28
Affecting the Implementation of Improved Sanitation in Africa* Factors K. O.
IWUGO,
B.SC.
(CHEM. TECH.), M.SC., PH.D., C.CHEM., M.R.I.C., M.R.S.H., M.I.P.H.E.,
M.I.W.E.S.
Department o f Civil Engineering, University, Zaria, Nigeria
Ahmadu Bello
WN THIS paper
an attempt is made to discuss several factors which are crucial to the successful implementation of any improved sanitation system in Africa. In most cases, there is little except a few words of common sense to say. Such factors as institutional development, user acceptance and health education do not have a well developed body of theory and practice. The central facts, however, are relatively obvious and simple while the subtleties and complications are largely unknown and unstudied.
miscellaneous
HEALTH ALTHOUGH the
reuse of wastes and excreta is gradually gaining recognition (Mara, 1976; Shuval, 1977), health remains the major social benefit and one of the major economic benefits which investors in excreta disposal hope to achieve and it is therefore of the utmost importance. The correlation between health and excreta disposal have been reviewed at length by Wagner and Lanoix (1958) and more recently by Feachem et al. (1978). Sadly enough, the health benefits resulting from improved sanitation systems still defy quantification.
INSTITUTIONS AND MANPOWER IT IS EVIDENT that any urban sanitation system requires a carefully designed, well managed and well staffed agency to operate it. It seems that few general prescriptions can be made and that the correct institutional arrangements will depend very much upon the existing municipal organization and the type of excreta disposal system to be managed. For instance, an institution set up to operate a bucket latrine system, which is very demanding of any municipality, may be quite inappropriate for a sewage system or a vented latrine programme. One institutional point which has emerged from recent sanitation studies in Africa (Iwugo et al., 1978a, 1978b, 1978c, 1978d) is that problems may arise when institutional control is given to a health authority or other agency, which lacks the necessary engineering expertise. A fundamental prerequisite of successful management must be the employment of a sufficient number of adequately paid, well motivated and appropriately trained engineers and physical scientists. In most Africa countries, these appropriately trained and motivated technologists do not appear to exist. They are not being produced by most African University
*Paper based on the author’s experience as the sanitary engineering consultant for the Africa Region in the World Bank Research Project on Appropriate Technology for Water Supply and Wastes Disposal for Developing Countries.
departments of engineering and technology (which generally follow European syllabi) nor yet by the new postgraduate courses in sanitary engineering (at Nairobi, Kenya, and Ahmadu Bello University, Nigeria). How many graduating sanitary engineers in Africa are as conversant with the design features of a pit latrine, a composting toilet, a bucket latrine or an aqua-privy toilet system as they are with design features of the activated sludge, percolating filter and possibly aerated lagoon sewage treatment systems? Current experience indicate few, if any at all! There is an urgent need not only to increase the rate of production of African sanitary engineers but also to drastically revise the syllabi. It is noteworthy that the training of professional engineers of all kinds has been seriously neglected in many African countries. In each of the nine African countries which were surveyed in a recent study (Feachem et al., 1978), there are considerably more fully trained doctors than engineers. USER ACCEPTANCE AND EDUCATION THERE IS clearly no point in investing in excreta disposal facilities which are unacceptable to the users. It is also mistaken to suppose that problems of user acceptance can be sorted out after construction through educational programmes. Statements like ’If the people do not like it, we will teach them to like it’ are simplistic, paternalistic and unrealistic. However, having accepted that user acceptance is crucial, it is of little help to make vague exhortations to designers and planners to involve the community in decision making. Since the designers and planners are generally foreign to the community, they require very precise guidance about how to involve the community and how to ensure that user preferences are fully accounted for in design. It will probably require a few more years of field experience with user-choice design techniques before a well-tried method emerges. However in the meantime, the outline given in Figure 1 may be of some help. In many cases user preference and user acceptance will be more closely linked to superstructure design than to substructure design. Provided that the excreta are removed from view and that the latrine does not smell, users may be influenced most by the design and colour of the latrine house and the seat or squatting slab. Considerable attention must therefore be given to details which may be trivial in the engineering sense but could be all important in determining the eventual use and hygienic maintenance of the new facilities.
