water to flush down waste than is needed for human consumption (43). This is a significant problem for growing cities such as Kathmandu which is affected with a critical water crisis. Furthermore, the sanitation systems that currently exist in Nepal add a significant amount of wastewater, so much that fertile soils are dying and rivers and ponds are being used as sewage tanks (43, 44). Two projects were implemented simultaneously in different provinces within Nepal, and both were overwhelmingly accepted and appreciated by the community. After these successful pilot projects, Ecosan was spread across the country and international initiatives eventually established over 605 systems by 2007 (43). A community perception survey done in 2006 shows an overwhelming acceptance by the Nepali community for Ecosan. The survey shows near unanimity (98%) in support for expanding the technology to other countries, and incredibly high compliance rates (88%) with appropriate waste-use in agriculture. Over 60% of farmers noticed improved agricultural output after using this system, proving the efficacy of the concept (45). Furthermore, the ecosan paradigm directly complemented a historical tradition used in Nepal and

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o th e rneigh b o ri co u n tr k n o w nas ― n t s oil‖ , whereby traditionally farmers would use ng ies igh animal waste and kitchen byproducts to fertilize and condition the soil (43, 45). This acceptance of Ecosan is further compounded by statistics which show that not only do men and women approve of the system, but so to o d o ch ildren th ro u s cho o ls ‘program s wh ic h ed ucate children gh o n th e merit o f im p ro ed s a n ita tio nIt‘s interes tin g to n ote th a talth ough men an d w o m b o th v . en approve of the technology, they do so for different reasons: men appreciate the hygienic aspect of the technology, while women value the agricultural value of the system (43). The survey also gave credence to the importance of taking into account cultural preferences when implementing technology: the Nepalese prefer to use water to cleanse the anus, which limited ecosan technologies to those which incorporated pour-flush mechanisms (45). The pilot program and subsequent projects also have exhibited an interesting effect on gender roles. During the study, it was found that Nepalese communities designated males the task of emptying and cleaning out urine containers used in Ecosan, while with the more conventional pit latrine systems it was the duty of the woman to clean and maintain the components. A division of duties between males and females is a cultural norm in Nepal, and it is thus important to note that the Ecosan technology did not affect the establishment of such divisions (43). In addition, the technology has improved education for both men and women about the importance of re-using waste and the imminent threats to the environment that more conventional systems pose. This education is helping improve cross-gender collaboration on Ecosan maintenance (43, 45). The project in Nepal also necessitated the taxation of individuals so that the construction of Ecosan could be subsidized. The project had the delicate task of striking a balance between

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taxation and user acceptance, but eventually a policy was implemented that was perceived as fair by the Nepali community (45).

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3.3. Other systems
3.3.1. Septic Tanks A pour-flush latrine, as well as other latrines, has the option of being connected to a septic tank: an underground, watertight chamber that receives the waste disposed of in the latrine (14). Septic tanks function as effective storage containers for solid waste, while effluent flows into a soakpit. Septic tanks can be used in urban areas and provide an alternative to directly releasing effluent into the soil and waste into rivers. See Table 3 for a summary of the advantages and disadvantages of septic tanks.

Table 3. Septic Tank Synopsis (Information adapted from 19 and 46)

Advantages -Allows safe disposal of wastewater -Can be used in urban areas -Little maintenance -Little odor and fly problems -Possibility of later being connected to a sewer

Disadvantages -Must be emptied regularly, usually requiring a vacuum tanker. -High cost of construction -Requires large volumes of water for flushing -Susceptible to overflow issues - Must be built next to permeable soil to ensure effluent absorption; increases risk of groundwater pollution

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3.3.2. Greywater management Greywater refers to wastewater that is generated by domestic processes. It poses a risk to both humans and the environment because of its potential to carry pathogens. Rather than simply disposing of greywater, individuals can actually use the greywater for irrigation. Although this process has strict guidelines codified by the World Health Organization, it is a better alternative than simply wasting the greywater (14).

