WATER AND SANITATION PROGRAM: WORKING PAPER

Targeting the Urban Poor and Improving Services in Small Towns Fecal Sludge Management Services Diagnostic and Decision-Support Tools: An Overview

Isabel Blackett and Peter Hawkins

August 2016

CONFERENCE EDITION

The Water and Sanitation Program is a multi-donor partnership, part of the World Bank Group’s Water Global Practice, supporting poor people in obtaining affordable, safe, and sustainable access to water and sanitation services. This document is an output of a World Bank study led by Isabel Blackett and Peter Hawkins. World Bank team members Zael Sanz, Ravi Joseph, Chris Heymans and Guy Hutton also contributed their expertise. Special thanks to the consultancy teams from Oxford Policy Management (OPM) and WEDC at Loughborough University, led by project manager Ian Ross, technical lead Rebecca Scott, and Ana Mujica, Zach White and Mike Smith.

The Water and Sanitation Program is a multi-donor partnership, part of the World Bank Group’s Water Global Practice, supporting poor people in obtaining affordable, safe, and sustainable access to water and sanitation services. WSP’s donors include Australia, Austria, Denmark, Finland, France, the Bill & Melinda Gates Foundation, Luxembourg, Netherlands, Norway, Sweden, Switzerland, United Kingdom, United States, and the World Bank.

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© 2016 International Bank for Reconstruction and Development / The World Bank 1818 H Street NW Washington DC 20433 Telephone: 202-473-1000 Internet: www.worldbank.org Targeting the Urban Poor and Improving Services in Small Towns Fecal Sludge Management Services Diagnostic and ­Decision-Support Tools: An Overview

Isabel Blackett and Peter Hawkins

August 2016

CONFERENCE EDITION Contents

Introduction...... 1 Overview of the Tools and How They Fit Together...... 2 Diagnostic Tool 1: Fecal Waste Flow Diagram...... 4 Diagnostic Tool 2: City Service Delivery Assessment...... 6 Diagnostic Tool 3: Prognosis for Change Assessment...... 8 Decision-Support Tool 4: Service Delivery Action Framework...... 10 Decision-Support Tool 5: Technical Intervention Options Assessment...... 13 Complementary Tools...... 15 Integrated Design Approach for Treatment...... 15 Public Health Risk Assessment...... 15 Urban Sanitation Status Index...... 16 FSM Costing...... 16 References...... 18

Figures 1: The Sanitation Service Chain...... 2 2: How the FSM Tools Fit Together...... 3 3: City-Wide Fecal Waste Flow in Lima, Peru...... 5 4: Fecal Waste Flow Diagram for Informal Settlements in Lima, Peru...... 5 5: City Service Delivery Assessment in Balikpapan, Indonesia...... 6 6: Interlinked City Service Delivery Assessment and Prognosis for Change Process...... 7 7: Three Key Concepts in Prognosis for Change...... 8 8: Process Map for Dhaka, Bangladesh...... 9 9: Correlation Between Open Defecation and Child Stunting...... 15 10: Examples of USSI Output Maps for Spatial Prioritization in Maputo, Mozambique...... 16

Tables 1: Summary of Tools and Their Objectives...... 3 2: Service Delivery Action Framework...... 11 3: Resulting Prioritized Actions: Illustrative Example for Dhaka City...... 12 4: Technical Intervention Options for Different System Types: FSM in Dhaka Slums...... 14

iv Targeting the Urban Poor and Improving Services in Small Towns

Introduction

Addressing the need for appropriately conceived and imple- ipal and community action, with limited acknowledgment mented fecal sludge management (FSM) services from on- that tackling the challenges will require substantial external site sanitation systems is critical to improving sanitation support—from other levels of government and/or through services in urban areas. A preliminary review of the status of investment projects, for example. The tools summarized FSM in 12 cities, drawing on secondary data, led to the here take these factors into account, and aim to help stake- adoption of some draft diagnostic tools and the proposed holders consider how to develop urban sanitation services development of others (Blackett et al. 2014). Building on that safely manage the large amount of fecal waste which is this, and using extensive primary data from five cities (Balik- not discharged into sewers. papan, Indonesia; Dhaka, Bangladesh; Hawassa, Ethiopia; Lima, Peru; and Santa Cruz, Bolivia), a series of diagnostic These tools are primarily intended for carrying out a sanita- and decision-support tools have been developed to inform tion situation diagnosis and the preliminary selection of the design of FSM intervention options in the context of intervention options, bringing a focus to each element of the the economic and political economy realities cities face. sanitation service chain (see Figure 1). They will be particu- larly useful at the project identification and preparation stage. This document provides an overview of the tools and how they might be used, and also provides links to other However, much of the data collected will also be useful in resources. The outputs of these tools are targeted at govern- the design of interventions. While some of the tools are ment decision-makers, development organizations, service applicable to urban sanitation as a whole, others are specific providers/utilities, and city/municipal authorities. An to FSM. In addition to the tools, a number of policy recom- increasing number of urban sanitation toolkits to guide mendations on FSM emerged from the work, including: decision-making at the city level already exist, but most of • FSM must be included in national policy and them do not focus specifically on FSM, nor do they address funding arrangements, complemented by city-level political economy issues. They also tend to focus on munic- sanitation planning systems, and bylaws that oblige both households and service providers to play their part in delivering a complete sanitation service chain. • The private sector has a crucial role to play, but CONTEXT needs incentives, technical assistance and access to • This document provides an overview of diag- safe disposal sites at economical distances from col- nostic and decision-support tools developed for lection areas. urban fecal sludge management services. Find • Clear definition of institutional roles, enforceable the tools online: worldbank.org/fsm regulations, and effective planning, budgeting and • Each tool is presented with an example based monitoring processes for FSM are essential. on primary data and an explanation of how its • Smart, targeted subsidies for poor customers will output can inform program design usually be needed in order to realize the potential • As each city and each country is unique, the public health benefits from FSM. tools will need to be adapted to the local situ- • Sanitation planning should be incremental, ation; selection and design of interventions will acknowledging the variation of urban conditions always require professional judgment within and between areas and over time, and consid- ering both networked and non-networked solutions.

