Building Demand for A 2015 Portfolio Update and Overview Water, Sanitation, and Hygiene Strategy

June 2015 ACKNOWLEDGMENTS We would like to thank all participants for their Water Institute at UNC, Steven Sugden from active engagement during the workshop as well as Water for People, Daniel Asamani from PLAN for their contributions to this report in the months International, Maria Laura Alzua from University following the Hanoi meeting. A special word of thanks of La Plata and Radu Ban of the Bill & Melinda to the staff of East Meets West (EMW, now Thrive Gates Foundation. Networks), the World Bank Water and Sanitation Program (WSP) and the National University of Civil A special thanks to Dr. Viet Anh from Hanoi Engineering for their assistance with organizing field University for taking care of government liaison as trips and other local preparations: well as arranging field visit permits and visitor visas.

Quang Vinh Nguyen, Country Coordinator WSP Also many thanks to Sarah Herr from the Bill Vietnam & Melinda Gates Foundation for travel and logistical support throughout the workshop (not Hang Diem Nguyen, WSP Vietnam to mention the period leading up to it). Hoa Thi Hoang, World Bank Vietnam Minh Chau Nguyen, EMW Vietnam Overall organization and facilitation was in the Hanh Nguyen, EMW Vietnam capable hands of Pete Cranston and Pippa Scott, with remote support from Nancy White. Dang Thi Thanh Huyen, National University of Civil Engineering, Vietnam Peter Feldman tirelessly supported the organization and documentation of the workshop; This year as in previous years, many participants he drafted the program, engaged and corresponded took on a presentation or facilitation role and we with participants and wrote the first drafts of this are grateful to: Ada Oko-Williams from WaterAid, report. We owe him an enormous debt of gratitude Theodora Adomako-Adjei from CWSA, Chander for his creativity, energy and persistence. Badloe, Lizette Burgers, Ann Thomas and Aiden Cronin from UNICEF, Anthony Waterkeyn from Ahead, Akramul Islam from BRAC, Ingeborg Photos: Krukkert from IRCWash, Susanna Smets and Joep Cover: Women review a map during a meeting to discuss sanitation and Verhagen from WSP, Dean Spears and Sangita Vyas safety issues in the NTPC Subhas camp (Delhi, , August 2014). This Page: Nguyen Van Phuc and his family stand next to their newly from r.i.c.e., Mushfiq Mubarak from IPA, Minh constructed hygienic behind their house in Long Hung commune Chau Nguyen from EMW, Jonny Crocker from the (Chau Thanh district, Tien Giang province, Vietnam, 2014). Table of Contents

PREFACE 4

INTRODUCTION 5 Evolution of the Foundation’s WSH Program 5 Building Demand for Sanitation Portfolio 7 Grant-making Approaches 8 Outcome Investing 8 Payment by Results 8 Contributing to WSH Sector Evidence Base 10 Focus on Learning 10

PORTFOLIO PROGRESS 11 Introduction 11 Grant & Project Summaries 14 Product Development Projects 14 Research and Knowledge Sharing Projects 19 Integrated Implementation and Research Projects 25

SUMMARY AND DISCUSSION OF WHAT’S WORKING 40 Reaching the Poorest at Scale...... 40 Ensuring Political Support and Government Capacity 42 Improving Sanitation Business Models 42 Making Sanitation More Affordable. 42 Integrating Supply-Side and Demand-Generating Projects 43 Solutions 43 Health Implications of Poor Sanitation 43

KNOWLEDGE MANAGEMENT AND RESEARCH NEEDS 45 Improvements in Learning and Knowledge Management 45 Curation 45 Connect 46 Learning Events 46 BDS Processes 46 Learning about Learning 47 Sharing Experience and Learning at the 2015 Hanoi Convening 47 Unanticipated Outcomes 47 Learning about Learning During the Convening 47

THE WAY FORWARD 48 Foundation Vision 48 Next Steps for the BDS Portfolio 48

APPENDIX 49 Footnotes 49 Participant Details 52 Notes 54

www.gatesfoundation.org Preface

In January 2015, Foundation staff, grantees and sanitation The year is 2015—the target for achieving the Millennium sector experts converged on Hanoi, Vietnam for a series of Development Goals (MDGs). As of 2014, the global MDG for important meetings. The first of these, the 5-day Fecal Sludge water supply (88% coverage) had been achieved—which is very Management III conference, focused on technical aspects of a encouraging news. However, there are still 76 countries who critical challenge—how to manage, treat, reuse, and dispose of have not yet reached the water MDG—including 45 which are waste which is accumulating at an increasing pace in ‘onsite’ not on track to meet it by the close of 2015.3 sanitation facilities throughout the world, particularly in developing countries. The conference provided an opportunity On the other hand, the sanitation MDG (75% coverage) for experts from many fields and organizations to exchange will likely not be achieved. Overall, sanitation coverage in ideas on preventing fecal sludge from entering into the developing countries increased 21 percentage points since 1990 environment, and ideally, how we might convert this waste into (a larger increase in coverage than for water supply)—which is products, energy, or fertilizers which will generate revenue and a worthy accomplishment. However, at least 108 countries are increase people’s standard of living. still shy of the MDG, and 79 of these countries are off track for reaching the sanitation MDG. Compounding this challenge The second meeting brought together Foundation grantees from is the fact that it will become increasingly difficult to reach all initiatives across our Water, Sanitation, and Hygiene (WSH) those who still lack access to improved sanitation; the progress strategy—Transformative Technologies; Urban Sanitation achieved so far has been more concentrated in urban and Markets; Building Demand for Sanitation; Policy, Advocacy and easily-accessible areas, and among the wealthier socioeconomic Communications; and Measurement, Learning and Evaluation. strata. The majority of those who have been left behind are poor Normally, most of these grantees don’t come into contact with and/or lack easy access to sanitation markets and services.4 each other, as they are working on distinctly different parts of In addition to the challenges just meeting the MDG targets the Foundation’s sanitation effort. However, in this first-of-its- (measured as access to improved sanitation), there is a growing kind convening we spent a very productive and enlightening day body of evidence demonstrating that the actual use of facilities discussing matters of interest to us all. Based on the success of is not guaranteed even where access exists. this event, we hope to continue to promote exchanges between sanitation grantees and other colleagues as the Foundation’s In spite of these challenges, or perhaps because of them, WSH program matures. the Foundation’s partners are a determined, resilient, and innovative group of professionals who consistently see The final meeting was a four-day event attended by all the opportunities and synergies rather than focusing on constraints Building Demand for Sanitation (BDS) grantees as well as and roadblocks. The Hanoi BDS workshop offered us another some of the Measurement, Learning and Evaluation (MLE) opportunity to focus our attention on what we’ve learned and grantees. This was the fourth such meeting of the BDS portfolio how we can use that knowledge to accelerate global progress partners,1 during which grantees and Foundation staff take towards achieving universal sanitation. stock of progress, discuss challenges, and propose new ideas. Many of the BDS grants have now either been completed, are The report that follows attempts to outline what the Foundation nearing completion, or have entered a new phase. There was and its BDS partners are doing to help meet these challenges obviously a lot to talk about, given the maturity of the projects and move the world towards universal sanitation. Naturally, it and research efforts. is impossible to capture everything that these individuals and organizations are accomplishing. However, I hope that readers The challenges facing the Foundation’s sanitation partners and will be inspired by it, and if particularly interested in certain our other colleagues working in the sector are enormous. Forty topics, projects or organizations—they can use the contact percent of the world’s population (2.5 billion people) practice information provided to find out more. OD or lack improved sanitation facilities; the consequences of this for human health and the environment are staggering. Poor sanitation contributes to about 700,000 child deaths Jan Willem Rosenboom from diarrhea each year, sanitation-related environmental June 30, 2015. enteropathy impedes child development and is linked to stunting and a reduced effectiveness of vaccines. Poor sanitation robs women and girls of their dignity and safety, and inflicts significant economic losses on national economies. In India alone, economic losses from poor sanitation are estimated to be $54 billion a year.2

4 | Building Demand for Sanitation Introduction

EVOLUTION OF THE FOUNDATION’S WATER, world had two fundamental elements: (i) 2.5 billion people, SANITATION AND HYGIENE (WSH) PROGRAM mainly in rural areas, lacked access to “improved” sanitation, The Water, Sanitation and Hygiene program of the Bill & meaning they practiced OD, or used unimproved pit ; Melinda Gates Foundation was launched in mid-2005 as a (ii) 2.1 billion people in urban areas—many of whom were “Learning Initiative,” eventually becoming a full-fledged considered to already have “improved” sanitation —were program under the Global Development Division in early 2010. capturing their waste on site—but nearly all of this waste The Foundation’s efforts in the WSH sector are now nearly was eventually being released into the environment without a decade old, and during that time it has undertaken a wide treatment. Importantly, the second failure was much less widely range of efforts involving research, experimentation, reflection, recognized within the WSH sector than the first. In other advocacy, and field implementation. words, the WSH strategy identified and tried to address needs and opportunities along the entire sanitation ‘value chain’ (see The early stages of the Foundation’s WSH effort explored a graphic below). broad menu of water, sanitation, and hygiene challenges facing the developing world. Research efforts, landscaping studies, and Further, the Foundation also concluded it was unrealistic to pilot projects were important parts of the Foundation’s early expect that piped sanitation would (within a reasonable time WSH investments, although some large-scale projects also got frame) be able to reach the majority of the poor. To serve the their start during this period (e.g., IRC’s Triple S and WSP’s poor, the Foundation believed it should focus on sustainable TSSM projects). Through these initiatives, and by listening to non-piped sanitation services. The ‘theory of change’ for and learning from many global leaders in the WSH sector, the generating widespread impact from this new program direction Foundation ultimately determined that its impact would be was based on the need to overcome three main challenges: greatest if it focused on achieving catalytic change in sanitation • Many people exhibited low demand for sanitation, even if they services for the poor—an area that has long been recognized valued improved health. as important by the global development community, but one • In terms of sanitation supply, fecal sludge (FS) extraction, which traditionally had received far less investment than water transport, treatment, and disposal remained costly and supply services. difficult. Through external consultations and internal analysis, the • The policy environment showed limited government capacity to Foundation believed that the sanitation crisis in the developing select effective solutions.

Sanitation Value Chain

Building Demand for Sanitation | 5 The Foundation thus determined it would contribute to 3) More Effective Policy and Advocacy – Advocacy work meeting and overcoming these challenges through three main to disseminate successful approaches to sanitation and grant-making initiatives: encourage changes in policy and funding priorities necessary 1) Ending Open (OD) – This approach combined to accelerate access to sustainable sanitation. several key elements: a) community-led demand stimulation; The Foundation’s present-day WSH program has grown out b) marketing affordable, desirable sanitation products and of the work done under these three initiatives. Along the services by local entrepreneurs; c) strengthened enabling way, the program structure has periodically been modified environment; d) capacity building for local governments; to incorporate lessons learned through the various research and, e) effective monitoring and evaluation. and implementation initiatives. The current WSH program 2) Improving Sanitation Tools and Technologies – structure has three principal, inter-related initiatives, and two Development of new tools and technologies with the goal of cross-cutting initiatives, as shown below. supporting scalable business models and technologies across These five initiatives reflect the Foundation’s current WSH the sanitation value chain. Three main sub-initiatives would priorities, showing our understanding of where the Foundation be: (i) Next generation latrine; (ii) Waste extracting and can have the greatest impact in a complex, diverse, and large transport; (iii) Waste treatment and reuse. sector.

TRANSFORMATIVE TECHNOLOGIES URBAN SANITATION MARKETS BUILDING DEMAND FOR SANITATION

• Applied Research • Market Research • Increase adoption of evidence-based • Innovation • Identify or create new markets practices • Prototyping • Promote uptake of service in low- • Contribute to at least 30 million people income urban areas living in OD Free (ODF) communities • Field Testing • Commercialization

• Encourage donors and implementers to invest in non-sewered sanitation POLICY, ADVOCACY & • Improve sanitation policies for the poor COMMUNICATIONS • Foster effective regulatory environments

• Efforts of the sanitation field are supported by strong measurement MEASUREMENT & EVALUATION and evaluation

6 | Building Demand for Sanitation www.gatesfoundation.org

BUILDING DEMAND FOR SANITATION PORTFOLIO The Sustainable Development Goals (SDGs) being proposed for Each of the BDS grantees are working hard to meet the ‘post 2015’ focus on achieving, among other things, universal challenges facing the sanitation sector (and have made great access to sanitation. Though the timeline for some of these new progress). Their accomplishments and more importantly, the development targets may extend to 2040, governments and key lessons learned from their work—are highlighted in the implementing partners will still need to accelerate the pace of chapter titled Grant and Project Summaries. progress in sanitation programs. Without accelerating the pace, some countries will not achieve universal access to sanitation until the 23rd century.

The core focus of the BDS portfolio is to help increase the 3-5 YEAR BDS GOALS 12-18 MONTH RESULTS efficiency and effectiveness of sanitation programs—in other words, to help ‘pick up the pace’ of sanitation improvement 30 million people in rural (and ensure the improvements are sustained). Based on sector Carry out at least 4 and urban areas demand, demand-generating, research and the Foundation’s findings over the past 10 years, use and form social norms integrated communications we believe these factors include: for sanitation via replicable and consumer awareness models • Promoting community-wide adoption (achieving open- campaigns in urban defecation-free status, or nearly so) environments • Reaching the poorest and most marginalized groups • Establishing an adequate supply of affordable (and Contribute to over 5 million aspirational) sanitation goods and services people in rural communities using improved sanitation • Providing access to affordable financing and credit, especially services for the poor • Integrating demand-led and supply-side interventions for The evidence base for Portfolio-generated optimal mutual benefit building sanitation demand information is readily is strengthened and used To operate effectively at scale, governments and the WASH available through the BDS to drive best practices and Knowledge Management sector in general must be supported by an ‘enabling deliver improved services. environment’ that can accelerate the process. The factors which Initiative we believe are most critical to this include: • Building capacity in governments and implementing agencies, Evidence from completed and strengthening their ownership, investment, and leadership CLTS and sanitation marketing grants is • Improving sector monitoring, verification and reporting effectively disseminated systems through appropriate • Establishing solid evidence on what works (and what channels doesn’t), and advocating for wide-spread adoption of the best approaches Field-based research The Foundation has established long-term and intermediate efforts constructively targets for the BDS portfolio which will continue to help align influence key implementation agencies its investment, and provide benchmarks against which progress can be measured.

Progress on these accelerating factors will be difficult without In India, two rural states (Bihar and Uttar Pradesh) improving the capture and transfer of sector knowledge. Many adapt the implementation WASH sector organizations have realized that, and in the of national sanitation past several years a number of agencies have sharpened their programs, with assistance focus on knowledge management, including the Foundation. from State and Federal- The chapter on Knowledge Management and Research Needs level Technical Support provides further information on the Foundation’s WSH Units knowledge management effort.

Building Demand for Sanitation | 7 GRANT-MAKING APPROACHES Payment by Results There are three features of BDS portfolio grants that are A special case of outcome investing is where payments to the important to mention; two of these are used widely across the grantee are actually linked to achieving specific outcomes. Foundation, and one is more specific to the BDS portfolio. The There are several ways of doing this, with varying degrees of first two features discussed below relate to i) how grants are linkage. On one end of the spectrum, all grant payments can be designed; and ii) the structure of grant payments. linked to achieving results or outcomes. The East Meets West grant for the CHOBA project in Vietnam and Cambodia is an Outcome Investing example of this; payments to EMW are made (largely) based This is an approach to grant making that establishes up-front a upon the number of toilets sold by the Vietnam Women’s Union clear vision of what a successful outcome to the project would (there also are other qualifying factors taken into account). This be, and then translates that vision into measurable outcome approach has enabled EMW and their partners to experiment (or sometimes output) indicators. This clarity of purpose then with their approach until it ‘clicked’ and started delivering guides the development of the grant agreement. Outcome results at scale. If the project had been more rigidly designed investing emphasizes: around specific activities and output deliverables, EMW and its • Aligning an investment around the intended impact of a partners might not have hit upon the highly effective approach project, rather than its activities or outputs; they are currently using (an approach with which EMW is now exceeding the original targets). • Translating project impacts into a number of specific, measurable outcomes that will serve as proxies for impact; Another approach to outcome investing involves establishing • Agreeing on a transparent and robust approach to measuring a baseline “satisfactory performance” project performance project outcomes as part of routine project monitoring. In level, and then linking “incentive payments” to outcomes some cases, independent third party verification of project which exceed this. In this situation, the Foundation provides results is included as part of the measurement approach. an agreed-upon base amount of financing for the project, and then pays the grantee an additional amount(s) if performance The main benefit of outcome investing is that it creates clarity exceeds expectations. The grant to International Development of purpose—aligning a grantee and the Foundation around Enterprises (iDE) for the Sanitation Marketing Scale-Up project a shared vision of success. From the Foundation’s point of in Cambodia was designed this way, as well as Foundation view, the advantage is that monitoring (and reporting) focus support for the WASH II program being carried out by BRAC in mostly on outcomes, making it easier to understand whether Bangladesh. the investment is paying off in terms of achieving the desired impact. From the grantee’s perspective, this approach empowers them to devise the best ways of delivering results—giving them the flexibility to adapt or change their project activities or approaches as required.

Community Health Club members in Rwanda displaying their certificates.

8 | Building Demand for Sanitation www.gatesfoundation.org

These outcome investing approaches provide greater flexibility to grantees in terms of project design and management, as well as meaningful financial incentives to outperform expectations. For the Foundation, outcome investing helps to reduce its financial risk in the case of under-performance, and helps keep its grant relationships focused on results and impact. In summary, outcome investing and payment by results has helped lead to: • Shared vision of success between the Foundation and grantees, and a shared sense of risk and reward; • Greater flexibility in project implementation for grantees, which in turn encourages innovation and rewards ambition; • Shift in grant management focus from verification of activities and expenditures to verification of results; • Project monitoring has become more effective and better- focused. Young women discussing hygiene and menstrual management, Bangladesh. The table below provides some additional examples and further details on how the Foundation has used outcome investing in the BDS portfolio:

GRANTEE ATTRIBUTES GRANT FEATURES RISK SHARING AND EXAMPLES

Agreement with grantee that the vision Strong on research but relatively of success is policy influence and not None. weak on policy influence (just) completion of research. Funding Example: r.i.c.e. based on activities.

Limited. Payments upfront for each Allowing the grantee the flexibility outcome, but follow-up payments to develop a research proposal with Weak on research but relatively conditional on reaching previous suitable partners. If research results strong on policy influence outcome. successfully influence policymakers, grant payout increases. Example: WSA Dakar (not known in BDS portfolio)

While developing business model, Limited. Paying for outcomes only in the New to the sector and developing payments based on activities; switching second half of the grant. business model. to outcome payments later as model becomes clear. Example: PSI Bihar (3SI grant).

Moderate. Part of the budget is Clearly defined outcomes and expected Has developed a business model and represented by incentive payments for value for money, with modest incentives is using the grant to reach scale. excellent targets, and hence is at risk. for reaching stretch goals. Example: iDE Cambodia

High. In the example, 80% of budget Cash on delivery applied to all service Has an excellent field presence, has is paid for outcomes upon delivery. An delivery targets, not just stretch goals. worked at scale, and has experience additional 12% of payments are linked to Highly incentivized to innovate to with outcome investing. ‘stretch’ goals optimize impact. Example: EMW Vietnam

Building Demand for Sanitation | 9 Contributing to WSH Sector Evidence Base Focus on Learning As discussed above, as the Foundation was determining whether A theme that connects different stages of the BDS strategy—and and how to invest in the WASH sector, it became clear that that has stayed constant throughout, independent of changes there was a lack of rigorous evidence5 on what was working (and to the initiative priorities- has been a focus on learning. The what was not) regarding sustainable sanitation delivery models previous section talked about the research and learning driven at scale. In response to this, the Foundation has endeavored to by specific questions. Apart from that important programmatic invest in learning and research to the extent practicable under learning, there is another level of learning focused on clearly the BDS portfolio. This research has been (and continues identifying, sharing and applying what we learn, leading over to be) conducted either as standalone investments (e.g., the time to better results in the sector. The report from the 2013 Innovations for Poverty Action research on the “migration of BDS convening in Cambodia put it nicely: sanitation demand” in Bangladesh), or as an integral part of an implementation program (e.g., the testing of CLTS facilitation “To enable progress on [factors that accelerate the delivery of approaches by Plan International and the University of North cost-effective sanitation at scale], they must be underpinned Carolina in , Ethiopia and Kenya, or the work on or supported by improved knowledge management and strengthening large-scale CLTS and sanitation marketing by dissemination, noting that the type of knowledge which is most WaterAid in Nigeria). impactful is that which is highly accessible, as well as that which is capable of being put to practical application in ongoing or This lack of rigorous evidence in the WASH sector has meant upcoming programs.” that many key programming decisions are (or have been) made based upon incomplete or inconclusive information—not so Stepping back and reflecting on what we are learning as a much in terms of what will have the greatest impact on health, sector has been one of the functions of the annual convenings. but particularly how to best influence sanitation and hygiene Those started in late 2011 in Kenya (focusing on metrics and behavior, or how to design and promote adoption of new sanitation measurement of progress monitoring), followed by the meetings technologies. Combining implementation and evidence-gathering in Cambodia (2013, “Learning what works”), Kenya (2014, has become one of the defining characteristics of the BDS portfolio. “Knowledge management”) and Vietnam in 2015 which is the This has led to productive partnerships between implementers and subject of this report. researchers (Plan and UNC; iDE and IDInsight; WaterAid and In the Hanoi convening the program included even more 6 IPA as well as EDePo ). The partnerships between implementing specific activities than in previous years designed to encourage agencies and research institutions have not always been easy for the reflection, surface ideas and insights. In response, there have grantees to establish, but once accomplished they have generally been very enthusiastic reactions from participants about the proven very beneficial for all involved. opportunities to learn and share after the convening (such as Broadly speaking, the Foundation invests in research to help the exchange visits that will take place later in the year). us (and others) find out “what works” in delivering sanitation and thus make more informed decisions about what kinds of programming to fund.

Should we support programs that link sanitation to micro- finance? Conditional cash transfer programs? CLTS programs that are implemented through partnership with teachers? Our hope is that by integrating learning initiatives (research) with implementation projects we will learn more about what works, and why it works. This information has been, and will continue to be fed into our own grantmaking efforts as well as shared with Governments and other organizations involved with WSH sector implementation.

Another goal of WSH research is to enable the Foundation to reflect on the value for money achieved by particular investments, and to share this information with others. For example—how cost effective are investments in sanitation? How could they be made more cost effective? How do investments in sanitation compare to other types of investments that compete Participants engaged in a “Fishbowl discussion” on financing and subsidies. as priorities within Governments and donor institutions?

10 | Building Demand for Sanitation Portfolio Progress

INTRODUCTION BDS grantees are carrying out a range of interventions and Preliminary or mid-project results are available, as well as the research efforts focused on sanitation demand creation, market final outcomes from a few grantees. establishment, systems strengthening (enabling environment), reaching and empowering marginalized groups, and The table below provides a quick overview of the current and understanding and improving behavior change approaches. In recently completed BDS portfolio projects, and their overall contrast to the situation in 2013 (when the previous portfolio focus. The narrative sections which follow the table provide report was issued), most of the grant-supported activities are more detail on each project, with highlights of their key now well underway, nearing completion, or fully completed. contributions and lessons learned.

GRANTEE PROJECT NAME LOCATION STATUS FOCUS

PRODUCT DEVELOPMENT GRANTS

Ongoing Designing New markets Develop new low-cost pan products American Standard Sanitation Products (follow up on the in Sub-Saharan that are adopted for use in one or more Brands (ASB) for Sub-Saharan earlier grant that Africa rural markets in Africa and Asia. Africa developed the original SaTo pan)

Develop an ecological that meets Fundacion In Terris The Earth Auger Ecuador Ongoing customers’ aspirations; goal of product (FIT) commercialization by 2016.

World Bank Water and Sanitation Support private sector to expand access to Program (WSP) Selling Sanitation Kenya Completed products that meet BoP consumer needs, and International and help create demand. Finance Corp. (IFC)

RESEARCH AND KNOWLEDGE SHARING GRANTS

Center for Distributive, Labor, and Social Evaluation of the RCT to assess effects of a CLTS program Studies (CEDLAS), Impact of a Rural Mali Completed on child health, welfare, and household University of La CLTS Programme sanitation behavior in rural Mali. Plata, ; UNICEF Mali

RCT in Ghana to analyze behavior change Determining the Cambodia, approaches used by CLTS as well as effectiveness and Eawag; USAID7 Ghana, Lao PDR, Starting ODF adoption process by communities. mode of operation Mozambique Preceded by an evaluation of completed of CLTS CLTS projects in 3 countries.

Building Demand for Sanitation | 11 GRANTEE PROJECT NAME LOCATION STATUS FOCUS

RESEARCH AND KNOWLEDGE SHARING GRANTS

Improving Rural Environment Total Sanitation To learn whether female Local Government and Population through members, working with women’s Bangladesh Ongoing Research Centre of Empowered Female groups, can establish effective sanitation Bangladesh (EPRC) Local Government improvements at scale. Members

Institute for Completed Promote learning and knowledge CLTS Knowledge Development Global (Continuing management for CLTS; expand and Hub Studies (IDS) Funding from SIDA) strengthen its application.

RCT to study effectiveness of demand Innovations for Inter-Linkages in generation, supply-side marketing, and Poverty Action Sanitation Demand Bangladesh Ending sanitation subsidies. Investigate influence (IPA) Across Households of sanitation decisions on decisions by others in a social network.

Study of how sanitation interventions affect Does Sanitation the behavior of seasonal migrants, and how IPA Bangladesh Ongoing Behavior Migrate? sanitation in towns affects migrants’ home villages on their return.

1. Analysis of large country data sets (starting with India) showing strong correlation between OD and stunting, Research Institute and reductions in stunting with SQUAT Report/ India and other for Compassionate Ongoing reductions in OD. Switching Study countries Economics (r.i.c.e.) 2. Study of sanitation behavior in 5 states in India showing widespread OD by latrine owners. Evidence linking OD and culture, explaining preference for OD.

INTEGRATED IMPLEMENTATION AND LEARNING INITIATIVES

RCT to test effectiveness of Community Community-Based Health Clubs (CHC) as a social mobilization Environmental and behavior change approach. The grant Africa Ahead Rwanda Ongoing Health Promotion makes uses of the fact that Rwanda is Programme establishing CHCs in all villages, over a period of a few years.

Innovations in Increasing sanitation coverage at scale Sustainable -with a special emphasis on reaching the BRAC Bangladesh Ongoing Sanitation in hardcore poor- as well as innovation and Bangladesh replication components.

Integrated Water Sanitation promotion and sustainable Central India and Sanitation India: Gujarat and sanitation technology for rural households, as Ongoing Initiative (CInI) Model for Rural Jharkhand part of livelihood projects aimed at alleviating India poverty among tribal communities.

Community Water A study of fecal sludge management and Sanitation Fecal Sludge Ghana Ongoing approaches in villages and small towns, to Agency of Ghana Management Study inform national FSM policy development. (CWSA)

12 | Building Demand for Sanitation www.gatesfoundation.org

GRANTEE PROJECT NAME LOCATION STATUS FOCUS

INTEGRATED IMPLEMENTATION AND LEARNING INITIATIVES

Sanitation financing, hygiene education, and marketing in a project driven by financial East Meets West Vietnam, transfers and incentives payments, to CHOBA Ongoing Foundation8 (EMW) Cambodia promote sanitation improvement in rural Vietnam and Cambodia, especially among the poorest.

Brought commercial sales of moderately- priced to scale. Demonstrated Completed market-based approaches can significantly International Sanitation (continuing with increase sanitation coverage in Cambodia, Development Marketing Scale-Up Cambodia funding from other also among the poor. Learning efforts Enterprises (iDE) Project (SMSU) sources) included testing of financing models, consumer price sensitivity and replication in other countries.

How to scale up CLTS while maintaining quality and containing costs. Research Plan International around testing impact of different internal with University Testing Modified Ethiopia, Ghana, Ongoing actors (natural leaders, teachers, and of North Carolina CLTS for Scalability Kenya district officials). Learning component (Plan/UNC) includes case studies, literature review, and dissemination. Supporting Develop sustainable sanitation business Sustainable models and products that match consumer Population Sanitation expectations. Demonstrate innovative Services Improvements India (Bihar) Ongoing financing approaches to increase coverage, International (PSI) through Supply- and conduct multi-media campaigns for side (3SI) sales and marketing. strengthening

Population Project Develop and test business models to Services Prasaadhan: rural India (Bihar) Ongoing promote rural FSM practices (focusing on International (PSI) pit emptying emptying).

Organize women into Self-Help Groups as Rajiv Gandhi Women’s agents of change in sanitation, hygiene, Mahila Vikas Empowerment and India (Uttar Ongoing and other social and economic spheres. Pariyojana Poverty Reduction Pradesh) Conduct research on effectiveness of (RGMVP) in Uttar Pradesh different implementation approaches.

Increase access to sanitation through Scaling-up and strengthening government sanitation Strengthening programs at scale; analyze program UNICEF Community Indonesia, Ongoing innovations and strategies; distil l lessons Approaches to Total learned and transmit learning to other Sanitation Asian and African countries.

To improve the effectiveness, efficiency, inclusion and sustainability of total Sustainable Total sanitation approaches in 3 States, and Nigeria: Jigawa, WaterAid Sanitation in Ongoing contribute to wider national and regional Ekiti and Enugu Nigeria good practice. Research impact of varied combinations of CLTS and marketing approaches.

Building Demand for Sanitation | 13 Grant & Project Summaries

PRODUCT DEVELOPMENT PROJECTS

Designing Sanitation Products for Sub-Saharan Africa Grantee: American Standard Brands Partners: UNICEF, Water for People, Cresstanks Ltd. and others Location: Uganda, Kenya, Rwanda Dates: May 2013 – December 2015 Information: Jim McHale [email protected]

American Standard Brands Focus and Objectives: This project is an extension of the Foundation’s previous partnership with American Standard Brands (ASB),9 under which ASB developed a prefabricated toilet pan in Bangladesh that was hygienic, easy to install and clean, and was economically mass-produced. The “Sato Pan” improved upon existing pan designs that were available on the open market, and in so doing, provided an affordable, attractive and hygienic alternative for consumers. Over 700,000 Sato Pans are now in use in Bangladesh, of which roughly 500,000 were donated by ASB to partner NGOs BRAC, Water for People, Save the Children, and WaterAid. About 200,000 units have been sold to consumers field trials, and refinement of products for market. Once these through the open market by the manufacturer, RFL Plastics. steps are completed—the final product(s) will be manufactured The retail price of the pan in rural Bangladesh is around $1.75, and marketed if warranted by a solid business case. which is within a price range that most consumers can afford. This price point allows for profit-taking throughout the supply Accomplishments to Date: chain, providing a sustainable business model. The product The ‘original’ Sato Pan as developed in Bangladesh consisted is considered both a programmatic and a commercial success of one basic pan design, with a flapper door to keep the pit and introduction into other countries (Timor Leste, Vanuatu, contents sealed from the environment. A ‘collection box’ was possibly India) has happened independent of project activities. also manufactured which served to adapt the pan for offset pit installations. The original Sato works best when installed in a Under this new partnership, ASB will introduce improved concrete slab. The concepts to be tested in Africa include the sanitation products at scale via market-based approaches in original design, plus three new variations: a ‘wide flange’ model one or more sub-Saharan African markets over a 2-year period. for installation in wooden or earthen structures; a ‘stool’ model The products will be variants of the Sato Pan developed in for seated use; and an ‘integral slab’ model. A new door Bangladesh. ASB will establish local production and marketing design, which is more lightly counterweighted and opens to a efforts, so as to help generate sanitation demand as well as steeper angle to minimize water usage has also been developed. contributing to livelihoods opportunities. Each of these models mentioned above can be fitted with either Project targets include: of the two trap door varieties. The new concepts are also fitted A ‘deep dive’ sanitation demand and supply analysis with a “pull string” for manual opening of the trap door. This (completed), followed by product development prototyping, was deemed necessary to allow for the passage of paper, leaves,

14 | Building Demand for Sanitation www.gatesfoundation.org etc., that might be used as wiping materials and would be too participating in the Rwanda field trials the seated version was light in weight to cause the trap door open on its own. preferred nearly 2:1. Three households that had originally selected the integral slab version requested to switch to the stool Production tooling for the wide flange pan (“Pan 2”) and the when seeing both products side by side. Although the stool new door (“Door 2”) have been produced with manufacturing concept was originally designed for the functional purpose of partner, Cresstanks, located in Kampala, Uganda. This new lifting the moving trap door mechanism up and away from the product will become commercially available in Uganda and opening to the pit, it appears that it could be viewed as a more other neighboring markets in 2015. The retail price point is aspirational, perhaps premium product for this market. expected to be below $5 USD. Next steps for the project will be to: Key Learnings from Project: Field trials of the stool and integral slab concepts are underway in Rwanda with assistance 1. Conduct field trials in Rwanda, Uganda, and Kenya and from the local UNICEF office. Additional field trials are being collect user feedback. planned for Uganda and Kenya, again with assistance from 2. Launch the large flange product on a commercial basis in UNICEF. Early feedback from users has been very positive, Uganda to determine price point, distribution strategy, with odor reduction and “cleanliness” being cited as the marketing plan, and other critical aspects of the business most significant benefits. One specific learning has been the model. unexpectedly high acceptance of the stool version in Rwanda. 3. Evaluate user feedback and determine whether to General opinion at the onset of the project was that the Sub- commercialize additional models. Saharan African consumer preferred squatting toilets and would not accept seated options. This thinking was generally confirmed in the initial field research interviews in and Kenya. However, in the relatively small sample of 15 families

A prototype of the new American Standard plastic slab with SaTo pan fitted in an existing latrine in Rwanda.

Building Demand for Sanitation | 15 Accomplishments to Date: The “Earth Auger”, Testing and Introducing • 86 demonstration Earth Augers installed; over 50 additional in Latin America’s Market a New installations expected in first quarter of 2015. Technology on Decentralized Sanitation • Arrangements for micro-financing household toilet purchases Grantee: Fundacion In Terris (FIT) should reduce cost for the user to $225-$565 (with the higher amount including the superstructure), paid back at $10-$24 Partner: Critical Practices LLC per month over a 2-year repayment period (equivalent to a Location: Ecuador cost of $0.07 to $0.17 per user per day for a family of five). Dates: July 2013 – December 2015 • Several State & County Governments are interested in Information: the toilet; approval for the design by National Ministry of Environment. Marcos Fioravanti [email protected] Key Learnings to Date: Early products, which were partly hand-built, had reliability and Charles (Chuck) Henry user acceptance issues and a relatively high cost. Project targets [email protected] were adjusted to provide more time for design improvements and collect in-depth performance data and user feedback. The business plan is currently under development, and the project Fundacion In Terris has been extended until end of 2015. Commercialization goals This project is developing an ecological, dry toilet that are focused on the Ecuadorian market. Lessons learnt: meets customers’ aspirations—with a goal of product • The discovery that it is possible to have plastic components commercialization by 2016. The Earth Auger (El Taladro de la manufactured without paying the full cost for a mold (but Tierra) is a urine-diverting dry toilet whose key innovations instead paying mold “rental charges” to the manufacturer) include a pedal-operated dry-flush mechanism, and an transformed manufacturing options allowing the project to automated composting system. When the pedal is operated the stop using the low-quality hand built components. feces, cleansing paper and automatically-added sawdust are • Testing early products at small scale and collecting user mechanically moved along through a pipe with an auger inside. feedback is necessary before scaling up production. Successive “flushes” mix and aerate the materials while moving • Business models need to be based on local field data. In the them through to a storage bag at the end of the pipe, where the absence of reliable data, crafting a sound business plan takes mixture is retained for further dehydration and pathogen die- significant investment of time, effort and resources. off prior to being used as a soil amendment. Urine is harvested separately, mixed with any wash water and drained, preferably Next Steps: to a nearby garden. In mass production the units (without Further efficiencies will be sought along the supply chain superstructure) are expected to cost between US$150 and to ensure sustainability, along with finding additional ways US$300. to reduce the unit’s retail cost. As the demonstration model moves towards production, FIT will increasingly focus on Project targets include: building demand for the units by increasing the product’s • Demonstration and testing of mass-produced Earth Auger aspirational features as well as further cost reductions. FIT will prototypes in sufficient numbers to assess the toilet’s use crowdsourcing to speed up development of solutions and functioning and acceptability by users, as well as the identify design and manufacturing improvements. From a user microbiological quality and the use of the final product (e.g., protection perspective, FIT will be seeking improved methods as fertilizer). for increasing (and measuring) pathogen die-off during the • Improve design and production, to increase product quality composting process, and to ensure the safety of land application and decrease manufacturing costs. of mature compost products. FIT also will collect data regarding • Develop a business plan for production, marketing, assembly users’ experience including the toilet itself, as well as any and distribution that is sustainable and competitive for benefits gained from composting. Ecuador.

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Selling Sanitation—Catalyzing the Market for Household Sanitation in Africa Grantees: IFC and WSP Partners: Numerous government, private sector, and financing organizations Location: Kenya Dates: 2012 – 2014 Information: IFC Website and Project Video Yolande Coombes (WSP) [email protected]

International Finance Corporation & Water and Sanitation Program-Africa Although half of Kenya’s base-of-pyramid (BoP) consumers already have the desire to invest in sanitation for their homes, the available options are complex to purchase and generally of poor quality. Sanitation products are not standardized, and sanitation businesses are not seeking new customers. To Plastic latrine slabs like this one are now manufactured and sold in Kenya. improve on this situation, the Selling Sanitation project10 has worked with businesses to develop affordable and desirable private sector sides elsewhere in East Africa, such as Uganda, sanitation products, with Government and financing Tanzania and Ethiopia. Manufacturers involved in Kenya are organizations to help establish a sustainable market for well-positioned to expand to access the larger regional market, sanitation services, and with outreach organizations to as several have factories in other East African countries and increase consumer demand and to help end OD through distribution networks spanning sub-Saharan Africa. CLTS campaigns, as well as to improve other hygiene-related behaviors such as hand washing. This is in line with and Accomplishments to Date: supportive of the Government of Kenya’s vision to achieve Through in-depth market research, and in partnership with universal access to sanitation by 2030. The project’s Foundation manufacturers, the project used the Human Centered Design funding officially ended in 2014, but WSP is continuing its work approach to develop a range of hygienic, aspirational plastic on this with other sources of financing. latrine slabs that are manufactured locally in Kenya (see photo). The slabs range in price from $17 to $55 (ex-factory), can be Project targets include: easily transported and stored, are easy to move to a new pit The overall IFC/WSP project target is to sell 1.5 million of the once the old one is full and provide an attractive and durable latrine slabs by 2020, including sales from expansion countries alternative to the built-to-order concrete products that had outside of Kenya. Selling Sanitation has already led to two dominated the Kenyan marketplace. partner investments of approximately $500,000. As a result, The project has also worked at the policy level to integrate one manufacturer, Silafrica, has developed the manufacturing market-based approaches into the Kenya Environmental capacity to produce over 10,000 units per month. The final Sanitation Policy and Strategy, as well as the National product design is fixed and distribution began in August Sanitation Bill. In addition, the project helped establish working 2014, with 1,000 durable plastic slabs sold even before the partnerships between NGOs, Government, and other agencies launch of the main demand creation campaign which began in to pool resources for more effective and cost-efficient behavior November 2014. Selling Sanitation also catalyzed the signing change and capacity-building campaigns. of a distribution agreement between Silafrica and Equity Bank to leverage their extensive BoP presence (Equity Bank provides Improving consumer access to affordable credit is another area 56% of all Kenyan bank accounts). of project engagement. The project is working with MFIs and Although these are still only early results in Kenya, there other partners to support development and testing of workable is already interest in replication from both the public and financing mechanisms that can enable more consumers gain access to new products. Mechanisms may include existing water,

Building Demand for Sanitation | 17 sanitation or housing MFI consumer loans, or working capital Next Steps: loans to private partners who can pass on terms of credit to The project will focus on expanding the market for the plastic consumers. slabs and going ‘the last mile’ to reach more consumers. Efforts will include helping the private sector to identify Key Learnings from project: optimal distribution channels, including engaging with local Through consumer and market research, the project has learned masons and artisans, marketing to communities who have that been triggered through CLTS, and utilizing new marketing • Sanitation customers were dissatisfied with available product channels. The project also will seek to address the complexity choices and were interested in latrine construction and of purchasing and financing by establishing partnerships with upgrades if costs were reasonable formal MFIs, Savings and Credit Cooperative Organizations, • Consumers did not know of options between traditional and and local micro-savings groups. Finally, an evaluation of the high-end concrete slabs; the aspirational high-end options impact of the plastic latrine slabs is planned to begin with a were financially out-of-reach for many, including BoP baseline study starting in March 2015. customers • Available slab products were not designed to fit consumer needs and preferences • Little to no market testing of plastic sanitation products had been done because onsite sanitation was still seen as a low priority and high risk market • Misinformation about improved latrines led manufacturers to design plastic products that did not fully achieve health benefits for consumers • The market for latrine slabs in rural and peri-urban Kenya was estimated at 1.6 billion KES (USD 19 million) in 2014

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RESEARCH AND KNOWLEDGE SHARING PROJECTS

Key Findings to Date: Evaluation of the Impact of a Rural CLTS The study showed that there was a significant increase in access Program to private latrines, improved quality of latrines, and a reduction in OD. Specifically, Institution: Center for Distributive, Labor, and Social Studies (CEDLAS), National • Access to private latrines nearly doubled among households in University of La Plata CLTS villages, going from 35% to 65% on average. Researcher: Dr. Maria Laura Alzua et al. • Adult OD rates fell by 70%; among children (aged 5-10) by 46%; and among children under five by 50% Location: Mali (Koulikoro Region) • Children too young to use latrines were more likely to use a Dates: April 2011 – May 2013 potty in CLTS villages (51% vs. 15%) Information: M.L. Alzua, CEDLAS CLTS intervention households also had cleaner latrines and [email protected] improved hygiene: • Households were three times more likely to have soap and 5 times more likely to have water (for handwashing) CEDLAS and UNICEF • Latrines were more than twice as likely to have a pit cover, and 20% less likely to have flies inside the latrine Research Focus and Objectives: This research effort was conducted as a learning exercise within Perhaps the most significant findings were related to child a large CLTS program being implemented by UNICEF in rural health and nutrition in the intervention areas. There was a Mali. The study was designed to assess the effects of a CLTS positive, significant impact on child growth patterns: children program on sanitation and defecation practices, child health, under five years in CLTS villages were found to be taller (+0.18 11 and other household and community attributes. height-for-age Z-score). Stunting was reduced by 17%, and Methodology: severe stunting in children under 2 years was lower by 23%. A randomized, controlled trial (RCT) was conducted with half There also was a 57% reduction in diarrhea-related under-five of the 121 eligible communities randomly assigned to receive mortality in CLTS villages. There was no statistically significant the CLTS intervention. The study investigated the intervention’s impact on child diarrheal disease or respiratory illness. effects upon sanitation adoption and defecation behavior, However, there were significant reductions in bloody stool child health and nutritional status, labor supply, schooling incidence. and women’s safety. Also investigated were what the drivers of collective action related to latrine adoption were, and to assess any effects related to social structure.

