Fecal Sludge Management Services Diagnostic and Decision-Support Tools: An OverviewIsabel Blackett and Peter Hawkins

August 2016

CONFERENCE EDITION

The Water and Sanitation Program is a multi-donor partnership, part of the World Bank Group’s Water Global Practice, supporting poor people in obtaining affordable, safe, and sustainable access to water and sanitation services.

Targeting the Urban Poor and Improving Services in Small Towns

WATER AND SANITATION PROGRAM: WORKING PAPER

This document is an output of a World Bank study led by Isabel Blackett and Peter Hawkins. World Bank team members Zael Sanz, Ravi Joseph, Chris Heymans and Guy Hutton also contributed their expertise. Special thanks to the consultancy teams from Oxford Policy Management (OPM) and WEDC at Loughborough University, led by project manager Ian Ross, technical lead Rebecca Scott, and Ana Mujica, Zach White and Mike Smith.

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Fecal Sludge Management Services Diagnostic and Decision-Support Tools: An OverviewIsabel Blackett and Peter Hawkins

August 2016

CONFERENCE EDITION

Targeting the Urban Poor and Improving Services in Small Towns

iv Targeting the Urban Poor and Improving Services in Small Towns

Introduction ...............................................................................1 Overview of the Tools and How They Fit Together .................... 2 Diagnostic Tool 1: Fecal Waste Flow Diagram .........................4 Diagnostic Tool 2: City Service Delivery Assessment .............. 6 Diagnostic Tool 3: Prognosis for Change Assessment ............ 8 Decision-Support Tool 4: Service Delivery

Action Framework ................................................................... 10 Decision-Support Tool 5: Technical Intervention

Options Assessment ............................................................... 13 Complementary Tools ............................................................. 15 Integrated Design Approach for Treatment ............................. 15 Public Health Risk Assessment .............................................. 15 Urban Sanitation Status Index ................................................ 16 FSM Costing .......................................................................... 16 References ............................................................................... 18

Figures 1: The Sanitation Service Chain ............................................ 2 2: How the FSM Tools Fit Together ....................................... 3 3: City-Wide Fecal Waste Flow in Lima, Peru ........................ 5 4: Fecal Waste Flow Diagram for Informal Settlements

in Lima, Peru ...................................................................... 5 5: City Service Delivery Assessment in Balikpapan,

Indonesia ........................................................................... 6 6: Interlinked City Service Delivery Assessment

and Prognosis for Change Process ................................... 7 7: Three Key Concepts in Prognosis for Change .................. 8 8: Process Map for Dhaka, Bangladesh ................................ 9 9: Correlation Between Open Defecation and Child

Stunting ........................................................................... 15 10: Examples of USSI Output Maps for Spatial

Prioritization in Maputo, Mozambique ............................. 16

Tables 1: Summary of Tools and Their Objectives .............................. 3 2: Service Delivery Action Framework ................................... 11 3: Resulting Prioritized Actions: Illustrative Example

for Dhaka City .................................................................... 12 4: Technical Intervention Options for Different System

Types: FSM in Dhaka Slums .............................................. 14

Contents

www.wsp.org 1

Addressing the need for appropriately conceived and imple-mented fecal sludge management (FSM) services from on-site sanitation systems is critical to improving sanitation services in urban areas. A preliminary review of the status of FSM in 12 cities, drawing on secondary data, led to the adoption of some draft diagnostic tools and the proposed development of others (Blackett et al. 2014). Building on this, and using extensive primary data from five cities (Balik-papan, Indonesia; Dhaka, Bangladesh; Hawassa, Ethiopia; Lima, Peru; and Santa Cruz, Bolivia), a series of diagnostic and decision-support tools have been developed to inform the design of FSM intervention options in the context of the economic and political economy realities cities face.

This document provides an overview of the tools and how they might be used, and also provides links to other resources. The outputs of these tools are targeted at govern-ment decision-makers, development organizations, service providers/utilities, and city/municipal authorities. An increasing number of urban sanitation toolkits to guide decision-making at the city level already exist, but most of them do not focus specifically on FSM, nor do they address political economy issues. They also tend to focus on munic-

ipal and community action, with limited acknowledgment that tackling the challenges will require substantial external support—from other levels of government and/or through investment projects, for example. The tools summarized here take these factors into account, and aim to help stake-holders consider how to develop urban sanitation services that safely manage the large amount of fecal waste which is not discharged into sewers.

These tools are primarily intended for carrying out a sanita-tion situation diagnosis and the preliminary selection of intervention options, bringing a focus to each element of the sanitation service chain (see Figure 1). They will be particu-larly useful at the project identification and preparation stage.

However, much of the data collected will also be useful in the design of interventions. While some of the tools are applicable to urban sanitation as a whole, others are specific to FSM. In addition to the tools, a number of policy recom-mendations on FSM emerged from the work, including:

• FSM must be included in national policy and funding arrangements, complemented by city-level sanitation planning systems, and bylaws that oblige both households and service providers to play their part in delivering a complete sanitation service chain.

• The private sector has a crucial role to play, but needs incentives, technical assistance and access to safe disposal sites at economical distances from col-lection areas.

• Clear definition of institutional roles, enforceable regulations, and effective planning, budgeting and monitoring processes for FSM are essential.

• Smart, targeted subsidies for poor customers will usually be needed in order to realize the potential public health benefits from FSM.

• Sanitation planning should be incremental, acknowledging the variation of urban conditions within and between areas and over time, and consid-ering both networked and non-networked solutions.

