The Social and Health Costs and Benefits of Faecal Sludge Composting 54

THE SOCIAL AND HEALTH COSTS AND BENEFITS OF

FAECAL SLUDGE COMPOSTING: A CASE OF KAMPALA CITY,

UGANDA

NELSON MUWEREZA

REG. NO: 2012/HD02/54U

A THESIS SUBMITTED TO THE DIRECTORATE OF RESEARCH

AND GRADUATE TRAINING IN PARTIAL FULFILLMENT OF

THE REQUIREMENTS FOR THE AWARD OF THE DEGREE OF

MASTER OF SCIENCE IN AGRICULTURAL AND APPLIED

ECONOMICS OF MAKERERE UNIVERSITY

OCTOBER, 2016

DECLARATION

I NELSON MUWEREZA, HEREBY DECLARE TO THE BEST OF MY KNOWLEDGE

AND UNDERSTANDING THAT THE ORIGINALITY OF THIS THESIS IS MY WORK,

AND HAS NEVER BEEN PRESENTED IN MAKERERE UNIVERSITY OR ANY OTHER

UNIVERSITY FOR THE AWARD OF A DEGREE.

Signature ...... Date ......

NELSON MUWEREZA

THIS THESIS HAS BEEN SUBMITTED WITH PERMISSION AND SATISFACTION FROM

UNIVERSITY SUPERVISORS

Signature ...... Date ......

FIRST SUPERVISOR: PROF. DICK SSERUNKUUMA

Signature ...... Date ......

SECOND SUPERVISOR: DR. GRACIOUS M. DIIRO

Signature ...... Date ......

THIRD SUPERVISOR: DR. SOUMYA BALASUBRAMANYA

DEDICATION

To my parents, Late Muwereza Jacob and Betty Basilica; brothers and sisters, Robert, Juliet,

Scovia, Ezra, and Cissy; sweet heart Joanita

ACKNOWLEDGEMENT

I would like to thank my supervisors, Prof. D. Sserunkuuma, Dr. G. M. Diiro and Dr. S.

Balasubramanya for their in-depth review of this thesis. I greatly appreciate the support, guidance, time and effort they were able to spend on the thesis despite their busy schedule.

Great thanks go to the Viva Voce panel for the insightful comments and recommendations which helped to shape this thesis further to the current state.

I wish to express my sincere appreciation to my family, Late Muwereza Jacob and Betty

Basilica, brothers and sisters, Robert, Juliet, Scovia, Ezra, and Cissy, for their support and encouragement, and to my friends Geoffrey, Emmanuel and Anthony for the moral support and encouragement. Special thanks go to my loved one – Joanita for being patient with me during the busy schedules of writing this thesis. I would also like to thank those whose names have not been mentioned for their contribution academically, morally and socially.

I would like to express my gratitude to the International Water Management Institute – Sri

Lanka for without their financial support this study would have not been possible. I am also grateful to Dr. W. Ekere for his outstanding leadership and moral support while managing the

Resource Recovery and Reuse Project at Makerere University.

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TABLE OF CONTENTS

DECLARATION ...... i DEDICATION ...... ii ACKNOWLEDGEMENT ...... iii TABLE OF CONTENTS ...... iv LIST OF TABLES ...... vii LIST OF FIGURES ...... viii LIST OF ACRONYMS ...... ix LIST OF CONVERSION FACTORS ...... x ABSTRACT ...... xi CHAPTER ONE ...... 1 INTRODUCTION ...... 1 1.1 Background of the study ...... 1

1.2 Problem statement ...... 5

1.3 Objectives of the study ...... 6

1.4 Hypotheses ...... 6

1.5 Justification of the study ...... 6

CHAPTER TWO ...... 8 LITERATURE REVIEW ...... 8 2.1 Overview of the chapter ...... 8

2.2 Empirical Studies on Cost Benefit analysis of faecal sludge management in developing Asian countries ...... 8

2.3 Empirical Studies on Cost Benefit analysis of faecal sludge management in developing countries ...... 10

2.4 Lessons learned from the review of literature and used to inform this study ...... 17

CHAPTER THREE ...... 20 METHODOLOGY ...... 20 3.1 Conceptual framework ...... 20

3.2 Study area ...... 23

3.3 Data sources and analysis ...... 23

3.3.1 Indicators of the social and health benefits and costs of faecal sludge composting 24

3.3.2 Quantification of the social and health benefits and costs, and computation of the net value of faecal sludge composting ...... 27

3.3.2.1 Description of the engineering design of the faecal sludge composting plant ...... 29

3.3.2.2 Faecal sludge production and composting scenarios in Kampala ...... 29

3.3.2.3 Quantitative Microbial Risk Assessment of faecal sludge composting in Kampala 31

3.3.2.4 Disability Adjusted Life Years of faecal sludge composting in Kampala ...... 35

3.3.2.5 Cost Benefit Analysis of faecal sludge composting in Kampala ...... 37

3.3.3 Cost-effectiveness of faecal sludge composting in Kampala...... 38

3.4 Sensitivity and uncertainty analysis of faecal sludge composting ...... 39

CHAPTER FOUR ...... 41 RESULTS AND DISCUSSION ...... 41 4.1 Overview of the chapter ...... 41

4.2 Characteristics of the urban households ...... 41

4.2.1 Socio-economic characteristics of urban households ...... 41

4.2.2 Health characteristics of urban households ...... 44

4.3 The indicators of the benefits and costs of faecal sludge composting ...... 45

4.3.1 The indicators of the social benefits of faecal sludge composting ...... 46

4.3.2 Health risk due to poor faecal sludge disposal ...... 48

4.3.3 The indicators of the health benefits of faecal sludge composting ...... 49

4.3.4 The indicators of the costs of faecal sludge composting ...... 53

4.4 The quantified costs and benefits and the net value of faecal sludge composting .... 54

4.4.1 The value of the social and health costs and benefits of faecal sludge composting 54

4.4.2 The net value of faecal sludge composting ...... 58

4.5 Sensitivity and uncertainty analysis of faecal sludge composting ...... 60

CHAPTER FIVE ...... 64 SUMMARY, CONCLUSIONS AND POLICY RECOMMENDATIONS ...... 64 5.1 Summary ...... 64

5.2 Conclusions ...... 66

5.3 Policy recommendations ...... 66

REFERENCES ...... 68 APPENDIX ...... 73

LIST OF TABLES

Table 3.1: Overview of the indicators of benefits and costs of faecal sludge composting ..... 26 Table 3.2: Methods of quantification of benefits and costs by impact and used data sources 28 Table 3.3: Sensitivity analysis scenarios for faecal sludge composting ...... 40 Table 4.1: Selected socio-economic characteristics of urban households ...... 43 Table 4.2: Selected health characteristics of urban households ...... 45 Table 4.3: Indicators of social benefits of faecal sludge composting ...... 47 Table 4.4: Significance of the health risks under the dumping of faecal sludge scenario ...... 49 Table 4.5: Indicators used to quantify the selected health benefits of faecal sludge composting ...... 51 Table 4.6: Indicators used to quantify the cost of faecal sludge composting ...... 54 Table 4.7: Net value of faecal sludge composting ...... 59 Table 4.8: Net Present Value, Benefit Cost Ratio and Cost-Effectiveness Ratio under different scenarios of faecal sludge composting ...... 63

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LIST OF FIGURES

Figure 1.1: Trend of Kampala City population over time ...... 3 Figure 3.1: Conceptualisation of Cost-Benefit Analysis for faecal sludge composting……..22

Figure 3.5: Trend of Central Bank Rate over time ...... 40 Figure 4.1: Aggregated non-monetised health benefits of faecal sludge composting ...... 55 Figure 4.2: Aggregated msonetised social and health benefits of faecal sludge composting .. 56 Figure 4.3: Aggregated monetised costs of faecal sludge composting ...... 58 Figure 4.4: Variation of annual Net Present Value under different scenarios of faecal sludge composting over time ...... 60 Figure 4.5: Variation of Benefit Cost Ratio under different scenarios of faecal sludge composting over time ...... 61 Figure 4.6: Variation of Cost-Effectiveness Ratio under different scenarios of faecal sludge composting over time ...... 62 Box 1.1: Brief description of Lubigi Sewerage Treatment Plant ...... 75 Box 2.2: Health Risk and Impact Assessment for Kampala City ...... 78

viii

LIST OF ACRONYMS

BOD Biological Oxygen Demand DALY Disability Adjusted Life Years DMTC Development Management And Training Consultants GDP Gross Domestic Product HRIA Health Risk and Impact Assessment KCCA Kampala City Council Authority NETWAS Network for Water and Sanitation NWSC National Water and Sewerage Corporation PEA Private Emptiers Association QMRA Quantitative Microbial Risk Assessment UBOS Uganda Bureau of Statistics UNPS Uganda National Panel Survey WHO World Health Organisation

LIST OF CONVERSION FACTORS

1 US$ = UGX2500

1€ = 1.384US$

1 Tonne = 1000 kgs

ABSTRACT

The study was conducted in Kampala City and targeted the population that uses on-site sanitation facilities. It heavily relied on Uganda national survey data, and was supplemented with primary data collected from key informants. Literature was used to identify and profile indicators for the selected social and health benefits and costs associated with faecal sludge composting. Cost Benefit Analysis based on averting behaviour and defensive expenditure and cost of illness and lost output was used to compute the net value of faecal sludge composting, and consequently determine whether the total costs outweigh the total benefits from implementing the intervention. In addition, the study adopted the Cost-Effective

Analysis model to determine the cost-effectiveness of faecal sludge compositing based on averted health costs as a robustness check on the results of the Cost Benefit Analysis. Both the

Cost Benefit Analysis and Cost-Effective Analysis were based on the Lubigi Faecal Sludge

Treatment Plant and were subjected to independent sensitivity analysis using realistic policy tools. Sensitivity analysis enabled the study to determine the scenario that yields the maximum net value of faecal sludge composting. The findings from this study suggest that the total benefits from implementing faecal sludge composting in an urban area outweigh the associated costs. The potential Net Present Value from the intervention when implemented in

Kampala was about US$176,305,220; with averted health costs contributing the largest share of benefit. Every US$1 invested in faecal sludge composting would yield about US$7.5 in benefits and averting one Disability Adjusted Life Year would require US$1.36 in investment. The sensitivity analysis showed that interest rate and urban population growth rate have a negative synergistic effect on both Net Present Value and Benefit Cost Ratio; and a positive synergistic effect on Cost-effectiveness Ratio. The maximum net value of composting was US$12.36 in benefits for every US$1 in costs.

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Poor hygiene and sanitation remain a major public health concern in many urban areas, particularly those in the developing world (Hutton et al., 2007). The World Health

Organisation (WHO) (2009) ranks poor sanitation and hygiene condition as the fourth leading global risk for burden of disease as measured in Disability Adjusted Life Years

(DALY). Several diseases such as diarrhoea, ascariasis, dracunculiasis, hookworm infection, schistosomiasis and trachoma that are common in many developing countries are caused by lack of proper sanitation and hygiene. These diseases have adverse health and economic impacts on the population, especially among children. Recent estimates show that about

88% of the global diarrhoea cases are due to poor sanitation and hygiene (Prüss-Üstün et al.,

2008), and about 1.5 million people die of diarrhoea related illness; with the majority of the deaths occurring among children (Hutton et al., 2007; Prüss-Üstün et al., 2008).

In Uganda, the coverage target of improved sanitation in urban areas by 2014 was 82% of the urban population and 72% of the rural population (WHO, 2014), although the national household survey of 2009/2010 estimated usage of improved sanitation facilities at 98.8% of the urban population (94.3% of the Kampala population only) and 89.6% of the rural population (Uganda Bureau of Statistics (UBOS), 2010). These facilities included only those which involve better access and safer disposal of human excreta, among which include: septic tank, simple pit latrine, Ventilated Improved Pit latrine, Sewerage and treated sewage

(Hutton et al., 2007). However, only 8% of the households with toilets in Uganda had hand washing facilities with soap, while the rest did not have such facilities (UBOS, 2010). As a

result, diarrhoea-related deaths which are attributable to poor sanitation and hygiene in

Uganda stood at 10,816 people (WHO, 2014); and about 440 children under the age of five die every week due to preventable sanitation related diseases (National Sanitation Guidelines,

2000). The National Sanitation Guidelines (2000) suggest that improved sanitation can half diarrhoea-related mortality among children and reduce the prevalence of diarrhoea by 35 -

40%.

The problem of poor hygiene and sanitation in many urban areas of developing countries is exacerbated by lack of proper methods of disposal of the large volumes of solid wastes

(Steiner et al., 2002; Prüss-Üstün et al., 2004; Hutton et al., 2007; Niwagaba, 2007), particularly municipal solid waste and faecal sludge produced by the ever increasing population (Figure 1.1). Faecal sludge refers to the undigested or partially digested solids that are produced when black water from on-site sanitation systems such as latrines and septic tanks, among others are stored or treated (Koné and Peter, 2008). Based on Steiner et al. (2003) who estimate that 76 persons produce 1 tonne of total solids per year, Uganda‘s population of 33 million people in 2011 produced approximately 433,418 tonnes of total solids of faecal sludge of which 13% was from urban areas (of which 5% was from

Kampala only). In terms of volume, Kampala City alone produces about 1.2 million tonnes of agro wastes annually and 1,500 tonnes of municipal solid waste every day (Uganda

Investment Authority, 2010). On a daily basis, approximately 10,000 – 16,000m3 (1.9x10-1 –

3.0x10-1 tonnes) and 300m3 (5.7x10-3 tonnes) of total solids of raw sewage is disposed at

Bugolobi Sewerage Treatment Plant through sewer lines in Kampala and by cesspool emptiers, respectively (NETWAS Uganda and DMTC, 2011). Annual total solids production is expected to triple every year at the national level and to increase by about six times in the city alone (Darnault, 2004; Jena, 2008; Urkiaga et al., 2008).

Figure 1.1: Trend of Kampala City population over time (Source: Secondary data)

Unfortunately, efforts made by the Government of Uganda and its development partners to improve sanitation do not match the growing demand for sanitation services. For instance, less than 7% of the population of Uganda has access to sewerage based facilities provided by the National Water and Sewerage Corporation (NWSC) (Niwagaba, 2007; and NETWAS

Uganda DMTC, 2011). Twinomucunguzi (2008) noted that only 10% of the population of

Kampala has access to the only sewer system that disposes raw sewage at Bugolobi

Sewerage Treatment Plant. Moreover, according to Steiner et al. (2003) and NETWAS

Uganda and DMTC (2011), only a small fraction of the total solids of raw sewage produced in urban areas of developing countries such as Kampala is treated, meaning that most of the raw sewage and other effluents are discharged directly into waterbodies and other un- gazetted areas. This situation is exacerbated by the fact that a few toilet emptying services providers such as the Kampala Capital City Authority (KCCA) and other private emptiers are available in Uganda, but do not meet the market demand in the city alone. KCCA has about 19 trucks while the Private Emptiers Association has about 35 trucks (GTZ, 2010) and most of which operate in Kampala City with a few trips to other urban areas in Uganda.

Steiner et al. (2003) recommend composting1 for better management of faecal sludge in cities of developing countries, because of its potential benefits to the population, which include averting both the environmental and health externalities (Prüss-Üstün et al., 2004;

Haruna et al., 2005; Eshet et al., 2006; Hutton et al., 2007; Kone et al., 2007; Keraita et al.,

2014). Faecal sludge composting generates environmental benefits, such as averted water pollution, biodiversity loss and greenhouse gas emissions; and it helps to avert morbidity, mortality and burden of diseases such as diarrhoea (Prüss-Üstün et al., 2004; Hutton et al.,

2007). In addition, faecal sludge composting creates employment opportunities in developing economies such as drivers of vacuum tankers that collect and haulage the sludge.

