Guy Howard (4117807)

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B   SANITATION: HOWARD6823rd WEDC Conference Durban, South Africa, 1997Strategic approaches to urban sanitationGuy Howard, UKWATER AND SANITATION FOR ALL: PARTNERSHIPS AND INNOVATIONSTHE PROVISION OF sanitation services for low-incomesettlements in urban areas of developing countries is a keychallenge which confronts communities, governments andprofessionals. Given rapid rates of urbanisation and theincreasing proportion of urban populations residing ininformal, unserved areas, the provision of such services isan urgent priority.Addressing urban sanitation requires a strategic ap-proach to service provision which maximises user involve-ment, identifies and employs appropriate technologies andwhich functions within an effective institutional frame-work. The first step in this process is to carry out adiagnostic study of the sector.A diagnostic study approach produces a ‘state of envi-ronment’ report which provides baseline data upon whichfuture planning can be based. National diagnostic stud-ies reflect national priorities and concerns more com-prehensively than those carried by or for externalagencies.National diagnostic studies are used to define key priori-ties and needs and lay the basis for a strategic response bythe sector to urban sanitation problems. This shouldemphasise the need for interventions to match communityneeds and preferences. The value and use of diagnosticstudies is discussed and illustrated by recent work under-taken in Zambia by the author and colleagues.Need for diagnostic studiesIn many developing countries, coverage of the populationwith access to adequate sanitation remains low. This isparticularly the case in low-income, informal settlementswhich are often considered illegal and therefore have no‘rights’ to sanitation services. A direct result of this situa-tion, is that morbidity due to preventable water andsanitation related disease remains high. For instance, inZambia, cholera has become endemic in many urban areasand incidence of diarrhoeal disease remains high (Sitali,1997; Howard et al, 1994).Whilst the problems in many urban areas may be onlytoo obvious, the solutions to these have often proved moreelusive. Key difficulties have been that there has beenlimited understanding of the underlying causes of poorsanitation and a piecemeal approach to improvements. Astudy carried out for the Commonwealth Secretariat(ComSec) in response to a request from the African Min-isters of Health, clearly indicated the need for the develop-ment of a more strategic approach to service provision(Howard and Bartram, 1993).In recognition of the problems faced in their urban areas,the Government of the Republic of Zambia (GRZ) re-quested support from ComSec and the World HealthOrganization (WHO) to assess the strategic options avail-able to them. The Robens Institute provided the technicalsupport to both organisations in looking at urban sanita-tion.Diagnostic studyIt was agreed at the outset of the project that the initialactivity was to evaluate the major shortcomings andfailures of urban sanitation within the wider context of thewater and sanitation sector and the development processin Zambia.In terms of establishing a strategic response to urbansanitation, this is essential because there are many precon-ceptions of why urban sanitation has failed to provide theservice demanded by the population. For instance, lowcoverage and poor sustainability have often been seen astechnological issues which can be resolved through theselection of appropriate technologies. There has been anassumption that the identification and implementation ofa new technology will automatically resolve the problems.It is rare, if ever, that these problems result from a singlecause which may be relatively easily overcome. It is farmore common to find that numerous factors are contrib-uting to poor sanitation provision.Therefore, the key to a strategic development of sanita-tion service provision in urban areas of developing coun-tries is a thorough understanding of the all the issues andproblems which affect the sector and which may contrib-ute to poor performance. It is only when the problems areclearly understood, that the solutions may be found. Thisrequires a broad approach to identify the major influenceson the sector performance and to assess the interaction ofdifferent factors and the ways in which these may beovercome (Howard, 1996).It was clear from the outset that it was important that theapproach adopted had to be driven by national, ratherthan external concerns. Zambia has had numerous assess-ments of the sector, but these have been carried out byexternal agencies looking at usually specific funding pos-sibilities. A national assessment has the value of beingbroader in outlook and thus assessing the factors whichgovern the sector performance. However, there is a valuein including international experience in the assessment asthis should facilitate the transfer the experience from othercountries.B   SANITATION: HOWARD69Study teamA study team was formed made up of four professionals:the Chief Health Inspector, Ministry of Health, GRZ; theCommunity Water Supply Advisor, WHO Lusaka; a mem-ber of staff from WHO Geneva; and a consultant from theRobens Institute. This group balanced both the need forthe study to be driven by national priorities and access toa broader range of expertise.MethodologyThe study team first identified the key areas to be evaluatedduring the study. These are summarised in Box 1 below. Ascan be seen from this figure, a broad range of issues areaddressed in a diagnostic study in order to evaluate thesector performance within the wider developmental con-text. Thus within the report of the study, each area wasextensively discussed, failings and success highlighted andconclusions drawn concerning future actions.The study identified