Human Waste Management MPH May 2015 Students

Human waste management (HWM)

For Extension MPH students

2007 EC

Worku Tefera (MPH, PhD fellow)

Session Objectives

1. Describe the definition of sanitation

2. Learn the significance of S&H

3. Analyze and compare the global, regional, and national situation in S&H

4. Share experience of some successful experiences in Ethiopia and to evaluate implementation of HEP

5. Identify the challenges/gaps to achieve UAP/MDG

5/4/2015 WTJAN2014 2

Outline

A. Definitions B. Historical perspective & Significance C. Global Situation & Regional Situation : Data &

progress towards MDG7 D. National Situation: towards UAP & MGD7 E. Experiences of SNNP Regional State F. Health Extension Program: Rural vs Urban

settings G. Gaps/Challenges to achieve sanitation and

hygiene (S&H) H. Way forward

5/4/2015 WTJAN2014 3

Definitions

Human waste: (Excreta)

Composition: faeces and urine

Sewage: faeces +urine + sullage+

Characteristics: amount, fractions

Q? Why do we want to know generation charcterstics

5/4/2015 WTJAN2014 4

A. Definition Sanitation (Defn): refers to the provision of facilities and

services for the safe disposal of human urine and faeces (WHO)

WHO/UNICEF Joint Monitoring Program (JMP): 2008 report sanitation is defined as grouped into 4 categories as: - This definition paved a new way to look at sanitation

1. Open defecation 2. Unimproved 3. Shared 4. Improved

5/4/2015 WTJAN2014 5

Operational Definition (JMP)

5/4/2015 6 WTJAN2014

Definitions contd Human waste management? - Proper handling, collection, transportation, and disposal

5/4/2015 WTJAN2014 7

Generation Collection

/storage

Transportation Treatment Disposal

Categories of Excreta disposal facilities

Transportation means;

Water carriage

Non-water carriage

Storage means

On-site and off-site facilities;

Investment type

Large scale and small scales

5/4/2015 WTJAN2014 8

The 4 Sanitation ladders 1. Open defecation:

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

2. Unimproved sanitation facilities:

Facilities that do not ensure hygienic separation of human excreta from human contact.

Unimproved facilities include pit latrines without a slab or platform, hanging latrines and bucket latrines.

3. Shared sanitation facilities:

Sanitation facilities of an otherwise acceptable type shared between two or more households Shared facilities include public toilets.

5/4/2015 WTJAN2014 9

: 4. Improved Sanitation facilities

Facilities that ensure hygienic separation of human excreta from human contact.

They include:

Flush or pour-flush toilet/latrine to:

- piped sewer system

- septic tank

- pit latrine

Ventilated improved pit (VIP) latrine

Pit latrine with slab

Composting toilet.

5/4/2015 WTJAN2014 10

B. Historical perspective & Significance Sanitation was being practiced since the ancient times

Mosses and Mohammed ordered in different times ordered their followers to keep sanity for themselves (as referred in Bible and Quran respectively)

In recent times, in the practice of Modern Medicine, the invention of Penicillin; DDT and other drugs has changed the health status of the world to the better.

Sanitation, according to Readers of BMJ: recently selected as the most important medical advance since 1840

5/4/2015 WTJAN2014 11

Public health importance

Cause of morbidity

Cause of mortality

Cause of disability

Measured by: magnitude; severity

OPD visits

Diarrhea episodes

5/4/2015 WTJAN2014 12

Transmission mechanisms

Direct ingestion: water, food, soil

Via vector

Via skin

Q? which is most important?

5/4/2015 WTJAN2014 13

5/4/2015 WTJAN2014 14

Faeco-oral transmission mechanisms Vs its use Source of infection?Host?Environment?