Faecal sludge composting has been adopted in many cities around the world, such as Kumasi in Ghana; Bamako in Mali; and Bangkok in Thailand, among others (Steiner et al., 2003). In

Uganda, however, the use of faecal sludge composting is still very low. Currently, NWSC is exploring the composting of faecal sludge mostly from the sewers (98% of the total solids of raw sewage received by the NWSC treatment plant in Kampala City) and to a very small extent (2%) from on-site sanitation facilities (NETWAS Uganda and DMTC, 2011).2 The

National Environment Management Authority on the other hand is only exploring composting of municipal solid waste but not faecal sludge. The limited use of faecal sludge composting is partly because of the dearth of evidence on the monetary value of the associated health and other environmental benefits, which limits the willingness of both government and its development partners to invest in proper faecal sludge management.

Hence, it was on this background that this study was conducted in Kampala City.

1 Faecal sludge composting is an anaerobic process of decomposition of faecal sludge into humus-like substances referred to as faecal sludge compost product and minerals by the action of micro-organisms combined with chemical and physical reactions (Peigna and Girardin, 2004).

2Calculated by author using daily FS collection through sewer and cesspool emptiers. For example, for on-site sanitation facilities; 5.7x10-3*100 /{[(1.9x10-1 + 3.0x10-1)/2]+ 5.7x10-3} = 2.3%. 4

1.2 Problem statement

Composting is increasingly becoming a popular approach for managing faecal sludge in developing countries. According to Steiner et al. (2003), the benefit of diarrhoea reduction due to faecal sludge composting alone amounts to about US$140 - 150 per tonne of total solids. Other benefits include US$3 per tonne of total solids of revenue from the sale of bio- solids and US$37 from landfill disposal savings. In Uganda, the NWSC has made some effort to compost faecal sludge particularly in Kampala City, albeit at a very small scale relative to the high volumes produced. Large scale composting in Uganda’s urban areas has not been adopted yet probably due to lack of adequate empirical evidence on the associated benefits.

These benefits and costs were explicitly documented in majority of the urban areas elsewhere where the intervention is being implemented on a larger scale. Steiner et al. (2003); Seidu and

Drechsel (2010) documented the benefits and costs in Ghana and Dodane et al. (2012) in

Senegal. In Uganda, meagre documentation was made by NETWAS Uganda and DMTC

(2011) and similar efforts by Renwick et al. (2007); Kabyanga (2012), albeit in biogas digesters with faecal sludge as an input to supplement on animal waste. This study sought to fill the knowledge gap by quantifying the potential social and health benefits and costs associated with faecal sludge compositing in Uganda, using a Cost Benefit Analysis framework. The study focused more on human health as opposed to other environmental externalities, as the former is of greater concern in waste management projects (Eshet et al., 2006; Kone et al., 2007).

1.3 Objectives of the study

The general objective of this study is to analyse the social and health benefits and costs of faecal sludge composting in Uganda. The specific objectives are to:

1) Profile the indicators of the various social and health benefits and costs

associated with faecal sludge composting;

2) Determine both the monetised and non-monetised value of the social and health

benefits and costs, and consequently the net value of faecal sludge composting;

and

3) Determine the scenario that yields the maximum net value of faecal sludge

composting.

1.4 Hypotheses

1) The total cost of faecal sludge composting outweighs the total benefit from

implementing the intervention; and

2) There is no synergistic effect between urban population growth rate and national

interest rate on the Net Present Value, Benefit Cost Ratio and Cost-Effectiveness

Ratio of faecal sludge composting.

1.5 Justification of the study

This study is the first of its kind in analysing the social and health benefits and costs of faecal sludge composting in Uganda. It adds on to the current body of literature on the economics of faecal sludge management. Previous efforts to conduct a Cost Benefit Analysis for faecal sludge management in Uganda are in small scale biogas digesters (Renwick et al.,

2007; Kabyanga, 2012). This study is different from the studies of Renwick et al. (2007);

Kabyanga (2012) in threefold; it focuses on (i) large scale faecal sludge treatment plants

rather than small scale biogas digesters; (ii) the urban population only; and (iii) human waste only because animal waste is not a major problem in urban areas. In particular, the study generates empirical data on the health externalities of faecal sludge composting in Uganda, and the associated costs and benefits to guide decision-making on the best investment strategy for improving sanitation and hygiene in Uganda’s urban areas.

CHAPTER TWO

LITERATURE REVIEW

2.1 Overview of the chapter

As early as the 20th century, Mar (1969) had recognised that proper waste disposal is technically viable at US$0.55/kg of dry sludge. In the 21th century, efforts to manage faecal sludge properly in urban areas were directed majorly towards finding the optimal disposal technology. In pursuit of this, several studies have been conducted, to analyse the technical and economic viability of the different faecal sludge management approaches in sub Saharan

African and some developing countries in Asia. Some of the studies reviewed in this thesis include Rytz (2001), Van der Hoek et al. (2002), Steiner et al. (2003), Kwon (2005),

Vodounhessi (2006), Hutton et al. (2007), Renwick et al. (2007), NETWAS Uganda and

DMTC (2011), Seidu and Drechsel (2010), Sridhar et al. (2011), Dodane et al. (2012) and

Chowdhry and Kone (2012), among others.

2.2 Empirical Studies on Cost Benefit analysis of faecal sludge management in

developing Asian countries

Rytz (2001) studied the technical, operational, organisational and financial aspects of a decentralised composting scheme in Dhaka, Bangladesh. The study aimed at generating more empirical information about the novel composting methods and their framework through collecting information about the health aspects of compost production, the financial aspects of the composting unit including economic aspects such as cost savings for the municipality and the marketing aspects of the compost product. The indicators used in the study included revenue from the sale of compost from organic waste; operation and maintenance and investment costs for organic waste collection companies and composting plants; cost

reduction for transporting and dumping of organic waste; and health risks of organic waste composting. The study relied on secondary data and literature review, a household survey, key informant interviews and laboratory analysis. The study findings showed that waste collection and composting were more beneficial than conventional solid waste management.

The Net Present Value for the pilot composting project ranged from US$ -1,787 to US$

51,397 while at full scale, the Net Present Value increased to US$15,508 and US$111,732 respectively. This is because composting reduced the amount of waste that needed to be transported and dumped at disposal sites, significantly saved costs for the municipality in terms of collecting and managing the waste, improved the quality of life for the residents, and a hygienic compost product was produced which when used in agriculture helped to avoid soil degradation.

Van der Hoek et al. (2002) examined the value of urban wastewater in agriculture; with a case study of Haroonabad, Pakistan. The indicators they considered included vegetable productivity, water and nutrient use, water and soil quality, water availability and water use, and prevalence of intestinal parasitic infections in the community. The study relied on data from key informant interviews, focus group discussions and semi-structured interviews. The results show that canal-water was more costly to use in agriculture than wastewater. They also found significantly more diarrheal diseases cases and other pathogenic infections such as hookworm and roundworm in households that used untreated wastewater as compared to those using canal water.

Kwon (2005) quantified and compared the costs and benefits of the different composting facilities in Vientiane, Lao PDR. The indicators considered include capital and operation and management costs, revenue from compost sale, avoided landfill costs and reduced

transportation costs. The study relied on data from literature review, field observations and key informant interviews. A financial feasibility analysis framework was used to analyse the collected data. Among the four alternatives considered, the study found only decentralised composting facilities constructed in the markets to be financially viable while the rest

(centralised facility constructed outside the city, centralised facility constructed in the city and decentralised facilities constructed next to the markets) were not. The decentralised composting facilities were found to yield an annual net benefit of US$210. This finding was explained by the variation in operation and maintenance costs across the four alternatives.

2.3 Empirical Studies on Cost Benefit analysis of faecal sludge management in

developing countries

Steiner et al. (2003) examined sustainable faecal sludge disposal in urban areas of Ghana and

Thailand. The indicators considered in their study included investment and operation and maintenance costs of faecal sludge management; revenue from faecal sludge extraction and haulage, and sale of faecal sludge compost products; savings from landfill disposal; health cost savings (medicine, hospital stay); and averted productivity loss due to lower mortality and morbidity. The results show that when the costs for buying land and monitoring the programme are excluded, faecal sludge composting would be economically viable. The

Benefit Cost Ratio was estimated at 2.5, implying that every one dollar spent on faecal sludge composting yields US$2.5 in benefits.

Vodounhessi (2006) assessed how faecal sludge management can be made an integrated part of an ecological sanitation approach in Kumasi, Ghana. The study considered the following indicators: revenue from faecal sludge extraction and haulage from households, discharge at faecal sludge treatment plant, and sell of faecal sludge; operation and maintenance, and

investment costs for faecal sludge extraction and haulage companies and faecal sludge treatment plant. The study relied on data from literature review, open discussion, key informant interviews, household and faecal sludge extraction and haulage company surveys and field observation. The study assumed that a household can spend 5% of their income on toilet emptying service; and farmers are willing to pay US$1.4 per 50kg bag of compost. The study found that faecal sludge extraction and haulage companies in Kumasi were paying about 5% of their revenue as discharge fee per trip at the faecal sludge treatment plant. It also found that the faecal sludge management system financial cost recovery could reach 167%.

The sensitivity analysis showed that only 55 to 70% of the revenue from toilet emptying service could achieve significant cost recovery of 100%.

Hutton et al. (2007) estimated the health impacts and economic costs and benefits of improving water supply and sanitation services in least developed countries that are “off- track” to meeting the targets for the Millennium Development Goals. The indicators considered included time savings associated with better access to water and sanitation, gain in productive time due to less time spent ill, economic gains associated with saved lives, health sector and patient costs saved due to less health seeking, and investment and operation and maintenace costs for low cost interventions such as construction of water supply and sanitation facilities. The study used literature review and secondary data, and found all low cost water and sanitation improvements to be viable in all developing countries. Improvement in sanitation was found to be more benefitial than improving water supply. Every one dollar spent on sanitation improvement provided a benefit of US$7 compared to US$3 in benefits arising from one dollar investment in water supply improvement. This finding was attributed to the larger averted health impacts, cost and time saving arising from improvement of sanitation compared to water supply.

Renwick et al. (2007) conducted a financial and economic cost-benefit analysis of an integrated household-level biogas, latrine, and hygiene program in sub Saharan Africa. They analysed the costs and benefits at region (sub Saharan Africa) and country level for Ethiopia,

Rwanda and Uganda. Their analysis relied on literature review, secondary data, and limited primary data. They considered a 5 year country specific roll-out period and 15 years for sub

Saharan Africa region. Their study adopted a discount rate of 3% and a depreciation period of

20 years for the biogas digesters. The costs that were modelled include the cost of installation and operation of biogas digesters; pour-flush latrine construction; expenditures on hygiene related materials such as soap; program expenditure; biogas digester subsidies and technical assistance. On the other hand, the benefits include a reduction in cooking and lighting fuel expenditures; increased time available for income-generating activities; the value of time savings associated with fuel wood collection, cooking and access to a latrine; reduced health- related expenditures; and a range of health-related and environmental benefits due to reduction in greenhouse gas emissions and deforestation. At sub Saharan Africa region level, the study found the Economic Internal Rate of Return for the base case scenario to be 178%.

Considering different assumptions, the results for the base case scenario yielded a Benefit

Cost Ratios ranging from 1.22 to 1.35. Specific to Uganda, the Net Present Value was estimated at US$4,800,881 while Benefit Cost Ratio was 1.25. In the sensitivity analysis, reduction in the cost of either the biogas digesters or latrine construction was observed to boost the economic viability of the intervention. The Net Present Value was estimated at

US$275,814,233 for Uganda while Benefit Cost Ratio was 6.84 and Economic Internal Rate of Return was 166%. Indeed, amongst the three countries from which case studies were taken, Uganda was found to benefit more from the biogas digester technology than either of

Rwanda or Ethiopia.

Seidu and Drechsel (2010) studied the cost-effectiveness of different interventions for diarrhoeal disease reduction among consumers of wastewater-irrigated lettuce in Ghana. The indicators considered by the study included Disability Adjusted Life Years (DALYs) and investment costs for low cost sanitation interventions. The study used secondary data and literature review, and a combination of Quantitative Microbial Risk Assessment (QMRA),

DALYs and Cost-Effective Analysis frameworks to estimate the health effects and the cost- effectiveness of the different interventions. Among the numerous pathogens studied, their findings showed viruses to contribute the highest annual infection risk from consumption of lettuce salad irrigated with untreated wastewater. The median viral infection risk under the existing wastewater irrigation practices was found to be 10–1 per person per year, which is well above the World Health Organisation (WHO) tolerable infection risk of 10–4 per person per year; while the risk for bacterial and protozoan infection was estimated at 10–5 per person per year, which is below the WHO standards. The exposure to infection risks led to about

477,258 mild diarrhoea cases, which is approximately 0.68 episodes of diarrhoea per consumer per year. About 14% and 0.1% of the 0.68 diarrhoea episodes were severe and fatal respectively and translated into 12,016 DALYs annually or 0.017 DALYs per person per year. The study observed a high DALY reduction of about 82% when the nine Wastewater

Treatment plants with nearby farmland and evenly distributed across Ghana are rehabilitated.

However, only 44% of the annual DALYs could be reduced when new Wastewater

Treatment plants are built. On average, they found the Cost-Effective Ratios ranged from

US$31 per DALY to US$812 per DALY. These results mean that the low-cost rehabilitation of a larger number of existing but underperforming Wastewater Treatment plants when evenly distributed across urban Ghana could be very cost-effective but not the construction of new Wastewater Treatment plants.

Sridhar et al. (2011) conducted a landscape analysis and business model assessment of faecal sludge management with a focus on extraction and haulage models in Nigeria. The indicators considered in this study included faecal sludge production, demand for vacuum trucks and revenue from faecal sludge emptying and haulage services. The study relied on data from literature review, household survey, participant observation, focus group discussions, Key

Informant interviews, and Global Positioning Systems. Both descriptive and inferential statistical methods were used for data analysis. The results show that most of the urban population in Nigeria depend on onsite sanitation. For example, in Abuja, the study found

70.4% of the respondents had onsite sanitation facilities. On disaggregating the respondents using onsite facilities, the study found that 43.2% used individual septic tanks while 24.8% used latrines. Despite the high usage of onsite sanitation in the cities, the study found that most of the respondents had poor faecal sludge management. This is because of underperformance of the central sewerage system in Abuja, non-functionality of the faecal sludge treatment plant in Ibadan and the vacuum trucks being emptied directly into the bush/creek in Yenagoa. The study found the emptying fees to range from US$66 to US$100, while the willingness to pay for faecal sludge extraction and haulage services ranged from

US$3.3 to US$100.0. In the 3 cities of Abuja, Ibadan and Yenagoa, the study found the average daily volume of faecal sludge that needed to be extracted from septic tanks to be about 2989, 2729 and 533 m3 respectively; which translates to approximately 447,847,

341,178 and 77,719m3 of faecal sludge per year, respectively. Most of the faecal sludge extraction and haulage business in Nigeria were found to be profitable. The profit margin for the companies ranged from US$10 to US$34 per trip. To a large extent, the variation in the profit margins was explained by equipment and maintenance costs; with purchase of fuel and truck servicing / repairs contributing about 80% of the operation and maintenance cost.