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4. Choosing Appropriate Technology: Barriers and Considerations
The utility of sanitation systems depends largely on selecting the appropriate technology to accommodate for geographical, financial, social, and institutional concerns (14). In order to effectively select the right technology, environmental concerns such as groundwater pollution must be addressed by assessing data on hydrogeological conditions. Along with selecting technologies congruent with environmental restrictions, community preferences must also be acknowledged. These preferences include having technologies that permit anal cleansing, having aesthetically pleasing technologies, having technologies that require little maintenance and require minimal construction costs, etc. In many instances, communal preferences will take precedence over environmental concerns (48). The factors of greatest priority can be categorized into technical, environmental, institutional, financial, and community factors (50). Technical factors to be considered are the design preference, including the form of the seat and the superstructure, the lifetime of the technology, the availability of construction materials, and the cost of construction. Environmental factors include the quality and composition of the soil and its susceptibility to pollution or leaching, groundwater level, pre-existing status of environmental pollution, the availability of water, and the potential of flooding. Institutional factors include pre-existing governmental sanitation strategies, availability of workers that can be used in the making of sanitation projects, and the potential involvement of the private sector. Financial factors involve any potential obstacle to effectively financing sanitation technologies. These factors include status quo public and private sector investment, availability of subsidies, community-based financing initiatives, etc.

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Community factors are abundant and can be divided into five subcategories: sociocultural factors; motivational factors; discouraging factors; social organization factors; and other factors. Potential sociocultural barriers include taboos, cultural habits, religious convention, preferred posture, disposition towards human waste, and gender-roles. Potential motivational barriers include convenience of use, privacy, status, health, and ownership. Discouraging factors include fear of darkness, fear of falling into holes, disgust with smell and/or insect nuisances, and fear of the sanitation technology breaking down. Social organization factors include the role of preexisting community leaders, the role of teachers with regard to encouraging sanitation policies, and the role of permanent public health workers. Other factors to be considered are population density, ground space for latrine implementation, and the size of roads (14, 48, 49, 50). In this section, we will cover the technical, institutional, and financial factors concerning each type of community in depth. Given the wide variability between different cultures, societies, and communities, environmental and community factors will be only generally covered.

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4.1. Unplanned, High-Density Urban Settlements For the first time in history the majority of individuals around the world live in urban areas (51). In these large urban areas, between 25%-50% of the population lacks access to sanitation technologies (14). Unplanned urban environments refer to the heavily populated settlements that arose without expectation (see Table 4 for more information). For this reason, access to a sewerage system or institutional sanitation support is impossible. Because there is a lack of clean water, people will either collect water from polluted rivers and streams or purchase water from unverified vendors selling water of dubious origin (52). In these urban areas, the streets are often turned into wastelands where open defecation and urination are regular happenings (14, 52). Slum dwellers make up 43% of the urban population and account for the majority of people who lack access to sanitation. Further complicating the issue is the fact that slum dwellers typically are unable to pay for sanitation technologies (14).

Table 4. Unplanned Urban Settlement Overview (adapted from 64)

Unplanned, High-Density Urban Settlements Overview 300-2000 persons per hectare Population Density Average household size 5-6 persons 20-40 liters per capita per day Water consumption Sources of wastewater Kitchen, laundry, showers, sanitation blocks, pit latrines, informal business and cottage industries

