literature review sanitation

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Literature review sanitation extended essay cover sheet format

Literature review sanitation


The global scope of such studies also make them unfit for use in specific local contexts. In parallel, financial cost data on specific sanitation systems seem much weaker and inconsistent. Robust knowledge on the financial cost of urban sanitation options would help ensure sustainable management of sanitation project finance. Similarly, being able to anticipate the full economic costs of sanitation projects would help avoid project failure.

Such knowledge would be of high utility to three groups of stakeholders, in particular: 1 service providers governments, utilities managing urban sanitation systems and bearing at least part of the cost of such systems; 2 users e.

This literature review primarily aims to compare the financial costs of different urban sanitation systems and identify patterns in terms of relative costs, based on existing comparisons in the literature and original analyses of cost data from various sources.

It also addresses a set of secondary objectives:. The objective is to get a clear understanding of what parameters affect financial costs;. This paper does not analyse the economic cost of urban sanitation systems, which would imply a broader, macroeconomic approach, including and monetising non-financial expenditures such as the opportunity cost for public authorities of building a new urban sanitation technology instead of using the same funds to support a different project or policy.

The contents of this review are divided into four sections. The next section presents the methodology used to review the literature on financial costs of urban sanitation systems, followed by a section covering the main qualitative findings, including an overview of the main publications on this subject and the main methodological issues and obstacles to the calculation of lifecycle costs of urban sanitation chains.

The following section presents the results of the analysis of financial cost data, including direct findings from the most relevant studies published to date and original quantitative analyses undertaken for the purpose of this paper. It also rapidly reviews the main findings of major studies looking at cost-benefits and cost-effectiveness of different sanitation options.

The final section provides a summary of findings and elaborates on steps ahead to enhance knowledge on the financial costs of urban sanitation systems. The analysis is framed by a focus on lifecycle costs and on the full sanitation chain. Table 1 provides further details of what each category of costs entails. Expenditures on direct and indirect support, such as educational programmes, institutional development and policy support, are excluded from the analysis. Source: McIntyre et al.

A sanitation chain typically comprises four elements: on-site facilities e. Figure 1 illustrates the four components of the sanitation chain, depending on the main type of sanitation option. This literature review will mainly cover cost data on the sanitation chain related to human excreta management. The objective of covering both lifecycle costs and the full sanitation chain is to capture the full economic costs of urban sanitation options, and thereby maximise the utility of cost estimates to service providers, consumers and donors.

Components of the sanitation chain. Adapted from Kyomugisha The review covers the academic literature and the grey literature published after , such as project briefs and professional reports published by development agencies, NGOs and multi-lateral development banks. Documents reviewed are extracted from online platforms such as the Sustainable Sanitation Alliance's website Susana , from the website of major International Financial Institutions IFIs , such as the World Bank and the African Development Bank, and from keyword-based inquiries on web browsers.

Cross-country analyses, global cost data reports and specific single project publications are all included in the analysis. An emphasis is placed on studies and project reports comparing two or more sanitation options. The review of the literature first shed light on three major international research initiatives on the economics of sanitation, and often referred to by other studies and reports. Each of these initiatives, however, does not fully fit the scope or purpose of the present literature review:.

Some of its objectives included obtaining information on the disaggregated costs of providing WASH service delivery models and understanding the relative importance of factors that influence cost levels McIntyre et al. The project focused on rural areas and peri-urban areas and therefore did not aim to collect data on the cost of sanitation systems in cities.

The findings of this project are nonetheless of high relevance from a methodological point of view. The first phase of the project aimed to address major gaps in evidence among developing countries on the economic impacts of sanitation. The second phase of the project delivers economic assessments of sanitation interventions and provides cost data on different sanitation options in rural and urban areas. Its main objective, however, is to compare the cost-benefits and cost-effectiveness of sanitation options, and cost data is not always fully disaggregated.

In addition, this second phase has only been completed in East Asia see www. The World Health Organization has published two main studies on the global costs and benefits of drinking water supply and sanitation interventions, the latest in Hutton In addition to assessing cost-benefit ratios of various sanitation options in rural and urban areas, the study provides global cost estimates of reaching the MDG target and universal coverage.

Such global data do not compare the cost of different sanitation options but provide unit cost data for sewer connections and septic tanks. The costs of other sanitation options and full sanitation chains are not included. Beyond these three major international research programmes, the number of academic and non-academic studies reporting the lifecycle costs of urban sanitation solutions is relatively small. Among the main 50 documents of the literature reporting the cost of urban sanitation and identified for this research work, the following limitations are persistent:.