Building Demand for Sanitation | 19 In terms of social effects, there were significant differences A reduction in the prevalence of diarrheal diseases may require in prosocial12 behaviors such as cooperation and community stronger adoption of hand-washing with soap, improved food empowerment in CLTS intervention areas. Increased feelings of hygiene, as well as improved access to safe water. privacy and safety were reported by women. The findings of this research were presented at several An unexpected finding was that no significant change in international public health conferences in 2014; the health the amount of diarrheal disease was found, yet there was a impact results will be published in an international journal. The significant impact on child growth. There also was no change results also will be presented and discussed with the Malian in the bacteriological quality of water in the intervention areas. government. The findings suggest that improved sanitation works to prevent child malnutrition; the mechanism may be that lower OD rates Next steps: in CLTS communities led to lower prevalence of non-diarrheal Future research will look further into the role of social networks but fecally-transmitted pathogens such as soil-transmitted on latrine adoption and OD practices, conduct a cost-benefit helminths, (Ascaris, hook-worm) and/or lower prevalence of analysis, and perform a comparative analysis using data from environmental enteropathy. India, Indonesia, Tanzania and Mali.

Eawag (Swiss Federal Institute of Aquatic Science Determining the Effectiveness and Mode of and Technology) Operation of CLTS Research Focus: Institution: Eawag To analyze the behavior change approaches used by CLTS and Researcher: Drs. Hans-Joachim Mosler and community ODF adoption processes. The research will attempt Miriam Harter to determine how different elements of CLTS affect behavior, and whether there are elements which have counter-effects Partners: USAID and Plan International on individuals or social systems. The study will identify the Location: Ghana, Cambodia, Lao PDR, and psychological determinants of behavior change triggered by the Mozambique CLTS activities. In addition, the study seeks to identify which Dates: November 2014 to October 2017 are the best combination of CLTS elements to attain an ODF community, and to unpack the ODF adoption process including Information: assessing which community members are ending OD first, who Miriam Harter is doing so last, and why. Finally, the identified combinations [email protected] of CLTS elements will be compared to a data-driven behavior Hans Mosler change strategy. [email protected] Methodology: Pre-surveys will be conducted in 3 countries (Cambodia, Lao PDR, and Mozambique) where CLTS has been implemented (600 households in each country). The main study to follow will be conducted in Ghana, as the research component of a large CLTS implementation program funded by USAID. The study includes face-to-face interviews in 3,125 randomly selected households using quantitative, structured interviews on three key behaviors: OD, latrine construction, and latrine use; as well as behavioral determinants. Spot checks will be conducted regarding OD within households and at the village level. The pre-surveys started in March 2015, and the main research in Ghana will follow—starting with a baseline survey in October 2015.

Household interviews in rural Cambodia

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Methodology: Improving Rural Effective Total Sanitation The study involves a RCT in 32 intervention and 32 control through Empowered Female Local Union Parishads. The implementation aspect of the study Government Members involves supporting FLGMs to work with CWGs in order to carry out sanitation and hygiene education interventions, as Institution: Environment and Population well as to promote hygiene and sanitation within the context of Research Centre the UP itself. Researcher: Dr. Bilqis Hoque Key Findings to Date: Partner: Jagoroni Chakra Foundation (JCF) Monitoring of intervention communities indicates that FLGM Location: Bangladesh (Comilla and Dinajpur and CWG-led hygiene promotion efforts have resulted in Upazilas) significant changes over baseline conditions. These changes Dates: May 2012 – Apr 2015 include: Information: • Rates of access to sanitary latrines increased to nearly 97% Bilqis Hoque from a baseline of around 80% (over a 2-year span). This [email protected] [email protected] exceeded the project target to increase access by 10 percentage points. Website: www.eprcbd.org • Observed presence of hand washing agents improved significantly. • About 40% of FLGMs showed good potential for coordinating Environment and Population Research Centre of sanitation at the UP level Bangladesh (EPRC) • Three out of 10 “Best Practice” fact sheets recently developed Research Focus: for Local Government were prepared by intervention FLGMs The importance of institutions in addressing long-term and their UP Chairmen. development challenges is well accepted, though there is a • The National Institute of Local Government agreed to lack of empirical evidence on their effectiveness. In particular, recommend FLGMs be considered as Chairs of the UP WASH there is little information available regarding the roles played Standing Committees. by female leadership in bringing about societal changes such as sanitation and hygiene improvement. Discussion of Findings: Results so far suggest that working with FLGMs improved their Although Bangladesh has made great strides since 1990 in overall capacity as UP members and they played important roles latrine coverage, nearly 45% of the rural population still lack in promoting sanitation in their Union Parishads, including access to sanitary latrines. Lack of local leadership has been both schools and communities. With CWG assistance, FLGMs shown to be an important factor influencing the adoption and demonstrated the potential to lead the drive to achieve total sustained use of latrines and related behavior change.13 EPRC is sanitation at the local level, in line with national sanitation policy. studying whether female Local Government members (FLGMs), working together with Cluster Women’s Groups (CWGs), can effectively promote sanitation, including ownership and use of improved latrines and related hygiene practices. The FLGMs are members of the Union Parishad14 (Council); each UP has three elected female representatives that serve on the 12-member body. Government policy stipulates that FLGMs should chair at least one third of the Council’s standing committees which in turn make recommendations for UP Council approval.

The knowledge gained hopefully will serve other rural populations in Bangladesh as well as other developing countries. Many if not most countries have also been promoting a greater role for local government in sanitation campaigns. Attention to gender and poverty issues is often acknowledged as a necessary component, but empirical evidence and practical guidance on how to do this effectively has been lacking.

A community gathering in Bangladesh

Building Demand for Sanitation | 21 There have been challenges to the project which are worth male and female UP members regarding their roles and considering. One hinged around incentives—as this project responsibilities. As female members’ capacity and confidence offered no financial or other incentives for community members increased, they sought greater and more equitable participation (e.g., latrine subsidies; meeting attendance costs) which in the governance process. Overall this trend is positive, though differed from some other major national projects. This resulted further evolution will likely need to take place regarding the in constraints to a number of FLGMs who faced difficulties roles and responsibilities of FLGMs and CWGs in the context of in building community participation. In addition, national UP governance. elections were followed by a prolonged period of unrest which influenced UP budgets and the ability to carry out project work; Finally, the lack of affordable pit de-sludging services and the project timeline had to be extended to accommodate this. treatment/disposal options are of increasing concern, especially as latrine use rises. Pit wastes continue to be disposed untreated Though most communities readily accepted FLGMs in into water bodies. their role as promoters of improved sanitation, this stronger leadership by FLGMs led to occasional tensions between

Next Steps: Networking and Action Learning to Support The Foundation’s project is now completed, but IDS has secured CLTS (CLTS Knowledge Hub) new sources of funding and continues to expand its services to the CLTS practitioner community in order to broaden, Institution: Institute of Development Studies improve and strengthen CLTS at scale. A recent innovation was Researcher: Prof. Robert Chambers the establishment of a new publication series called “Frontiers Location: Global of CLTS: Innovations and Insights”. The Knowledge Hub continues to focus on policy engagement in India, recognizing Dates: Feb 2012 – Sept 2014 that India’s sanitation situation is a major challenge in the Information: sector. IDS will continue to engage with the Government of Robert Chambers India in an attempt to understand and constructively influence [email protected] policy and practice there. For example, IDS has taken part in Petra Bongartz initiatives and discussions leading to new national guidelines [email protected] for the (India’s national sanitation program), and is tracking developments regarding the proposed www.communityledtotalsanitation.org guidelines for Rapid Action Learning Units.

A particular focus for the Hub are the second and third Institute for Development Studies (IDS) generation challenges that have arisen now that CLTS is being implemented at scale, and in many cases by Government. Focus and Objectives: Sustainability is one of the central challenges that encompasses Promote learning and management of knowledge about the many other issues such as equity and inclusion; integration CLTS approach; expand and strengthen its application, quality of sanitation technology design and marketing; post ODF and scale. follow up; monitoring; and ODF verification. In 2015, the Hub Key activities: will host a write-shop on sustainability which will result in a Convened learning workshops with practitioners, documented publication. The Hub is also engaged in learning more about and published lessons learned, maintained the CLTS website, adaptations of CLTS in urban settings, and plans to conduct published a periodic newsletter with programmatic updates, research, hold thematic workshops, and prepare papers on this and engaged in action learning and networking with CLTS topic during 2015-16. practitioners.

From a technical perspective, the Knowledge Hub also promoted equity and inclusion in sanitation programs, sustainability of the approach, and enhanced monitoring and verification. The Hub also carried out important policy and advocacy work with leading organizations and key government bodies.

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Does Sanitation Behavior Migrate? Institution: Innovations for Poverty Action Researcher: Dr. Ahmed Mushfiq Mobarak Location: Bangladesh Dates: Sep 2013 – Sep 2015 Information: A. Mushfiq Mobarak [email protected]

Innovations for Poverty Action (IPA) Research Focus: Result of previous research: CLTS or latrine supply alone did not lead to large changes 15 This study by researchers at IPA seeks to answer two related in latrine ownership relative to the control group. CLTS + subsidy had the biggest questions: do rural sanitation campaigns impact migrant impact (and even households that did not win the subsidy showed a big increase). (worker) behaviors when they move to cities and towns? Conversely, do migrant workers bring back sanitation habits acquired in cities and towns to their home villages?

Methodology: Next steps: Two sets of experiments were conducted: The research continues and once data collection is complete, 1. Sanitation campaigns16 were randomly assigned to rural findings will be published. Any implications for program design villages, and the sanitation behaviors of migrants from those or implementation will be considered jointly with implementing villages were tracked when they moved to cities and towns. organizations. 2. Incentives to seasonally migrate were randomly assigned Previous research: to rural residents,17 encouraging them to move to cities IPA conducted an earlier study (2011-13) in Bangladesh entitled and towns for work during the slack season. The sanitation Inter-Linkages in Sanitation Demand across Households, in behaviors of returning migrants were tracked, both at their partnership with WaterAid Bangladesh and Village Education destination and at their origin. Resource Center (VERC). The research was conducted in rural areas of Tanore Upazila (located about 265 km northwest of Discussion of Findings: Dhaka). The study still has at least one more round of data collection to go, so results are preliminary at this point. For Experiment 1 The research (an RCT conducted in 380 villages) focused (effects of sanitation campaigns on the sanitation practices of on testing the effectiveness of different types of sanitation migrants) the following results were observed: interventions intended to increase hygienic latrine ownership. • Sanitation campaigns decrease OD among migrants Key questions addressed: • Migrants from households who invested in latrines (through • Is demand generation necessary or sufficient? randomized subsidies) are less likely to practice OD at their • Is a supply-side push necessary or sufficient? destination • Are subsidies necessary? For Experiment 2 (effects of migration on sanitation behavior of • Who should you subsidize? How should you subsidize? returning migrants): The demand-generating approach, referred to as the ‘latrine • Adults who migrate are much more likely to practice OD when promotion program’ (LPP) was a version of CLTS carried out by they return home if they migrated to high-OD destinations VERC. The supply program (latrine supply agent or LSA) was (such as small towns). Adults who migrate to a low OD area a respected community member with knowledge of sanitation (such as a city) show no difference in OD behavior against the technology. The subsidy program was run as a lottery among control group. poorer households, and if awarded would cover about 75% of hygienic latrine cost.

Building Demand for Sanitation | 23 Effect on latrine ownership was greatest for the subsidy sanitation or lack of access to markets for toilet components are treatment-eligible households were 16% more likely than not the key deterrents to sanitation investments in this setting. those in control villages to own a latrine (averaging for those Instead, the results suggest that financial constraints are an who both won and lost the subsidy lottery). Households in the important limiting factor. Asking community members to make LPP + Subsidy treatment group were 14% more likely to have a joint investment commitment is a good idea, but study results latrines than in the LPP only group. Even subsidy lottery ‘losers’ suggest this should be accompanied by subsidies targeted to the were 7% more likely to own latrines (than control villages), poorest members of the community. Further analysis of the indicating that sanitation investment decisions made by one data from this study will further investigate the links between household were influenced by those made by another. This is subsidies and investment decisions by others. Shame, aspiration an important finding, because program implementers have or changing social norms could all be at play in this case (do often made the assumption that providing a subsidy to some richer households buy a latrine after the poorer households discourages others from investing in a toilet. In this study, this receive a subsidy because they are ashamed of remaining was not the case. The LPP-only group had the lowest increase in without toilet? Or are poorer households investing because they latrine ownership (around 6%). aspire to be like their richer neighbors? Or does the provision of a large number of subsidies help change social norms in the The small effects of the LPP Only and Supply Only treatments community?). Further results and any implications for programs suggest that lack of information about the benefits of improved will be published as they become available.

Figure 1: Males from HHs with latrines who practice OD Sanitation Quality, Use, Access, and Trends (SQUAT survey results). (SQUAT Report); and Switching Study Institution: Research Institute for Compassionate Economics Researchers: Dr. Dean Spears, Sangita Vyas, and others Location: India (5 states) Dates: March 2013 – August 2015 Information: Dean Spears [email protected] Sangita Vyas [email protected] http://riceinstitute.org/research/

Discussion of Findings: Research Institute for Compassionate Economics India with its very high OD rate is an outlier compared to other Asian and South Asian countries. Simple latrines are unpopular (r.i.c.e.) in India, especially in the northern plains states, though they Research Focus: have gained popularity in many other countries in the region These related studies examined the drivers of OD in India, and in Africa. Comparing India to other countries, India’s higher including links between OD and culture, and the reasons why OD rate does not appear to be correlated with income, poverty, people use or do not use latrines. education, or access to water. Importantly, access to sanitation is not really the answer—even households with latrines still have Methodology: members which practice OD—as many as 40% or more of rural For the SQUAT Report, 3,200 households in 13 districts were household members with latrines may still OD. sampled in 5 states.18 The sampled states are home to one third of the global OD population. The data were analyzed quantitatively. Another important finding is that Government-constructed or The Switching Study19 was a semi-quantitative survey using supported latrines are less likely to be used than private latrines. structured interviews (100 conducted) across Gujarat, Haryana, One reason is that private latrines typically have much larger- Uttar Pradesh and the Nepali terai. capacity pits which require much less frequent emptying.

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OD practices and low preference for latrines appears linked require much stronger attention to drivers of behavior, which to cultural beliefs about ‘purity’ and ‘pollution’. The presence include religious and cultural values, among other challenges. of a latrine in the home is seen as ‘polluting’, whereas OD is seen as pleasant, invigorating, and a healthy lifestyle practice. Next steps: Latrine use is also associated with weakness—they are built for The preference for very large latrine pits and related cultural the convenience of sick people, the elderly, young children, and preferences will be key issues to address in any sanitation women who recently delivered a baby; i.e., people who would campaign. These policy issues should be discussed with local, have a hard time walking long distances to defecate. Relatively state and national government. few interviewees expressed interest in having a latrine, when New questions being considered in ongoing research include given a choice of other consumer goods. analysis of cultural links to the Infant Mortality Rate, and Moreover, higher-caste members do not prefer simple pit latrines possible links between sanitation and anemia. because they require more frequent emptying (and contact Previous research: with pit emptiers, who are seen as polluting). At the same time, R.i.c.e. has carried out a number of studies on the correlation lower-caste members want to distance themselves from manual between stunting and OD—starting with the Indian question scavenging and pit emptying as symbols of the past and of (why are children in India shorter, on average, than children oppression. in sub-Saharan Africa who are poorer, on average?) as well as These findings help explain the high rate of OD, the preference performing similar analyses on other country data sets. The for private over Government latrines, and the difficulty of findings demonstrate strong correlations between stunting and promoting latrines in areas with limited space around the the percent of households who engage in OD. These results, household. Therefore, solving the OD problem in India will and numerous related research studies, can be found on the r.i.c.e. website.

INTEGRATED IMPLEMENTATION AND RESEARCH PROJECTS

intensities of CHC interventions. The ‘Lite’ version is more in Community-Based Environmental Health line with the PHAST20 method of health and hygiene education. Promotion Programme in Rwanda The CHC model was adopted for the Rwandan Community- Based Environmental Health Promotion Programme (CBEHPP) Grantee: Africa Ahead because previous research had demonstrated CHCs capable of Partners: Ministry of Health achieving high levels of cost-effective behavior change. This Location: Rwanda (Rusizi District) project randomly selected 150 villages and is delivering the ‘Classic’ (20-module) version of CHC trainings to 50 villages; 50 Dates: October 2013 - December 2016 villages are receiving the ‘Lite’ version, and the rest are control Information: villages. (All Lite and Control villages will receive ‘Classic’ CHC Anthony Waterkeyn training after the RCT is completed in early 2016). [email protected] Accomplishments to Date: After six months of intervention, field monitoring indicates participating households (8,420) have made significant gains Africa Ahead with an average 41% improvement in hygiene behaviors across Description and Approach: 14 water and home hygiene indicators. Anecdotal evidence This project tests the effectiveness of different approaches suggests district and sub-district leadership are becoming of Community Health Clubs (CHC); the evaluation seeks to engaged with the CHCs and are taking responsibility for distinguish between two levels of intervention: the ‘Classic’ supporting their preventative health and hygiene efforts. Some CHC approach and a ‘Lite’ version. The ‘Classic CHC’ model CHCs are forming village-based enterprises, registering as claims to achieve high levels of hygiene behavior change cooperatives, and opening bank accounts. Such promising together with holistic preventative health outcomes (that developments will continue to be monitored and supported. includes ODF, demand for improved sanitation, and hand- The evaluation’s RCT results will not be available until the washing) together with significantly strengthened social beginning of 2016. In the meantime, impressed with the results cohesion and the empowerment of women. The research will to date, the MoH has called for a scale-up of CHCs nationally. employ an RCT to test the effectiveness of the two different

Building Demand for Sanitation | 25 Innovations in Sustainable Sanitation in Bangladesh Grantee: BRAC Partner: IRC Location: Bangladesh Dates: Oct 2011 – August 2015 Information: Md. Akramul Islam Ingeborg Krukkert [email protected] [email protected] http://wash.brac.net/ www.ircwash.org/home

Private business supplying latrine components to rural customers.

BRAC Description and Approach: promotion, and documentation and learning. IRC also was This grant supports BRAC’s WASH II program, which covers coordinating action research to address some of the key half the country’s upazilas21 and whose overall targets included challenges identified in phase one of BRAC WASH, including reaching 51 million people. The Foundation sought to reach low-cost sanitation technologies for high water table areas, at least 1.2 million persons with the funds it provided; as of business models for turning waste into energy, composting December 2014, BRAC had reached nearly 4.5 million (who options for pit contents, and ways to simplify monitoring and have obtained new or upgraded latrines). The project used reporting processes. a community-based integrated approach and also provided financial subsidies for the ultra-poor,22 and loans for poor Project objectives included: households. The project sought to increase sanitation coverage as • Improved understanding of what it takes to reach the hardcore well as sustaining it by strengthening demand, supply, finance, poor and greater effectiveness reaching them through the and enabling environment. Foundation-specific components project; included reaching the poorest; emptying pit latrines and • Improved understanding of long term sustainability and producing organic compost from the composted waste; adoption factors influencing it; of the approach by government and other NGOs, cost analysis • Pilot-scale “sustainability” efforts to identify new solutions for (WashCost); and using smart phones for monitoring. Additional pit emptying, including micro-production of organic fertilizer support for BRAC’s WASH II program (and for the earlier WASH and producing energy from fecal sludge combined with I program) was provided by the Dutch government (DGIS). agriculture waste;23 The BRAC project aimed to bring sanitation services to at least 1 • Availability of low cost latrine options for use in challenging million people in the existing 152 upazilas, and at least 225,000 areas; people in five new upazilas. In addition, targets were specified • Adoption of components of the project model by local for sustainable sanitation use (measured six months after government and other agencies (e.g., use of twin pit latrines, implementation); the design of a “waste to energy” component copying of “sustainability” pilots). focused on handling waste from latrine pits; and the replication of WASH II project approaches by others. In fact, the project Accomplishments to Date: (which will finish later this year) exceeded “satisfactory” project Over the past eight years BRAC WASH has set new standards target levels on almost every key indicator (reaching “excellent” for large-scale interventions in low-income rural communities. on many), according to an independent verification study BRAC has combined mass mobilization, community completed as part of the BDS grant incentive payment scheme. participation and leadership, and behavior change campaigns— facilitated by well-organized management strategies. BRAC also Some of the result areas have been supported by BRAC’s made substantial progress in monitoring hygiene practices at knowledge partner, IRC. IRC was jointly en-gaged by the scale and in developing a unified monitoring platform for key Dutch government and the Foundation to focus on qualitative program data including finance. monitoring, strengthening the sanitation supply chain, hygiene

26 | Building Demand for Sanitation www.gatesfoundation.org

Principal accomplishments include: Key Learnings from project: • Integrated approach to hygiene, sanitation and water can GOALS ACCOMPLISHED TO DATE deliver long-term change. However, sustained behavior change requires time, patience and frequent interpersonal and gender- 4,004,425 persons with new 1,225,000 persons with latrines; targeted communication. sanitation services in 157 • Availability of water is crucial for maintaining hygienic Upazilas 452,715 persons with behavior. repaired latrines • Strong staffing commitment to hygiene behavior change was 95% sustained access in a key to success—BRAC trained over 8,000 staff to improve target areas (baseline of 98% sustained access their communication skills. 51%) • Strong political commitment, government support, and Selection of poor & ultra collaboration with NGOs, CSOs, and other partners played a 650,514 households poor: 600,000 crucial role in the project’s success. • Grants given to ultra-poor only after coverage reached 60% Grant support to ultra poor: 145,529 households 132,177 (demonstrating community commitment). • BRAC target was 90% coverage (achievement was 98%). Loan support to poor: 14,880 households This high coverage figure was reached across all economic 14,880 strata, and did not exclude the poor or ultra-poor (90% of all Rural Sanitation Centers toilets resulting from the project reached ultra poor or poor 5324 (RSCs): 53 households).

Entrepreneurs to market Next Steps: 2 organic fertilizer: 8 The Foundation’s project is almost completed, but reaching the ‘last mile’ still remains a priority, along with sustaining Action research completed; Low-cost sanitation options gains made during the project. This goes especially for the report due in 2015 ultra-poor, who often find it expensive to maintain hygienic behaviors. Also, further research is needed to develop low- 874,000 twin pit latrines in Pit composting options use in 157 Upazilas cost and sustainable sanitation technologies for challenging hydrogeologic conditions. Over 12 million cluster meetings with women’s groups; over 2 million cluster meetings with Menstrual hygiene adolescent girls25 management Health volunteers sold over 1 million bars of soap; 1.1 million sanitary napkin packets

Adoption of project model Twin pit latrine model components by local adopted by government government and other agencies, RSCs and NGOs at agencies community level

Building Demand for Sanitation | 27 Ghana: Sanitation and Hygiene in Small Towns and Rural Areas Grantee: CWSA Partners: AFD and EIB Location: Ghana Dates: June 2014 - December 2018 Information: Theodora Adomako-Adjei [email protected]

Community Water and Sanitation Agency of Ghana (CWSA) Description and Approach: This project was originally designed to establish an innovations unit at CWSA, to support a €80 million sanitation and water supply program for small towns and rural areas, financed through loans from the French government (AFD) and the European Investment Bank (EIB). The Foundation grant was restructured when the loan was canceled; however, the planned feasibility study of technical options for Fecal Sludge Management (FSM) in small towns and rural areas has moved forward. Possible next steps depend on the results of the study.

Project Goals and Accomplishments: The FSM study is underway and should provide an overview of existing public and private options used by households, institutions and public facilities. The study includes a review of national policy and strategy, as well as management, business, and operating models for fecal sludge collection, transportation, treatment and disposal or re-use. The results are expected in the first half of 2015 and will be used by CWSA to pilot sanitation options and associated FSM practices for institutions (such as schools and clinics) and public places (such as markets and bus stops). A national FSM strategy will be developed on the basis of the study and pilot results. Residents walk by an open sewer in a slum (Accra, Ghana, January 2014).

28 | Building Demand for Sanitation www.gatesfoundation.org

Project Goals and Accomplishments: Community Hygiene Output Based Aid (CHOBA) Grantee: East Meets West Foundation GOALS ACCOMPLISHED TO DATE Partner: Water and Sanitation Reference Center; 110,825 poor households 85,926 poor households Mekong Development Research Institute in Vietnam and 50,558 in in Vietnam and 42,023 in Cambodia install and use Cambodia mobilized as of Location: Vietnam and Cambodia hygienic latrines. February 2015 Dates: May 2012 – June 2016 Target communes Information: reach 30% increase 37 communes reach at least Jeff Albert in sanitation coverage 30% increase in coverage; [email protected] from baseline, and 95% 95% coverage in 1 commune in http://thrivenetworks.org/impact/case-studies coverage in about 71 Vietnam communes

Hygiene promoted by VWU as part of national 26 East Meets West Foundation (EMW) campaign (“clean house, Improved hygiene clean community and clean Description and Approach: behavior in target nation”). Hygiene messages This project merges sanitation financing, hygiene education, communes communicated in various marketing, financial transfers and rewards, and output-based meetings with beneficiaries In aid in an effort to deliver hygienic latrines and septic systems Cambodia. in rural Vietnam and Cambodia, with a strong emphasis on low-income households. CHOBA is designed to address two MEL systems set up as planned. challenges: first, it seeks to accelerate the climb up the sanitation Baseline data in Vietnam for ladder; and second, it focuses explicitly on the poorest 40% of 1 million households, and the rural population. With these challenges in mind, standard about 220,000 households in Set up monitoring, Cambodia. Information used CLTS approaches are not applicable. evaluation and learning to perform analysis and refine In Vietnam, the main implementing organization is the (MEL) systems approach. Data collection by tablet, directly populating a Vietnam Women’s Union (VWU), a government-affiliated database “in the cloud” with mass membership organization whose provincial chapters extensive information and field 2,500 volunteers to promote hygiene behavior change and analytical capacity. motivate the construction of sanitary latrines. Critically, these VWU motivators connect target households with sanitation RCT on effects of consumer hardware providers and construction contractors while also rebates and CCT is ongoing in Vietnam. Mid-term survey facilitating access to consumer credit. Both EMW and the Conduct research conducted end of 2013. Final VWU are compensated for the development and management to evaluate EMW's survey (Hai Duong) conducted approach and to provide expenses only after producing well-defined outputs: hygienic January 2015; Tien Giang evidence for large-scale latrines built and used by poor households. VWU motivators survey scheduled March replication in turn earn modest financial rewards for each poor household 2015. In Cambodia, research that elects to purchase a latrine. In Cambodia, these facilitation underway on OBA incentives functions are assumed largely by Village Chiefs, Village and sanitation marketing. Commune Councils, and the Provincial Departments of Rural Development (PDRDs). tend to go for the ‘low hanging fruit’ (i.e., better-off households who can more easily afford to build latrines). Under the OBA Another program element intended to incentivize household system, field workers provide more help to poor households action are 1) a “consumer rebate” following verification of a and get more effective penetration of the lowest quintiles. In properly built hygienic latrine and evidence of usage; and 2) 2014 the project reached an average of nearly 7,800 low-income conditional cash transfers to local government authorities when households per month (Vietnam and Cambodia combined) communities reach certain sanitation coverage targets. with peak monthly latrine output surpassing 11,300.

Key Learnings: An accurate monitoring and verification system needs to be A well-structured results-based payment approach can change an integral part of the project to ensure incentive payments the mind-set of field workers who, even when well-intentioned, are fairly distributed, and to reach the poorest income strata.

Building Demand for Sanitation | 29 Moreover, a range of incentive types may be needed for different stakeholders (e.g., household rebates, incentive for volunteers, Sanitation Marketing Scale-Up Project (SMSU) and conditional cash transfers for communes—that are focused Grantee: International Development Enterprises on both reaching the poor and improving coverage). Different approaches may be needed even for the extremely poor. Partner: Cambodian Government, PATH, WSP, IDinsight, WSP, 17 Triggers Government buy-in and commitment are critical for scaling Location: Cambodia (60 districts in 7 provinces) up. Incentive and management payments to government authorities may require fine-tuning; indeed, CHOBA’s had to be Dates: October 2011 – October 2014 restructured early on during implementation to make sure they Information: were more effective at engaging government. Also important Yi Wei for scalability is the way verification is set up, and trade-offs [email protected] between accuracy and cost may need to be made (at larger scale http://www.ide-cambodia.org/ of implementation, it will be difficult and costly to verify all applications made, the way they are now).

RCT results have so far confirmed that CHOBA incentives effectively encourage poor households to climb the sanitation International Development Enterprises (iDE) ladder and install hygienic latrines. Results also indicate Description and Approach: consumer rebates have a greater impact on sanitation The SMSU project set out to determine whether commercial improvements than CCTs (which are paid to the community). sales of latrines through private businesses and sales agents Final surveys will provide further evidence for these analyses. could be scaled up and also reach the poor. SMSU follows on an earlier program that, among other activities, developed the “Easy Overall, results-based payments have helped increase project Latrine” for the rural Cambodian market. The award-winning effectiveness and sharpened its focus on reaching the poor. Easy Latrine was developed through a ‘Human Centered Design” However, it has taken time to build the capacity and trust approach and made a number of significant breakthroughs, chief required to implement this relatively complex programmatic among which was it provided an aspirational model that was approach. convenient, desirable, and affordable for a rural household, and CHOBA has demonstrated that there is indeed considerable attractive for local enterprises to produce and sell. iDE’s role was consumer demand for household sanitation in both Vietnam to improve the consumer sanitation experience by streamlining and Cambodia, though financing remains a significant the supply chain, developing a direct sales team, and engaging issue. Most sanitation investments in Cambodia tend to local government. This disrupted the formerly fragmented be financed by family savings and loans from friends and market in which households had to exert significant effort to relatives. In Vietnam, however, access to affordable credit from procure a desired sanitation solution, and businesses were only microfinance institutions appears to play a major role in moving catering to wealthy households. poor households up the sanitation ladder. SMSU also set ambitious project targets, and had met or Remaining challenges: Reducing operational costs (and in exceeded most of them, demonstrating that a market-based particular the costs of latrine hardware components and approach can effectively increase sanitation coverage in 27 construction) as well as finding ways to more accurately Cambodia at almost seven times the typical background rate. measure hygiene (and other types of) behavior change are The project collected strong evidence that providing access two areas of focus. Strategically, EMW is actively seeking to to affordable financing options at the point of sale increases transition the OBA approach from a donor-supported model to sales (by a factor of 4). Training businesses and sales agents to one that is self-sustaining. conduct effective marketing and direct sales has helped to close deals at the household level. Next steps: The final phase of the project will focus on CCT implementation Key Learnings: and transitions to commercialization. EMW also is piloting a Rural Cambodian households are willing and able to purchase commercialization model that seeks to address the challenges of a desirable sanitation solution at market price without subsidy, transitioning to a self-financing model, as well as maintaining and at scale. Moreover, businesses are willing to invest in the the high output achieved by the VMU during the project. sanitation market and cater to low-income rural households. Microfinance, if available to latrine purchasers, was shown to have the potential to increase market demand four-fold. However, MFIs have so far been reluctant to expand their services for household sanitation loans.

30 | Building Demand for Sanitation www.gatesfoundation.org

Project Goals and Accomplishments:

TARGET TARGET KEY MILESTONES BASELINE28 ACHIEVEMENT (SATISFACTORY LEVEL) (EXCELLENT LEVEL)

70,000 latrines purchased from N/A 70,000 140,000 141,030 project-connected enterprises

45,000 latrines purchased in target districts from enterprises N/A 45,000 N/A 90,138 not connected to the project

41% total latrine coverage in 29% 41% 60% 45% target districts

10,500 latrines purchased by poor households from project- connected enterprises and/ N/A 10,500 42,000 30,191 or through project-connected finance mechanisms

90 enterprises profitably serving rural households with affordable N/A 90 N/A 12429 sanitary latrines

Direct sales in communities worked well as a means of reaching Accomplishments to Date: The project set and has met or the rural poor. However, most private businesses were reluctant exceeded most of its original targets (see Table above). to hire and manage a sales team, so iDE has taken on a greater role of supporting sales. Figure 2: Sanitation marketing is taking off in Cambodia Remaining Challenges: Ensuring access to an adequate supply of latrines and microfinance has been a constraint. Therefore, iDE is focusing on “unblocking” the supply chain and exploring whether an in-house microfinance capacity would be an effective way to alleviate this problem. iDE has also sought ways to establish effective, targeted financial subsidies for the poor to increase sales (in partnership with East Meets West/CHOBA project).

Affordably and sustainably addressing sanitation needs in challenging environments (e.g., flood-prone areas, collapsing soils) continues to be a concern in Cambodia, as well as in many other countries. Fecal sludge management, especially in the rural context, remains a challenge, especially in the context of financial viability.

Next Steps: The SMSU Project has been completed; however, iDE will continue the program with other sources of support, aiming to increase rural sanitation coverage from the current 45% to 74% in three years. Work will continue on scaling up microcredit for latrines, developing and marketing low-cost superstructures, bundling latrines sales with sales of household water filters and hand hygiene products, and testing further smart subsidy interventions.

Building Demand for Sanitation | 31 • Natural leaders, teachers, and local government actors Testing CLTS Approaches for Scalability (TCAS) identified as community change agents, but no rigorous Grantee: Plan International USA evidence was provided on their actual effectiveness Partner: University of North Carolina • More rigorous evaluations of CLTS impact are needed, including on the effectiveness of the various techniques used Location: Ghana, Ethiopia, Kenya by CLTS on long-term behavior change Dates: October 2011 – September 2015 The search for informal literature on CLTS turned up more Information: than six times as much documentation—115 relevant reports Darren Saywell were found, mainly on projects (often in the form of case [email protected] studies) produced by international NGOs and international Jonny Crocker organizations like WSP and IDS. The informal literature review [email protected] found that: http://www.planusa.org/content2675015 • Generally, CLTS case studies were done on ‘successful projects’ http://waterinstitute.unc.edu/clts/ • Methodology was less rigorous than those documented in formal literature • Focus was on project processes and implementation (not impacts) Plan International and University of North Carolina (Plan/UNC) • Structured post-triggering follow-up activities helped communities eliminate OD. Visits by ‘outsiders’ were Description and Approach: considered most effective. The TCAS project aims to learn, capture and share reliable and unbiased information on CLTS approaches and scalability. • Natural leaders, teachers, and local government actors TCAS is exploring how to overcome selected implementation identified as change agents, but no rigorous evidence on their challenges while maintaining quality and containing costs. A impact on CLTS (same finding as for formal literature) key aspect of this is to experiment with the roles of different • Children and women often cited as most effective natural ‘local actors’ in three focus countries: natural leaders in Ghana, leaders; teachers mainly mentioned in only in the context of teachers in Ethiopia, and district officials in Kenya. A range “school-led” CLTS projects of research and learning activities also are integrated into the • Greater rigor and consistency is needed in project monitoring project, including seven CLTS case studies, a global review of and evaluation methods (so as to generate better data on literature on the effectiveness of CLTS, and detailed evaluations project performance) of the three country-level efforts. Local, regional, and global learning and dissemination events are planned to ensure that The project’s integrated implementation and research phase TCAS’ findings reach a wide range of stakeholders.

Accomplishments to Date: The early phase of the project included desk-based reviews (led by UNC researchers) to systematically review the formal (peer- reviewed) and informal (grey) literature on the effectiveness and impact of CLTS programs. A key finding of the review of formal literature is that there is very little of it—an extensive search yielded only 18 peer-reviewed articles dealing with CLTS or total sanitation approaches. The findings of this review included: • The focus was mainly on project impacts, although study designs were often inappropriate for the types of conclusions drawn • Generally, CLTS was found to have a positive impact on latrine access and usage • Children identified as effective behavior change agents for peers in schools

At the convening, posters and drawings were used to highlight progress and setbacks.

32 | Building Demand for Sanitation www.gatesfoundation.org was informed by the literature review phase, and was designed Figure 3: Household Sanitation Access & Practices after to provide rigorous evidence with regards to the effectiveness 18 months of CLTS of natural leaders, teachers, and local government in CLTS 50% campaigns. Implementation is mostly completed in the three ss Conventional Pilot target countries, and evaluation of those efforts is currently cce 40% underway. Preliminary findings from Ethiopia (where teacher- facilitated CLTS was the focus of the research) suggest the 30% following: 20% • Teachers may be more appropriate in supporting roles, rather than leading 10%

• Kebele (village cluster) administrators seemed to be the most Household Sanitation A 0% important actors (an unexpected finding) Open Dig & Bury Communal Shared Private Defecation Latrtine Latrine Latrine • CLTS seems to work best in settings where baseline latrine access is low and OD is high Overall results in Ghana showed a rise of about 25% in use of Preliminary findings from three regions in Ghana (where private and shared latrines, and a drop of 22% in OD. In Upper training CLTS natural leaders was the focus of the research) West, the share of private and shared latrines rose from about suggest the following: 17% to 65%, an increase of about 48%. • CLTS facilitation intensity varied between regions and Research in Kenya is still under way and the findings will be throughout the year analyzed in the coming months. Early findings suggest that the • Intensive Natural Leader training required about 50% more training and engagement of local government officials appears facilitation time to have improved budget allocations for sanitation, and possibly • Natural Leader training had positive impacts in all 3 regions individual performance. Financial flow systems are critically • Natural leader training impact was greatest in Ghana’s Upper important and can create bottlenecks to scaling. West region, possibly because Next steps: The project is scheduled to be completed during o Upper West is more remote, with low expectation of 2015. The focus of remaining activities will include a deeper sanitation subsidies analysis of cost effectiveness data, completion of the Kenya research, developing final conclusions and findings, carrying out o Communities are smaller, more homogenous and cohesive learning events, and other information dissemination efforts. o There is little to no reliance on communal or shared latrines

Building Demand for Sanitation | 33 privacy and other social-status concerns. Health is not an Supporting Sustainable Sanitation important driver. Improvements through Supply-Side • Consumers want a high quality product that does not require Strengthening (3SI) frequent emptying. However, existing models usually cost the Grantee: Population Services International equivalent of $400 or more, and may require engaging with multiple businesses/providers. Partners: Monitor Deloitte, Water for People • Availability of affordable credit can help move consumers; Location: India (Bihar State) however, lowest quintiles may require partial to full subsidies. Dates: July 2012 – June 2017 • The ideal envisioned solution was a ‘Turnkey Service Provider’ Information: model, however a lighter-touch model based around Cement Shankar Narayan Ring Manufacturers (where enterprises provide substructure [email protected] and toilet components to consumers) is proving to be more appropriate (primarily because it lowers costs). http://www.psi.org/publication/getting-to-know- psis-market-based-sanitation-work-in-india/ To date, around 9,400 toilets have been sold by sanitation enterprises, with over 84,000 households visited. One third of http://www.inclusive-markets.org/sanitation the toilets sold were to BoP customers, and roughly 5% were sold with loans.

