ISSUE 12ISSUE 13 FEBRUARY 1999DECEMBER 1999 WATERfront · waterfront issue 12issue 13 • february 1999december 1999 a unicef publication on water, environment, sanitation and hygiene

ISSUE 12 • FEBRUARY 1999

WATERfrontISSUE 13 • DECEMBER 1999

A UNICEF PUBLICATION ON WATER, ENVIRONMENT, SANITATION AND HYGIENE

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unicefUnited Nations Children’s FundFonds des Nations Unies pour l’enfanceFondo de las Naciones Unidas para la Infancia

earching for effective ways to make newbreakthroughs for the world’s children,UNICEF recently made preliminary

recommendations for a global agenda for chil-dren (The future global agenda for children:imperatives for the twenty-first century, paperpresented to the UNICEF Executive Board,document E/ICEF/1999/10, 13 April 1999).The agenda stresses three goals centred oncrucial developmental stages in a child’s life,because within them lies the key to breakingpersisting cycles of poverty:

■ Infants start lifehealthy, and youngchildren arenurtured in a safeand caring environ-ment that enablesthem to bephysically healthy,mentally alert,emotionally secure, socially competent andintellectually able to learn.

■ All children, including the poorest andmost disadvantaged, have access to good-quality basic education and complete thebasic education cycle.

■ Adolescents have the opportunity to fullydevelop their individual capacities in safeand enabling environments, and are helpedto participate and contribute to their societies.

While shielding children from preventabledeath must always remain a UNICEF priority,the new strategy goes beyond child survival: itplaces early childhood care and education forall at the heart of a wider undertaking to realize

A future global agenda for children:The links with sanitation, hygiene,water and environment

children’s rights and eventually reduce poverty,recognizing always that there are inherent linksbetween the survival, development and well-being of children and the realization ofwomen’s rights from girlhood onwards.

A new context for sanitation,hygiene, water and environmentactivitiesEarly childhood careThe vital importance of children’s earliestyears is reflected in one of UNICEF’s latest

approaches, the ECCprogramme (EarlyChildhood Care forSurvival, Growth andDevelopment).Focusing on the childfrom conception untilthe age of eight, withspecial attention to thefirst four years, the

approach seeks to achieve the full potential ofevery child by working within the family andthe community and by using an integratedrather than a sectoral approach.

In a world where the health and lives ofmore than half the world’s children are con-stantly threatened by environmental hazards,most of these in their own home and immedi-ate surroundings, it is easy to see how childrengain from access to safe and convenient drink-ing water and from activities to promote ap-propriate hygiene and sanitation practices, aswell as protection against environmentalthreats.

Water and environmental sanitation pro-

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Table of Contents

1 A future global agendafor children: The links withsanitation, hygiene, waterand environment

3 The night Mitch hitTegucigalpa: 800,000 leftwithout water and sewerservices

5 “Everybody lives downstream”:World Water Day 1999

7 Introducing SanPlat latrinesin Niger

11 Fluoride in water: An overview

14 Water for Panama’s poorest

16 The risk to groundwatersupplies from on-site sanitation

19 Honduras: Wastewatertreatment in poor urbanneighbourhoods

21 Headlining sanitation inUganda’s newspapers

22 Sanitation consumers in Benin:Understanding the market

27 New publications

28 “The time for action is now”

[The strategy] places early childhoodcare and education for all at theheart of a wider undertaking to

realize children’s rights andeventually reduce poverty…

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Issue 13 • December 1999unicef WATERfront

grammes that have already shifted awayfrom the conventional delivery of waterand sanitation services, towards thepromotion of hygiene and sanitationwithin family and community, readilyfind their place within the ECCapproach. For these programmes thechallenge is to remain focused on chil-dren and to create synergy with all theother programme sectors involved in thecomplex process of child development.As Colin Davis phrased it in his speechat Addis Ababa, reproduced in this issueof WATERfront, “as we are about toenter the next millennium, it has per-haps never been more urgent to ensurethat integration, or at least convergence,actually takes place”—meaning integra-tion not only of water, sanitation andhygiene activities but of all activities thatfoster full development of the youngchild.