Introduction

• This document provides an overview of diag-nostic and decision-support tools developed for urban fecal sludge management services. Find the tools online: worldbank.org/fsm

• Each tool is presented with an example based on primary data and an explanation of how its output can inform program design

• As each city and each country is unique, the tools will need to be adapted to the local situ-ation; selection and design of interventions will always require professional judgment

CONTEXT

Fecal Sludge Management Services Diagnostic and Decision-Support Tools: An Overview Introduction

2 Targeting the Urban Poor and Improving Services in Small Towns

FIGURE 1: THE SANITATION SERVICE CHAIN

MDGs Sustainable Development Goals

Sewerage

On-site systems with Fecal Sludge Management

Containment Emptying Conveyance Treatment End-use/Disposal

End-use/Disposal

End-use/Disposal

WC Sewerage networkpumping stations

Sewagetreatment

works

Latrineor

septic tank

Vacuum truck

Primary emptying

Transfer

Safely covered and replaced in new location

Treatmentplant

Overview of the Tools and How They Fit TogetherTable 1 summarizes the tools and their objectives, as well as other related tools which play an important role in the planning and implementation of urban sanitation solutions but which were not developed as part of this initiative. Fig-ure 2 sets out how the different tools fit together.

The following fecal sludge management diagnostic and decision-support tools prepared under this study are listed below and are available online: worldbank.org/fsm.

The Summary Report collates the lessons learned from developing and applying the tools and guidelines in five cit-ies around the world.

The Tools and Guidelines describe in detail the data and analytical framework used to produce the outputs, and how to apply them.

The Data Collection Instruments are generic instruments covering all key aspects of the diagnostics, and should be adapted to each specific local situation.

The Terms of Reference are generic documents for con-tracting the FSM diagnostics to consultants, and should be adapted according to the local situation and to the scope of studies and analysis required.

City case studies for Balikpapan, Dhaka, Hawassa, Lima, and Santa Cruz.

Fecal Sludge Management Services Diagnostic and Decision-Support Tools: An Overview Introduction

www.wsp.org 3

FIGURE 2: HOW THE FSM TOOLS FIT TOGETHER

DIAGNOSTICS & DECISION SUPPORT

1. Fecal Waste Flow Diagram (SFD)

2. City Service Delivery Assessment

3. Prognosis for change: Political economy analysis

4. Service Delivery Action Framework

Developedunder

this study

Developedunder otherinitiatives

Institutions,financing

Sludge volumes &characteristics

Spatialdata

Costs

Fecal sludgetechnical tools:

QuantificationCharacterizationTreatment design

Urban SanitationStatus Index (USSI)

FSM costing tool

5. Intervention options assessment framework

Institutions, systemsenabling environment

Technical design& costing

Prioritization

PROJECT DESIGN

TABLE 1: SUMMARY OF TOOLS AND THEIR OBJECTIVES

Tool Objective

Diagnostic tools

1 Fecal Waste Flow Diagram Represents where fecal waste goes, what proportion is managed and where the unmanaged portion ends up

2 Service Delivery Assessment Assesses the enabling environment and quality of service delivery along the service chain, identifying areas for attention

3 Prognosis for Change (Political Economy Analysis)

Identifies the interests and incentives that could block action, and possible entry points for overcoming them

Decision-support tools

4 Service Delivery Action Framework Guides identification of actions in relation to the enabling environment, necessary to deliver the desired results

5 Intervention Options Assessment Guides the identification of technical interventions along the service chain—linking to project/program design guidelines

4 Targeting the Urban Poor and Improving Services in Small Towns

Diagnostic Tool 1: Fecal Waste Flow Diagram

A Fecal Waste Flow Diagram (often referred to as an “SFD”) is a visualization of how fecal waste (both fecal sludge and wastewater) flows along the sanitation service chain in a given city. The proportions of households using different sanitation options are identified according to where the waste goes (e.g., sewer, on-site containment, etc.). At each stage of the chain, the proportion of fecal waste that is effec-tively managed continues as a green arrow, while any pro-portion identified as ineffectively managed turns into a brown (or red) arrow.

Data sources used to develop the figures for the diagrams include household surveys, key informant interviews, secondary and grey literature, reports, observation of ser-vice provision/providers, and measurements at treatment facilities. A growing number of SFDs funded through a Bill & Melinda Gates Foundation initiative are available at susana.org/sfd.

Figures 3 and 4 show examples of fecal waste flow diagrams for Lima, Peru. The first represents a city-wide picture, while the second represents the situation for the city’s infor-mal settlements. This separate analysis allows decision-makers to focus on delivering city-wide services which are also responsive to the needs of poor communities.

As illustrated in this case (and as is the case in the majority of cities around the world), the sanitation situation in low-income, informal settlements is generally much worse than the city-wide picture, with far more fecal waste going directly into the local environment, and, in the Lima case (Figure 4), via precarious unlined pits which tend to leak. Such disaggregated information can help inform the devel-opment of appropriate sanitation interventions for low-income communities, for example improvements to on-site containment or improved desludging services.

Fecal Sludge Management Services Diagnostic and Decision-Support Tools: An Overview Diagnostic Tool 1: Fecal Waste Flow Diagram

www.wsp.org 5

FIGURE 3: CITY-WIDE FECAL WASTE FLOW IN LIMA, PERU

Containment Emptying Transport Treatment Reuse/disposal

Sewerage 92%

Septic tank—FScontained 3%

Unlined pit—partly emptiable 4%

On-site straightto drain 0.4%

Open defecation 1%

Treated

Not treated

Directly released to the sea 27%

Local area and beyond Receiving waters

67%

25%

49%

1% 0.4% 4%

25%

18%

3%

48%

52%

FIGURE 4: FECAL WASTE FLOW DIAGRAM FOR INFORMAL SETTLEMENTS IN LIMA, PERU

Containment Emptying Transport Treatment Reuse/disposal

Septic tanks/UDDT—FS

contained 1%

Not treated

Local area and irrigation channels

49%1%

99%

1%

Unlined pits—partly

emptiable 96%

On-site straight

to drain 3%

TransportedNot transported

1%93%

2%3%

3%

6 Targeting the Urban Poor and Improving Services in Small Towns

The process of developing the CSDA is just as useful as the results derived, as it requires key stakeholders to discuss all stages of the FSM service chain and to use the evidence regarding the current FSM situation to agree upon the allo-cated scores.