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4.1.1. Technical challenges Due to the constrained availability of water in high-density urban areas, dry latrines are the most appropriate option (14). In India, for example, it is estimated that by 2050, half of In d a‘s p op uatio n w ill b e liv in g in u rban areas and w ill face acute water problems (53). In i l slums, where homes can be less than 10 m , private toilets are not feasible. Wherever there are space constraints, community-based sanitation that utilizes a network within houses is viable. However, many international agencies have cautioned against the use such shared sanitation options because empirically users have failed to maintain the technology. Studies have shown that confusion over ownership is to blame for failure in maintenance (14). Given that dry latrines are the most technically feasible technologies, development projects must consider the mechanism by which waste is to be transferred and disposed of. WaterAid has found that the most effective technology is a vacutug, functionally a vacuum on wheels designed to create pressure within pit latrine holes and suck up waste. Given the narrow streets of heavily populated urban areas, a smaller, portable version of the vacutug may be necessary. One such version is currently being piloted by WaterAid and has a capacity of 200 liters. Users are to suck up as much waste as possible and transfer it to a larger, 1500 liter tanker that can be used to transfer waste to its final destination (54). The necessity of transportation systems raises other, technical and institutional problems that need to be addressed. For example, in many developing countries, collection facilities are underdeveloped, which means that waste emptied by tankers would go untreated and could eventually ferment dangerous bacteria (14, 54). Even if there are developed collection facilities, they are often far away from the slums, which increases transportation costs (54). In order to remedy this problem, a decentralized approach whereby
2

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smaller treatment facilities are constructed closer to points of use is preferable to a single large facility (63). Another significant factor is the issue of land-rights in urban areas (54). The people living in unplanned urban areas typically are housed in large slums that do not legally belong to its inhabitants. Governments are therefore hesitant to recognize the legitimacy of such settlements and thus refrain from providing public sanitation services (52). Furthermore, because these communities tend to be transient and fear eviction, household and private sector investment is depressed. What is worse is that the residents of these communities are often evicted if the land they occupy becomes lucrative. For this reason, residents may resist international sanitation assistance for fear that such developmental action would boost the marketability of the land for authorities to sell (54). The below case study is one such example.

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4.1.1.1 Case Study: TTC Bustee, Dhaka, Bangladesh TTC bustee is an unplanned slum bordering roads in Dhaka. TTC is adjacent to a residential compound known as the Colony which houses post office staff and oversees affairs of th e b u s te . O n e of WaterAid‘s partners engaged in c o m m uity d is c u s s io n s ith oc cu pan ts o f e n w th e bustee in order to address imminent sanitation concerns. Cooperation was nearly unanimous. Through extensive discussion, it was revealed that the community demanded improved sanitation not because of perceived health benefits but because of the social advantages new technologies could offer: privacy, convenience, aesthetics, etc. Individual latrines were an impossibility due to size constraints, so a community-based sanitation structure was designed that would accommodate community preferences: separate washing area for women, division between men‘s and women‘s sections, hand-washing station, good ventilation, and little maintenance and operation requirements. The finished design was approved by the Dhaka City Corporation (DCC) and the Dhaka Water and Sewerage Authority (DWASA), both of which oversee developmental projects. The Colony community resisted the implementation of sanitation technologies arguing that such intervention would legitimize the legal existence of the bustee. Due to such complaints, the TTC bustee was forcibly evicted without any prior warning or plan for relocation (54). WaterAid has since engaged in high-level communication with DCC, DWASA, an d th e District Co mmissio n e office an d hav e nego tiate d a p olicy where r‘s families are permitted to return the bustee and are given access to the newly-built sanitation facility (55).

Fortu n a ely, WaterAid‘s partners have coord in t ated o n o th e r roe cts where they p j successfully proved that people living in these high-density populations are accountable for sanitation technologies and will pay their water bills, disproving the myth that slum residents are

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unaccountable (52). WaterAid has outlined a couple of potential solutions to the land tenure issue: 1. Legalize the slum communities- This would recognize the legitimacy of community members and allow for the provision of public services such as sanitation. Unfortunately, this tends to boost the desirability of living conditions, making the community attractive to middle-class residents who displace poorer residents. Legalization may also be fraught with resistance as municipalities are hesitant to recognize these slums because many are prone to environmental disasters like flooding (52). 2. Private sector participation- Private sector participation is advocated by the World Bank and other international organizations with the idea that private sector involvement can: a) address the lack government investment in sanitation and rehabilitate old systems; b) improve the efficiency of water services delivery; and c) allow the government to deal on actual governmental obligations rather than running a service (53). It is suggested that the private sector will be able to see the potential profitability of catering to poor slum communities and is likely to address sanitation concerns without regard to the legal status of such communities, caring only about the perceived permanency of the settlements (52). Current statistics show that public sector provision of services is woefully inadequate, with many countries investing only 1-2% of their GDP to water services. To reach their Millennium Development Goals, many countries will have to invest $11-25 billion in sanitation endeavors alone for the next 12 years. This is a feat seems like an impossibility without private sector participation (53). The main criticism offered by opponents of private sector