For water and sanitation pro-grammes that have yet to make the shift,the ECC approach supplies a frameworkfor it. UNICEF New York recently pre-pared and tested a draft manual forthree-day workshops on the approach(see box), to help communities andhouseholds analyse their needs in a waythat will lead to the convergent pro-gramming envisaged in the globalagenda for children. The workshopmanual includes coverage of hygieneand sanitation issues.

Basic educationMeeting every child’s right to basic edu-cation will produce many positive out-comes for children and help breaklongstanding cycles of deprivation, dis-crimination, and exclusion. It goes with-out saying that children need to be ableto learn in healthy, clean and safe condi-tions. School sanitation and hygieneeducation are integral to schoolchil-dren’s education and health, improvingboth the school and the children’sachievement at school, and must not beperceived as peripheral improvementsthat are merely tacked on to a schooland its curriculum.

Indeed, school sanitation and hy-giene education activities, together withhealth and nutrition interventions, be-

come even more important under theglobal agenda for children: as countriesnear their goal of education for all, thenew intakes of children swelling theschool populations will likely be themore deprived children, living in moredifficult circumstances. These childrenmay have had much less exposure thanother children to basic sanitary facilitieslike latrines and to good hygiene andhealth practices.

UNICEF is already active in manycountries in school sanitation and hy-giene education, and the goal of clean,safe schools is receiving fresh impetusunder two major new programmes:

■ The Netherlands Government haspledged supplementary funding of$1.2 million for methodology devel-opment and knowledge dissemina-tion: pilot programmes in sixcountries went into action in No-vember 1999, under the general guid-ance of UNICEF New York and theIRC International Water and Sanita-tion Centre in Delft. The six coun-tries are Burkina Faso, Colombia,Nepal, Nicaragua, Viet Nam andZambia.

■ Under the Global EnvironmentalSanitation Initiative, UNICEF and itspartners are trying to mobilize thefunding to test and advocate inte-grated approaches towards a safeschool environment for all children,with linkages to community actionsand health education. The plansinclude regional and international

meetings, developing advocacy mate-rials, and documenting pilot pro-grammes.

Adolescent developmentRecognition has been growing of thethreats faced by adolescents, notablyunemployment, lack of access to qualityeducation, vulnerability to infectionssuch as AIDS/HIV, and involuntary in-volvement in armed conflicts or violence.

Here again, a role for water andenvironmental sanitation is not difficultto find. A safe and supportive home,school and community environment isas necessary to teenagers as to youngerchildren, and adolescents are at specialrisk in the street and the workplace. Atthe same time, teenagers are a valuableresource for sustainable human develop-ment, and participation in communitydevelopment can be meaningful to boththe young people themselves and thecommunity as a whole. Water and sani-tation activities that can benefit frominvolving young people and simultane-ously build their skills and self-esteeminclude maintenance of water points,teaching hygiene to younger children,care of the local environment, and otherroles in upgrading their communities.

The global agenda for children offersrewarding challenges for all of us whowork in the fields of sanitation, hygiene,water and environment. More childrenare surviving today than ever before,into conditions that have improved tooslowly if they have improved at all. Thisis the time to take up the challenge.

Draft manual for workshops on early child care

UNICEF has recently developed a draft manual for three-day workshops on the ECCprogramme approach. The workshops are organized around the triple A principle—analysis, assessment, action—starting from what people already know, do and want tohelp communities gauge their priorities and choose suitable action.

The chapter on hygiene and sanitation in the workshop manual lists the environmentalhazards for child health and identifies the most significant, such as transmission of diar-rhoeal diseases; environmental issues are also checklisted on the sheets for the householdobservation visits that are a key element in the process.

The manual is intended for all personnel of programmes involving caretakers of childrenaged 0–3 years, from whatever sector—water, sanitation, health, nutrition, agriculture,community development, family planning, education, women’s issues and the media.Copies are obtainable from the WES Section, UNICEF New York, [email protected].