Excreta

host

Water

Soil

food

Hands

Flies

Objectives

1. Disease prevention and control

2. Pollution control

3. Public nuisance control

5/4/2015 WTJAN2014 15

MDGs

Goal 1. Eradicate extreme poverty and hunger

Goal 2. Achieve universal primary education

Goal 3. Promote gender equality and empower women

Goal 5. Improve maternal health;

Goal4: Reduce child mortality

Goal 6. Combat HIV/AIDS, malaria and other diseases

Goal 7. Ensure environmental sustainability

Goal 8. Develop a global partnership for development

5/4/2015 WTJAN2014 16

MDG Vs Sanitation Goal 7. Ensure environmental sustainability Target 10 Halve, by 2015, the proportion of people without sustainable

access to safe drinking water and basic sanitation Indicators

30. Proportion of population with sustainable access to an improved water source, urban and rural (UNICEF-WHO) 31. Proportion of population with access to improved sanitation, urban and rural (UNICEF-WHO)

Target 11 By 2020, to have achieved a significant improvement in the

lives of at least 100 million slum dwellers Indicators

32. Proportion of households with access to secure tenure (UN-HABITAT)

5/4/2015 WTJAN2014 17

Events In 2000, MDG declared using as a base 1990, and as

target accomplishment year 2015

Targets on Sanitation was added in 2002 in South Africa

In 2008, sanitation in Africa is given much emphasis and International Year of Sanitation was launched in Durban, SA, to renew and further strengthen the commitment;

Africa San +5 Conference: African Ministries of Water/Sanitation sector and Heads of delegations from 32 African countries passed The eThekwini declaration in Feb 2008. (AMCOW: African Ministries council on W&S)

5/4/2015 WTJAN2014 18

International Year of Sanitation www.sanitation2008.org

5/4/2015 WTJAN2014 19

Key points of The eThekwini About 589 mill. People (>60% of Africas popn.) currently do

not have access to safe sanitation Estimated 1 million Africans die every year from sanitation,

hygiene, and drinking water-related diseases;

Welcome IYS 2008 to draw attention that sanitation is important for economic development and poverty reduction

Positively impacting on sanitation will impact also other development goals

AMCOW has committed itself to lead Africa-S&H MDG Prepare and implement country specific plan to achieve

S&H_MDG

5/4/2015 WTJAN2014 20

Five key Messages of IYS

2008- International Year of Sanitation (IYS)

Sanitation is vital for human health

Sanitation generates economic benefits

Sanitation contributes to dignity and social development

Sanitation helps the environment

Sanitation is achievable

5/4/2015 WTJAN2014 21

Sanitation is vital for human health

5/4/2015 WTJAN2014 22

Key Points: (Source: Progress for Children (PFC) 6, UNICEF 2006).

Reducing diarrheal disease 5000 deaths of U5 daily (2004); 1.5 mill yearly from diarrhea

Reducing child mortality 88% U5 diarrh. deaths related to lack of watsan 17% of total U5 mortality due to diarrhea

(excluding neonatal diarrhea)

2/3rd of diarrh. Related U5 deaths- S & H

Improving Health Diarrhoea as proportionate cause of child mortality: 2nd highest single cause after

pneumonia

Improving nutrition Improving cognitive development

Contextualize to local

Therefore, think of (calculate) the situation in Ethiopia in terms of:

1. % of U5 deaths related to diarrhea due to poor WaSH

2. Rate of worm infection in children

3. Rates of respiratory illnesses in children

5/4/2015 WTJAN2014 23

Sanitation generates economic benefits

Key Points: Lives lost

For every 10 yr increase in life expectancy at birth, 0.3-0.4% economic growth per year can be gained, WHO estimates.

Medical costs Lost time and productivity

WHO estimates, achieving MDG for san., $66 bill. Will be gained

For every $1 spent/invested on san., there is $9.1 return

Lower tourism Female literacy and GDP

For every 10% increase in fem. Literacy, economy can grow by 0.3%

5/4/2015 WTJAN2014 24

Contextualize to local

1. Female literacy rates (correlated to potential GDP increases);

2. Annual health costs correlated to diarrheal disease;

3. Estimates of total national investment into sanitation needed to meet MDGs.

5/4/2015 WTJAN2014 25

PROGRESS ON IMPROVING

GLOBAL SANITATION: Background 2.5 billion: Number of people without

access to improved sanitation. The vast majority live in Asia and Sub-Saharan Africa.