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participation is that basic human rights, like access to water, should not be commodified, and that poor people will be unable to afford expensive water services. However, studies show that the poorest of the poor are currently paying more for their water from dubious water vendors than are middle-class residents who get their water from a piped water supply (53). 3. Working together- Local communities and municipal governments should work with each other to create collaborative policy solutions that ensure that each voice in the community is heard. Municipal governments should also advocate on behalf of their communities to non-governmental organizations (NGO) to ensure that the poorest of the poor have a vehicle through which to communicate needs (52).

4.1.2. Financial Challenges Underinvestment in sanitation services is one the main reasons that sanitation in urban areas is rarely available (14). Community-based federations in more than 20 nations have risen to the cause to improve infrastructural problems. These federations are representative organizations that are formed by the urban poor to work with local and national governments to address sanitation needs. These federations are large and work within and between communities to address sanitation issues affecting each household. Over the last decade, these federations have become transnational in nature and have demonstrated their capacity to work with local and nongovernmental organizations to facilitate developmental projects. These communities help to inject quick, short-term funds for those communities in need of immediate relief. Therefore, international assistance should focus on developing these federations to provide for the possibility of financial relief. For residents who are not reached by these federations or are without an ability to pay for them, government subsidies or grants can be procured to incentivize

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maintenance of sanitation technologies (57). Because of the lack of money available in many urban areas, dry latrines—which are the least expensive of the latrines—may be the most viable option (14).

4.1.3. Institutional Challenges As stated before, governments and international institutions should reaffirm and strengthen preexisting community efforts for water sanitation. Unfortunately, community-based federations do not take responsibility for waste-water treatment, leaving the burden on municipal go vern m ts. T h u s ,it s h o u ld e th e m u n ic ip govern m t‘s to p p rio ri to fund and coordinate en b al en ty projects that can implement wastewater treatment technologies (14). A primary institutional necessity is one of capacity building characterized by the strengthening of knowledge, skills, and attitudes of individuals and organizations within communities (58). Institutional capacities allow an organization to swiftly and adequately resolve problems and harness opportunities (59). UNU-INWH established 4 tenets of capacity building that are required at the community, state, and federal levels (60): 1. ―Educate and train, including community awareness building, adult training, and formal education, so as to provide sufficient numbers of competent human resources to develop an d ap ply enab ling system s .‖ 2. ―Measure and understand aquatic systems, through monitoring, applied research, technology development, and forecasting, so that reliable data is used for analysis and decision-making.‖

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3.

―Legislate, regulate and achieve compliance through effective governmental, nongovernmental and private sector institutions and through efficient enforcement and community acceptance.‖

4.

―Pro vid eap p ro priate an d affordab le w ater infrastructu re, s ervic es a n d products through sustained investment and management by both private enterprises and public agencies.‖

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4.2. Planned, High-Density Urban Settlements Planned, high-density settlements typically exist in the center of cities and are usually home to large commercial operations (14). They are tenured settlements with formal title deeds (64). Table 5 below summarizes key information:
Table 5. Planned Urban Settlement Overview (adapted from 64)