Some studies only report one or two types of cost, and thus do not look at the full lifecycle costs of urban sanitation systems. A total of 10 documents only reviewed one type of cost — in most cases capital costs see for example Ulrich et al. In some studies, various types of costs are included but there is no clarity on what each category entails. It is therefore impossible to verify whether the cost approach is comprehensive and includes all or at least the main components of lifecycle costs as described in Table 1.

Out of 50 documents reviewed, only 19 report costs on at least the first three elements of the sanitation chain. Poor thoroughness of reporting in the literature further limited the number of relevant studies identified during the review. Data is often not sufficiently disaggregated for the purpose of this research work. This is observed at different levels:.

In some cases, cost data provided do not clearly distinguish between rural and urban areas see for instance Water Sanitation and Hygiene WASH Institute This issue is still persistent in the sector, in particular regarding unit cost data.

Many studies have demonstrated that the costs of sanitation options tend to vary significantly between rural and urban areas Klutse et al. In many cases, cost data provided do not specify sanitation options clearly enough. For instance, Ross et al. Kennedy-Walker compares the cost of sewerage to public toilets, without specifying the type of toilets and treatment applied.

This is further complicated by the fact that some systems mix different sanitation solutions into hybrid systems. Generally speaking, existing cost studies have been limited by the lack of robust and accurate cost data, in particular those aiming to estimate regional and global costs and not focusing on a specific sanitation project. The lack of unit cost data by country, in particular, is often described as a limit by the authors of such studies.

For instance, Hutton grounds its cost-benefits and cost-effectiveness analyses of urban sanitation options on unit cost data but these are not available in every country. To circumvent this problem, the author filled the gap by replicating unit cost data of neighbouring countries. The lack of data is partly due to the absence of efforts at the national level to report sanitation costs thoroughly, but it also owes to the absence of proper urban sanitation systems in developing countries.

Many cities indeed lack integrated FSM systems: on-site facilities such as septic tanks, for instance, are not properly and frequently desludged, or no proper treatment process is applied to faecal sludge Kyomugisha However, since the cities studied do not always have an integrated FSM system, reported cost sometimes only cover on-site facilities.

The following issues also explain the lack of data on the cost of urban sanitation:. This may be explained by the lack of a financial and economic background in the sanitation sector; and. Only 11 documents within this shortlist provide cost data. This should allow for a more robust comparison of costs across studies. These studies include among others: a research article on the costs of conventional sewerage and FSM systems based on septic tanks in Dakar, Senegal Dodane et al.

Most of these studies however only look at one city context and do not compare all types of sanitation options. As such, there is no existing major research work analysing the lifecycle costs of a large diversity of urban sanitation options over a wide geographical area. In addition, even within the shortlisted studies, there is uncertainty about the thoroughness and consistency of methodologies employed to calculate lifecycle costs.

For instance, some studies aim to report lifecycle costs but only two types of costs are reported usually capital and recurrent costs , and it is unclear whether other types of costs capital maintenance costs, cost of capital are also included in these two categories.

The sources of data and methodologies for estimating costs of different sanitation options are not always consistent across studies but also within a same study looking at several different sanitation options. In some cases, there is not much information on the methodology employed to calculate lifecycle costs.

The inconsistent methodologies and lack of data observed in the literature on the costs of urban sanitation significantly limit opportunities to compare lifecycle costs across studies, hence the need to shortlist studies with the most thorough cost data reporting. However, the relevance of comparing cost data between these shortlisted documents remains limited, in particular owing to the numerous determinants of the costs of urban sanitation systems identified through the review and summarised in Table 2.

Sources: Dodane et al. The existence of many cost determinants complicates the comparison of cost data across projects and across geographical contexts, in particular because they have a high sensitivity to local contexts. The cost of a septic tank-based FSM system may differ significantly from one country to another, in this regard. This explains why some studies choose to report a wide cost range for each sanitation option, which is not very useful for comparative purposes see for instance IRC WASHCost , Parkinson et al.

This also means that, unless very detailed information on all these cost determinants are provided in each study and project report, comparing different sanitation options across different contexts is meaningless Ulrich et al. Likewise, global or continental cost estimates as found in some publications are not much use for specific city-based projects, since local conditions are bound to significantly affect costs Whittington et al.

Ideally, it would be worth analyzing the weight of each cost determinant in total costs across studies and projects, in order to further understand to what extent each factor affects financial costs of urban sanitation systems, and how costs can be anticipated to vary across different geographical, urban and socioeconomic contexts. However, the large majority of documents reviewed do not include detailed information on the above listed cost determinants, such as service level.