NETWAS Uganda and DMTC (2011) conducted a market study on demand for use of wastewater, excreta and faecal sludge and other related by-products in Uganda. The study was carried out in 8 towns (Kampala, Mityana, Jinja, Busia, Mbarara, Rukungiri, Gulu and

Adjumani) in the 4 regions of Uganda. The study relied on data from literature review, key informant interviews and focus group discussions. The study found that towns with large populations produce larger volumes of wastewater, urine and faecal sludge. The demand for wastewater and other related products was found to be highest in Kampala. Out of the 8 districts covered by this study, only Kampala was found to have a few farmers using faecal sludge, and on non-food items only. The study found higher demand for urine than faecal sludge. The study suggested a total charge of US$28 for a two-tonne vacuum truck of faecal sludge, which includes the cost of buying, transporting and applying the sludge. For the case of wastewater sludge, the total cost was estimated to vary between US$6 and US$24.

Dodane et al. (2012) compared the Sewer based and faecal sludge management systems in

Dakar, Senegal under similar operating conditions. The indicators considered in the study were capital and operating costs of the faecal sludge management and sewer based systems.

The study used data on capital and operating costs of the faecal sludge management and sewer based systems obtained from literature review and secondary data sources and key informant interviews. The study found the sewer based system to be more expensive than the faecal sludge management system. The annualised capital for the sewer based system estimated at US$42.66 capita−1 year−1 was found to be ten times that for faecal sludge management, estimated at US$4.05 capita−1 year−1. The annual operating cost for sewer based

(US$11.98 capita−1 year−1) was close to twice that of faecal sludge management (US$7.58 capita−1 year−1); while the combined capital and operating cost for sewer based (US$54.64 capita−1 year−1) was five times that for faecal sludge management ($11.63 capita−1 year−1).

The costs for sewer based were found to be almost entirely borne by the Senegal National

Sanitation Utility, with only 6% of the annualised cost borne by the users. The faecal sludge management was found to operate with a different business model, with costs spread among households, private companies, and the Senegal National Sanitation Utility. The study concluded that sewer based was 40 times more expensive than faecal sludge management.

Chowdhry and Kone (2012) analysed faecal sludge extraction and haulage businesses in

Africa (Burkina Faso, Ethiopia, Kenya, Nigeria and Senegal) and Asia (Bangladesh,

Cambodia, India, Malaysia and Vietnam). The indicators considered by their study were the demand for and supply of sanitation extraction and haulage services, as well as revenues and expenditures of existing private enterprises in faecal sludge management. The study used secondary data, direct field observations, household surveys, and interviews with faecal sludge management stakeholders. The study found that majority of the households in the 30 cities surveyed were not connected to the sewer system and mostly used onsite sanitation facilities. In Bangladesh, Burkina Faso, Cambodia, Ethiopia and Kenya, pit latrines were the most common onsite sanitation technology, while septic tanks were dominant in the other five countries. The study found that households spend only a small percentage (less than 4%) of their income (the average monthly income was found to range from US$170 to US$600) on onsite sanitation. The total available market for emptying service across the 30 cities was estimated at US$134 million, ranging between US$200,000 and over US$40 million for the capital cities alone. It was also found that the choice of trucks used by the private operators had a significant impact on business profitability. The results show that in Asia where operators locally assemble the vacuum trucks, it costs about US$11,000 in operating expenses for a truck compared to three times as much in Africa where old refurbished second-hand trucks are used. These costs are spent on variable costs such as fuel and

maintenance and on fixed costs such as staff salaries. Despite the fact that faecal sludge extraction and haulage business was found to be expensive to operate in Africa, the annual profit per truck was found to be US$12,000; which is twice that in Asia. This is because of the higher empting fee of US$60 relative to US$28 in Asia and more trips per day per truck made in Africa. Furthermore, the study shows that across all countries, operators who had one truck had unstable profitability and operated near loss. Operators who had two or more trucks were found to have greater efficiency, less downtime and higher chances to capture commercial emptying contracts.

2.4 Lessons learned from the review of literature and used to inform this study

In most empirical studies, literature review is very important in guiding the study design.

Several lessons were learned from the studies that were reviewed in this thesis. This section discusses in detail the lessons that informed or guided this study.

Majority of the reviewed studies did not focus on faecal sludge; the major sanitation challenge in most urban areas of developing countries but rather focused on other resources such as organic waste, market waste, animals waste while a few integrated these resources with faecal sludge. For example Rytz (2001) considered only organic waste, Renwick et al.

(2007) considered both animal and human waste and Seidu and Drechsel (2010) considered only wastewater. Despite the meagre efforts to study faecal sludge composting, those that attempted focused on other technologies such as biogas digesters as the case of Renwick et al.

(2007) and did not evaluate the faecal sludge composting technology. Only Steiner et al.

(2003) evaluated faecal sludge composting technology, moroever in urban areas of Ghana and Thailand and not Uganda. Therefore, the findings of these studies may not directly apply

to the faecal sludge problem in Uganda. None the less, the reviewed studies such as Hutton et al. (2007) and Seidu and Drechsel (2010) guided the methodology of this study.

Of the meagre efforts, most of the reviewed studies did not explicitly study the economic viability of the sanitation projects they focused on. Determination of the Net Present Value,

Benefit Cost Ratio, Economic Internal Rate Of Return and Cost-Effectiveness Ratios of the sanitation project requires the identification and quantification of project externalities such as the disease burden associated with faecal sludge composting project. Only Hutton et al.

(2007) considered the health externality in computing the Net Present Value of improving sanitation while only Seidu and Drechsel (2010) considered it by studying the cost- effectiveness of improving sanitation. None the less, all the reviewed studies guided this study to identify and profile indicators for the various social and health benefits and costs associated with faecal sludge composting; and to quantify and use these benefits and costs to determine the net value and scenario that yields the maximum net value of faecal sludge composting.

Some studies such as Renwick et al. (2007) used very low discount rates of 3% which may not apply in Uganda at the moment. The ideal discount rate in Uganda is the Central Bank

Rate of 11.5% (Bank of Uganda, 2014). If applied in studying the benefits and costs of faecal sludge composting in urban areas of Uganda, the low discount rates would over-estimate the economic viability of the faecal sludge composting project. Never the less, the reviewed studies guided this study on conducting the sensitivity analysis using discount rates.

The reviewed studies also considered a lower depreciation period for the capital investments for the sanitation projects they studied. For example, Vodounhessi (2006) considered a

depreciation period of 15 years and 10 years by Rytz (2001) yet basing on the government program “Kampala Sanitation Master Plan” which runs from 2003 to 2033, a depreciation preiod of 20 years for the faecal sludge composting project would be more ideal (Newton,

2010). Moreover, Steiner et al. (2002) argued that longer depreciation periods of 15 to 20 years for the faecal sludge composting projects exist in developing countries. Therefore, it was imperative to consider newer and yet low-cost capital investments for the faecal sludge composting project in this study similar to the biogas digester project studied by Renwick et al. (2007).

CHAPTER THREE

METHODOLOGY

3.1 Conceptual framework

Figure 3.1 presents the conceptual framework developed by this study. Under the dumping of faecal sludge scenario, the sludge is discharged into landfills, water bodies or left underground in on-site sanitation facilities, among others. These disposal mechanisms cause specific health and other environmental externalities and risks. However, because the former is of more concern than the latter, the conceptual framework for this study focused only on the health externalities and risks. Individuals who are exposed to these externalities and risks are likely to be infected by waterborne diseases like diarrhoea. Morbid adults are likely to spend part if not all of the household income on treatment and may not work during such periods, school-going children may not attend school and babies will require special care from adults. The health sector will spend on morbid individuals who seek medical care to supplement on the individual expenditure. Some of the morbid individuals will succumb to the diarrhoeal illness, resulting into a total loss of productive time. A summation of these costs yield the health costs of dumping faecal sludge in the environment. A transition from dumping of faecal sludge to composting implies that the health externalities and risks from the former become benefits referred to as avoided health costs in the latter. On one hand, composting of faecal sludge is also associated with its own health costs such as infections from exposure of workers to pathogens. However, these costs are negligible since they can be minimised by improved occupational health. On the other hand, faecal sludge composting creates a consumer surplus as well as employment income such as from jobs for drivers of vacuum tankers and their support staff. The Intervention also yields revenue for the composting plant as well as the entrepreneurs who purchase the vacuum tankers.

The main financial cost of implementing the faecal sludge composting intervention include:

(i) the capital cost of purchasing equipment; and (ii) the operation and maintenance cost of both the treatment plant and vacuum tankers. These costs would not occur when the intervention is not undertaken in the urban area.

Following the economic theory of total value by Lancaster (1966); Hendler (1975), the sum of the avoided costs from dumping of faecal sludge and the direct benefits less the costs from faecal sludge composting gave the Net Present Value and the associated Benefit Cost Ratio,

Economic Internal Rate of Return and Cost-Effectiveness Ratio for the various scenarios.

Figure 3.1: Conceptualisation of Cost Benefit Analysis for faecal sludge composting 22

3.2 Study area

This study was conducted in Kampala City, the only city and capital of Uganda. It is located in the central part of Uganda, East Africa. The population of Kampala City was estimated at about 1.72 million people by 2011 and was dominated by the under 18 years cohort, a few above 60 years and with more females than males (The Uganda Bureau of Statistics (UBOS),

2010). This thesis targeted the population that uses on-site sanitation facilities, who constitute about 90% of population of Kampala (Twinomucunguzi, 2008). The city is drained by several degraded wetlands among which, the Nakivubo and Lubigi Wetlands are the most important. These wetlands are very important for the improved livelihood of the city population. This is because Nakivubo wetland for example drains into Lake Victoria at

Murchison Bay, the most important source of the city’s piped water.

3.3 Data sources and analysis

Similar to recent studies such as Vodounhessi (2006); Hutton et al. (2007); Seidu and

Drechsel (2010), this study heavily relied on Uganda National Panel Survey (UNPS)

2009/2010 data and literature which were supplemeneted with limited primary data in the form of key informant interviews. UNPS 2009/2010 is a national wide survey of 2,975 households, from which about 239 households in Kampala City were extracted for analysis at household level (UBOS, 2010). To supplement on the secondary data, six key informant interviews were conducted in April, 2014; one from Bugolobi Sewerage Treatment Plant of

National Water and Sewerage Corporation (NWSC), three from the new Lubigi Faecal

Sludge Treatment Plant of NWSC and two from Private Emptiers Association (PEA)

(Appendix 3). The rational for conducting key informant interviews was because NWSC is the most experienced organisation in faecal sludge composting while PEA is the umbrella body for private faecal sludge collectors in Uganda. Hence, this gave a clear picture of the

costs and benefits of faecal sludge composting in the highly recommended private-public partnership framework (Steiner et al., 2003). These data sources were found to be sufficient in addressing all attribution issues related to the costs and benefits of faecal sludge composting.

The descriptive statistics were generated in STATA 13 while both the Cost Benefit Analysis and the Cost-Effective Analysis were independently conducted in Microsoft excel 2013.

All prices that were acquired from secondary data were deflated before conducting the Cost

Benefit Analysis using a Gross Domestic Product deflator. The study relied on Gross

Domestic Product deflators for the years 2000 to 2012.3 Price adjustment using Gross

Domestic Product deflators has ever been used by previous studies such as Hutton et al.

(2007). The exchange rate for 20th April 2014 from Bank of Uganda was used to standardise all prices from secondary data to dollars.

3.3.1 Indicators of the social and health benefits and costs of faecal sludge composting

To achieve Objective 1, the thesis relied on literature to profile the indicators of the selected costs and benefits of faecal sludge composting. The limited primary data as well as the UNPS

2009/2010 data were corroborated with literature to establish the value of the profiled indicators (Table 3.1). The study further assumed that an average of 2 diarrhoea episodes per person each corresponding to a rainy season would occur annually in Kampala City and the per capita effect of other factors that cause diarrhoea would be constant for the entire 20 year period.

3 World Bank Development Indicators http://data.worldbank.org/indicator/NY.GDP.DEFL.ZS 24

Similar to recent studies, this study underestimated the net value from faecal sludge composting. The underestimation was partly because the study used proxies in valuing the selected benefits and costs as well as a few benefits and costs were considered due to resource constraints. Other benefits such as averted Greenhouse gas emissions and costs for faecal sludge composting exist but were not considered in this thesis. Thus, when estimating the costs and benefits, the aim of the study was not to include all the costs and benefits but rather to estimate those that were identified as most important and whose data could readily be available within the limited resources.

Table 3.1: Overview of the indicators of benefits and costs of faecal sludge composting

Component Indicators Description Market price of faecal sludge compost, Revenue from Output of faecal sludge compost, This is the income a faecal sludge treatment plant earns operating an Market wage rate, Discharge fee per trip, from sell of FS compost product and from discharge Faecal Sludge Total number of trips per faecal sludge fees levied on faecal sludge collectors. Treatment Plant treatment plant per annum trips This refers to the income that workers in both faecal Employment Market wage rate, Total Man hours sludge treatment plant and faecal sludge extraction and income haulage companies earn Willingness to Pay for compost, Market Consumer This is the benefit consumers of faecal sludge compost price of faecal sludge compost, Market surplus product get when the product is made. demand for faecal sludge compost Faecal sludge Faecal sludge extraction and haulage extraction and This is the revenue faecal sludge collectors earn fees haulage revenue Number of days off work due to diarrhoea Number of days off school due to diarrhoea

Number of baby days gained due to This is the avoided health costs from dumping faecal Health 4 diarrhoea sludge while it is a health cost for the case of externality Number of days gained from death composting faecal sludge avoided due to diarrhoea5 Expenditure of health sector on diarrhoea Expenditure of individual on diarrhoea This refers to the amount of money saved by faecal Savings in sludge extraction and haulage companies as a result of Change in haulage distance transport reduction in haulage distance due to the construction of faecal sludge treatment plant Land size, price per square feet This refers to the amount of money that needs to be Construction of offices, platforms and invested in constructing the faecal sludge treatment Capital costs sheds, drying beds, water and electricity plant and purchasing of faecal sludge extraction and connection haulage trucks. Number of trucks, price of each truck Wage rate, salary, man hours, number of This refers to the annual expenditure by both faecal Operation and salary workers, salary sludge treatment plant and faecal sludge extraction and Maintenance haulage companies in operating and maintaining their costs Maintenance costs businesses.

4 Number of baby days gained due to diarrhoea refers to the number of days that an adult saves by not spending time looking after a baby who is suffering from diarrhoea. 5 Number of days gained from death avoided due to diarrhoea refers to the time saved when an individual doesn’t die before the life expectancy as a result of diarrhoea. 26

3.3.2 Quantification of the social and health benefits and costs, and computation of the

net value of faecal sludge composting

To achieve Objective 2, Hypothesis 1 was tested using empirical evidence from the Cost

Benefit Analysis. The Cost Benefit Analysis was conducted after quantifying the social and health costs and benefits using the profiled indicators (Section 3.3.1).The methods used to quantify the selected social and health costs and benefits of faecal sludge composting in

Kampala City are summarised in Table 3.2. A combination of Quantitative Microbial Risk

Assessment (QMRA) and Disability Adjusted Life Years (DALYs) was used to quantify the health benefits and costs while other methods were used for the social benefits and costs.

These methods are discussed in detail in the sub-sections that follow.