Next Steps: Developing a platform for sanitation loans Population Services International (PSI) through MFI partners; creating an enabling environment for Description and Approach: The 3SI project will demonstrate customers to get access to subsidies; and an increased focus on the potential for market-based solutions to increase access to demand generation through Behavior Change Communication improved toilet facilities among the poor in Bihar through a campaigns. mix of private and public sector support. Market research was conducted to analyze consumer needs, aspirations and ability to pay. In addition, the project studied the private sector to assess its existing capacity and needs, and to develop more effective business models and toilet designs. The project also will demonstrate innovative financing approaches to increase coverage, as well as helping generate demand through multi- media sales and marketing campaigns.

Accomplishments to Date: Market research30 has shown that latent demand for toilets exists—84% of households expressed a desired to own a toilet, and 38% had already researched the options. However, the lack of affordable, aspirational products remains a major market constraint in Bihar, as elsewhere. Analysis of the current household toilet designs suggests it might be possible to reduce toilet cost further by improving design and other efficiencies.

Financing is also a significant constraint, as households rarely have sufficient cash on hand for a toilet purchase, and there are other products and services which are in higher demand. Availability of affordable credit and targeted subsidies to the poor would facilitate sales, especially to base of pyramid (BoP) consumers. Existing Government of India sanitation financing schemes could help in this regard, especially if the Government scheme could be integrated with an improved sanitation marketplace and more efficient targeting of the poor.

Additional learnings from project include:

• Demand for sanitation in Bihar is driven by convenience, Proud owner in front of her newly completed latrine.

34 | Building Demand for Sanitation www.gatesfoundation.org

Each model is tested in 40 selected villages (160 total) selected Women’s Empowerment and Poverty randomly from the two target districts. The target area’s Reduction Project baseline survey highlights the extent of the sanitation challenge being faced: Grantee: Rajiv Gandhi Mahila Vikas Pariyojana (RGMVP) • 97% of population reported engaging in OD Partners: Shramik Bharti and International • Average time to reach OD site from home is 30 minutes Center for Research on Women • Toilets available at only 9.4% of households. Location: India (Uttar Pradesh State) • 85% of women do not have hygienic menstrual hygiene 31 Dates: Oct 2012 – June 2015 practices Information: Accomplishments to Date: Historically, RGMVP has organized Krapal Singh over 1.4 million poor households into over 120,000 SHGs, as [email protected] well as forming over 150 “Block Organizations” and over 5,000 http://www.rgmvp.org/programmes-health. Village Organizations across 42 districts. These bodies address asp?lk=pr3 issues related to health, collective social action, human rights, and access to credit. The research effort is being implemented Twitter: @RGMVP in 160 villages out of over 50,000 villages where RGMVP has a presence.

Rajiv Gandhi Mahila Vikas Pariyojana (RGMVP) During the project, RGMVP or their community partners have: Description and Approach: The project aims to increase • Delivered over 300 WASH training sessions the number of poor women organized into Self-Help Groups • Delivered over 200 sessions on menstrual hygiene (SHGs) and SHG federations, and to test efficacy of community management (MHM) institutions to promote improved sanitation and hygiene • Organized and trained 63 Young Women’s SHGs practices in parts of Sultanpur and Amethi Districts in Uttar • Renovated 786 defunct toilets, and constructed 132 new toilets Pradesh. Learning questions being addressed include: using SHG funds • Does building of social capital through SHGs improve hygiene • Facilitated 537 new toilets ‘sanctioned for construction’ by and sanitation outcomes in the community? Government scheme • Do expedited SHG models and their sanitation interventions lead to similar outcomes as the full-scope, phased SHG (Model Preliminary results monitoring indicates that over 1000 women 1 below)? in 44 villages have improved MHM practices; improved WASH hygiene practices are also reported (hand washing with soap; • How do these compare with the normal Government improved water handling, and household water treatment). sanitation promotion approach? Young Women SHGs also have taken on key roles in spreading • What is the cost effectiveness of these models? sanitation awareness and adopting and spreading behavior The four ‘models’ being tested are: change in sanitation and hygiene practices. 1. RGMVP sanitation interventions as part of larger package of Next Steps: The project continues to implement the various community strengthening with mature SHGs SHG models and will carry out end line surveys and data 2. RGMVP sanitation interventions delivered simultaneously analysis during April to June 2015. Some of the key challenges with SHG formations in new villages the project will continue to seek to overcome: 3. Standalone sanitation interventions by Shramik Bharti in • Extreme poverty of many residents in the target areas villages where no SHGs are present • Trying to change behavior over a relatively short span of time 4. Control villages with interventions under the Government of • Lack of awareness about Government sanitation programs India’s sanitation campaign • Constraints on the supply side in meeting increased demand for sanitation • Lack of land (space) required to construct a latrine at many households

Building Demand for Sanitation | 35 Malawi declared, in its 2011 national sanitation strategy, that Scaling Up and Strengthening Community 2015 was the year it would achieve 100% ODF. This would Approaches to Total Sanitation be an astonishing achievement, since (as of 2012) Malawi’s national improved sanitation usage rate was only 10%.35 This Grantee: UNICEF challenge is in part what led UNICEF to select Malawi as one Partners: Government and civil society Partners of the focus countries for this project. UNICEF is supporting Location: Indonesia and Malawi the national ODF Task Force, and among other activities has helped to improve the national sanitation monitoring system. Dates: November 2012 – November 2016 The project also is strengthening the supply side through Information: latrine construction and business management training, and Global: a marketing campaign carried out in partnership with PSI. Lizette Burgers [email protected] However, cumulative progress has been slower than expected. Africa: New ODF communities number 446 (representing over 45,000 Ann Thomas [email protected] households). But the ODF ‘hit rate’ is only 30% after 6 months. Positive examples do exist, including one Traditional Area that Asia: has attained ODF and which serves as a constructive role model. Chander Badloe [email protected] Regionally, UNICEF is engaged in a number of monitoring and learning efforts as part of this project—including: • Online Sanitation Monitoring Toolkit UNICEF (published at www.sanitationmonitoringtoolkit.com). Description and Approach: UNICEF supports implementation • Supporting Kenya, Mozambique, and on CATS of CLTS or CATS programs in a large number of countries reviews and tools development globally, mostly in Africa and Asia. This project is designed • Preparing CLTS reviews and case studies to support CATS innovations and implementation strategies in two countries—Malawi and Indonesia—and to distil and • Learning projects including use of Social Norms Theory, small disseminate lessons learned to other UNICEF country programs town approaches to CLTS, regional sanitation supply chains in Africa and Asia. Among other goals, the project seeks to meet research, and reviews of School Led Total Sanitation ambitious ODF ‘hit rates, 32 of 66% and a ‘reach’ target of 85%. • Learning, and dissemination events

Accomplishments to Date: In Indonesia, access to improved Next Steps: In Indonesia, UNICEF will improve sanitation facilities currently stands at 59% of the population, communications and advocacy; promote stronger M&E, assess which is significantly short of the MDG target of 86 percent. the potential for more intensive supply-side work, and improve An estimated 54 million people still practice OD, or about post-triggering data capture and analysis. UNICEF also will one quarter of the population. On a country basis, this is increase its focus on accelerating progress in weaker-performing second only to the size of the population practicing OD in districts. India.33 UNICEF is supporting Indonesia’s national “STBM”34 campaign to help accelerate sanitation progress. A number of In Malawi, UNICEF will continue to work with PSI to help key steps have been taken to systematize STBM, including a strengthen sanitation marketing campaigns, and will increase Knowledge, Attitudes, and Practice (KAP) survey, a review of its focus on strengthening local government leadership of existing evidence, development of STBM training materials, sanitation campaigns. establishment of a knowledge management framework, and Across both country programs, UNICEF is focusing on bringing undertaking Joint Technical Reviews with the Government of intent to the learning focus and not giving in to “focusing on Indonesia. New alliances have been built to make sanitation the numbers” in light of the missed targets. In the long run, and hygiene communications more effective; and the use of unlocking insights into what makes for successful program social media has been expanded. However, though the enabling delivery at scale will be more useful than just delivering against environment in Indonesia is supportive, a number of key a coverage target. challenges remain. Progress achieved against project targets has been off track in terms of number of new latrines constructed. Other challenges include lack of partner implementation capacity, low hit rate of ODF villages, continued fragmentation of the sanitation sector, and impediments to sharing and disseminating lessons learned.

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Sustainable Total Sanitation in Nigeria Grantee: WaterAid Partners: Local Government Authorities; CSOs Location: Nigeria (Ekiti, Enugu, Jigawa states) Dates: July 2012 – June 2016 Information: Ada Oko-Williams [email protected] Ephraim Danladi [email protected] Erik Harvey [email protected] Sarah Dobsevage [email protected]

WaterAid Description and Approach: The project seeks to improve the effectiveness, efficiency, inclusion and sustainability of total A pour-flush latrine with offset pit under construction. sanitation approaches in Jigawa, Ekiti and Enugu States of Nigeria (targeting 625,000 people), and through the learning so generated contribute to wider national and regional latrines. On the other hand, the fact that there is no shame good practice. The project encompasses components of in OD means that there is no “internal” personal or family implementation, action learning and research, and advocacy. pressure to improve.

Accomplishments to Date: To date, 76% of the 382 target Supply-side research has found the latrine purchasing process communities have been triggered and are undergoing follow-up (through multiple artisans) to be complex, and it is difficult monitoring. Both demand-side and supply-side research efforts for home owners to estimate the cost of the complete product. have been completed, and the results are being incorporated Though an extensive rural marketplace infrastructure exists, into project plans. New community monitoring approaches sanitation hardware retailers and concrete block producers also have emerged. The CLTS approach has been reviewed; operate in a fragmented manner, and labor must be procured community monitoring forms for effective follow up (towards separately. In addition, quality of the finished product varies achieving ODF in triggered communities) also have been greatly. Testing of improved sanitation products has been developed. conducted in Ekiti and Enugu States and WaterAid has taken feedback from this process into account when establishing the Demand-side research has shown that rural households are sanitation marketing approach and when developing sanitation increasingly exposed to urban lifestyles and upwardly mobile; products that appeal to consumers. there is reasonable access to cash and modern building materials. Yet OD is still a widespread practice. Households Next Steps: WaterAid is continuing its work to rationalize express dissatisfaction with this situation, often including and strengthen the sanitation marketplace, and to integrate their current sanitation facilities—which points to potentially these supply-side efforts with demand generation. As part of large opportunities for sanitation marketing enterprises. There this effort, WaterAid is trying to improve information about is little expressed household interest in low-quality latrine sanitation products and increase transparency regarding investments; but rather a preference to wait and build an ‘ideal’ pricing, and increasing access to affordable credit and finding facility. In terms of motivating forces—external pressure from, other suitable mechanisms for improving financing of and enforcement of local ordinances by village leaders seem sanitation for the poor. Other challenges to be addressed include to be effective for motivating toilet construction. There is also designing sanitation communication campaigns which can a positive effect from families returning home from abroad tackle the changing demand situation in communities in an that prompts home improvement projects including household iterative and flexible manner.

Building Demand for Sanitation | 37 The theory of change involves working on 4 key areas in order Scaling Up Rural Sanitation to accelerate the pace of sanitation program scale-up: Grantee: Water and Sanitation Program • Generating demand for improved sanitation at scale Partners: Governments, civil society, and • Strengthening supply of sanitation products at scale private sector partners • Strengthening the enabling environment Location: India, Indonesia, and Tanzania • Learning and knowledge management (plus 10 expansion countries) Translating these four strategic pillars into project activities has Dates: 2007 – Present broadly meant that WSP’s service delivery model has involved Information: the following: Craig Kullman • Problem identification (multi-sector, results-focused) [email protected] • Design (utilizing the best ideas and evidence available) Yolande Coombes • Implementation and iterative improvement (technical [email protected] assistance, capacity building, and operational learning) Susanna Smets • Evaluation and learning (sharing knowledge from successes [email protected] and failures; new products and tools; and promoting south-to- Joep Verhagen south learning) [email protected] Accomplishments to Date: Governments in the original 3 focus http://www.wsp.org/global-initiatives/global- countries plus 10 expansion countries have now increased their scaling-sanitation-project access to improved sanitation to an aggregate total of over 20 million persons. In addition, the initiative has contributed to ending OD by an additional 19 million persons. While it is not WSP possible to summarize this level of effort in a page or two, some key examples of learning shared at the recent Grantee workshop Description and Approach: The World Bank’s Water and in Hanoi in 2015 follow below. Sanitation Program (WSP) has been working with the Foundation since the latter’s WSH effort was still a ‘learning It can be a ‘long road’ from fragmented implementation to initiative’; WSP’s role has evolved considerably as the coherent national sanitation programs. WSP support to the Foundation’s engagement with the WSH sector has changed Government of Indonesia began in East Java (rural population and grown over the years. However, WSP’s core strengths in of 20 million) in 2007, and based on lessons from failure addressing strategic-level issues with governments as well and success, by 2014 the Government is now implementing as advancing innovative implementation approaches in the a national rural sanitation program (120 million people), field have remained central to WSP’s relationship with the supported through a large scale World Bank financed program Foundation’s WSH program. designed based on lessons from WSP technical assistance.

WSP’s Scaling Up Rural Sanitation (SURS) business area is an Specific key learnings from Indonesia are relevant to many outgrowth of that evolution, and WSP’s mandate is to support country settings, and include: governments to catalyze systematic changes for reaching scale in • A heavy investment in institutional capacity building can pay rural sanitation programs at the country level. The geographic big dividends over the long term. WSP anchored its capacity focus of WSP engagement has grown rapidly from its initial building efforts in the existing (pre-service) government Total Sanitation and Sanitation Marketing (TSSM) project in training system, helped government develop an accredited India, Indonesia, and Tanzania—to a global learning program training program for in-service professional staff, as well as covering 13 countries in four regions, including Bangladesh, on-line training as a supporting mechanism. Implementation Cambodia, Ethiopia, Kenya, Lao PDR, Niger, Pakistan, , Guidelines for the Government’s national program were the Philippines, Uganda, and Vietnam. Under WSP’s business supported, help harmonize implementation and form the area “Sustainable Services through Domestic Private Sector backbone of the capacity building program. Participation”, WSP has worked with governments in some • Supporting a process to move from patchwork financing of those as well as additional countries to catalyze private and project delivery, to bringing different sources of finance sector service delivery on rural sanitation, such as Bangladesh, together for a program that covers all communities in a phased Nicaragua, Niger and Peru. manner in targeted districts.

38 | Building Demand for Sanitation www.gatesfoundation.org

• Supporting Government monitoring systems and their Figure 4: From Fragmentation to National Program: national scale-up and usage, rather than developing project- Empowering Government at Different Levels while based systems. Building on Strength of all Players WSP’s engagement with the sanitation marketplace in Indonesia also has evolved from analyzing sanitation markets and developing new products and services—to operating at a more strategic level. This evolution has taken many years, but has led to a scale-up of the sanitation marketing effort:

1. Filling gaps: Developing and testing new products and business models 2. Promoting business models: Training sanitation entrepreneurs on the ‘one-stop shop approach’ 3. Starting an industrial network: Coaching businesses, establishing certification processes, and facilitating access to capital 4. Growth and sustainability: Supporting the network, which has taken shape as a national business association, while it coaches and collaborates with actors throughout the government, with decentralized engagement at district level; sanitation value chain, and moves to a franchise model to harmonization of program and financing approaches; increased aggregate value-adding services to its members resource mobilization; and leveraging of national, sub-national and development partner funds. Another lesson learned is from India, with the Government’s focus on toilet construction, instead of sanitation behaviors Next Steps: WSP is actively engaged in the ‘post-2015’ process of WSP has supported central and state government to make a establishing global new water, sanitation and hygiene targets— critical shift in thinking to focus on monitoring outcomes, and universal access will likely comprise the core of these new which is critical in an environment where massive resources goals. With 2.5 billion people in need of access to sanitation are being channeled for toilet construction subsidies. The (over 70% of them in rural areas), there is still plenty of work application of a third party mobile monitoring system and its ahead for the entire sector. WSP will continue to work with the scale-up at national level is transformational in ensuring a focus Foundation and other partners to 1) Eliminate OD by 2025; on results. WSP as part of the World Bank team is supporting 2) reform sanitation policies and accelerate progress towards the design of a new large-scale rural sanitation loan, originally achieving universal access by 2030; and 3) increase its focus on targeting at least eight lagging states, but recently expanded to the elimination of inequalities in access. WSP will carry out cover the whole country, ensuring a focus on results in behavior two core activities to help governments achieve greater equity in change. rural sanitation:

Cambodia provides another example of the ‘long road’ from • Integrate sanitation into existing nationwide poverty fragmentation to harmonized national programs, led by alleviation, health and nutrition programs that target poor government. With many active sanitation partners, and a households. Key to this will be working with country-led lack of harmonized program approaches or financial flow programs that are providing publicly financed subsidies to mechanisms, the sanitation sector started out as on the left side the poorest to meet other social needs, to learn how subsidies of the diagram—with a smorgasbord of actors, approaches, for sanitation can be integrated into these programs without and implementation systems. The Government of Cambodia, distorting the market. together with WSP and sanitation sector partners are actively • Identify opportunities to work with local financial institutions working towards the situation depicted on the right side to extend financing to the extreme poor, leveraging subsidies of the diagram: a national rural sanitation program led by when possible.

Building Demand for Sanitation | 39 Summary and Discussion of What’s Working

Ten issues were identified during the 2013 Sanitation Partners’ Workshop as being CHALLENGES IN GENERATING of critical importance to effectively and sustainably scale up sanitation programming. DEMAND FOR SANITATION How have the partners working on projects Programs focused on creating demand for within the BDS portfolio been contributing to sanitation face daunting challenges, depending progress on these issues? on the context. These may include: Reaching the poorest at scale. • Lack of access to easy and affordable credit It is the poorest who most lack sanitation services and who are • Lack of aspirational and affordable latrine disproportionately affected by the health problems stemming options from unhygienic environments. To reach the poorest more • Consumer desire for higher-end options and efficiently, several sub-issues were identified: the need for lack of interest in simple, home-built latrines continued innovations in demand generation including CLTS; • Complicated process to procure a latrine pro-poor credit and marketing schemes; and financial support (multiple businesses or persons involved) mechanisms for the poor which do not distort the sanitation marketplace. • Lack of marketing and sales capacity in the private sanitation sector Demand Generation. • Cultural preferences which favor OD (e.g., in Progress is being made in a number of key areas, including India) ongoing investigations on how CLTS campaigns can be made • Poor quality implementation (e.g., of CLTS more effective, sustainable, and cost efficient. PLAN and UNC triggering or mobilizing) are working to better understand the relative impact of different • Low capacity of implementing agency(ies) and internal actors on CLTS impact; WSP and others are working poor coordination on harmonizing national approaches and making campaigns more systematic; IDS36 and others are continuing to promote at- • Heterogeneous population; lack of communal scale approaches; future BDS work also will look at identifying cohesion; conflict; seasonal migration drivers of demand in, and effective approaches for, peri-urban • Proximity to subsidized programs; expectations and urban environments. of hand-outs at the community level

A key challenge with CLTS has been the uneven ODF ‘hit rate’ • Lack of land or space around the home to build a achieved within and across countries. UNICEF has challenged latrine itself in Malawi and Indonesia with an ambitious project target • Occupants don’t own land (and landlord of 66% ODF communities (per total triggered), with a ‘reach’ unwilling to install a latrine) target of 85%. The project has more than one year to go, but so • Collapsing soils and other physical challenges far it has proven challenging to achieve those high hit rates. On • Lack of support from village leaders and/or the other hand, UNICEF’s CLTS program in Mali was able to local Government achieve a hit rate of 97% ODF in the 60 communities that were part of the RCT on CLTS impacts conducted there by CEDLAS. The Mali campaign had a strong focus on post-triggering follow up (weekly visits for 3 to 4 months), which may be part of the reason why this hit rate (and other performance indicators) were so high. While the benefits of intensive post-triggering

40 | Building Demand for Sanitation www.gatesfoundation.org follow up are well noted, being able to scale this intensive approach up in a cost-effective manner remains a challenge. The EAWAG-USAID research in Ghana may shed light on the question whether it is possible to design a CLTS-type approach that routinely results in a higher hit rate (which, if this could be done, would lower the cost of attaining ODF).

The Foundation and others are also considering the drawbacks to monitoring primarily “ODF” achievements in CLTS programs. While ODF communities certainly represent a desirable endpoint for CLTS campaigns (and other sanitation campaigns as well) – this metric also results in a binary situation whereby CLTS either ‘succeeds’ (ODF status achieved) or ‘fails’ (ODF not attained). In the latter case there may still be a significant decrease in OD and increase in the access to and use of latrines. The Foundation is already exploring how to accomplish this more nuanced type of monitoring of CLTS performance with help from UNICEF in Indonesia.

Other methods of demand generation are also moving forward. BRAC is using an ‘integrated approach’ to demand generation and hygiene behavior change communication which involves Volunteers are selected to help organize the village to build latrines during a forming, training and supporting village WASH committees, Community-Led Total Sanitation (CLTS) triggering session at the Maparanhanga and uses PRA37 techniques (among others) to promote effective village (Mozambique, September, 2009). WASH improvements. By the very nature of BRAC’s size in Bangladesh, their WASH II program (which the Foundation is other interventions) is another important factor to consider supporting) is operating at scale and already reaches many parts in sanitation demand generation. Another factor to consider of the country. WASH II includes financial incentives for the in sanitation demand generation is the effect and importance ultra-poor, and credit financing schemes for the poor. of credit schemes, subsides, and other financial interventions. Experience suggests that households are willing investors East Meets West and iDE have made excellent progress in on-site sanitation and often pay the bulk of sanitation generating demand through sanitation marketing efforts. hardware costs. Toilets are aspirational products and many In Vietnam, EMW has used an output-based aid approach consumers, including the poor, want higher-quality sanitation to strongly incentivize the implementing agency (Vietnam products. However, cash flow issues can impede the poor from Women’s Union) to reach the poor with improved sanitation acting on these decisions. Household sanitation investments options. Credit and other financial awards are used at various also must compete with other spending priorities such as levels in the project to help drive results and enable the poorest education, health care, communi-cation, transportation, and to purchase aspirational sanitation systems. In Cambodia, entertainment. iDE has also reached the poor with improved sanitation through sanitation marketing campaigns backed by affordable Subsidies have long been a controversial matter in the sector, financing schemes. However, they have found that microfinance with some agencies and experts arguing that subsidies distort institutions are unwilling to scale up loan portfolios for the market, confuse the behavior change progress at the household sanitation purchases. Also, iDE has found that community and house-hold level, and create an undesirable sanitation-oriented businesses are often reluctant to invest in dependency on external agencies. Observations made by and manage the direct sales teams required to reach customers WaterAid and VERC in Bangladesh in the late 1990s led to the at the community level. conclusion that hardware subsidies were part of the problem rather than the solution; this in turn led to the development of New implementation research on sanitation demand generation CLTS as a method of putting communities back in charge of and behavior change will be conducted on the effectiveness and their sanitation decisions.38 Yet more recent research carried cost of the Community Health Club model being advocated out by IPA in Bangladesh39 suggests that generating demand by Africa Ahead. The integrated research and implementation (through CLTS) may have little overall effect on ownership of effort will assess whether a less intensive CHC approach can still hygienic latrines without some type of financing being made deliver results (which would be a more scalable model). available. The seeming contradiction raised by these two Sanitation financing (including credit schemes, subsidies, and studies, though they are separated in time by well over a decade,

Building Demand for Sanitation | 41 is indicative of the fact that this issue is still of major concern to on a regular basis, as people move out of –but also move into- sanitation-focused organizations and communities alike. poverty over time).

The modalities employed by agencies using hardware subsidies • PSI in India’s Bihar State found that households rarely have highlighted in the 2003 publication by Kar and IDS were sufficient cash on hand for a toilet purchase, and other problematic for a variety of reasons: products and services are in greater demand. Affordable credit and targeted subsidies to the poor would facilitate sales to base • Approaches were not harmonized among agencies and varied of pyramid (BoP) consumers; they are exploring how to use considerably. existing Government of India financing schemes into a more • Subsidies were often captured by the better-off and did not efficient sanitation marketplace and with better targeting of reach the poorest; little targeting of the poorest took place. the poor. • Poorest households could not afford the required cash • WSP and IFC in Kenya are working with MFIs to develop and investment needed to construct functioning toilets where test financing mechanisms that can enable more consumers subsidies took the form of in-kind sanitation hardware gain access to new products. Mechanisms may include water, components. sanitation or housing loans, or working capital loans to • Subsidy funds are usually limited and not sufficient to provide sanitation entrepreneurs who can in turn pass on terms of a subsidy to everybody who qualifies for one. This can lead credit to consumers. to capture of subsidies by the fastest movers and confusion These findings point to better ways of supporting sanitation among those who are left behind. investment, especially by poor households, than those used • Progress was generally measured in terms of the number of in the subsidy and hardware-driven programs of the 1990s toilets built, rather than behavior change (use) or reduction in and early 2000s. Where findings can be translated into clear (or end to) OD. program- or policy guidance, BDS grantees will be strongly encouraged to publish and share such guidance. Effective Additional research and experimentation since the early 2000s uptake in the sector should then lead to adaptation of these has led to greater understanding of how to apply sanitation improvements to new countries and environments, for further credit and subsidy schemes in a manner that does not distort replication and scaling. markets or create dis-incentives at the household or community level. Some of the contributions that BDS grantees have recently Ensuring political support and Government made in this regard include: capacity still requires attention—particularly regarding policy • East Meets West in Vietnam found that households would harmonization, operational planning, sector coordination, postpone sanitation investment until they had sufficient financial contributions, and efficiency of expenditure. funding to pay for the type of facility they wanted. In such Capacity building efforts also must be better coordinated and situations, offering affordable financing to households can act institutionalized. There has been a lot of progress on this in as a catalyst for investment decisions. the past ten years, but there is still a long way to go. Experience from BDS grantees (especially WSP) suggests that these tasks • iDE Cambodia, with PATH, saw a 400% increase in demand can be accomplished, but that it will take time, significant levels for Easy Latrines sold at market price when financing was of investment, and a government prepared to lead. made available. However, MFIs do not appear prepared to scale up this type of consumer loan program, in spite of the Improving sanitation business models requires new 100% repayment rate suggesting that the poor are not risky as and better sales approaches, simplifying the purchase process, creditors had thought.40 and improving the range and type of products and services sold. • CInI, who work in some of India’s most challenging areas, These innovations need to continue, and the most effective acts as a financial intermediary to help make Government models scaled up. BDS partners have been making great strides financing delivery systems more efficient. CInI provides up- in this arena, including at-scale efforts by iDE’s SMSU project front payments to households who want to build toilets; after in Cambodia,41 PSI’s 3SI project in Bihar, WSP & IFC’s Selling those toilets are built, households apply for the Government Sanitation project in Kenya, and others. subsidy. When households receive the subsidy, they pay CInI back. Making sanitation more affordable. The cost of hygienic toilets that appeal to consumers has been brought • BRAC in Bangladesh are targeting sanitation subsidies to down in many places, but are still generally out of the reach the ultra-poor, using a clear set of criteria applied during a of the poorest. BDS partners who are working on making community census (the recent outcome verification study sanitation options less expensive include: suggested that BRAC should update household classifications

42 | Building Demand for Sanitation www.gatesfoundation.org

sanitation marketing at scale may only reach early adopters and the better off, without reaching ODF). On-going work under the BDS portfolio will need to strengthen efforts to integrate these two powerful, yet distinct programmatic approaches—which in the past have typically worked in relative isolation from each other. BRAC, iDE, WSP, and East Meets West have made great strides by improving the supply of affordable sanitation options, reaching the poor through targeted sanitation financing supports, as well as promoting adoption of sanitation throughout entire communities. WaterAid is also working on this challenging problem in Nigeria.

Fecal sludge management solutions are needed now, or in the near future, for the solids accumulating in on-site sanitation. Additional work is needed to establish pit emptying services that are hygienic, environmentally sound, and affordable, as well as improving sanitation services such as repair, maintenance, and upgrades. Water for People, in partnership with PSI, are working to develop more efficient ways of emptying fecal sludge in slums and poor communities. The Foundation’s Urban Sanitation Markets (USM) and Early consumer testing of ASB products in Africa showed a ‘sitting option’ for latrines to be popular in some countries. Transformative Technologies (TT) portfolios are also working extensively on the FSM issue, from a markets/business model • American Standard Brands whose Bangladesh-based “Sato and technology development perspective respectively. Pan” project improved upon the design of inexpensive but Health implications of poor sanitation. Research poor-quality pour-flush pans sold there. Having succeeded conducted by the Research Institute for Compassionate with at-scale sales in Bangladesh (over 700,000 sold), the Economics (r.i.c.e.) has demonstrated a strong correlation Foundation is now supporting ASB to develop and trial similar between OD and stunting in India and several other countries and new types of pans in Sub-Saharan Africa, in partnership in Asia and Africa. This information has been incredibly helpful with iDE. to the WASH sector (e.g. in arguing for more attention and • WSP & IFC used Human Centered Design to develop a range investment, given the broad impacts on health) but arguably of plastic latrine slabs which are affordable ($17 - $55, ex- the biggest impact so far has been on the nutrition sector. Large factory), can be easily transported and stored, and which are funders and implementers (such as USAID and UNICEF) have an attractive and durable alternative to masonry products. begun to consider integrated Nutrition and WASH programs. Over 620,000 units have already been sold. The CEDLAS study of UNICEF’s CLTS program in Mali • iDE Cambodia, also using Human Centered Design, demonstrated how decreases in OD can lead to reduced stunting developed the Easy Latrine (prior to the Foundation- and other positive health outcomes. At the same time, Emory supported SMSU project). The Easy Latrine, priced at around University’s study of the Indian Government’s Total Sanitation $50, cost a fraction of what consumers typically paid for Campaign in Orissa State found increased latrine coverage made-to-order masonry latrines. Over 140,000 have been sold but did not identify any reduction in the reported prevalence through the SMSU project. of diarrheal diseases in children. The findings of these three research efforts highlight the challenges in understanding the • PSI in Bihar found that existing toilet options cost $400 or health impacts of WASH interventions, and the significant more, and were complex to purchase. Design and production remaining unknowns. efficiencies have brought this price down significantly, but additional cost efficiencies are still being sought. Over 6,000 of The results of the two impact evaluations (Orissa and Mali) are these lower-cost toilets have been sold by sanitation enterprises particularly interesting, as their results seem quite different. trained and supported by the project. In Mali, a focused and well-orchestrated CLTS campaign with strong Government support was found to reduce adult OD rates Integrating supply-side and demand-generating by 70% (child OD fell by 46%), and access to latrines in-creased projects has the potential to ensure sustainable sanitation from 35% to 65%. CLTS intervention households also had outcomes. Supply-side and demand-generating approaches cleaner latrines and improved hygiene. It also is worth noting each face challenges (e.g., CLTS campaigns at scale often fail that the early phase of the research (i.e., baseline study) was to result in hygienic, user-friendly sanitation facilities; and

Building Demand for Sanitation | 43 used to help the field implementers to focus their CLTS effort among children, or impacts on stunting. And while the outcome on the most critical aspects of the intervention, to improve in terms of increased sanitation coverage was dramatic, no their mobilization strategy, and to sharpen their monitoring communities achieved ODF status, and latrine usage was only program. around 36% by the end of the effort. Intervention area hand hygiene did not noticeably improve, nor did household water The most significant health findings from Mali were that quality.43 Why did this intervention, which was at least partially stunting was reduced by 17%, and severe stunting in children successful in reducing OD and increasing access to latrines, not under 2 years was reduced by 23%. There also was a 57% result in any detectable child health improvements? Possible reduction in diarrhea-related under-five mortality. However, reasons for this include: there was no significant impact on child diarrheal disease morbidity or respiratory illness. • The level of latrine coverage and/or latrine use achieved were too low to have a significant health impact. Interpreting the results of the Mali study, the following were • The intervention did not impact enough transmission concluded: pathways (e.g., hands after defecation, child feces) or sources • The Mali implementation team used the research opportunity of exposure. 42 to improve their overall program implementation. • Environmental pathogens were persistent, and the 21-month • A highly successful CLTS campaign (96% of communities follow up period was too short to see any impact. declared ODF) led to reduced stunting and other positive • The intervention did not adequately contain excreta. health effects in children within a period of less than two years. Comparing the outcomes of these two research studies, two of • There was no significant impact on child diarrheal disease the main conclusions that can be drawn are: morbidity. • Sanitation interventions need to achieve very high use of • The intervention had no discernable impact on household improved sanitation (as opposed to high coverage) to produce water quality, hand hygiene, or the cleanliness around houses. better health outcomes. Striving to achieve ODF status (or The impact on children’s health was not through these nearly so) is important. pathways. • As multiple routes of exposure to pathogens exist, improving • Health impact appears to have resulted from increased hygiene behavior, drinking water quality, and management of (individual) latrine use and reduced OD. child feces are critically important for WASH interventions. • There was no indication that access to sanitation was declining The BDS program and its research partners will continue to over time. work on interpreting these findings, and disseminating the results. With reference to the Orissa study, future work will In Orissa, access to latrines increased dramatically—from less include studies to assess the determinants of latrine uptake than 10% to around 63% in the intervention area. However, and use; microbial source tracking, and dissemination of the there were no observed changes in diarrheal disease morbidity findings in India and discussion of their policy implications.

44 | Building Demand for Sanitation Knowledge Management and Research Needs

IMPROVEMENTS IN LEARNING AND provided economically (approximately 4-5 person days per KNOWLEDGE MANAGEMENT month) such a curation service depends on recommendations The BDS portfolio has invested in an 18-month Knowledge from within the recipient network, which are not coming Sharing and Learning project. In this section we recap on the forward sufficiently; another constraint is the paywall barrier BDS Knowledge Management (KM) work-stream and describe blocking access to many current publications. how the project contributed to the 2015 annual convening Curated Repository which aimed to integrate Knowledge and Learning activities throughout the event. Designed after consultations with This stream aims to provide a working prototype of a curated grantees in 2014, the BDS KM project has six activity areas, database of core WSH digital content, comprising both addressing the two principal aims in the project’s Terms of Foundation and other information. A prototype was prepared Reference: for demonstration at the 2015 convening, to gauge reactions and enroll grantees interested in testing the prototype. The 1. Improve BDS portfolio’s knowledge sharing and uptake of prototype uses the Mendeley platform. Before opting for a effective approaches by grantees; discrete repository the project reviewed the major existing 2. Improve management of, and access to, WSH information. WASH databases against criteria including the utility of their classification and search capabilities; the transparency of Curation their curation processes; facilities to upload documents; user A key requirement from the 2014 consultation was to “increase ranking and comment functions; and whether the material the signal to noise ratio” of content that floods across desks could be accessed offline. The well-structured WSSCC database and email inboxes. A related grantee recommendation was for was judged the closest match to BDS grantee focus in terms of a curated, online collection of WSH/BDS relevant material, content but none of those reviewed provided offline capabilities. formally organized as in a traditional database, and with After a review of the options, Mendeley.com was chosen as the features such as user ratings to make the material more easiest to use and well featured of the platforms that could be accessible and dynamic. Accordingly two sets of activities focus accessed across systems (Windows, Android, iOS) and devices on content curation. (tablets, phones lap- or desktop computers) with automatic on- and offline synchronization of content. Curated Updates Two curators from grantee organizations were engaged to review and select a small number of current WSH documents, accompanied by a one or two sentence synthesis of each. The monthly email digest goes to all grantees, and others who are recommended or ask to join the list. Driven by peer recommendations the list had grown to 130 recipients by the sixth issue (January 2015). Platform statistics show that the mailing’s open and ‘click’ rates are consistently higher than the industry (not-for-profit) average. The generally positive reactions from recipients were confirmed at the 2015 convening, although non-recipients questioned the value of ‘yet another information service’. Following the convening feedback the remaining issues will be slightly shorter (four rather than five recommendations), bias grantees own publications, maintain the focus on relevant themes, and increase multimedia content. While the case is demonstrated that a useful service can be

Building Demand for Sanitation | 45 The content in the prototype is a sample selection of 60 current Figure 5: Ideas generated by participants during the and influential content items uploaded into a Mendeley group “learning events” session and tagged according to a classification structure developed in consultation with the BDS KM Technical Advisory Group. The WHAT MAKES A GOOD LEARNING EVENT? sample comprises both materials produced by the Foundation’s programs and other publicly available material. Questions about • Being outside our familiar context helps to how a more comprehensive collection could be chosen and what challenge your thoughts and ideology processes could be established to maintain and update it will • Exposure to a good example helps to define strategy need to be addressed if a workable model of a curated database • Ensure the right people and mix of people can be demonstrated. It would be a sizeable task, since there participate in the learning process is currently no easily identifiable and accessible collection of Foundation WASH materials. • “Seeing is believing” • Learning is a journey which takes time and needs The prototype will be tested by a group of volunteers over the space for reflection next three months. • Learning comes through ‘friction’, dig below the Connect surface and be open and frank about failures. The target is to increase engagement and knowledge sharing between grantees using digital platforms. These include public social networks like LinkedIn and Twitter; specialist, public bring alive learning points and leave behind hooks for memory, online communities such as SuSanA.org, the WSSCC LinkedIn often provided by the Punch Line – or what is the point of group44; and platforms private to the grantees. The latter are your story? In the session participants reflected on and shared intended to encourage more open conversations than might examples – stories of successful learning experiences or events. occur in a fully public space. We are currently using Dgroups. In plenary we summarized some of the critical success factors. org for an email list and a private blog space.45 An objective of Participants were then invited to apply for small grants in the first phase of the KM project was to build a greater sense of support of learning exchange visits between grantees whose aim a BDS identity within the grantee network. While the visibility is both the continue the kind of deep-dive knowledge exchange of (and appreciation for) the KM activities within BDS has that occurs during face-to-face events like convenings and to grown during the project, developing a strong sense of a BDS reflect openly about learning and sharing processes. Five blogs community would take longer than the 18-month project from a recent visit by the KM team to East Meets West46 and timespan. We will continue using private spaces to encourage a Learning Workshop at WEDC conference were presented as exchanges between grantees and we will also be engaging more an example of an open reflective learning journal, using digital actively in KM activities on the public SuSanA.org platform as media to en-liven the material. we transition to the end of the KM project.

Learning Events BDS Processes The aim of this stream is to help in the development of a This work-stream aims to focus on and harvest the knowledge Learning Culture within BDS, working with BDS program sharing and learning that occur during events, both face-to- staff to advance and model a way of working that maximizes face and online, experimenting with different ways to improve opportunities for learning and knowledge sharing across the learning and knowledge sharing within the BDS portfolio. portfolio. One of the central arguments of the BDSKM program “Designing effective learning events” was the theme of one of is that, in common with other development sectors, there is two sessions at the 2015 convening which specifically focused an over-emphasis on knowledge products and outputs, and not on KM. enough emphasis on the reflection and learning processes that “Reflection and Learning are allocated small amounts of time” produce sustainable change within projects and organizations.47 was the unsurprising conclusion of our initial exercise with This work stream is central to such a reorientation. BDS workshop participants. A subsequent exercise revealed that the management has been testing out different ways to encourage majority of grantees still don’t engage with each other between and model processes that encourage reflection and learning, convenings, a huge lost opportunity. The session also focused including quarterly ‘open-agenda’ regional teleconferences on surfacing examples of good practice in shared learning. with grantees and the posting of questions about long-standing Following examples from two participants about how difficult ‘knotty problems’ on the Dgroups email group. As described it is to share learning unless it is face to face, we zeroed in on below, BDS management extended this approach into the 2015 stories as one of the most effective ways to capture attention, convening, leading activities designed to encourage reflection and sharing.