Downloaded from rsh.sagepub.com at The University of Iowa Libraries on June 13, 2015
29 The need for user education will be reduced by following the guidelines for user acceptance which have been discussed in the foregoing paragraphs. If the users have taken part in the selection and design of the new facilities, and if they feel that the choice of technology was partly theirs, they may well have a positive attitude towards the innovation and be at least moderately
1 personal and latrine cleanliness 2 correct operation of the system 3 correct and conscientious maintenance of the system
4 full use of the new facilities by children; and 5 at least partial payment in cash or kind for the benefits received.
of its technical characteristics. However, it will still be necessary to mount a continuing and vigorous community campaign with special emphasis on the aware
following points: Figure 1
Possible sequence for community involvement in the choice and design of excreta disposal systems
CHILDREN AND EXCRETED DISEASES TRANSMISSION MANY OF the excreted infections have a very markedly non-uniform distribution of prevalence between different age groups. While all of them are found among people of all ages, many of them are concentrated in particular age groups. Table I states the age group which is most afflicted by the main excreted infections in areas where these infections are endemic. This Table clearly showas that many of these infections are primarily infections of childhood or that they afflict children as well as adults. This has the greatest relevance for disease control through excreta disposal
improvements.
In all societies children below the age of about 3 will defaecate whenever and wherever they feel the need. A proportion of these children will be excreting substantial quantities of pathogens. In some societies their stools are regarded as relatively inoffensive and they are allowed to defaecate anywhere in or near the house. In this case it is highly likely that their stools will play a significant role in transmitting infection to other children and adults. This applies not only to those infections without a latency period but also to infections like ascariasis, hookworm and trichuriasis where the defaecation habits of children will determine the degree of soil pollution in the yard and around the house and this, in turn, will largely determine the prevalence and intensity of these geohelminthic diseases in the household.
TABLEI The age of maximum
prevalence of some major excreted infections in indigenous populations of endemic area
* : Prevalent -:
Not
prevalent
Downloaded from rsh.sagepub.com at The University of Iowa Libraries on June 13, 2015
30 In other societies by contrast, strenuous efforts are made to control and manage the stools of young children, either by making them wear nappies or by cleaning up their stools whenever they are observed. Either of these reactions should have an important influence on the intra-familial transmission of excreted pathogens. Between these two extremes there is a whole range of intermediate behaviour patterns with regard to the reaction of adults to the stools of young children. In most poor communities, the picture is closer to the first example than to the second. The relevant response of government and other responsible agencies to this situation is health education of mothers to encourage a belief that the stools of young children are dangerous and should be hygienically disposed of. The problem is primarily connected with attitudes and behaviour. However, the provision of some form of toilet for the disposal of the child’s stool, and, maybe more importantly, a convenient water supply will greatly assist child
(diaper
hygiene. Turning to children over 3 years; they are capable of using a toilet if one of suitable design is available. Children in the age range 3-13 frequently do not use toilets even where they are available because: 1 to
they find it by adults;
inconvenient and
are not
encouraged
2 they are afraid of falling down the hole or of being attacked by pigs or other animals which may live next to the latrine;
3 they cannot because the toilet is little people cannot use it: 4
so
designed
that
they are prevented from doing so by adults who do messing up their nice clean
not want the children
toilet.