Table 3.2: Methods of quantification of benefits and costs by impact

Cost Benefit Analysis component Methods Revenue from operating an Faecal (Market price of faecal sludge compost* Output of faecal sludge compost per Sludge Treatment Plant year) + Total discharge fee from faecal sludge collectors Employment income Market wage rate* Man hours per year (Willingness to Pay for faecal sludge compost- Price of faecal sludge Consumer surplus compost)* Output of faecal sludge compost demanded per year Faecal sludge extraction and Pit latrine emptying and transport fee * number of latrines emptied per year * haulage Revenue number of trips per latrine emptied Daily opportunity cost of labour * number of days off work per year Daily opportunity cost of labour * number of days off school per year Daily opportunity cost of labour *number of baby days per year Health Externality Daily opportunity cost of labour * number of days gained from death avoided per year Savings in health sector per year Savings by individual per year Change in haulage distance* number of latrines emptied per year * number of Savings in transport trips per latrine emptied (Construction of offices + platforms and sheds + drying beds + water and electricity connection) *number of faecal sludge Composting Plant Capital (Number of trucks per each faecal sludge collector * price of each truck)*number of collectors (Annual expenditure on wages for casual labour per faecal sludge Composting Plant + annual expenditure on salaries per faecal sludge Composting Plant) * Operation and maintenance costs number of faecal sludge Composting Plant Annual maintenance costs per faecal sludge composting plant *number of faecal sludge composting plant

3.3.2.1 Description of the engineering design of the faecal sludge composting plant

The quantification of benefits and costs of faecal sludge composting in this thesis relied on the engineering design of the newly built Lubigi Faecal Sludge Treatment Plant in Kampala

(Appendix 1). Compared to the Buobai Full Scale Faecal Sludge Treatment Plant in Ghana, the Lubigi model is larger (Steiner et al., 2002; Vodounhessi, 2006). The Buobai Full Scale model consists of 2 anaerobic ponds in series as compared to 3 for the Lubigi model. The dimensions for the first anaerobic pond for the Buobai Full Scale model are 3,300m2 by surface and 6.5m by depth while the second pond is 2,475m2 by surface and 5m by depth. On the other hand, the dimensions for each anaerobic pond for the Lubigi model are 70m by length, 30m by width and 4,240m3 by volume. The Buobai Full Scale model has 1 facultative pond while the Lubigi model has 2. The facultative pond for the Buobai Full Scale model measures 7,800m2 by surface and 2.3m by depth while each for the Lubigi model measures

170m by length, 50m by width and 11,530m3 by volume. The Buobai Full Scale model has an annual capacity of 1,500 tonnes of total solid (293,542 Person Equivalents) as compared to

22,800 (4,461,840 Person Equivalents) for the Lubigi model.

3.3.2.2 Faecal sludge production and composting scenarios in Kampala

Several equations were used to quantify the social and health costs and benefits of faecal sludge composting. First, the urban population was projected from the year 2011 through

2014 (the first year, also called year 0) to 2033 (the last year, also called year 19) using a geometric curve presented in Equation 1 (UBOS, 2007).

품풔 푵풕+ퟏ = 푵풕풆 (1)

Where Nt+1 is the projected population of Kampala at time t + 1, t = 0,1, 2 … 19 is time in years corresponding to 2014, 2015,….2033, g is the population growth rate for Kampala, s =

1; is the time interval between the years.

The Potential Total Solids without Composting (PTS) were defined as in Equation 2.

푷푻푺풕+ퟏ = 휶푵풕+ퟏ + 휷푷푻푺풕 (2)

Where α is the annual rate of faecal sludge production, β is the proportion of faecal sludge that remains from un-composted faecal sludge in the previous year and the rest are defined as before. In this thesis, only 25% of the total faecal sludge load by 2033 would be composted. Thus, with composting, the actual amount of faecal sludge that would be available in Kampala (ATS) was defined by Equation 3.

훼푁푡+1 푖푓 퐹푆푇푃푠푐푎푙푒 ≥ 푃푇푆푡 퐴푇푆푡+1 = { (3) 훼푁푡+1 + 훽(퐴푇푆푡 − 퐹푆푇푃푠푐푎푙푒) 푖푓 퐹푆푇푃푠푐푎푙푒 ≤ 푃푇푆푡

Where FSTPscale is the amount of faecal sludge that would be composted annually using the new Lubigi Faecal Sludge Treatment Plant technology such that exactly 25% of the PTS would have been composted. The rest of the variables are defined as before.

The annual faecal sludge collected (CTS) was defined by Equation 4 and the annual output of faecal sludge compost (OTS) by Equation 5.

퐴푇푆푡+1 푖푓 퐹푆푇푃푠푐푎푙푒 ≥ 퐴푇푆푡+1 퐶푇푆푡+1 = { (4) 퐹푆푇푃푠푐푎푙푒 푖푓 퐹푆푇푃푠푐푎푙푒 ≤ 퐴푇푆푡+1

훾퐴푇푆푡+1 푖푓 퐹푆푇푃푠푐푎푙푒 ≥ 퐴푇푆푡+1 푂푇푆푡+1 = { (5) 훾퐹푆푇푃푠푐푎푙푒 푖푓 퐹푆푇푃푠푐푎푙푒 ≤ 퐴푇푆푡+1

Where γ is the conversion factor for faecal sludge to a compost product. This factor takes care of the losses in weight of the total solids as a result of water loss and residuals, among others during composting.

3.3.2.3 Quantitative Microbial Risk Assessment of faecal sludge composting in Kampala

The QMRA was used to estimate quantitatively the health effects of faecal sludge composting in Kampala City. The health effects would arise from the improved disposal of faecal sludge by collecting it from on-site sanitation facilities and converting it into a sanitised compost product. Despite its weaknesses, recent studies such as Seidu and Drechsel

(2010) have noted QMRA to have several contributions, such as its ability to estimate very low levels of risk of infection or disease, low-cost method of predicting risk of infection or disease and facilitates comparisons of different exposure routes. This thesis followed the

QMRA framework in Seidu and Drechsel (2010). The first step of the QMRA was the Health

Risk and Impact Assessment (HRIA) for both the dumping and composting of faecal sludge scenarios (Petterson et al., 2006; Seidu and Drechsel, 2010). The HRIA involved hazard identification; exposure assessment, dose–response and risk of infection estimation; and finally estimation of diarrhoea DALYs (Appendix 2).

Given the different faecal sludge management approaches, water pollution is one of the most important health hazards in the city which results from the contamination of water with faecal organisms (Darnault, 2004; Peigna and Girardin, 2004; Prüss-Üstün et al., (2004); Haruna et al., 2005; Jena, 2008). Recent studies such as Haruna et al. (2005); Winkler et al. (2014) show that both the total coliform counts and faecal coliform in most of the water samples from randomly selected water sources from different parts of the city exceeded the recommended World Health Organisation (WHO) guidelines for bacteriological quality of drinking water. The WHO (1993) recommends safe drinking water to have less than 1 faecal coliform per 100 ml and 10 total coliforms per 100 ml.

Among others, epidemiological investigations of diarrhoea prevalence in urban areas of developing countries have increasingly embraced rotavirus, Salmonella and Cryptosporidium as the major plague for the observed poor sanitation related morbidity and mortality (Howard et al., 2006; Seidu and Drechsel, 2010). Therefore, similar to Seidu and Drechsel (2010), rotavirus, Cryptosporidium and Salmonella were chosen as representative diarrhoea causing organisms. Among other routes, rotavirus, Salmonella and Cryptosporidium organisms can be transmitted via the consumption of wastewater-irrigated vegetables, vegetables grown in faecal sludge contaminated soils and drinking of contaminated water (Prüss-Üstün et al.,

2004; Haruna et al., 2005; Hutton et al., 2007; Jena, 2008; Seidu and Drechsel, 2010). This thesis considered only consumption of wastewater-irrigated vegetables and drinking of contaminated water. This is because the health risk associated with consuming vegetables grown in faecal sludge contaminated soils is minimal if a sanitised compost product is used.

Moreover, in most urban areas in developing countries such as Kampala City vegetables are grown majorly using wastewater from degraded and faecal sludge polluted wetlands

(Kyambadde, 2005).

The exposure to each of the pathogenic organisms was modelled for both wastewater- irrigated vegetables and drinking of contaminated water. Eating of lettuce was used as a proxy for wastewater-irrigated vegetables in estimating the reductions in faecal coliforms attributable to faecal sludge composting. The probability distribution of the reduction in faecal coliforms due to faecal sludge composting were assumed to be equal to those reported by Seidu and Drechsel (2010) for domestic wastewater treatment. The dosage of each of the pathogenic organisms (퐷푖) that an individual in the city is exposed to after consumption of lettuce grown in a faecal sludge polluted wetland was defined by Equation 6.

−푛 퐷푖 = 푄푖. 푉푖. 푉푐. 10 (6)

Where 푄푖 is the quantity of lettuce that is consumed per meal per person (g), 푉푖 is the volume

-1 of contaminated water that remains on the lettuce after harvesting (mlg ), 푉푐 is the concentration of pathogens per volume of contaminated water (number of pathogens g-1), and

푛 is the log unit reduction in pathogens due to faecal sludge composting. In this thesis, the

-1 empirical value of 푄푖 was assumed to be 4.3g, 푉푖 ranged between 10.8 and 15mlg , 푛 was between 3 and 6 (Seidu and Drechsel, 2010). Moreover, Niwagaba (2009) observed faecal sludge composting to result into at least 3 logs reduction in pathogenic organisms while Kone

7 -1 (2007) observed a range between 1.5 and 2 logs. The value of 푉푐 was 1.1x 10 g (Keraita and Amoah, 2011). Niwagaba (2009) observed the concentration of E-coli and Enterococcus in pure faecal sludge in orders of 4.2 x 105 and 3.7 x 106cfu g-1 respectively. The rest of the variables were estimated from UNPS 2009/2010.

On the other hand, the dosage of each of the pathogenic organisms (퐷푖) that an individual in

Kampala City is exposed to after drinking the contaminated water is defined by Equation 7.

−푛 퐷푖 = 푄푖. 푉푐. 10 (7)

Where 푄푖 is the quantity of water consumed per day per person (l), 푉푐 is the concentration of pathogens per volume of drinking water (number of pathogens l-1), and 푛 is the log unit pathogen reduction due to faecal sludge composting. The empirical value of 푄푖 was assumed to be about 10% of the domestic water consumption per capita in Kampala City, 푉푐 was assumed to range between 0 and 4050cfu/100ml (Haruna, 2005; Howard et al., 2006). The daily per capita domestic water consumption was estimated from UNPS 2009/2010.

For each of the exposure routes discussed above, a Beta–Poisson dose-response relationship was fitted for both rotavirus and Salmonella and a single hit exponential dose-response model for Cryptosporidium (Seidu and Drechsel, 2010). For a single exposure to the pathogenic organisms through either comsuption of lettuce from faecal sludge pollutted wetlands or drinking of contaminated water, the Beta–Poisson and single hit exponential dose-response models were defined by Equation 8 and 9 respectively.

1 퐷푖 −훼 푃푖(푑) = 1 − [1 + ( ) (2훼 − 1)] (8) 푁50

−(푟퐷푖) 푃푖(푑) = 1 − 푒 (9)

Where 푃푖(푑) is the probability of an individual becoming infected after ingesting 퐷푖 number of pathogenic organisms, 푁50 is the median infection dose representing the number of pathogenic organisms that will infect 50% of the exposed population; and 훼 and 푟 are dimensionless infectivity constants for rotavirus and Salmonella, and Cryptosporidium respectively. In this thesis, 푁50 and 훼 were assumed to be 6.17 and 0.253 for rotavirus,

23,600 and 0.3126 for Salmonella respectively and 0.0042 for 푟 for Cryptosporidium (Seidu and Drechsel, 2010). By accounting for the dose and frequency of consumption presented above, the annual risk of infection (푃퐴) for each of the pathogenic organisms for each of the exposure routes was estimated by Equation 10.

푁 푃퐴 = 1 − [1 − 푃푖(푑)] (10)

Where 푁 is the number of times an individual either consumes lettuce grown in the faecal sludge polluted wetland or drinks contaminated water in a year and the rest are defined as before. In this thesis, 푁 was assumed to be 156 for consumption of lettuce (Seidu and

Drechsel, 2010) and 365 for drinking of water respectively.

3.3.2.4 Disability Adjusted Life Years of faecal sludge composting in Kampala

The estimation of DALYs followed the HRIA. Only one pathogenic organism and exposure route associated with the highest risk was finally chosen as a proxy to estimate the DALYs.

DALYs help to ascertain the efficacy of the faecal sludge composting intervention in comparison with the dumping of the faecal sludge scenario. This approach quantified the burden of morbidity and mortality of diarrhoea disease cases in Kampala City. As shown in

Equation 11, the approach aggregates the years of life lost due to premature mortality (푌퐿퐿푠) and the years of life an individual lives with a disability (푌퐿퐷푠) and are standardised using severity or disability weights (Murray, 1994; Fox-Rushby and Hanson, 2001; Seidu and

Drechsel, 2010). The DALYs estimated in this thesis were categorised into babies, school- going children and adults.6

퐷퐴퐿푌푠 = 푌퐿퐿푠 + 푌퐿퐷푠 (11)

The annual 푌퐿퐿푠 and 푌퐿퐷푠 were estimated using Equations 12 and 13 (Murray, 1994; Fox-

Rushby and Hanson, 2001; Seidu and Drechsel, 2010).

6 Adults are those who are at least 18 years old, school children are those who are 5–18 years old and babies are those who are 0-4 years old (Hutton et al., 2007). 35

퐾퐶푒푟푎 푌퐿퐿푠(푟, 퐾, 훽) = {푒−(푟+훽)(퐿+푎)[−푟(푟 + 훽)(퐿 + 푎) − 1] − 푒−(푟+훽)푎[−(푟 + 훽)푎 − (푟+훽)2

1−퐾 1]} + (1 − 푒−푟퐿) (12) 푟

퐾퐶푒푟푎 푌퐿퐷푠(푟, 퐾, 훽) = 퐷 { {푒−(푟+훽)(퐿+푎)[−푟(푟 + 훽)(퐿 + 푎) − 1] − 푒−(푟+훽)푎[−(푟 + 훽)푎 − (푟+훽)2

1−퐾 1]} + (1 − 푒−푟퐿)} (13) 푟

Where 퐾 is an age weighting modulation factor; 퐶 is a constant; 푟 is a discount rate; 푎 is the age of death or age of onset of a disability for any of babies, school-going children and adults; 훽 is a parameter from the age weighting function; 퐿 is the standard expectation of life at age 푎; and 퐷 is the disability weight. 퐾 was varied between 0 and 1, 퐶 and 훽 were set at

0.1658 and 0.04 respectively. A discount rate of 11.5%, the central bank rate in Uganda as of

May 2014 (Bank of Uganda, 2016) was used. The value of 퐿 for babies, school-going children and adults in Kampala City was assumed to be equal to 57 years (the average life expectance at birth for the population of Uganda) less by 푎.7 For each of babies, school-going children and adults, 푎 was assumed to be equal to the respective average age estimated from

UNPS 2009/2010. The severity index for mild and severe diarrhoea disease due to rotavirus was set at 0.1 and 0.23 respectively; watery and bloody diarrhoea due to Salmonella at 0.067 and 0.39 respectively while watery diarrhoea due to Cryptosporidium at 0.067. The disability weight was varied between 0.096 and 0.920 (Murray, 1994). The duration of one episode of diarrhoea, among other variables were estimated from UNPS 2009/2010. The total DALYs for each of dumping and composting of faecal sludge were calculated by multiplying the

DALYs for one individual by the exposed proportion of the city population under each scenario.

7 World Health Organisation Indicators. http://www.who.int/countries/uga/en/ 36

Evaluation methods such as Averting Behaviour and Defensive Expenditure, Cost of Illness and Lost Output methods (Pearce et al., 2006) were used to estimate the health costs and benefits of faecal sludge composting using DALYs in Kampala City (Table 3.1). Averting behaviour and defensive expenditure is where an individual avoids negative intangible impacts such as diarrhoea illness by for example building a faecal sludge treatment plant.

Cost of illness and lost output is where the monetary value of intangible impacts such as illness are observed through market goods such as cost of treatment (Pearce et al., 2006).

These methods have been used by recent studies such as Vodounhessi (2006) and Hutton et al. (2007).