This evidence may have come from key informant inter-views, secondary literature, focus group discussions, or field-based observations. An initial stakeholder mapping exercise is necessary to ensure that the interviews are tar-geted at those best placed to inform and to generate unbi-ased scoring. Details of questions and indicators used in the process are given in the Tools and Guidelines and Data Collection Instruments.

The City Service Delivery Assessment (CSDA) for FSM aims to answer overarching questions about the quality of the enabling environment, the extent of FSM service devel-opment and the commitment to FSM service sustainability. It provides a structured assessment, based on responding to objective questions on FSM service performance through all stages of the service chain, so as to identify priority areas for action. The current format of the CSDA is adapted from the one used in the FSM 12-city study, which itself was derived from the World Bank Group’s Water and Sani-tation Program’s Country Status Overviews for Water and Sanitation (AMCOW 2011).

A key output from the CSDA process is the scorecard. An example for Balikpapan, Indonesia, is shown in Figure 5.

Diagnostic Tool 2: City Service Delivery Assessment

FIGURE 5: CITY SERVICE DELIVERY ASSESSMENT IN BALIKPAPAN, INDONESIA

Containment Emptying Transport Treatment Reuse/disposal

Policy

Planning

Budget

Expenditure

Equity

Output monitoring

Operation & maintenance

Expansion

Service outcome

0.5

0

0

1

0

0

1

0

0

1

0

0

0.5

0

0

0

1

0

1.5

1

0.5

0

1

0.5

0

0

0

0

0

0

0

0

2.5

1.5

1.5

2.5

1.5

1.5

1

0

0

1.5

0.5

0

1.5

Enabling

Developing

Sustaining

Key:Poor Developing Good

Fecal Sludge Management Services Diagnostic and Decision-Support Tools: An Overview Diagnostic Tool 2: City Service Delivery Assessment

www.wsp.org 7

The resulting scorecard shows areas of strength and weak-ness for FSM in the city and helps identify priority areas for action—which may include a national dimension (see Table 3 under Decision-Support Tool 4). As the illustrative CSDA from Balikpapan shows, some likely priority areas for action might include: establishing plans and associated bud-gets to improve FSM services; and making poor-inclusive technical interventions to deliver services to all.

The CSDA process does not, however, explain why the cur-rent situation prevails, nor does it identify potential obsta-cles to progress. This is why the CSDA should be undertaken

as an iterative process, which also takes into account the political economy of FSM in the city in question. A Prog-nosis for Change (PFC) assessment (see below) supports an explanation as to why the CSDA looks the way it does. Fig-ure 6 summarizes this interlinked process, starting with the stakeholder mapping exercise. Once priority areas in the CSDA have been identified, a PFC assessment is under-taken. This then informs the intervention options assess-ment (see below), so that possible intervention options are considered in the context of the city’s political economy realities.

FIGURE 6: INTERLINKED CITY SERVICE DELIVERY ASSESSMENT AND PROGNOSIS FOR CHANGE PROCESS

Stakeholder mapping

City SDA process

mobilizes decision-makersand produces scorecard

Identification ofpriority areas in CSDA

Intervention optionsassessment

Prognosis forchange assessment

including stakeholder analysis

Separate discussionsaround planning and

implementation

8 Targeting the Urban Poor and Improving Services in Small Towns

Secondly, a PFC considers the incentives, which institu-tions provide to stakeholders. A stakeholder is any individ-ual or group with an interest in the outcome of a national or local policy. In FSM, some examples of relevant stake-holders may include (but are certainly not limited to) sludge truck companies, manual emptiers, the city council, line ministries, and slum-dwellers.

Finally, a PFC considers how stakeholders exert influence, which is defined as the formal or informal power to cause or prevent something. A city council may have formal legal power, but if their FSM bylaws are openly flouted, then their influence is low.

In addition, it is important to understand that the political economy is strongly linked to a financing dimension. The availability of finance, and the mechanisms through which it is distributed, have a profound impact on what actually happens with regard to appropriate FSM in a city.

In order to be practically useful, a PFC assessment should consider the implications of the findings for effective engagement in a reform or change process. National policy and fiscal approaches are relevant here. In many cities, local financial resources are lacking and will continue to require (if not depend upon) some assistance from higher levels of government—such arrangements ought to be clear and rooted in national level policy.

Various tools for undertaking a PFC assessment are included in the full Tools and Guidelines, but one example is given in the FSM Case Study for Dhaka, Bangladesh. It shows a process map for the construction of a new building in Dhaka (Figure 8). The central column shows the formal process, while the right-hand column shows the informal process, which happens in practice. The left-hand column then shows entry points for engagement, which are judged crucial for getting value out of the PFC analysis and for consequently improving FSM in the city.

The Prognosis for Change (PFC) assessment considers the positions of various stakeholders, in particular the institu-tions and incentives involved in FSM in the city. A PFC assessment is essentially a political economy analysis in which delicate topics are addressed sensitively, such that the analysis can be shared and discussed with all stakeholders.

A PFC assessment aims to understand three things, as dis-cussed in the FSM Tools and Guidelines and illustrated in Figure 7. Firstly, it considers how “institutions” function. Here, institutions are defined as “the rules and norms gov-erning human interaction,” rather than a narrow definition of “organizations.” Institutions can be formal (such as regu-latory standards or bylaws about dumping fecal sludge [FS]), or informal (such as attitudes towards reusing FS in agriculture, or issues and interests that may run counter to, or be potentially supportive of, FSM).

