Which way’s up? – a closer look at the sanitation ladder

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Now that the first year of the Sustainable Development Goals (SDGs) is almost over, it’s no surprise that a lot of the conversation at the UNC Water and Health Conference this week has centred on how WASH-related targets (mostly within Goal 6) will be met and, in particular, how they will be monitored. The complexity (and sheer number) of targets appear to be nothing short of a monitoring nightmare, but one which many in the field have enthusiastically embraced as an opportunity to build on previous monitoring processes.

Representatives from the WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP) kicked off the week with a presentation focused on the sanitation and hygiene targets. Of note is the introduction of a clearly defined ladder for reporting on the progress of hand washing - notably absent in the MDGs.

Most of the discussion was focused on the sanitation ladder and in particular the renaming of the category ‘shared’ to ‘limited service’ (at least, within the presentation!) which re-opened a long-standing debate about shared sanitation facilities. I recall a heated session at the 2014 WASH Conference in Brisbane, Australia, convened by Catarina Fonseca (IRC). On one side, shared WASH facilities - both water and sanitation - were deemed inappropriate and unsustainable due to the lack of a sense of ownership (and therefore maintenance) by users. On the other side there were various arguments about ‘shared facilities’ being better than ‘no facilities’ and stories of places where shared facilities were successful (for example, the public toilets run as a small business by women’s groups with the Asha program in Delhi slums).

Shared facilities are still in their own separate rung (below ‘basic service’) on the sanitation ladder of progress toward the sanitation-related SDGs, indicating there is still hesitation to consider shared services fully appropriate or sustainable. A point raised in several presentations throughout the week was that shared sanitation is quite common but it is rarely measured in monitoring and evaluation and even then, the type of sharing is almost never measured. Surely it makes a difference whether a toilet is being shared between 2-3 households or 20 households? Interestingly enough, when sharing was mentioned throughout the conference, I never got the impression that it was considered an inappropriate option; and indeed, many presenters considered shared facilities as improved. As one attendee pointed out, in slum communities where people live in single-roomed rented dwellings, shared toilets are the only improved sanitation option (without rehousing people), hence the previous JMP definition of an improved sanitation system is somewhat limiting. The promotion of shared sanitation to ‘limited service’ was therefore warmly welcomed, particularly as this gives implementers some leverage to advocate for shared sanitation systems to governments and donors.

Dr Jamie Bartram, Director of the Water Institute at UNC, offered an interesting challenge to the sanitation ladder as it is currently conceived in the sanitation field generally (not just by the JMP), suggesting that perhaps it is too narrow a perspective of sanitation outcomes. The sanitation ladder is designed with the perspective of the user in mind, that is, ‘where am I going to take a crap today?’. ‘Will it be behind a bush or in a simple pit or on a flushable toilet?’

The problem with this is the focus on the users’ experience of defecating and doesn’t tell us about the environmental sanitation status of the system. A user who previously defecated in a simple pit but now defecates in a flush toilet probably feels that they have moved up the sanitation ladder. However, if the flush toilet drains directly to an open sewer, or alternatively to a septic tank which gets emptied regularly but by a collector who dumps the waste into a river then this is unlikely to be safer overall than a simple pit latrine and should therefore be considered a step down the ladder. For this reason, Jamie argued, it’s great to see the SDG target 6.2 which includes improved sanitation right next to 6.3 which is about improving water quality by reducing wastewater pollution.

I think the Shit Flow Diagram (SFD) (which got a regular plugging by Professor Barbara Evans of Leeds University this week!) is part of an effective response to the dilemma raised by Bartram. At least in the context of urban sanitation systems, the SFD gives a clear picture of sanitation status or service from the environmental sanitation perspective by plotting the pathways of faeces at different points including containment, emptying, transport, treatment and end-use or disposal (see picture attached). Hopefully information from tools such as the SFD will be combined with rungs on the sanitation ladder to construct a more holistic picture of sanitation status in various settings.

It will be interesting to see how the final JMP monitoring framework for sanitation (and indeed other forms of the sanitation ladder) will take both the users’ experience as well as the environmental sanitation perspective into account with baseline data expected to be released next year – not an easy task, but one which the JMP team are embracing wholeheartedly.

Naomi Francis is a PhD Candidate at the Nossal Institute for Public Health at the University of Melbourne.

Date: 14 October 2016