3.3.2.5 Cost Benefit Analysis of faecal sludge composting in Kampala

The Cost Benefit Analysis was used to test Hypothesis 1 as well as achieve Objective 2 of this study. Cost Benefit Analysis is a method used to identify, analyse and present the costs and benefits of various options of activities, policies or scenarios to decision makers (Pearce et al., 2006). It is based on the theory of welfare economics (Kateregga, 2012). This thesis adopted the Cost Benefit Analysis framework in Pearce et al. (2006).

After quantification of the selected social and health costs and benefits, a Cost Benefit

Analysis of faecal sludge composting was conducted. The present value of each cost and benefit was estimated using a discount rate of 11.5%; the central bank rate in Uganda as of

May 2014 (Bank of Uganda, 2016). The discount rate that was used in this thesis is higher than the 10% that existed when Kateregga (2012) conducted their Cost Benefit Analysis on pesticide use in Uganda. The present value of all costs were aggregated into a total cost and total benefit for all the benefits. Both the total cost and benefits were applied in Equation 14 to 16 to estimate the Net Present Value, Benefit Cost Ratio and Economic Internal Rate of

Return. Following the theory of welfare economics, faecal sludge composting project would be viable only if it is Net Present Value is positive, Benefit Cost Ratio is greater than one and discount rate is lower than Economic Internal Rate of Return (Hicks, 1939; Kaldor, 1939;

Keenan and Snow, 1999; and Hutton et al., 2007).

(퐵 −퐶 ) 푁푃푉 = ∑푡 푡 푡 (14) ∞ 0 (1+푟∗)푡

(퐵 −퐶 ) 0 = ∑푡 푡 푡 푟∗ = 퐸퐼푅푅 (15) 0 (1+푟∗)푡

퐵 ∑푡 푡 0(1+푟)푡 퐵퐶푅 = 퐶 (16) ∑푡 푡 0(1+푟)푡

Where NPV∞ is the social welfare measure, r discount rate, Bt and Ct are total benefits and costs in year t respectively, EIRR is the Economic Internal Rate of Return in year t and

BCRt is the Benefit Cost Ratio.

3.3.3 Cost-effectiveness of faecal sludge composting in Kampala

Cost-Effective Analysis was conducted to compute Cost-Effectiveness Ratios; which provided a robustness check for the results from the Cost Benefit Analysis. The average Cost-

Effectiveness Ratios were calculated in US$ per DALY (i.e. the cost incurred for each DALY averted by the faecal sludge composting intervention) after accounting for the DALYs averted for the interventions in relation to the status quo (no intervention scenario) (Equation

17). All costs and DALYs averted were discounted at 11.5% as baseline; the central bank rate in Uganda as of May 2014 (Bank of Uganda, 2016). By comparing with the recommended cut-off value of US$150/DALY averted in a developing country (World Bank, 1993), faecal sludge composting was considered cost-effective only if it yielded Cost-Effectiveness Ratios of less than US$150/DALY and unattractive if otherwise.

퐶 ∑푡 푡 0(1+푟)푡 퐶퐸푅 = 퐷퐴퐿푌 (17) ∑푡 푡 0(1+푟)푡

Where 퐶퐸푅 is the cost-effectiveness ratio, r discount rate, Ct are total costs in year t, respectively, 퐷퐴퐿푌푡 is Disability Adjusted Life Years in year t.

3.4 Sensitivity and uncertainty analysis of faecal sludge composting

A sensitivity and uncertainty analysis was conducted to achieve Objective 3 as well as test

Hypothesis 2 of this study. Both the Cost Benefit Analysis and Cost-Effective Analysis were independently subjected to a sensitivity and uncertainty analysis using different national interest rates and urban population growth rates in Uganda; which are the major policy tools in the Uganda economy. Discount rates from lowest recorded central bank rate of 11% to highest of 23% were used (Figure 3.5). This thesis also conducted a sensitivity analysis by assuming a change in the urban population growth rate from the current 5.6% to the national rate of 3.2%. Thus, by combining the different discount and urban population growth rates, about 10 scenarios were simulated and their respective net values were computed (Table

3.3).

Figure 3.5: Trend of Central Bank Rate over time (Source: Bank of Uganda data)

Table 3.3: Sensitivity analysis scenarios for faecal sludge composting

Scenario Discount rate (%) Urban population growth rate (%)

A 11.5 5.6

B 11.5 3.2

C 11 5.6

D 11 3.2

E 15 5.6

F 15 3.2

G 17 5.6

H 17 3.2

I 23 5.6

J 23 3.2

CHAPTER FOUR

RESULTS AND DISCUSSION

4.1 Overview of the chapter

This chapter presents the results of this study and their discussion. The findings are summarised in tables as means, proportions, Net Present Values, Benefit Cost Ratios and

Cost-Effectiveness Ratios of faecal sludge composting in Kampala City, among others. This chapter is divided into five sub-sections. The first sub-section is an introduction to the chapter. Before reporting on the results of the analysis on economic viability of faecal sludge composting, the second sub-section summarizes the socio-economic, health and location characteristics of the urban households that were sampled in Uganda National Panel Survey

(UNPS) 2009/2010, and whose data informed this study. The third sub-section presents the indicators of the social and health benefits and costs that were profiled in this study. The fourth sub-section computes and discusses the net value of faecal sludge composting in

Kampala City; and the last sub-section is about the sensitivity and uncertainty analysis of the faecal sludge composting project.

4.2 Characteristics of the urban households

This section summarises the socio-economic, health and location characteristics of the urban households that were sampled in the UNPS 2009/2010 survey.

4.2.1 Socio-economic characteristics of urban households

The selected socio-economic characteristics of the sampled urban households are presented in

Table 4.1. Urban households were described with respect to the age of babies, school-going children and adults in the household at the time of the survey, because these variables were

used in computing the net value of faecal sludge composting. The mean age of babies in urban households was two years, eleven years for school-going children and thirty three years for the adults; and majority (92%) of the school-going children were attending school at the time of the survey. The mean household size was about five persons; with male adults contributing an average of one person and two persons for female adults. The mean number of children in the sampled urban households was about two persons; with about two persons in the school-going category and one person in the baby category.

The characteristics of labour among the urban households was the other important variable that was used in the cost benefit analysis. Most of the sampled urban households in Kampala

City earned income from wage employment (44%) followed by non-agricultural enterprises

(31%) and property income (8%). The results show that the households in Kampala City that are involved in wage employment received about US$0.99 for every hour of work and provided about 2,721 man hours of labour per year. On average, only one adult provided this labour in every urban household in Kampala.

Urban households were also described with respect to access to improved Water, Sanitation and Hygiene services. Most of the sampled urban households (99%) had improved toilet facilities and also accessed improved water sources (95%). This finding is in agreement with

Uganda Bureau of Statistics (2010) who argued that about 92% of households in urban areas of Uganda have access to improved water supply. However, this finding suggests that

Kampala City has not yet met the 98% target of improved water supply coverage (Prüss-

Üstün et al., 2004). Each day, these households collected about 19 litres per adult equivalent of domestic water and as a result they spent about US$5 on water for domestic purposes per month. The results also show that most of the sampled urban households (93%) did

something to make water safe for drinking. Such practices included boiling only, both boiling and filtering, and covering the drinking water during storage, among others.

Table 4.1: Selected socio-economic characteristics of urban households

Description of socio-economic variable n Mean Age of adults (completed years) 239 32.73 (8.86) Age of school-going children (completed years) 150 10.87 (2.97) Age of babies (completed years) 102 1.92 (1.20) Household size (number of members) 239 5.08 (3.31) Number of male adults 239 1.35 (1.05) Number of female adult 239 1.57 (1.26) Number of children 239 2.26 (2.23) Number of school-going children 239 1.69 (1.90) Number of babies 239 0.57 (0.75) Number of adults who provide labour 137 1.49 (0.86) Wage rate (US$ per hour) 137 0.95 (0.12) Labour supply (man hours per year) 137 2721.29 (1337.80) Description of socio-economic variable n Proportion School-going children currently attending school (1 = Yes and 0 = Otherwise) 150 0.92 (0.27) Wage employment income source (1= Yes and 0 = Otherwise) 239 0.44 (0.50) Non- agricultural enterprises income source (1= Yes and 0 = Otherwise) 239 0.31 (0.46) Type of toilet facility mainly used (1 = Improved and 0 = Otherwise) 239 0.99 (0.09) Type of water source mainly used (1 = Improved and 0 = Otherwise) 239 0.95 (0.22) Quantity of water collected by household (l per Adult equivalent per day) 239 18.86 (10.03) Cost of water collected per month (US$) 239 5.10 (5.12) Practices to make drinking water safe (1 = Do something and 0 = Otherwise) 239 0.93 (0.25) Cover drinking water during storage (1= Yes and 0 = Otherwise) 239 0.92 (0.26) Notice: Standard deviation in parenthesis Data Source: UNPS 2009/2010

4.2.2 Health characteristics of urban households

The study also described sampled urban households with respect to illnesses and injuries suffered in the last 30 days before UNPS 2009/2010 (Table 4.2). Most (67%) of the urban households had members who had fallen sick due to various illnesses including diarrhoea

(chronic or acute); and on average, about two household members suffered from some illness or injury in the last 30 days before the survey. Only 6% of the households had members who had suffered from diarrhoea in the last 30 days before the survey; and on average, only one household member had done so. Overall, diarrhoea was reported to be more prevalent among babies than either school-going children or adults. Fourteen percent of the urban households had a baby who suffered from diarrhoea in the last 30 days and only 0.4% of the urban households had adults who suffered from the illness. Of those households that had school- going children, none reported to have had members in this category who suffered from diarrhoea illness in the last 30 days before the survey.

Households in Kampala City reported that their members suffered from illness for about nine days; and eleven days for babies who specifically suffered from diarrhoea. The household members who suffered from any illness or injury and those that took care of the babies that suffered from diarrhoea spent about four days when not working, and the household spent about US$4 on treating all the members who fell ill. The treatment facility that urban households used to treat their members who suffered from illness in the last 30 days were within 2km from their dwellings.

Table 4.2: Selected health characteristics of urban households

Description of health variables n Proportion Whether any household member fell ill or injured in the last 30 days (1= Yes and 0 = Otherwise) 239 0.67 (0.47) Whether any household member suffered from diarrhoea in the last 30 days (1= Yes and 0 = 239 0.06 (0.24) Otherwise) Whether any adult household member suffered from diarrhoea in the last 30 days (1= Yes and 0 = 239 0.004 (0.06) Otherwise) Whether any school-going child household member suffered from diarrhoea in the last 30 days 150 0.00 (0.00) (1= Yes and 0 = Otherwise) Whether any baby household member suffered from diarrhoea in the last 30 days (1= Yes and 0 = 102 0.14 (0.35) Otherwise) Description of health variables n Mean Number of household members who suffered from illness or injury in the last 30 days 161 2.38 (1.64) Number of household members who suffered from diarrhoea in the last 30 days 15 1.00 (0.00) Number of adult household members who suffered from diarrhoea in the last 30 days 1 1.00 (-) Number of baby household members who suffered from diarrhoea in the last 30 days 14 1.00 (0.00) Length of illness of household members in last 30 days (days) 161 9.40 (6.65) Length of diarrhoea illness in adult household members in last 30 days (days) 1 7.00 (-) Length of diarrhoea illness in baby household members in last 30 days (days) 14 11.07 (9.65) Lost productive time due to illness of household members in last 30 days (days) 160 3.66 (5.15) Lost productive time due to diarrhoea illness in adult household members in last 30 days (days) 1 7.00 (-) Lost productive time due to diarrhoea illness in baby household members in last 30 days (days) 14 4.36 (6.46) Distance to facility where households sought treatment for members who suffered from diarrhoea 15 1.85 (5.08) in last 30 days (km) Total cost of treatment of household members who suffered from diarrhoea in last 30 days (US$) 15 3.61 (2.87) Notice: Standard deviation in parenthesis - is not applicable Data Source: UNPS 2009/2010

4.3 The indicators of the benefits and costs of faecal sludge composting

The benefits that were profiled in this thesis were revenue from the sale of the sanitised faecal sludge compost product, income from employment along the faecal sludge composting value chain, consumer surplus, avoided health costs, revenue from faecal sludge extraction and haulage business and savings from reduced haulage distance. While investments costs

including capital costs to construct the faecal sludge treatment plant and purchase of the faecal sludge extraction and haulage trucks, and operation and maintenance costs for both the treatment plant and the extraction and haulage businesses were profiled as the costs of the intervention. The sub-sections that follow discuss in detail the indicators of the selected costs and benefits of faecal sludge composting (see Appendix 5.1 for more highlights).

4.3.1 The indicators of the social benefits of faecal sludge composting

Table 4.3 presents the indicators of the selected social benefits of faecal sludge composting.

Revenue earned from the discharge fee of faecal sludge at the faecal sludge treatment plant, selling of the compost product and emptying and transporting of faecal sludge from on-site sanitation facilities were profiled (Appendix 3). The study found that faecal sludge compost product would be demanded by forestry, compound designing and flower nursery operations in the peri-urban areas, among others (Makerere University and Urban Harvest, 2009; and

GTZ, 2010), thus it assumed that all the produced product would be consumed. The price for faecal sludge compost product was found to be US$ 3.2 per tonne of faecal sludge, which is lower than the US$8 reported by Kwon (2005) and US$540 per tonne of inorganic fertilizer

(Chemonics International and International Fertilizer Development Centre, 2007).

Table 4. 3: Indicators of social benefits of faecal sludge composting

Indicators of the social benefits Value Source Revenue from operating a faecal sludge treatment plant Market price of faecal sludge compost (US$ per tonne of faecal sludge) 3.20 Primary data Output of faecal sludge compost per year (tonnes of total solids) 6076.91 Equation 5 and Steiner et al. (2002) Discharge fee from faecal sludge collectors (US$ per tonne of faecal sludge) 2.80 Primary data Annual quantity of faecal sludge discharged (tonnes of total solids) 30,384.53 Equation 4 and Steiner et al. (2002) Employment income Market wage rate (US$ per man day) 7.57 UNPS 2009/2010. Annual labour supply in faecal sludge treatment plant (man days) 2,798.63 Primary data and Kwon (2005) Annual labour supply in faecal sludge collection business (man days) 145,845.75 Kwon (2005) and Primary data Consumer surplus Willingness to Pay for faecal sludge compost (US$ per tonne of faecal sludge) 28.00 Vodounhessi (2006) Market price of faecal sludge compost (US$ per tonne of faecal sludge) 3.20 Primary data Output of faecal sludge compost per year (tonnes of total solids) 6076.91 Equation 5 and Steiner et al. (2002) FS extraction and haulage Revenue Pit latrine emptying and transport fee (US$ per tonne of faecal sludge) 12.00 Primary data Annual quantity of faecal sludge collected (tonnes of total solids) 30,384.53 Equation 4 and Steiner et al. (2002) Savings in transport Percentage reduction in faecal sludge haulage distance (%) 20 Steiner et al. (2002) and Vodounhessi (2006) Haulage cost (US$ per tonne of faecal sludge) 3.60 Primary data, Steiner et al. (2002) and Vodounhessi (2006) Annual quantity of faecal sludge collected (tonnes of total solids) 30,384.53 Equation 4 and Steiner et al. (2002)

Recent studies such as NETWAS Uganda and DMTC (2011) have found a very high demand for faecal sludge emptying services in Kampala City by institutions and households that use on-site sanitation facilities. These institutions such as schools, hotels and hospitals, among others and households with the majority located in slum areas would pay for the emptying services provided to them by the emptiers. After collecting the faecal sludge from on-site sanitation facilities, the emptiers would discharge it at a fee at the faecal sludge treatment plants. This thesis used faecal sludge extraction and haulage fees for a 5 tonne vacuum truck and discharge fees were within the ranges (US$2 to US$4 per trip in Kampala City) reported by NETWAS Uganda and DMTC (2011).