1 billion: At the rate of current progress, the world will miss the MDG for sanitation by this many people. 1.7 billion: Number of people who lack access to improved sanitation facilities even if the MDG for sanitation is met. 40%: Percentage decline in open defecation worldwide between 1990 and 2010 (from 25 percent to 15 percent). 1.1 billion: Number of people who still defecate in the open. Most live in rural parts of South Asia and Sub-Saharan

Africa. Source: Progress on Sanitation and Drinking Water2012 Update, WHO/UNICEF. Available at

www.wssinfo.org/fileadmin/user_upload/resources/JMP-report-2012-en.pdf.

5/4/2015 26 WTJAN2014

C. Global & Regional Situation: Data & progress towards MDG7

Current Status: Globally, 2.5 billion people without improved sanitation (JMP, 2008)

Open defecation, worldwide, decline from 24% (1990) to 18% (2006)

Open defecation still widely practiced in:

Southern Asia: 48% Sub-Saharan Africa: 28% SE Asia: 18% of the popn.

5/4/2015 WTJAN2014 27

Data & Progress

In contrast, in Eastern Asia: only 3% of popn. practice OD

Progress: 62% of the worlds popn uses improved sanitation

The world is NOT ON TRACK to meet the MDG on Sanitation,

Why????

Only 8% decrease in proportion of people w/o access to improved sanitation (between 1990 & 2006) achieved

5/4/2015 WTJAN2014 28

Is Sanitation Achievable?

Best Practice Exemplary: Thailand has achieved over 98%

sanitary latrine coverage nationwide in 2005

CLTS & MDG

5/4/2015 WTJAN2014 31

D. National Situation: towards UAP & MGD7

For many years, Ethiopia achieved a sanitation coverage increase of less than 1% a year,

National Health and water policies; and sanitation strategy: fertile policy environments for the WaSH sector

Universal Access Plan (UAP): plans to achieve 98% of drinking water and 100% sanitation coverage by 2012.

Progress: Latrine Data from Welfare Monitoring.doc Where are we??

In 2000E.C: -water supply coverage- about 59% (MoWR) Sanitation coverage- 37% (MoH)

Q. Will Ethiopia achieve MDG 7 & UAP???

5/4/2015 WTJAN2014 32

Types of facilities in urban centers, CSA 1994

5/4/2015 WTJAN2014 33

Facility type % housing units

Flush private 3.45

Flush shared 2.04

Pit private 24.20

Pit shared 26.85

No latrine 42.33

NA 1.13

HW: coverage status

2000: Welfare Monitoring data, CSA (n=25898)

5/4/2015 WTJAN2014 34

Type Urban Rural Overall

Flush, % 7.0 0.8 5.3

Pit latrine, % 64.6 8.1 22.6

Total 71.5 8.9 17.9

Management of Sanitation Projects

Steps in small scale facility management A. Feasibility study Culture of the target population; Socio-economic profiles; Community involvement; Existing tech options KAP towards excreta management Sustainability

5/4/2015 WTJAN2014 35

Steps in small scale facility management, contd

B. Planning specifics Training and piloting Technology options: cost Sitting Size and shape of storage Slab structures comforting: squatting hole, vent, foot

step Construction material; Final disposal options;

5/4/2015 WTJAN2014 36

Steps in small scale facility management, contd

C. Implementation phase

Training: crafts men, users

Procurements

Construction by plan: (Any experience?)

Community involvement: individual, committees (experience?);

Piloting:

5/4/2015 WTJAN2014 37

Steps in small scale facility management, contd

D. Project support communication

Education

Supervision

Public M & E

5/4/2015 WTJAN2014 38

Technology options: low cost

Options in Ethiopia

Traditional pit latrine: private, shared

VIP latrine: improved version (private, shared)

Eco-San (Ecological Sanitation)

Q? In Butajira: users are not willing to cooperate for VIPs. Why?

5/4/2015 WTJAN2014 39

Is VIP a costly technology? Home work

Assumption:

3x3m size costs about ?30 000 Birr

Structure is a standard, has 4 squatting holes

Service years 15-20 years minimum.