As with the very young children, it is of vital importthat the stools of these children are hygienically disposed of because some of them will be rich in pathogens. The solution lies in a combination of the provision of a toilet which children are able and happy to use and health education for the mothers so that they compel their children to do so. Education for school children could also be effective here and it is vitally important that all schools have well-maintained latrines so that the children may learn from positive experience. ance
I
COMMUNAL OR PRIVATE SANITATION SYSTEM? EXPERIENCE with public latrines of all kinds in all countries has often been unsatisfactory. The basic problem is that a public facility appears to belong to no-one individual and so there is very little commitment by individual users to keeping it clean and operating it properly. This is as true in New York as it is in Lagos or Calcutta. Public or communal latrines should usually only be considered for institutions (e.g. schools) or where speas for instance the use cial cultural conditions apply of communal blocks by extended families in Ibadan (Ademuwagun, 1975; Iwugo, et al. 1978a). In any case it will nearly always be necessary for paid employees to be engaged with responsibility for cleaning and upkeep. The installation of a tap in the block which may be used to hose down the floors and walls several times a day is -
not
onl helpful
but
Cases have been
imperative. ~wugo, 1978c) where public aquaprivy systems grossly misused and abused because taps
known were
were
installed in the toilet blocks. Communal latrines often require
not
lighting or they will
not be used after dark. Arrangements must be made before hand to pay for and water, because communities are seldom able to raise money regularly
lighting
by voluntary collections. Another difficult question surrounding communal facilities is that of privacy. The requirements for privacy of the population must be clearly understood and respected. A compromise between public and private latrines,
which is used in some parts of India, is said to have a central latrine block serving 8-15 households, in which each household keeps its cubicle locked and is responsible for its upkeep. Experience shows that each household will zealously guard its cubicle and keep it clean, but that maintenance of the overall system (e.g. blockage in the effluent pipe) will cause organisational problems. Provided that the municipal authority can assume the responsibility of the collection and treatment components of this type of system, this system should operate satisfactorily. Lastly, a communal latrine is necessarily a certain distance from each household, and this may be enough to deter some users, particularly at night or during wet or cold weather. In some societies, it may be essential that each family has its own latrine, in or very close to the house.
CONCLUSION THIS PAPER has briefly highlighted those factors which may deter the implementation of improved sanitation systems in Africa. Although most of the low-cost sanitation systems which are currently being used in Africa obviously need technical modification and improvement, the factors discussed in this paper should be very seriously considered if the necessary health benefits are to be derived by the installation of these i improved sanitation systems.
I
REFERENCES
ADEMUWAGUN, Z. A. (1975). ’A study of the Health Education component of the comfort stations in Ibadan, Nigeria’. University of
. Ibadan
FEACHEM, R., BRADLEY, D. J., GARELICK, H., and MARA, D.D.
(1978). ’Health Aspects of Excreta Washington: World Bank.
and Wastewater
Management’.
FEACHEM, R., MARA, D. D. and IWUGO, K. O. (1978). ’Alternative Sanitation Technologies for the Urban Poor in Africa’. Washington: World Bank. IWUGO, K. O., MARA, D. D. and FEACHEM, R. G. (1978a). ’Sanitation Studies in Africa Site Report No. 1, Ibadan, Nigeria’. —
World Bank. IWUGO, K. O., MARA, D. D. and FEACHEM, R. G. (1978b) ’Sanitation Site Report No. 2, New Bussa, Nigeria’. Studies in Africa Washington: World Bank. IWUGO, K. O., MARA, D. D. and FEACHEM, R. G. (1978c). ’Sanitation Studies in Africa Site Report No. 3, Kumasi, Ghana’. Washington: World Bank. IWUGO, K. O., MARA, D. D. and FEACHEM, R. G. (1978d). ’Sanitation Studies in Africa Site Report No. 4, Ndola and LUsaka, Zambia’. Washington: World Bank. MARA, D. D. (1976). ’Sewage Treatment in Hot Climates’. London:
Washington:
—
—
—
Wiley.
SHUVAL, H. I. (1977). ’Nightsoil Composting’ PU Report No.
RES12.
. Washington: World Bank
WAGNER, E. G. and LANOIX, J. P. (1958). ’Excreta Disposal for Rural Areas and Small Communities’. Geneva: World Health Organisation.
Downloaded from rsh.sagepub.com at The University of Iowa Libraries on June 13, 2015
Affecting the Implementation of Improved Sanitation in Africa* Factors K. O.