46 | Building Demand for Sanitation www.gatesfoundation.org

Learning about Learning UNANTICIPATED OUTCOMES This overarching workstream aims to encourage reflections High on the list of priorities that emerged from the January on the learning process during the project and to develop 2014 grantee consultation was ‘learning from failure’. For the recommendations on how to create and foster a stronger Hanoi convening we were keen to explore how organizations learning environment. The approach is to constantly ask and projects respond to unanticipated outcomes, which questions and communicate about learning and exchange included runaway successes as well as failures. We were aware processes. The most complete model to date is the set of blogs of the sensitivity involved in sharing publicly stories of failure, referred to above from the 2014 exploration of the East Meets especially in a workshop organized by the donor organization. West program but it was also a central theme of the 2015 So we structured the session to encourage and allow frank convening. exchanges within small groups. Participants were asked to tell a story about a situation where there was an unanticipated outcome, involving success or failure. The groups then had SHARING EXPERIENCE AND LEARNING AT to share only one story in plenary, along with the lessons THE 2015 HANOI CONVENING learned from the whole collection of stories. While photos of Knowledge and Learning were central to the design of the the flipcharts recording the lessons are available from the KM convening, which aimed to enable grantees OneDrive50 we believe that sharing and story-telling with others • To share, “the most exciting new and emerging results from was the more important process, which intended to normalize (their) work; the idea that failures are common, sharing is useful and valuable • To have “open and candid conversation amongst grantees and learning can emerge from that sharing. between grantees and Foundation staff”; • To “examine important technical issues and challenges of LEARNING ABOUT LEARNING DURING THE mutual interest (and to seek solutions with fresh points of CONVENING view)”; Building on that work we introduced activities to encourage • And to “identify opportunities for knowledge sharing, reflection and sharing between participants, based on the ‘art 51 research, and other types of follow-up”. form conversations’ methodology , at key moments during the event, including at the end of the day, before lunch-breaks Annual convenings are, of course, Learning Events and the and also as part of agenda sessions. This spirit continued after BDS KM team worked with the Foundation team to construct the event, with at least five blogs reflecting on the convening an agenda which maximized opportunities for learning and published soon after the event, as well as notes being shared and knowledge sharing. The agenda was designed to balance circulated among some of the grantees. different modes of knowledge sharing and learning, including: • Sharing information and updates from projects using posters48, with a whole afternoon for grantees to review and engage with each other around the posters • Field visits and session to share learning and a 90-minute reflection session on the following morning • Traditional presentation sessions, tightly chaired, to provide ‘TED’ style rapid, detailed input, with time for Q&A (two topics) • Fishbowl format discussions for whole-group conversations about two key topics, Rural Sanitation Financing and Subsidies and Rural Hygiene and Sanitation Behavior Change (see also this blog on the fishbowl formats49)

Participants discussed project updates using poster presentations.

Building Demand for Sanitation | 47 The Way Forward

FOUNDATION VISION The Foundation’s vision for the WSH sector is simple but Note that this does not mean the Foundation considers rural ambitious: the adoption and use of sustainable sanitation sanitation a low priority for the sector. With over 70% of those services for all. To contribute to this outcome, we make lacking adequate sanitation living in rural areas and an even investments, forge partnerships, and advocate for opportunities greater majority of the deaths from diarrheal disease occurring that have the potential to make quality sanitation technologies in rural areas, rural sanitation is central to meeting global WSH and services safe and affordable for everyone. The Foundation’s and related health, nutrition, and education targets. We are co-chairs are ‘bullish’ on sanitation and see the Foundation’s acutely aware that rural residents who lack improved sanitation role as a sector catalyst to make high-risk (and potentially high- outnumber their urban area counterparts by one billion. impact) investments that would not otherwise happen. The BDS portfolio’s contribution to the Foundation’s overall As explained earlier, the WSH program has evolved since vision for the WSH sector focuses on several key aspects of the its inception as a learning initiative in 2005 to focus on two challenge: fundamental challenges: • Strengthening individual and collective demand for sanitation 1. Expanding and improving sanitation without central sewers, • Working to sustainably end OD and promoting adoption of because this is (and will be) the most common type of improved sanitation services sanitation service used by the poor; • Increasing the use of evidence-based practices 2. Making sanitation safe and sustainable by establishing more effective fecal waste management systems. The BDS program also hopes to substantially impact sector progress on the ground: Our strategic focus is on the science, technologies, market approaches, processes, and tools that will transform these • Contribute to at least 30 million people living in Open aspects of the sanitation sector. We believe the focus on non- Defecation Free (ODF) communities piped sanitation makes good sense, because establishing • Increase adoption of evidence-based practices in rural and water-based sewage systems and wastewater treatment plants urban sanitation will be too costly for the foreseeable future in most developing • Explore better ways to drive adoption of hygienic sanitation market scenarios. Along with the focus on transforming practices on-site sanitation, the WSH program as a whole has tilted towards urban sanitation. Development of new on-site BDS grantees have made great strides in addressing the need sanitation approaches and technologies could accelerate the to strengthen both rural and urban demand generation and adoption of improved sanitation services—and the Foundation the effective collection and use of program evidence; these believes that improved products and services will first become accomplishments (and ongoing work) were summarized in economical in more densely populated urban environments. the Portfolio Progress section above. As the Foundation shifts Further supporting our focus on urban areas is the fact that the more of its implementation resources to urban environments, population of urban residents lacking sanitation has increased we expect to make no major new investments in BDS by nearly 40% since 1990, whereas the rural population lacking implementation grants, though we will continue our focus sanitation has dropped by 18% over the same time period.52 on BDS learning and research, knowledge management, and integrating BDS learning with Urban Sanitation Markets and Transformative Technology initiatives.

48 | Building Demand for Sanitation www.gatesfoundation.org

NEXT STEPS FOR THE BDS PORTFOLIO During 2015 and beyond, the Foundation will continue to evidence. Work underway with WHO includes the development pursue ways of accelerating the scale-up of sanitation demand- of official Guidelines on Sanitation and Health, as well as generating approaches and programs. Many of the projects the development of new monitoring guidelines and tools for mentioned in this report are ongoing, and results from those application by the Joint Monitoring Program (JMP) once the efforts are still forthcoming. However, some projects have new Sustainable Development Goals (SDG) have been adopted been completed, and there are preliminary results from several (the SDGs are expected to include a much stronger focus on the of the ongoing efforts. The BDS Knowledge Management full sanitation chain, including fecal sludge management and initiative will gain prominence as the Foundation seeks to treatment, than the MDGs did). Also in support of the SDGs share information within the portfolio, and disseminate it to is the work ongoing at the Water Institute at the University other agencies, experts, and countries. New projects which have of North Carolina: a proof of concept on how to estimate the recently, or are soon to come on line—should benefit from amount of untreated human waste which is returned to the the greater focus on KM and the lessons learned by mature environment at the country level. and completed projects. The Foundation also will increasingly seek ways of integrating the knowledge generated by the BDS The BDS initiative remains focused on developing a better portfolio with its other sanitation initiatives, especially the understanding of demand for sanitation, including CLTS as Urban Sanitation Markets effort. a demand generation method that has been widely adopted by governments and organizations. A new research effort India is already an important focus of the BDS effort, and on CLTS will be carried out by Eawag, focusing on how the this will only increase in the future. New investment in India various aspects of this method work in terms of the behavior will grow substantially from 2015, and will be supported by a change mechanisms at work, and the relative effectiveness of its dedicated WSH team based at the Foundation’s office in New various components. Plan and UNC will complete their detailed Delhi. Efforts to reach the marginalized (i.e., through the assessment of the effectiveness of internal actors in the CLTS work of RGMVP, CInI, and others) and improve market and process, as well as conducting an analysis of cost effectiveness. Government sanitation program efficiencies (PSI, CInI) will Plan and UNC also will carry out a number of internal and continue, with more results from these projects expected during external learning and dissemination efforts as the project winds 2015-16. R.i.c.e. will continue and expand its research efforts on up later in 2015. the Indian sanitation challenge; furthering its work on latrine preferences and related cultural influences include analysis of The BDS effort also will continue its efforts to integrate cultural links to the Infant Mortality Rate, and possible links with other parts of the Foundation’s WSH program, namely between sanitation and anemia. R.i.c.e (and others) also will the Urban Sanitation Markets (USM) and Transformative support the Government of India to examine the growing body Technologies (TT) initiatives. Sanitation market interventions of sanitation program evidence and address these issues at the and product development efforts being carried out by policy level. Fundacion In Terris, IFC & WSP Africa, American Standard Brands, iDE, PSI, and CInI are all making important Work in Bangladesh will continue, with the EPRC research contributions that should provide useful products, project on the effectiveness of female local Government implementation “business models” and insights that are members set to deliver results later in 2015. Innovations for relevant for both rural and urban settings, and which hopefully Poverty Action will continue its research (led by Mushfiq can be carried forward to scale. Mobarak) on the effectiveness of different sanitation behavior change tools and approaches. BRAC plans to continue Related to this “blurring of the lines” between the different expanding its work on rural WASH (independent of foundation WSH initiatives is a new direction which the BDS initiative will funding) and discussions about a partnership with the add to its currently strongly rural focus: to develop a better foundation WSH team to start tackling sanitation for the urban understanding of the urban environment, including questions poor are ongoing. of demand generation and service provision. Starting from 2015, this focus will be further developed and will progressively New investments currently under development demonstrate become part of the results reported by the BDS initiative. a continued focus on generating, disseminating and applying

Building Demand for Sanitation | 49 Appendix

FOOTNOTES 1 Previous meetings were held in Nairobi (2012), Phnom Penh (2013), and 16 Campaigns comprised a latrine promotion program (a CLTS-type of Nairobi (2014). The BDS portfolio was called “Sanitation Delivery Models” approach); 75% latrine purchase subsidies for the poorest population segment; until 2013. and sanitation ‘supply agents’ who helped arrange latrine purchases and help with installations. 2 Economic Impacts of Inadequate Sanitation in India; Water and Sanitation Program (2011). 17 The provision of incentives for seasonal migration were part of a larger and unrelated study about seasonal migration of agricultural workers to cities. 3 Progress on Drinking Water and Sanitation, 2014 Update. WHO and UNICEF, 2014. 18 Bihar, Haryana, Madhya Pradesh, Rajasthan, and Uttar Pradesh states.

4 Ibid. 19 R.i.c.e. also received financial support from India Globalization Capital for the Switching Study. 5 Rigorous evidence not only tells us what happens as the result of a specific intervention, it also tells us what would have happened in the absence of 20 Participatory Hygiene and Sanitation Transformation. the intervention. This allows researchers to make strong causal connections (“result “X” happened because of activity A”). For increased confidence in 21 An Upazila is the second lowest tier of regional administration in Bangladesh. the results, such research requires a control group (which does not receive the The structure consists of Divisions (7), Districts (64), Upazilas (488), and project intervention), randomized assignments of who will receive the project Union Parishads (UPs), of which there are over 4,500. intervention, and a carefully computed (often large) sample size. 22 Households with less than 10 decimals (400 m2) of land, no productive assets, 6 The Centre for the Evaluation of Development Policies. children of school-going age who are working, and no active adult male present. 7 This research project also includes a significant, at-scale implementation component (supported by USAID). 23 Although tests on organic fertilizer were carried out and approvals were obtained, the efforts to establish small businesses selling it were largely 8 Also known as “Thrive Networks”. abandoned as demand is very low and chemical fertilizer is heavily subsidized.

9 ASB is now part of the Lixil Corporation of Japan. 24 Including training of more than 5,600 Rural Sanitation Centre owners.

10 Selling Sanitation partners include: Manufacturers SIL Africa Limited and 25 Monthly women’s cluster meetings comprised of women from 10 households; Kentainers Limited; Kenya Ministry of Public Health and Sanitation, AMREF, cluster meetings for adolescent girls from 45 households. Menstrual hygiene FHI 360, KWAHO, Plan International Kenya, PSK, Red Cross, SNV, WSSCC, messages are covered during these meetings. World Vision, and UNICEF. 26 Now part of Thrive Networks. 11 Collaborators: A.J. Pickering, Stanford University; H. Djebbari, Aix-Marseille University; J.C. Cardenas, University of the Andes; and M.A. Lopera, Université 27 SMSU saw a 16% increase in coverage in project areas over 2.5 years between Laval. Implementers: N. Osbert, UNICEF and M. Coulibaly, Government of the baseline and endline, meaning a 6.4% annual rate of increase in sanitation Mali (National Directorate of Sanitation). coverage. According to the WHO/UNICEF JMP Report for Water Supply and Sanitation from March 2010, the average rate of increase in sanitation for 12 These are social behaviors that benefit others or society as a whole, such as Cambodia was 0.923%. 6.4/0.923 = 6.93 helping, sharing or cooperating. 28 If relevant and available. 13 Long-Term Sustainability of Improved Sanitation in Rural Bangladesh. WSP Technical Paper (2011). 29 By the end of Period 3, 90% of active businesses were profitable with an average operating profit of $0.26 per dollar of sales. At this time, there were 138 Active 14 Union Parishads (Union Councils) are the lowest level of local government LBOs (defined as having made a sale in the previous 6 months as of Oct. 2014) in Bangladesh. A Union is comprised of nine Wards or villages; the ‘UP’ has responsibility for economic and social development of the Union. 30 Conducted by Monitor Inclusive Markets (now Monitor FSG).

15 Co-researchers: Raymond Guiteras and Shyamal Chowdhury. 31 During menstruation, instead of using sanitary napkins, women use homemade pads made from old cloth. They often reuse these without proper cleaning as they feel shy to take care of these needs openly. Women also generally have no access to safe toilets or bathing spaces.

50 | Building Demand for Sanitation www.gatesfoundation.org

32 An imprecise term, but one generally used to mean the number of villages 41 Including the “CLEAR” sales approach introduced by PATH. which achieve ODF status per the number of villages triggered using CLTS/ CATS. 42 While the UNICEF/Government of Mali implementation team used baseline findings to improve their CLTS pro-gram, their access to these data did not in 33 Progress on Drinking Water and Sanitation, 2014 Update (2012 data). any way compromise the integrity of the RCT research methodology.

34 Indonesia’s Sanitasi Total Berbasis Masyarakat (STBM) campaign is comprised 43 No significant difference between intervention and control household water of 5 elements: 1. Stopping ; 2. Handwashing with soap; 3. quality over time; although water quality in both areas did generally improve Household Drinking Water and Food Management; 4. Household Waste during the course of the study. Management; and 5. Household Liquid Waste Management. 44 Community of Practice on Sanitation and Hygiene in Developing Countries 35 Progress on Drinking Water and Sanitation, 2014 Update (2012 data). 45 http://www.bdskm.net/online-spaces/km-talks/ 36 IDS is no longer working under a Foundation grant, but the Knowledge Hub continues to promote and document CLTS experience. 46 http://www.euforicservices.com/search/label/oba

37 Participatory Rural Appraisal. PRA methods used by BRAC include transect 47 From blog about Learning Event in Hanoi with East Meets West http://bit.ly/ walks and social mapping. ZmbmTe

38 Subsidy or self-respect? Participatory total community sanitation in Bangladesh 48 http://tinyurl.com/mup6tuw (IDS Working Paper 184). K. Kar 2003. 49 http://bit.ly/1BQETEe 39 See the discussion of IPA research on “Inter-Linkages in Sanitation Demand Across Households” in Bangladesh. 50 See http://1drv.ms/19sgwCl

40 iDE is considering ways of developing an in-house microfinance capacity to 51 Described in this post-convening blogpost http://bit.ly/1LjO3PN address this challenge. 52 Joint Monitoring Program (2014).

Building Demand for Sanitation | 51 PARTICIPANT DETAILS

FIRST LAST ORGANIZATION EMAIL LOCATION (PROJECT)

1 Anthony Waterkyn Africa Ahead [email protected] (Rwanda)

USA (Bangladesh, 2 Jim McHale American Standard Brands [email protected] Uganda)

Bill & Melinda Gates 3 Radu Ban Foundation [email protected] Seattle, USA

Bill & Melinda Gates 4 Stephanie Drozer Foundation [email protected] Seattle, USA

Bill & Melinda Gates 5 Sarah Herr Foundation [email protected] Seattle, USA

Bill & Melinda Gates janwillem.rosenboom@gatesfoundation. 6 Jan Willem Rosenboom Foundation org Seattle, USA

7 Akramul Islam BRAC [email protected] Bangladesh

8 Milan Kantu Barua BRAC [email protected] Bangladesh

CEDLAS- Universidad 9 Maria Laura Alzua Nacional de La Plata, [email protected] Argentina (Mali) Argentina

Collectives for Integrated 10 Vartika Jaini Livelihood Initiatives [email protected] Delhi, India

Community Water and 11 Theodora Adomako-Adjei Sanitation Agency [email protected] Accra, Ghana

12 Chuck Henry Critical Practices LLC [email protected] USA (Ecuador)

13 Hans Mossler EAWAG [email protected] Switzerland (Ghana)

14 Pete Cranston Euforic Services [email protected] UK

15 Peter Feldman Euforic Services [email protected] Seattle, USA

16 Pippa Scott Euforic Services [email protected] UK

17 Marcos Fioravanti Fundacion in Terris [email protected] Quito, Ecuador

18 Juan Pablo Arguello Yepez Fundacion in Terris [email protected] Quito, Ecuador

19 Yi Wei iDE [email protected] Phnom Penh, Cambodia

International Water and 20 Eric Baetens Sanitation Centre (IRC) [email protected] The Hague, Netherlands

International Water and Netherlands 21 Ingeborg Krukkert Sanitation Centre (IRC) [email protected] (Bangladesh)

22 Fisseha Atalie Plan Ethiopia [email protected] Addis Ababa, Ethiopia

23 Daniel Asamani Plan Ghana [email protected] Accra, Ghana

24 Mulugeta Balecha Plan International USA [email protected] Washington DC, USA

52 | Building Demand for Sanitation www.gatesfoundation.org

FIRST LAST ORGANIZATION EMAIL LOCATION (PROJECT)

25 Rosalyn Okwiri Plan Kenya [email protected] Nairobi, Kenya

26 Shankar Narayan PSI [email protected] Delhi, India

27 Dean Spears r.i.c.e. [email protected] Uttar Pradesh, India

28 Sangita Vyas r.i.c.e. [email protected] Uttar Pradesh, India

29 Divyang Waghela Sir Ratan TATA Trust [email protected] India

Rajiv Gandhi Mahila Vikas 30 Krapal Singh Pariyojana (RGMVP) [email protected] Delhi, India

31 Arno Rosemarin Susanna [email protected] Stockholm, Sweden

32 Jonny Crocker The Water Institute at UNC [email protected] Chapel Hill, NC, USA

33 Nguyen Hong Hanh Thrive Networks [email protected] Hanoi, Vietnam

34 Kim Hor Thrive Networks [email protected] Hanoi, Vietnam

35 Minh Chau Nguyen Thrive Networks [email protected] Hanoi, Vietnam

36 Nguyen Quang Quynh Thrive Networks [email protected] Hanoi, Vietnam

37 Hien Vo Thrive Networks [email protected] Hanoi, Vietnam

38 Lalit Patra UNICEF Viet Nam [email protected] Hanoi, Vietnam

39 Lizette Burgers UNICEF Headquarters [email protected] New York, NY, USA

40 Aidan Cronin UNICEF Indonesia [email protected] Jakarta, Indonesia

41 Paulos Workneh UNICEF Malawi [email protected] Lilongwe, Malawi

42 Chander Badloe UNICEF RO Bangkok [email protected] Bangkok, Thailand

43 Ann Thomas UNICEF RO Kenya [email protected] Nairobi, Kenya

44 Bilqis Hoque Uttara University and EPRC [email protected] Dhaka, Bangladesh

45 Steve Sugden Water for People [email protected] UK

WaterAid Nigeria (replace 46 Ephraim Danladi Mimi) [email protected] Abuja, Nigeria

47 Ada Oko-Williams WaterAid UK [email protected] UK (Nigeria)

48 Viet-Anh Nguyen World Bank [email protected] Hanoi, Vietnam

WSP East Asia and the 49 Susanna Smets Pacific [email protected] Phnom Penh, Cambodia

50 Virak Chan WSP Cambodia [email protected] Phnom Penh, Cambodia

51 Joep Verhagen WSP India [email protected] Delhi, India

52 Mushfiq Mobarak Yale University [email protected] USA (Bangladesh)

Building Demand for Sanitation | 53 NOTES

54 | Building Demand for Sanitation www.gatesfoundation.org

NOTES

Building Demand for Sanitation | 55 www.gatesfoundation.org

Guided by the belief that every life has equal value, the Bill & Melinda Gates Foundation works to help all people lead healthy, productive lives. In developing countries, it focuses on improving people’s health and giving them the chance to lift themselves out of hunger and extreme poverty. In the United States, it seeks to ensure that all people—especially those with the fewest resources—have access to the opportunities they need to succeed in school and life. Based in Seattle, Washington, the foundation is led by CEO Sue Desmond-Hellmann and Co-chair William H. Gates Sr., under the direction of Bill and Melinda Gates and Warren Buffett. For additional information on the Bill & Melinda Gates Foundation, please visit our website: www.gatesfoundation.org. © 2015 Bill & Melinda Gates Foundation. All Rights Reserved. Bill & Melinda Gates Foundation is a registered trademark in the United States and other countries. Gates Open Research Gates Open Research 2017, 1:10 Last updated: 05 JUN 2018

RESEARCH ARTICLE Implementation and process analysis of pilot scale multi-phase anaerobic fermentation and digestion of faecal sludge in Ghana [version 1; referees: 2 approved] Justin Shih1, Ato Fanyin-Martin 2, Edris Taher1, Kartik Chandran 1

1Earth and Environmental Engineering, Columbia University, New York, NY, 10027, USA 2Chemical Engineering,, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana v1 First published: 06 Nov 2017, 1:10 (doi: 10.12688/gatesopenres.12754.1) Open Peer Review Latest published: 06 Nov 2017, 1:10 (doi: 10.12688/gatesopenres.12754.1) Referee Status: Abstract Background. In Ghana, faecal sludge (FS) from on-site sanitation facilities is often discharged untreated into the environment, leading to significant insults to Invited Referees environmental and human health. Anaerobic digestion offers an attractive 1 2 pathway for FS treatment with the concomitant production of energy in the form of methane. Another innovative option includes separating digestion into version 1 acidogenesis (production of volatile fatty acids (VFA)) and methanogenesis published report report (production of methane), which could ultimately facilitate the production of an 06 Nov 2017 array of biofuels and biochemicals from the VFA. This work describes the development, implementation and modeling based analysis of a novel 1 Thammarat Koottatep, Asian Institute of multiphase anaerobic fermentation-digestion process aimed at FS treatment in Kumasi, Ghana. Technology, Thailand Methods. A pilot-scale anaerobic fermentation process was implemented at Tatchai Pussayanavin, Asian Institute of the Kumasi Metropolitan Assembly’s Oti Sanitary Landfill Site at Adanse Technology, Thailand Dompoase. The process consisted of six 10 m3 reactors in series, which were Zifu Li, University of Science and inoculated with bovine rumen and fed with fecal sludge obtained from public 2 toilets. The performance of the fermentation process was characterized in Technology Beijing, China terms of both aqueous and gaseous variables representing the conversion of influent organic carbon to VFA as well as CH4. Using the operating data, the Discuss this article first-ever process model for FS fermentation and digestion was developed and Comments (0) calibrated, based on the activated sludge model framework. Results and Conclusions. This work represents one of the first systematic efforts at integrated FS characterization and process modeling to enable anaerobic fermentation and digestion of FS. It is shown that owing to pre-fermentation of FS in public septage holding tanks, one could employ significantly smaller digesters (lower capital costs) or increased loading capabilities for FS conversion to biogas or VFA. Further, using the first-ever calibrated process model for FS fermentation and digestion presented herein, we expect improved and more mechanistically informed development and application of different process designs and configurations for global FS management practice.

Keywords faecal sludge, anaerobic fermentation and digestion, volatile fatty acid, chemical oxygen demand

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Corresponding author: Kartik Chandran ([email protected]) Author roles: Shih J: Data Curation, Formal Analysis, Investigation, Methodology, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing; Fanyin-Martin A: Formal Analysis, Investigation; Taher E: Data Curation, Formal Analysis; Chandran K: Conceptualization, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Supervision, Writing – Review & Editing Competing interests: No competing interests were disclosed. How to cite this article: Shih J, Fanyin-Martin A, Taher E and Chandran K. Implementation and process analysis of pilot scale multi-phase anaerobic fermentation and digestion of faecal sludge in Ghana [version 1; referees: 2 approved] Gates Open Research 2017, 1:10 (doi: 10.12688/gatesopenres.12754.1) Copyright: © 2017 Shih J et al. This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Grant information: Bill and Melinda Gates Foundation [OPP1019896]. First published: 06 Nov 2017, 1:10 (doi: 10.12688/gatesopenres.12754.1)

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Introduction designers and engineers can perform a more accurate cost benefit In Ghana, faecal sludge (FS) from on-site sanitation facili- analysis for resource recovery in specific systems. Accordingly, ties is often discharged untreated into drainage ditches, inland this work describes the process development, implementation and waters, and the Atlantic Ocean, leading to deteriorating water modeling based process analysis of a novel multi-phase anaerobic quality and increasing the spread of gastro-intestinal infections fermentation-digestion process aimed at FS processing in Kumasi, (Cofie et al., 2006). While conventional wastewater treatment Ghana. (primary, secondary, and tertiary) has proven to be effective in developed countries, the associated high energy demands with Methods such treatment models may be cost prohibitive for developing Study background and facility layout countries to sustain (Murray & Buckley, 2010). One promising In partnership with the Kumasi Metropolitan Assembly, strategy for sustained FS treatment is to consider any potential pilot-scale anaerobic fermentation and digestion of FS was con- end uses of FS that can offer incentives through resource recov- ducted at the Kumasi Metropolitan Assembly’s Oti Sanitary ery (Diener et al., 2014). Anaerobic digestion offers an attractive Landfill Site at Adanse Dompoase (Dompoase), the disposal pathway for FS treatment with the concomitant production of point for FS from Kumasi and bordering neighborhoods. FS from energy in the form of methane. Another innovative option includes septic tanks, aqua privies, latrines, or unsewered public toilets separating digestion into acidogenesis (production of volatile (Cofie et al., 2006; Kuffour et al., 2013) is regularly collected fatty acids (VFA)) and methanogenesis (production of methane), by vacuum trucks and discharged into a series of waste stabili- thereby facilitating the production of an array of biofuels and zation ponds. FS from public toilets was exclusively used in this biochemicals from the VFA (Chandran, 2014). study since it represents the largest toilet usage category (34.6% of Ghanaians) as reported by the 2010 Ghana Census (Ghana In order to determine the feasibility of these treatment technolo- Statistical Service, 2012). FS includes both wet gies, numerous FS characterization studies have been performed (utilizing water for flushing) and dry (not utilizing flush water) in the last two decades (Bassan et al., 2013; Kengne et al., 2011; toilet blocks. Koottatep et al., 2005), including those specifically evaluated in Ghana (Cofie et al., 2006; Strauss et al., 1997). These studies The multi-phase anaerobic fermentation-digestion process provide a baseline of FS characteristics, often focusing on consisted of six, 10 m3 concrete anaerobic reactors in series chemical oxygen demand (COD), biochemical oxygen demand, (labeled R1- R6 in Figure 1). The anaerobic reactors were bur- solids (total solids, total volatile solids, total suspended solids, ied and operated unheated with an average liquid temperature of or volatile suspended solids), COD fractionation (Lopez-Vazquez 28°C. Two sample ports each were installed on R1, R2, R4, and et al., 2014), pH, or ammonia-nitrogen. However, there is a R6 for initial inoculation, mixing, and liquid sampling. FS was general lack of FS characterization beyond conventional received from vacuum trucks in batches of 5–10 m3 and fed in parameters. turn into a 1.2 m × 1.2 m receiving box (0.3 m depth) through a 1 cm metal screen, which typically retained clothing material, This absence of more detailed characterization presents a chal- condoms, plastic bags, and plastic wrappers. The variable batch lenge for determining clear design guidelines for resource or volume was due to the maximum capacity and the load volume energy recovery. For example, in Ghana, anaerobic digesters carried by the specific trucks, which varied by delivery. After accepting FS are typically sized for a solids retention time (SRT) FS was received, it was pumped into a 10 m3 holding tank of 15–60 days for pathogen reduction (Bensah & Brew-Hammond, (round, 2.4 meters tall) at grade before gravity fed into the first 2010). In the United States, the design SRT of sewage reactor in the series of six reactors (Figure 1). The 10 m3 holding sludge digesters for biosolids treatment is dependent on the tank allowed for a defined volume to be loaded into the system. desired biosolids Class (USEPA, 2006), but is usually higher than 20 days for single stage mesophilic digesters (Song et al., Loading periods – fed batch loading 2004) to meet pathogen and volatile solids reduction require- The monitoring data for this study was separated into two ments. However, if methane production and hygienization are distinctive loading periods: Loading Period One (days 1–70), concurrent project goals, it may not be necessary for them to beginning on April 22, 2013, and loading Period Two (days occur in the same process (Astals et al., 2012). Rather, by pair- 71–156). Period One had an average daily loading volume of ing individual goals with specific processes as part of a multi-stage 2,806±3,484 L, resulting in an average hydraulic retention time system, the improvements in efficiency may result in more (HRT) of 3.6 days per reactor. Period Two had an average daily efficient, lower cost systems. loading volume of 4,413±1,540 L, resulting in an average HRT of 2.3 days per reactor. In general, Period Two had higher overall Given that initial capital cost is a key limiting factor to biogas loading volumes and less loading volume variability (Figure S1), dissemination, especially in developing nations (Bensah & due to more consistent loading days throughout the week Brew-Hammond, 2010), any reductions in anaerobic digester (6.4 days per week vs. 3.5 days per week, on average over the sizing (where applicable) may assist in more efficient FS two respective loading periods). Period One was also character- management and improved systems for biogas production and ized by higher precipitation than Period Two, which in combina- usage. Smaller digesters also open up opportunities for installa- tion with unpaved roads led to difficulties in receiving influent tion in dense urban areas with space limitations. By determining at the site, which resulted in increased loading volumes to the optimal SRT for recovery of specific end products, process compensate during Period One.

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Figure 1. Layout of the faecal sludge anaerobic fermentation and digestion facility in Kumasi, Ghana.

During Period One, the sample ports extended until 73 cm from increasing to 2,500 L/day (on pre-Day 106), and finally reaching the bottom of the reactor, and the 2” mixing pipes extended to 4,000 L/day (on pre-Day 131). the bottom of the reactor. However, due to increased clogging of gas sample lines, these sample ports were shortened to the The reactors were mixed five days a week during Period One elevation of the reactor shoulder for Period Two. This allowed and seven days a week during Period Two by pump circulation with the discharge pipe to direct FS towards the foam breakers, a gasoline powered 2” centrifugal pump (standard trash pump) at potentially preventing solids accumulation that was passing 340 L/min for 16 minutes per day (clockwise for 8 minutes and through the foam breakers and clogging the gas sample lines. counter-clockwise for 8 minutes). On sampling days, the first operation performed was gas flow measurement and gas analysis Before the start of both Period One and Period Two, FS was through the gas sample ports installed onto R1, R2, R4, and R6. transferred between the two rows of reactors to allow for Plastic flexible tubing was used to connect the sample port to an physical removal of any rumen, settled solids, and upper crust inverted graduated cylinder, allowing for gas flow measurement layer from the active liquid stream. This ensured that any organic through the volume displacement method. Starting from Day 85, a contributions during the Loading Periods were due to incoming GFM416 gas analyzer (Gas Data Ltd., Coventry, UK) was used to FS and not any previous solids accumulation. measure CH4, CO2, and H2S in the off gas.

Start-up and process operation and monitoring Reactor samples were taken twice a week from R1, R2, R4, and The inoculation and start-up period spanned 144 days (pre-Day R6 through the sample ports immediately after reactor mixing. 1 to pre-Day 144), beginning on November 29th, 2012. Bovine A 237 mL Bacon Bomb sampler (Clarkson Laboratory and rumen was used to inoculate the reactors. Rumen is a well- Supply Inc., Chula Vista, CA) was lowered through the sample documented inoculum for anaerobic digestion (Hu & Yu, 2005; port to take one sample 20 cm from the bottom of the reactor Lopes et al., 2004) and was sufficiently available from the Kumasi and one sample 30 cm above the first sample from both sample Abattoir. On pre-Day 1, R1 was loaded with 8,500 L of FS and ports. These four samples were mixed together in a 1 liter plastic inoculated with 1,500 L of bovine rumen (separated from blood container and stored in a cooler until transport to the lab. and carcass). All reactors were filled with FS on pre-Day 51, and additional rumen (1,500 L per reactor) was loaded through the Laboratory analysis of reactor samples was performed at sample ports into R1, R2, R4, and R6 on pre-Day 71. FS load- Kwame Nkrumah University of Science and Technology in ing was ramped-up starting from 1,000 L/day (on pre-Day 91), Kumasi, Ghana. Total chemical oxygen demand (tCOD, HACH

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Method 8000) and total volatile fatty acids (VFA, HACH previous FS study. A full factorial central composite response Method 8196) were tested twice a week, while total suspended surface design was created in Minitab for the following influent solids (TSS, US EPA Method 160.2), volatile suspended solids parameters and factor ranges: readily biodegradable (including (VSS, US EPA Method 160.4), alkalinity (US EPA Method acetate) g COD/ g total COD (Fbs, 0.05–0.2); ordinary het- 310.1), pH (US EPA Method 150.1), and ammonia-nitrogen erotrophic organisms (OHO) COD fraction g COD/ g total COD

(NH3-N, US EPA Method 350.3) were tested once a week. Related (FZbh, 0.1–0.5); acetoclastic methanogen COD fraction g COD/ g methods pertaining to analysis of wastewater-related samples total COD (FZbam, 0.0001–0.005); and hydrogenotrophic metha- can also be found readily at https://www.epa.gov/cwa-methods. nogen COD fraction g COD/ g total COD (FZbhm, 0.0001–0.005).

Process modeling Calibration Phase 2: Given that Biowin simulates the anaero- The pilot facility was dynamically simulated using BioWin 4 bic digester modules as completely mixed reactors, increased (EnviroSim, Oakville, CA) through input of measured influent reactor sizes for R1 and R2 were explored in addition to influent loads and calibration with measured reactor results. The Biowin parameters to simulate longer solids retention time in the upstream setup consisted of six anaerobic digester modules in series reactors. A half factorial central composite response surface each defined with a 10,000 liter volume, depth of 1.8 meters design was created for the following influent parameters and and space volume of 1,500 L under 103 kPa to represent factor ranges: Fbs (0.03–0.27), FZbh (0.01–0.1), FZbam (0.0001– field reactors. Daily loading volumes, tCOD, pH, alkalinity, and 0.01), FZbhm (0.0001–0.01), R1 volume (10,000–30,000 L), and inorganic suspended solids (ISS) were directly inputted from R2 volume (10,000–30,000 L). measured influent values. A total kjeldahl nitrogen (TKN)/COD ratio of 0.16 TKN/COD was determined by calculating a ratio Calibration Phase 3: Reaction rates were considered next, of NH3-N/COD and scaling by 33% to balance nitrogen in the focusing on the key aspects of anaerobic digestion: hydrolysis, influent, and a total phosphorus (TP)/COD ratio of 0.04 was acidogenesis, acetogenesis, and methanogenesis. A half facto- determined from measured phosphorus in Kumasi FS. Nitrate rial central composite response surface design was created for N and dissolved oxygen were left as 0 mgN/L and 0 mg/L, the following reaction rates and factor ranges: hydrolysis rate respectively, given the anaerobic conditions of toilet systems, (0.36–3.84), maximum specific growth rate of OHO (0.07–3.13), and calcium and magnesium were left as default values of 80 maximum specific growth rate of acetogens (0.07–0.43), maximum mg/L and 15 mg/L. Finally, given that FS vacuum trucks often do specific growth rate of acetoclastic methanogens (0.07–0.53), and not remove all settled material from toilet systems, “settled” maximum specific growth rate of hydrogenotrophic methanogens wastewater COD fractionation values were used as initial values. (0.07–2.73) on VFA and gas production. Note: Biowin utilizes a 0.2 anaerobic hydrolysis factor to account for reduced hydrolysis The calibration methodology focused on identifying and limit- rates under anaerobic conditions. To further explore the extent of ing model adjustments to a minimal number of significant, justi- reaction rate adjustments, local rate parameters were grouped into fiable parameters. Throughout the calibration, central composite R1–R2 and R3–R6 due to the hydraulic connection locations, as response surface designs were created using Minitab 17 (State well as the solids distribution profile. College, PA) to evaluate the significance of variables, determine optimal variable inputs (through the response optimizer tool) and Calibration Phase 4: Volume-less point clarifiers were added to minimize the number of model runs required to evaluate mul- recirculate solids within each reactor to simulate the observed tiple variables. Optimal variable inputs were evaluated by their solids concentrations therein. The point clarifiers allow solids to composite desirability, which is calculated as the weighted be concentrated or diluted depending on the flow split ratio and geometric mean of individual desired responses (measured from solids removal percentage. These point clarifier settings were 0 to 1, 1 as ideal). Given the number of variables and reactors, iteratively adjusted to calibrate tCOD concentrations. model development was based on average simulated and average observed values over both loading periods. Calibration Phase 5: After determining which COD fractiona- tion values, influent microbial groups, and reaction rates signifi- The calibration process was conducted through a chronologi- cantly affected VFA and gas production, these variables (along cal series of hypotheses that primarily focused on VFA concen- with point clarifiers) were simultaneously considered for cali- trations and gas production. VFA and gas production serve as bration. Additionally, the simulated microbial population ratios benchmarks that characterize the stage or degree of anaerobic in R4 and R6 were considered as reference values for the digestion, and they are also the target end products for this study. influent conditions to reflect a microbial distribution where tCOD, % CH4, and % CO2 were also directly used for model methanogenesis is active and stable. calibration. All considered variables are documented through the following calibration phases (Figure 2): Calibration Phase 6: Several alternatives were investigated to

calibrate the % CH4 and % CO2 content in the off gas, including: Calibration Phase 1: COD influent parameters were the first to lowering the hydrogenotrophic methanogen growth rate (along be adjusted due to COD fractionation reference values as well as with increasing the acetoclastic methanogenic maximum specific expected microbial populations inherent in FS. A soluble unbio- growth rate to compensate for lower gas production), increas- degradable fraction (Fus) of 0.09 and particulate unbiodegrada- ing the hydrolysis rate (to promote subsequent CO2 production ble fraction (Fup) of 0.47 was used (Dangol et al., 2013) from a during fermentation), lowering the readily biodegradable COD

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Figure 2. Model development chronology. COD, chemical oxygen demand.

content in the influent to reduce initial gas production spikes is the HRT per reactor, and CODr is the tCOD (g) loaded into the in upstream reactors, increasing the gas-liquid mass transfer reactor. coefficient for CO2, and finally increasing the stoichiometric CO2 yield (moles of CO produced per mole of acetate formed) for Qr × HRTr 2 E = OHO. gas COD (Eq. 1) r For the final model configuration, each parameter per reactor Statistical analysis was evaluated (using Microsoft Excel 2010) by determining the Process modeling was conducted using BioWin 4 (EnviroSim, root mean square error, as well as the Nash-Sutcliffe coefficient to Oakville, CA). Minitab 17 (State College, PA) was employed to consider the observed data variance. evaluate the significance of variables, determine optimal- vari able inputs (through the response optimizer tool) and optimize Gas production efficiency the number of model runs required to evaluate multiple variables.

Gas production efficiency per reactor (Egas) was calculated with Added statistical analysis was conducted using built-in subroutines

Eq. 1, where Qr is the gas production rate (mL off gas/day), HRTr in Microsoft Excel 2010.