Other elements that present obstacles to comparison of urban sanitation costs across different studies include the fact that different metrics are chosen across the literature to account for sanitation costs. A study of WSP in India for instance provides cost data on on-site facilities expressed as cost per unit, and provides cost data on wastewater treatment facilities, expressed as cost per volume of water treated.

Many studies and reports also use cost per capita or cost per household as their main metrics. In order to circumvent the aforementioned methodological issues and obstacles to cost data comparison, the quantitative analyses presented in this section focus on a comparison of cost ratios between different urban sanitation systems taken within a same study or report.

The objective is to avoid comparing the cost of two or more urban sanitation systems in place in different contexts — which could significantly affect the determinants of costs — and to avoid comparative obstacles associated with different reporting methods used across the shortlisted documents e. In most cases, calculations were made using the annualised capital and recurrent costs and other types of costs if specified directly given in the literature.

However, in some documents capital costs are not annualised since these are one-off investment costs and therefore no overall cost is given for the entire sanitation system at focus. This required assigning a lifetime to each type of technology option included in these studies. The lifetime was selected based on the lifetime most frequently given to these specific elements of the sanitation chain in the literature.

Therefore they may not reflect the actual asset life in the cities at study. In addition to the comparison of sanitation cost ratios, three secondary analyses are provided in this section:. A comparison of costs of on-site technologies with the full sanitation chain associated. The purpose is to assess the weight of on-site facilities in total costs. The result of the analysis could help decision-makers and operators anticipate on which elements of the sanitation project are likely to drive costs upwards, and pay particular attention to the associated choice of technology.

A comparison of costs of different on-site technologies. The purpose is to help decision-makers and operators have a better understanding of the full cost associated with each on-site option. If on-site technologies are found to account for a significant share of total costs, such data may be particularly useful to guide relevant authorities in their choice of sanitation technology.

This article only aims to compare the cost of different sanitation options, without taking into account the effectiveness and benefits of each system. For instance, each sanitation system does not provide the same level of service, both at the user interface level in terms of hygienic conditions and in terms of on-site treatment of faecal sludge.

This should also be taken into account by decision-makers in developing countries before choosing which sanitation system to set up. The final subsection briefly introduces the challenges and future research needed about knowledge on the benefits of sanitation.

First, an analysis of lifecycle cost ratios of full urban sanitation chain systems was undertaken. Individual ratios were calculated from studies and projects analysing the lifecycle costs of two or more urban sanitation systems. These individual ratios were then compiled and compared, in order to assess whether general patterns could be identified across all ratios calculated.

Out of 50 documents reviewed, only 11 provided the data necessary for this analysis, i. Most of these studies only cover capital and operating and maintenance costs. Most studies from which the data was collected look at one or two particular local contexts, however some provide data at a continental scale e. The most recurrent comparison found in the literature is between conventional sewer systems and FSM systems based on septic tanks, and between conventional sewer systems and FSM systems based on wet pit latrines.

Conventional sewer systems are in all cases the most expensive sanitation option, followed, in order of cost, by sanitation systems comprising septic tanks, ventilated improved pit latrines VIP , urine diverting dry toilets UDDT and wet pit latrines.

The cost ratio between conventional sewer systems and FSM systems based on septic tanks is not always significant, as it ranges from around 1 i. Their separate cost ratios to conventional sewers and FSM systems based on septic tanks are also similar. Not surprisingly, the cost of simplified sewer systems is found to be lower than conventional sewer systems, but it is also found to be cheaper than septic tank-based systems.

However, cost ratio data relative to other sanitation systems is almost nonexistent, which does not allow drawing further conclusions and locating this particular sanitation solution on the sanitation cost ladder. Interestingly however, data retrieved from a study of The World Bank c indicate that the cost of simplified condominial sewerage is lower than FSM systems based on wet pit latrines in Senegal, in particular because such latrines have been installed in areas characterised by high population density, impermeable soils and high water table, which is less suitable and therefore more costly for this type of solution.

Amongst the studies reviewed to extract the data presented in Figure 2 , some of the most thorough references in terms of methodology and cost reporting include a study comparing the lifecycle costs of sewerage systems with the lifecycle costs of septic tank-based systems in Dakar, Senegal Dodane et al. The authors calculated a total annual cost of USD 55 per capita for the sewerage to wastewater treatment plant system and a total annual cost of USD 12 per capita for the FSM system based on septic tanks and drying beds.

The study also identifies which stakeholders bear the costs of both sanitation systems, and concludes that the utility bears the majority of costs in the case of the sewer based system, while users bear the majority of costs of the FSM system. In the case of the sewerage system, the authors calculate that households bear only around 3.