Diagnostic Tool 3: Prognosis for Change Assessment

FIGURE 7: THREE KEY CONCEPTS IN PROGNOSIS FOR CHANGE

providingincentives to

exerting

Institutions

(formal or informal)

Stakeholders

(individual, groupor agency)

Influence

(formal orinformal power)

Fecal Sludge Management Services Diagnostic and Decision-Support Tools: An Overview Diagnostic Tool 3: Prognosis for Change Assessment

www.wsp.org 9

FIGURE 8: PROCESS MAP FOR DHAKA, BANGLADESH

Entry Points Formal Process Informal Process

Improve application scrutiny by all parties

Improve quality of inspections by RAJUK

Developer applies to Capital Development Authority

(RAJUK) for permit

RAJUK reviews application and consults other relevant authorities linked to FSM service provision (e.g., DCCs, DWASA)

RAJUK approves construction

Developer constructs building with septic tanks & leach pits not

connected to drains

RAJUK inspects during and after construction for compliance

Occupants of completed building arrange for emptying of septic tanks

when required

RAJUK expects Dhaka City Council (DCC)/Dhaka Water and Sewerage Authority (DWASA) to provide services, without asking

Developer connects toilets or septic tanks directly to the storm water drains

Not enough RAJUK staff to do proper inspections and enforce compliance

Occupants do nothing, as all waste goes to drains

10 Targeting the Urban Poor and Improving Services in Small Towns

When considered together, the outputs of the diagnostic and decision-support tools provide information that can be used to inform the design of an FSM improvement and investment program. In all cities, interventions to improve the enabling environment will also be needed alongside technical intervention options. Based on the experience gathered in the process of developing the tools, a Service Delivery Action Framework (SDAF, see Table 2) can be developed.

The SDAF sets out the range of non-technical or “institu-tional” interventions that may be appropriate for a given city, depending on the status of FSM service development, as characterized by the CSDA. Actions are grouped accord-ing to how developed the enabling environment currently is, with three stages characterized as: Basic, Intermediate or Consolidating. Actions are informed by the current reality experienced on the ground and are defined to highlight where best to focus attention for each aspect of the enabling environment, with the goal of improving services. Table 2 presents actions in an abridged format; see the Tools and Guidelines for more comprehensive descriptions. Further elements of the enabling environment are informed by recent research, such as the SPLASH Urban Sanitation Research Programme (Medland et al. 2015).

For each component of the enabling environment (policy, institutional arrangements, budgets, etc.), specific activities can be identified. This may result in actions taken from Basic, Intermediate or Consolidating stages as appropriate to a given city. Those designing FSM interventions should consider how activities will need to be implemented through pragmatic steps such that they are “actionable.” The result will be a range of actions targeted at the national, city and user levels, which can then be considered in more detail to inform project and program planning and implementation.

Identifying the most appropriate actions must take into account the reality of any given city and recognize that the stages are essentially sequential—i.e., starting with basic actions before moving towards intermediate and then con-solidating actions. Thus, if a city has already addressed basic actions, the intermediate actions will most likely be the ones to focus on for the particular issues being addressed.

This is illustrated by way of an example of an SDAF in FSM Case Study for Dhaka, Bangladesh. Table 3 high-lights appropriate actions for each element of the enabling environment, informed by the extent to which actions have already been achieved in the city. Identified actions which could be considered by decision-makers are shown in the boxes with red outline and light red shading.

Dhaka city’s CSDA scorecard highlighted that progress in the enabling environment is limited to the development of policy around containment at the household (a toilet or latrine). The establishment of an institutional framework for FSM more generally—a focus on intermediate actions is needed in relation to these areas. However, basic actions remain the priority in all other areas, including in plan-ning, budgeting, promotion and capacity.

Making actions context-specific: A further step in the process takes the actions from each of the highlighted areas and translates them into objectives, targets, indicators and inputs that respond to the specific context of the given city, and which does so at an appropriate scale (e.g., city-wide, or focused on specific locations), to enable detailed planning. This step must not be overlooked, as it requires a significant commitment of time, resources and skills to achieve effec-tive results.

Decision-Support Tool 4: Service Delivery Action Framework

Fecal Sludge Management Services Diagnostic and Decision-Support Tools: An Overview Decision-Support Tool 4: Service Delivery Action Framework

www.wsp.org 11

TAB

LE

2: S

ER

VIC

E D

ELI

VE

RY

AC

TIO

N F

RA

ME

WO

RK

Pla

nnin

g no

n-te

chni

cal c

omp

onen

ts (c

urre

ntly

for

FSM

)