4.3.2 Health risk due to poor faecal sludge disposal

The annual infection risks associated with the faecal – oral route are presented in Table 4.4.

The results show a high viral infection risk in Kampala City. Moreover, the highest pathogenic infection risk occurs mostly when individuals consume vegetable salad than drinking contaminated water. When an individual consumes vegetable salad grown in faecal sludge polluted wetlands, each of the viral, bacterial and protozoan infection risk are of a magnitude of 1.00 per person per year. While individuals who drink contaminated water, are likely to be exposed to a viral infection risk of a magnitude of 8.10 x 10-1 per person per year while those of bacterial and protozoan are 3.06 x 10-4 and 1.18 x 10-2 per person per year respectively. These findings indicate that the risks associated with any of the three pathogenic infections given the current dumping of faecal sludge scenario don’t meet the World Health

Organisation (WHO) tolerable infection risk of 10-4 per person per year. The results mean that if all the 5,306,666 people who would not be served by the sewerage system in Kampala

City by 2033 consume vegetable salad, without the composting of faecal sludge scenario, nearly the whole population would be at risk of infection with any of rotavirus,

Cryptosporidium or Salmonella. While as for drinking water, about 81% of the projected population who would be accessing on-site sanitation by 2033 would be at risk of rotavirus infection in that year alone, while only 1% would be susceptible to Cryptosporidium and a lower proportion to Salmonella infections (<1%). This finding is in agreement with Winkler et al. (2014) who found that the concentration of faecal coliforms and E. coli but not

Salmonella sp. in the Nakivubo channel, swamp and community but not in the lake exceeded the national and international standards (Section 3.3.2.3). Thus, the levels of diarrhoea morbidity which are reported in Section 4.2.2 are realistic to the urban population of

Kampala.

Table 4.4: Significance of the health risks under the dumping of faecal sludge scenario Rotavirus Salmonella Cryptosporidium

Drinking Vegetable Drinking Vegetable Drinking Vegetable water consumption water consumption water consumption

Dosage 7.74 x 10-3 1.63 x 104 7.74 x 10-3 1.63 x 104 7.74 x 10-3 1.63 x 104 Daily probability 4.54 x 10-3 9.31 x 10-1 8.39 x 10-7 4.47 x 10-1 3.25 x 10-5 1.00 Annual risk of 8.10 x 10-1 1.00 3.06 x 10-4 1.00 1.18 x 10-2 1.00 infection

4.3.3 The indicators of the health benefits of faecal sludge composting

Table 4.5 presents the indicators used to quantify health benefits of faecal sludge composting in Kampala City. The values of these indicators were based on an average of 2 diarrhoea episodes per person per year, only adults earn income and may stay home to look after sick babies, and only school-going children loose school time due to diarrhoea morbidity. The findings show that about 18 adults and 263 babies in every 10,000 people chosen at random from the exposed urban population will be averted from diarrhoea infection. Morbidity in babies affects the available time for work among the adults who stay home to baby sit them

(Hutton et al., 2007). These adults could be in position to do some work around the home as

they look after the sick baby (ies). This is why the number of days gained by an adult from not baby-sitting a sick baby per year is too lower than what they gain when adults are sick.

When individuals die before their life expectancy due diarrhoea morbidity, they lose productive time which is equivalent to complete years. The public is likely to seek less of medical care due to averted diarrhoea morbidity. This results into a health sector saving on every averted diarrhoeal episode as well as individual saving from reduced expenditure on transport to medical facility and the associated medical care bills.

Table 4.5: Indicators used to quantify the selected health benefits of faecal sludge composting

Indicators of health benefits Value Source Productive years saved due to averted death in adults Daily opportunity cost of labour (US$ per man day) 7.57 UNPS 2009/2010 Disability Adjusted Life Years in adults (years) 32 Equation 11 Case fatality rate in population (%) 14 Accorsi et al. (2005) Number of days gained from avoided death per person per year (man days) 365 Proportion of Adults with averted diarrhoea (%) 0.18 Seidu and Drechsel (2010) and UNPS 2009/2010 Productive years saved due to averted death in babies Daily opportunity cost of labour (US$ per man day) 7.57 UNPS 2009/2010 Disability Adjusted Life Years in babies (years) 49 Equation 11 Case fatality rate in population (%) 14 Accorsi et al. (2005) Number of days gained from avoided death per person per year (man days) 365 Proportion of babies with averted diarrhoea (%) 2.63 Seidu and Drechsel (2010) and UNPS 2009/2010 Averted work time in adults Number of days off work per year due to illness of adult (man days) 14 UNPS 2009/2010 Daily opportunity cost of labour (US$ per man day) 7.57 UNPS 2009/2010 Proportion of Adults with averted diarrhoea (%) 0.18 Seidu and Drechsel (2010) and UNPS 2009/2010 Averted baby days in adults Proportion of babies with averted diarrhoea (%) 2.63 Seidu and Drechsel (2010) and UNPS 2009/2010 Number of days gained by adult from not baby-sitting a sick child per year (man days) 4.36 UNPS 2009/2010 Daily opportunity cost of labour (US$ per man day) 7.57 UNPS 2009/2010 Savings in health sector per year Unit cost per treatment for Health centre (US$) 2.2 Hutton et al. (2007) Probability of visiting public hospitals and health centres given that you have diarrhoea (%) 8.16 UNPS 2009/2010

Indicators of health benefits Value Source Visits per case to Health Centre (Days) 1 Hutton et al. (2007) Savings by individual per year Expenditure (including Treatment and Transport) per person per year (US$) 9.81 UNPS 2009/2010

4.3.4 The indicators of the costs of faecal sludge composting

Investment costs for the faecal sludge treatment plant and vacuum trucks was another important component that was profiled and formed the main part of the costs of the intervention. Table 4.6 presents the indicators of the investment costs for the faecal sludge composting intervetion in Kampala City (Appendix 3). The main indicators of the investment costs that were profiled included the annualised capital cost of constructing the treatment plant, purchasing the vacuum tankers to collect the faecal sludge from on-site sanitation facilities and discharge it at the treatment plant, and the operation and maintenance cost for both the treatment plant and the vacuum tankers. However, the cost of land was not included in the annualised capital cost of feacal sludge treatment plant, because the Government of

Uganda has land which she would give out for free to public projects (Mercedes Stickler,

2012). To achieve the 25% reduction in total solid in Kampala by 2033, the findings show that only 1 optimal faecal sludge treatment plant would be built and would be identical to the engineering design of Lubigi Faecal Sludge Treatment Plant model (Steiner, 2002). Steiner

(2002) suggest that in low cost sanitation, haulage costs increase with the size of the treatment plant. Moreover, very large treatment plants would motivate illegal and unregulated disposal of faecal sludge by collectors and also would be expensive to construct given that land is limited both within and near cities. An additional 87 vacuum trucks would be required to supplement on the exiting 75 (56 and 19 currently owned by Private Emptiers Association and Kampala Capita City Authority respectively) so as to meet the 25% faecal sludge reduction by 2033 (Brikke and Bredero, 2003; NETWAS Uganda and DMTC, 2011;

Ssenyondo and Kinobe, personal communication, 2014).

Table 4.6: Indicators used to quantify the cost of faecal sludge composting

Indicators of investment costs Value Source

Investment cost for faecal sludge treatment plant

Annualised capital costs (US$) a 1,674,662 Steiner (2002); and Annualised operation and maintenance (US$) 188,437 primary data

Total number of faecal sludge treatment plants needed to achieve the 25% 1 target scale of operation

Investment cost for faecal sludge collection and haulage business

Annualised capital costs (US$) 5,188 Steiner (2002); Brikke and Bredero (2003); Annualised operation and maintenance (US$) 20,270 Kwon (2005); and primary data Total number of vacuum trucks needed to achieve the 25% target scale of 162 operation Total number of new vacuum trucks needed to achieve the 25% target scale 87 of operation Notice: a Cost of land not included

4.4 The quantified costs and benefits and the net value of faecal sludge composting

In this sub-section, the quantified social and health costs and benefits are discussed and are used to compute the net value of faecal sludge composting in Kampala City. The net value of faecal sludge composting is discussed in detail under this sub-section.

4.4.1 The value of the social and health costs and benefits of faecal sludge composting

Figure 4.1 presents the aggregated non-monetised benefits that were used to compute the cost-effectiveness of the faecal sludge composting plant for the 20 years of the program.

Averted DALYs for babies would contribute the largest (96%) share of benefit of the total benefits of faecal sludge composting for the models, followed by adults (4%) and no recorded benefit to school-going children. This finding shows that averted health effects in babies due to improved sanitation and hygiene arising from faecal sludge composting is likely to be the main reason for investing in this intervention. 54

Figure 4.1: Aggregated non-monetised health benefits of faecal sludge composting

Figure 4.2 presents the aggregated monetised benefits of faecal sludge composting for the 20 years of the program. The largest (79%) share of total benefits would be contributed by health benefits in terms of averted disability and mortality in babies, followed by saved productive time for adults who would care for the morbid babies (7%), and averted disability and mortality in adults (5%). No benefit would yield from averted disability and mortality in school-going children. This finding corroborates Eshet et al. (2006); Kone et al. (2007) who argued that health externalities are of greater concern in most waste management projects.

The high share of health benefits can be explained by the fact that the sanitised faecal sludge compost product leads to improved occupational health and safety and reduces the likelihood of workers being infected by pathogens. Furthermore, this finding corroborates Hutton et al.

(2007) and Prüss-Üstün et al. (2008) who showed that about 88% of the global diarrhoea cases are due to poor sanitation and hygiene, and about 1.5 million people die of diarrhoea related illness; with the majority of the deaths occurring among children.

Figure 4.2: Aggregated monetised social and health benefits of faecal sludge composting

Among the other benefits, employment income would contribute the most to total social benefits in the Lubigi Faecal Sludge Treatment Plant model, with a total of about 493 jobs created in the plant and the faecal sludge extraction and haulage business (Appendix 3). The largest proportion (98.6%) of jobs would be in faecal sludge extraction and haulage business.

The second largest non-health benefit would be in the form of revenue collection from the envisioned faecal sludge treatment plants (both selling faecal sludge compost product and levying discharge fees from faecal sludge collectors who discharge the raw faecal sludge at the faecal sludge treatment plant). Moreover, revenue from selling of faecal sludge compost is likely to increase with low cost innovations such packaging compost in 5, 10, 20, 25 and 50 kg bags as well as converting the cakes into pellets (Appendix 4). Third in importance among the non-health benefits would be revenue from faecal sludge extraction and haulage business.

The faecal sludge emptiers would benefit from both the revenue from faecal sludge extraction and haulage fees and savings in operation and maintenance costs due to reduced haulage

distance. Faecal sludge extraction and haulage fees would be paid by households and institutions such as schools whenever their pits and septic tanks are emptied. NETWAS

Uganda and DMTC (2011) noted the existence of a high demand for cesspool services by school, hotels, hospitals, institutions and households, among others.

The aggregated monetised costs of faecal sludge composting for the 20 year period of the programme are presented in Figure 4.3. The findings show that the capital cost of constructing the faecal sludge treatment plant would constitute the largest proportion of the total cost of faecal sludge composting, accounting for 53% of the total cost for the Lubigi model. This would be followed by the operation and maintenance costs of faecal sludge extraction and haulage business (about 30% of the total cost). This finding does not corroborate that of Steiner et al. (2002); Kwon (2005); Vodounhessi (2006) who found operation and maitenance costs for the Buobai Full Scale model to contribute the largest proportion of the investment costs.

Figure 4.3: Aggregated monetised costs of faecal sludge composting

4.4.2 The net value of faecal sludge composting

Table 4.7 presents the aggregated Net Present Value, Benefit Cost Ratio, Economic Internal

Rate of Return, and Cost-Effective Ratios of faecal sludge compositing for the 20 year period of the programme. The results show that the Lubigi Faecal Sludge Treatment Plant model would be economically viable if faecal sludge is composted into a sanitized product. This is because at the current discount rate of 11.5%, the model had potential positive Net Present

Value, Benefit Cost Ratio that were greater than one, Economic Internal Rate of Return greater than the central bank rate of 11.5%, and Cost-Effectiveness Ratios were less than the recommended cut-off value of US$150/DALY averted in developing countries (World Bank,

1993). These results show that faecal sludge composting would contribute to improvement in social welfare when implemented. This is because the total benefits of implementing the intervention outweigh the costs. Adopting the Lubigi model would yield US$7.5 in benefits for every US$1 invested in faecal sludge composting. The findings further show that every

DALY due to diarrhoea infection would be averted by an investment of US$1.36 in faecal

sludge composting. These findings corroborate those of Rtyz (2001); Steiner et al. (2003);

Kwon (2005); Vodounhessi (2006); Hutton et al. (2007); Renwick et al. (2007); Seidu and

Drechsel (2010) who found different faecal sludge management options economically viable.

Steiner et al. (2003) found the benefits of Buobai Faecal Sludge model to outweigh the costs of implementing the intervention. The findings of Steiner et al. (2003) implied that Buobai

Faecal Sludge Treatment Plant yielded US$2.5 in benefits for every US$1 invested in faecal sludge composting. Renwick et al. (2007) found the Net Present Value of faecal sludge composting using low cost biogas digesters in Uganda to be US$275,814,233, with US$1 of investment yielding US$6.84 in benefits and a higher Economic Internal Rate of Return of

166%. Hutton et al. (2007) also found similar results in developing countries with US$1 of investment in improved sanitation yielding US$7 in benefits, with averted health effects contributing the largest share.

Table 4.7: Net value of faecal sludge composting

Measures of economic viability Value Net Present Value (US$) 176,305,220 Benefit Cost Ratio 7.50 Economic Internal rate of return (%) 74.4 Cost-Effectiveness Ratio 1.36 Discount rate (%) 11.5 Length of program (years) 20 Required treatment plants to achieve 25% target 1

4.5 Sensitivity and uncertainty analysis of faecal sludge composting

A sensitivity and uncertainty analysis was conducted for both the Cost Benefit Analysis and

Cost-Effective Analysis. Figure 4.4 presents the annual Net Present Value under different scenarios of faecal sludge composting for the 20 years of the programme. The results show that a fall in interest rate at a constant urban population growth rate would significantly increase the Net Present Value of the faecal sludge composting project. However, the rate of urban population growth rate would have a reverse effect on Net Present Value as compared to the interest rate when the latter is constant. The findings further show that when both the interest rate and urban population growth rates fall sharply, the Net Present Value of the faecal sludge composting project would significantly increase. This was demonstrated by a shift from scenario I to H, G to either D or B, and E to either D or B.

Figure 4.4: Variation of annual Net Present Value under different scenarios of faecal sludge composting over time

Figure 4.5 presents the findings on the variation of Benefit Cost Ratio under different scenarios of faecal sludge composting over time. Similar to the behaviour of Net Present

Value, a negative relationship was found between interest rates and Benefit Cost Ratio. A fall in interest rate at constant urban population growth rate resulted in an increase in the Benefit

Cost Ratio. This was demonstrated by a shift from scenario I to G, E, and C, in that order. To differ from the behaviour of Net Present Value, a negative relationship was found between population growth rate and Benefit Cost Ratio. A fall in urban population growth rate at constant interest rate resulted in an increase in Benefit Cost Ratio. This was demonstrated by a shift from scenario I to J, G to H, and E to F, among others. As expected, a fall in both the interest rate and urban population growth rate resulted in an increase in Benefit Cost Ratio.

This was demonstrated by a shift from scenario I to H, G to F, and E to D, among others.