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Issue 13 • December 1999 unicef WATERfront

The night Mitch hit Tegucigalpa:800,000 left without water and sewer servicesBy Anthony P. Brand, Secretary, Regional Water and Sanitation Network for Central America, Tegucigalpa, Honduras

uring the last week of October1998, the most lethal hurricaneon record would plunge Hondu-

ras into a national emergency fromwhich it will take many years to recuper-ate. Hurricane Mitch crawled just off-shore of Nicaragua and Honduras,raining heavily for a week before makinglandfall. But in a matter of hours, itveered inland and crossed the entirecountry, causing damage in every one ofHonduras’ 18 departments. In thestorm’s last hours over Tegucigalpa, thecapital, and southern Honduras, morerain fell (almost 900 mm) than normallyfalls during an entire year. Unfortu-nately, so many of the country’s water-sheds have been overexploited that theseheavy rainfalls caused inordinatemudslides and damage, especiallyaround the capital.

Nationwide, almost 2 million peoplewere driven from their homes and some14,000 disappeared or died. When mostfamilies returned home after the storm,it was to find much of their crops anddozens of roads and bridges destroyedor unusable. Some 200,000 people, 80%of them women and children, lost theirhomes. Of the 15,000 citizens ofTegucigalpa left homeless, most wereamong the very poor living along thepolluted riverbanks or on the steep hill-sides in the barrios. During a survey ofthe damage, a helicopter crash took thelives of Cesar Castellanos, the popularcity mayor, and three others.

All over the country, water and basicsanitation infrastructure was crippled.Wellfields were flooded, pumps ruinedand sewage systems burst. Forty-eight ofthe country’s 50 largest cities and townsreported damage to systems and failuresin their water supplies. Nationwide, 70%of the population, nearly 4.2 millionpeople, lost water service. The Ministryof Health estimates that 3,500 rural wells

were knocked out and that almost52,000 latrines, serving more than300,000 people, were destroyed or leftunusable. Of the 4,066 rural piped watersystems, almost half (1,800) were out ofservice by the morning of 31 October,mostly as the result of landslides damag-ing or destroying main conduction linesand intakes. Hand-dug wells were filledin and handpumps swept away. Many ofthe wells that remained were severelycontaminated.

By midnight, Mitch hit Tegucigalpa,the Honduran capital of close to a mil-lion people. Confounding the scientiststhat had just downrated it to a tropicalstorm, it saved its most intense rains andgreatest damage for last. Power wasknocked out nationwide and wearyradio announcers broadcast by emer-gency generators all night, warningwhich neighbourhoods were floodingand where makeshift shelters were beingestablished. At 2 a.m. the call went outto save the trucks and cars of the Na-tional Autonomous Water and SewerService (SANAA), the nation’s watersupply agency: as the flood reachedSANAA’s downtown headquarters, therising water was twisting the vehicleslike toys around poles and buildings orsweeping them away altogether.

All of the city’s four aqueducts intothe capital were out of service. Only afew scattered deep wells were pumpingfor tank trucks. Three of the city’s fourwater purification plants were out ofcommission (one washed completelyaway) and the floods had buried or sweptaway thousands of lengths of pipe, hard-ware, tools, pumps and pick-ups. Theentire supply of chlorine gas was gone,under thousands of cubic feet of mud.

The threat to public health was in-creasing each day. Although rich andpoor neighbourhoods alike had beenflooded and none had piped water, the

homeless, sick and poor were the hard-est hit. More than 21,000 people inTegucigalpa had flocked to 130 make-shift shelters in schools, churches andcommunity centres, none of which hadrunning water and few had adequatesanitary facilities. Public and privatehospitals faced crisis, with no water forpatients or hygiene. Hundreds scav-enged for spoiled food in the publicmarkets, now filled with two or threestoreys of mud.

Fortunately, SANAA and UNICEFhave for a decade supported a peri-urban programme that supplies water tolow-income neighbourhoods. The Ex-ecuting Unit for Barrios in Developmenthad 10 water tank trucks for regularservice to the highest barrios, and thesewere quickly pressed into 24-hour serv-ice. Hospitals and shelters were theirfirst priority, but before the first day ofthe emergency was over SANAA realizedthat these trucks alone were not going tobe enough.