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Results and discussion reactors owing to higher fermentation kinetics relative to metha- Faecal sludge characterization nogenesis kinetics (Metcalf & Eddy, 2003), VFA concentra- The observed high variability of tCOD and TSS in influent tions were actually highest in the influent and steadily decreased loads (Table 1), stable pH of 8.1±0.3 and 7.9±0.2 (Period One across the reactors. Gas production followed a similar trend, with and Two, respectively), and average NH3-N of 2039±1248 and maximal values in the first reactor decreasing to the last- reac

963±1,253 ppm (Period One and Two, respectively) were all tor. % CH4 and % CO2 remained consistent across the reactors. consistent with previous FS characterization studies (Bassan % CH4 averaged 63.5±2.1%, 64.3±2.1%, 63.6±2.0%, 64.2±2.3%, et al., 2013; Cofie et al., 2006; Kengne et al., 2011). Despite the 62.8±1.8% and 63.2±2.0% and % CO2 averaged 24.4±2.6%, high variability of tCOD, average influent VFA remained -rela 24.3±1.8%, 21.9±1.9%, 24.0±1.9%, 23.2±2.5% and 24.3±2.1% in tively low at 1151±839 and 1646±1214 mgCOD/L, and average R1–R6, respectively. H2S (ppm) varied in the reactors, averaging alkalinity was measured as 170±94 and 141±73 mmol/L (Period 2159±474, 2444±299, 2795±442, 2791±305, 3012±460 and One and Two, respectively), which is higher than observed in 2766±354 in R1–R6, respectively. sewage (80 mmol/L, Forster-Carneiro et al., 2010). All of these measured parameters suggest that FS is partially degraded with Given that the reactors in Kumasi, like many anaerobic digesters low acidogenesis and some buffering capacity, which is to be in the developing world, were unmixed, a generally decreasing expected given that the emptying frequency of FS varies from solids distribution across successive reactors was observed in “weeks to years” (Niwagaba et al., 2014). terms of COD, TSS, and VSS concentrations. Elevated concen- trations in R2 may have been caused by conveyance of solids tCOD concentrations in the influent FS were statistically through localized flow paths at the bottom of R1 (Figure 1), while higher (p=0.012) in Period Two (31,354±22,740 mg/L) than in the mid-level connections between R2–R6 encouraged settling in Period One (14,549±10,863 mg/L). Influent total solids (TS) in the reactors. Unmixed systems will inevitably be affected by the Period One averaged 16,255±13,691 (n=16), while in Period hydraulic conditions of the system, which presents a challenge in Two they averaged 25,390±27,695 (n=13). One potential expla- developing general performance guidelines. Accumulated solids nation for the differences in tCOD is that increased precipitation may also eventually decrease the overall working volume of the during Period One may have caused stormwater runoff to enter reactor and should be addressed to improve process efficiency. toilet systems and dilute the FS. Another supposition is that water is more available during the rainy season, and that FS truck Despite the potential impacts to gas production at the pilot facil- operators are more willing to use water to aid in FS extraction ity, solids accumulation was not likely the governing factor. from toilet systems. Although a previous study in Ouagadougou, While a baseline level of gas production may be expected from Burkina Faso, did not find significant differences in FS sampled retained solids, gas production in upstream reactors was still during the dry and rainy seasons (Bassan et al., 2013), tCOD observed to drop down to very low levels, suggesting that retained concentrations in Ouagadougou for latrines and septic tanks solids do not considerably contribute to gas production in a sus- (10725±9508 mg/L) were also on average lower than in Kumasi. tained way. Rather, the fluctuating, yet considerable gas produc- Given that FS is highly variable even within a community or tion in upstream reactors was due to the influent FS loads. The township, it is difficult to discern the exact explanation for the measured performance of this pilot facility represents one of the differences across countries. Any planned FS treatment facility first efforts to document the fermentation and digestion of actual would greatly benefit from local FS characterization. FS loads delivered by , allowing for an accurate consideration of the effect of FS variability. The processing Inoculation and reactor performance modeling analysis presented next offers further insights into the Inoculation and start-up of the pilot reactors occurred over a measured trends in VFA and gas production from the FS treatment total of 131 days. Any rumen addition or increase to the FS load- process. ing rate was followed by weeks of observation to prevent over accumulation of VFA and subsequent inhibition of methano- Process model calibration genesis (Wang et al., 2009). However, throughout this entire Specifically, the following influent substrate fraction (Fbs) and start-up period, VFA averaged 427±305, 318±154, 286±119, and biomass fractions (FZbh, and FZbam) were found to statistically 268±129 mgCOD/L in R1, R2, R4, and R6, respectively (Figure S2). significantly impact (p<0.05) VFA and gas production in all reac- Gas production was highest in the first reactor, averaging tors, while the biomass fraction, FZbhm, significantly impacted 0.070±0.065, 0.043±0.037, 0.029±0.016, and 0.018±0.011 m3/hr for R1-R2 VFA and R1 gas production. Through adjustment in R1, R2, R4, and R6, respectively (Figure S3). Additionally, of these parameters, it was found that Biowin either under- the highest gas production values were not observed until higher simulated VFA in downstream reactors or under-simulated gas FS loading rates. The lack of VFA accumulation in all reactors production in upstream reactors. When increased R1 and R2 and generally limited gas production in downstream reactors reactor volumes were explored to simulate solids accumula- suggest that the inoculation and ramp-up loading could have been tion through increased retention times (thus increasing gas pro- implemented in a shorter time period. duction), both R1 and R2 volumes were found to be significant (p<0.05) for VFA and gas production, with the exception of Similar VFA and gas production trends were also observed gas production in R4. While Minitab’s response optimizer tool during full operation of the reactors. While it was expected that yielded numerous combinations of inputs for successfully simu- VFA concentrations would be maximal in the upstream anaerobic lating VFA and gas production, the ability to control R1 and R2

Page 7 of 16 Table 1. Measured data for Period One and Two. COD, chemical oxygen demand; VFA, volatile fatty acids.

Total COD (mg/L) Total Suspended Solids (mg/L) Volatile Suspended Solids (mg/L) Total VFA (mgCOD/L) Period One Period Two Period One Period Two Period One Period Two Period One Period Two Avg±SD (n) Avg±SD (n) Avg±SD (n) Avg±SD (n) Avg±SD (n) Avg±SD (n) Avg±SD (n) Avg±SD (n) Influent 14549±10863 (16) 31354±22740 (16) 13580±14553 (16) 18044±19463 (14) 11058±11755 (16) 14400±15179 (14) 1151±839 (18) 1646±1214 (21) R1 12749±6879 (16) 23094±23306 (18) 7648±2235 (9) 19723±13610 (13) 5903±1434 (9) 14813±10508 (13) 808±343 (18) 1049±551 (23) R2 15282±8323 (16) 19432±19472 (16) 10626±3756 (9) 19165±11195 (13) 8099±2759 (9) 14853±8258 (13) 733±269 (18) 936±461 (23) R3 R4 10882±9837 (16) 15440±15661 (18) 6869±6112 (9) 12258±7605 (13) 5304±4468 (9) 9331±5587 (13) 542±267 (18) 642±206 (23) R5 R6 6761±6252 (16) 7684±2876 (16) 2340±1494 (9) 7200±7173 (13) 1972±1153 (9) 5592±5204 (13) 514±180 (18) 652±278 (23)

Off Gas Flow Rate (m3/hr) pH Alkalinity (mmol/L) NH3-N (ppm) Period One Period Two Period One Period Two Period One Period Two Period One Period Two Avg±SD (n) Avg±SD (n) Avg±SD (n) Avg±SD (n) Avg±SD (n) Avg±SD (n) Avg±SD (n) Avg±SD (n)

Influent 8.09±0.33 (8) 7.93±0.16 (7) 170±94 (8) 141±73 (7) 2039±1248 (11) 963±1253 (5) Gates OpenResearch2017,1:10Lastupdated:05JUN2018 R1 0.083±0.070 (15) 0.209±0.170 (23) 8.28±0.15 (5) 7.91±0.27 (8) 136±38 (5) 133±85 (8) 1728±774 (8) 1078±931 (6) R2 0.057±0.039 (18) 0.144±0.097 (22) 8.24±0.10 (5) 7.90±0.30 (8) 162±25 (5) 140±59 (8) 1681±579 (8) 1210±963 (6) R3 0.061±0.051 (13) R4 0.023±0.017 (17) 0.046±0.050 (23) 8.21±0.11 (5) 8.00±0.26 (8) 112±32 (5) 121±36 (8) 1310±537 (8) 979±619 (6) R5 0.025±0.011 (13) R6 0.006±0.005 (15) 0.015±0.014 (23) 8.21±0.15 (5) 7.99±0.22 (8) 98±28 (5) 115±34 (8) 1244±575 (8) 915±551 (6) Page 8of16 Gates Open Research 2017, 1:10 Last updated: 05 JUN 2018

volumes resulted in highly heterogeneous options that did not reactions rates were re-evaluated for gas composition, any adjust- provide insight into the distinguishing characteristics of FS or FS ments negatively affected VFA and gas production congruence. fermentation and digestion. Reactors volumes were subsequently Another strategy was to increase the gas-liquid mass transfer left at 10,000 L to explore additional calibration options. coefficient (kL) for CO2 to promote gaseous CO2, but this did

not have detectable effect on % CO2 in the off gas. In order to

When hydrolysis, acidogenesis, acetogenesis, and methanogen- better match the gas composition, the stoichiometric CO2 yield esis reaction rates were adjusted for the system, Biowin con- (moles of CO2 produced per mole of acetate formed) for OHO was tinued to either under-simulate VFA in downstream reactors or ultimately increased. Due to acetoclastic methanogen dominance under-simulate gas production in upstream reactors. The hydroly- over hydrogenotrophic methanogens, a higher amount of acetate sis rate, maximum specific growth rate of OHO, and the maximum may be required in the system, thus increasing the stoichiomet- specific growth rate of acetoclastic methanogens significantly ric yield above the Biowin default. It was found that an increase affected VFA and gas production, while the maximum specific from the default 0.7 to 1.2 moles CO2/moles acetate successfully growth rate for acetogens and the maximum specific growth brought the simulated % CH4 and % CO2 in range with measured rate for hydrogenotrophic methanogens (for gas production in values. R4 and R6) were not significant (p>0.05). While separate rate adjustments for R1–R2 allowed for increased congruence of Final model configuration and performance simulated and observed VFA and gas production, reactions rates The calibrated model ultimately focused on the following were ultimately left as global values for the entire system due influent parameters (all expressed as g COD/ g total COD): Fbs to the lack of sufficient justification for rate differences among (0.09), Fus (0.09), Fup (0.47), FZbh (0.05), and FZbam (0.015). reactors. The acetoclastic methanogen maximum specific growth rate

(0.1/day) and stoichiometric CO2 yield for OHO (1.2 moles The solids distribution in the system was addressed by pairing CO2/moles acetate) were also adjusted from default values. Point the reactors with point clarifiers, which allowed for direct control clarifiers were implemented on R2–R6 with 25% solids removal of the solids concentration in each reactor. Given that Biowin’s and underflow ratios of 0.2, 0.35, 0.5, 0.625 and 0.75 for R2–R6, anaerobic digester modules are complete-mix reactors, simu- respectively. lated tCOD concentrations were initially high in downstream reactors. Point clarifiers were added to R2, R4 and R6, and Fbs was decreased from 0.27 to 0.09 g COD/ g total COD due additional point clarifiers were eventually added to R3 and R5 in to prior fermentation and digestion within the toilet systems. the final model configurationFigure ( 3). Accordingly, Fus and Fup were increased from 0.08 to 0.09 and 0.08 to 0.47 g COD/ g total COD, respectively, to represent When the un-adjusted microbial population ratios were explored higher concentrations of remaining unbiodegradable content. for R4 and R6, it was found that the concentration of OHO FZbh were increased from 0.01 to 0.05 OHO COD/total COD and were roughly 2–3 times the amount of acetoclastic methano- FZbam (acetoclastic methanogens) from 0.0001 to 0.015 aceto- gens, which were in-turn roughly 3 times the amount of hydrog- clastic methanogen COD/total COD to reflect the high micro- enotrophic methanogens. Hydrogenotrophic methanogens were bial concentrations inherent in FS, as demonstrated by maximal found to be 10–20 times the amount of acetogens. Once the influ- gas production in upstream reactors. While the influent concen- ent concentrations of these microbial groups along with COD trations of acetogens and hydrogenotrophic methanogen con- fractionation values and reaction rates were considered together, centrations were adjusted in previous stages, due to their minor congruence of VFA and gas production was obtained without effects on VFA and gas production, they remained as default adjusting local rate parameters. The best configuration from this values. The acetoclastic methanogenesis maximum specific phase retained default values for the hydrolysis rate (2.1 day-1), growth rate was decreased from 0.3 to 0.1 day-1 due to the fermentation rate (1.6 day-1) and hydrogenotrophic methano- background methanogen population in the reactors, as well as genesis rate (1.4 day-1), and largely focused on adjusting FZbh, potential ammonia inhibition of methanogenesis (Yenigün & FZbam and the acetoclastic methanogenesis rate. Demirel, 2013).

The final model consideration was the % CH4 and % CO2 in the Figure 4 and Figure 5 demonstrate congruence between simu- off gas, which Biowin was initially over-simulating and under- lated and observed output for VFA and gas production. The other simulating, respectively. While COD fractionation values and parameters are documented in Figure S4–Figure S9. Table S1

Figure 3. Final model configuration.

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Figure 4. Total VFA, simulated and observed.

Figure 5. Off gas flow rate, simulated and observed.

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documents the root mean square error and Nash-Sutcliffe coef- had roughly 15% more gas production after 14 days (140 vs ficient for all parameters per reactor. While the Nash-Sutcliffe 122 mL off gas/g tCOD loaded). The 75th percentile of cumula- coefficients were close to 0 for TSS, VSS, tCOD (Reactors 1, tive gas production for Period One and Two were obtained in 14 2, 4) and gas production (Reactors 1, 2, 4), the VFA coefficient of 22 days and 9 of 14 days respectively (Figure 6). These effi- ranged from -2 to -6. Given the variability in COD loading, ciencies were in range with a biomethane potential study in China, Biowin simulated equivalent peaks in VFA, causing a higher which found that FS produced 87 ml gas/g FS at 30°C (Song et al., residual variance than the observed data variance. While these 2011). Period Two had a 1.23 tCOD/TS ratio, resulting in roughly values demonstrate that the model does not perfectly simulate all 172 mL off gas/ g dry FS after 14 days. However, given the vari- observed values, the model calibration process still resulted in ability of FS beyond tCOD or TS, it is expected that biometh- overall congruity and allows for an evaluation of VFA and gas ane potential studies would also yield variable results. When production potential. comparing with sewage sludge, one study in Sweden reported 271 m3/ton VS loaded (271 mL/g VS), which at 76% VS/TS, is Given the antecedent retention time in public toilet systems 206 mL/g dry sewage sludge (Davidsson et al., 2008). While it is and subsequent methanogen population in FS, average influent difficult to directly juxtapose these two waste streams -consider VFA concentrations were less than 2,000 mg COD/L. Addition- ing the variability in each, the gas production efficiency of FS is ally, any further fermentation/digestion was shown to decrease comparable and has sufficient potential for further consideration. VFA concentrations in the reactors. While these concentrations are lower in comparison to the potential of other feedstocks This study presents one of the first calibrated FS fermenta- (Chang et al., 2010), VFA can be harvested directly from FS tion and digestion process models. By exploring characteriza- without additional fermentation. Finally, given the variability of tion of FS beyond tCOD and investigating reactor performance toilet systems, there is potential for producing higher concen- beyond conventional process indicators (pH, alkalinity, gas pro- trations of VFA from less stabilized sources, such as toilet duction, etc.), a more detailed and complete understanding is systems that are emptied more frequently or toilet systems with formed. FS, though often guided by wastewater or sewage sludge lower water content and higher organic concentrations. literature, is a very different feedstock. FS composition is highly variable, contains limited readily biodegradable COD due to Gas production efficiency (mL off gas/g tCOD loaded) was prior degradation, and also harbors considerable OHO and calculated to be maximal in R1 and subsequently decreasing methanogen concentrations. These singular characteristics have through R6 for both Period One and Two. In addition, gas pro- far-reaching implications for FS treatment design, which cur- duction efficiency in Period Two (14.0±2.0, 10.9±1.2, 10.4±1.4, rently (erroneously) still relies on typical guidelines such as 20 9.6±1.5, 8.5±1.6, and 7.3±1.7 mL off gas/g tCOD loaded in day SRT for anaerobic processes at 30°C (Metcalf & Eddy, 2003). R1–R6, respectively) was significantly higher in all reactors than Non-idealities such as settling also need to be considered for efficiency in Period One (11.2±2.7, 8.5±1.6, 7.6±1.5, 6.5±1.5, FS treatment process optimization, especially for highly concen- 5.6±1.5, and 4.6±1.5 mL off gas/g tCOD loaded in R1–R6, respec- trated FS. In order to effectively plan and evaluate these systems, tively). Period Two, which had more consistent loading volumes, all of these factors must be examined on a case by case basis.

Figure 6. Cumulative gas production per COD loaded. COD, chemical oxygen demand; HRT, hydraulic retention time.

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Conclusions FS streams, as well as additional recovery of even higher-value This work documents the start-up and operation of a pilot scale resource outputs. FS anaerobic fermentation and digestion system that processed FS from vacuum trucks in Kumasi, Ghana over a five month Data availability period. By utilizing measured field data from the pilot plant, Monitoring data during start-up and full operation are available this work details one of the first systematic efforts at integrated on OSF: http://doi.org/10.17605/OSF.IO/WGRDX (Chandran, FS characterization and process modeling to enable anaerobic 2017). Data are available under the terms of the Creative Commons fermentation and digestion of FS. In addition to recording con- Zero “No rights reserved” data waiver (CC0 1.0 Public domain ventional process parameters for FS characterization, COD dedication). fractionation and existing microbial concentrations were also explored. In sum, it is shown that owing to pre-fermentation and digestion of FS in toilet systems, maximal VFA and gas produc- Competing interests tion are expected at SRT values less than five days. While treat- No competing interests were disclosed. ment modules such as biogas settlers are effective at maximizing gas production per COD load due to extended SRT (months or Grant information years) until desludging, these modules eventually become accu- Bill and Melinda Gates Foundation [OPP1019896]. mulated with digested sludge with lower gas production efficiency. There is potential for smaller digester units with lower SRT (for Acknowledgments gas production) to be paired with a subsequent treatment step for Support from the overall project team and the Kumasi Metropoli- potentially more cost effective hygienization, such as drying beds tan Assembly and Waste Enterprisers is gratefully acknowledged. or infiltration based methods. This calibrated FS process model, This work was presented at the 3rd International Faecal Sludge along with the documented calibration approach, allows for future Management Conference on January 20, 2015 (presentation research into the expansion of biogas production from varying available at https://osf.io/nym3z/).

Supplementary material Supplementary File 1: File containing Table S1 (Statistical model evaluation); Figure S1 (Influent loading volumes); Figure S2 (Total volatile fatty acids, inoculation and ramp-up); Figure S3 (Off-gas flow rate, inoculation and ramp-up); Figure S4 (Total chemical oxygen demand, simulated and observed); Figure S5 (Total suspended solids, simulated and observed); Figure S6 (Volatile suspended solids, simu- lated and observed); Figure S7 (% CH4 and % CO2, simulated and observed); Figure S8 (pH, simulated and observed); Figure S9 (Alkalinity, simulated and observed). Click here to access the data.

References

Astals S, Venegas C, Peces M, et al.: Balancing hygienization and anaerobic Chang HN, Kim NJ, Kang J, et al.: Biomass-derived volatile fatty acid platform digestion of raw sewage sludge. Water Res. 2012; 46(19): 6218–6227. for fuels and chemicals. Biotechnol Bioprocess Eng. 2010; 15(1): 1–10. PubMed Abstract | Publisher Full Text Publisher Full Text Bassan M, Tchonda T, Yiougo L, et al.: Characterization of faecal sludge during Cofie OO, Agbottah S, Strauss M,et al.: Solid-liquid separation of faecal sludge dry and rainy seasons in Ouagadougou, Burkina Faso. Presented at the using drying beds in Ghana: Implications for nutrient recycling in urban 36th WEDC International Conference, Delivering Water, Sanitation And Hygiene agriculture. Water Res. 2006; 40(1): 75–82. Services. In An Uncertain Environment, Nakuru, Kenya, 2013. PubMed Abstract | Publisher Full Text Reference Source Dangol B, Hooijmans CM, Lopez-Vazquez CM, et al.: Assessing the feasibility of Bensah EC, Brew-Hammond A: Biogas technology dissemination in Ghana: faecal sludge cotreatment in a plant. 2013. history, current status, future prospects, and policy significance. Int J Energy Davidsson A, Lövstedt C, la Cour Jansen JI, et al.: Co-digestion of grease trap Environ. 2010; 1(2): 277–294. sludge and sewage sludge. Waste Manag. 2008; 28(6): 986–992. Reference Source PubMed Abstract | Publisher Full Text Chandran K: Technologies and Framework for Resource Recovery and Diener S, Semiyaga S, Niwagaba CB, et al.: A value proposition: Resource Beneficiation from Human Waste. In: Water Reclamation and Sustainability. recovery from faecal sludge—Can it be the driver for improved sanitation? Elsevier, San Diego, CA, 2014; 415–430. Resour Conserv Recycl. 2014; 88: 32–38. Publisher Full Text Publisher Full Text Chandran K: “Implementation and Process Analysis of Pilot Scale Multi-Phase Forster-Carneiro T, Riau V, Pérez M: Mesophilic anaerobic digestion of sewage Anaerobic Fermentation and Digestion of Faecal Sludge in Ghana.” Open sludge to obtain class B biosolids: Microbiological methods development. Science Framework. 2017. Biomass Bioenergy. 2010; 34(12): 1805–1812. Data Source Publisher Full Text

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Ghana Statistical Service: Population and Housing Census Summary Report of Murray A, Buckley C: Designing reuse-oriented sanitation infrastructure: the design Final Results 2010. 2012. for service planning approach. Wastewater Irrig. 2010; 303. Reference Source Reference Source Hu ZH, Yu HQ: Application of rumen microorganisms for enhanced anaerobic Niwagaba CB, Mbéguéré M, Strande L: Faecal Sludge Quantification, fermentation of corn stover. Process Biochem. 2005; 40(7): 2371–2377. Characterisation and Treatment Objectives. Faecal Sludge Manag Syst Approach Publisher Full Text Implement Oper. 2014; 19. Kengne IM, Kengne ES, Akoa A, et al.: Vertical-flow constructed wetlands as an Reference Source emerging solution for faecal sludge dewatering in developing countries. Song YC, Kwon SJ, Woo JH: Mesophilic and thermophilic temperature co-phase J Water Sanit Hyg Dev. 2011; 1(1): 13–19. anaerobic digestion compared with single-stage mesophilic- and thermophilic Publisher Full Text digestion of sewage sludge. Water Res. 2004; 38(7): 1653–1662. Koottatep T, Surinkul, N, Polprasert C, et al.: Treatment of septage in constructed PubMed Abstract | Publisher Full Text wetlands in tropical climate: lessons learnt from seven years of operation. Song ZL, Qin JJ, Yang GH, et al.: Effect of Human Excreta Mixture on Biogas Water Sci Technol. 2005; 51(9): 119–126. Production. Adv Mater Res. 2011; 347–353: 2570–2575. PubMed Abstract Publisher Full Text Kuffour AR, Awuah E, Sarpong D, et al.: Effects of Different Solid Loading Rates Strauss M, Larmie S, Heinss U: Treatment of sludges from on-site sanitation of Faecal Sludge on the Dewatering Performance of Unplanted Filter Bed. — Low-cost options. Water Sci Technol. 1997; 35(6): 129–136. Civ Environ Res. 2013; 3(4): 39–48. Publisher Full Text Reference Source Lopes W, Leite VD, Prasad S: Influence of inoculum on performance of anaerobic USEPA: Biosolids Technology Fact Sheet Multi-Stage Anaerobic Digestion (No. reactors for treating municipal solid waste. Bioresour Technol. 2004; 94(3): 261–266. EPA 832-F-06-031). Office of Water, USEPA, 2006. PubMed Abstract | Publisher Full Text Reference Source Lopez-Vazquez CM, Dangol B, Hooijmans CM, et al.: Co-treatment of Faecal Wang Y, Zhang Y, Wang J, et al.: Effects of volatile fatty acid concentrations on Sludge in Municipal Wastewater Treatment Plants. In: Faecal Sludge Management: methane yield and methanogenic bacteria. Biomass Bioenergy. 2009; 33(5): Systems Approach for Implementation and Operation. 2014. 848–853. Reference Source Publisher Full Text Metcalf, Eddy: Wastewater engineering: treatment and reuse. 4th ed. ed, McGraw- Yenigün O, Demirel B: Ammonia inhibition in anaerobic digestion: A review. Hill series in civil and environmental engineering. McGraw-Hill, Boston, 2003. Process Biochem. 2013; 48(5–6): 901–911. Reference Source Publisher Full Text

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May 2015

Prepared for the Sanitation Research Fund for Africa (SRFA) Project of the Water Research Commission and the Bill and Melinda Gates Foundation

WRC Report No. KV 340/15 ISBN 978-1-4312-0685-8 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

DISCLAIMER This report was compiled from country reports submitted by research teams involved in the Sanitation Research Fund for Africa (SRFA) Project. This report has been reviewed by the Water Research Commission (WRC) and approved for publication. Approval does not signify that the contents necessarily reflect the views and policies of the WRC nor does mention of trade names or commercial products constitute endorsement or recommendation for use. Further, the WRC, Bill and Melinda Gates Foundation and the service provider take no responsibility for any inaccuracies or undisclosed sources from these country reports.

© Water Research Commission

191 Anderson Street Northcliff 2195 Tel: 27 (0) 11 476 5915 Fax: 0866498600 Cell number: 27 (0)834606832 E-mail: [email protected]

The publication of this report emanates from a project entitled The Status of Faecal Sludge Management in Eight Southern and East African Countries (WRC Report No. K8/1100/11)

WRC Report No. KV 340/15 ISBN 978-1-4312-0685-8

01 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

Executive Summary

Background Sub-Saharan Africa still lags behind in achieving the Millennium Development Goals for sanitation. In 2012, 644 million people in sub-Saharan Africa, that is 70% of the population, used an unimproved toilet facility or resorted to open defecation (WHO/UNICEF, 2014). The percentage for open defecation has dropped by 11% in the period 1990-2012, but the number of people defecating in the open is still increasing in 26 of 44 countries in sub-Saharan Africa. The statistics of projected growth in population and the rate of urbanisation mean that sub-Saharan cities have an ever increasing population to serve with water and sanitation. As most of the urban poor rely on on- site sanitation, these statistics present a growing challenge for faecal sludge management. Reported daily collections of faecal sludge show that only a fraction of the estimated volume of faecal sludge to be collected and disposed of daily reaches safe disposal sites. The rest is either used in agriculture or aquaculture or discharged indiscriminately into lanes, drainage ditches, inland waters, estuaries and the sea, or onto open urban spaces, posing a serious health risk. Managing faecal sludge that reaches safe or legal treatment or disposal sites has its own challenges. Research from around the world indicates that faecal sludge varies widely in physico-chemical characteristics, even within the same city, making management of this waste stream more challenging than wastewater. Despite the seriousness of the health risk, the management of faecal sludge from on-site sanitation systems does not get the attention it deserves. Development goals focus primarily on providing sanitation facilities and often overlook the need for cost-effective processes to collect, transport, treat and re-use the faecal sludge that accumulates in them, and the operation and maintenance needed to keep the toilets in an acceptable condition. The Water Research Commission of South Africa has commissioned several projects over the years to solve challenges along the faecal sludge value chain, but further research on faecal sludge management is still urgently needed. For example, there is a general lack of scientific knowledge of how pit toilets work and how fast they fill up. Most disposal and treatment solutions are still in pilot or testing stage, making it difficult for local authorities and private pit emptying service providers to make informed decisions. Moreover, there is a general lack of reliable information in sub-Saharan Africa on the actual numbers of each of the different types of toilets or toilet practices out there and the condition in which they are in.

The Sanitation Research Fund for Africa (SRFA) Project

In 2012, the Water Research Commission, together with the Bill and Melinda Gates Foundation, took a strategic decision to develop capacity in Africa to deal with faecal sludge management. This initiative, known as the Sanitation Research Fund for Africa (SRFA) Project, provides an exclusive research and development grant of up to US$200 000 to African institutions and organisations. 12 African institutions and organisations from eight Southern and East African countries were awarded research grants: a. East Africa: Kenya, Ethiopia and Malawi (2 research teams) b. : Uganda (2 research teams) c. Southern Africa: , South Africa (3 research teams), Zimbabwe and Zambia

02 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

The Project comprises two focus areas: a. The physical and chemical processes occurring in “dry” pit toilets and their contribution to the physico-chemical characteristics of faecal sludge, the level of pathogens and pit filling rates. b. Technology for desludging, transporting, treating and disposing of faecal sludge, which would benefit people and the environment. The first task of the research teams was to research the baseline conditions of faecal sludge management in their respective countries. This report presents a consolidated review of their findings, which cover the sanitation policy environment and faecal sludge management practices in these eight Southern and East African countries.

Summary of findings

General state of sanitation The challenges that these countries experience with faecal sludge management in urban and peri-urban areas are similar, but the general state of sanitation differs considerably as figures from the latest WHO/UNICEF report (2014) indicate. Substantial progress has been made in access to sanitation since 1990; yet only South Africa and Botswana serve more than 50% of the population with an improved sanitation facility. The figures for toilet facilities are based on infrastructure projects; they give no indication in what condition these toilets are or how the wastewater and faecal sludge that they collect are managed.

The enabling framework Since the 1970s, sanitation programmes focussed mainly on infrastructure development to eradicate open defecation and bucket latrines. (See details of South Africa's bucket eradication programme in the sub- sections on South Africa.) Sanitation legislation, policy and strategy reflect this drive for infrastructure development. What would happen when the pits were full, were not a concern at the time. As a result, faecal sludge management is largely absent in policy and legislation as the country profiles in the report will illustrate. The responsibility for sanitation is vested in a range of government ministries and agencies. In most of the countries studied, these ministries include the Departments of Water Affairs, Environmental Affairs, Local government, Health and Education.1 In most of the countries, institutional arrangements are complex and fragmented. The structure of local authorities and the delineation between urban and rural jurisdiction vary considerably between the eight countries. In the majority of the countries, implementation is the responsibility of the local authority. Limited capacity, inadequate by-laws and enforcement, action plans and budgets hamper effective faecal sludge management. In some countries, the distinction between urban and rural sanitation has turned peri-urban sanitation into a no-man's land in terms of policy and legislation - see the Zimbabwe profile. There are exceptions: in an attempt to consolidate the sector, Botswana, for example, rationalised water and sanitation services under a single state-owned utility in 2009. National budgets allocate significantly more to water than to sanitation. To meet the Millennium Development Goal for sanitation, sub-Saharan Africa needs to invest an estimated 0.6 percent of its gross domestic product (GDP) annually on sanitation. Five of the eight countries (Ethiopia, Kenya, Malawi, Zambia and Zimbabwe) spent less than 0.6%, according to an AICD DH/MICS Survey Database of 2007 (Morella et al., 2008).

03 1Each country has its own name for these Ministries. THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

The focus of these limited budgets is on the provision of sanitation facilities, and less on operation and maintenance. As a result, local authorities do not have enough budgeted funds for faecal sludge management. Water and sanitation made up an average of 6.48% of donor spending in Africa in 20122 . Donor funding and other aid to sanitation goes mainly to infrastructure development and health and hygiene education. 80% of aid flows in the water sector were extended in the form of projects (mainly investment projects). Projects for large systems are still predominant and accounted for 41% of total contributions to the water and sanitation sector in 2010-11.

Faecal sludge management in practice Many issues regarding faecal sludge management have not been resolved yet; as a result there are no common standards and best practices for on-site sanitation:

Pit latrines Pit latrines are by far the most common on-site facility in informal urban and peri-urban settlements and rural areas. Only three of the eight countries developed a minimum standard for a sanitation facility: Botswana (the double vaulted VIP latrine), South Africa (the VIP latrine) and Zimbabwe (the Blair VIP latrine). In Botswana, South Africa and Zimbabwe, there has been large infrastructure programmes to supply sanitation that meets the basic standard. The wide variety of pit latrine technologies and sludge characteristics in the countries studied makes management of these systems difficult. For example, many pit toilets that the research teams encountered had no slab covering to access the sludge, unlike in South Africa where it is a requirement. It is commonly acknowledged that pit latrines could contaminate groundwater in certain circumstances. Yet, the literature gives disparate guidelines on the safe distance between a pit latrine and a water source. Alternative improved options, such as the pour flush, urine-diverting toilet and other eco-sanitation types have been mainly confined to small-scale donor-funded projects. An exception is the eThekwini dehydration toilet (UDDT) project. Several research reports mention that the social acceptability of handling and re-using dried or treated faecal sludge or urine on-site remains a challenge.

Operation and maintenance Pit latrines, even if it is a VIP that is not full yet, continue to be an unpleasant solution due to odour, flies and safety. In practice, eco-san alternatives such as UDDT do not seem to resolve the issue of odour and flies. The literature on faecal sludge management abounds with pictures of dirty and blocked toilets, but it does not indicate to what extent this problem is an engineering problem or an operation and maintenance problem. When users do not clean up their own urine and faeces spills on the seat and the floor, or faeces sticking to the inside of the bowl, someone has to clean up behind them. If no-one takes this responsibility, and disinfectant and cleaning materials are unaffordable or absent, any toilet, whether waterborne or a pit latrine, will smell and become unhygienic to use. In cities such as Kampala, Uganda, where most pit latrines are communal or shared among households, the problem is exacerbated. All over the world, from households to public spaces, thousands and thousands, probably millions of cleaners, mostly women, have to clean toilets after they have been used. Nowhere in the literature have we seen this problem, which is also a gender one, being addressed directly. The country reports do not make a link between open defecation and dysfunctional or unhygienic toilets. It is likely that open defecation will continue to be practised in Africa as long as there are toilets that are dysfunctional or unhygienic.

2http://webnet.oecd.org/dcdgraphs/CPA_recipient/ 04 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

Also, the reports emphasise that all aspects of the sanitation value chain are affected if solid waste is indiscriminately disposed of into toilets. If solid waste is not regularly removed from peri-urban and urban settlements, some of it end up in toilets.

Full pits The rate at which pits fill up in a particular country is a function of many variables, such as pit size, soil quality, groundwater level, the number of people who share the latrine, anal cleansing practices and solid waste dumped into the pit. It is therefore difficult to plan a pit-emptying programme that would fit all scenarios. Emptying on demand seems to be the common approach. Full pits are either emptied or replaced. Where there is space available and soil conditions are favourable, the common practice is to replace the pit.

Sludge removal Sludge removal technologies are either mechanised or manual, or mixed. Vacuum trucks are the most common mechanised pit-emptying technology. In many low income areas, the plots or the top structures of latrines are not accessible to vacuum trucks and these residents have no choice but to resort to manual removal. In some instances, faecal sludge can only be accessed by removing the toilet or other structural components. Also, vacuum trucks struggle to deal with thick sludge and solid waste found in the pits. Mechanised pit emptying is expensive and low income residents can't afford vacuum trucks, unless the service is subsidised by the local authority, which the local authority, in turn, cannot sustain. Innovative pit emptying technologies seldom survive the pilot stage due to a lack of institutional support, maintenance issues such as a spare part that has to be imported or inadequate fees to cover costs. Manual emptying is still common in areas where people cannot afford the mechanised service or where the mechanised service has broken down or cannot access the pit. While there seems to be no lack of manual pit emptying entrepreneurs, they lack business skills and the financing to add some mechanised support to their operations. See the eThekwini project in the South Africa profile for an example of a large-scale manual emptying programme. Also, most mechanised options for manual operators have not scaled up beyond the pilot phase as a result of unforeseen mechanical problems or costs. The work conditions of manual emptiers are unpleasant and unsafe, because occupational health and safety measures are mostly absent.

Sludge disposal, treatment and re-use Inadequate treatment and re-use of faecal sludge seems to be a common problem of most urban local authorities. The country reports mention lack of institutional support, funds and skills. Most city wastewater treatment plants receive faecal sludge where it is co-treated with wastewater. Shock loads are a risk, but in some African cities, the wastewater treatment plants are dysfunctional irrespective of whether they receive faecal sludge or not. The effect of large quantities of faecal sludge on activated sludge plants still has to be studied further. Various new technologies to treat faecal sludge, such as deep row entrenchment, are being introduced, but there is no single solution yet. In some countries, treatment plants in the major cities are being upgraded to make provision for faecal sludge. For example, the city of Kampala is currently building two faecal sludge treatment plants with a capacity of 200 m³/day each, one at Lubigi and another one at Nalukolongo. A donor-funded project, FaME, will be piloting the use of faecal sludge to fuel brick kilns at the Lubigi plant in Kampala. In the absence of proper regulation and law enforcement, manual emptiers tend to dump their sludge loads as fast as possible and where it is the most convenient, creating a hazard to the environment. So far, there has not been much success with the on-site treatment and re-use of faecal sludge in the eight countries studied. Eco-san facilities, such as the urine diversion dehydration toilets (UDDTs) and , have had slow uptake for various reasons. Residents don't like to handle faecal sludge or they don't perceive these toilets as an improved sanitation facility, because they still have a smell nuisance.

05 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

The commercial re-use of faecal sludge takes place on a small scale, but there are some successful and innovative pilots, for example the biogas projects of the Umande Trust in Nairobi and the Dream Team in Zambia.

Considerations for the future Faecal sludge is a valuable resource that is still largely unexplored. It is evident that challenges and the areas to be addressed listed above call for an integrated management solution that can turn faecal sludge from waste to resource on a large scale. It is essential that the sanitation managers of local authorities and utilities meet regularly at a sub-Saharan forum to share success stories and lessons learnt. It is also essential that the required budgets, skills and technology are harnessed to solve the faecal sludge problem of African cities effectively. Possible focus areas:  WASH campaigns that include educating children and adults (males and females) to be responsible and hygienic toilet users and cleaners.  Solid waste removal services to informal settlements. Privatising re-cycling services might work.  A cost effective and safe alternative for the pit to solve the problems with pit-emptying and potential groundwater contamination.  Research and development of financially viable and scalable solutions for the treatment and re-use of faecal sludge. The cost-benefit calculation must reverse the money flow, i.e. owners or collectors in money or by-products for faecal sludge.  Supportive policy and legislation, and micro financing for the private sector to invest in these solutions.

06 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

Table of Contents

Executive summary 2 Table of Contents 7 List of Tables 10 List of Figures 10 Acknowledgements 11 1. Introduction 12 1.1 The challenge of feacal sludge management in sub-Saharan Africa 12 1.2 The Water Research Commission (WRC) of South Africa 13 1.3 The Sanitation Research Fund for Africa (SRFA) Project 14 1.4 The scope of this report 16 2. Methodology 17 3. Definitions 19 3.1 Feacal sludge management 19 3.1.1 Feacal sludge 19 3.1.2 Feacal sludge as a health hazard 19 3.1.3 Feacal sludge management 19 3.1.4 Collection and discharge 20 3.1.5 Treatment and re-use 20 3.2 The sanitation ladder 21 3.3 On-site sanitation 21 3.3.1 On-site sanitation facilities 21 3.3.2 Unimproved on-site facilities 22 3.3.3 Improved on-site facilities 22 4. The socio-economic context 25 4.1 Overview 25 4.2 Donor aid for sanitation 26 5. The sanitation policy environment 28 5.1 Botswana 28 5.1.1 Brief history of sanitation development 28 5.1.2 Policy and legislation 29 5.1.3 Institutional arrangements 30 5.2 Ethiopia 31 5.3 Kenya 32 5.3.1 Policy and legislation 32 5.3.2 Institutional arrangements 32

07 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

5.4 Malawi 33 5.4.1 Policy and legislation 33 5.4.2 Institutional arrangements 33 5.5 South Africa 35 5.5.1 Policy and legislation 35 5.5.2 Institutional arrangements 36 5.6 Uganda 37 5.7 Zambia 39 5.7.1 Policy and legislation 39 5.7.2 Institutional arrangements 40 5.8 Zimbabwe 41 5.8.1 Policy and legislation 41 5.8.2 Institutional arrangements 42 6. Dashboard of progress in sanitation 43 6.1 In sub-Saharan Africa from 1990 to 2012 43 6.2 In eight Southern and East African countries 44 7. Country profiles 46 7.1 Botswana 47 7.1.1 Main issues 47 7.1.2 Types of on-site facilities 47 7.1.3 Faecal sludge management practices 47 7.2 Ethiopia 48 7.2.1 Main issues 48 7.2.2 Types of on-site facilities 48 7.2.3 Faecal sludge management practices 48 7.3 Kenya 49 7.3.1 Main issues 49 7.3.2 Types of on-site sanitation 49 7.3.3 Faecal sludge collection and disposal practices 49 7.3.4 Treatment and re-use practices 50 7.4 Malawi 52 7.4.1 Main issues 52 7.4.2 Types of on-site sanitation 52 7.4.3 Faecal sludge management practices 52 7.5 South Africa 54 7.5.1 Main issues 54 7.5.2 Types of on-site sanitation 54

08 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

7.5.3 Faecal sludge management practices 54 7.5.4 eThekwini Metro 57 7.6 Uganda 59 7.6.1 Main issues 59 7.6.2 Types of on-site sanitation 59 7.6.3 Faecal sludge management practices 60 7.6.4 Treatment and re-use 61 7.7 Zambia 62 7.7.1 Main issues 62 7.7.2 Types of on-site sanitation 62 7.7.3 Faecal sludge management practices 62 7.8 Zimbabwe 63 7.8.1 Main issues 63 7.8.2 Types of on-site sanitation 64 7.8.3 Faecal sludge management practices 64 8. Conclusions 65 8.1 Policy and legislation 65 8.2 Responsibilities, capacity and funding 65 8.3 Standards for on-site sanitation facilities 66 8.4 The sanitation value chain 67 8.4.1 Full pits 67 8.4.2 On-site disposal 67 8.4.3 Pit-emptying and transportation 67 8.4.4 Treatment, disposal and re-use 68 9. References 70

09 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

List of Tables

Table 1: Overview of economic and political indicators in eight Southern and East African countries 25 Table 2: Institutional roles and relationships in water and sanitation in Kenya 32 Table 3: Legislation on public health, environmental protection and occupation safety in Malawi 33 Table 4: Major policies and legislation that relate to sanitation in Uganda 37 Table 5: Milestones in the water and sanitation sector in Zimbabwe 41 Table 6: Sanitation in eight Southern and East African countries 44

List of Figures

Figure 1: Some of WRC research reports on faecal sludge management 13 Figure 2: The eight Southern and East African countries that received SRFA grants 14 Figure 3: Some of the technologies being piloted in the SRFA Project 15 Figure 4: The sanitation ladder 21 Figure 5: The BOTVIP and the South African VIP 23 Figure 6: Breakdown of aid to water and sanitation projects 26 Figure 7: Progress in sanitation in sub-Saharan Africa 43 Figure 8: The general state of sanitation in the 8 participating countries 45 Figure 9: Research team from Ethiopia sampling a pit toilet 46 Figure 10: Overview of available treatments and disposal methods of faecal sludge in South Africa 55 Figure 11: Dewatering technologies employed in South Africa (dry mass % as base) 56 Figure 12: Tertiary treatment and additional stabilisation technologies employed in South Africa (dry mass % as base) 56 Figure 13: The sanitation value chain 65 Figure 14: Unsafe faecal sludge disposal in Dakar (2012) 66

10 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

Acknowledgements

The Bill and Melinda Gates Foundation is acknowledged for its grant to the Sanitation Research Fund for Africa (SRFA) Project, from which the information in this document is sourced.