Figure 4.5: Variation of Benefit Cost Ratio under different scenarios of faecal sludge composting over time

The variation of Cost-Effectiveness Ratio under different scenarios of faecal sludge composting with time is presented in Figure 4.6. The findings show that both interest rate and urban population growth rate have independent positive relationships with Cost-Effectiveness

Ratio. A fall in either interest rate at constant urban population growth rate or urban population growth rate at constant interest rate results into a decrease in Cost-Effectiveness

Ratio. The effect of interest rates was demonstrated by a shift from scenario I to G, E, and C, in that order while that of urban population growth rate was demonstrated by a shift from scenario I to J, G to H, and E to F, among others. Similar to the previous finds of this study, a fall in both interest rate and urban population growth rate results in a decrease in Cost-

Effectiveness Ratio. This was demonstrated by a shift from scenario I to H, G to F, and E to

D, among others.

Figure 4.6: Variation of Cost-Effectiveness Ratio under different scenarios of faecal sludge composting over time

Table 4.8 presents the aggregated Net Present Value, Benefit Cost Ratio and Cost-

Effectiveness Ratio under different scenarios of faecal sludge composting for the 20 years of the programme. Despite the fact that the largest Net Present Value was recorded in scenario

C, the findings show that scenario D would yield the highest net value. This scenario would yield a Net Present Value of US$ 139,421,137 in the 20 years of the programme, a Benefit

Cost Ratio of 12 and a Cost-Effectiveness Ratio of US$0.82/DALY. These findings show that every US$1 that would be invested in the composting intervention would yield US$12 of benefits if the economic environment is maintained at the lowest possible interest rate of 11% and at the national interest rate of 3.2%. Lastly, every DALY due diarrhoea infection that would be averted in Kampala would require US$0.82 investment in the faecal sludge composting intervention. These findings corroborate those of Steiner et al. (2002); Hutton et al. (2007); Seidu and Drechsel (2010); Kateregga (2012) who recommended low interest rates as a prerequisite for the economic viability of interventions to improve urban sanitation.

Table 4.8: Net Present Value, Benefit Cost Ratio and Cost-Effectiveness Ratio under different scenarios of faecal sludge composting

Net Present Value Benefit Cost Cost-Effectiveness Scenario (US$) Ratio Ratio A 176,305,220.15 7.50 1.36 B 132,433,501.21 11.85 0.85 C 186,293,603.76 7.79 1.31 D 139,421,137.35 12.36 0.82 E 120,798,963.96 5.76 1.77 F 93,349,588.57 8.89 1.14 G 97,719,383.33 4.95 2.06 H 76,945,289.54 7.56 1.34 I 51,560,100.25 3.17 3.23 J 43,769,631.73 4.75 2.13

CHAPTER FIVE

SUMMARY, CONCLUSIONS AND POLICY RECOMMENDATIONS

5.1 Summary

Poor hygiene and sanitation remains a major public health concern in many urban areas, particularly those in the developing world, where it causes various diseases such as diarrhoea, particularly amongst the children. This thesis explored the social and health costs and benefits of faecal sludge composting in Kampala City, Uganda as a means for improved sanitation. The specific objectives of this thesis are to, identify and profile indicators for the various social and health benefits and costs associated with faecal sludge composting; to determine both the monetised and non-monetised value of the social and health benefits and costs, and consequently the net value of faecal sludge composting; and determine the scenario that yields the maximum net value of faecal sludge composting.

The study was conducted in Kampala City and targeted the population that uses on-site sanitation facilities. It heavily relied on Uganda National Panel Survey 2009/2010, limited literature and supplemented by primary data in the form of key informants interviews. A Cost

Benefit Analysis based on averting behaviour and defensive expenditure; and cost of illness and lost output were used to determine the economic viability of faecal sludge composting in

Kampala City. In addition, the study adopted the Cost-Effective Analysis model to determine the cost-effectiveness of faecal sludge compositing based on averted health costs. Both the

Cost Benefit Analysis and Cost-Effective Analysis were based on the Lubigi Faecal Sludge

Treatment Plant model and were independently subjected to a sensitivity analysis to determine the scenario that yields the maximum net value.

The findings of the study show that urban households had an average size of five members.

Most households earned their income from wage employment, followed by non-agricultural enterprises and property income. Nearly all the households in Kampala had improved toilets and used improved water sources. To ensure that drinking water was safe for drinking, most households undertook practices such covering water during storage, boiling and filtering, among others. Most households had members who suffered from some illness in the last 30 days with only 6% reporting diarrhoea cases. Overall, diarrhoea was reported to be more prevalent among babies than either school-going children or adults. About 14% of the babies in the urban households suffered from diarrhoea in the last 30 days before the survey, 0.4% for adults and none for school-going children. The household members who fell ill suffered for about nine days, spent about four days when not working and the household spent about

US$3.6 on treating all these members.

The results of the Cost Benefit Analysis suggest that the total benefits of adopting the Lubigi

Faecal Sludge Treatment Plant model would outweigh the associated costs. The Lubigi model was found to have Net Present Value estimated at US$ 176,305,220. Averted health costs would contribute the largest share of benefits to society (faecal sludge haulage companies, faecal sludge composting companies, employees and faecal sludge consumers) and capital investment costs would contribute the most to the costs. The Benefit Cost Ratio results show that if the Lubigi model is adopted, every US$1 invested in faecal sludge composting would yield about US$7.5 in benefits. The Cost-Effectiveness Ratios estimates were found to be

US$1.34 of investment for every averted DALY of infection. The sensitivity analysis showed that the net value of faecal sludge composting would increase when both discount rates and urban population growth rate were decreased.

5.2 Conclusions

Basing on the findings of this study, the benefits of faecal sludge composting in an urban area outweigh the associated costs of implementing the intervention. The health benefit, particularly in children under 5 years is the major reason for the economic viability of faecal sludge composting in an urban area. The total capital cost for the faecal sludge treatment plant is the major hindrance to the economic viability of faecal sludge composting in urban areas. Both interest rates and urban population growth rate have a synergistic effect on the net value of faecal sludge composting. The effect was negative on Net Present Value and Benefit

Cost Ratio and positive effect on Cost-Effectiveness Ratio. When interest rate is 11% and urban population growth rate is lowered to the current national level of 3.2%, the net value of faecal sludge composting is maximum.

5.3 Policy recommendations

Basing on the findings of this study, it is highly recommended that the Government of

Uganda and other development partners invest in faecal sludge composting in urban areas as a means to improve sanitation and hygiene. This is because the findings showed that the total benefits of faecal sludge composting outweigh the associated costs. Given that Uganda’s urban areas will still rely more on on-site sanitation systems by 2033, investing in faecal sludge composting in urban areas would have significant social and health benefits.

The Government of Uganda should put in place macro-economic policies that would maintain low interest rates in the country. Together with her development partners, the government should also solicit for cheaper sources of funding for the intervention. This is because faecal sludge composting was found to be more economically viable at lower interest

rates than the current central bank rate of 11.5%. This will enhance the benefits of faecal sludge composting to the urban population.

Government of Uganda and other development partners should strengthen family planning interventions in the country, with specific emphasis on urban areas. The Government should also increase public investments such as schools and hospital, among others in other areas outside Kampala. These interventions will reduce the urban population growth rate to the national level of 3.2%; which was found to boost the net value from faecal sludge composting in the city.

Further research should be conducted to estimate the net value of faecal sludge composting by considering the cost of land and other environmental benefits such as averted Greenhouse

Gases and biodiversity loss in faecal sludge polluted environments, among others which this study did not take into account. This will provide a better precision of the net value of faecal sludge composting as compared to the current.

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APPENDIX

Appendix 1: An overview of Lubigi Faecal Sludge Treatment Plant

Box 1.1: Brief description of Lubigi Sewerage Treatment Plant

The Lubigi Faecal Sludge Treatment Plant is located in Kawempe Division, Kampala City (Appendix 1.1 to 1.3). The plant was designed to receive both septage and sewage. The design capacity for the plant is 4000 and 5000m3 per day of sepatge and sewage respectively. The plant has a dumping bay which has the capacity to receive faecal sludge from 3 vacuum trucks while offsite section receives sewage from sewers. Each of the dumping bay and the offsite sewer inlet empty their contents into independent screen pumps. The screen pumps sort solid waste such as poly-ethene from faecal sludge treatment plant and wastewater. Each of faecal sludge and sewage from the screen pump is pumped into independent grit removal areas where sand is removed from the solids. From the grit removal area, each of sewage and faecal sludge is pumped into sedimentation tanks of 1,250m3. The plant has 2 sedimentation tanks. These tanks have pumps that separate liquid from the solids. The solids settle in the sedimentation tank and are pumped to the covered drying beds. The covered drying beds are 19 in number and measuring 7x34m and 4,522m2 total area. The sludge is then scooped using machines and disposed of at the store. The store has 19 compartments of 7x34m and 4,522m2 total area. The liquids from all sedimentation tanks are pumped into a flow measurement, after which are distributed to 3 Anaerobic ponds of 70m length, 30m width and 4,240m3 volume. Despite the fact that the anaerobic ponds have not yet been de-sludged, the solids would be mechanically scooped after 1 to 2 years. The scooped solids would be dried in the 30 uncovered drying beds of 7x34m. The liquids from the anaerobic ponds are pumped into the Facultative Ponds. There are 2 Facultative ponds of 170m length, 50m width and 11,530m3 of volume. The effluent from Facultative ponds is then released into the natural wetland for further treatment.

Appendix 1.1: Vacuum tanker Appendix 1.2: Sedimentation Appendix 1.3: Covered drying at dumping bay tank bed

Source: Orwiny (personal communication, 2014)

Appendix 2: Situation analysis of the different Faecal Sludge Management approaches

Appendix 2.3: Worker at faecal sludge screen area of Appendix 2.1: Pit latrines near a drainage channel in a Appendix 2.2: Plastic bags commonly disposed with fresh faecal material (Source: CIDI, 2010) Lubigi faecal sludge treatment plant (Source: Author, Kampala slum (Source: Nakato et al., 2012) 2014)

Appendix 2.6: Health grass in wetland at effluent Appendix 2.4: Worker removing helminth scum from Appendix 2.5: Removed helminth scum from anaerobic outlet from Lubigi faecal sludge treatment plant anaerobic pond of Lubigi faecal sludge treatment plant pond of Lubigi faecal sludge treatment plant (Source: (Source: Author, 2014) (Source: Author, 2014) Author, 2014)

Box 2.1: Health Risk and Impact Assessment for Kampala City

Health Risk Assessment (HRA) and the Health Impact Assessment (HIA) were conducted in Kampala City for several business models including Treated wastewater for irrigation, large-scale composting for revenue generation and high value fertilizer production for profit. The HRA aimed at identifying health risks associated with the input resources (e.g. faecal sludge, waste water) of proposed models and defining what control measures are needed for safeguarding occupational health and producing outputs (e.g. treated waste water, soil conditioner) that are compliant with national and international quality requirements. The HIA aimed at identifying potential health impacts (positive or negative) at community level under the scenario that the proposed models are implemented at scale in Kampala area. The magnitude of potential impacts was determined by means of a semi-quantitative impact assessment as well as using evidence-based methods (see detailed methodology in Winkler et al., 2014).

From the in-depth study at the Nakivubo channel and wetland, the most common infections were hookworm and T. trichiura with prevalence of 27.8% and 26.1% in local farmers, respectively. Prevalence of Giardia lamblia was found to be considerably lower (below 2% in all population groups sampled). Entamoeba coli was found to be the most common type of intestinal protozoa in farmers (prevalence: 38.4%) and the general community (prevalence: 36.2%). Eye problems and skin problems were reported by approximately 30% of all population groups investigated. Acute respiratory diseases were found to be a major public health concern in Kampala (second leading cause of consultations at health facilities). This clearly showed that a lot of transmission is taking place, with poor personal hygiene and poor sanitation system as two important determinants. Moreover, the study also found that the concentration of faecal coliforms and E. coli but not Salmonella sp. in the channel, swamp and community but not in lake exceeded the national and international standards. The mean concentration of faecal coliforms and E. coli was 4.3x106, 3.8x105 in the channel; 2.9x105, 9.9x105 in the swamp and 1.5x107, 7.3x105 in community respectively.

Pathogens mostly from human and/or animal wastes that serve as inputs per se for the proposed business models were found to be major health hazards. However, all of the identified occupational health risk – such as exposure to pathogens, skin cuts or inhalation of toxic gases – can be managed by providing appropriate PPE, worker education and appropriate design of the operation and technical elements of the model.

Treated wastewater for irrigation and fertilizer were found to have the greatest potential for having a positive impact since they will result in a reduction in exposure to pathogens at community level. Treated wastewater for irrigation would have a moderate positive impact (535) on reduction in respiratory, diarrhoeal and intestinal diseases. Large-scale composting for revenue generation would have a minor positive impact (4) on community in terms of reduction in respiratory, diarrhoeal and intestinal diseases while it would have a moderate positive impact (75) in terms of indirect health benefits due to reduced MSW loads on landfills. High value fertilizer production for profit would also have the same impact as Large-scale composting for revenue generation.

Source: Winkler et al. (2014)

Appendix 3: Profitability analysis of faecal sludge composting business

Appendix 3.1: Projected annual Gross Margin for Lubigi Sewerage Treatment Plant, Uganda

The table below presents the projected variable costs and revenue from Lubigi Faecal Sludge Treatment Plant in Kampala City, Uganda (see Appendix 3 for details). The total variable costs are estimated at US$141,400 per year. Staff costs contribute the largest share of the variable costs (56.6%), followed by subsidy to pipe network (14.1%) while Electro- Mechanical machines are the least (8.5%). The total annual revenue is projected at US$228,000. Sewage billing is will contribute the largest share of revenue to the plant (42.1%), followed by revenue from discharge fee (31.6%) and revenue from sell of faecal sludge compost is least (26.3%). The annual gross margin for this plant would be about US$86,600. This implies that the plant is financially viable.

Item Benefit (US$) Item Cost (US$) Revenue from sell of compost 60,000 Staff costs 80,000 Sewage billing 96,000 Electro- mechanical machines 12,000 Discharge fee 72,000 Supplies 15,000 Utility bills (electricity 90%) 14,400 Subsidy to pipe network 20,000 Sub total 228,000 Sub total 141,400 Gross Margin 86,600

Source: Orwiny (personal communication, 2014)

Appendix 3.2: Annual Gross Margin for faecal sludge extraction and haulage business in Uganda

The table below presents the variable costs and revenue from faecal sludge emptying and haulage business for one vacuum truck in Kampala City, Uganda (Appendix 2.1). The total variable costs are estimated at US$20,516.8 per year. Fuel contributes the largest share of the variable costs (70.7%), followed by the discharge fee (10.6%) while the subscription fee to The PEA is the least. The total annual revenue was estimated at US$31,200. The annual gross margin for this business would

be about US$10,683.2. This implies that the faecal sludge Appendix 2.1: Vacuum tankers at extraction and haulage and haulage is a financially viable PEA parking yard business. Often, truck owners hand the responsibility of managing and marketing the business to truck drivers. The truck owner gets a mandatory US$160 per week which amounts to US$8,320 in annual benefits. Therefore, the drivers reaps annual benefits amounting to about US$2,363.2.

Item Benefit (US$) Item Costs (US$) Emptying revenue 31,200 Subscription fee 208 2 casual labourers 3,120

Servicing pump and 496.8 engine every 4 months Discharge fee 2,184

Fuel 14,508

Total revenue 31,200 Total variable costs 20,516.8 Gross Margin a 10,683.2 Net benefit to truck owner 8,320 Net benefit to truck driver 2,363.2

a 4000 litre vacuum truck is assumed when calculating the gross margins

Source: Ssenyondo and Kinobe (2014).