which were the priority issues to beaddressed and made recommendations concerning howthese may be overcome. In Zambia, there were two keyfactors which had to be resolved in order to optimise sectorperformance: the institutional framework; and, land ten-ure and service provision in informal settlements. Theresolution of these is discussed below.Data collectionGood data collection is the core of effective diagnosticstudies and unless reliable and accurate information anddata can be collected and collated, the value of the studywill be reduced. Information will be available in manyforms and it is important that these are all accessed duringthe study and thus a flexible approach should be main-tained.A number of  likely key information sources can beidentified as follows:Published literature. This is often scarce. In Zambia, thestudy team found very little in the way of published formalliterature regarding sanitation in urban areas. Thus duringthe desk top study, little emphasis and time was spent inreviewing this.‘Grey’ or unpublished literature. This is likely to be a farmore productive source of information and often providesa good insight to the causes of sector failings. This type ofinformation is not, and is never likely to be, published andas a result, is often plainer speaking than published litera-ture which must pay more attention to sensibilities. InZambia, much of the primary information used to build upa picture of the sector was drawn from Governmentreports, donor reports and evaluations and training mate-rials.Discussions with sector staff. This is important as sectorstaff will understand the environment within which theywork and the shortfalls and constraints they face. Inparticular, senior staff will have clear ideas about thecauses of poor performance and the ways in which thesector could be optimised. This information is not held inany documentation but provides a clear insight to how theservices are implemented and problems faced. For in-stance, in Zambia staff highlighted that because currentsector investment was focused on water supply, alreadyoverloaded sewer systems were expected to cope withincreased return flows, a situation which led to increasingbreaks and flooding of raw sewage.Field visits. This are invaluable as they provide opportu-nities to assess real conditions and put the issues andconstraints highlighted in grey literature and in discussionwith staff into their real-life context. In Zambia thisinvolved visits to low-income areas, treatment plants andsanitation projects in Lusaka, Kitwe, Ndola and Luanshya.The link to strategyA diagnostic study provides a situation analysis of thesector and assesses strengths and weakness and highlightsthe key areas which should be addressed. The study can beused to prioritise particular settlements, groups and ac-tions that will have greatest short term impact. It alsoevaluates long-term needs for sustainability in the sectorand highlights those issues which are most problematicand require resolution if they sustainable services are to beprovided.Basic country information(geography, health priorities, urban environment)Water and sanitation policy and planning(planning mechanisms; legislative framework; past investments andtrends; policies and investment priorities; constraints and resourcerequirements)Institutional framework(sector overview; present institutional framework; proposed restructuringand discussion)Urban sanitation provision(existing coverage levels by urban area)Sanitation technologies(on-site and off-site technologies used; treatment technologies; possiblealternatives and improved designs)Urban sanitation improvements(rehabilitation; cost-recovery)Information systems(information management systems; inventories; information exchange)Monitoring(coverage levels; public health; effluent quality)Health and hygiene education(programmes; staff; community participation)Community participation(community based programmes; NGO involvement; promotion  ofcommunity participation)Human resource development(current training opportunities - in-house, colleges; improvements -formal, in-service, community)Conclusionsstrategic; institutional; technical; HRD)Future actions(strategy for immediate action)Box 1. Issues addressed in the diagnostic studyof urban sanitation in  Zambia, 1994B   SANITATION: HOWARD70However, a diagnostic study however, is only of real usefor the sector if it is seen as the first step in strategydevelopment (Howard 1996). The process is shown inFigure 1.The strategy developed should address issues such ascost-recovery, technologies to be employed, human re-sources development and mechanisms for promoting com-munity-based approaches to sanitation provision. In par-ticular, the strategy must address the resources required bythe sector and the source of finance required to promoteimprovements.In addition to identifying weaknesses, the diagnosticstudy must identify possible solutions to the issues raised.For instance, in Zambia, recommendations were made toreview tenure systems and investigate ways of promotingservice improvements in the short-term. This in essenceargued for a separation of service provision from landtenure issues. Whilst it is often argued that any form ofservice provision is a recognition of right to abode, (Payne,1997) this need not be the case and workable solutions toservice provision in these areas can be found.A suggested model for extending coverage into low-income areas was developed which promoted a morecommunity-based approach and which proposed the useof loans and grant systems to fund improvements. Theactive participation of the private sector was also encour-aged in activities such as desludging latrine pits withgovernment (national and local) playing a regulatory andfacilitating role, rather than being a service provider.The study also identified a range of other issues whereurgent attention was