www.wsp.org 1 Fecal Sludge Management Services Diagnostic and Decision-Support Tools: An Overview Introduction

FIGURE 1: THE SANITATION SERVICE CHAIN

MDGs Sustainable Development Goals

End-use/ Containment Emptying Conveyance Treatment Disposal

Sewerage

Sewage Sewerage network End-use/ WC treatment pumping stations Disposal works

On-site systems with Fecal Sludge Management

Vacuum truck

Latrine Treatment End-use/ or Primary plant Transfer Disposal septic tank emptying

Safely covered and replaced in new location

Overview of the Tools and How They The Tools and Guidelines describe in detail the data and Fit Together analytical framework used to produce the outputs, and how Table 1 summarizes the tools and their objectives, as well as to apply them. other related tools which play an important role in the planning and implementation of urban sanitation solutions The Data Collection Instruments are generic instruments but which were not developed as part of this initiative. Fig- covering all key aspects of the diagnostics, and should be ure 2 sets out how the different tools fit together. adapted to each specific local situation.

The following fecal sludge management diagnostic and The Terms of Reference are generic documents for con- decision-support tools prepared under this study are listed tracting the FSM diagnostics to consultants, and should be below and are available online: worldbank.org/fsm. adapted according to the local situation and to the scope of studies and analysis required. The Summary Report collates the lessons learned from developing and applying the tools and guidelines in five cit- City case studies for Balikpapan, Dhaka, Hawassa, Lima, ies around the world. and Santa Cruz.

2 Targeting the Urban Poor and Improving Services in Small Towns Fecal Sludge Management Services Diagnostic and Decision-Support Tools: An Overview Introduction

TABLE 1: SUMMARY OF TOOLS AND THEIR OBJECTIVES Tool Objective Diagnostic 1 Fecal Waste Flow Diagram Represents where fecal waste goes, what proportion is managed and where the tools unmanaged portion ends up 2 Service Delivery Assessment Assesses the enabling environment and quality of service delivery along the service chain, identifying areas for attention 3 Prognosis for Change Identifies the interests and incentives that could block action, and possible entry (Political Economy Analysis) points for overcoming them Decision- 4 Service Delivery Action Framework Guides identification of actions in relation to the enabling environment, necessary support tools to deliver the desired results 5 Intervention Options Assessment Guides the identification of technical interventions along the service chain—linking to project/program design guidelines

FIGURE 2: HOW THE FSM TOOLS FIT TOGETHER

DIAGNOSTICS & DECISION SUPPORT

1. Fecal Waste Flow Diagram (SFD)

Developed Institutions, Sludge volumes & Spatial under financing characteristics data this study Urban Sanitation 2. City Service Delivery Fecal sludge Status Index (USSI) Developed Assessment technical tools: under other Costs initiatives Quantification Characterization 3. Prognosis for change: FSM costing tool Political economy analysis Treatment design

4. Service Delivery Action 5. Intervention options assessment framework Framework

Institutions, systems Technical design Prioritization enabling environment & costing PROJECT DESIGN

www.wsp.org 3

Diagnostic Tool 1: Fecal Waste Flow Diagram

A Fecal Waste Flow Diagram (often referred to as an “SFD”) Figures 3 and 4 show examples of fecal waste flow diagrams is a visualization of how fecal waste (both fecal sludge and for Lima, Peru. The first represents a city-wide picture, wastewater) flows along the sanitation service chain in a while the second represents the situation for the city’s infor- given city. The proportions of households using different mal settlements. This separate analysis allows decision- sanitation options are identified according to where the makers to focus on delivering city-wide services which are waste goes (e.g., sewer, on-site containment, etc.). At each also responsive to the needs of poor communities. stage of the chain, the proportion of fecal waste that is effec- tively managed continues as a green arrow, while any pro- As illustrated in this case (and as is the case in the majority portion identified as ineffectively managed turns into a of cities around the world), the sanitation situation in low- brown (or red) arrow. income, informal settlements is generally much worse than the city-wide picture, with far more fecal waste going Data sources used to develop the figures for the diagrams directly into the local environment, and, in the Lima case include household surveys, key informant interviews, (Figure 4), via precarious unlined pits which tend to leak. ­secondary and grey literature, reports, observation of ser- Such disaggregated information can help inform the devel- vice provision/providers, and measurements at treatment opment of appropriate sanitation interventions for low- facilities. A growing number of SFDs funded through a income communities, for example improvements to on-site Bill & Melinda Gates Foundation initiative are available at containment or improved desludging services. susana.org/sfd.