In this study, the breakdown of costs by stakeholders includes transfer costs such as the sanitation tax paid by householders to the utility. Since it is reported as negative and positive cash flows for both stakeholders, its effect is cancelled when aggregating to total costs.

This is mainly due to the fact that households have to pay for septic tank installations and desludging Compilation of lifecycle cost ratios of full sanitation chain solutions. Although sanitation systems are here indicated by the name of their on-site facility e. A cost ratio below 1 indicates the reverse. This threshold is represented by a red line on the graph. For instance, the first category on the horizontal axis shows that conventional sewer systems are between 1.

In order to make their calculations, the authors of this study collected data from existing reports, databases and interviews. Capital and operating costs were then itemised against the major component of each sanitation system, and the financial flows of each stakeholder were also determined for both. Finally, the financial flows were converted to an annual per capita basis.

Each major component of the sanitation chain was given a specific lifetime and a real interest rate was chosen in order to make this calculation. It was also assumed that both types of sanitation systems FSM and sewerage provide the same level of service. Another relevant study looks at the lifecycle costs of hypothetical FSM systems vs.

The authors conclude that the FSM system based on septic tanks or pit latrines, depending on cases, is slightly more expensive than any hybrid solutions involving simplified sewerage Figure 3. This study illustrates the complexity of sanitation systems and the fact that categorising sanitation options is not straightforward as hybrid solutions have been put in place in some cities.

In this study, data on the cost of sanitation technology was systematically collected from secondary sources on FSM systems in Dhaka or extrapolated from contexts outside Bangladesh. According to the author, methodologies employed in these sources are not always fully described, so a strong assumption is made on the correspondence between the context of these secondary sources and the context of Dhaka.

Costs per capita were calculated based on a household survey which served the purpose of other analyses in the same study. No information is given on specific lifetime given to each component for the sanitation systems, and it seems that the difference in asset life was not taken into account.

This may unfairly bias the results in favour of sanitation options whose asset life is shorter than the other options. Annual lifecycle costs per household of FSM vs. Source: Ross et al. Another study, undertaken by The Boston Consulting Group BCG , also concludes that FSM systems based on septic tanks tend to be more expensive than simplified sewerage systems, although the difference is not so clear Cairns-Smith et al.

It also concludes that both tend to be less expensive than conventional sewerage systems Figure 4. The data presented do not refer to a specific city context but rather targets developing countries in general, hence the wide cost brackets. However, no information is provided on the methodologies used in these secondary sources. Likewise, it seems authors did not apply a specific lifetime for each sanitation option in particular as each category may imply multiple technology choices.

Annual lifecycle costs per capita of centralised conventional and simplified sewerage, and septic tank based FSM systems full sanitation chain. Cost calculations were made assuming a lifetime of 20 years for all the above sanitation options. Source: Cairns-Smith et al. Several reports of the World Bank also provide thorough data on the costs of urban sanitation. The results, summarised in Figure 5 , are in line with the general cost hierarchy mentioned earlier and observable in Figure 2.

The data was collected from project documents, the database of the operators and surveys designed for the purpose of this research work. Detailed explanation is also given on what each type of costs entail and how they were calculated. The study adopted a standard design for costing the cubicles, toilets and septic tanks across the study sites. Hence, differences in cost estimates are attributable solely to variations in prices and labour costs. Annual lifecycle costs per household of urban sanitation systems in the Philippines full sanitation chain.

Source: The World Bank a. Another report on sanitation in Senegal and Burkina Faso also shows that conventional sewers are more expensive than simplified sewerage, VIP and wet latrines; interestingly, it also shows that wet latrines are more expensive than simplified sewerage, as mentioned previously The World Bank c. The level of service is assumed to be the same for all sanitation systems at study, and is simply defined as a system that covers the full sanitation chain.

Similarly to Dodane et al. Sanitation costs were calculated by annualising capital costs and adding them to recurrent costs. It is unclear how the data for each type of sanitation system was retrieved. The second objective of the analysis was to compare the cost of on-site sanitation options to the cost of the full sanitation chain which includes these on-site sanitation facilities.

The objective was to assess whether on-site facilities account for a significant share of total costs of sanitation systems. Again, only the 11 relevant studies mentioned previously can be used to undertake this analysis, and only three of them provide breakdown data which allows comparing on-site facility costs and total costs.

