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Frequently Asked Questions

1. What is sanitation?
The definition in this resource guide is a focused one: “the infrastructure and service provision required for the safe management of human excreta.” These include, for example, latrines, sewers, and wastewater treatment works.
However, different groups and individuals use the term sanitation in different ways, and it is important to be clear about the meaning in different contexts. (The problem is the same in many languages: assainissement and saneamiento present the same problem in French and Spanish.) Wider definitions focus on “the infrastructure and services required to provide and maintain a healthy environment.”
Such definitions thus include solid waste management, surface water drainage, air pollution control and even water supply under the general heading of sanitation. One way to resolve this difference is to reserve the term “sanitation” for excreta related facilities and services (as we have done in this resource guide) and to use the broader term “environmental sanitation” to cover the wider range of facilities and services required to ensure a healthy environment.
2. What is Hygiene Promotion?

Hygiene promotion, in this Resource Guide, refers to a planned approach to preventing diarrhoeal diseases through the widespread adoption of safe hygiene practices. It begins with and is built on what local people know, do and want. It can further be defined as “the processes to promote changes in behavior to reduce the spread of sanitation-related diseases”. These include, for example, efforts to promote the washing of hands with soap at critical times, and the safe management of children’s feces. See Basics of Hygiene Promotion for more on this subject. 



3. How is Hygiene Promotion different from traditional Hygiene Education?
“Hygiene education focused on teaching both children and adults about germs, bacteria, fecal-oral transmission routes and so forth, on the assumption that greater understanding is the most effective route to changed behavior. The world of advertising and advocacy has long known that while education and knowledge about health can influence behavior, many other mechanisms may be more effective in changing behavior. Status, pride, dignity, comfort and convenience can often be more effective motivators for change than epidemiological statistics. 
Hygiene promotion therefore considers good hygiene as a behavior to be promoted by whichever means and “triggers” are most effective for a specific community and audience. Hygiene education can play an important part in hygiene promotion. See Hygiene and Sanitation Promotion for more on this subject.

4. What are the public health benefits of sanitation and hygiene?
Diarrheal disease is the most important public health problem from inadequate sanitation and hygiene, and kills approximately 2 million children a year. Approximately 90% of the toll of diarrhea is attributed to water, sanitation and hygiene by the Disease Control Priorities Project. As a rule of thumb, sanitation can be expected to reduce diarrhea by about a third and improved hygiene can be expected to reduce diarrhea by about a half. (see Fewtrell and Colford, 2004. Water Sanitation and Hygiene: Interventions and Diarrhea: A Systematic Review and Meta-Analysis, World Bank) 
In trying to assess the impact of sanitation and hygiene interventions, there are fundamental difficulties in (a) separating the effects of sanitation hardware from those of the safer hygiene behavior which those who invest in sanitation are likely to adopt, and (b) measuring the effectiveness of hygiene promotion efforts in changing behavior.
The importance of various routes of fecal-oral disease transmission (as shown in the F-diagram) also varies widely, and would influence the effectiveness of different interventions. While many believe that actual measurement of the health impact of sanitation and hygiene interventions is not practical or cost-effective on a routine operational basis, the epidemiological evidence and opinion is clear that improving sanitation and water supply services, along with hygiene promotion are effective ways to reduce the toll of diarrhea, worm infections, schistosomiasis and other diseases.
5. Why has progress in sanitation and hygiene been so slow?
There are many reasons why sanitation and hygiene promotion are difficult, and here are some of the most important to bear in mind:
  • Safe sanitation and hygiene require changes in very personal behavior and habits. No agency can “give” safe sanitation and hygiene to a community, the individuals in that population have to want and adopt different patterns of behavior. Changing behavior and attitudes takes more time than building physical works.
  • Sanitation and hygiene improvements must work at the level of each household. Traditional public works projects (including even water supply) can make some progress through economies of scale and the provision of lcommunity-wide infrastructure. Sanitation and hygiene operates on a much finer level, and does not realize the economies of scale of major public works investments in energy generation, dam construction, etc.
  • Sanitation and hygiene are embarrassing issues. All people in all cultures aspire to “cleanliness”, and communications around sanitation and hygiene are often loaded with implications of superiority. No government minister, and no villager, likes to think that others perceive his or her society as “dirty” or “unclean” It is almost always easier for governments and voters to be excited about new water supplies, schools or roads than about sanitation and hygiene efforts.
  • The victims of poor sanitation and hygiene are “invisible”.  The toll of diarrhea and inadequate sanitation is overwhelmingly among children under 5. Such victims do not vote, and do not yet contribute to the economy, and so are not considered as important to society as other age groups. (One of the reasons why governments have moved to address AIDS is precisely its direct impact upon economic development, as it strikes at the key age group of young adults.)
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6. What is total sanitation?
Total Sanitation was first developed in Bangladesh as an approach to improving rural sanitation. Variants of the concept have now emerged in other countries, including India, Pakistan, Indonesia, and Ethiopia.
It is essentially a ‘campaign’ approach that first and foremost emphasizes the need to eliminate the behavior of open defecation through interaction with whole communities rather than individual households. While improving access to sanitation hardware is clearly an important element, the distinctive aspects of the approach are its focus on behavior at the community level. An external agent, such as an NGO, is required to facilitate the process and develop demand for an excreta-free environment.