4 Targeting the Urban Poor and Improving Services in Small Towns Fecal Sludge Management Services Diagnostic and Decision-Support Tools: An Overview Diagnostic Tool 1: Fecal Waste Flow Diagram

FIGURE 3: CITY-WIDE FECAL WASTE FLOW IN LIMA, PERU

Reuse/ Containment Emptying Transport Treatment disposal 52%

Treated 49% 67%

Sewerage 92%

Not treated

Directly 25% released to the sea 27%

Septic tank—FS 3% contained 3% Unlined pit— partly emptiable 4% On-site straight to drain 0.4% Open defecation 1% 0.4% 4% 25% 18% 1% Local area and beyond Receiving waters 48%

FIGURE 4: FECAL WASTE FLOW DIAGRAM FOR INFORMAL SETTLEMENTS IN LIMA, PERU

Reuse/ Containment Emptying Transport Treatment disposal

Septic tanks/ UDDT—FS 1% contained 1% 1% 49%

Unlined pits— partly emptiable 96%

Transported Not treated 3% Not transported On-site straight to drain 3% 93% 3% 2% 1%

99% Local area and irrigation channels

www.wsp.org 5

Diagnostic Tool 2: City Service Delivery Assessment

The City Service Delivery Assessment (CSDA) for FSM The process of developing the CSDA is just as useful as the aims to answer overarching questions about the quality of results derived, as it requires key stakeholders to discuss all the enabling environment, the extent of FSM service devel- stages of the FSM service chain and to use the evidence opment and the commitment to FSM service sustainability. regarding the current FSM situation to agree upon the allo- It provides a structured assessment, based on responding to cated scores. objective questions on FSM service performance through all stages of the service chain, so as to identify priority areas This evidence may have come from key informant inter- for action. The current format of the CSDA is adapted views, secondary literature, focus group discussions, or from the one used in the FSM 12-city study, which itself field-based observations. An initial stakeholder mapping was derived from the World Bank Group’s Water and Sani- exercise is necessary to ensure that the interviews are tar- tation Program’s Country Status Overviews for Water and geted at those best placed to inform and to generate unbi- Sanitation (AMCOW 2011). ased scoring. Details of questions and indicators used in the process are given in the Tools and Guidelines and Data A key output from the CSDA process is the scorecard. An Collection Instruments. example for Balikpapan, Indonesia, is shown in Figure 5.

FIGURE 5: CITY SERVICE DELIVERY ASSESSMENT IN BALIKPAPAN, INDONESIA

Reuse/ Containment Emptying Transport Treatment disposal Enabling Policy 0.5 1 1 1 0.5 Planning 0 0 0 0 0 Budget 0 0 0 0 0

Developing Expenditure 0 1.5 0 0 0 Equity 1 1 1 0 0 Output monitoring 0 0.5 0.5 0 0

Sustaining Operation & 0 1.5 1.5 0 0.5 maintenance Expansion 0 1.5 1.5 0 0 Service outcome 2.5 2.5 1 1.5 1.5

Poor Developing Good Key:

6 Targeting the Urban Poor and Improving Services in Small Towns Fecal Sludge Management Services Diagnostic and Decision-Support Tools: An Overview Diagnostic Tool 2: City Service Delivery Assessment

FIGURE 6: INTERLINKED CITY SERVICE DELIVERY ASSESSMENT AND PROGNOSIS FOR CHANGE PROCESS

City SDA process Stakeholder mapping mobilizes decision-makers and produces scorecard

Prognosis for Identification of change assessment priority areas in CSDA including stakeholder analysis

Separate discussions Intervention options around planning and assessment implementation

The resulting scorecard shows areas of strength and weak- as an iterative process, which also takes into account the ness for FSM in the city and helps identify priority areas for political economy of FSM in the city in question. A Prog- action—which may include a national dimension (see nosis for Change (PFC) assessment (see below) supports an Table 3 under Decision-Support Tool 4). As the illustrative explanation as to why the CSDA looks the way it does. Fig- CSDA from Balikpapan shows, some likely priority areas for ure 6 summarizes this interlinked process, starting with the action might include: establishing plans and associated bud- stakeholder mapping exercise. Once priority areas in the gets to improve FSM services; and making poor-inclusive CSDA have been identified, a PFC assessment is under- technical interventions to deliver services to all. taken. This then informs the intervention options assess- ment (see below), so that possible intervention options are The CSDA process does not, however, explain why the cur- considered in the context of the city’s political economy rent situation prevails, nor does it identify potential obsta- realities. cles to progress. This is why the CSDA should be undertaken