The research teams involved in the SRFA Project are also acknowledged:

University of Malawi The Polytechnic

11 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

1. Introduction

1.1 The challenge of faecal sludge management in sub- Saharan Africa

Sub-Saharan Africa still lags behind in achieving the Millennium Development Goals for sanitation. In 2012, 644 million people in sub-Saharan Africa, that is 70% of the population, used an unimproved toilet facility or resorted to open defecation (WHO/UNICEF, 2014). On-site sanitation systems, such as septic tanks, pit latrines of different types and bucket latrines, prevail in both rural and urban areas in sub-Saharan Africa. In fact, in most cities in developing countries, on-site sanitation facilities make up the majority of toilet facilities, because off-site (sewered) sanitation is not feasible or affordable (Koné & Strauss, 2004). Reported daily collections of faecal sludge show that only a fraction of the estimated volume of faecal sludge to be collected and disposed of daily reaches safe disposal sites (Koné & Strauss, 2004). The rest is either used in agriculture or aquaculture or discharged indiscriminately into lanes, drainage ditches, inland waters, estuaries and the sea, or onto open urban spaces, posing a serious health risk (Klingel et al., 2002). The causes for the unrecorded and clandestine disposal of faecal sludge are multiple: long haulage distances to treatment sites, non-affordability, the difficulty for mechanical and manual pit emptying services to gain access to toilets in densely-populated areas and the dumping of solid waste into toilets (Ingallinella et al., 2002; Ahmed & Rahman, 2003; Koné & Strauss, 2004; Koottatep et al., 2012; Bakare, 2014). Managing faecal sludge that reaches safe or legal treatment or disposal sites has its own challenges. Research from around the world indicates that faecal sludge varies widely in physico-chemical characteristics, even within the same city, making management of this waste stream more challenging than wastewater (Ingallinella et al., 2002; Ahmed & Rahman, 2003; Koottatep et al., 2012; Bakare, 2014). Given the high volumes of sludge produced, and the large number of on-site sanitation technologies, one would expect most developing countries to have faecal sludge management policies and legislation in place. However, this is not the case. Most African countries do not have guidelines for the management of faecal sludge from on-site sanitation systems, except for the guiding documents developed by the Department of Water and Sanitation in Developing Countries (Sandec) at the Swiss Federal Institute of Aquatic Science and Technology (Eawag) (Klingel et al., 2002). Research on faecal sludge management is still scant. For example, there is a general lack of scientific knowledge of how pit toilets work and how fast they fill up. Most disposal and treatment solutions are still in pilot or testing stage, making it difficult for local authorities and private pit emptying service providers to make informed decisions. Moreover, there is a general lack of reliable information in sub-Saharan Africa on the actual numbers of each of the different types of toilets or toilet practices out there and the condition in which they are.

12 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

1.2 The Water Research Commission (WRC) of South Africa The WRC, the primary water and wastewater research funding organisation in South Africa, has commissioned several projects over the years to solve challenges along the faecal sludge value chain. In the early 2000s, as a result of the rapid upscaling of dry sanitation technologies in South Africa, the eThekwini Municipality, with the city of Durban at its core, was confronted with the challenge of emptying thousands of pit latrines. The municipality required critical know-how in faecal sludge management. It was evident to the WRC that research and development on faecal sludge management was urgent and of strategic importance. The organisation therefore decided to fund a series of research and development projects to support municipalities with this task. The research funded by the WRC investigated faecal sludge management with reference to ventilated improved pit latrines (VIPs), the South African basic level of improved sanitation. A series of three volumes was produced: 1. Understanding sludge accumulation in VIPs and strategies for emptying full pits (Still and Foxon, 2012); 2. A scientific understanding of sludge build up and accumulation in pit latrines (Still and Foxon, 2012); and 3. The development of pit emptying technologies (Still and O’Riordan, 2012).

Figure 1. Some of the WRC research reports on faecal sludge management

Over the years, the WRC has continued to commission several research projects to investigate and evaluate options for on-site sanitation systems and faecal sludge treatment technologies. Solutions that stimulate sludge beneficiation, entrepreneurship and job creation are encouraged. An example of this is the social franchising concept piloted in the Eastern Cape to run the operation and maintenance of the water and sanitation facilities of 400 schools in the Eastern Cape (Wall & Ive, 2013). The improvement of sanitation facilities within the pilot area was so successful that the Department of Education requested that the programme be extended to a further 1,000 schools in the Eastern Cape. The WRC, through a partnership with the African Development Bank, has also recently embarked on a project to upscale the social franchising concept and incorporate innovative technologies into the faecal sludge management chain. A new programme, in partnership with the Department of Science and Technology and the Bill and Melinda Gates Foundation (BMGF), will pilot the next generation of toilet technologies in South Africa, using innovative processes to transform faecal sludge into products that have commercial value (WIN-SA, 2014).

13 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

1.3 The Sanitation Research Fund for Africa (SRFA) Project The WRC is well aware of the strategic importance to develop human capacity to solve the challenges of faecal sludge management in Africa. A strategic partnership was formed with the BMGF Water, Sanitation and Hygiene Programme to fund solutions and develop capacity in this regard in sub-Saharan Africa. This initiative, known as the Sanitation Research Fund for Africa (SRFA) Project, provides an exclusive grant of up to US$200 000 to African institutions and organisations. In 2013, an open request for proposals was issued. 12 African institutions and organisations from eight Southern and Eastern African countries were awarded research grants: a. East Africa: Kenya, Ethiopia and Malawi (2 research teams) b. Central Africa: Uganda (2 research teams) c. Southern Africa: Botswana, South Africa (3 research teams), Zimbabwe and Zambia

Figure 2. The eight Southern and East African countries that received SRFA grants

14 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

No more than two research grants were awarded per country. South Africa was the exception, because the WRC provided the funding to two universities. The WRC's research funding model was applied to the grantee projects: payment based on deliverables and a peer review of project progress through a Reference Group, consisting of the world's leading sanitation experts. The funding makes provision for capital expenses and capacity and competency development in the form of post-graduate studies. The Project is divided into two focus areas: 1. The physical and chemical processes occurring in “dry” pit toilets and their contribution to the physico-chemical characteristics of faecal sludge, the level of pathogens and pit filling rates (six research teams). The pit characterisation studies aim to expand the knowledge base that the WRC developed with reference to eThekwini to different user habits and local conditions. The results will assist designers and operators of desludging and treatment technologies, and also inform management plans and policies around faecal sludge management. 2. Technology for desludging, transporting, treating and disposing of faecal sludge, which would benefit people and the environment (another six research teams). The treatment processes that the research teams are investigating include solar pasteurisation and hybrid anaerobic technologies (combined with pasteurisation or co-digestion). It is envisaged that the end-products from the treatment processes will be sterile and hold some monetary value, the proceeds of which can be channelled back into the faecal management chain, in particular the operation and maintenance of on-site sanitation technologies (WIN-SA, 2014).

Decentralised anaerobic plant for pit Solar pasteurising unit for on-site emptiers to reduce transportation costs faecal sludge treatment (Photo: ATL- (Photo: Water for People, Uganda) Hydro, South Africa).

Figure 3: Some of the technologies being piloted in the SRFA Project.

The Project provides a mechanism for African researchers to showcase their abilities and develop solutions customised to their environment and the available resources. It also provides an opportunity for African researchers and developers to gain more experience in research-related project management and to learn from a peer review of their work by an international panel of sanitation experts.

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1.4 The scope of this report The first task of the research teams was to research the baseline conditions of faecal sludge management in their respective countries. This report presents a consolidated review of their findings, which cover the sanitation policy environment and faecal sludge management practices in these eight Southern and Eastern African countries. The report comprises the following subsections: 1. Scope of the report 2. Methodology – the methods used to source and collate the information that the reader will find in this report 3. Definitions 4. The economic context 5. The sanitation policy environment 6. A dashboard of the status of sanitation in eight Southern and East African countries 7. A short profile of the individual countries: i. Main issues ii. On-site facilities iii. Faecal sludge management practices 8. Conclusions

16 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

2. Methodology

The country studies used mainly two types of research methods: 1. Desk research to report on faecal sludge management in sanitation policy and legislation, and institutional arrangements; and 2. Primary research in the form of field visits, surveys, in-depth interviews and focus groups to report on faecal sludge management practices in specific areas of the capital or main cities of the country. Some reports also relied on desk research to report on faecal sludge management practices in general in that country. The research institutions, the coverage of findings on faecal sludge management practices and their research methodologies are summarised below: Botswana  University of Botswana  Coverage: The whole country  Method: Desk research Ethiopia  Jimma University and Ministry of Water and Energy  Coverage: Addis Ababa  Method: Household survey: 40 households from 2 districts in 5 sub-cities – randomly selected Kenya  Egerton University  Coverage: Major urban areas: Nairobi, Kisumo, Mombasa  Method: Desk research Malawi  University of Malawi  Coverage: Ntopwa settlement in Blantyre  Method: Household survey: 221 households, randomly selected South Africa  ATL Hydro: Coverage – national; methodology – desk research  Rhodes University: Coverage – Eastern Cape municipalities; methodology – desk research  University of North West: Coverage – North West Province; method – interviews with municipal officials (no numbers) and 43 residents in 10 municipalities Uganda  Makarere University: Coverage – mainly Kampala; method – desk research  Water for People: Coverage – national; method – desk research and seven stakeholder interviews

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Zambia  University of Zambia  Coverage: Lusaka only  Method: Desk study: one stakeholder workshop and four community Focus Group Discussions (one in each of the four selected study areas) — latrine surveys (25 in each of the study areas and administration of a total of 115 household questionnaires on sludge handling and utilisation in the four study sites) Zimbabwe  Chinhoyi University  Coverage: Eight urban centres, including the cities of Harare and Buluwayo  Method: Site visits and field observations; interviews and focus group discussions with local officials, NGO staff and community members (no numbers)

The country reports were supplemented with information from the following sources (see references):  The websites and reports of local water management institutions and research organisations.  Websites and reports of international organisations, such as OECD, WaterAid, USAID, UNICEF and the World Health Organisation (WHO).  Statistics from WHO/UNICEF and the World Bank. In the next chapter, the basic definitions are presented to provide the reader with a better understanding of terminology and the concepts presented later in the report.

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3. Definitions The report uses the following definitions of key terms and technologies:

3.1 Faecal sludge management3

3.1.1 Faecal sludge For the purpose of this report, faecal sludge will be defined as human excreta that is disposed of in facilities located on a housing plot (on-site sanitation facilities) and in fields, forests, bodies of water or other open spaces (open defecation) (EAWAG/SANDEC, 2008). EAWAG/SANDEC (2008) also uses the following technical definition: "Faecal sludge is the general term for undigested or partially digested slurry or solids resulting from storage or treatment of black water or excreta". This report does not consider sludge from septic tanks as faecal sludge as it is biochemically more stable due to longer storage periods than sludge from dry sanitation installations. On the other hand, sludge from septic tanks is often collected and treated together with faecal sludge. In this instance, the report will mention sludge from septic tanks.

3.1.2 Faecal sludge as a health hazard In many developing countries, increasing urbanisation has led to a backlog in services, such as housing, water and sanitation. As a result, large informal settlements or slum areas with inadequate water and sanitation services have become typical of cities in developing countries. Large quantities of faecal sludge accumulate in these areas, which may have the following negative effects on the urban environment and on public health (Klingel et al., 2002):  Environmental pollution is caused by effluents of not regularly de-sludged on-site sanitation facilities;  Large amounts of faecal sludge removed from sanitation facilities are dumped indiscriminately into the environment due to a lack of disposal facilities;  Faecal sludge is used in unhygienic ways in agriculture because no sludge treatment is available. Proper management of faecal sludge can avoid these problems.

3.1.3 Faecal sludge management According to EAWAG/SANDEC (2008), faecal sludge management comprises the following aspects:  Legislation, policy and strategy to set objectives and criteria  Implementation  Collection  Treatment  Re-use and disposal  Responsibilities, communication and coordination; financial arrangements, timeframe

3 Faecal sludge management as defined by Klingel, Montangero, Konè and 19 Strauss (2002). THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

3.1.4 Collection and discharge Collection is either manual or mechanised. The most basic manual collection method involves climbing into a pit with shovels and buckets and hoisting the sludge up and into some container. Safety equipment is typically absent. More advanced methods involve some mechanised apparatus that pumps the sludge out of the pit. The sludge gulper, the diaphragm pump, the motorised pit screw auger, the nibbler and MAPET are innovations that have been used in pilot studies (Strande et al., 2014). Vehicle-mounted mechanised methods include the following:  The conventional vacuum tanker is often the favoured technology when able to access the housing plot and the pit, because there is minimal contact with the pit contents and it is more efficient in evacuating sludge than its alternatives (Eales, 2005). A hose connects the pit contents to a truck-mounted tank (1–10 m³ in capacity) and a vacuum pump is connected to the tank (Klingel et al., 2002). Large trucks often have difficulty accessing pit latrines or septic tanks in areas with narrow or non-driveable roads.  In 1997, with the sponsorship of UN-HABITAT, the Vacutug was developed and piloted in Nairobi, Kenya. The aim was to develop a pit latrine exhauster that was suitable for areas that are inaccessible to vacuum trucks. The simple design consists of a small gasoline engine, a 500-litre tank and a 4 m PVC hose that can suck up to 1700 litres of sludge per minute. The vacuum can be reversed to discharge the faecal sludge at a centralised facility or collection point. The Vacutug requires two operators and can move at speeds of up to 5 km per hour. Ideally, the point of discharge should be within 1 km of the service area. Since then, four further versions were developed, but there was no reference to their use in the countries studied. Discharging practices include adding the faecal sludge to the urban wastewater stream for co-treatment in wastewater treatment plants, sea outfalls, burial onsite, disposal at landfill sites, agroforestry, and taking the sludge to a point where it is treated for re-use.

3.1.5 Treatment and re-use Klingel and co-authors (2002) identified a list of faecal sludge treatment processes that the authors considered potentially suitable for developing countries. These are:  Solids-liquid separation;  Settling/thickening tanks or ponds (non-mechanised, batch-operated);  Unplanted drying beds;  Constructed wetlands;  Pond treatment of faecal sludge supernatants or percolates;  Combined composting with organic solid waste; and  Anaerobic digestion with biogas utilization. New treatment technologies still being experimented on or in pilot stage include :  Pyrolysis – the thermal decomposition of human solid waste in an oxygen-free environment to produce biochar;  Electrolysis – using electrical currents to break down the chemicals in human liquid-waste;  Pasteurisation – a heat treating process which thermally sterilises human waste;  Plasma gasification – using microwave technology to gasify human waste; and  On-site membrane technology to purify liquid waste through filtration. According to Sudhir Pillay of the WRC, despite 10 years of further research, there is currently still no definite conclusion as to which treatment method is the most suitable as the physico-chemical properties of faecal sludge is highly variable and most solutions have not been demonstrated at scale (Personal communication, 2015).

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3.2 The sanitation ladder In line with the approach of the World Health Organisation (WHO), this report presents sanitation statistics as a four-step ladder (WHO/UNICEF, 2013):

Using an improved sanitation facility Sharing an improved sanitation facility (public facility or Using an unimproved sharing with two or sanitation facility more households at Practicing open home) defecation

UNIMPROVED IMPROVED

Figure 4. The sanitation ladder

3.3 On-site sanitation WHO/UNICEF (2013) group sanitation facilities as follows:

Open defecation4 Defecation in fields, forests, bushes, bodies of water or other open spaces, or disposal of human faeces with solid waste.

Unimproved Facilities that do not ensure hygienic separation of human excreta from human contact. Unimproved facilities include pit latrines without a slab or platform, hanging latrines and bucket latrines.

Shared Sanitation facilities of an otherwise acceptable type shared between two or more households. Shared facilities include public toilets. Only facilities that are not shared or not public are considered improved.

Improved Facilities that ensure hygienic separation of human excreta from human contact. They include:  Flush or pour-flush toilet/latrine to piped sewer system, or pit latrine;  Ventilated improved pit (VIP) latrine;  Pit latrine with slab;  .

3.3.1 On-site sanitation facilities EAWAG/SANDEC (2008) defines on-site sanitation as "a system of sanitation whose storage facilities are contained within the plot occupied by a dwelling". On-site sanitation can be classified into two main categories: wet (which requires water for flushing) and dry (which does not require water for flushing). Pit latrines, VIPs and urine diversion (UD) toilets are all forms of on-site sanitation (Tissington, 2011).

4 Open defecation encourages the spread of faeces-related diseases, such as diarrhoea, worm infestation, typhoid, cholera and dysentery. Water pollution is also 21 caused by the run-off surface water from areas where people have openly defecated. THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

On-site sanitation facilities can be either unimproved or improved. Sanitation statistics sometimes also refer to sanitation facilities as basic, safe or 'adequate'. For example, the WHO/UNICEF definition for "adequate sanitation at home" for post-2015 refers to:  Using an improved sanitation facility at home, and  Sharing this facility between five households or less. This report refers to 'unimproved' or 'improved', but it will also use the description of the respective countries where applicable.

3.3.2 Unimproved on-site facilities5 3.3.2.1 Simple pit latrines The basic elements of a pit latrine are: a hole dug in the ground, a squatting slab and a super structure erected over it. The excreta falls into the hole where the urine and other liquids soak into the ground and solid materials are retained and decomposed in the pit. Pit latrines are a drop-and-store sanitation system. Little or minimum operation and maintenance are required and not much focus is given to the facilities until they eventually fill up with the faecal matter and other materials dropped inside. The problem-in-waiting emerges when the pit requires emptying or replacement. Advantages:  a better solution than open defecation,  easily constructed and cost effective,  does not require water to operate, and  the technology is simple and understandable. Disadvantages: Simple pit latrines attract flies and create a smell nuisance, frequently collapse if not well lined, can pollute groundwater and are not easy to construct on rocky ground. 3.3.2.2 Hanging latrines Hanging latrines are toilets built over the sea, a river, or any other body of water, into which excreta drops directly (WHO/UNICEF Joint Monitoring Programme, 2015). 3.3.2.3 Bucket latrines Bucket latrines refer to the use of a bucket or container, usually placed in a hole under the floor, for the retention of excreta, along with anal cleaning material, which needs to be periodically removed for treatment, disposal, or use as fertiliser (WHO/UNICEF Joint Monitoring Programme, 2015).

3.3.3 Improved on-site facilities Facilities that are classified as improved on-site sanitation include the following: 3.3.3.1 Waterborne sanitation with a septic tank Septic tanks are watertight buried receptacles that are designed and constructed to receive waste from waterborne toilets. 3.3.3.2 Riflo septica sanitation system Developed in Italy, and introduced to Kenya by Riflo Industries, this system is similar to a septic tank and uses micro-organisms to biodegrade toilet waste and the discharge is recyclable water. The unit is available in a wide range of sizes for domestic, commercial and industrial sanitation and costs between US$ 750 to US$ 1000 (Egerton University, 2014).

5Definitions from http://www.wssinfo.org/definitions-methods/watsan-categories/ 22 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

3.3.3.3 Aqua-Privy An aqua-privy functions in a similar manner to a septic tank whilst avoiding the need for a consistent water supply to operate a flush toilet. It consists of a squatting plate constructed above a small septic tank that has an integral drop pipe that is submerged into the water tank to form a water seal (Egerton University, 2014). Regular emptying and maintaining the water level are burdensome requirements. Failure to maintain the water seal has been the main problem. This leads to intense odour release and fly and mosquito nuisance. The aqua-privy has no advantage over pour-flush, which is less expensive and easier to maintain. 3.3.3.4 VIP latrines Ventilated improved pit (VIP) latrines can overcome the disadvantages of the simple pit latrine. The basic elements of a VIP latrine are a pit, a cover slab and ventilation pipe hole, a super structure for privacy and protection from weather, as well as a fly screen to keep the latrine free from flies and odours. See illustration below. To deal with overflow, VIP latrines are sometimes connected to a septic tank (Makerere University, 2014).

Fly-screen Flyscreen Superstructure Vent pipe Ventpipe Ventilation Gap Door SUPERSTRUCTURE Pedestal with lid

Seat Insert Slab

Collar

Fard Ringbeam Cover- Pit SUPERSTRUCTURE Removable slabs Coverslab Pit

Figure 5. The BOTVIP (left) and The South African VIP (right) (Odirile et al., 2013)

3.3.3.5 The Blair VIP latrine The Blair VIP latrine has been developed by the Zimbabwean Blair Research Institute, now called the National Institute of Health Research. The main disadvantages are the high costs, and the fact that the design does not seem to enable the easy emptying of pits when full. 3.3.3.6 Pour- A water-seal is created by a plastic U-bend that prevents odour and flies (this system is less susceptible to building errors than the VIP system). The system only requires a few litres of water and so should not put a strain on resources (Harvey et al., 2002; Ahmed & Rahman, 2003). The Water Research Commission of South Africa, together with Partners in Development, has recently began piloting an innovative variation of the pour–flush toilet that prevents blockages from and newspaper (Pillay, 2014).

23 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

3.3.3.7 Urine Diverting Dry Toilet (UDDT) A Urine Diverting Dry Toilet (UDDT) is a toilet that operates without water and has a divider so that the user, with little effort can divert the urine away from the faeces. The UDDT toilet is built in such a way that urine is collected and drained from the front area of the toilet, while faeces fall through a large chute (hole) in the back (EAWAG/SANDEC, 2008). The UDDT, unlike other sanitation systems has two outlets and two collection systems that separate the urine and the faeces in order to simplify their safe recycling and the use of their unmixed nutrient content (Kvarnström et al., 2011). The UDDT is applicable where water is inadequate for waterborne systems and the ground condition has unstable soils, rocky ground or flooded area and generally not suitable for construction of pit latrines. Education and demonstration projects are essential in achieving good acceptance with users (EAWAG/SANDEC, 2008). 3.3.3.8 Ecological compost latrines Two types are found in the countries studied: single-pit or single-compartment latrines (for example, ) and twin-pit or twin-compartment latrines (often called Fossa alterna). Composting latrines are shallow vaults, into which excreta, kitchen waste and similar materials are added. The waste and excreta break down together to produce a compost which can be dug out and used as fertiliser. The Arborloo or Eco-pit is the simplest type of ecological sanitation system. A sanitary slab and a light weight latrine super structure is placed on a shallow un-lined pit (as deep as the soil conditions allow) and when the pit is full, the slab and the super structure are moved to a new pit and the existing pit covered and a tree planted on top of the pit (Egerton University, 2014). In a twin-compartment latrine or Fossa alterna there are two shallow vaults, one of which is used at a time. When one is nearly full, it is covered with soil and left for at least two years for the excreta and waste to decompose and for the pathogenic germs in it do die. While the first vault is closed, the second is used. When the second is nearly full, the first is opened, the compost dug out for use as fertiliser and the first vault re- used (WHO, no date). Compost formed by the combination of urine and faeces is better, but these toilets are more likely to smell if used carelessly and they require much greater quantities of carbonaceous residues like sawdust and straw. Many of the more complex types require dry access under the toilet via a basement or cellar room (Pickford, 1995).

24 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

4. The socio-economic context

4.1 Overview The table below gives a brief overview of the eight countries' political stability, population growth, the increase in urbanisation, economic growth, gross domestic product per capita and donor involvement in sanitation.

Table 1. Overview of economic and political indicators in eight Southern and East African Countries

Country Population Increase in Average GDP7 per % Donor Donor Political stability increase urban GDP growth capita, 2013 spending on spending per (1990-2011) population in past 5 in US$ water and capita (US$ (1990-2011) years6 sanitation million) (2012)8 20129 Botswana 1,47% 20% +/-5% 7,315.0 0,9% 63.2 Stable democracy Ethiopia 1,75% 4% +/-10% 505.0 7,31% 30.6 Stable democracy Largely uncontested ruling party Kenya 1,77% 7% +/-6% 1,245.5 7.6% 49 Unstable democracy Security threats posed by local militants

Malawi 1,64% 4% +/-4.5% 226.5 Down 5.53% 55.7 Stable democracy from 2010

South Africa 1,37% 10% +/-2.5% 6,617.9 0.4% 21.8 Stable democracy Down from 2010

Uganda 1,95% 5% +/-5.5% 57.0 5.52% 44.8 Stable democracy

Zambia 1,71% 0% +/-7% 1,844.8 7.66% 69.3 Stable democracy Zimbabwe 1,22% 10% +/-8% Down 953.4 7.83% 47.8 Vulnerable but stable from 2012 democracy

Sources: (CIA, 2015), (The World Bank, 2015b), (WHO/UNICEF, 2014) The population growth (annual %) in sub-Saharan Africa was last measured at 2.53% in 2011, according to the World Bank (2015b). The statistics of projected growth in population and the rate of urbanisation mean that sub-Saharan cities have an ever increasing population to serve with water and sanitation. As most of the urban poor rely on on-site sanitation, these statistics present a growing challenge for faecal sludge management (WHO/UNICEF, 2014).

6 http://www.imf.org/external/pubs/ft/reo/2014/afr/eng/sreo1014.pdf 7 GDP per capita is gross domestic product divided by midyear population. GDP is the sum of gross value added by all resident producers in the economy plus any product taxes and minus any subsidies not included in the value of the products. It is calculated without making deductions for depreciation of fabricated assets or for depletion and degradation of natural resources. Figures are in current US$ . 8 http://webnet.oecd.org/dcdgraphs/CPA_recipient/ 25 9 http://webnet.oecd.org/dcdgraphs/CPA_recipient/ THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

4.2 Donor aid for sanitation Sub-Saharan Africa received 25% of total aid to the water sector. Water and sanitation made up an average of 6.48% of donor spending in Africa in 201210 . Projections for aid until 2017 are stable. The amounts remain the same, but population increases lower the amount per capita (OECD, 2012). Per capita Country Programmable Aid11 is slightly down from the average of 38.7 million US$ per capita in 2010-2012 to 36.9 million US$ projected for 2017. Aid to water and sanitation is predominantly in the form of infrastructure investment projects. In 2010-2011, the distribution of Development Assistance Committee (DAC) members' bilateral flows in the water sector by aid modality was as follows (OECD-DAC, 2013):  80% of aid flows in the water sector were extended in the form of projects (mainly investment projects). Projects for large systems are still predominant and accounted for 41% of total contributions to the water and sanitation sector in 2010-2011;  6% were allocated through sector budget support mainly by the EU institutions;  6% through technical assistance;  5% through pooled contributions to specific purpose programmes managed by international organisations, e.g. Inter-American Development Bank Water and Sanitation Fund, UN-Habitat Trust Fund for Water and Sanitation, World Bank Water and Sanitation Programme;  2% through pooled contributions to basket funds. Below is the breakdown of aid to water versus sanitation projects (2010-2011) (OECD-DAC, 2013):

Aid to water and sanitation projects

Water supply & sanitation - large systems

3% 3% Basic sanitation and drinking water supply 2% 7% Water resources policy, management 41% River development 21%

Waste management & disposal

23% Water resources protection

Education & training water and sanitation

Figure 6. Breakdown of aid to water and sanitation projects

10http://webnet.oecd.org/dcdgraphs/CPA_recipient/ 11Country Programmable Aid (CPA) is a concept of the Organisation for Economic Co-operation and Development (OECD). It captures the flows of aid that go to the partner countries. 26 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

Faecal sludge has recently become the focus of several donor-funded research programmes of which the SFRA Project is one. Another example is SPLASH, funded by ADA (Austria), MAEE (France), SIDA (Sweden), SDC (Switzerland) and DFID (UK) and the Bill and Melinda Gates Foundation's Water, Sanitation and Hygiene Programme. In this programme, European researchers work in collaboration with colleagues in Cameroon, Ghana, Kenya, Uganda, Rwanda, Mozambique and Senegal on all aspects of the sanitation value chain (WIN-SA, 2014).

27 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

5. The sanitation policy environment

The overview below indicates how different aspects of faecal sludge management are addressed in policy and legislation in the eight countries. Where information was available, the section also refers to institutional arrangements. Since the 1970s, sanitation programmes focussed mainly on infrastructure development to eradicate open defecation and bucket latrines. (See details of South Africa's bucket eradication programme in the sub- sections on South Africa.) Only three of the eight countries developed a minimum standard for a sanitation facility: Botswana (the double vaulted VIP latrine), South Africa (the VIP latrine) and Zimbabwe (the Blair VIP latrine). Sanitation legislation, policy and strategy reflect this drive for infrastructure development. What would happen when the pits were full, were not a concern at the time. As a result, faecal sludge management is largely absent in policy and legislation as the country profiles below will illustrate. Policies and legislation that relate to sanitation originate from different Ministries, such as Water, Environment, Education and Health. However, local authorities, which fall under another Ministry, are in most cases responsible for implementation. In most of the countries, institutional arrangements are complex and fragmented. The structure of local authorities and the delineation between urban and rural jurisdiction vary considerably between the eight countries. The distinction between urban and rural sanitation has turned peri-urban sanitation into a no-man's land in terms of policy and legislation - see the Zimbabwe profile below. There are exceptions: in an attempt to consolidate the sector, Botswana, for example, rationalised water and sanitation services under a single state-owned utility in 2009.

5.1 Botswana 5.1.1 Brief history of sanitation development 5.1.1.1 Urban Sanitation Research Project (USRP) In 1971, the government of Botswana introduced the scheme of providing latrines at subsidised costs to households in urban areas with this project. The aim of the USRP was to improve the poor sanitary conditions in growing towns and cities. The project introduced VIP latrines in Botswana. Later, a double vault VIP latrine was adopted as the standard sanitation facility in urban areas. A self-help approach was followed. In 1979, the City and Town Councils resolved to provide substructures for the latrine and each plot-holder was responsible for completing the super structure. All registered plot- holders were required to pay a monthly service levy to cover the costs of road maintenance, water supply, refuse collection, toilet emptying, secondary infrastructure and administration (Ghanie, 1982). 5.1.1.2 Environmental Sanitation and Protection Pilot Programme (ESPP). By 1980, the USRP was extended. This programme was funded by UNICEF, the United States Agency for International Development (USAID) and the German KFW Development Bank. The aim of the project was to develop, test and evaluate approaches to health education and to provide on- site sanitation technology in rural areas that is affordable and easy to understand. The ESPP was piloted for two years in six small and medium villages in Kgatleng and Southern Districts.

28 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

During the project implementation a single vault VIP latrine was installed and was eventually adopted for use in the whole of rural Botswana (Jacks et al., 1999; DSWM, 2002). At the end of the two-year pilot project, 245 latrines were constructed. 5.1.1.3 Self-Help Environmental Sanitation Project (SHESP) By 1984, with the help of UNICEF, the Government of Botswana initiated the second phase of the project under ESPP, known as Self-Help Environmental Sanitation Project (SHESP). The aim of the project was to address the shortcomings of ESPP in relation to health, education and project implementation and enhance community commitment to the programme. The SHESP provided pit latrines, but also acted as a social mobilisation and health education project. The SHESP, like the ESPP, was piloted in four District Councils: Southern, Kgatleng with two additional districts of Kweneng and Central. By 1988, 3500 latrines had been constructed under this programme. By the end of 1990, the project covered approximately 80 rural settlements and the process of extending this project to the remaining district villages got underway (TAG, 2003). 5.1.1.4 The National Rural Sanitation Programme (NRSP) In 1991, a study was commissioned to assist the Government of Botswana in designing a National Rural Sanitation Programme (NRSP) strategy for the National Development Plan 7 (NDP7), and beyond. Between 1992 and 1997 (Brandberg, 1991), the National Rural Sanitation Programme (with support from the Swedish International Development Agency and UNICEF) provided more than 30 000 pit latrine substructures (Bolaane & Ikgopoleng, 2011; Odirile et al., 2013). 5.1.2 Policy and legislation The legislative framework for sanitation services in Botswana comprises the Acts, strategies and policies listed below: 5.1.2.1 Waste Management Strategy (1998) This strategy provides for the efficient management of waste, as well as the implementation of the Basel Convention. It promotes the health and well-being of the people of Botswana through the provision of appropriate and sustainable wastewater and sanitation management. 5.1.2.2 Policy for Wastewater and Sanitation (2001) This policy aims to “promote the health and well-being of the people of Botswana through the provision of appropriate and sustainable wastewater / sanitation management and to introduce mechanisms for the protection and conservation of water resources” (Centre for Applied Research, 2011). The specific objectives are to: a. Develop regulatory and legislative framework on wastewater / sanitation issues; b. Introduce development planning concepts in wastewater / sanitation at district and national level; c. Promote stakeholder involvement in wastewater management; d. Introduce effective and sustainable operation and maintenance of wastewater / sanitation systems; e. Establish basic principles for pricing and cost recovery for wastewater / sanitation facilities; f. Establishment of national effluent discharge guidelines; g. Establish an industrial pollution control framework based on the Polluter Pays Principle; h. Conserve water by re-use of return flows; and i. Promote health and sanitation education and awareness initiatives.

29 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

This policy is being implemented under the Department of Pollution Control and Waste Management. 5.1.2.3 National Master Plan for Wastewater and Sanitation (2003) The Botswana National Master Plan for Wastewater and Sanitation developed strategies for the implementation of the National Wastewater and Sanitation Management Policy. The Master Plan is the foundation for sanitation and wastewater management until 2030. The Master Plan recommends (Centre for Applied Research, 2011): a. Enactment of legislation for the wastewater and sanitation sector; b. Upgrading of existing and development of new wastewater treatment facilities (capital investment plan up to 2030); and c. Re-use and recycling of treated wastewater. The objective is to re-use and recycle 96% of the outflow by 2030 through agricultural re-use and reduction of losses in the treatment systems. It comprises a set of 13 planning and technical design manuals with strategies and a budget for each village in the country. 5.1.3 Institutional arrangements The National Rural Sanitation Programme is delivered through a complex institutional arrangement: The Ministry of Environment Wildlife and Tourism and the Department of Waste Management and Pollution Control coordinate the programme, but it is implemented by the ten District Councils (Botswana Association of Local Authorities, 2015) under the Ministry of Local Government. In May 2009, the Water Sector Reforms Programme came into effect to simplify institutional arrangements. The programme resulted from a study to rationalise the water sector in Botswana and ensure uniform service levels for all. In terms of these reforms, the government of Botswana made the Water Utilities Corporation (WUC) responsible for wastewater and on-site sanitation management, in addition to water services, in the whole of Botswana. The WUC was scheduled to take over wastewater services in all the urban centres and villages in the whole country by the end of 2014 (Water Utilities Corporation, 2015). The WUC is a parastatal organisation, wholly owned by the Botswana Government. It was established in 1970 by an Act of Parliament (Laws of Botswana Cap 74:02).

30 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

5.2 Ethiopia Besides legislation and policy that refer to sanitation in broad terms, the researchers from Jimma University and the Department of Water and Energy could not find legal instruments, policies, strategies and plans that specifically refer to faecal sludge or pit emptying, and its management. Operational guidelines and clearly defined stakeholder responsibilities are also lacking (Jimma University, 2014). Below are some examples of sanitation legislation and policy. The Federal Democratic Republic of Ethiopia (FDRE) Constitution is the basis for all development-related policies, and legal provisions and related outcomes within the country. Article 44/1 of the Constitution gives all persons the right to live in a clean and healthy environment, while Article 92/1 of the Constitution states that the government has the duty to ensure this right. Article 92/2 of the Constitution requires that the design and implementation of development programmes and projects should not damage or destroy the environment (FDRE, 1994). Several policies refer to environmental and personal health in relation to sanitation services and mention sanitation as a high priority:  The Environmental policy of Ethiopia (EPA, 1997).  Health policy of Ethiopia (Ministry of Health, 1993).  Ethiopian Water Resources Management Proclamation No. 197/2000 article 11 and 13 prohibits the release of untreated waste into natural water bodies.  The Ethiopian Public Health Proclamation No. 200/2000 article 12 states that “no person shall dispose solid, liquid or any other waste in a manner which contaminates the environment or affects the health of the society”.  A national hygiene and sanitation strategy (Ministry of Health, 2005) as well as protocols for hygiene and on-site sanitation (Ministry of Health, 2006) were developed by the Ethiopian Ministry of Health.  A National Water, Sanitation and Hygiene (WaSH) implementation framework was ratified by the Ministry of Health, Water and Energy, Education, and Finance and Economic Development in 2013 (FDRE, 2013).

31 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

5.3 Kenya

5.3.1 Policy and legislation Kenya has laws, policies and regulations relating to the water supply, sanitation, waste management and environment, but they are "scattered" over different government departments and institutions. Some aspects are duplicated or repeated several times in the various policies and laws (Egerton University, 2014). 5.3.2 Institutional arrangements Institutional arrangements are complex and duplication occurs at local level as the table below illustrates:

Table 2. Institutional roles and relationships in water and sanitation in Kenya

Institutional roles and relationships

Sectors and Water supply Sewerage and General School Urban subsectors related sanitation and sanitation sanitation hygiene hygiene promotion promotion

Ministry of Water and Irrigation Ministry of Sector Physical Ministry of leadership Health and Education (national) Sanitation

Water Services Regulatory Water Regulation Board Services (national) Regulatory Board

National Water Service Conservation development and Pipeline and provision Corporation (national) Water Services Trust Fund (WSTF)

Service Water Services Boards development and provision (regional)

District Public Health Officers Service development Water service providers Local and provision authorities (local) District Water Officers

Roles and responsibilities are not clearly defined and often the institutions lack the capacity (technical, human resources and financial) to monitor and enforce the laws (Egerton University, 2014).

32 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

5.4 Malawi

5.4.1 Policy and legislation Similar to the countries above, Malawi does not have explicit legislation on faecal sludge management. The reference to faecal sludge is by inference and obtained in different legislation on public health, environmental protection and occupation safety, as the table below illustrates:

Table 3. Legislation on public health, environmental protection and occupation safety in Malawi

Government institution Policy or legislation Faecal sludge management (FSM) Ministry of Irrigation and Water National Sanitation Policy (2008) The mission of the policy is “to ensure Development that all people in Malawi own and have access to improved sanitation facilities, practise safe hygiene, and practise safe recycling of liquid and solid waste for sustainable environmental management and socio economic development”. No specific targets, responsibilities, treatment or re-use technologies, responsibilities or funding mechanisms National Water Policy (2005) No mention of FSM Emphasize research and private- public partnerships in sanitation National Water Development No mention of FSM Programme (NWDP) (2011) Refers to "investments and technical assistance for sanitation and hygiene investments". Malawi Growth and No mention of FSM Development Strategy II (MGDs Focuses on thematic areas, of which II) one is Public Health, Sanitation, Malaria and HIV and AIDS. Water Resources Act (2013) No mention of FSM Focuses on the establishment of river basin authorities and sub-catchment management units Ministry of Natural Resources and National Environmental Policy No mention of FSM Environmental Affairs (2004) Focuses on hygiene and sanitation provision

5.4.2 Institutional arrangements The relationship between policy and legislation, and institutional arrangements is complex. Roles and inter- relationships are not well coordinated as the examples in the next paragraph illustrate: The Ministry of Irrigation and Water Development, the water boards and city assemblies are responsible for water supply. The main institutions responsible for sanitation are the Ministry of Irrigation and Water Development, city assemblies and the Ministry of Health and Population. However, water supply and sanitation are also provided by civil-society organisations and international donors who set up and fund their own water and sanitation projects.