Sta

ges

of

Act

ion

Bas

ic A

ctio

nsC

ritic

al In

terv

entio

ns

for

Pub

lic H

ealth

Pro

tect

ion

Inte

rmed

iate

Act

ions

Str

eng

then

ing

Exi

stin

g F

oun

dat

ions

Co

nso

lidat

ing

Act

ions

Fo

cuse

d o

n F

ull-

Cha

in,

Sus

tain

able

Ser

vice

s

National

Po

licy,

leg

isla

tio

n an

d

reg

ulat

ion

• R

evie

w n

atio

nal s

anita

tion

pol

icy

and

ens

ure

FSM

is in

clud

ed•

Rev

iew

reg

ulat

ory

fram

ewor

k ar

ound

the

p

rote

ctio

n of

pub

lic h

ealth

and

env

ironm

ent

• S

et n

orm

s/st

and

ard

s fo

r p

ublic

hea

lth a

nd

envi

ronm

enta

l pro

tect

ion

• E

stab

lish

lega

l bas

is fo

r re

gula

tion

of F

SM

se

rvic

es

• R

equi

re lo

cal r

egul

atio

n an

d it

s en

forc

emen

t •

Dev

elop

a p

olic

y/re

gula

tory

fram

ewor

k to

in

cent

iviz

e tr

eatm

ent

and

reu

se o

ptio

ns

Inst

itut

iona

l ar

rang

emen

ts•

Rev

iew

inst

itutio

nal a

rran

gem

ents

for

sani

tatio

n—en

sure

FS

M is

incl

uded

• Id

entif

y an

inst

itutio

nal f

ram

ewor

k fo

r FS

M

with

cle

ar r

oles

and

coo

rdin

atio

n

• E

stab

lish

inst

itutio

nal f

ram

ewor

k fo

r FS

M w

ith d

efin

ed r

oles

and

coo

rdin

atio

n m

echa

nism

s •

Est

ablis

h in

stitu

tiona

l rol

es fo

r fe

cal s

lud

ge

trea

tmen

t an

d r

euse

op

tions

• S

tren

gthe

n in

stitu

tiona

l fra

mew

ork

to

enha

nce

serv

ice

outc

omes

, with

fully

im

ple

men

ted

rol

es a

nd c

oord

inat

ion

• C

onsi

der

(dis

)ince

ntiv

es fo

r im

pro

ved

FS

M

Pla

nnin

g, m

oni

tori

ng

and

eva

luat

ion

• B

uild

aw

aren

ess

of F

SM

in n

atio

nal p

lann

ing

entit

ies

and

rel

evan

t se

ctor

min

istr

ies

(wor

ks, h

ousi

ng, h

ealth

, env

ironm

ent,

etc

.)