www.wsp.org 7

Diagnostic Tool 3: Prognosis for Change Assessment

The Prognosis for Change (PFC) assessment considers the Secondly, a PFC considers the incentives, which institu- positions of various stakeholders, in particular the institu- tions provide to stakeholders. A stakeholder is any individ- tions and incentives involved in FSM in the city. A PFC ual or group with an interest in the outcome of a national assessment is essentially a political economy analysis in or local policy. In FSM, some examples of relevant stake- which delicate topics are addressed sensitively, such that the holders may include (but are certainly not limited to) sludge analysis can be shared and discussed with all stakeholders. truck companies, manual emptiers, the city council, line ministries, and slum-dwellers. A PFC assessment aims to understand three things, as dis- cussed in the FSM Tools and Guidelines and illustrated in Finally, a PFC considers how stakeholders exert influence, Figure 7. Firstly, it considers how “institutions” function. which is defined as the formal or informal power to cause or Here, institutions are defined as “the rules and norms gov- prevent something. A city council may have formal legal erning human interaction,” rather than a narrow definition power, but if their FSM bylaws are openly flouted, then of “organizations.” Institutions can be formal (such as regu- their influence is low. latory standards or bylaws about dumping fecal sludge [FS]), or informal (such as attitudes towards reusing FS in In addition, it is important to understand that the political agriculture, or issues and interests that may run counter to, economy is strongly linked to a financing dimension. The or be potentially supportive of, FSM). availability of finance, and the mechanisms through which it is distributed, have a profound impact on what actually happens with regard to appropriate FSM in a city.

In order to be practically useful, a PFC assessment should FIGURE 7: THREE KEY CONCEPTS IN PROGNOSIS FOR CHANGE consider the implications of the findings for effective engagement in a reform or change process. National policy and fiscal approaches are relevant here. In many cities, local Institutions financial resources are lacking and will continue to require (formal (if not depend upon) some assistance from higher levels of or informal) government—such arrangements ought to be clear and rooted in national level policy.

providing Stakeholders Various tools for undertaking a PFC assessment are included incentives to (individual, group in the full Tools and Guidelines, but one example is given or agency) in the FSM Case Study for Dhaka, Bangladesh. It shows a process map for the construction of a new building in Dhaka (Figure 8). The central column shows the formal Influence process, while the right-hand column shows the informal exerting (formal or process, which happens in practice. The left-hand column informal power) then shows entry points for engagement, which are judged crucial for getting value out of the PFC analysis and for consequently improving FSM in the city.

8 Targeting the Urban Poor and Improving Services in Small Towns Fecal Sludge Management Services Diagnostic and Decision-Support Tools: An Overview Diagnostic Tool 3: Prognosis for Change Assessment

FIGURE 8: PROCESS MAP FOR DHAKA, BANGLADESH

Entry Points Formal Process Informal Process

Developer applies to Capital Development Authority (RAJUK) for permit

RAJUK expects Dhaka City RAJUK reviews application and consults Improve application Council (DCC)/Dhaka Water and other relevant authorities linked to FSM scrutiny by all parties Sewerage Authority (DWASA) to service provision (e.g., DCCs, DWASA) provide services, without asking

RAJUK approves construction

Developer constructs building with Developer connects toilets or septic septic tanks & leach pits not tanks directly to the storm water drains connected to drains

Improve quality of RAJUK inspects during and after Not enough RAJUK staff to do proper inspections by RAJUK construction for compliance inspections and enforce compliance

Occupants of completed building Occupants do nothing, as all arrange for emptying of septic tanks waste goes to drains when required

www.wsp.org 9

Decision-Support Tool 4: Service Delivery Action Framework

When considered together, the outputs of the diagnostic Identifying the most appropriate actions must take into and decision-support tools provide information that can be account the reality of any given city and recognize that the used to inform the design of an FSM improvement and stages are essentially sequential—i.e., starting with basic investment program. In all cities, interventions to improve actions before moving towards intermediate and then con- the enabling environment will also be needed alongside solidating actions. Thus, if a city has already addressed basic technical intervention options. Based on the experience actions, the intermediate actions will most likely be the ones gathered in the process of developing the tools, a Service to focus on for the particular issues being addressed. Delivery Action Framework (SDAF, see Table 2) can be developed. This is illustrated by way of an example of an SDAF in FSM Case Study for Dhaka, Bangladesh. Table 3 high- The SDAF sets out the range of non-technical or “institu- lights appropriate actions for each element of the enabling tional” interventions that may be appropriate for a given environment, informed by the extent to which actions have city, depending on the status of FSM service development, already been achieved in the city. Identified actions which as characterized by the CSDA. Actions are grouped accord- could be considered by decision-makers are shown in the ing to how developed the enabling environment currently boxes with red outline and light red shading. is, with three stages characterized as: Basic, Intermediate or Consolidating. Actions are informed by the current reality Dhaka city’s CSDA scorecard highlighted that progress in experienced on the ground and are defined to highlight the enabling environment is limited to the development where best to focus attention for each aspect of the enabling of policy around containment at the household (a toilet or environment, with the goal of improving services. Table 2 latrine). The establishment of an institutional framework presents actions in an abridged format; see the Tools and for FSM more generally—a focus on intermediate actions Guidelines for more comprehensive descriptions. Further is needed in relation to these areas. However, basic actions elements of the enabling environment are informed by remain the priority in all other areas, including in plan- recent research, such as the SPLASH Urban Sanitation ning, budgeting, promotion and capacity. Research Programme (Medland et al. 2015). Making actions context-specific: A further step in the For each component of the enabling environment (policy, process takes the actions from each of the highlighted areas institutional arrangements, budgets, etc.), specific activities and translates them into objectives, targets, indicators and can be identified. This may result in actions taken from inputs that respond to the specific context of the given city, Basic, Intermediate or Consolidating stages as appropriate to and which does so at an appropriate scale (e.g., city-wide, or a given city. Those designing FSM interventions should focused on specific locations), to enable detailed planning. consider how activities will need to be implemented through This step must not be overlooked, as it requires a significant pragmatic steps such that they are “actionable.” The result commitment of time, resources and skills to achieve effec- will be a range of actions targeted at the national, city and tive results. user levels, which can then be considered in more detail to inform project and program planning and implementation.