Desludging service: ?200 Birr in 3 years;

Users: 4 families;

Users income: middle class family

5/4/2015 WTJAN2014 40

Investment opportunities

Loan: long term

Seed money by NGOs

Bank loans

Sanitation bank by donors/government

Credit associations;

Monthly contribution by users;

Cost reduction strategies: efficiency, low cost tech, labour contribution

5/4/2015 WTJAN2014 41

The quality of sewage for disposal:

Three parameters to be evaluated:

i. Organoleptic (physical): colour, odour, etc

ii. Chemical indicators: pH, concentration of toxic chemicals, level of BOD and COD;

iii. Bacterial load within acceptable range;

5/4/2015 WTJAN2014 42

Latrine coverage status

Problem assessment

M & E Indicators

Latrine coverage: proportion of HHs or equivalent population with some kind of latrine

Type of latrine: flush Vs dry pit

Quality of latrine: construction, cleanliness, standards

5/4/2015 WTJAN2014 43

Latrine coverage

Trend in urban latrine coverage in Ethiopia,

1980-2002 (urban, country, rural)

0

10

20

30

40

50

60

70

80

1965 1975 1985 1995 2005

Years

Po

pu

lati

on

access t

o l

atr

ine,

%

5/4/2015 WTJAN2014 44

Urban

Country rural

Deductions for national figures

Service Actual:

1980-2002

Projected

1980-2004

Access to latrine 12% 11.5%

No change

9% 13

0.11/annualy

5/4/2015 WTJAN2014 45

Deductions/conclusions: latrine use

Overall the coverage is less: 13% projected (

Basic questions?

Will there be an improvement in latrine use?

Human element: Culture? Education, participation?

Resources: poverty? Loan? Credits?

Policies/regulations/enforcement?

Demographic issues: pop growth, migration, etc?

What are the basic problems? Barriers? Opportunities?

HSDP

Health services extension

Community involvement/resources

5/4/2015 WTJAN2014 47

Which data source is better?

CSA Population and housing Census: 1984, 1994, 2007?

Welfare Monitoring Survey:

DHS 2000, 2005?

5/4/2015 WTJAN2014 48

5/4/2015 WTJAN2014 51

Summary Table VIII.4 - Distribution of Households by Type of Toilet

Facility,

Place of Residence and Survey year

5/4/2015 WTJAN2014 53

% of HHs accessing to improved

sanitation, CSA 2004

1996 1998 2000 2004

2005

(DHS)

Country

level 13 16 18 20.6 19.2

Rural 5 7.5 8.9 21.3 10.8

Urban 58 67.7 71.6 80.2 69.1

Health and Health Related Indicators (MoH), 1998-2002 E.C

5/4/2015 WTJAN2014 54

Indicator 1998 2000 2001 200

2 2003? 2004 2005

% % % % Access to Improved water supply N 61.2 59.5 66.2 69

U 93.6 86.2 88.6 N/A

R 55.8 53.9 61.5 N/A Access to Improved sanitation N 19.3 37 60 74.9

U 69.2 N/A N/A N/A

R 11 N/A N/A N/A

Sanitation (EDHS 2011)

5/4/2015 WTJAN2014 55

How would you interpret the data?

With precaution

Physical accessibility

Utilization of Latrine

In East Gojam Zone, Hulet Yeju Ensse Wereda: Latrine coverage 87%; latrines utilizing HHs: 61%

In Alaba Latrine coverage is 69% and in Mirab Abaya it is 94% (survey in 2008)?

How do you explain these figures?

5/4/2015 WTJAN2014 56

SWOT on Ethiopian WaSH?

Strength:???/ HEP,

Weaknesses?

Opportunities? GSF, ?

Threats? Climate change?

5/4/2015 WTJAN2014 57

The Way forward? 1. Intensifying efforts is needed to upgrade technical skills of HEWs

for better performance in CLTS in rural areas and to improve the quality of latrines.

2. The role of the private sector in sanitation is crucial, especially in urban areas.

3. Sanitation Marketing is key task to accomplish to improve the quality to latrines once the communities are triggered with CLTS along side with post-triggering follow up.

4. There is a need to strengthen MDG efforts to meet sanitation targets by 2015 and Planning for Sanitation/WASH beyond 2015 is required, with possible focus on WASH as a Post-MDG

5. Maximum effort is demanded to mobilize resources for sanitation integrated with hygiene at community as well as Institutional level, and utilize it efficiently. 5/4/2015 WTJAN2014 58

End