Results are therefore not robust and would need to be strengthened with further data. The analysis from these documents nonetheless suggest that the share of on-site facility costs out of total costs tend to be much higher in the case of FSM systems that in the case of conventional sewer systems Figure 6. Ross et al. Share of on-site facility cost out of total system cost of various sanitation solutions. However, such data must be handled carefully as the share of on-site sanitation facilities is highly dependent on the type of treatment applied at a later stage of the sanitation chain.

The share of on-site facility costs to total costs is likely to be lower if the treatment method is more advanced. Data from Ross et al. Likewise, the costs of on-site sanitation can vary significantly depending on the type of solution selected, and therefore modify its weight in total costs. Indeed, on-site sanitation options may perform partial treatment before being transported to a final treatment site. Dodane et al. In the context of Dhaka, Ross et al.

The costs are broken down into capital costs and capital maintenance costs. The objective was to determine whether patterns differ substantially from those identified for the full sanitation chain. The results are displayed in Figure 7. Overall, cost patterns for on-site facilities alone are quite similar to those identified for the full sanitation chain.

However, the following observations can be made:. The cost ratios of septic tanks to VIP and septic tanks to pit latrines tend to be higher than when the full sanitation chain is compared, as in Figure 2. Compilation of lifecycle cost ratios of on-site sanitation solutions.

For this particular analysis more data on dry pit latrines were available than for the cost ratio comparison for the full sanitation chain. Conventional sewer systems present the lowest median value The lower median values for conventional sewer systems can be explained by the high capital investment needed to build such systems.

A few studies present interesting data. Similarly, Dodane et al. Similar results were obtained in a study conducted by Cairns-Smith et al. This analysis is however limited by the fact that the categorisation by type of costs is highly inconsistent across studies. Indeed, while some research works provide a complete breakdown of costs, as listed in Table 1 , the majority of documents reviewed provide a simple division between capital costs and recurrent costs, without specifying whether capital maintenance costs are taken into account and if yes, in which category they were included.

Public sanitation blocks that can be used by anyone, normally for a small fee per use, can be an acceptable alternative provided that they are well operated and maintained and have hour access. Finally, in less densely populated low-income urban areas, on-site sanitation options of the types described in section 3 in Text S1 for rural areas are often applicable. Sanitation promotion is one of the most important roles the health sector can have in environmental health planning, because behaviours must be changed to increase householders' demand for and sustained use of sanitation, especially in rural areas where the pressure for change is lower.

Thus, two of the most promising large-scale sanitation programmes in Africa are centred around demand creation and are both led and delivered by the Ministry of Health and its associated structures [37] , [61] , [62].

Alternatively, it can be incorporated into a wider integrated community health package such as Ethiopia's HEP Health Extension Programme , which was developed in to prevent the five most prevalent diseases in the country [61] , [62] ; safe sanitation and hygiene became a major focus within HEP because of the recognition that these diseases are all linked with poor environmental health.

Promotion alone by the health sector may be insufficient, however, to ensure sanitation adoption and maintenance. In many countries, Environmental Health Officers are responsible for ensuring the sanitary condition and hygienic emptying of toilets, and have the power to sanction dissenting households with fines and court action [65]. This enforcement role of the health sector is particularly important in urban areas where high-density living increases the risks of faecal contamination of the environment and where one person's lack of sanitation can affect the health of many other people.

The health sector also has an important role to play in advocacy and leadership. Politicians and the general public listen to doctors. That puts an onus on the medical profession to speak out on all important health issues, including sanitation. Historically, this has not happened. Given the huge potential health-cost savings achieved through improved sanitation, the health sector should be advocating for stronger institutional leadership, stronger national planning, and the establishment of clear responsibilities and budget lines for sanitation.

Unfortunately, although the international health community puts large human and financial resources into many low- to medium-cost health interventions such as immunization and bed net distribution, it has been slow to act on the evidence showing that sanitation promotion and hygiene promotion are among the most cost-effective public health interventions available to developing countries.

Finally, the well-honed epidemiology and surveillance skills of health professionals must also now be applied to sanitation to establish clear links between national health information systems and sanitation planning and financing, which has historically been separate from health in most countries. The lack of national policies is a major constraint to success in sanitation see section 5 in Text S1 for additional information on this and other constraints.

Governments in general and health ministries in particular cannot play their key roles as facilitators and regulators of sanitation without policies that support the transformation of national institutions into lead institutions for sanitation, that increase focus on household behaviours and community action, that promote demand creation, and that enable health systems to incorporate sanitation and hygiene.

Other constraints to success in sanitation are population growth and increasingly high population densities in urban and periurban areas of developing countries. Finally, although macroeconomic analysis shows that sanitation generates economic benefit, the benefit does not necessarily accrue to the person who invests in the improved sanitation. So the economics at the household level remain a constraint to success in sanitation—many people are simply unable or unwilling to invest, given all the other competing demands on their money.