10 Targeting the Urban Poor and Improving Services in Small Towns Fecal Sludge Management Services Diagnostic and Decision-Support Tools: An Overview Decision-Support Tool 4: Service Delivery Action Framework Sustainable Services Consolidating Actions Focused on Full-Chain, Require local regulation and its enforcement and its enforcement local regulation Require framework to Develop a policy/regulatory options and reuse incentivize treatment institutional framework to Strengthen enhance service outcomes, with fully and coordination implemented roles FSM Consider (dis)incentives for improved monitoring of all services Strengthen Develop plans to enhance treatment technologies capacity and reuse sector capacity for services, Strengthen markets and reuse including treatment reuse Mobilize finance for FS processing, and disposal waters Regulate pollution of receiving Penalize for indiscriminate FS dumping use of emptiable facilities Enforce for managing institutional roles Strengthen FS management, including improved options facilities and reuse treatment FSM Implement (dis)incentives for improved plans to enhance treatment Introduce arrangements capacity and reuse and reuse M&E of treatment Strengthen arrangements against service standards of FS Stimulate market demand for reuse Consolidate/expand services based on outcome of pilot studies plants and FS processing Build/rehabilitate of FS develop business models for reuse Identify opportunities for financial flows the sale of FS end products generated from options Gain user opinions on reuse of service quality for Focus on enforcement landlords • • • • • • • • • • • • • • • • • • • • • Intermediate Actions Strengthening Existing Foundations Set norms/standards for public health and Set norms/standards protection environmental of FSM Establish legal basis for regulation services Establish institutional framework for and coordination FSM with defined roles mechanisms for fecal sludge Establish institutional roles options and reuse treatment Establish monitoring framework for service on emptying services standards—focus Establish systems to evaluate service quality Build public and private sector capacity for city-wide FSM services with FSM funding Develop programs windows and incentives for cities bylaws and their enforcement Strengthen of service providers regulation Introduce sites Incentivize disposal at recognized Establish local institutional framework for defined and agreed services—with roles and reuse for FS treatment Establish roles FSM Consider (dis)incentives for improved streams Establish revenue Refine and implement local service plans Establish monitoring and evaluation (M&E) of service standards Disseminate public FSM services information development of improved, Promote/support emptiable containment facilities of service providers role Strengthen Pilot scheduled desludging/ transfer stations financial specific pro-poor Introduce subsidies) arrangements (such as targeted services Gain user feedback on improved Develop assistance and enforcement packages for landlords • • • • • • • • • • • • • • • • • • • • • • • • Basic Actions Critical Interventions for Public Health Protection Review national sanitation policy and ensure Review national sanitation policy and ensure FSM is included the framework around Review regulatory of public health and environment protection Review institutional arrangements for FSM is included sanitation—ensure Identify an institutional framework for FSM and coordination with clear roles of FSM in national planning Build awareness sector ministries entities and relevant etc.) (works, housing, health, environment, Identify scale of the capacity gap and TA FSM service needs to address required the around and agreement Build awareness for FSM services budgetary requirements Review/establish bylaws, ensuring they on-site systems and FSM services address Review institutional arrangements for FSM is included sanitation—ensure FSM for framework institutional local Identify gender and pro-poor Conduct area-based, focused diagnostic studies Develop plans, finance and institutional needs options Plan and design FS treatment Stimulate customer demand/ willingness to pay (WTP) for FSM TA Identify capacity gaps and required private sector services appropriate Promote for safer disposal of Implement measures dumped in the environment FS currently Identify the extent of financing required to the service improvements to address poorest Consult communities, identify needs and wants and tenants Engage with/consult landlords on constraints to FSM services • • • • • • • • • • • • • • • • • • • •

Policy, legislation and Policy, regulation Legislation and enforcement Planning Institutional arrangements Planning, monitoring and evaluation Capacity and technical assistance Financing Institutional arrangements Planning, monitoring and evaluation Promotion Capacity and technical assistance Financing sanitation Tenant Stages of Action