required. This included resolving theinstitutional framework, for which an outline model wasdeveloped. In addition, guidance was provided on possibletechnologies that had not been used which had beensuccessful elsewhere and recommended research into theirpotential use in the country.Strategy developmentIn order to develop a workable strategy, it was felt essentialthat key sector professionals could review the findings ofthe diagnostic study and identify the key principles thatshould underpin the strategic development of the sub-sector. This was achieved through holding a review work-shop for senior sector staff and by identifying a small groupof professionals to develop a strategy statement, supportedby facilitating actions required.The workshop was a participatory event which outlinedthe key issues to be covered within the strategy, theprinciples underpinning the strategy and identified threekey areas where proposals should be prepared for activi-ties to be funded. These were: human resource develop-ment; research and development of appropriate technol-ogy; and the promotion of community-based approaches.Following this workshop, a small working group met toprepare the strategy and proposals for projects. This groupwas composed of senior national staff and an externalfacilitator. The group prepared the strategy statementwhich focused on the need to provide sustainable servicesto the entire urban population and identified how priorityissues should be resolved. To support this strategy state-ment, proposals were developed in the areas identifiedabove which included concrete actions and were linked toFigure 1. Diagnostic studies within the strategy process Strategy- linked sanitation improvements with health reforms- addressed urban and peri-urban areas- linked sanitation to other sectors- outlined implementation and set proposals in a strategic context Human resources development- training needs assessment- develop HRD strategy based on assessment- develop and deliver training courses- strengthen existing training opportunities Research and development of appropriate technologies forlow-income areas- inventory of existing infrastructure- selection of technologies for testing (assess successful technologiesfrom other countries)- pilot projects with communities to evaluate technologies- definition of appropriate technologies and supporting activities Community participation and community-based approaches- assessment of existing programmes- training of trainers in agencies and community- mass communicationBox 2. Strategy and proposals developed in ZambiaB   SANITATION: HOWARD71developing sustainable approaches to urban sanitation.The strategy statement and proposals were presented toGovernment and donors and met with a positive response.It is now incumbent on the Government of Zambia tofollow these approaches up through official channels.The key components of the strategy developed and theproposals prepared to support the strategy are shown inBox 2. It is important to note that urban sanitationimprovement was clearly set within the context of thehealth sector reform as this process emphasised the needfor preventative health measures and the decentralisationof health care to within easy reach of every household andcommunity. The proposals developed were seen as key inpromoting sustainable sanitation improvements in strate-gic way. Thus, it was accepted that a longer time scale wasnecessary in order to define an approach which led tolasting solutions to all the urban population in Zambia.ConclusionDiagnostic studies allow the sector to critically appraiseit’s performance and identify where failures are occurring.Only by a through understanding of the problems and theircauses can the sector hope to overcome the constraints itfaces and provide adequate sanitation services to all itspopulation. In 1994 a diagnostic study was undertaken ofurban sanitation in Zambia, which was part of a processof strengthening the strategic development of sanitationservice provision and the role of the Ministry of Health inpromoting and supporting sanitation improvement.It is believed that the approach adopted in Zambia canprovide a model for other countries wishing to addresstheir urban sanitation concerns. Subsequent dissemina-tion of the approach adopted in Zambia (Howard, 1996)and a presentation to the West African Health MinistersMeeting in Banjul in 1995, demonstrated an interest in themodel. Such studies greatly assist countries in identifyingthe causes of sanitation problems in urban areas andprovides governments with information which they canuse to develop strategic response to these problems andlobby for funds from the donor community. They can alsoprovide the basis of more structured development ofsanitation and provision of guidelines on acceptable tech-nologies, training programmes and community involve-ment.ReferencesHOWARD, G., 1996, Urbanisation, Sanitation and Envi-ronmental Health, Commonwealth Secretariat, Lon-don.HOWARD, G., and BARTRAM, J., 1993, Infrastructureand Training Needs for Sustainable Urban Sanitation inAfrica, Commonwealth Secretariat and Robens Insti-tute, Guildford.HOWARD, G., HUEB, J., CHISANGA, S., and CHULU,F., 1994, Urban Sanitation in Zambia: Mission Report,WHO, Ministry of  Health, Commonwealth Secretariat,Robens Institute, Guildford.PAYNE, G., 1997, Urban Land Tenure and PropertyRights in Developing Countries: A Review, IT Publica-tions, London.SITALI, F., 1997, PMO Lusaka Perspective, in Report ofa Workshop on the use of the Cholera Fact Sheets,Lusaka, Zambia, 13-17 January, Robens Institute, Guild-ford.GUY HOWARD, Head Overseas Projects, Robens Centrefor Public and Environmental Health, University ofSurrey.

Strategic approaches to urban sanitation

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Strategic approaches to urban sanitation

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