IWUGO,
B.SC.
(CHEM. TECH.), M.SC., PH.D., C.CHEM., M.R.I.C., M.R.S.H., M.I.P.H.E.,
M.I.W.E.S.
Department o f Civil Engineering, University, Zaria, Nigeria
Ahmadu Bello
WN THIS paper
an attempt is made to discuss several factors which are crucial to the successful implementation of any improved sanitation system in Africa. In most cases, there is little except a few words of common sense to say. Such factors as institutional development, user acceptance and health education do not have a well developed body of theory and practice. The central facts, however, are relatively obvious and simple while the subtleties and complications are largely unknown and unstudied.
miscellaneous
HEALTH ALTHOUGH the
reuse of wastes and excreta is gradually gaining recognition (Mara, 1976; Shuval, 1977), health remains the major social benefit and one of the major economic benefits which investors in excreta disposal hope to achieve and it is therefore of the utmost importance. The correlation between health and excreta disposal have been reviewed at length by Wagner and Lanoix (1958) and more recently by Feachem et al. (1978). Sadly enough, the health benefits resulting from improved sanitation systems still defy quantification.
INSTITUTIONS AND MANPOWER IT IS EVIDENT that any urban sanitation system requires a carefully designed, well managed and well staffed agency to operate it. It seems that few general prescriptions can be made and that the correct institutional arrangements will depend very much upon the existing municipal organization and the type of excreta disposal system to be managed. For instance, an institution set up to operate a bucket latrine system, which is very demanding of any municipality, may be quite inappropriate for a sewage system or a vented latrine programme. One institutional point which has emerged from recent sanitation studies in Africa (Iwugo et al., 1978a, 1978b, 1978c, 1978d) is that problems may arise when institutional control is given to a health authority or other agency, which lacks the necessary engineering expertise. A fundamental prerequisite of successful management must be the employment of a sufficient number of adequately paid, well motivated and appropriately trained engineers and physical scientists. In most Africa countries, these appropriately trained and motivated technologists do not appear to exist. They are not being produced by most African University
*Paper based on the author’s experience as the sanitary engineering consultant for the Africa Region in the World Bank Research Project on Appropriate Technology for Water Supply and Wastes Disposal for Developing Countries.
departments of engineering and technology (which generally follow European syllabi) nor yet by the new postgraduate courses in sanitary engineering (at Nairobi, Kenya, and Ahmadu Bello University, Nigeria). How many graduating sanitary engineers in Africa are as conversant with the design features of a pit latrine, a composting toilet, a bucket latrine or an aqua-privy toilet system as they are with design features of the activated sludge, percolating filter and possibly aerated lagoon sewage treatment systems? Current experience indicate few, if any at all! There is an urgent need not only to increase the rate of production of African sanitary engineers but also to drastically revise the syllabi. It is noteworthy that the training of professional engineers of all kinds has been seriously neglected in many African countries. In each of the nine African countries which were surveyed in a recent study (Feachem et al., 1978), there are considerably more fully trained doctors than engineers. USER ACCEPTANCE AND EDUCATION THERE IS clearly no point in investing in excreta disposal facilities which are unacceptable to the users. It is also mistaken to suppose that problems of user acceptance can be sorted out after construction through educational programmes. Statements like ’If the people do not like it, we will teach them to like it’ are simplistic, paternalistic and unrealistic. However, having accepted that user acceptance is crucial, it is of little help to make vague exhortations to designers and planners to involve the community in decision making. Since the designers and planners are generally foreign to the community, they require very precise guidance about how to involve the community and how to ensure that user preferences are fully accounted for in design. It will probably require a few more years of field experience with user-choice design techniques before a well-tried method emerges. However in the meantime, the outline given in Figure 1 may be of some help. In many cases user preference and user acceptance will be more closely linked to superstructure design than to substructure design. Provided that the excreta are removed from view and that the latrine does not smell, users may be influenced most by the design and colour of the latrine house and the seat or squatting slab. Considerable attention must therefore be given to details which may be trivial in the engineering sense but could be all important in determining the eventual use and hygienic maintenance of the new facilities.