• E

stab

lish

mon

itorin

g fr

amew

ork

for

serv

ice

stan

dar

ds—

focu

s on

em

pty

ing

serv

ices

• E

stab

lish

syst

ems

to e

valu

ate

serv

ice

qua

lity

• S

tren

gthe

n m

onito

ring

of a

ll se

rvic

es•

Dev

elop

pla

ns t

o en

hanc

e tr

eatm

ent

cap

acity

and

reu

se t

echn

olog

ies

Cap

acit

y an

d

tech

nica

l ass

ista

nce

• Id

entif

y sc

ale

of t

he c

apac

ity g

ap a

nd T

A

req

uire

d t

o ad

dre

ss F

SM

ser

vice

nee

ds

• B

uild

pub

lic a

nd p

rivat

e se

ctor

cap

acity

for

city

-wid

e FS

M s

ervi

ces

• S

tren

gthe

n se

ctor

cap

acity

for

serv

ices

, in

clud

ing

trea

tmen

t an

d r

euse

mar

kets

Fina

ncin

g•

Bui

ld a

war

enes

s an

d a

gree

men

t ar

ound

the

b

udge

tary

req

uire

men

ts fo

r FS

M s

ervi

ces

• D

evel

op p

rogr

ams

with

FS

M fu

ndin

g w

ind

ows

and

ince

ntiv

es fo

r ci

ties

• M

obili

ze fi

nanc

e fo

r FS

pro

cess

ing,

reu

se

and

dis

pos

al

Local

Leg

isla

tio

n an

d

enfo

rcem

ent

• R

evie

w/e

stab

lish

byl

aws,

ens

urin

g th

ey

add

ress

on-

site

sys

tem

s an

d F

SM

ser

vice

s•

Str

engt

hen

byl

aws

and

the

ir en

forc

emen

t•

Intr

oduc

e re

gula

tion

of s

ervi

ce p

rovi

der

s•

Ince

ntiv

ize

dis

pos

al a

t re

cogn

ized

site

s

• R

egul

ate

pol

lutio

n of

rec

eivi

ng w

ater

s •

Pen

aliz

e fo

r in

dis

crim

inat

e FS

dum

pin

g •

Enf

orce

use

of e

mp

tiab

le fa

cilit

ies

Inst

itut

iona

l ar

rang

emen

ts•

Rev

iew

inst

itutio

nal a

rran

gem

ents

for

sani

tatio

n—en

sure

FS

M is

incl

uded

• Id

entif

y lo

cal i

nstit

utio

nal f

ram

ewor

k fo

r FS

M

• E

stab

lish

loca

l ins

titut

iona

l fra

mew

ork

for

serv

ices

—w

ith r

oles

def

ined

and

agr

eed

• E

stab

lish

role

s fo

r FS

tre

atm

ent

and

reu

se•

Con

sid

er (d

is)in

cent

ives

for

imp

rove

d F

SM

• S

tren

gthe

n in

stitu

tiona

l rol

es fo

r m

anag

ing

imp

rove

d F

S m

anag

emen

t, in

clud

ing

trea

tmen

t fa

cilit

ies

and

reu

se o

ptio

ns•

Imp

lem

ent

(dis

)ince

ntiv

es fo

r im

pro

ved

FS

M

Pla

nnin

g, m

oni

tori

ng

and

eva

luat

ion

• C

ond

uct

area

-bas

ed, g

end

er a

nd p

ro-p

oor

focu

sed

dia

gnos

tic s

tud

ies

• D

evel

op p

lans

, fin

ance

and

inst

itutio

nal

need

s•

Pla

n an

d d

esig

n FS

tre

atm

ent

optio

ns

• E

stab

lish

reve

nue

stre

ams

• R

efin

e an

d im

ple

men

t lo

cal s

ervi

ce p

lans

• E

stab

lish

mon

itorin

g an

d e

valu

atio

n (M

&E

) of

ser

vice

sta

ndar

ds

• In

trod

uce

pla

ns t

o en

hanc

e tr

eatm

ent

cap

acity

and

reu

se a

rran

gem

ents

• S

tren

gthe

n M

&E

of t

reat

men

t an

d r

euse

ar

rang

emen

ts a

gain

st s

ervi

ce s

tand

ard

s

Pro

mo

tio

n•

Stim

ulat

e cu

stom

er d

eman

d/

will

ingn

ess

to

pay

(WTP

) for

FS

M

• D

isse

min

ate

pub

lic F

SM

ser

vice

s in

form

atio

n•

Stim

ulat

e m

arke

t d

eman

d fo

r re

use

of F

S

Cap

acit

y an

d

tech

nica

l ass

ista

nce

• Id

entif

y ca

pac

ity g

aps

and

req

uire

d T

A•

Pro

mot

e ap

pro

pria

te p

rivat

e se

ctor

ser

vice

s •

Imp

lem

ent

mea

sure

s fo

r sa

fer

dis

pos

al o

f FS

cur

rent

ly d

ump

ed in

the

env

ironm

ent

• P

rom

ote/

sup

por

t d

evel

opm

ent

of im

pro

ved

, em

ptia

ble

con

tain

men

t fa

cilit

ies

• S

tren

gthe

n ro

le o

f ser

vice

pro

vid

ers

• P

ilot

sche

dul

ed d

eslu

dgi

ng/

tran

sfer

sta

tions

• C

onso

lidat

e/ex

pan

d s

ervi

ces

bas

ed o

n ou

tcom

e of

pilo

t st

udie

s•

Bui

ld/r

ehab

ilita

te F

S p

roce

ssin

g p

lant

s an

d

dev

elop

bus

ines

s m

odel

s fo

r re

use

of F

S

Fina

ncin

g•

Iden

tify

the

exte

nt o

f fin

anci

ng r

equi

red

to

ad

dre

ss s

ervi

ce im

pro

vem

ents

to

the

poo

rest

• In

trod

uce

spec

ific

pro

-poo

r fin

anci

al

arra

ngem

ents

(suc

h as

tar

gete

d s

ubsi

die

s)•

Iden

tify

opp

ortu

nitie

s fo

r fin

anci

al fl

ows

gene

rate

d fr

om t

he s

ale

of F

S e

nd p

rod

ucts

Users

Pla

nnin

g•

Con

sult

com

mun

ities

, id

entif

y ne

eds

and

w

ants

• G

ain

user

feed

bac

k on

imp

rove

d s

ervi

ces

• G

ain

user

op

inio

ns o

n re

use

optio

ns

Tena

nt s

anit

atio

n•

Eng

age

with

/con

sult

land

lord

s an

d t

enan

ts

on c

onst

rain

ts t

o FS

M s

ervi

ces

• D

evel

op a

ssis

tanc

e an

d e

nfor

cem

ent

pac

kage

s fo

r la

ndlo

rds

• Fo

cus

on e

nfor

cem

ent

of s

ervi

ce q

ualit

y fo

r la

ndlo

rds

Fecal Sludge Management Services Diagnostic and Decision-Support Tools: An Overview Decision-Support Tool 4: Service Delivery Action Framework

12 Targeting the Urban Poor and Improving Services in Small Towns

TABLE 3: RESULTING PRIORITIZED ACTIONS: ILLUSTRATIVE EXAMPLE FOR DHAKA CITY

Stages of ActionBasic Actions

Critical Interventions for Public Health Protection

Intermediate Actions Strengthening Existing

Foundations

Consolidating Actions Focused on Full-Chain, Sustainable Services

Nat

iona

l

Policy, legislation and regulation

• Review national sanitation policy and ensure FSM is included

• Review regulatory framework around the protection of public health and environment

• Set norms/ standards for public health and environmental protection

• Establish legal basis for regulation of FSM services

• Require local regulation and its enforcement

• Develop a policy/regulatory framework to incentivize treatment and reuse options

Institutional arrangements

• Review institutional arrangements for sanitation—ensure FSM is included

• Identify an institutional framework for FSM with clear roles and coordination

• Establish institutional framework for FSM with defined roles and coordination mechanisms

• Establish institutional roles for fecal sludge treatment and reuse options

• Strengthen institutional framework to enhance service outcomes, with fully implemented roles and coordination

Planning, monitoring and evaluation

• Build awareness of FSM in national planning entities and relevant sector ministries (works, housing, health, environment, etc.)

• Establish monitoring framework for service standards—focus on emptying services

• Establish systems to evaluate service quality

• Strengthen monitoring of all services

• Develop plans to enhance treatment capacity and reuse technologies

Capacity and technical assistance

• Identify scale of the capacity gap and TA required to address FSM service needs

• Build public and private sector capacity for city-wide FSM services

• Strengthen sector capacity for services, including treatment and reuse markets

Financing • Build awareness and agreement around the budgetary requirements for FSM services

• Develop programs with FSM funding windows and incentives for cities

• Mobilize finance for FS processing, reuse and disposal

Loca

l

Legislation and enforcement

• Review/establish bylaws, ensuring they address on-site systems and FSM services

• Strengthen bylaws and their enforcement

• Introduce regulation of service providers

• Incentivize disposal at recognized sites

• Regulate pollution of receiving waters

• Penalize for indiscriminate FS dumping

• Enforce use of emptiable facilities

Institutional arrangements

• Review institutional arrangements for sanitation—ensure FSM is included

• Identify local institutional framework for FSM

• Establish local institutional framework for services—with roles defined and agreed

• Establish roles for FS treatment and reuse

• Strengthen institutional roles for managing improved FS management, including treatment facilities and reuse options

Planning, monitoring and evaluation

• Conduct area-based, gender and pro-poor focused diagnostic studies

• Develop plans, finance and institutional needs

• Plan and design FS treatment options

• Establish revenue streams • Refine and implement local service

plans• Establish M&E of service standards

• Introduce plans to enhance treatment capacity and reuse arrangements

• Strengthen M&E of treatment and reuse arrangements against service standards

Promotion • Stimulate customer demand/ WTP for FSM

• Disseminate public FSM services information

• Stimulate market demand for reuse of FS

Capacity and technical assistance

• Identify capacity gaps and required TA

• Promote private sector emptying services

• Implement measures for safer disposal of FS currently dumped in the environment

• Promote/support development of improved, emptiable containment facilities

• Strengthen role of service providers• Pilot scheduled desludging/

transfer stations

• Consolidate/expand services based on outcome of pilot studies

• Build/rehabilitate FS processing plants and develop business models for reuse of FS

Financing • Identify the extent of financing required to address service improvements to the poorest

• Introduce specific pro-poor financial arrangements (such as targeted subsidies)

• Identify opportunities for financial flows generated from the sale of FS end products

Use

rs

Planning • Consult communities, identify needs and wants

• Gain user feedback on improved services

• Gain user opinions on reuse options

Tenant sanitation

• Engage with/consult landlords on constraints to FSM services

• Develop assistance and enforcement packages for landlords

• Focus on enforcement of service quality for landlords

www.wsp.org 13

Table 4 shows an example of Technical Intervention Options along the service chain, proposed for slum areas in Dhaka. It is focused on FSM services as the only feasible short- to medium-term solution for these areas. The same table can and should be applied to other aspects of urban sanitation, including sewered options, as explained in the Tools and Guidelines. This example highlights how tech-nical interventions will be most varied at the stages of con-tainment, emptying and transport, while treatment, disposal and end-use options are likely to coalesce into similar solutions.