National Local Users : SERVICE DELIVERY ACTION FRAMEWORK DELIVERY 2 : SERVICE TABLE  Planning non-technical components (currently for FSM ) www.wsp.org 11 Fecal Sludge Management Services Diagnostic and Decision-Support Tools: An Overview Decision-Support Tool 4: Service Delivery Action Framework

TABLE 3: RESULTING PRIORITIZED ACTIONS: ILLUSTRATIVE EXAMPLE FOR DHAKA CITY Basic Actions Intermediate Actions Consolidating Actions Stages of Action Critical Interventions for Public Strengthening Existing Focused on Full-Chain, Health Protection Foundations Sustainable Services Policy, • Review national sanitation policy • Set norms/ standards for public • Require local regulation and its legislation and and ensure FSM is included health and environmental enforcement regulation • Review regulatory framework protection • Develop a policy/regulatory around the protection of public • Establish legal basis for regulation framework to incentivize treatment health and environment of FSM services and reuse options Institutional • Review institutional arrangements • Establish institutional framework • Strengthen institutional framework arrangements for sanitation—ensure FSM is for FSM with defined roles and to enhance service outcomes, included coordination mechanisms with fully implemented roles and • Identify an institutional framework • Establish institutional roles for fecal coordination for FSM with clear roles and sludge treatment and reuse options coordination Planning, • Build awareness of FSM in national • Establish monitoring framework • Strengthen monitoring of all

National monitoring and planning entities and relevant for service standards—focus on services evaluation sector ministries (works, housing, emptying services • Develop plans to enhance health, environment, etc.) • Establish systems to evaluate treatment capacity and reuse service quality technologies Capacity and • Identify scale of the capacity gap • Build public and private sector • Strengthen sector capacity for technical and TA required to address FSM capacity for city-wide FSM services, including treatment and assistance service needs services reuse markets Financing • Build awareness and agreement • Develop programs with FSM • Mobilize finance for FS processing, around the budgetary requirements funding windows and incentives reuse and disposal for FSM services for cities Legislation and • Review/establish bylaws, ensuring • Strengthen bylaws and their • Regulate pollution of receiving enforcement they address on-site systems and enforcement waters FSM services • Introduce regulation of service • Penalize for indiscriminate providers FS dumping • Incentivize disposal at recognized • Enforce use of emptiable facilities sites Institutional • Review institutional arrangements • Establish local institutional • Strengthen institutional roles arrangements for sanitation—ensure FSM is framework for services—with roles for managing improved FS included defined and agreed management, including treatment • Identify local institutional • Establish roles for FS treatment facilities and reuse options framework for FSM and reuse Planning, • Conduct area-based, gender • Establish revenue streams • Introduce plans to enhance monitoring and and pro-poor focused diagnostic • Refine and implement local service treatment capacity and reuse evaluation studies plans arrangements • Develop plans, finance and • Establish M&E of service standards • Strengthen M&E of treatment and institutional needs reuse arrangements against service Local • Plan and design FS treatment standards options Promotion • Stimulate customer demand/ WTP • Disseminate public FSM services • Stimulate market demand for reuse for FSM information of FS Capacity and • Identify capacity gaps and required • Promote/support development of • Consolidate/expand services technical TA improved, emptiable containment based on outcome of pilot studies assistance • Promote private sector emptying facilities • Build/rehabilitate FS processing services • Strengthen role of service providers plants and develop business • Implement measures for safer • Pilot scheduled desludging/ models for reuse of FS disposal of FS currently dumped in transfer stations the environment Financing • Identify the extent of financing • Introduce specific pro-poor • Identify opportunities for financial required to address service financial arrangements (such as flows generated from the sale of improvements to the poorest targeted subsidies) FS end products Planning • Consult communities, identify • Gain user feedback on improved • Gain user opinions on reuse needs and wants services options Tenant • Engage with/consult landlords on • Develop assistance and • Focus on enforcement of service Users sanitation constraints to FSM services enforcement packages for quality for landlords landlords

12 Targeting the Urban Poor and Improving Services in Small Towns

Decision-Support Tool 5: Technical Intervention Options Assessment

The CSDA process highlights priority areas for action Table 4 shows an example of Technical Intervention through the service chain, which are then considered in Options along the service chain, proposed for slum areas in relation to the Prognosis for Change. Together with the Dhaka. It is focused on FSM services as the only feasible outputs from the other tools, a comprehensive set of infor- short- to medium-term solution for these areas. The same mation results, which informs the identification of Inter- table can and should be applied to other aspects of urban vention Options for technical service improvements and sanitation, including sewered options, as explained in the developing program design guidelines. In turn, these will Tools and Guidelines. This example highlights how tech- guide further discussions included in detailed project plan- nical interventions will be most varied at the stages of con- ning and implementation. This section outlines how the tainment, emptying and transport, while treatment, collected information may be brought to bear on the iden- disposal and end-use options are likely to coalesce into tification of Technical Intervention Options. similar solutions.