Appendix 4: Field notice for Key Informant Interviews

Organisation: Private Emptiers Association

Name: Mr Ssenyondo Hassan, Name: Mr Kinobe Markson, Office: Vice Chairman Office: Driver, Contact: 0772417003 Contact: 0755546753

Briefly describe your involvement in Faecal Sludge Management  We are involved in emptying septic tanks and toilets, plumbing works, unblocking cesspools and sewage drainages;  We are all under The Private Emptier’s Association (PEA), which is a membership based organisation; and  To get membership, a person pays about US$80 once in a lifetime for membership and US$4 per week as subscription. Briefly describe the management of your organisation  PEA is managed by its members;  The management team for PEA consist of a Chairman, Vice Chairman, Treasurer, Secretary, Defence Officer, Hygiene Officer and a Spokesperson;  The management team is democratically elected for a 3 year tenure; and  The management team doesn’t get salary but rather get an appreciation paid to them once in a year. How many vacuum trucks is the organisation responsible for and how are they owned?  PEA is responsible for about 56 vacuum trucks;  The trucks have various capacity but most are of 3000 and 4000 litres capacity, while others are of 1800, 2500 and 10,000 litres. There is only one 1800 litre vacuum truck in the association; and  The trucks are owned by the individual members and most own only one truck. A few trucks are owned by companies that are members of the association. As an experienced faecal sludge emptier, what are the fixed and variable costs you usually incur in this business  The fixed cost is purchasing the vacuum truck. Most members purchase second hand Japanese cars whose costs vary with the capacity and mileage of the truck. Most trucks have a mileage ranging from 30,000 to 100,000. A 1800 litre vacuum truck costs about US$10,000; while a 2,500 litre truck costs US$12,000; 4000 litre (US$24,000) and 10,000 litre (US$60,000);  The first variable cost is fuel. Most vacuum trucks use diesel. For a distance of about 10 km from Lubigi Faecal Sludge Treatment Plant, about 6 litres of diesel would be required for a to and fro journey. Assuming the current fuel price of US$1.24 per litre of diesel, the fuel cost is about US$0.372 per kilometre;  The second variable cost is maintenance cost for the vacuum truck. About US$25.6 would be required to purchase hydraulic fluid to service the pump after every 4 to 5 months. Also, US$140 would be incurred to service the engine for every 4 to 5 months;  Human capital is the other variable cost. Every truck has 3 workers (a driver and 2 casual labourers). The driver is responsible for the truck and earns a net pay after paying off the 2 labourers and the weekly profit of US$160 to the owner of the vacuum truck. The causal labourers are paid about US$4 per trip;  On discharging at Bugolobi or Lubigi Faecal Sludge Treatment Plant, the emptiers pay a fee per trip to the treatment plant. About US$2.8 is paid for both a 4,000 and 5,000 litre truck while US$4 is for a 10,000 litre truck; and  Neither is any form of tax nor rent for the parking yard is paid. The parking yard is provided for free by National Water and Sewerage Corporation. Who are your clients and how much revenue do you earn?  The major clients are households with septic tanks and pit latrines, schools, hotels and sometimes embassies;  Households pay in cash while institutions such as schools, hotels and embassies pay by cheque;  The emptiers charge about US$40 to US$80 per trip for faecal sludge extraction and haulage from households. Specifically, for a 4,000 litre truck, the emptiers charge US$40, while US$60 is charged

for a 5,000 litre and 10,000 litre and above (US$80). However in congested areas, the costs increase due to increased use of hydraulic fluid, fuel and also time. For example, for a 2,500 litre truck the emptying may increase from US$32 to US$80; and  They don’t sell raw faecal sludge, once collected, it is disposed at the treatment plant. On rare occasions they dispose of faecal sludge at un-gazetted places such as gardens on request from farmers. What is the emptying frequency of onsite sanitation facilities in Kampala?  One average, a full toilet may require about 4 trips of a 5,000 litre truck. While for rental houses who share a toilet, require emptying services after about every 8 months; and  One truck can make about 10 to 15 trips per week. Do the emptying activities affect your health? If yes, how?  No, faecal sludge collectors and transporters rarely fall sick due to faecal sludge extraction and haulage related illnesses. However, usually new workers may fall sick due to bad odour. Do you think faecal sludge compost can be used by farmers? If yes have you ever seen one using it and why?  Yes, the driver had ever observed his father using the faecal sludge compost from Bugolobi Sewerage Treatment Plant. The father usually buys at US$16 per trip of an ‘Elf”. He observed that the crops were healthier as compared to when raw animal faecal material was used. What challenges do you always find when doing this business?  Some clients don’t want to pay for the service;  Society under looks people who are employed in the faecal sludge emptying business;  People don’t know how to use toilets. In many cases toilets are filled with bottles and clothes, among other blocking materials; and  Some places have limited access. This increases on the cost of doing business.

Organisation: National Water and Sewerage Corporation

Name: Eng. James Miiro Maiteki Name: Eng. Martin Orwiny Name: Mr Andrew Kabuga Office: Sewerage services Manager Office: Engineer, Lubigi Faecal Office: Over seer, Lubigi Contact: +256717316567 Sludge Treatment Plant Faecal Sludge Treatment Plant Contact: +256752784242 Contact: +256772892375

Briefly describe your involvement in faecal sludge management  Lubigi Faecal Sludge Treatment Plant is the first and only sewerage treatment plan specifically designed to receive septage (faecal sludge from onsite sanitation);  This is the second plant in Kampala City after Bugolobi Sewerage Treatment plant which was specifically designed to receive sewage (faecal material from off-site sanitation);  Lubigi Faecal Sludge Treatment Plant was constructed five years ago and has only been operational for five months; and  Lubigi Faecal Sludge Treatment Plant receives faecal material from off-site facilities in Katanga, Makerere and Mulago, among others. For onsite sanitation, the faecal material is received from pit latrines and septic tanks from households and schools, among others. These on site facilities are in Kampala City and the suburbs. Who are the actors in Faecal Sludge Management in Kampala City?  National Water and Sewerage Corporation is responsible for implementing improved sanitation policies in urban areas, including Kampala City;  Kampala Capital City Authority collects and discharges faecal sludge at Lubigi Faecal Sludge Treatment Plant;  Uganda Police collects and discharges faecal sludge at Lubigi Faecal Sludge Treatment Plant;  Private Emptiers’ Association collects and discharges faecal sludge at Lubigi Faecal Sludge Treatment Plant;  Ministry of health responsible for formulating Public health policies in Uganda as well as support local government in its implementation;  National Environment Management Authority is responsible for enforcing sanitation policies in Ugandan environs; and  Directorate of Water Development is responsible for policy formulation. Briefly describe the Faecal Sludge Treatment Plant for your organisation?  Lubigi Faecal Sludge Treatment Plant was designed to receive both septage and sewage;  The design capacity for the plant is 4000 and 5000m3 per day of sepatge and sewage respectively;  The plant has already reached its maximum capacity. Despite its design limitations, now have resorted to discharging at Bugolobi Sewerage Treatment Plant;  Currently, about 483,000m3 of Faecal Sludge is produced per day while 211,000m3 is collected daily;  The plant has a dumping bay which receives faecal sludge from 3 vacuum trucks while off-site section receives sewage from sewers;  Each of the dumping bay and the off-site sewer inlet empty their contents into independent screen pumps. The screen pumps sort solid waste such as polyethene from faecal sludge and wastewater. By the help of sensors in the screen pump, sewage is pumped to an upper level, the level of the plant;  Each of faecal sludge and sewage from the screen pump is pumped into independent Grit removal area where sand is removed from faecal sludge. The grit is also used for soil conditioning;  From the Grit removal area, each of sewage and faecal sludge is pumped into sedimentation tanks of 1,250m3. The plant is has 2 sedimentation tanks. These tanks have pumps that separate liquid from the solids;  The solids settle in the sedimentation tank and are pumped to the covered drying beds. The covered drying beds are 19 in number and measuring 7x34m and 4,522m2 total area;  The sludge is then scooped using machines and disposed of at the store. The store has 19 compartments of 7x34m and 4,522m2 total area. The sludge is stored for 6 months to achieve maximum hygienisation.  Hygienised sludge is free from helminths and can be used by farmers in agricultural activities;  The liquids from all sedimentation tanks are pumped into a flow measurement, after which are 85

distributed to 3 Anaerobic ponds (length = 70m, Width=30m and volume = 4,240m3). The anaerobic activity generates more solids. Though have not desludged yet, the solids would be mechanically scooped after 1- 2 years. The scooped solids would be dried in the 30 uncovered drying beds of 7x34m;  The liquids from the anaerobic ponds are pumped into the Facultative Ponds. There are 2 Facultative ponds of 170m length, 50m width and 11,530m3 of volume. At this point, the plant has achieved about 80% treatment and remaining 20% is done by the natural wetland; and  The effluent from Facultative ponds is then released into the natural wetland for further treatment. The effluent released into the wetland has negligible impact on the environment. This is evidenced by the green grass, large number of birds and insects, among other biodiversity from the outlet point. Do you currently produce faecal sludge compost? If yes, how much? If yes, have you sold some? If you have sold, at what price?  Yes, Lubigi Faecal Sludge Treatment Plant is currently producing faecal sludge cakes;  About 5 tonnes of faecal sludge cake are produced daily from onsite sanitation facilities. However, there is no production yet from offsite sanitation facilities;  No sells of faecal sludge cakes have been made at the moment. This is because Anaerobic ponds have not been dis-sludged while cakes stored in the sedimentation ponds have only been kept for 5 months;  Despite the fact that no sells have been made yet, the standard prices will apply. At Bugolobi Sewerage Treatment Plant, 1m3 is sold at US$4. Is faecal sludge compost from this treatment plant safe for re-use in agriculture?  Yes it will be safe for re-use. However, application is always limited to horticultural and landscape activities only and not food crop production;  From experiences from Bugolobi Sewerage Treatment Plant, tests such as heavy metal and helminths egg counts are always done before faecal sludge compost is sold for re-use;  At Lubigi Faecal Sludge Treatment Plant, tests for hygienisation are being done from the Government Chemist Laboratory. However, the results are not yet out because the 6 month storage period has not yet elapsed;  However, following some experimental works at Bugolobi Sewerage Treatment Plant, it was observed that after the 6 months storage period, the helminths re-activated when the compost was applied to the garden; Is there any special tests you have performed on the treatment plant that you would like to share? Or any other concern?  Have measured the Total Suspended Solids and Settlelable Solids in the Sediment Tank;  Total Suspended Solids were estimated at 13,614 mg/L while Settlelable Solids were estimated at 25 g/L;  Other parameters that are constantly monitored are BOD and COD;  No tests have ever been conducted to measure the Green House Gas effect of composting; and  At Bugolobi Sewerage Treatment Plant, a facility to generate energy from Faecal Sludge is under construction. Has the treatment plant had effect on the health of the population of Kampala? If yes, how? And how about the workers at the plant?  There has been improved sanitation in Kampala City and improved waste disposal into the environment; Reduced possible disease infections;  Diarrhoea disease in Kampala population should have reduced by 92%. This is because 92% of the population of Kampala is benefiting from the intervention;  About 8% of the population uses offsite sanitation facilities while 92% use the onsite sanitation;  Amongst the workers, stomach upsets are the most common health effects. The stomach upsets are caused by the bad smell. Diarrhoea is rare and typhoid has not been recorded; and  However, occupational health and safety is emphasised at the plant. This includes vaccination such as hepatitis and tetanus, use of gas masks and gas detectors, among others. How much are the revenues for this plant? How about the investment costs for this plant? How much do you spend as operation and maintenance costs of the plant?  The costs and benefits are projected and listed in table below;  At Bugolobi Sewerage Treatment Plant, US$160 is generated daily from sell of about 30 – 35m3. 86

The demand is highest during rainy season and currently is out of stock.

Item Benefit (US$ per year) Revenue from sell of compost 60,000 Sewage billing 96,000 Discharge fee 72,000 Sub total 228,000 Item O+M Cost (US$ per year) Staff costs 80,000 Electro- mechanical machines 12,000 Supplies 15,000 Utility bills (electricity 90%) 14,400 Subsidy to pipe network 20,000 Sub total 141,400 Item Investment Cost Capital cost (cost for whole facility (50% of 19,376,860 capital cost) and sewer network)

What challenges those the plant face? Are there some recommendations you have to ensure improved faecal sludge management in Kampala City?  Limited value addition to faecal sludge compost. Recommend bagging of the compost in say 5, 10, 20, 25 and 50 kg, label and brand. The value addition can also include mixing faecal sludge with other organic compounds such as coffee husks;  The plant has limited equipment such as those required to detect chromium;  There is need to setup demonstration farms to show farmers how it works;  To ensure effectiveness of killing helmiths, burning of faecal sludge at high temperatures can be recommended;  Sell the bag of compost at US$2 per kilogram.

Name: Miss Eunice Lydia Office: Cashier, Bugolobi Sewerage Treatment Plant Contact: 0717316945 Do you sell faecal sludge compost at this treatment plant? If yes, how much? Bugolobi Sewerage Treatment Plant sells faecal sludge compost but usually in the dry season. The prices range from US$2 to US$40. Specifically, a double cabin of faecal sludge costs US$2, 2t truck US$8, forward (US$16), fuso and tata (US$28) and Magulu Kumi (US$40).

Do faecal sludge emptiers pay for discharge services at this treatment plant? If yes, how much? Faecal Sludge collectors pay for every trip of faecal sludge they dispose at Bugolobi Sewerage Treatment Plant. The fees range from US$2 to US$8. Specifically, for a 2t truck, the faecal sludge collector pays US$2, 3-4t pays US$2.8, 6-10t (US$4) and 20t (US$8).

Do workers at this treatment plant fall sick because of faecal sludge? If yes, which diseases? Disease incidence amongst the workers is low.

Appendix 5: Other key assumptions considered in the cost benefit analysis

Appendix 5.1: Assumptions made in the Cost Benefit Analysis

Assumption Reference Depreciation period of the plant and tankers is 20 years Steiner et al. (2002) Population growth rate for Kampala is constant at 5.6 % Nyakaana et al. (n.d) 76 persons produce 1 tonnes of total solids per year, 1 Person Equivalent equals to 14g total solids per day per capita and the total Steiner et al. (2002) solids content of septage and public toilet mixture from onsite sanitation facilities is 25g/l Steiner et al. (2002), Brikke and Bredero (2003) All the vacuum trucks used have capacity of about 5m3 and Vodounhessi (2006) The price of each vacuum tanker is US$ 40,000 Steiner et al. (2002) and Brikke and Bredero (2003) Fuel cost and fuel price are US$0.11/km and US$0.53/L for a 5 tonne truck (given the fuel efficiency of 5km/L), respectively. Truck maintenance cost is US$0.13/km and each truck is assumed Kwon (2005) to travel an average distance of 50 km per round trip for 5 trips per day During composting, about 80% of total solids weight is lost a Steiner et al. (2002) Farmers are willing to pay US$28 per tonne of compost Vodounhessi (2006) Case fatality rate for diarrhoea in Kampala is about 14 %. Accorsi et al. (2005) The concentration of pathogens in drinking water is about Howard et al.(2006) 14cfu/100ml for protected spring One person consumes about 13g in three times per week of Seidu and Drechsel (2010) lettuce Composting of faecal sludge would avert 44% of the diarrhoea and DALYs in the population under the business as usual. This thesis assumes that farmers can easily transport the faecal sludge compost product from the faecal sludge treatment plant without difficult. Thaddous et al. (2007) and Seidu and Drechsel Furthermore, this thesis assumed no increase in diarrhoea (2010) amongst the workers in the different FS composting value chains due to contact. This is because of improved Occupational Health and Safety at the faecal sludge treatment plant Notice: a An up scaled plant treating about 25,000m3 faecal sludge per year would produce about 5,000m3 of compost