Planned, High-Density Urban Settlements Overview Depends on whether the development is a high, Population Density middle, or low income area. The lower the income, the greater the density Average household size 4-5 persons Depends upon income strata and water availability Water consumption Sources of wastewater Kitchen, laundry, showers, sanitation facilities 4.2.1. Technical Challenges All of the technologies discussed in Section 4 are appropriate for these settlements (14). Unfortunately, local policy makers typically choose conventional technologies because they are not aware of alternatives (61). Dry toilets should be considered as a viable option when adequate space is available. Environmentally sound dry latrines, such as urine-diversion toilets, may be used in apartment buildings, with basement vaults as waste storage facilities. If water-borne toilets are used, low cost sewerage is required because there is usually not enough land to permit on-site disposal. Fortunately, low-cost sewerage is available which can be installed in backyards or under side-walks (14, 62). For high-income, planned urban settlements, septic tanks with connections to small-bore sewers are typically suggested. This system could eventually become part of a communal sewer system. Unfortunately, some local regulations limit the choice of systems and may force sanitation options that are incompatible with environmental endeavors and user priorities (64).

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4.2.2. Financial Challenges Planned, high-density urban settlements have the greatest success in harnessing funds for sanitation from loans and private investment, although these areas are notorious for failed sanitation projects due to financial collapse (67). This is because the typical technologies used in these areas are expensive, and residents cannot pay back loans, causing project failure (68). A multiplicity of finance options is available due to the diverse nature of planned urban settlement residents. In order to fund sanitation, governments have used many different mechanisms such as taxes, grants, cross -sub sid ies, a n d ―lifeline‖ rates (6 5 ,6 6). Long-term sanitation has proven most effective when there has been a continuous stream of external funding (69).

4.2.3. Institutional Challenges Inadequate institutional capacity is frequently cited as the biggest impediment to sanitation success (69). As explained in Section 4.1.3., institutional capacity is crucial to problem resolution. One such problem is that outdated public policies make it unaffordable for the private sector to reach out to poor communities. Therefore, strong government oversight and political change is crucial to ensuring private sector involvement in poor communities (14).

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4.3. Peri-urban Settlements Peri-urban centers are small urban locations with medium populations which exhibit characteristics of both urban and rural areas (14). As of 2000, 53% of the people living in a global urban population were living in communities with less than 500,000 people, and the expansion of sanitation has failed to keep pace with the rate of growth (73). Peri-urban areas are characterized by uncertain tenure, minimal or no infrastructure, low incomes, and lack of recognition by formal governments. Because of the sheer size of peri-urban populations, municipal governments tend to ignore them, overwhelmed by the needs of the populations (74).

Table 6. Peri-urban Settlements Overview (adapted from 64)

Peri-urban Settlements Overview 100 - 300 persons per hectare Population Density Average household size ~5 persons 40 - 60 liters per capita per day Water consumption Sources of wastewater Kitchen, laundry, showers, sanitation facilities, informal businesses and cottage industries 4.3.1. Technical Challenges All of the technologies discussed in Section 4 are viable for the peri-urban sector, although selection of technology will depend on housing density and other factors; for communities with a high population density, simplified sewerage may be desirable, but for smaller communities, on-site disposal options may be most attractive. Most peri-urban areas are also developed on geographically undesirable areas (along gullies and ravines, rocky terrain, or steep slopes), because those locations tend to be least expensive to purchase and are thus attractive to poor individuals looking for cheap housing. Furthermore, the legality of tenure is unlikely to be challenged when there is no motive for residential construction in those areas by the government (74). Given the tendency for peri-urban areas to be geographically tenuous, it is

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important to select a technology that is resistant to environmental anomalies, such as technologies that are installed above ground. Latrines are usually insufficient for a number of reasons: they are inadequate for high-density peri-urban areas; there is usually not enough land to re-dig holes when old ones fill up; multistory housing which typifies peri-urban community living is unsuitable for latrines; and nearby groundwater runs the risk of contamination. Even water-based latrines can be problematic in areas with strained water supplies (74). Many traditionally low -co s t tech n o lo ies are cons id e ―low-co s t‖o nly be c a s e their g red u capital costs are low. Engineers and policymakers rarely factor in the labor necessitated for maintenance and use of the technology when determining appropriate technology. However, in peri-urban areas where entire families are expected to work whole days just to make enough money to satisfy basic needs, time is invaluable and cannot be wasted on frivolities like repairing and constructing latrines. It is therefore important to consider technologies that have high capital costs but low maintenance and labor force requirements (14, 74).