Once Technical Intervention Options have been proposed, it is essential to consider the ‘institutional’ elements within the broader enabling environment that show up as priority areas for action in the CSDA scorecard and in light of the Prognosis for Change. These elements must be addressed if technical interventions are to provide effective and sustain-able services. This process is structured around the Service Delivery Action Framework set out in the previous section. A comprehensive description of technical options is found in Fecal Sludge Management: Systems Approach for Integrated Implementation and Operation (more information in the Complementary Tools section).

The CSDA process highlights priority areas for action through the service chain, which are then considered in relation to the Prognosis for Change. Together with the outputs from the other tools, a comprehensive set of infor-mation results, which informs the identification of Inter-vention Options for technical service improvements and developing program design guidelines. In turn, these will guide further discussions included in detailed project plan-ning and implementation. This section outlines how the collected information may be brought to bear on the iden-tification of Technical Intervention Options.

The starting point in identifying Technical Intervention Options is the fecal waste flow diagram for the area under consideration, which identifies and indicates the magnitude of the ineffectively managed fecal waste flows. The signifi-cant issues and problems need to be identified for each fecal waste stream shown in the diagram to build up a table that “maps” system types against stages of the service chain. Informed by expertise on good sanitation and fecal sludge management practices appropriate for the target city, poten-tial technical solutions can be proposed for each stage. As a technical solution is identified at a given stage in the service chain, it is essential to consider the implications for the other stages of the chain and identify the associated inter-ventions required.

Decision-Support Tool 5: Technical Intervention Options Assessment

Fecal Sludge Management Services Diagnostic and Decision-Support Tools: An Overview Decision-Support Tool 5: Technical Intervention Options Assessment

14 Targeting the Urban Poor and Improving Services in Small Towns

TABLE 4: TECHNICAL INTERVENTION OPTIONS FOR DIFFERENT SYSTEM TYPES: FSM IN DHAKA SLUMS

System type • Key problems

(one example per system)

Potential Solutions (one or two options for each system type shown here)

Containment Emptying Transport Treatment Disposal End-Use

On-site containment: emptiable• Limited use

of emptying services—high rate of FS discharge to drains

Improve the design and construction of septic tanks (STs) and pits, with standards followed to maximize retention of FS

Improve range of responsive and affordable emptying options and services

Identify, pilot and develop innovative transport solutions (mechanized or human powered), offering affordable and responsive services Introduce transfer stations for small-vehicle operators—linked to larger collection services to take FS to treatment sites

Introduce a range of de-centralized treatment facilities and/or FS handling station at wastewater treatment plants

Modify existing sites and manage new FS disposal sites—to minimize risk to public and environmental health

Explore financially viable options for FS end-use

On-site containment: non-emptiable• Poor containment

infrastructure

Modify existing STs/pits, to convert to being emptiable and also providing effective containment

Extend emptying services to additional sanitation facilities

No containment• Direct discharge to

environment

Invest in new household-level containment options, where acceptable to users

Identify ways to service new household containment options without direct discharge

www.wsp.org 15

Integrated Design Approach for TreatmentIn low-income countries, regulations affecting fecal sludge often do not exist, or are not enforced, which makes defin-ing performance goals for fecal sludge management extremely challenging. Many sanitation infrastructure proj-ects are designed to high performance goals, but end up not performing as intended and frequently failing. While over-designing of systems wastes money and resources, under-designing does not provide adequate protection for human health and the environment. Performance goals should ide-ally include provisions for resource recovery, which can also generate extra financial flows to offset some of the costs in the service chain. Systems including resource recovery can also provide an incentive for efficient and effective collec-tion and transport services, and the optimized operation of treatment plants, in the form of pressures generated by mar-ket demand.

SANDEC at EAWAG has published useful reference mate-rial in Fecal Sludge Management: Systems Approach for Inte-grated Implementation and Operation (EAWAG/SANDEC 2014) and is currently developing tools to support the inte-grated design of fecal sludge management and treatment. The tools will be based on field experience in FSM and address five core areas, with the following objectives:

• Market Driven Approach: to aid selection of treated end-products with the greatest potential for market volume and growth;

• Evaluating collection and transport service delivery and the siting of treatment plants;

• Optimized treatment technologies for resource recovery: to optimize existing treatment technolo-gies for increased volumetric capacity or reduced footprint of the treatment plant;

• Fecal sludge quantification and characterization: to estimate the characteristics and quantities of fecal sludge on a city-wide scale, or an appropriate scale to suit the intended treatment plant; and

• Laboratory methods: to prepare reliable and repli-cable standard methods for laboratory analysis of fecal sludge.

Public Health Risk AssessmentOne of the main rationales for improving sanitation is to improve public health. Statistical analysis shows that stunting, which aggregates many of the effects of poor sanitation, is closely correlated with levels of open defecation, and more so in more densely populated (urban) areas, than in less densely populated areas (Spears 2013), as illustrated in Figure 9. Many studies also show that improving sanitation reduces diarrheal disease, although a causal relationship is harder to pin down.