For the hundreds of thousands ofpeople that were waiting for SANAAwater trucks to come to their neighbour-hood, it was frustrating to see private

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Displaced families wait to fill containerswith water from a tank provided byUNICEF in the community of Miraflores,unaffected by hurricane Mitch and housingsome 350 displaced people south ofTegucigalpa.

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water vendors servicing those familieswith enough money ($50) to buy atruckload of water. Long lines wereforming wherever there was a rumourthat a SANAA truck might arrive. Whenthe trucks finally did, they were so over-whelmed that they quickly ran dry, andin some places long lines of anxiouspeople left with empty buckets werebeginning to turn angry. A social crisis,as well as a public health disaster, mightcome next.

SANAA called all private water ven-dors to their civic duty, offering to hirethem to deliver public water. Privatetrucks, however, were making moresales than they could handle at their ownprices. In the second Emergency Decreeissued by President Carlos Flores, theSANAA quickly developed a system todispatch its new fleet of 60 water trucks,in twos and threes to adequately cover agiven barrio. Regular schedules weredeveloped to deliver water to sheltersand high-risk neighbourhoods every twoto four days. Hospitals were targeted fordaily or more frequent deliveries.

Gradually, the hard-working (andlittle-sleeping) SANAA staff began tobring piped water into Tegucigalpa.After four days, water was flowing fromone main reservoir, but the distributionnetwork was so heavily damaged thewater could not be delivered. Emergencypipe was laid above ground to get waterto critical areas. Crews worked feverishlyin the mountains to replace destroyedmain lines and in the city to repair orbypass the damaged distribution net-work. But the situation was not stable,and serious epidemics seemed likely ifadditional help was not rallied.

But as soon the storm lifted, a seachange in the attitude and organizationof Hondurans began to appear, andgrows stronger still today. Neighbourhelped neighbour and soon entireneighbourhoods were spontaneouslyorganizing crews to search for victimsand begin the clean-up. Honduranchurches, NGOs, and businesses joinedforces with the police and governmentagencies. Foreign agencies, churches,governments and armies quickly mobi-lized relief supplies and crews.

The major actors in the nationalwater and sanitation sector (includingUNICEF) have for the last decade beencoordinating strategies and actionsthrough a unique Collaborative Groupfor Water and Sanitation. Ideally suitedto post-disaster efforts, this formal body,under the leadership of the Ministry ofHealth, quickly divided the countryamong its member agencies. In eachzone, a different NGO, donor or govern-ment programme organized damageassessment and supplied guidance forinternational donations, providing a fastand coordinated response that coveredthe country.

Within the UN system, UNICEFHonduras was designated the focal pointfor water and sanitation to coordinatedonations and facilitate the activities ofSANAA and the Ministry of Health. Thefirst actions taken were the donation ofemergency water tanks for shelters andthe organizing of water trucks. For thereconstruction of communities through-out the country, UNICEF supporteddamage assessments; provided technicalassistance for water supply and sanita-tion to shelters; arranged donations ofemergency water treatment plants, pipesand tools; and provided 350 tons oflime, chlorine and other chemicals. AsSANAA’s manager Humberto Puertonoted, “UNICEF was one of the veryfirst international agencies to mobilizesupport for the country. We are verygrateful.” In parallel with emergencysupport to the central Government,UNICEF’s relationships with dozens ofmunicipalities supplied a ready channelto reach rural Hondurans with spareparts and chlorine.

Internationally, UNICEF mobilizedjournalists and high-profile visits byUNICEF National Committees and theExecutive Director, Carol Bellamy.Funds and volunteers have come fromall over the globe.

International volunteers foundthemselves working side by side withHondurans of all classes. Market ven-dors, students and professionals werecleaning mud from downtown buildingsand homes, delivering food or staffingnearby shelters. UNICEF and the Na-

tional University recruited 10,000 vol-unteers, close to 4,000 of whom wereworking to get water delivered. Students,Boy Scouts and UN Volunteers guidedwater trucks on their deliveries, cleanedout SANAA warehouses and dug pipes,valves, trucks and supplies out fromunder acres of mud.