4.3.2. Financial Challenges Private investors tend to avoid financing sanitation projects in peri-urban areas more so than urban areas because it is difficult to establish an economy of scale, and the smaller population provides less lucrative opportunities. The unfortunate irony is that peri-urban areas require the most funding because the technology in these areas tends to be expensive to accommodate for the terrible physical terrain on which communities live (75). Research also shows that smaller peri-urban areas have less accountable municipal governments which are unlikely to get fiscally involved in sanitation policies (67). It has been shown that microloans can stimulate demand for sanitation and lead to rapid dissemination of technology throughout

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peri-urban regions (14). However, loans and credit programs have notable drawbacks: high transaction costs, lengthy approval processes, high interest rates and loan security requirements, legal land registration, mortgage requirements, and an insufficient number of personnel allocated to serve customers in low-income brackets, etc. (75). Fortunately, these drawbacks have been o verco m eby NGO‘s in m any in stances (see Figure 8).

Two NGO Loan Success Stories
CHF and UNICEF Provide Options for Peri-Urban Sanitation In Honduras, the Cooperative Housing Foundation (CHF) and UNICEF hope to improve unhealthy sanitary conditions through a sanitation loan program for low-income families. The program aims to increase interest in using credit to make sanitation improvements, and to raise awareness of the need for better environmental sanitation. Loans are available to participating families to build shower stalls, construct water storage tanks and wash stands, implement rooftop rainwater collection systems, or make other improvements, such as devising an appropriate way to dispose of human excreta. People have the option of building alternatives to simple pit latrines, including ventilated improved pit (VIP) latrines, dry compost latrines, and pour- flush toilets. Loans also can be used to make a legal connection to a city‘s waterb o r e n sewerage system when possible. By offering a variety of options in a broader price range and linking them to well-managed credit programs, CHF and UNICEF hope to increase the demand for urban sanitation. Original Printed in Source: Ref. 77 Seen in Ref. 75 Grameen Bank: Sanitation Loans for the Poor The Grameen Bank has gained international acclaim for its novel approach to economic development and poverty reduction in Bangladesh—making small loans at commercial rates to groups of poor people in rural areas. Today, it has nearly one million borrowing members in over 24,000 communities; nine out of ten borrowers are women from families that are landless and without assets. Each individual who receives a loan must agree to the ban k ‘s"Sixteen Principles ,‖ one o f which states, "We will not defecate in the open. We will use pit latrines." To date, more than 100,000 latrines have been financed. A subsidiary loan program also has been developed through which a latrine can be purchased with a US $14 loan repayable over a one-year period.

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Original Printed in Source: Ref. 78 Seen in Ref. 75
Figure 8. Two NGO Loan Success Stories (75, 77, 78)

However, in order to assess the appropriate financial mechanism, policymakers should assess the willingness of community members to pay for sanitation technology through a survey, which is typically distributed in urban areas with fruitful returns. Figure 9 elaborates on the important qualities of a Willingness-to-Pay survey (76).

Important Components in a Willingness-to-Pay Study
A well-designed willingness-to-pay study will achieve the following: • Assess household decision-makingan d res ource allo catio n , giv e n users ‘ limited time and money. o What types of technologies do people want? o What are they willing to pay to build, operate, and maintain a system? o Who within the household makes the decisions? o Who controls the resources? Determine the financial resources available from the user group, and for what use they are intended. Clarify cost recovery issues. o How are costs to be divided among users? o What is the acceptable time frame for cost recovery? o What subsidies, if any, are needed? Define the appropriate level of service based on technical and institutional options, recognizing that the design process takes time and requires user participation.