Public health risk has two components: hazard, or the lev-els of fecal contamination along the pathways from feces to mouth; and exposure, or the frequency and extent of con-tact with contamination.

Hazard is estimated from measurements of fecal pollution in the environment, or by taking the fecal waste flow dia-gram further by considering microbiological decay along the pathways. Exposure is more difficult to estimate but may involve individual and group surveys, observation, key

Complementary Tools

FIGURE 9: CORRELATION BETWEEN OPEN DEFECATION AND CHILD STUNTING

Stu

ntin

g in

dex

(neg

ativ

e z-

scor

e) 3

2.5

2

1.5

1

0.5

0

Urban Rural

Under 3 years old Under 5 years old

Effect on Child Height ofEliminating Open Defecation

Source: Spears, D. (2013). DHS data from 130 countries.

Fecal Sludge Management Services Diagnostic and Decision-Support Tools: An Overview Complementary Tools

16 Targeting the Urban Poor and Improving Services in Small Towns

(ii)  emptying and conveyance; and (iii)  treatment and disposal—and a fourth related component: (iv) complemen-tary services (solid waste and drainage). These components are mapped to give a sense of where in a city the service chain is failing most severely (see maps in Figure 10). They can also be aggregated into an overall USSI for each neighborhood based on a weighted geometric mean of all the variables.

FSM CostingUSAID are supporting the development of a FSM costing and financing tool, which is currently being field tested in Indonesia. This comprehensive tool has the potential for adaptation for use in other countries. The tool estimates the number of staff, number of trucks, capital costs and on-going operation and maintenance costs for a complete FSM system including collection, treatment, management and community engagement. The tool calculates appropriate tariffs to cover all of these costs, based on local capital and recurrent unit cost data, and presents relevant financial data

informant interviews, GPS mapping, etc. Various initiatives are under development to assess public health risks associ-ated with inadequate sanitation, which should help pin-point priorities to be targeted with specific interventions.

Urban Sanitation Status IndexThe Urban Sanitation Status Index (USSI) is a tool based on the sanitation service chain that visualizes the sanitation status of a city by ward or neighborhood—i.e., by the lowest admin-istrative city sub-unit. The USSI is based on 20 qualitative indicators assessed via household surveys and key informant interviews. It uses similar data (but in larger quantity, allowing for spatial disaggregation) to those required to develop an SFD, but also includes some basic data on solid waste and drainage, which are important complementary aspects of san-itation in its narrower sense of excreta management.

The base indicators are aggregated into three components grouped along the sanitation service chain: (i) containment;

Emptying and Conveyance Overall Urban Sanitation Status Index

FIGURE 10: EXAMPLES OF USSI OUTPUT MAPS FOR SPATIAL PRIORITIZATION IN MAPUTO, MOZAMBIQUE

Source: Hawkins, Peter and Odete Muximpua. 2015. Developing Business Models for Fecal Sludge Management in Maputo (unpublished paper). Washington DC: The World Bank.

Fecal Sludge Management Services Diagnostic and Decision-Support Tools: An Overview Complementary Tools

www.wsp.org 17

in a variety of formats and reports. Other functionalities of the tool include:

• Evaluation of distances and times required for collec-tion of septage;

• Comparisons between different FSM service delivery models (private sector and government) and septage treatment options; and

• Modeling of capital and recurrent financing from government and non-government loans, grants and revenue, in addition to charges paid by serviced customers.

This tool is not widely available yet, and still requires fur-ther testing and development. It would, in any case, need to be adapted for application in any specific country or city.

18 Targeting the Urban Poor and Improving Services in Small Towns

AMCOW (African Ministers Council on Water). 2011. AMCOW Country Status Overviews—Regional Synthesis Report. Pathways to Progress: Transition-ing to Country-Led Service Delivery Pathways to Meet Africa’s Water Supply and Sanitation Targets. Wash-ington, DC: The World Bank/Water and Sanita-tion Program. http://www.wsp.org/wsp/content/pathways-progress-status-water-and-sanitation-africa.

Blackett, Isabel C., Hawkins, Peter M., Heymans, and Chris. 2014. The Missing Link in Sanitation Service Delivery: A Review of Fecal Sludge Management in 12 Cities. Water and Sanitation Program Research Brief. Washington DC: World Bank Group.

EAWAG/SANDEC. 2014. Edited by Linda Strande, Mariska Ronteltap, and Damir Brdjanovic. Fecal Sludge Management: Systems Approach for Implementation and Operation. London: IWA Publishing. http://www .eawag.ch/fileadmin/Domain1/Abteilungen/sandec/ publikationen/EWM/Book/FSM_Book_LowRes.pdf.

Medland, L., Cotton, A.P., and Scott, R.E. 2015. SPLASH Urban Sanitation Research Programme Briefing Note 1: An Enabling Environment for Urban Sanitation.

Loughborough, UK: Water, Engineering and Develop-ment Centre (WEDC), Loughborough University.

Peal A., Evans B., Blackett I., Hawkins P., and Hey-mans C. 2014. “Fecal Sludge Management (FSM): Analytical Tools for Assessing FSM in Cities.” Review Paper. Journal of Water, Sanitation and Hygiene for Development: 4:371–383.

Spears, D. 2013. How Much International Variation in Child Height Can Sanitation Explain? World Bank Policy Research Working Paper 6351. Washington, DC: World Bank.

World Bank. 2007. Tools for Institutional, Political, and Social Analysis of Policy Reform: A Sourcebook for Devel-opment Practitioners. Washington, DC: World Bank. For guidance on stakeholder mapping, see p. 126ff.

World Bank. 2011. The Political Economy of Sanitation: How Can We Increase Investment and Improve Service for the Poor? (Main Report). Water and Sanitation Program Technical Paper. Washington, DC: World Bank.

References

Note: All World Bank Group publications are available for download at documents.worldbank.org.