The starting point in identifying Technical Intervention Once Technical Intervention Options have been proposed, Options is the fecal waste flow diagram for the area under it is essential to consider the ‘institutional’ elements within consideration, which identifies and indicates the magnitude the broader enabling environment that show up as priority of the ineffectively managed fecal waste flows. The signifi- areas for action in the CSDA scorecard and in light of the cant issues and problems need to be identified for each fecal Prognosis for Change. These elements must be addressed if waste stream shown in the diagram to build up a table that technical interventions are to provide effective and sustain- “maps” system types against stages of the service chain. able services. This process is structured around the Service Informed by expertise on good sanitation and fecal sludge Delivery Action Framework set out in the previous section. management practices appropriate for the target city, poten- A comprehensive description of technical options is found tial technical solutions can be proposed for each stage. As a in Fecal Sludge Management: Systems Approach for Integrated technical solution is identified at a given stage in the service Implementation and Operation (more information in the chain, it is essential to consider the implications for the Complementary Tools section). other stages of the chain and identify the associated inter- ventions required.

www.wsp.org 13 Fecal Sludge Management Services Diagnostic and Decision-Support Tools: An Overview Decision-Support Tool 5: Technical Intervention Options Assessment

TABLE 4: TECHNICAL INTERVENTION OPTIONS FOR DIFFERENT SYSTEM TYPES: FSM IN DHAKA SLUMS

System type Potential Solutions (one or two options for each system type shown here) • Key problems (one example per system) Containment Emptying Transport Treatment Disposal End-Use

On-site containment: Improve the Improve range Identify, pilot emptiable design and of responsive and develop • Limited use construction and affordable innovative of emptying of septic tanks emptying options transport services—high rate (STs) and pits, and services solutions of FS discharge to with standards (mechanized or drains followed to human powered), maximize offering retention of FS affordable and responsive Introduce a range Modify existing services of de-centralized sites and On-site containment: Modify existing Extend emptying treatment manage new FS Explore non-emptiable STs/pits, to services to Introduce transfer facilities and/ disposal sites—to financially viable • Poor containment convert to being additional stations for or FS handling minimize risk options for FS infrastructure emptiable and sanitation small-vehicle station at to public and end-use also providing facilities operators— wastewater environmental effective linked to larger treatment plants health containment collection services to take FS to treatment No containment Invest in new Identify ways sites • Direct discharge to household-level to service new environment containment household options, where containment acceptable to options without users direct discharge

14 Targeting the Urban Poor and Improving Services in Small Towns

Complementary Tools

Integrated Design Approach for Treatment Public Health Risk Assessment In low-income countries, regulations affecting fecal sludge One of the main rationales for improving sanitation is to often do not exist, or are not enforced, which makes defin- improve public health. Statistical analysis shows that stunting, ing performance goals for fecal sludge management which aggregates many of the effects of poor sanitation, is extremely challenging. Many sanitation infrastructure proj- closely correlated with levels of open defecation, and more so ects are designed to high performance goals, but end up not in more densely populated (urban) areas, than in less densely performing as intended and frequently failing. While over- populated areas (Spears 2013), as illustrated in Figure 9. Many designing of systems wastes money and resources, under- studies also show that improving sanitation reduces diarrheal designing does not provide adequate protection for human disease, although a causal relationship is harder to pin down. health and the environment. Performance goals should ide- ally include provisions for resource recovery, which can also Public health risk has two components: hazard, or the lev- generate extra financial flows to offset some of the costs in els of fecal contamination along the pathways from feces to the service chain. Systems including resource recovery can mouth; and exposure, or the frequency and extent of con- also provide an incentive for efficient and effective collec- tact with contamination. tion and transport services, and the optimized operation of treatment plants, in the form of pressures generated by mar- Hazard is estimated from measurements of fecal pollution ket demand. in the environment, or by taking the fecal waste flow dia- gram further by considering microbiological decay along SANDEC at EAWAG has published useful reference mate- the pathways. Exposure is more difficult to estimate but rial in Fecal Sludge Management: Systems Approach for Inte- may involve individual and group surveys, observation, key grated Implementation and Operation (EAWAG/SANDEC 2014) and is currently developing tools to support the inte- grated design of fecal sludge management and treatment. The tools will be based on field experience in FSM and FIGURE 9: CORRELATION BETWEEN OPEN DEFECATION AND CHILD STUNTING address five core areas, with the following objectives: • Market Driven Approach: to aid selection of treated Effect on Child Height of end-products with the greatest potential for market Eliminating Open Defecation volume and growth; 3 • Evaluating collection and transport service delivery 2.5

and the siting of treatment plants; e z-score) • Optimized treatment technologies for resource 2 recovery: to optimize existing treatment technolo- 1.5 gies for increased volumetric capacity or reduced x (negativ 1 footprint of the treatment plant; • Fecal sludge quantification and characterization: to 0.5 estimate the characteristics and quantities of fecal

Stunting inde 0 sludge on a city-wide scale, or an appropriate scale to Urban Rural suit the intended treatment plant; and • Laboratory methods: to prepare reliable and repli- Under 3 years old Under 5 years old cable standard methods for laboratory analysis of fecal sludge. Source: Spears, D. (2013). DHS data from 130 countries.