This under-researched topic is currently under investigation by the WASHCost Project, which is studying the life-cycle costs of water, sanitation, and hygiene services in rural and periurban areas in four countries [67]. Sanitation is a complex topic, with links to health and to social and economic development. It affects many but is championed by few.

From our analysis of the situation, we believe that three major strategies could achieve success in sanitation. The most important of these strategies is political leadership, which is manifested by establishing clear institutional responsibility and specific budget lines for sanitation, and by ensuring that public sector agencies working in health, in water resources, and in utility services work together better.

The regional sanitation conference declarations [51] released during the International Year of Sanitation, in which many government ministers were personally involved, were an important step forward. In addition, the biennial global reports on sanitation and drinking water published by the World Health Organization and UNICEF [4] , [68] contribute towards political leadership and aid effectiveness by publicising the sanitation work of both developing country governments and support agencies.

The second strategy is the shift from centralised supply-led infrastructure provision to decentralised, people-centred demand creation coupled with support to service providers to meet that demand. This strategy is transforming sanitation from a minor grant-based development sector into a major area of human economic activity and inherently addresses the problem of affordability, since people install whatever sanitation systems they can afford and subsequently upgrade them as economic circumstances permit.

The final strategy is the full involvement of the health sector in sanitation. The health sector has a powerful motivation for improving sanitation, and much strength to contribute to achieving this goal. Many years have passed since this Declaration, and the body of evidence about sanitation has increased substantially.

The health sector now needs to reassert its commitment and leadership to help achieve a world in which everybody has access to adequate sanitation. Supporting Information. The authors have declared that no competing interests exist. No funding sources were used to write this article. Provenance: Not commissioned; externally peer reviewed. National Center for Biotechnology Information , U. PLoS Med. Published online Nov Author information Copyright and License information Disclaimer. The Policy Forum allows health policy makers around the world to discuss challenges and opportunities for improving health care in their societies.

Copyright Mara et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. This article has been cited by other articles in PMC.

Summary Points 2. Introduction and Definitions Adequate sanitation, together with good hygiene and safe water, are fundamental to good health and to social and economic development. Open in a separate window. Figure 1.

Faeco-oral disease transmission pathways and interventions to break them. Diarrhoeal Diseases Diarrhoeal diseases are the most important of the faeco-oral diseases globally, causing around 1. Neglected Tropical Diseases Neglected tropical diseases, while resulting in little mortality, cause substantial disability-adjusted life year DALY losses in developing countries [21]. Acute Respiratory Infections With 4.

Wider Benefits of Sanitation In addition to its impact on health, improved sanitation generates both social and economic benefits. Table 1 Economic benefits resulting from meeting the MDG sanitation target and from achieving universal sanitation access. Source: [40]. Table 2 Cost-benefit ratios for achieving the MDG water supply and sanitation targets and for universal water supply and sanitation coverage.

Analysis of the Current Situation Coverage Currently, some 2. Reasons for Slow Progress For many years, national governments, aid agencies, and charities have subsidised sewerage and toilet construction as a means to improve access. Successful Approaches to Sanitation Recently, there has been a shift away from centrally planned provision of infrastructure towards demand-led approaches that create and serve people's motivation to improve their own sanitation.

Sanitation Marketing Sanitation marketing uses a range of interventions to raise householders' demand for improved sanitation [38]. Community Health Clubs Community Health Clubs aim to change sanitation and hygiene attitudes and behaviour through communal activities. Sanitation as a Business Traditionally, sanitation has been regarded as a centrally provided service with little role for the creativity or energy of business.

Approaches Emphasising Low Cost Many sanitation advocates now place the affordability of the toilets at the centre of the planning process. Approaches Specific to Urban Sanitation Most successful demand-led approaches have been developed in rural contexts.

The Role of the Health Sector in Improving Sanitation Sanitation promotion is one of the most important roles the health sector can have in environmental health planning, because behaviours must be changed to increase householders' demand for and sustained use of sanitation, especially in rural areas where the pressure for change is lower.

Constraints to Success in Sanitation The lack of national policies is a major constraint to success in sanitation see section 5 in Text S1 for additional information on this and other constraints. Strategies to Achieve Success in Sanitation Sanitation is a complex topic, with links to health and to social and economic development.