Downloaded from rsh.sagepub.com at The University of Iowa Libraries on June 13, 2015
29 The need for user education will be reduced by following the guidelines for user acceptance which have been discussed in the foregoing paragraphs. If the users have taken part in the selection and design of the new facilities, and if they feel that the choice of technology was partly theirs, they may well have a positive attitude towards the innovation and be at least moderately
1 personal and latrine cleanliness 2 correct operation of the system 3 correct and conscientious maintenance of the system
4 full use of the new facilities by children; and 5 at least partial payment in cash or kind for the benefits received.
of its technical characteristics. However, it will still be necessary to mount a continuing and vigorous community campaign with special emphasis on the aware
following points: Figure 1
Possible sequence for community involvement in the choice and design of excreta disposal systems
CHILDREN AND EXCRETED DISEASES TRANSMISSION MANY OF the excreted infections have a very markedly non-uniform distribution of prevalence between different age groups. While all of them are found among people of all ages, many of them are concentrated in particular age groups. Table I states the age group which is most afflicted by the main excreted infections in areas where these infections are endemic. This Table clearly showas that many of these infections are primarily infections of childhood or that they afflict children as well as adults. This has the greatest relevance for disease control through excreta disposal
improvements.
In all societies children below the age of about 3 will defaecate whenever and wherever they feel the need. A proportion of these children will be excreting substantial quantities of pathogens. In some societies their stools are regarded as relatively inoffensive and they are allowed to defaecate anywhere in or near the house. In this case it is highly likely that their stools will play a significant role in transmitting infection to other children and adults. This applies not only to those infections without a latency period but also to infections like ascariasis, hookworm and trichuriasis where the defaecation habits of children will determine the degree of soil pollution in the yard and around the house and this, in turn, will largely determine the prevalence and intensity of these geohelminthic diseases in the household.
TABLEI The age of maximum
prevalence of some major excreted infections in indigenous populations of endemic area
* : Prevalent -:
Not
prevalent
Downloaded from rsh.sagepub.com at The University of Iowa Libraries on June 13, 2015
30 In other societies by contrast, strenuous efforts are made to control and manage the stools of young children, either by making them wear nappies or by cleaning up their stools whenever they are observed. Either of these reactions should have an important influence on the intra-familial transmission of excreted pathogens. Between these two extremes there is a whole range of intermediate behaviour patterns with regard to the reaction of adults to the stools of young children. In most poor communities, the picture is closer to the first example than to the second. The relevant response of government and other responsible agencies to this situation is health education of mothers to encourage a belief that the stools of young children are dangerous and should be hygienically disposed of. The problem is primarily connected with attitudes and behaviour. However, the provision of some form of toilet for the disposal of the child’s stool, and, maybe more importantly, a convenient water supply will greatly assist child
(diaper
hygiene. Turning to children over 3 years; they are capable of using a toilet if one of suitable design is available. Children in the age range 3-13 frequently do not use toilets even where they are available because: 1 to
they find it by adults;
inconvenient and
are not
encouraged
2 they are afraid of falling down the hole or of being attacked by pigs or other animals which may live next to the latrine;
3 they cannot because the toilet is little people cannot use it: 4
so
designed
that
they are prevented from doing so by adults who do messing up their nice clean
not want the children
toilet.