Health promoters and staff from theMinistry of Health, along with volun-teers, canvassed the barrios with house-hold visits and group meetings topromote and distribute chlorine and toorient neighbourhoods on how to pro-tect their health.

The actions of Honduran publichealth and water officials, with timelysupport from international partners,prevented outbreaks of disease in theweeks after the hurricane. While cases ofdiarrhoea did increase dramatically afterMitch, the only near-outbreaks of chol-era and leptospirosis occurred inflooded areas in the north of the coun-try, where stagnant water remained forweeks. Some of the first volunteers andfamilies that attempted to clean up inthose areas suffered from these sanita-tion-related diseases, until a Cubanmedical unit and others identified theproblem and appropriate measures weretaken. Boots and gloves were issued toall those that needed them, both in thenorth and among Tegucigalpa’s volun-teer brigades.

In the capital, SANAA made progressin restoring the water supply. Two weeksafter the disaster, about 25% of the cityhad rationed water service. After onemonth, less than half were back on line.Three months later, 80% of the city hadservice restored. Now, eight months afterthe storm, all but 10% have water service.

The sanitation situation is muchmore drastic. The city sewer system wasalready very deficient before Mitch, butis now beyond repair. The storm over-whelmed the network; pipes were irrepa-rably broken and collectors crackedopen, spewing sewage onto the streets.Almost $150 million is required to re-store what was lost and expand sewerageto all residents. The threats to their healthfrom contamination are still very real,

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BhutanBy Sampath Kumar,UNICEF ThimphuWorld Water Day wascelebrated in 15 of Bhu-tan’s 20 districts. The highlight of eachevent was the inaugurating of a newrural water supply project for that dis-trict. Every event was attended by thedistrict dzongda (administrator) as wellas key community representatives fromeach block of the district, communitymembers, and block and district admin-istrative personnel.

Minister Sangay Nidup of the Minis-try of Health and Education and theUNICEF Representative attended thecelebration in Chukha district. InThimphu district, staff from variousministries and from UNICEF took part.The activities in Samdup Jongkhar dis-trict featured students from the RoyalBhutan Polytechnic.

The main topics:

1. The theme “Everybody lives down-stream”. The importance of construct-ing latrines and proper drainage wasdiscussed, as was the protection ofdrinking water sources from animalsand from various human activities,planting trees to prevent soil erosionand drying up of water sources, keep-ing stream water clean, and relatedissues.

2. Good management of water resources.The topics covered included the useof water for drinking, other domesticpurposes, animals, and irrigation;personal, household and community

hygiene; and proper storage andhandling of drinking water.

3. Prevention and control of water-bornediseases. Audiences were briefed onhow these are spread and how toprevent them, for instance by properfood preparation and storage. Wash-ing of hands was emphasized.

4. Operation and maintenance of watersupply schemes. Under this heading,speakers reviewed the importance ofgood O&M and the key role of com-munities.

The Bhutan Broadcasting Corpora-tion aired several programmes and in-terviews on water and hygiene. Kuensel,Bhutan’s only newspaper, published atwo-page supplement on these themes.

Since the Water Day celebrationsproved a useful way to disseminate keymessages, the Government now plans tocelebrate it every year in the nation’sdistricts and blocks.

AfghanistanBy E. Karim,UNICEF KabulThe seventh World Wa-ter Day was celebratednear Kabul in the central region and inthe eastern provinces of Nangarhar,Kunar and Laghman.

UNICEF joined forces with the RuralRehabilitation Department (RRD) tohonour the Water Day in Bakhtyaranvillage, Dehsabz district, about 24 kilo-metres south-east of the capital, Kabul.The open-air event lasted from 10 a.m.

to 12 noon and was attended by around300 people. Among them were theUNICEF Representative; the head ofRRD; Taliban authorities; representativesof UN agencies and NGOs; and commu-nity members, including children.