Footnotes The authors have declared that no competing interests exist. References 1. Singh M. Accessed 15 July Effects of improved water supply and sanitation on ascariasis, diarrhoea, dracunculiasis, hookworm infection, schistosomiasis, and trachoma. Bull World Health Organ. Water and sanitation associated with improved child growth. Eur J Clin Nutr. Progress on sanitation and drinking-water — update. Geneva: World Health Organization; Chadwick E.

Report on an inquiry into the sanitary condition of the labouring population of Great Britain. London: Her Majesty's Stationery Office; Ferriman A. Safer water, better health: costs, benefits and sustainability of interventions to protect and promote health. Creating healthy cities in the 21st century.

In: Satterthwaite D, editor. The Earthscan reader on sustainable cities. London: Earthscan Publications; Sanitation and disease. Health aspects of wastewater and excreta management. Excreta disposal in rural areas and small communities. The burden of disease and mortality by condition: data, methods, and results for Global burden of disease and risk factors. New York: Oxford University Press; The global burden of diarrhoeal disease, as estimated from studies published between and Global, regional, and national causes of child mortality in a systematic analysis.

Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis. Lancet Infect Dis. Ecological sanitation. Waddington H, Snilstveit B. Effectiveness and sustainability of water, sanitation, and hygiene interventions in combating diarrhoea. J Dev Effect. Effect of city-wide sanitation programme on reduction in rate of childhood diarrhoea in northeast Brazil: assessment by two cohort studies. Effects of sewerage on diarrhoea and enteric infections: a systematic review and meta-analysis.

Risk factors for childhood diarrhea incidence: dynamic analysis of a longitudinal study. Diarrhea — whose faeces matter? Reflections from studies in a Peruvian shanty town. J Paediatr Infect Dis. Control of neglected tropical diseases. N Engl J Med. Global data on visual impairment in the year Comparison of annual and biannual mass antibiotic administration for elimination of infectious trachoma.

Cook JA. Eliminating blinding trachoma. Role of flies and provision of latrines in trachoma control: cluster-randomised controlled trial. Soil-transmitted helminth infections: updating the global picture. Trends Parasitol.

Malnutrition and parasitic helminth infections. Helminth infections: soil—transmitted helminth infections and schistosomiasis. Disease control priorities in developing countries, 2nd edn. Intervention for the control of soil-transmitted helminthiasis in the community. Global burden of disease: update. Geneva: World Health Organization, ; Acute respiratory infections update February Recent diarrhoeal illness and risk of lower respiratory infections in children under the age of 5 years.

Int J Epidemiol. World Bank. Environmental health and child survival: epidemiology, economics, experience. Washington, DC: World Bank; Malnutrition: quantifying the health impact at national and local levels. Maternal and child undernutrition: consequences for adult health and human capital.

Water Supply and Sanitation Collaborative Council. Jenkins MW, Curtis V. Soc Sci Med. Jenkins MW, Scott B. Behavioral indicators of household decision-making and demand for sanitation and potential gains from social marketing in Ghana. Mahon T, Fernandes M. Gend Dev. Economic and health effects of increasing coverage of low-cost household drinking-water supply and sanitation interventions to countries off-track to meet MDG target Hutton G, Haller H.

Evaluation of the costs and benefits of water and sanitation improvements at the global level. Hutton G. Economic impacts of sanitation in Lao PDR.


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In the world health organizations expert committee on environmental sanitation defines environmental sanitation as the control of community, water supplies, excreta and waste water disposal, refuse disposal, vector of diseases, housing conditions, food supplies and handling conditions, food supplies and atmospheric conditions and the safety of the working environment.

Environmental problems have grown in complexity especially with the advert of radiation and chemical hazards. Meanwhile the world needs for the basic sanitation services like drinking water supply, excreta and waste water disposal , have greatly increased as a result of rapid population growth and highly expectations.

There has been considerable awareness of water supply in institution, but the problems of excreta and waste disposal have receive less attention. In Enugu State College of Education Technical , every where is littered with pure water polythene, pieces of papers and so on, without proper disposal. In order to focus attention of these problems. Sanitation exercise should be done daily to keep the environment clean by employing labourers that will help keep the school clean.

Environments should be formulated in order to kill dangerous animals like snake, scorpion etc. In school hostels, there are problems of over-crowding and these affects the health of the students in the hostel. More than students share four 4 toilets. Mostly girls in hostel have inadequate sanitation facilities. With this premise, the researchers seek to find out the implication of sanitation practices on students health in Enugu State College of Education Technical.