www.wsp.org 15 Fecal Sludge Management Services Diagnostic and Decision-Support Tools: An Overview Complementary Tools

informant interviews, GPS mapping, etc. Various initiatives (ii) emptying and conveyance; and (iii) treatment and are under development to assess public health risks associ- ­disposal—and a fourth related component: (iv) complemen- ated with inadequate sanitation, which should help pin- tary services (solid waste and drainage). These components point priorities to be targeted with specific interventions. are mapped to give a sense of where in a city the service chain is failing most severely (see maps in Figure 10). They can also Urban Sanitation Status Index be aggregated into an overall USSI for each neighborhood The Urban Sanitation Status Index (USSI) is a tool based on based on a weighted geometric mean of all the variables. the sanitation service chain that visualizes the sanitation status of a city by ward or neighborhood—i.e., by the lowest admin- FSM Costing istrative city sub-unit. The USSI is based on 20 qualitative USAID are supporting the development of a FSM costing indicators assessed via household surveys and key informant and financing tool, which is currently being field tested in interviews. It uses similar data (but in larger quantity, allowing Indonesia. This comprehensive tool has the potential for for spatial disaggregation) to those required to develop an adaptation for use in other countries. The tool estimates the SFD, but also includes some basic data on solid waste and number of staff, number of trucks, capital costs and on- drainage, which are important complementary aspects of san- going operation and maintenance costs for a complete FSM itation in its narrower sense of excreta management. system including collection, treatment, management and community engagement. The tool calculates appropriate The base indicators are aggregated into three components tariffs to cover all of these costs, based on local capital and grouped along the sanitation service chain: (i) containment; recurrent unit cost data, and presents relevant financial data

FIGURE 10: EXAMPLES OF USSI OUTPUT MAPS FOR SPATIAL PRIORITIZATION IN MAPUTO, MOZAMBIQUE

Emptying and Conveyance Overall Urban Sanitation Status Index

Source: Hawkins, Peter and Odete Muximpua. 2015. Developing Business Models for Fecal Sludge Management in Maputo (unpublished paper). Washington DC: The World Bank.

16 Targeting the Urban Poor and Improving Services in Small Towns Fecal Sludge Management Services Diagnostic and Decision-Support Tools: An Overview Complementary Tools

in a variety of formats and reports. Other functionalities of • Modeling of capital and recurrent financing from the tool include: government and non-government loans, grants and • Evaluation of distances and times required for collec- revenue, in addition to charges paid by serviced tion of septage; customers. • Comparisons between different FSM service delivery models (private sector and government) and septage This tool is not widely available yet, and still requires fur- treatment options; and ther testing and development. It would, in any case, need to be adapted for application in any specific country or city.

www.wsp.org 17 References

AMCOW (African Ministers Council on Water). 2011. Loughborough, UK: Water, Engineering and Develop- AMCOW Country Status Overviews—Regional ment Centre (WEDC), Loughborough University. Synthesis Report. Pathways to Progress: Transition- Peal A., Evans B., Blackett I., Hawkins P., and Hey- ing to Country-Led Service Delivery Pathways to Meet mans C. 2014. “Fecal Sludge Management (FSM): Africa’s Water Supply and Sanitation Targets. Wash- Analytical Tools for Assessing FSM in Cities.” Review ington, DC: The World Bank/Water and Sanita- Paper. Journal of Water, Sanitation and Hygiene for tion Program. http://www.wsp.org/wsp/content/ Development: 4:371–383. pathways-progress-status-water-and-sanitation-africa. Spears, D. 2013. How Much International Variation in Blackett, Isabel C., Hawkins, Peter M., Heymans, and Child Height Can Sanitation Explain? World Bank Chris. 2014. The Missing Link in Sanitation Service Policy Research Working Paper 6351. Washington, DC: Delivery: A Review of Fecal Sludge Management in World Bank. 12 Cities. Water and Sanitation Program Research Brief. World Bank. 2007. Tools for Institutional, Political, and Washington DC: World Bank Group. Social Analysis of Policy Reform: A Sourcebook for Devel- EAWAG/SANDEC. 2014. Edited by Linda Strande, opment Practitioners. Washington, DC: World Bank. Mariska Ronteltap, and Damir Brdjanovic. Fecal Sludge For guidance on stakeholder mapping, see p. 126ff. Management: Systems Approach for Implementation and World Bank. 2011. The Political Economy of Sanitation: Operation. London: IWA Publishing. http://www How Can We Increase Investment and Improve Service for .eawag.ch/fileadmin/Domain1/Abteilungen/sandec/ the Poor? (Main Report). Water and Sanitation Program publikationen/EWM/Book/FSM_Book_LowRes.pdf. Technical Paper. Washington, DC: World Bank. Medland, L., Cotton, A.P., and Scott, R.E. 2015. SPLASH Urban Sanitation Research Programme Briefing Note 1: An Enabling Environment for Urban Sanitation.

Note: All World Bank Group publications are available for download at documents.worldbank.org.

18 Targeting the Urban Poor and Improving Services in Small Towns