• •

Source: Whittington et al. 1992.
Figure 9. Willingness-to-Pay Survey (76)

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4.3.3. Institutional Challenges Two problems arise from inadequate institutional capacity within peri-urban areas: limited financial investment, and decreased technical capacity. With regard to financial investment, governments tend to see fewer returns on investment in sanitation and invest in other areas (67). It is therefore important to educate governments on the indirect costs of inadequate sanitation: environmental degradation, economic losses, diseases, water insecurity, etc. (14). With regard to technical capacity, governments tend to have a very small base of expert consultants that can communicate local problems and generate informed solutions. Without experts that understand local context, decision making is informed by intuition and generic research that is inappropriate for addressing specific concerns (67).

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4.4. Rural Settlements Rural areas are on the decline in most parts around the world (51). Central Asia and Eurasia have the greatest proliferation of rural populations, where the need for sanitation outpaces that of even urban areas (79).

4.4.1. Technical Challenges Fear of groundwater pollution is the biggest obstacle to effective sanitation in rural areas. It is therefore important that on-site sanitation technologies that do not require damaging water tables be utilized. Urine-diverting latrines are the best option because they are stored aboveground and they can facilitate agriculture through its nutrient recycling mechanism. The other major factor hindering sanitation projects is the inability for communities to maintain technology. Project failure is most often the cause of inadequate local knowledge about operation and maintenance requirements. It is thus important that communities be educated and trained appropriately (14).

4.4.2. Financial Challenges Demand in rural areas for sanitation technologies is low and therefore there is little targeted support from the private or public sectors. In order to defray the costs of technology, volunteer labor in rural areas has been shown to reduce costs of installation. Much like other demographic areas, access to credit may be the most viable financial stimulation mechanism, as proven in sub-Saharan Africa (7).

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4.4.3. Institutional Challenges Out of all the demographics, rural areas have the worst institutional oversight and capacity. In order to compensate for the lack of institutional intervention, community-based projects are prevalent. However, these community-based projects are often fraught with problems that limit the scope of sanitation projects, such as lack of financing and technical problems. It is therefore important for government institutions to take responsibility for the financing and oversight of sanitation development in rural areas (7).

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4.5. General Factors to Consider 4.5.1. Typical Community Factors The most common cultural factor that inhibits effective sanitation is a taboo associated with defecation. There is often a sense of shame experienced when individuals in parts of the developing world are encouraged to discuss the subject. Unfortunately, this self-imposed restriction on communication inhibits nuanced sanitation approaches, and only perpetuates archaic practices that are known for their poor track record. In many cultures, women are not supposed to be seen outside their homes, a fact that speaks to the necessity for certain in-home technologies. Although women express a private interest in having a latrine, the sensitivity of the subject makes it difficult for them to communicate their need to males who decide on whether a toilet is installed in the house or not (70). Certain sanitation systems such as composting toilets and bucket latrines require wastehandling, which, in many cultures, is frowned upon because of the stigma associated with excreta. For many cultures, waste is to be disposed of immediately without regard to re-use. If this is the case, it may be necessary to opt for technology that does not require wastehandling (71). The material used for anal cleaning also affects selection of appropriate technology (14, 71). If dry latrines are used, water is typically not the main resource that people use for anal cleansing. Rather, individuals tend to use materials such as sticks, stones, corn cobs, and mud balls. If water is used it is important that the soil on which the latrine is built be permeable. This way, water can seep into the ground, rather than building up in the pit which can displace pit contents. Wherever water is the preferred resource for anal cleaning, a wet latrine is necessitated. For this reason, coastal communities tend to prefer wet latrines (72).