Inadequate sanitation and water in school jeopardize not only the students health but also their attendance. Girls in particular area likely to be kept out of school, if there is no sanitation. Seminars should be organized in institutions to help educate students more, especially girls in the hostel on menstrual hygiene, sanitation hygienic practices, cleanliness in the surroundings. To make everywhere conducive for teaching and learning, lack of skills and this have hindered the educational prospects of girls residing in the hostel.

Flies petch on dirts, toilet etc and later petch on uncovered foods and all this are dangerous to human health. Diseases related to poor sanitation and water availability causes many people to die of sickness like cholera, diarrhea, malaria, typhoid which damages the body tissues. However, it is not clear on the extent in which school management and student union government SUG have contributed in curbing poor sanitation practices.

The problem of this study is to find out the strategies which could be employ to provide facilities to students to reduce dirtiness. Specifically this study was to: 1. Determine the extent in which the school management have contributed in providing facilities that will enhance sanitation practices in Enugu State College of Education Technical Enugu. Find out the strategies that could be employed to curb dirtiness in Enugu State College of Education Technical. The finding will help the following people: The students to know the needs of hygiene or health practices, because cleanliness in next to Godliness and also enable to have a sound health, if sanitation is practiced by the students, sickness and diseases will be reduced.

To the school management: The findings will help the school management to provide adequate facilities that will enable the labourers to keep the environment clean and tidy, also provide fund for buying disinfectant and Antiseptic, and also paying the labourers. Government:- The findings will help the government, to formulate a policies that will enable their follow students keep the environment clean and regulations on the school.

Also they serve as a mediator between the management and the students. What are the causes of poor sanitation practices on students health in Enugu State college of Education Technical? What are the dangers of poor sanitation practices on students health in Enugu State College of Education Technical Enugu.? American Industrialization had many effects come out of it, both positive effects and negative effects.

Then the negative effects of Industrialization are exploitation of workers, overpopulation in urban cities and environmental damages. They are typically using your money to provide loans and make interest off that money. As a result, the American people lost confidence in their security of banks and began withdrawing at the same time. Because of this, between 9, to 11, banks dissolved during a three-year period. Once a bank dissolved, there was no way of getting your money out and no insurance for your loss.

Have you heard of how many people are in the streets in Honduras? Honduras is the second country with the most economical problems in Central America. Economical problems clearly lead to lots of problems, the lack of job opportunities lead to economical instabilities, economical instabilities lead to lots of things, in this case homelessness.

About , Hondurans find themselves with no home and no warmth of a family. This kind of economical situation has been going on for quite a while and in my opinion its time for us to join together. Almost 1 out of every 6 people alive are unable to adequately access water, and worse still, over double that number lack basic sanitation, for which water is a necessity.

Clean water i. Rapid increase in population, industrialization, droughts and demands from variety of users are the major factors that led to clean drinking water shortage. With the current relief then, it just not enough for him through every month. Credibility Statement: At First, I thought hunger only exit in developing poverty country, like Africa or South Asian or the area happened natural disaster. However after I do a lot of research, the number of hunger people in America, it really surprise me.

In an official census was taken and concluded that the population of Somalia was approximately 10,, Of the approximately Overcrowding affects the cost of incarceration and the mentality of prisoners. However, the issue has yet to be seriously addressed.

In fact, many politicians claim that mass incarceration has led to a dramatic decline in crime, citing statistics from the s, when crime rates fell by almost 40 percent. However, further research has proven that mass incarceration has little effect on crime rates.

The penny cost 2x as much as it really is. Though the penny has been part of the U. S for more than a hundred years, it should not be minted anymore because of the high production cost and other countries such as canada don 't even bother using them at all. People argue that the penny should stay because of its long time and history with the US, but what they don 't know is that the penny cost more than 2.

That inclination continued until the accumulation of problems reached an unsolvable threshold. After that, the city began to deteriorate gradually under the weight of its political-bred issues. For instance, the failure to address the increasing tax rate increased the financial burden of the residents Guerrieri, Hartley and Hurst Even with high taxes, the city did not provide expected services. The sugar act, which was passed a little under a year ago, already made things very hard on the family and this would just make matters worse.

The sugar act put taxes on sugar and molasses. The Cranes ' were not very happy about this second act that Britain was enacting. Everything was extremely hard on Bruce Crane because he did not earn a lot with his job at the local iron factory. He had to support himself, his wife Janet Crane, and his three children, Alice, age 13, Ella, age 9 and their 5 month old brother, Oliver. The effects of overpopulation and lack of natural resources have caused the supply of water in California to become limited.

The state needs about eleven trillion gallons of water to recover from this ferocious three year drought. This complication started from and has been continued throughout and has been the driest record of California in the past years causing less fog in the valley and less snow in the mountains.

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