7. What is ecosan?

Ecosan is shorthand for ‘ecological sanitation’. The key characteristic of ecological sanitation is that it treats human excreta as a resource, operating as a ‘closed loop’ that safely returning nutrients to the environment rather than flushing them away or storing them indefinitely in a pit.

Advocates of ecosan emphasise that it is a way of thinking rather than a specific technology. In practice, most ecosan systems are dry systems (i.e. not dependent on water for flushing) incorporating urine separation. For further information on ecosan see the UNDP publication "Closing the Loop" or the relevant page on Sanicon. GTZ has a specialist team looking at ecosan. See their website.
8. Where can I find information on successful sanitation interventions? 
For a list of recommended publications see the Further Resources and more specifically, section-wise Selected Publications.
9. What are the best available basic publications in the field for non-specialists?

For a list of recommended publications see the Further Resources and more specifically, section-wise Selected Publications.
10. How much does sanitation cost?
It is hard to give a definitive answer to this question since the cost of sanitation depends on the technology and construction standards adopted, local prices and whether or not the cost of off-site facilities, provided to reduce or prevent adverse effects on the environment and public health, are included. For further information see the Infrastructure Costing of this Resource Guide. 
11. Does sewerage always provide a better level of service than on-site sanitation?
The main advantage of sewerage over on-site sanitation is its safe and reliable removal of large amounts of water (wastewater and sullage) from the plot. From the consumer’s point of view, a well-functioning septic tank and a well-functioning sewer system offer the same levels of sanitation service, (although the septic tank imposes an additional maintenance cost on the household for desludging). As population densities increase, it becomes increasingly difficult to manage large amounts of wastewater safely through septic tanks and drainage fields, so these are frequently replaced by sewers.

Despite these advantages in relatively high density areas, sewerage also entails substantial costs and risks. The capital, operating and environmental costs of sewerage can be high It should also be understood that there is no credible evidence that a well-functioning sewerage system offers any public health advantage over any other well-functioning lower-cost sanitation system. From a public health cost-effectiveness perspective, there is every incentive to adopt on-site sanitation where wastewater volumes are low.

12. When is it appropriate to use public, shared and individual sanitation facilities?

Individual household sanitation facilities should be provided whenever possible, because the public health benefits of sanitation are closely linked to their use by the sick and the very young. In addition, individual household facilities do not present the same management problems that public toilets do.
If affordability is a problem, it is better to explore ways of reducing the cost of individual facilities, encouraging users to save for improved sanitation facilities or even, as a last resort, providing targeted subsidies rather than providing public facilities. Where space for household facilities is a problem, the option of providing shared facilities, with one toilet serving a limited number of families, may be considered.However, situations arise where communities have no choice but to opt for public or community toilets, and some good experience is evident from Mumbai.

Last updated: 2008-06-25

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