33 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

Local governments are mandated by the Local Government Act to be responsible for water and sanitation, while the Water Works Act and the National Sanitation Policy mandate the water boards to have this responsibility (Zeleza-Manda, 2009). The Malawian government's priority with regard to funding, even in seeking donor support, remains water supply. Sanitation is neglected or at best left with non-government organisations. The only major government concern in connection with sanitation is hygiene education or treatment of sufferers in cases of disease outbreak (Zeleza-Manda, 2009). WaterAid UK confirmed this finding. According to the organisation, the root cause of lack of progress in the sanitation sector is political neglect: sanitation “is given low priority by donor and recipient governments alike. In sub-Saharan Africa, at current rates of progress, the 2015 MDG target for sanitation will not be met until 2076” (Water Aid Malawi, 2007). In the same report, WaterAid ranks Malawi the lowest of 12 countries in prioritization of sanitation. The quote below from The Nation illustrates this neglect. Further evidence of the relative neglect of sanitation is apparent in Mchesi in Lilongwe. Biwi Primary School was built in 1983 with four toilet blocks for 2,300 pupils. In 1995 a community secondary school opened on the same site. The toilets were used by both schools and also by the surrounding communities, but became blocked in 2003. For five years, the schools remained without any toilet facility, forcing pupils to use the nearby woodlot, and leading to a high drop-out rate among female pupils. As the government took no action, school teachers requested public support by organizing walks to raise funds for toilet construction. (Source: The Nation newspaper, 21 July 2008: “Two Lilongwe schools without toilets for five years”)

34 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

5.5 South Africa12 5.1 Policy and legislation The disposal of faecal sludge is subject to regulation and control by the Department of Water Affairs in terms of the National Water Act (Act 36 of 1998) and the Environment Conservation Act (Act 73 of 1989). The current regulatory legislation that governs the handling, disposal, management and re-use of pit sludge includes the following:  Fertilisers, Farm Feeds, Agricultural Remedies and Stock Remedies Act (Act 36 of 1947)  Water Act (Act 54 of 1956)  Conservation of Agricultural Resources Act (Act 43 of 1983)  Environment Conservation Act (Act 73 of 1989)  Water Services Act (Act 108 of 1997)  National Water Act (Act 36 of 1998)  National Environmental Management Act (Act 107 of 1998)  National Health Act (Act 61 of 2003) The acts above do not address faecal sludge directly, but they can be and have been interpreted and used to develop further policies, frameworks or guidelines for the handling, disposal, management and re-use of pit latrine sludge. The Strategic Framework for Water Services (DWAF, 2003) includes faecal sludge, although not by name, when it defines sanitation services as: “[...] the collection, removal, disposal or treatment of human excreta and domestic wastewater, and the collection, treatment and disposal of industrial wastewater. This includes all the organisational arrangements necessary to ensure the provision of sanitation services including, amongst others, appropriate health, hygiene and sanitation related awareness, the measurement of the quality and quantity of discharges where appropriate, and the associated billing, collection of revenue and consumer care.” In 2006, the Department of Water Affairs () developed the 'Guidelines for the Utilisation and Disposal of Wastewater Sludge' comprising five volumes. The guidelines were developed to encourage the implementation of beneficial use of sludge (Still & Foxon, 2012). Volumes 1 and 2 were published in March 2006, Volume 5 was published in March 2008, and Volumes 3 and 4 in 2009. The five volumes addressed the following:  Volume 1: Selection of management options (Snyman & Herselman, 2006a)  Volume 2: Requirements for the agricultural use of sludge (Snyman & Herselman, 2006b)  Volume 3: Requirements for the on-site and off-site disposal of sludge (Herselman & Snyman, 2009)  Volume 4: Requirements for the bene cial use of sludge at high loading rates (Herselman & Moodley, 2009)  Volume 5: Requirements for thermal sludge management practices and for commercial products containing sludge (Herselman et al., 2008) However, like previous acts and the Minimum Requirements Waste Management Series, these guidelines do not include or address pit latrine sludge specifically, even though VIP latrines are considered a basic minimum level of sanitation in South Africa. Therefore, a growing need to further develop policy, guidelines and procedures for the management of pit sludge in South Africa is required so that WSAs can be properly equipped to deal effectively with full pit latrines (Still & Foxon, 2012).

35 12 This section is based on Snyman (2007). THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

5.5.2 Institutional arrangements The roles and responsibilities of government with regard to basic sanitation; and in particular the key role played by local government, are set out in the following Acts:  The Constitution of the Republic of South Africa (Act 108 of 1996)  The Municipal Systems Act (Act 32 of 2000)  The National Water Act (Act 36 of 1998)  The Water Services Act (Act 108 of 1997)  The Municipal Structures Act (Act 33 of 2000)  The National Environmental Management Act (Act 107 of 1998)  The Division of Revenue Bill In terms of the institutional roles and responsibilities for sanitation service provision, the Constitution places the direct responsibility at local government level. This was then translated to authorised local government institutions (Water Services Authorities), which are either a Metro, a District municipality or a Local Municipality. In 2000, the Department of Water Affairs and Forestry (DWAF) published the Model Water Services By-laws (DWAF, 2000) under the directive of the Water Services Act. It suggests that: “Charges in respect of the removal or collection of conservancy tank contents, or the emptying of pits will cover all the operating and maintenance costs arising from the removal of the pit contents, its transportation to a disposal site, the treatment of the contents to achieve a sanitary condition and the final disposal of any solid residues and are payable by the owner.” From a national and provincial perspective, the responsibility was initially within DWAF from 1994 to 2001, the funding and monitoring function then moved to the Department of Provincial and Local Government in 2001 via the Municipal Infrastructure Grant funding instrument. In 2009, the National Sanitation Programme Unit (NSPU) was moved from the Department of Water Affairs (DWA) to the Department of Human Settlements, but with DWA retaining certain responsibilities in the sector, including regulation, information management, high level planning and management of the Bulk Infrastructure Grant. At provincial level, responsibility for sanitation now rested with the Department of Human Settlements, but with certain links to the Departments of Health, Water Affairs, Education and Public Works. In 2014, the sanitation function moved back to the Department of Water Affairs and the Department's name changed to Water and Sanitation (DHS, 2012). The 2012 government report on the status of sanitation services in South Africa, says the following about the institutional arrangement: " Fragmentation of responsibilities for sanitation at national, provincial and local levels results in no single national authority taking responsibility for performance monitoring of municipal service provision (including monitoring of construction of infrastructure) and unclear performance standards." Most municipalities and Water Services Authorities do not have operation and maintenance procedures and plans for VIP toilets and it was reported that they had no budgets or plans to ensure the long-term sustainability of VIP toilets (Mjoli, 2010). A strategic sanitation review by the South African Local Government Association (SALGA)13 , found that 68 of 169 Water Services Authorities claim to empty pit latrines. Only 25 of these WSAs had a policy concerning these activities, of which 7 had this policy in draft stage. The lack of policies and budgets could be ascribed to an interpretation of the Strategic Framework of Water Services, in terms of which VIP toilets are an interim measure for urban and peri-urban settlements to be eventually replaced by waterborne sanitation (Berner et al., 2013).

13South African Local Government Association. Strategic sanitation review on operations, maintenance and sustainability of Ventilated Improved Pit toilets including aspects of sustainability related to the eradication of buckets within the Free State province, June 2009. http://www.salga.org.za/app/webroot/assets/files/Research_Results/SALGA%20VIP%20%20BUCKET %20STUDY%20DOC%2009%20v2%20for%20WG.pdf. 36 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

5.6 Uganda The policy and legislative framework for the water and sanitation sector in Uganda has evolved tremendously since the late 1980s and can be described as reasonably well-developed (Makerere University, 2014). The table below summarises major policies and legislation that relate to sanitation.

Table 4: Major policies and legislation that relate to sanitation in Uganda

Ministry Policy & Legislation Relevance to sanitation All Constitution of the Republic of A clean and healthy environment is a basic human Uganda (1995) right. Poverty Eradication Action Plan No mention of faecal sludge. (PEAP) (1997-2010) Sets government's overall objective for the water and sanitation sector: sustainable provision of safe water Later replaced by the National within easy reach and hygienic sanitation facilities to Development Plan rural and urban populations with effective use and functionality of the facilities. The Uganda Country Strategy No mention of faecal sludge. (2010-2015) Recognises importance of sustainable sanitation. Ministry of Water National Environmental No mention of faecal sludge. and Management Authority (NEMA) Regulatory standards for drinking water quality, Environment Statute (1995) effluent. Water Statute (1995) No mention of faecal sludge management. Provides for water and sewage authorities to be constituted. Provides for the control of pollution and the promotion of safe storage, treatment, discharge and disposal of harmful waste. National Environment NEMA to licence any person intending to transport (Waste Management) waste or operate a waste treatment plant or disposal Regulations, S.I.No 52/1999 site. (This would include faecal sludge.)

Ministry of Water National Water and Sewerage Provides for National Water and Sewerage and Corporation Statute (1995) Corporation (NWSC), a parastatal that provides water Environment and sewerage services in large urban centres, and in (continued) any area in which it may be appointed to do so under the Water Statute (1995).

Water Policy (1999) No mention of faecal sludge. Same objectives set as above. National Environmental Health No mention of faecal sludge. Policy (2005) Provides a framework for the development of services and programmes at national and local government levels. Objectives linked to MDGs.

Ministry of The Universal Primary Education This policy emphasises that all primary schools shall Education and Policy have health programmes, and aims at a rapid Sports expansion of facilities, including sanitation infrastructure.

37 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

Ministry of Local Local Government Act (1997) Decentralises services to local level, including giving Government urban councils the responsibility to provide "sanitary services for the removal and disposal of night soil (human excreta)". Weak interaction between the local authorities and faecal sludge service providers results in an unregulated service.

Ministry of National Sanitation Guidelines The objective of the guidelines is to provide a guide Health for local authorities and to promote a standardised approach. Public Health Act (1964) Local authorities may give notice to owners to clean or upgrade sanitation facilities in their buildings.

The fact that sanitation does not appear in any of the Ministry names is telling. The Ministry of Water and Environment is the lead agency for formulating national water and sanitation policies (Plan International, 2011). The responsibility for sanitation is shared between the Ministries listed above. In 2001, they signed a Memorandum of Understanding (MoU) on their respective responsibilities and tasks. In terms of this, the Ministry of Health took responsibility for household sanitation, the Ministry of Water and Environment for sanitation in urban areas and rural growth centres, and the Ministry of Education and Sports for school sanitation (Plan International, 2011). Lack of skills at local government level and weak enforcement seem to be the main reasons why policies and legislation are not implemented (Musabe & Nsubuga, 2014). Musabe & Nsubuga (2014) cites the approach of the Ministry of Water and Environment as a success story in this regard. The Ministry requires that households in small towns put in place the required basic sanitation facilities as a pre-condition to accessing a water connection. Apparently, this has significantly improved latrine coverage in many of the small towns in Uganda. The National Sanitation Working Group was created to coordinate the responsibilities split between the different Ministries. It is responsible for establishing clear budget mechanisms for sanitation to fulfil the institutional mandates in the MoU between the ministries and to coordinate between local governments and national government on policy guidance and advocacy. Sector reforms in the period 1998-2003 included the commercialisation and modernisation of the National Water and Sewerage Corporation (NWSC) operating in cities and larger towns, as well as decentralisation and private sector participation in small towns (UN-Water/World Water Assessment Programme, 2006). Presently, the NWSC supports the faecal sludge management sector by receiving and treating faecal sludge that service providers deliver at any of the 15 designated wastewater treatment plants across the country. They charge a small fee per delivery (Musabe & Nsubuga, 2014).

38 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

5.7 Zambia In 2011, the government of the Republic of Zambia recognised the urgent need to address and remedy the water supply and sanitation situation in urban areas, specifically peri-urban settlements, by introducing the National Urban Water Supply and Sanitation Programme. The aim of this programme was to create a robust and sustainable water and sanitation health service system (MLGH, 2011). Despite these initiatives, very little has been achieved with respect to the standard of the sanitation services offered in the country (Tembo & Nyambe, 2013). The National Urban Water and Sanitation programme budget for 2011 provides for 61% of allocation to water and 14% to sanitation with 25% going to other functions (WaterAid, 2014). 5.7.1 Policy and legislation As far as could be established, no policy or piece of legislation directly refers to faecal sludge management (Tembo & Nyambe, 2013). The following pieces of policy and legislation imply faecal sludge management in Zambia:  The National Water Policy of 2007 This policy promotes the development of sustainable water resources with special regard to providing adequate quality and quantity water for all users in Zambia. Sustainable quality water implies preventing the pollution of water resources. This is relevant for faecal sludge management as the pollution of water resources might occur if pit contents are incorrectly disposed of (Tembo & Nyambe, 2013).  The National Decentralisation Policy of 2002 Through this policy, local authorities are reaffirmed as the institutions responsible for water supply and sanitation in Zambia. Local authorities are therefore responsible for all sanitation services in peri-urban areas, including faecal sludge management (Tembo & Nyambe, 2013).  Local Government Act (CAP 281) The Act mandates local authorities to maintain environmental health services, environmental conservation and prevention of pollution of water resources in Zambia (Tembo & Nyambe, 2013).  Sixth National Development Plans The Sixth National Development Plans contains a chapter on water and sanitation. This chapter's vision of the Water and Sanitation sector is “a Zambia where all users have access to water and sanitation and utilise them in an efficient and sustainable manner for wealth creation and improved livelihood by 2030”. The sector goal is furthermore to “achieve 75 percent accessibility to reliable safe water and 60 percent adequate sanitation by 2015 in order to enhance economic growth and improve the quality of life”. The vision and goal imply all aspects of adequate sanitation, including faecal sludge management (Tembo & Nyambe, 2013).  Environmental Management Act of 2011 This Act provides for the protection of the environment and the control of pollution. It prohibits the pollution of water resources with untreated wastewater or faecal sludge (Tembo & Nyambe, 2013).  Water Act (CAP 198) The Water Act provides direction to the use, diversion and allocation of water in Zambia. This act relates to faecal sludge management, because improper disposal of faecal sludge from pit latrines could pollute water bodies (Tembo & Nyambe, 2013).  The Water Supply and Sanitation Act No. 28 of 1997 The Act provides for the establishment of the National Water and Sanitation Council (NWASCO), which acts as regulator in the provision of water and sanitation services. NWASCO regulates the water utilities. As most urban and peri-urban areas in Zambia fall within the jurisdiction of the water utilities, urban pit emptying activities will therefore be regulated by NWASCO (Tembo & Nyambe, 2013).

39 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

 Public Health Act (CAP 295) The Public Health Act regulates public health in Zambia. All faecal sludge management services should be operated in accordance with the stipulations of this Act. However, it is common practice in the peri-urban areas of Zambia to discharge pit contents in drainage channels, especially where the emptying is done informally. This creates a health hazard (Tembo & Nyambe, 2013).

5.7.2 Institutional arrangements The National Rural Water Supply and Sanitation Programme (2006-2015) and the National Urban Water Supply and Sanitation Programme (2011-2030) are being rolled out under the leadership of the Ministry of Local Government and Housing. Rural water, sanitation and hygiene service delivery is decentralised to local authorities (Government of Zambia, 2012). Most local authorities in urban areas have created commercial utilities to provide services. 50 commercial utilities were formed by local authorities, some of which have subsequently merged. Approximately 20 local authorities still provide water and sanitation services through their Works departments. The local authorities have a particularly bad service record, with coverage levels actually declining (USAID, 2010).

40 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

5.8 Zimbabwe According to the country report, water, sanitation and hygiene policies are coordinated by various institutions and government departments. Their specific roles on faecal and other sludge management are not clear (Bangira et al., 2014). 5.8.1 Policy and legislation The table below depicts important milestones in the development of the water and sanitation sector in Zimbabwe since independence.

Table 5: Milestones in the water and sanitation sector in Zimbabwe

Date Event 1980 National Independence 1985 National Master Plan for rural water supply and sanitation 1987 National Action Committee (NAC) established 1987 Integrated Rural Water Supply and Sanitation programme launched 1999 Water Act 1999 Zimbabwe National Water Authority established 2004 Draft Water and Sanitation Policy 2008 Cholera outbreak kills more than 4000 people 2010 National Action Committee (NAC) re-launched 2011 National Sanitation and Hygiene strategy 2013 National Water Policy

Source: (GoZ, 2011)

No national policy describes the provision of sanitation services in informal settlements, or the roles and responsibilities of different agencies. No national policy or legislation also mentions faecal sludge explicitly (Bangira et al., 2014).

41 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

5.8.2 Institutional arrangements Institutional arrangements in the water and sanitation sector are complex as the diagram below shows14:

Deputy Prime Minister Infrastructure Cluster

Ministerial Committee for Water and Sanitation MWRDM (Chair) MoHCW, MoTCID, MoA, MLGRUD

National Coordination Unit (NCU) National Action Committee (NAC) Donor Groups in MWRDM PS Level MWRDM (Chair) World Bank UNICEF (Co-chair) MoHCW, MoTCID, MoA, MLGRUD, - supports NAC and all sub-committees MoF, MoEM, MoWAGCD, MIT, MAMID, MENR, MEPD

Rural WSS NAC Sub- Urban WSS NAC Sub- WRM NAC Sub- National Hygiene and Committee Committee Committee Sanitation Taskforce MoTCID (Chair), MLGRUD, MLGRUD (Chair), MWRDM (Chair), MoHCW (Chair) MoHCW, MWRDM, DDF, MoHCW, MWRDM, ZINWA, EMA, MLGRUD, ZINWA, MYDIE, MWAGCD, MoEN MoE, MOA AGRITEX, MoF, DPP

Provincial Level PWSSC MoTCID (Chair) Urban Councils Catchment Councils

Thus, coordination and allocation of responsibilities is often a challenge (Bangira et al., 2014). Zimbabwe comprises 10 administrative provinces and 32 urban local authorities. Local authorities are classified and ranked according to their size and levels of development into city councils, municipalities, town councils and local boards (GoZ, 2011). These local authorities are autonomous bodies that are responsible for the administration of their areas of jurisdiction and for the provision of services and infrastructure to rate payers. They have the authority to levy rates and charges on rate payers in order to raise revenue to cover the cost of council activities (GoZ, 2011). However, roles in sanitation management and provision between rural and urban local authorities, and local authorities and government departments, especially with respect to peri-urban areas are fuzzy (Bangira et al., 2014). Enforcement of environmental and public health regulations relating to sanitation is often weak and ineffective. Political interference has also been an issue (Bangira et al., 2014). The water and sanitation sector has a record of poor engagement with the private sector (Bangira et al., 2014). Sub-economic tariffs have led to insufficient funds for normal operation, repair and maintenance. Additionally, for most local authorities, water and sanitation revenue is not ring-fenced to benefit the sector. Revenue collection mechanisms are largely unclear (Bangira et al., 2014).

14 The acronyms are not explained as the purpose of the diagram is to illustrate the complexity of institutional arrangements. 42 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

6. Dashboard of progress in sanitation

6.1 In sub-Saharan Africa from 1990 to 2012 According to WHO and UNICEF's updated report on global trends in sanitation and drinking water of 2014 (WHO/UNICEF, 2014), progress in sanitation in sub-Saharan Africa can be depicted as follows:

Progress in sanitation in sub-Saharan Africa

36%

30% 26% 26% 25% 24% 19% 14%

OPEN DEFECATION UNIMPROVED SHARED IMPROVED IMPROVED SANITATION SANITATION SANITATION 1990 2012

Figure 7. Progress in sanitation in sub-Saharan Africa

The percentage for open defecation has dropped by 11% in the period 1990-2012, but the number of people defecating in the open is still increasing in 26 of 44 countries in sub-Saharan Africa. Of the eight countries studied in the region, Ethiopia has made the most remarkable progress during the past 25 years: open defecation declined from 92% in 1990 to 37% in 2012. The number of people in this part of Africa who are still using unimproved sanitation facilities has increased slightly. This probably indicates a shift from open defecation to an unimproved facility.

43 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

6.2 In eight Southern and East African countries The status of, and progress in, sanitation in the eight countries that participate in this project is summarised in the table below:

Table 6. Sanitation in eight Southern and East African countries (WHO/UNICEF, 2014)15

Country Year USE OF SANITATION FACILITIES (percentage of population) URBAN RURAL NATIONAL Proportion of Unimproved Unimproved Unimproved the 2012 population that gained access since 2000 (%) Improved Unimproved Improved Improved Shared Shared Open defecation Shared Open defecation Unimproved Open defecation Unimproved Botswana 1990 61 5 23 11 22 6 20 52 39 5 21 35 19 2000 70 6 18 6 32 8 17 43 52 7 18 23 2012 78 6 16 0 42 11 12 35 64 8 15 13 Ethiopia 1990 19 29 12 40 0 0 0 100 2 4 2 92 18 2000 22 34 17 27 6 2 7 85 8 7 9 76 2012 27 42 23 8 23 7 27 43 24 13 26 37 Kenya 1990 26 40 31 3 24 16 38 22 25 20 36 19 10 2000 29 44 24 3 26 17 38 19 27 22 35 16 2012 31 48 18 3 29 19 35 17 30 26 31 13 Malawi 1990 27 22 47 4 7 4 56 33 10 6 55 29 3 2000 25 20 52 3 8 4 66 22 10 6 65 19 2012 22 18 58 2 8 4 80 8 10 6 77 7 South Africa 1990 75 13 10 2 40 7 26 27 58 10 18 14 19 2000 78 13 7 2 49 9 21 21 65 11 14 10 2012 82 14 3 1 62 12 16 10 74 13 8 5 Uganda 1990 32 49 17 2 25 13 40 22 26 17 37 20 14 2000 32 50 16 2 29 15 40 16 30 19 36 15 2012 33 50 15 2 34 17 40 9 34 23 35 8 Zambia 1990 61 26 10 3 29 7 22 42 41 14 19 26 14 2000 59 25 14 2 31 7 29 33 41 13 24 22 2012 56 24 18 2 34 8 33 25 43 14 27 16 Zimbabwe 1990 54 46 0 0 35 18 0 47 41 26 0 33 3 2000 53 45 1 1 34 17 5 44 40 27 3 30 2012 52 44 2 2 32 16 12 40 40 27 8 25

Although the figures reflect substantial progress in six of the eight Southern and East African countries, only Botswana and South Africa serve more than 50% of the population with an improved sanitation facility. Improved sanitation has come to a virtual standstill in Malawi and Zimbabwe since 1990. The only shift seems to be from open defecation to using an unimproved facility. The figures above might also paint a rosier picture of sanitation services than the actual state of affairs. The figures state how many toilets have been built; they give no indication in what condition these toilets are or how the wastewater and faecal sludge that they collect are managed.

15 Most of the figures (also for 1990 and 2000) have changed from the WHO/UNICEF 2013 update to the 2014 update. The Malawi figures in previous versions seem to have been corrected in the 2014 update. 44 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

The challenges that these countries experience with faecal sludge management in urban and peri-urban areas are similar, but the general state of sanitation differs considerably as the figure below illustrates.

Access to sanitation (% of the population)

Improved Shared Unimproved Open defecation

7 8 5 36% 13 16 13 8 25 37 15 13 35 31 8 27 8

77 27 26 14 23 26 74 13 64

40 43 30 34 6 24 10

MALAWI ETHIOPIA KENYA UGANDA ZIMBABWE ZAMBIA BOTSWANA SOUTH AFRICA

Figure 8. The general state of sanitation in the 8 participating countries (WHO/UNICEF report, 2014)

According to WaterAid (2011)16 , inadequate water and sanitation services are estimated to cost sub-Saharan Africa more than the whole continent receives in development aid – US$47.6 billion in 2009. Water and sanitation health (WaSH) are being side-lined as governments concentrate on health and education, says the WaterAid report. "Meanwhile, people's lack of access to clean water and basic sanitation services is holding back social and economic development in the region, costing around 5 percent of gross domestic product (GDP) every year. The World Health Organisation (WHO) estimated the financial impact of inadequate WaSH facilities by looking at the health issues linked to poor hygiene, child mortality, waterborne tropical diseases, the time people spend collecting water; and reductions in educational achievement due to illness and girls' attendance rates at schools."

16http://www.irinnews.org/report/94241/africa-sub-saharan-sanitation-targets-two- 45 centuries-away THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

7. Country profiles

This section gives a brief overview of on-site sanitation facilities and faecal sludge management in each of the studied countries. In summary, the country reports found the following: 1. Pit latrines are by far the most common on- site facility in informal urban and peri-urban settlements and rural areas. In Botswana, South Africa and Zimbabwe, there has been large infrastructure programmes to supply sanitation that meets the basic standard. Alternative improved options, such as the pour flush, urine-diverting toilet and other eco-sanitation types have been mainly confined to small-scale donor-funded projects. Several research reports mention that the social acceptability of handling and re-using dried or treated faecal sludge or urine on-site remains a challenge. 2. Different types of facilities are called a “pit toilet”. The lack of standardisation adds a layer of complexity to the faecal sludge management process. For example, many pit toilets that the research teams encountered had no slab covering to access the sludge, unlike in South Africa where it is a requirement. Sludge samples, in these cases, had to be obtained through the pedestal (see picture). 3. The rate at which pits fill up in a particular country is a function of many variables, such as pit size, soil quality, groundwater level, the number of people who share the latrine, anal cleansing practices and solid Figure 9. Research team from Ethiopia waste dumped into the pit. It is therefore difficult to plan a pit-emptying programme sampling a pit toilet that would fit all scenarios. Emptying on (Photo: Jimma University). demand seems to be the common approach.

46 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

7.1 Botswana 7.1.1 Main issues Due to Botswana's scarce water resources, the country's population relies heavily on groundwater as a source of drinking water. The drawback of low-cost on-site sanitation facilities is however the potential pollution of groundwater resources (Odirile et al., 2013). According to the country report (2013), most of Botswana's groundwater sources are contaminated by poor faecal sludge management. In 2000, a groundwater quality survey sampled 47 public and private wells in and around Francistown. Analyses showed that nitrate concentrations well above the maximum allowable limit of 45 mg/litre for drinking water in Botswana were frequent within the city area, often reaching values between 100 and 300 mg/litre. Though enviro-loos were introduced to curb underground water pollution across the country, these have not functioned well. Various reports on the evaluation of these technologies show that communities prefer waterborne toilets or the VIP latrine (Odirile et al., 2013). Pit-emptying procedures are not always effective. Pits are often inaccessible to emptying vehicles. Traffic congestion prevents efficient emptying and haulage; emptying services are usually poorly managed. As such, much of the faecal sludge produced, collected, hauled and disposed of in urban centres remains as yet unaccounted for (Odirile et al., 2013). 7.1.2 Types of on-site facilities Pit latrines are the most commonly used form of on-site sanitation in Botswana (Odirile et al., 2013). A double vault VIP latrine was adopted as a standard sanitation facility in urban areas. These latrines can either be ventilated or not, and are fitted with a concrete slab. Similar to South Africa, the Government of Botswana does however, not consider a non-ventilated pit latrine to be adequate. Pit design varies according to terrain, but research found most to be between 1.5 and 2.5 metres deep. Most of the rural BOTVIP latrine designs provide removable cover slabs (Nostrand & Wilson, 1983, as quoted in Odirile et al., 2013). These enable the pit to be maintained, repaired or emptied, if a vacuum tanker truck is available and can get access. 7.1.3 Faecal sludge management practices Although the Water Utilities Corporation (WUC) is responsible for wastewater services, there is no mention of faecal sludge management on the WUC's website. It is also evident from the latest annual report of the WUC that faecal sludge management still requires development: Wastewater services continued to be a burden to the Corporation as they did not generate any revenue, but remained expensive to run. These services were taken over from the former operators without any applicable tariff and the Corporation continued to operate in the same fashion. In a quest to make the service self-financing, the Corporation set out to develop a cost reflective tariff which was still under development by the close of the reporting period. (Annual Report 2013/14:21) According to the country report (Odirile et al., 2013), the following management practices are followed: In urban areas, faecal sludge is collected by individuals in private pick-up trucks. There are no health and safety measures in place. These private emptiers use small or large vacuum tankers. In some instances, the sludge is added to the wastewater stream or combined with wastewater at the wastewater treatment plant, where it is then treated. In other instances, faecal sludge collected from pit latrines and septic tanks is transported to the main wastewater treatment plant, dried in drying beds and sold to the public for use in gardens as manure. In the rural areas, it is not common to remove faecal sludge. Most rural householders will close the pit and relocate their latrine when it is full. The BOTVIP components may be re-used in the new location.

47 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

7.2 Ethiopia The information on faecal sludge management in Ethiopia is based on a survey of 403 households in urban slums in Addis Ababa (Beyene, Hailu, Faris & Kloos, 2015). No conclusions can therefore be made about the rest of the country. 7.2.1 Main issues Due to the fact that 80% of the residents in Addis Ababa live in urban slums (UN-Habitat, 2007), the city has many sanitation problems. 26% of the houses in the city, mostly the peri-urban areas, do not have access to any type of sanitation facilities and thus use rivers, flood ditches and open spaces (Jimma University, 2014). Poor on-site sanitation practices ultimately expose the whole community to the risk of acquiring waterborne and environmental diseases. In Ethiopia, institutional and legal aspects regarding faecal sludge management have not yet been implemented. It is therefore urgent to establish a regulatory basis for proper faecal sludge management in the country (Jimma University, 2014). 7.2.2 Types of on-site facilities Pit latrines are the most common type of low-cost on-site sanitation facility used in the peri-urban areas of Addis Ababa (Jimma University, 2014). The survey found that 63.28% of the households have access to a pit latrine with a super structure, whereas 22.33% use a pit latrine without a super structure. Open defecation is practiced by 8.19% of the households. The other types of sanitation facilities used are a VIP latrine (5.21%) and a pour flush toilet (0.99%) (Jimma University, 2014). 7.2.3 Faecal sludge management practices In the peri-urban areas of Addis Ababa, most of the pit latrines are full (Jimma University, 2014). The disposal of pit latrine sludge is therefore a major concern in the city. The City Government of Addis Ababa Water and Sewerage Authority is responsible for the provision of the city's water supply and sewerage services (Jimma University, 2014). The Authority is also responsible for the construction of shared and public sanitation facilities and sludge emptying services in peri-urban areas. In its business process re-engineering programme, Addis Ababa Water and Sewerage Authority identifies and states that it works closely with the following key stakeholders: Municipality of Addis Ababa, Ministry of Water and Energy, Ministry of Finance and Economy, Addis Ababa Roads Authority, NGOs and Funding Agencies (World Bank, UN-HABITAT, African Development Bank), the Ethiopian Environmental Protection Authority, Addis Ababa Office of Land Administration, Addis Ababa Infrastructure and Construction Authority, Addis Ababa Health Bureau, and Oromia Regional State. The survey did not find evidence of this cooperation. The Addis Ababa Water and Sewerage Authority mostly uses pit emptying trucks to collect and dispose of faecal sludge. Sludge from toilet facilities and septic tanks is transported and disposed of into drying beds near the Kaliti treatment plant and in Kotebe Yerer Ber. The survey indicates that 327 of the households (88.38%) use municipal emptying services whereas 29 (7.84%) connect their on-site sanitation facilities to nearby flood ditches or rivers (Jimma University, 2014). Other faecal sludge management practices include private pit emptying (1.62%), being connected to a sewer system (1.08%), and constructing a new on-site sanitation facility (1.08%). Among the households that use municipal or private pit emptying services only 14.6% were satisfied with the services. The availability of the services (few trucks; three-month waiting period) and high cost of the services (between US$9.30 and US$36.00) were the main reasons for the dissatisfaction. On average, the pit latrines are emptied twice a year, but, due to the severe constraints of pit emptying services, most of the households' sanitation facilities were full (Jimma University, 2014). There were no on-site faecal sludge recovery, treatment or disposal facilities available in the peri-urban areas surveyed (Jimma University, 2014).

48 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

7.3 Kenya The information in the Egerton University report (2014) on faecal sludge management practices is mainly based on information from:  A survey that Losai Management Ltd (2011) conducted with funds from the BMGF in Nairobi, Mombasa and Kisumo;  Another BMGF-funded report (Chowdry & Koné, 2012), which summarises the Losai report; and  Studies by Muchiri (2009) and Sagwe (2010) in the town of Nakuru. 7.3.1 Main issues WHO data shows that diarrheal diseases accounted for 16% of under-five mortality in Kenya in 2006 and 7% of deaths overall. Waterborne sewerage systems are found in the cities of Nairobi, Mombasa and Kisumu, as well as in other larger municipalities, but only 14% of the country's population, living in urban areas, have access to waterborne sanitation systems (MoWi, 2007). Most of the water supply and wastewater collection, treatment and disposal systems have been deteriorating rapidly and fail to meet the water demands of the ever- increasing population. On-site sanitation, on the other hand, is a common mode of disposing of human waste in the peri-urban and rural settlements of Kenya. The faecal sludge of urban households in Kenya that make use of on-site sanitation facilities are disposed into nearby streams, which contaminates ground- and surface water (Egerton University, 2014). Open defecation is down but still widely practiced in rural areas: In 2012, only 3% of the population in urban Kenya practiced open defecation in comparison with 17% of the rural population (WHO/UNICEF, 2014). 7.3.2 Types of on-site sanitation In Kenya, over 70% of sanitation systems are pit latrines, because they are cheap, easy to construct and do not require water (Egerton University, 2014). No distinction is made between improved and unimproved pit latrines, but the report refers to a survey conducted in the town of Nakuru, which found that 49% of respondents used simple pit latrines (Muchiri et al., 2009, as quoted in Egerton University 2014). The study referred to above found that 88% of households in Kisumu have access to sanitation facilities of one type or another, within their compound. In Mombasa, this is 91% whilst in Nairobi it is 85%. Of this, 43% in Kisumu, 62% in Mombasa and 56% in Nairobi, use facilities that may be categorised as safe or hygienic management of human waste (VIP latrine, septic tank, cesspool, and waterborne linked to the sewer system). The average number of users per toilet in Kisumu is 8, Mombasa 4 and Nairobi 12. Of those without access to a sanitation facility at home, 40% in Kisumu and 50% in Mombasa and a lower 20% in Nairobi, dispose of human waste in open spaces, drainage channels and other unsafe sites (Losai Management Ltd, 2011). 7.3.3 Faecal sludge collection and disposal practices The sludge accumulation rates in pit latrines are dependent on the number of users, the type of anal cleaning material, the degree to which the pit is used for disposal of other household waste and the degree to which the pit is drained (Still, 2002). In Kenya, the average sludge accumulation rate is between 25 and 30 litres per user per year varying from as little as 10 litres to as much as 100 litres per user annually. In coastal cities such as Mombasa, pit latrines are shallow due to the high groundwater level and frequent emptying is therefore required (Egerton University, 2014). In Nairobi, and other cities and towns, the task of emptying is mainly the role of the city and local authorities. Most local authorities however lack the specialised equipment and trucks required. In Nakuru, for example, the municipal council has since 2008 stopped providing their mechanical emptying service due to the breakdown of their exhauster truck. Spare parts are not locally available and have to be sourced abroad. As a result, the private sector is left with the responsibility of offering the service. In 1997, with the sponsorship of UN-HABITAT, the Vacutug was developed and piloted in Nairobi, Kenya. The aim was to develop a pit-latrine exhauster that was suitable for areas that were previously inaccessible. Unfortunately, the apparatus developed some mechanical problems in the pilot phase.

49 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

No information could be found on the UN-HABITAT website as to the current status of the Vacutug in Kenya. Pit emptying services, whether mechanical or manual, are in high demand. According to the Losai survey (Losai Management Ltd, 2011), there are 74 trucks operating in the 3 cities (Nairobi, Kisumu and Mombasa) while there are 43 registered operators. In Mombasa, there are operators who do not own vehicles but hire one when they get a client. The truck capacity ranges from 6,000 litres to 22,000 litres. The trucks are strategically displayed and mobile numbers for contact are printed on the trucks. The city authorities in Nairobi, Mombasa and Kisumo require faecal sludge extraction trucks to have a licence and pay a fee. Each truck providing faecal sludge extraction is classified broadly as a sanitation truck and is required to meet certain design and fitting requirements (Chowdhry & Koné, 2012). Manual emptying is usually done in areas that are inaccessible by mechanical trucks – usually slums and informal settlements. In Kenya, manual labour is also being used to empty out the public sanitation blocks or bio-centres (see below), which are located in low-income areas unreachable by trucks. “Given the social stigma, illegality of the work and difficulty of performing this job, many choose to do this in the middle of the night for fear of being arrested or recognized. Some reported needing to use alcohol before starting the work in order to get through it. In Kenya, teams of five workers provide emptying services in the urban informal settlements, and lease the equipment from an umbrella group that rents the equipment to the various manual emptiers operating in the settlements" (Chowdhry & Koné, 2012, p. 46). Eales (2005, p. 3) describes the conditions under which these pit emptiers work as follows: “The job is generally done by men, working in teams of two to four people. Sometimes they begin by pouring paraffin into the pit to override the smell of the excreta. The three men interviewed for this study had no protective clothing, gloves, boots or face-masks. They sometimes use plastic bags over their hands. The waste is removed using a bucket on a rope, and the contents are then transferred to a 100 litre drum. Depending on the nature of the access path, the drum might have to be carried 50 or 100 metres to a handcart, which is used to wheel the waste to a disposal site. The waste is disposed of by emptying it into the sewer system (where there is no structure obstructing the manhole cover), dumping it in a stream, or transferring it to a mechanical desludger for disposal elsewhere.” There are many pit-emptying entrepreneurs in Kenya, but they lack the necessary business management skills, such as accounting skills, to be successful. The report of Chowdhry and Koné (2012) gives financial details of these businesses, including start-up loans. These entrepreneurs are also subjected to the negative attitudes of the community towards pit emptying as a business, expensive registration procedures, and the harassment from local authorities since their activities are often classified as a nuisance (Egerton University, 2014). Studies conducted in Kibera, a peri-urban area in Nairobi, shows that 33% of the households make use of mechanical emptying whereas 28% rely on the manual emptying of their pit latrines. Other techniques used include gravitational emptying where the content of septic tanks is directed to flow to lower water channels by means of gravity (Egerton University, 2014). Pit emptying services are more active in the rainy season, when ingress of storm water tends to fill pits and when it is convenient to dump faecal sludge in full streams. In Kisumu, mechanical emptying costs on average US$52 while manual emptying costs only US$30 (Chowdhry & Koné, 2012). City authorities allow mechanical and manual operators to empty the sludge into manholes once they take it out of the pits after getting a permit. In Nairobi, they must get a permit from the Nairobi Water and Sewerage Company. Faecal sludge collection operators are required to discharge the sludge at designated tipping points that are connected to the sewage lines. 7.3.4 Treatment and re-use practices Nairobi, Kisumo and Mombasa each has two wastewater treatment plants (Chowdhry & Koné, 2012, p. 29). The faecal sludge from the designated tipping points in Nairobi and Kisumu mixes up with sewage and ends up in wastewater stabilization ponds. At the Kisat plant in Nairobi, faecal sludge is conditioned in cold digestion tanks and dried in sludge-drying beds before disposal.

50 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

According to the Losai report (2011), the Mombasa plants are dysfunctional and untreated effluent (including faecal sludge) goes into the ocean. Treated faecal sludge, when available, is sold in Kisumu and Nairobi at a price of US$1.25 to US$1.45 per ton. The main challenges with sales of treated faecal sludge in Kenya are that the product is bulky and not packaged. Logistical problems therefore arise in the transportation and distribution process. Faecal sludge from waste treatment plants is acceptable among the local residents, but they are resistant to the use of dried faecal matter from urine diversion dry toilets (Chowdhry & Koné, 2012). However, faecal sludge re-use in Kenya does take place in what are referred to as bio-centres. The bio- centres are communal toilet and facilities that have been built by the Umande Trust, a local NGO. The toilets generate methane gas (biogas) for local residents17. More than 100 bio-centres exist in the three cities studied (Nairobi, Kisumo and Mombasa). At these bio-centres, faecal sludge generates biogas that is used for cooking purposes at the cooking facilities present at these centres. The bio-centres typically produce 12 m³ gas per day (Chowdhry & Koné, 2012). The Sanergy for-profit enterprise18 operates in a similar way. It designs and manufactures toilets with a sealable container, called Fresh Life. Local residents are their franchise partners. These operators purchase and operate the facilities. Sanergy daily collects the sealable containers and replaces them with clean, empty ones. The faecal sludge is converted at a centralised facility into organic fertiliser and biogas. Sanergy generates about US$1 250 from each toilet from the sale of by-products. The revenue is channelled back to the operators as an incentive to service the toilets (Bayrasli, 2011). These examples of faecal sludge re-use can be regarded as success stories.