As with the very young children, it is of vital importthat the stools of these children are hygienically disposed of because some of them will be rich in pathogens. The solution lies in a combination of the provision of a toilet which children are able and happy to use and health education for the mothers so that they compel their children to do so. Education for school children could also be effective here and it is vitally important that all schools have well-maintained latrines so that the children may learn from positive experience. ance
I
COMMUNAL OR PRIVATE SANITATION SYSTEM? EXPERIENCE with public latrines of all kinds in all countries has often been unsatisfactory. The basic problem is that a public facility appears to belong to no-one individual and so there is very little commitment by individual users to keeping it clean and operating it properly. This is as true in New York as it is in Lagos or Calcutta. Public or communal latrines should usually only be considered for institutions (e.g. schools) or where speas for instance the use cial cultural conditions apply of communal blocks by extended families in Ibadan (Ademuwagun, 1975; Iwugo, et al. 1978a). In any case it will nearly always be necessary for paid employees to be engaged with responsibility for cleaning and upkeep. The installation of a tap in the block which may be used to hose down the floors and walls several times a day is -
not
onl helpful
but
Cases have been
imperative. ~wugo, 1978c) where public aquaprivy systems grossly misused and abused because taps
known were
were
installed in the toilet blocks. Communal latrines often require
not
lighting or they will
not be used after dark. Arrangements must be made before hand to pay for and water, because communities are seldom able to raise money regularly
lighting
by voluntary collections. Another difficult question surrounding communal facilities is that of privacy. The requirements for privacy of the population must be clearly understood and respected. A compromise between public and private latrines,
which is used in some parts of India, is said to have a central latrine block serving 8-15 households, in which each household keeps its cubicle locked and is responsible for its upkeep. Experience shows that each household will zealously guard its cubicle and keep it clean, but that maintenance of the overall system (e.g. blockage in the effluent pipe) will cause organisational problems. Provided that the municipal authority can assume the responsibility of the collection and treatment components of this type of system, this system should operate satisfactorily. Lastly, a communal latrine is necessarily a certain distance from each household, and this may be enough to deter some users, particularly at night or during wet or cold weather. In some societies, it may be essential that each family has its own latrine, in or very close to the house.
CONCLUSION THIS PAPER has briefly highlighted those factors which may deter the implementation of improved sanitation systems in Africa. Although most of the low-cost sanitation systems which are currently being used in Africa obviously need technical modification and improvement, the factors discussed in this paper should be very seriously considered if the necessary health benefits are to be derived by the installation of these i improved sanitation systems.
I
REFERENCES
ADEMUWAGUN, Z. A. (1975). ’A study of the Health Education component of the comfort stations in Ibadan, Nigeria’. University of
. Ibadan
FEACHEM, R., BRADLEY, D. J., GARELICK, H., and MARA, D.D.
(1978). ’Health Aspects of Excreta Washington: World Bank.
and Wastewater
Management’.
FEACHEM, R., MARA, D. D. and IWUGO, K. O. (1978). ’Alternative Sanitation Technologies for the Urban Poor in Africa’. Washington: World Bank. IWUGO, K. O., MARA, D. D. and FEACHEM, R. G. (1978a). ’Sanitation Studies in Africa Site Report No. 1, Ibadan, Nigeria’. —
World Bank. IWUGO, K. O., MARA, D. D. and FEACHEM, R. G. (1978b) ’Sanitation Site Report No. 2, New Bussa, Nigeria’. Studies in Africa Washington: World Bank. IWUGO, K. O., MARA, D. D. and FEACHEM, R. G. (1978c). ’Sanitation Studies in Africa Site Report No. 3, Kumasi, Ghana’. Washington: World Bank. IWUGO, K. O., MARA, D. D. and FEACHEM, R. G. (1978d). ’Sanitation Studies in Africa Site Report No. 4, Ndola and LUsaka, Zambia’. Washington: World Bank. MARA, D. D. (1976). ’Sewage Treatment in Hot Climates’. London:
Washington:
—
—
—
Wiley.
SHUVAL, H. I. (1977). ’Nightsoil Composting’ PU Report No.
RES12.
. Washington: World Bank
WAGNER, E. G. and LANOIX, J. P. (1958). ’Excreta Disposal for Rural Areas and Small Communities’. Geneva: World Health Organisation.
Downloaded from rsh.sagepub.com at The University of Iowa Libraries on June 13, 2015