The speakers at the event (theUNICEF Representative, head of RRD,Taliban personnel, and the head of theInternational Committee of the RedCross water programme in Kabul) em-phasized the importance of safe drinkingwater and keeping water sources clean.With technical and financial supportfrom UNICEF, RRD has recently pro-vided Bakhtyaran’s villagers with safedrinking water through the constructionof handpump wells under an integratedwater, sanitation and hygiene project forabout 25,000 people in Dehsabz district.

The Water Day was also feted inJalalabad, at the heart of the easternregion. The activities, held at the Sanita-tion Training and Demonstration Cen-tre, centred on the theme of clean riverbasin management and also focused onthe role of women and girls in handlingthe difficult job of transporting water fordomestic uses.

Other provinces of the eastern re-gion hosted events organized by RRDpersonnel. Female education monitorsheld meetings and discussions withwomen in Mehterlam (capital ofLaghman province), Surkhrod (districtof Nangarhar province) and Asadabad(district of Kunar province). RRDKunar held a gathering on the bank ofthe Kunar river in Narang district whichbrought together government officials,

The UN system celebrates World Water Day every yearon 22 March. The theme for 1999 was “Everybody livesdownstream.” All people, whether they live in cities orthe countryside, are affected by the activities of theirneighbours that impact on fresh water. While soundconservation and management policies have a positive

“Everybody lives downstream”—World Water Day 1999

impact on neighbours, it is unfortunately more commonto find upstream neighbours polluting the water forconsumers downstream.

UNICEF field offices marked the event by participat-ing in activities organized with their counterparts. Hereare some examples.

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community leaders, community mem-bers and RRD staff.

At all these events to salute WorldWater Day, colourful banners carriedmessages on the importance of safewater, keeping water sources clean andpaying attention to hygiene and theenvironment.

Cape VerdeBy Antero de Pina,UNICEF PraiaCape Verde is a verysmall country of 400,000inhabitants with an estimated drinkingwater supply coverage of 76% (86% inurban and 58% in rural areas). Mostpeople still depend on public waterpoints for their needs, as house connec-tions serve less than 20% of the popula-tion. Sanitation coverage is still quitelow, estimated at 39% in 1998 (61% inurban and 19% in rural areas). In conse-quence, diarrhoeal diseases remain oneof the leading causes of childhood mor-bidity and mortality.

Because of rainfall scarcity and ir-regular distribution (less than 250 mm ayear, but sometimes in heavy down-pours), the country is becoming eachyear more dependent on desalinationplants, which are already the mainsources of drinking water in the threemajor urban centres—Praia, Mindeloand Espargos. Some islands (mountain-ous) still rely on groundwater andsprings for irrigation and domestic con-sumption. Despite annual floods, rain-water harvesting using catchment damshas failed to attract because of the highinvestment costs.

The preparations for World WaterDay 1999 were mounted by personnelfrom the UNICEF water supply andsanitation programme, the UNDP-funded Cape Verde water and sanitationproject, and a national NGO for protect-ing the environment. Activities centredon schools, to promote safe environ-mental and hygiene practices and raiseawareness of the need for water conser-vation.

Some 200 schoolchildren gathered ata Praia secondary school to hear aspeech on water conservation and pollu-

tion and watch a video on the conse-quences of water pollution, followed bya debate and a question-and-answersession. On the islands of Santiago andMaio, a further 800 schoolchildren at-tended safe hygiene promotion sessionsat five primary schools. Parents andteachers performed in lively playsdramatizing the issues, and the childrenwon prizes such as toothbrushes, combs,nail clippers and copies of Facts for Life.National television, radio and a newspa-per covered these events.

For next year an official partnershipis being drawn up between the NationalWater Resources Management Institute,a national NGO and the UNDP waterand sanitation project to establish an-nual prizes for primary and secondaryschool students. This national contestwill be used as an advocacy tool to pro-mote World Water Day 2000. The plansinclude hands-on experience for theschoolchildren and field trips to projectsites, with the emphasis on water con-servation and production using renew-able energy.

Côte d’IvoireBy Souleymane Diabate,UNICEF AbidjanWorld Water Day wascelebrated in Côted’Ivoire by the Government with thesupport of UNDP, UNICEF and a pri-vate-sector enterprise (SODECI) in-volved in distributing water nationwide.