17Shimanyula, James (27 October 2014). "Biogas helping to clean up Nairobi slum". Deutsche Welle. Retrieved April 2015. 51 18http://saner.gy/our-work/the-sanergy-model# THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

7.4 Malawi 7.4.1 Main issues According to the USAid country report on water and sanitation in Malawi (2010), the interaction between pit latrines and shallow wells make sanitation particularly problematic in peri-urban areas in Malawi. Financial, managerial and technical capacity are severely lacking at all levels. Between 2010 and 2030, Malawi's urban population is expected to double. The challenge to provide adequate sanitation and efficient faecal sludge management in urban areas will therefore increase (Zeleza- Manda, 2009). 7.4.2 Types of on-site sanitation Pit latrines (simple or improved), with or without a super-structure of logs or a concrete slab over the pit, are by far the most common type of on-site sanitation. For example, a study of 220 households in the Ntopwa settlement in Blantyre (Polytechnic University of Malawi, 2013) found that 92.8% of households use pit latrines, but many of these pit latrines are shared. 54.7% of the households with latrines allow others to use their latrines free of charge. Most people in the settlement are tenants and therefore unwilling to pay for better toilets. 50% of households without a pit latrine cited lack of labour and money as the reason. According to Zeleza-Manda (2009), the adoption of eco-san toilets in Malawi has been slow and very limited to date, except in Malawi Homeless People's Federation villages where adoption is tied to acceptance of Federation membership. For example, in Mgona, a squatter area in Lilongwe City, the eco-san toilet project, which is supported financially by WaterAid and Training Support for Partners19 , is still in its infancy, largely because adoption is a matter of conviction – and many, including government officials, are reluctant to handle faecal matter. In Mgona, fewer than 10 households have adopted the Fossa alterna, about 6 have adopted the Arborloo, while the Skyloo is totally shunned on account of its cost and lack of understanding the operation of the new technology. Even in the Federation villages, some households use ordinary pit latrines “disguised” with a Skyloo super structure. For instance, at Angelogoveya Federation Village, there are 55 pit latrines, some with Skyloo super structures. The reason for the disguise relates to the stigma of touching faecal matter (Zeleza-Manda, 2009). 7.4.3 Faecal sludge management practices 7.4.3.1 Sanitation Systems Pit Latrines According to a survey conducted with 1 178 respondents in nine areas in Malawi's largest cities, Blantyre, Lilongwe and Mzuzu (Zeleza-Manda, 2009), full pits are common for the following reasons: Most housing plots in all nine settlements studied have more than one household living there, and many have more than two households. One of the main ways in which housing in informal settlements has expanded has been through increasing the number of people and households living on each plot. For instance, 8% of plots have between 10 and 55 households (Zeleza-Manda, 2009). Of those who shared toilets with other households, 14.5% shared with two households, 12.6% shared with three households and nearly 3% shared with between 15 and 55 other households. The sharing of toilets may be a major cause of early filling up. While most pit latrines are intended to last for 10 years, experience shows that most stay usable for less than 5 years (Vasquez, 2008), sometimes due to fall-ins especially in sandy soil and water-logged areas. When full, the toilets are supposed to be emptied by special equipment provided by city authorities, but the equipment is often lacking. Blantyre has only one vehicle on the road and depends on hiring another from Luchenza township. Even if the equipment were available, high fees deter clients from low-income communities. For example, the cost of emptying a septic tank in Blantyre is MK10 000 (US$20)20 per load, while for pit latrines it is MK3 000 (US$10.5) per load. In Mzuzu, it costs MK9 000 (US$19). In Lilongwe, where the service has been privatised, pit-latrine emptying costs MK11 000.62 (US$23).

19Training Support for Partners is a process-oriented capacity building NGO registered as a trust. https://www.facebook.com/TrainingSupportForPartnersTsp 201 US dollar = plus-minus 450 Malawian Kwacha 52 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

In the absence of emptying services, and encouraged by large plot sizes, many people simply dig a new latrine when an old one is full. Plot sizes (15 m x 25 m) in planned low-income areas are designed to encourage the digging of successive pit latrines. In the yards of old houses, several pit holes line the backyard, posing continuous danger to children and groundwater (Zeleza-Manda, 2009). According to city authorities, the major hindrance to emptying pit latrines is the illegal nature of developments and congestion that makes it difficult for vehicles to enter the areas. However, while this may be true of squatter areas, evidence shows that little or no such service is provided in areas that are planned and have access roads (Vasquez, 2008). Ecological toilets Because of problems with Arborloos and Fossa alterna, the Malawi Homeless People's Federation then changed to urine-diversion dry toilets (UDDTs), or Skyloos, to avoid or reduce problems of contamination and foul smells. The adoption of urine-diversion dry toilets however has yet to solve all these problems, as the urine, rather than being collected, is diverted into drains or small soak pits at the back of the super structure thereby producing a foul smell for neighbours, and possibly endangering groundwater (Zeleza- Manda, 2009). Observations showed that some of the UDDTs did not have roofs and in the rainy seasons would get flooded, affecting the drying and composting process of faeces. Further, many households do not add ash and soil as recommended: either they use too much soil, leading to early filling up, or the soil it too sandy, leading to poor composting (Zeleza-Manda, 2009). 7.4.3.2 Re-use The first harvest of urine diverting dry toilet or Skyloo manure in Blantyre went at a test price of MK1 000 per 50 kg bag. It was sold to the Blantyre City Parks Department. Because of the value attached to the manure, other organisations are also adopting the technology and there might be potential for the Skyloo technology to be scaled up. Zeleza-Manda (2009) cites a fertiliser manufacturer, Optichem Ltd, which has tested Skyloo faecal manure, and found it to have such high nutrient content that the company ordered 20 tons. 7.4.3.3 Non-government involvement WaterAid in Malawi is strongly committed to addressing the issue of exclusion, to ensure that the poorest and the most vulnerable and marginalised groups, including women and children, have access to clean water and sanitation.

53 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

7.5 South Africa 7.5.1 Main issues Most municipalities and Water Services Authorities do not have operation and maintenance procedures and plans for VIP toilets and it was reported that they had no budgets or plans for ensuring long-term sustainability of VIP toilets (Mjoli, 2010). In the urban areas of South Africa, faecal sludge is usually added to the wastewater stream where it is subject to co-treatment in wastewater treatment plants, as well as waste stabilisation ponds (Mjoli, 2010). The wastewater treatment plants where faecal sludge from VIP toilets is emptied into are often not equipped for proper sludge management. 7.5.2 Types of on-site sanitation The Strategic Framework for Water Services (DWAF, 2003) defines a basic level of sanitation as the provision of a facility, which is easily accessible to a household and should include the sustainable operation of the facility, including the safe removal of human waste and wastewater from the premises when appropriate and necessary, and is inclusive of the communication of good sanitation, hygiene and related practices. The definition of a basic level sanitation service has led to the adoption of the VIP toilet as the minimum acceptable level of sanitation within South Africa (Salisbury et al., 2009). South Africa's groundwater guidelines recommend that pit latrines are located at least 75 m from water sources (Still & Nash, 2002). Based on the 2003 Strategic Framework for Water Services, the Free Basic Sanitation Implementation Strategy (DWAF, 2003) guides Water Services Authorities in “providing all citizens with free basic sanitation by 2014” and aligning their own policies with national policy. Large-scale infrastructure programmes were subsequently implemented to build VIPs to reach this goal. The large-scale construction of VIP toilets also followed from the active bucket eradication programme. In February 2005, the bucket sanitation backlog in formal townships was estimated at 252 254 buckets (DWAF, 2009). Former President Mbeki, in his state of the nation address of February 2006, set a target for the eradication of all pre-1994 sanitation buckets from the formal townships by December 2007. In reality, the achievement of the minimum standard for sanitation is less favourable than official figures indicate:  In 2007, the then Department of Water and Forestry commissioned the CSIR to conduct a national audit of water and sanitation projects (SALGA, 2009). The audit reported that, of the 2,410 on-site sanitation projects, only 41% had actually been completed. Approximately 25% of on-site toilets were inadequately designed for ventilation.  68% of on-site top structures were constructed in a way that meant they could not be mobilised when the pits were full.  At 60% of the facilities, municipalities were only conducting reactive maintenance; and 40% of municipalities had inadequate maintenance capacity (SALGA, 2009; DHS, 2012).  Furthermore, the construction of VIP toilets was carried out without putting in place any plans for emptying the full pits as the national sanitation policy did not provide guidelines on how municipalities should deal with full pits. 7.5.3 Faecal sludge management practices 7.5.3.1 Collection and disposal Presently there are two options available to the owners of single pit VIP toilets when these become full. Users can either empty the full pit or construct a new toilet on an adjacent site (Bester & Austin, 2000; Thye et al., 2009; Still & Foxon, 2012). Alternatively, if the pit is full, municipalities provide a new VIP or an agent is added to the pit contents to liquefy the sludge. Then a vacuum tanker removes as much sludge as possible. Most municipalities and Water Services Authorities use a vacuum tanker to empty septic tanks.

54 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

Water Services Authorities often experience problems in providing a reliable, effective and affordable mechanised service to empty pits in unplanned urban settlements, as well as rural areas as tanker trucks often cannot reach households which need to be serviced because roads are poor and paths are too narrow (Bester & Austin, 2000; Still & Foxon, 2012). Furthermore, households do not always have the funds to pay for mechanised pit emptying, using cheaper manual pit emptying methods as an alternative. Some municipalities provide additives to slow down filling despite evidence that the additives have little effect. For example, the Alfred Nzo District Municipality treats 20 000 urban pit toilets monthly with additives (Rhodes University, 2014). 7.5.3.2 Treatment and re-use In the urban areas of South Africa, Water Services Authorities use various treatments and disposal methods for dealing with highly concentrated pit sludge from VIP toilets. The figure below gives an overview of methods and implications.

Highly concentrated pit latrine sludge

Anaerobic Y Regular digestor emptying?

N Dumping N On-site N Nutrient N Treatment? disposal? re-use? Sewer Y Y discharge Y Setling-thickening tanks Raw faecal sludge acceptable? Shock loading Anaerobic, Pit N of wastewater burial facuitative & Co-compost treatment plant maturation ponds with organic Y Deep row solid waste entrenchment Sludge drying bed

Non-edible Environmental Aquaculture Agriculture biomass pollution Figure 10. Overview of available treatments and disposal methods of faecal sludge in South Africa (Radford et al., 2011)

Vacuum tanks usually dispose of faecal sludge at the municipal wastewater treatment plants. In a number of municipalities, these plants struggle to meet regulatory requirements. Part of the problem might be the vacuum tanks that discharge their sludge into the inlet structure of the wastewater treatment plant. This might cause shock loads. There seems to be little experience regarding the treatment process and there are no established strategies to deal with problems (Berner et al., 2013). See also the experience of eThekwini in this regard below.

55 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

The figures below (Snyman, 2007)12 summarise sludge treatment technologies at municipal wastewater plants in South Africa.

None 17%

Belt filter press 29%

Centrifuge 5% Drying beds 36% Paddies 9% Lagoon 4%

Figure 11. Dewatering technologies employed in South Africa (dry mass % as base)

Aerobic digestion 3% Composting 19%

Pelletisation 4%

None 74%

Figure 12. Tertiary treatment and additional stabilisation technologies employed in South Africa (dry mass % as base)

21 If the data for dewatering technologies is reworked to represent the number of plants rather than the dry mass percentage, the figures are significantly different. Drying beds are used at 45% of the plants followed by belt filter presses (15%), ,centrifuges (5%), paddies (9%), lagoons (4%) while 24% of the plants employ no 56 dewatering (Snyman, 2007). THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

Composting is used by both metropolitan city councils and plants in smaller towns while pelletisation is only employed by large metropolitan councils, which is why the mass percentage is relatively high (19%). Only 9% of the number of plants surveyed composted the sludge (Snyman, 2007). Final disposal methods employed by the wastewater treatment plants surveyed in South Africa are still dominated by on-site disposal methods. This includes direct land application and stockpiling of the sludge on site. The beneficial use of sewage sludge includes the use of the sludge by the local municipality or farmers to generate compost, using it as the bottom layer for golf courses or using it to cultivate instant lawn. In some cases, the sludge is sold or given to a contractor in exchange for bulking agent (Snyman, 2007). 7.5.4 eThekwini Metro 7.5.4.1 From manual emptying of VIP latrines to UDDTs The eThekwini Metro municipality in KwaZulu-Natal has initiated several bold and innovative large- scale projects to manage faecal sludge22 . These projects generated valuable lessons for other cities in Africa and other developing countries. eThekwini Metro comprises the city of Durban and the surrounding peri-urban and some rural areas. It has a population of just over three million. With VIP toilets as the preferred basic sanitation option in informal settlements and peri-urban areas, a sustainable pit emptying service is crucial. In 2005, the city had 100 000 VIP pit latrines in its area. The municipality made a commitment to empty pits at least once every 5 years. That meant emptying 20 000 pits per year, which was a huge challenge. Mechanised emptying was found to be expensive; often the site could not be accessed and the process could frequently not deal with heavy sludge and solid matter found in the pits. The municipality then embarked on a large-scale manual emptying programme in collaboration with the private sector. Cost remained an issue. At the time, the municipality charged R80 to empty a pit, but the actual cost could be up to R1 000. The municipality subsidised the balance. This was obviously not sustainable in the long term. Therefore, the municipality had to reconsider its infrastructure solution for sanitation in previously unserved peri-urban and rural areas. A limited water supply meant that it had to be a dry sanitation system. Subsequently, the municipality embarked on a project that installed a urine diversion dehydration toilet (UDDT) and a yard tank, filled free of charge with 9 kℓ of water per month in an estimated 74 606 households in 65 areas (Roma et al., 2013). In 2011, the eThekwini municipality conducted a survey with 17 449 householders in 65 areas. The purpose of the survey was to evaluate the use and conditions of UDDTs. 80% of households reported that they always use the UDDTs. 14% had a pit latrine in close proximity. Satisfaction with the UDDTs was disappointing: 70% reported dissatisfaction; bad smell was the most critical challenge. Interestingly, there was a correlation between dissatisfaction and households that have a pit latrine on the plot. The researchers concluded that the pit latrine's closer proximity to the house might contribute to the perception. Awareness of the economic benefit of the UDDT was found to be low. The research recommended that acceptance could be improved if users understand the importance and potential of waste as a useful resource (Roma et al., 2013). 7.5.4.2 Treatment When a WRC study (Bhagwan et al., 2008) confirmed the municipality's experience that co-treatment of large volumes of faecal sludge with municipal wastewater in activated sludge wastewater treatment plants could lead to operational problems, eThekwini Metro started to experiment with alternative treatment options. Deep row entrenchment was adapted for faecal sludge23 (Still et al., 2012). The results were positive: Limited nitrate leaching was found in the soil and tests conducted in the area showed that surrounding groundwater bodies remained free from pollution. It also appeared that the fast growing trees took up the additional nutrients. However, environmental regulations will only allow deep row entrenchment for pit sludge disposal at pilot scale in the near future (Still et al., 2012).

22http://www.infrastructurene.ws/2013/01/09/tackling-durbans-sanitation-crisis-head-on/ 23Deep row entrenchment consists of digging deep trenches, filling them with sludge and covering them with soil. Trees are then planted on top, which benefit from the organic matter 57 and nutrients that are slowly released from the FS (Roma et al., 2013). THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

eThekwini Water and Sanitation also combined drying and pelletizing faecal sludge. The method is called LaDePa (Latrine Dehydration and Pasteurisation). The LaDePa system was developed in conjunction with the municipality's technology partner, Particle Separation Systems. The pellets can be sold and used as a fuel or as a soil amendment. 7.5.4.3 Sharing lessons learnt eThekwini had many lessons to share from its faecal sludge management programme. The municipality set up MILE (the Municipal Institute of Learning) in Durban, South Africa, to transfer knowledge and experiences to other municipalities throughout Africa. MILE offers training courses and field visits on a regular basis with funding from the United Nations Institute for Training and Research (UNITAR) and the municipality. eThekwini Water and Sanitation also partners with municipalities throughout Africa to share knowledge and bring about improvements in service provision. The senior management of eThekwini Water and Sanitation also interacts and shares experiences with the management of other water and sanitation organisations in low- and middle-income countries with funding provided by the Water and Sanitation Programme of the World Bank (Strande et al., 2014).

58 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

7.6 Uganda 7.6.1 Main issues The situation in Kampala is typical of all the urban centres of Uganda: A large proportion of the population lives in low-income informal settlements. Due to rapid population expansion, general disregard of proper urban planning and failure to adhere to existing construction guidelines, only 10% of the city's population is connected to the sewer lines of the National Water and Sewerage Corporation (Makerere University, 2014). According to an earlier study by Water for People (2013), there is a shortfall of 63% in the supply of pit emptying services in Kampala (Musabe & Nsubuga, 2014). As a result, sanitation provision in Kampala is grossly deficient: most people do not have access to a hygienic toilet and large amounts of faecal waste are discharged to the environment without adequate treatment (Hutton et al., 2007). According to Musabe & Nsubunga (2014), the main issues with sanitation services and faecal sludge management are the following:  Local authorities do not provide standard latrine designs.  Lack of price regulation for emptying services.  Lack of faecal sludge transfer stations and decentralised treatment facilities, which makes faecal sludge transport very expensive for operators.  Limited re-use of treated faecal sludge.  Lack of technical skills to develop faecal sludge management technologies and logistics. The majority (70%) of Kampala's poor households are tenants (Günther et al., 2011). Landlords are often absent and tenants are unwilling to spend the little money they have on upgrading sanitation facilities (Musabe & Nsubuga, 2014). 7.6.2 Types of on-site sanitation The pit latrine is the simplest and most common excreta disposal system in Uganda. According to the Uganda National Household Survey (2010), 89.2% of households own pit and VIP latrines; 2.2% own flush latrine facilities and 8.7% do not own a toilet (Musabe & Nsubuga, 2014). Most pit latrines in Kampala are communal and shared among different types of households. On average, one pit latrine is used by 30 individuals or 7 households. Günther et al. (2011) noted that only 22% of households have access to private sanitation facilities and this explains, according to them, why only 47% of the sanitation facilities are clean enough to be used properly. In addition to human excreta, pit latrines are also used to dispose of a whole range of other products including sanitary towels, diapers, broken bottles and plastics. This may shorten the filling time of the pit latrine. 45% of latrines are abandoned after 5 years because they are full or broken down (Günther et al., 2011). Other types of on-site facilities used in the city include (Makerere University, 2014): 1. Flying toilets: The use of polythene bags for disposal of faecal matter, which is thrown into drainage channels or any other place like rooftops and roadsides. This is common in the majority of the slums around Kampala. 2. Double storey pit latrines: These are built in swampy areas where toilet pits cannot be sunk without water filling up. The only solution they have is to build a tank-like structure on the soil surface with stairs to climb up to the seating area. These tank-like structures have an outlet at the bottom, which they can easily open and close. This outlet is normally opened when it is raining to allow the pit content to flow with the run-off. Some of these pits are lined with cement to prolong their lifespan. Some are built as VIPs and others like simple pit latrines.

59 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

3. Eco-san toilets: Uganda has initiated several programmes to generate useful products from human faeces and improve hygiene through eco-san toilets. Some communities in Uganda have been found to be very sceptical about eco-sanitation in general and the use of faecal products as soil fertility enhancers. The unwillingness to use fertilisers from human faeces was attributed to a lack of knowledge, fear of associated health risks and cultural beliefs. The use of UDDTs is new. Acceptance is problematic, due to ash shortages. Ash is used to cover the faeces. Some of the eco- san toilets have been abandoned without using them. 7.6.3 Faecal sludge management practices The city of Kampala is characterised by illegal sanitation practices, lack of regulation and enforcement, and the limited functionality of wastewater treatment works, all of which have impacted negatively on the sanitation situation and caused contamination of water resources. The enforcement of by-laws varies considerably and public sector capacity to do this is weak. Moreover, efforts to improve urban sanitation are highly fragmented, and mandates are not fully adhered to. Consequently hygiene, the environment, and the water quality of and around Kampala are all seriously threatened by the inadequate sanitation services (Makerere University, 2014). 7.6.3.1 Practices to control odour and improve decomposition Odour is a major problem with toilets. The practices below are quoted in the country report (Makerere University, 2014) and illustrate that people need a simple, cost effective method to control odour. Unfortunately, not all methods are effective and some inhibit natural decomposition in the pit latrines:  Effective microorganisms (EMO). This seems to still be in an experimental stage (Makerere University, 2014).  Some people throw used radio cells in pit latrines with a belief that these used cells will react with the faecal matter and reduce its volume, thus controlling the filling-up of the pit.  Others pour used motor vehicle oils into the pit latrine to control odours and flies. This probably works because the oil floats on top of the liquid part of the pit content and cuts off the supply of oxygen to maggots and other micro-organisms that need oxygen. 7.6.3.2 Pit emptying practices The following pit emptying techniques are used in Kampala (Makerere University, 2014):  Trucks locally referred to as ‟kabuyonjo”, which are equipped to empty pit latrines by suction. The pit content is then either taken to a treatment plant or disposed of at another place convenient to the truck operator. Most trucks are imported. High costs and import tax, plus difficulty to get spare parts, create shortages and broken down trucks.  The gulper is a new pumping tool that can reach pit latrines not accessible for trucks. It is promoted by Water for People and has been used successfully in experiments.  Manual emptying.  Wetland emptying: This method is used in storeyed pit latrines located in wetlands. The faecal waste outlet is opened when it rains to allow pit content outflow to run off. Swopping is a variation on the traditional pit-emptying practice. This method is used by people who have two pit latrines. When the one latrine gets full, the second pit latrine is opened for use. By the time the second one gets full, the faecal matter in the first pit is assumed to have stabilised with low levels of pathogens. The first pit is emptied before it is re-used, closed and the cycle continues (Makerere University, 2014). Faecal sludge that is emptied manually is usually buried. A pit is dug near the pit latrine to be emptied and the faecal matter is put in there and then covered with soil (Makerere University, 2014). Faecal sludge that is removed from the plot through manual or mechanical means is disposed of at designated wastewater treatment plants. Operators need a licence to transport faecal sludge, but this is seldom enforced (Musabe & Nsubuga, 2014).

60 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

7.6.4 Treatment and re-use Most of the wastewater treatment plants are designed for wastewater treatment and not faecal sludge. Overloading of plants has been reported at some of the plants (Musabe & Nsubuga, 2014). The Makarere University report (2014) mentions composting and incineration as treatment methods in Kampala, but no details are given. The city of Kampala is currently building two faecal sludge treatment plants with a capacity of 200 m³/day each, one at Lubigi and another one at Nalukolongo. A donor-funded project, FaME (one of the SPLASH projects), will be piloting the use of faecal sludge to fuel brick kilns at the Lubigi plant in Kampala (WIN- SA, 2014; EAWAG, 2014). A study by GTZ (2010) shows that attitudes toward the re-use of faecal sludge probably also affect the success of re-use technologies. Small-scale farmers in Uganda, who cannot afford to buy commercial fertilisers, would be willing to use excreta and urine, provided they didn't have to incur transport costs. The medium scale farmers were also willing to use faeces and urine, but considered the collection process tiresome and would prefer a distribution scheme or company to do it. On the other hand, large-scale farmers did not think it was economically viable to use human waste and would prefer to use commercial fertiliser due to the high ratio of nutrients to weight. Ogwang, quoted in the Makarere University report (2014), advised that human faeces would be more acceptable as fertiliser if blended with animal waste.

61 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

7.7 Zambia This country report refers to on-site sanitation in Lusaka only. 7.7.1 Main issues Most of the areas of Lusaka without sanitation services rely on groundwater (boreholes) as sources of water. Two major concerns arise. Firstly, most plot sizes are small: rarely going beyond 1000 square metres. This puts boreholes in close proximity to soakaways. Secondly, the geology of Lusaka is mostly dolomite, which has a low pollution attenuation capacity. This implies that with continued use of on-site sanitation systems, most of the city's ground water will get contaminated and the likelihood of disease outbreaks will increase (Tembo & Nyambe, 2013). 7.7.2 Types of on-site sanitation In most high density, low income urban areas of Lusaka (mostly peri-urban areas), disposal of excreta via sewerage systems is non-existing. High connection charges are often a prohibiting factor. This leaves on-site sanitation systems as the most common form of excreta disposal – 70% of the population use on site sanitation facilities. The common types are:  Septic tank systems;  Pour Flush latrines;  Improved single-pit latrines;  Ordinary Pit latrines;  Ventilated Improved Pit (VIP) latrines; and  Eco-san toilets (Urine Diversion latrines). In most peri-urban areas, pit latrines are the most common means of excreta disposal. Where financial resources are available, an improved single-pit latrine (provided with structurally safe squatting plate and super structure) is constructed. However, the majority of pit latrines are of a very poor quality with some just comprising a hole in the ground and a basic super structure (Tembo & Nyambe, 2013). 7.7.3 Faecal sludge management practices Formal emptying of septic tanks is done by registered enterprises that use vacuum trucks or tankers. In this case, the emptying is usually at one of the city's treatment plants with Manchinchi conventional wastewater treatment plant being the most used for this purpose. Where the septic tanks are emptied informally, unregistered individuals carry out the task. In this case, chemicals are sometimes added to the contents of the tank to fluidise it. Removal is through scooping using different types of improvised tools. The scooped out contents will then be buried in a pit specifically dug to receive the tank contents without any form of treatment. In a few cases, HTH (a commercial dry chlorine product) will be added to the contents as a way of disinfecting (Tembo & Nyambe, 2013). Years back, the pit emptying was done by the local authority (Lusaka City Council). Unfortunately, the local authority could no longer sustain this service. The result was accumulation of solids in the tanks, which eventually got into the small-bore24 sewers. This resulted in clogging since the sewers were not designed to transport the solid component of wastewater. Consequently, overflows on the streets became common. Recently, a Community Based Enterprise (CBE) calling itself “The Dream Team”, managed by a Water Trust in one of the settlements (Kanyama) has mobilised local residents to start a formal pit latrine desludging enterprise. They are using modified scooping tools to empty the pits. The scooped faecal matter is loaded into 60 litre barrels on push-carts. The contents are discharged at a biogas producing facility, which is managed by a Water Trust. This service is offered at a cost of about US$50 per 1 to 12 barrels scooped. For barrels between 13 and 24, the charge is US$65 (Tembo & Nyambe, 2013). Most of the eco-san facilities in Lusaka are emptied by individuals. Emptying is usually done at night. A pit will be prepared during daytime in readiness for the vault contents. The pits are usually dug just in front of the vault doors. After the contents has been offloaded into the pit, the pit is covered with soil and the cycle is repeated.

24Simplified sewerage, also called small-bore sewerage, is a sewer system that collects all household wastewater (WC wastes and sullage) in small-diameter pipes laid at fairly flat gradients. Small-bore sewerage is prone to blockages if not managed 62 properly. http://en.wikipedia.org/wiki/Simplified_sewerage THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

7.8 Zimbabwe 7.8.1 Main issues Historically, Zimbabwe had a dual sanitation policy: waterborne sanitation linked to a sewer system for urban areas and the indigenous Blair VIP latrine for rural areas. The Blair VIP latrine was developed by the Blair Research Institute, now called the National Institute of Health Research. Up to about the year 2000, Zimbabwe had a robust water and sanitation sector in urban areas, with modern, highly mechanised, and well designed and functional sewer networks and wastewater treatment works. The latter consisted mainly of biological nutrient removal systems, trickling filters and waste stabilisation ponds. However, these systems are currently either totally non-functional or only partially functional, because local authorities are struggling to operate and maintain the highly mechanised and technically complex energy- demanding sanitation systems (Bangira et al., 2014). As a result, most of the wastewater treatment plants currently simply bury sludge on site, contaminating groundwater (Bangira et al., 2014). The rural water, sanitation and hygiene sector had an impressive record of researching and implementing rural sanitation programmes, with the Zimbabwean designed Blair Ventilated Improved Pit toilets being built in large numbers, mainly through donor-assisted funding mechanisms. The considerable donor support (up to 5 bags of cement per family) had to be matched by a large contribution from the family (bricks, labour, paying an artisan). This design did not focus on the re-use of sludge or on the emptying of pits, as one would have had to dismantle the toilet physically to easily access the pit contents (Bangira et al., 2014). Half a million units were built, serving an estimated three million people. The programme was promoted vigorously by the Environmental Health Department of the Ministry of Health. The was built in households and as multi-compartment units at schools, clinics and other institutions. No consideration was made to the issue of pit emptying and faecal sludge management. A new set of toilets was simply built when the old set was full. When donor support faded, the number of units built rapidly declined. The standardised Blair VIP latrine was too expensive for most families to build themselves (Bangira et al., 2014). Since the 1990s, years of drought, political, economic, and social upheaval brought economic challenges that saw high unemployment25 . This pushed people into the informal economy and migration from rural to urban areas increased (Bangira et al., 2014). Following the National Land Reform Programme in 2000, there has been a rise in peri-urban and informal settlements in and around major towns and cities. National policy stipulates that only waterborne sanitation is allowed for urban areas. But, urban centres cannot afford or sustain waterborne sanitation in these settlements. In the absence of donor support, the possible improved alternative, the Blair VIP latrine, has also become unaffordable. As a result, no sanitation (and water) services are provided in urban and peri-urban informal settlements. In cases where these services are provided, they are in the form of public latrines that are used by large numbers of people (Bangira et al., 2014). Faecal sludge accumulates and there is no policy or formal management guidelines in place to deal with the situation (Bangira et al., 2014).

25Unemployment figures found in the literature, range from 10% (the official figure, 63 based on a 2011 survey) to as high as 95%. None of these figures seem to be reliable. THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

7.8.2 Types of on-site sanitation In the absence of formal service delivery, informal settlement dwellers dig their own unimproved pit latrines or defecate in the open. NGOs in Zimbabwe have repeatedly ignored legislation and promoted and constructed various forms of eco- friendly on-site sanitation facilities. A case in point is the work of the Mvuramanzi Trust in the peri-urban informal settlements of Hatcliffe extension, Dzivarasekwa extension and Porta Farm since 1999. By 2002, about 1650 ecological pit latrines had been built with the intention that the pit contents (after proper storage) would be used as a soil conditioner. The Mvuramanzi Trust built Arborloos (shallow pit toilets), Fossa alterna and Skyloos (urine diversion toilets) at individual homesteads, and some urine diversion toilets at institutional premises (Bangira, et. al., 2014). 7.8.3 Faecal sludge management practices Currently there is no policy in place on the emptying of pit latrine toilets. Most of the settlements are relatively new and it appears that the pits have not yet filled up, although a crisis is looming, given that the pits may fill up soon. The current practice is that when a pit is full, the latrine is simply abandoned, and a new one is constructed adjacent to it. However, challenges due to space have been encountered given the small stand sizes (Bangira, et. al., 2014). In the town of Chinhoyi, 115 km from Harare, the NGO Homeless People's Federation assisted a community to build Skyloo and Fossa alterna latrines. The Skyloo serves a household of six. They can use each vault (roughly 1 square metre volume) for 1 year and 6 months, after which a layer of topsoil is put on top, the vault is sealed and left to compost for a further 6 months before the contents are extracted. The community is organised into a club, which centres on the management of these latrines and disseminates educational material, besides also assisting others with no latrines to set up their own (Bangira et al., 2014).

64 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

8. Conclusions

Most sub-Saharan countries are characterised by high population increase rates and rapid urbanisation. An ever increasing number of people flock to informal settlements in and on the outskirts of cities and towns. Governments and local authorities specifically fail to keep up with service provision. In many cases water, sanitation and solid waste removal services do not ensure environmental sustainability. Because there is no alternative, most people in these informal urban and peri-urban settlements make use of unimproved on-site sanitation, creating large amounts of faecal waste. Faecal sludge management is often hopelessly inadequate. As a result, large quantities of faecal sludge are discharged to the environment without treatment. This creates unhygienic living conditions and is likely to increase the outbreak of infectious diseases, such as diarrhoea, worm infestation, typhoid, cholera and dysentery. The challenges surrounding faecal sludge management affect all aspects of the sanitation value chain.

8.1 Policy and legislation In all the studied countries, a range of ministries has policies and acts that relate to sanitation. These policies and legislation have broad sanitation objectives; however, few mention faecal sludge management and its aspects specifically. Targets and timeframes, if set, are for sanitation facilities. Sanitation regulation is complicated by overlapping lines of authority between different government departments (Bahri, 2012). For example, in South Africa, eThekwini Metro's successful pilot with deep-row entrenchment cannot be upscaled, because environmental legislation prohibits the large-scale use of faecal sludge in deep-row entrenchment. Focus areas:  National policy and legislation that specifically deal with faecal sludge management.  Aligning policy and legislation across different government departments.

8.2 Responsibilities, capacity and funding As mentioned above, the responsibility for sanitation tends to overlap between a range of government ministries and agencies. In most of the studied countries, these ministries include the Departments of Water Affairs, Environmental Affairs, Local government, Health and Education26 . However, in practice, it is usually the local authority (under different names), which is ultimately responsible for faecal sludge management. In most instances, the high-level policies and legislation do not link sufficiently to by-laws and implementation at local level. National budgets allocate significantly more to water than to sanitation. The focus of sanitation budgets is mainly on the provision of sanitation facilities, and less on operation and maintenance. As a result, local authorities do not have enough budgeted funds for faecal sludge management. Also, capacity for implementation and law enforcement at local level seem to be generally weak. Donor funding and other aid to sanitation go mainly to infrastructure development and health and hygiene education.

26 65 Each country has its own name for these Ministries. THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

Focus areas:  Is the responsible authority supported by the necessary by-laws and implementation strategies?  Is the responsible authority equipped with an adequate budget and capacity to manage faecal sludge efficiently and enforce by-laws?  If not, can this be addressed or should one look at an alternative responsible authority, such as an urban or a national water and sanitation utility? To what extent can faecal sludge management be privatised?

8.3 Standards for on-site sanitation facilities Pit latrines are the most commonly used on-site facility in the studied countries. Yet, only South Africa, Botswana and Zimbabwe have a clear minimum standard for an improved pit latrine (VIP, BOTVIP and Blair VIP). Unfortunately, standards are not always applied consistently when these toilets are built. It is commonly acknowledged that pit latrines could contaminate groundwater in certain circumstances. Yet, the literature gives disparate guidelines on the safe distance between a pit latrine and a water source (Graham & Polizzotto, 2013). Pit latrines, even if it is a VIP that is not full yet, continue to be an unpleasant solution due to odour, flies and safety. In practice, eco-san alternatives, such as the urine diversion dehydration toilets (UDDTs) do not seem to resolve the issue of odour and flies (Roma et al., 2013). The literature on faecal sludge management abounds with pictures of dirty and blocked toilets, but the literature does not indicate to what extent this problem is an engineering problem or an operation and maintenance problem. All over the world, from households to public spaces, thousands and thousands, probably millions, of cleaners, mostly women, have to clean toilets after they have been used. When users do not clean up their own urine and faeces spills on the seat and the floor, or faeces sticking to the inside of the bowl, someone has to clean up behind them. If no-one takes this responsibility, and disinfectant and cleaning materials are unaffordable or absent, any toilet, whether waterborne or a pit latrine, will smell and become unhygienic to use. Nowhere in the literature have we seen this problem, which is also a gender one, being addressed directly. The country reports do not make a link between open defecation and dysfunctional or unhygienic toilets. It is likely that open defecation will continue to be practised in Africa as long as there are toilets that are dysfunctional or unhygienic. Focus areas:  A uniform standard for an improved pit latrine.  Clear standards on the safe distance between a pit latrine and a water source.  WASH campaigns that include educating children and adults (males and females) to be responsible and hygienic toilet users and cleaners.  The sanitation value chain

66 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

8.4 The sanitation value chain

CAPTURE STORAGE TRANSPORT TREATMENT RE-USE

Figure 13. The sanitation value chain (Bill & Melinda Gates Foundation, 2010)

All along the value chain, current technology and faecal management practices present serious challenges: 8.4.1 Full pits The time that it takes for pits to get full is a function of a number of factors that are well documented in the literature. The presence of solid waste in the pits is one of the main contributing factors. Education programmes might improve the situation, but unless the responsible authority removes solid waste regularly from informal settlements, it is unlikely that this problem will be resolved. 8.4.2 On-site disposal On-site disposal (with or without treatment) of faecal sludge has not yet been resolved. The practice to close a full pit and dig a new one is only feasible on large stands, but this could increase the risk of groundwater contamination. On-site treatment and re-use, such as with the urine diversion dehydrating toilets, still has a long way to go to become acceptable, if ever. 8.4.3 Pit-emptying and transportation Mechanical and manual pit emptying services remain challenging for a number of reasons, which are also well documented in the literature: exposure to pathogens, sludge remaining in the pit, access, the consistency of the sludge, mechanical problems with suction, cost, etc. Currently, if the owner of the toilet does not or cannot pay for the service, the service is not sustainable. Some of the faecal sludge collected from pit latrines is legally added to the wastewater stream or taken to treatment facilities. Unfortunately, because of long distances to treatment facilities and cost, an unquantified but large proportion is illegally dumped in rivers, streams, the ocean or open spaces, creating a health hazard.

67 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

The figure below illustrates this for Dakar, Senegal.

Sanitation markets in Dakar (volume of Faecal Sludge in m3 per year)

Production Estimated annual production (2012): 1,565,911 m3 (-25% / +50%)

On-site sanitation: ~1,017,842 m3 A Off-site sanitation (-25% / +50%)

Semi- Open Pit Septic tanks collective Sewers defecation latrines Collection 58% (small-bore) 35% ~ 0% 2% 5%

~ 441,708 m3 Remains B (-25% /+50%) in latrine (10%) Unquanitfied Manual emptiers & Mechanical emptiers Transport others (family)

C 218,149 m3

Unquantified but potentially Faecal sludge Wastewater Treatment large treatment plants treatment plants

D Demand to be created Unquantified but Disposal Burying / unsafe disposal in limited the neighbourhood (620 m3 in 2008) Sea outfall

Treated dry FS Treated dry FS Re-use for end-use sold for end-use sold to industries to local farmers

Figure 14. Unsafe faecal sludge disposal in Dakar (2012)27

8.4.4 Treatment, disposal and re-use The literature points out that existing faecal sludge treatment plants and wastewater treatment plants in the studied countries are often dysfunctional. Large amounts of faecal sludge exacerbate the issues that these treatment plants have to deal with. On the other hand, the country reports cite several examples of successful pilot projects with innovative faecal sludge treatment and re-use technology, for example, the biogas projects of the Umande Trust in Nairobi and the Dream Team in Zambia.

27Source: FaME project. http://www.slideshare.net/tremoletconsulting/fame-presentation- 04112014-vf 68 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

Faecal sludge is a valuable resource that is still largely unexplored. For the future, it will be essential to research and develop further the potential economic value of faecal sludge for biogas or fertiliser or other applications. Focus areas:  Solid waste removal services to informal settlements. Privatising recycling services might work.  A cost effective and safe alternative for the pit to solve the problems with pit- emptying and potential groundwater contamination.  Research and development of financially viable and scalable solutions for the re-use of faecal sludge. The cost-benefit calculation must reverse the money flow, i.e. pay toilet owners or collectors in money or by-products for faecal sludge.  Supportive policy and legislation, and micro financing for the private sector to invest in these solutions. It is evident that these challenges and the areas to be addressed listed above call for an integrated management solution that can turn faecal sludge from waste to resource on a large scale.

69 THE STATUS OF FAECAL SLUDGE MANAGEMENT IN EIGHT SOUTHERN AND EAST AFRICAN COUNTRIES

9. References

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74 This report emanates from country reports from the Sanitation Research Fund for Africa (SRFA) Project.

Obtainable from

Water Research Commission Private Bag X03 GEZINA, 0031

[email protected] or download from www.wrc.org.za

For more information:

Dr. Sudhir Pillay

Water Research Commission Marumati Building Pretoria South Africa [email protected]

Other WRC reports that may be of interest:

· 1745/1/12

· 1745/2/12

· 1745/3/12

· 2381/P/15

These reports are available on www.wrc.org.za