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Privacy requirements are another important consideration, as many different cultures experience shame when observed defecating by others (72). The World Bank has isolated three approaches to design communal sanitation blocks in order to keep privacy in mind. The first is to develop a public system, in which any user can enter any toilet compartment that is vacant. The second is to provide an independent cubicle within the community sanitation development that is for the exclusive use of one household. The last approach is the combination of the first two types, in which a large communal sanitation block is provided but reserved for the exclusive use of one large group (80). A common discouraging factor is the belief that certain diseases, which arise from a lack of sanitation, are inevitable. Communities may therefore be unpersuaded by claims that new technologies will offer considerable health improvements. For many people, an understanding of the link between sanitation and disease is unclear. Therefore, projects that attempt to propagate sanitation technologies by focusing on their health aspect are often unsuccessful in maintaining user interest. Instead, case studies have shown that aesthetics play a far more powerful role than the practical aspects of sanitation technology; the cleaner and better the condition of technologies, the more it is viewed as a positive, effective system. The most common community factors that influence the willingness of sanitation adaptation are summarized below (taken directly from 70):

• • • • • • • • • •

Level of income Costs of technology adopted Financial arrangement for implementation Beliefs and expectations about sanitation project implementation Caution in investing scarce funds Opposition from local leaders Limited interest in improvements Inadequate administrative procedures Lack of understanding resulting from inadequate communications support Unfilled expectations

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• • •

Delays in project expectation Lack of agency support in providing services for maintenance and toilet emptying Lack of agency involvement in training and promotion

4.5.2. Typical Environmental Factors Environmental factors such as water availability, soil conditions, groundwater depth, potential for groundwater pollution, and population densities must be considered when choosing appropriate technology. Water availability is a key factor in deciding the viability of wet latrines, because without a reliable source of water, wet latrines are impractical. Soil permeability is another important factor. Soils low in permeability are unsuitable for pit latrines because effluent is unable to leech into the soil. Furthermore, the stability of the soil reflects the stability of the pit. The less stable the surrounding soil, the greater the need for protective pit lining within the latrines. Furthermore, groundwater level is another factor that must be considered. The higher the groundwater, the more difficult the construction of a toilet becomes and the greater the risk of groundwater pollution. Population density is another important factor, as the greater the density the less the space available to construct toilets (70). In areas of high population density, shared, community-based sanitation options are most viable (14).

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5. Conclusion
This goal of this paper was to elaborate on the magnitude and scope of the sanitation crises while articulating the challenges and opportunities of various situations around the globe. The population of individuals without sanitation is enormous, despite the fact that developed countries have the means and will to provide technology to countries in need. The problem, therefore, seems to be one of mutual naiveté on behalf of donor and recipient countries. Donors are often unaware of the geographic, cultural, social, and environmental issues that hinder sanitation development and are likely to prescribe solutions that are incongruent with the needs of developing countries. Recipient countries are often plagued with a misunderstanding about the relationship between sanitation and disease and are likely to put up unwarranted resistance to sanitation technologies. Donor countries often operate from many fallacious presumptions which prevent long-term implementation: they assume countries have strong institutional and financial sectors; they presume that developing countries are aware of the requirements necessary to maintain and operate technology; and they often try to sublimate their own cultural and social values onto other countries with their choice in technology (14). Clearly, there is a need for mutual communication and understanding between both the host and recipient countries. In order for any project to be sustainable in the long-run, it is important that developing countries invest in themselves, stabilizing and strengthening their own institutional capacity, financial ability, and technical skills. It is also important that recipient countries consider the value of ecosan technologies, even if they are at first turned off by the idea of re-using waste. The merit and advantages of such technologies are enormous and can be used to address numerous concerns afflicting developing countries, other than sanitation issues. There is not a

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one-size-fits-all approach to sanitation, and it is important that the factors outlined in this paper are contemplated with caution before selecting an appropriate technology. This understanding is important if developing countries wish to reach Millennium Development Goals and improve the lives of their populations.

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6. References
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78. UDNP. 1992. Matching Technology to People’s Needs and Means. 79. Rockstrom J, Axberg G, Falkenmark M, Lannerstad M, Rosemarin A, et al. 2005. Sustainable Pathways to Attain the Millennium Development Goals: Assessing the Key Role of Water, Energy and Sanitation. Stockholm, Swed.: Stockholm Environ. Inst. 80. McGill University. 2006. Essential Factors for the Provision of Sanitation Systems in Coastal Communities. http://www.mcgill.ca/mchg/student/sanitation/chapter6/#N_12

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