On 21 March, the eve of Water Day,the Minister of Infrastructures delivereda speech on national television, widelycovered by the press, on the theme “Eve-rybody lives downstream”.

On 22 March the High Commis-sioner for Hydraulics held a conferencepresenting the nation’s new law on man-agement of water resources. In the de-bate that followed, the audience showedkeen interest in this new instrument formanaging the water sector: the Ministerexplained its benefits and stressed theneed to promote it with the help ofNGOs and the media. This event, too,was covered by national television.

And finally, a photo exhibit wasopened to the public that afternoon,

organized by the World Bank’s localwater and sanitation group around thisyear’s Water Day theme.

MalawiBy Kabuka Banda,UNICEF LilongweNational radio broadcasta panel discussion on theeve of World Water Day. The panelconsisted of colleagues from the Minis-try of Water Development; the UNDP/World Bank water and sanitation group;the Environmental Affairs Department;the national water boards; and UNICEF.Issues discussed included environmentalprotection; water resources policies;community involvement in resourceprotection, development and manage-ment; and the roles of variousstakeholders in the management of wa-ter resources.

The Lilongwe Water Board, one offive in the nation, mounted an open day.The Minister of Water Developmentmade the speech declaring the exhibitsopen, and the Controller of Water Serv-ices (Ministry of Water and Irrigation)also toured the display.

The event went well and attendancewas good. About 70% of the visitorswere schoolchildren from primary andsecondary schools around the city.

A popular attraction was the videoshow that ran all day. ‘Malangizo aUkhondo’, adapted from the video ‘Pre-scription for Health’, shows water pollu-tion, unprotected water sources and theunhygienic practices common in manyhouseholds; it spells out the risks tochildren’s lives and presents varioussolutions.

RwandaBy Flavia Mutamutega,UNICEF KigaliIn Rwanda, World WaterDay was heralded by afull week of sensitization activities organ-ized by the Ministry of Energy, Waterand Natural Resources and Environ-mental Protection (MINERENA) incollaboration with many of its partnersfor water and sanitation—UNICEF,

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Introducing SanPlat latrines in NigerBy Arlette Yepdujo, Hygiene/Sanitation Consultant, and Christian Guerre, WES Officer, UNICEF Niamey

Sanitation problems in NigerThe health situation of Niger’s popula-tion is critical, particularly for children,who suffer high rates of illness and deathfrom repeated bouts of diarrhoea. Ac-cording to the 1998 Demographic andhealth survey for Niger, 38% of childrenunder five had had one or more episodesof diarrhoea in the two weeks precedingthe study. The prevalence of diarrhoea isparticularly high in young children aged6–11 months (50% had diarrhoea) and12–23 months (41%). The main cause ispoor hygiene habits among the popula-tion. The situation is all the more seri-ous because 95% of households in ruralareas have no toilet whatsoever (DHSsurvey, 1998)—and 80% of the popula-tion live in rural areas.

Sanitation plays an important role inprotecting populations from illness. Italso has an important influence on chil-dren’s nutrition, as it helps them to avoidintestinal worms. Depending on the sizeof the worm load, roundworm (ascaria-sis) can divert a large part of children’sfood intake. Whipworm can retard chil-dren’s growth, and hookworm is a lead-ing cause of anaemia. The absence oflatrines in 95% of villages is without adoubt one of the causes of children’smalnutrition in Niger.

In discussions, women are oftenasked why they would like to have aprivate toilet, and regularly give thefollowing response: “When we givebirth, we don’t have enough strength togo far to seek the privacy to relieve our-selves. A latrine would be a welcomerelief for us.” Approximately 60% ofbirths in rural areas take place awayfrom the health centres where a latrinewould be available.

In Niger, there are sequesteredwomen who can defecate only after dark.Quite apart from the distress caused bywaiting for nightfall to defecate or uri-nate, this can lead to serious illness.

For the above reasons, the introduc-

tion and widespread distribution of alatrine accessible to the poorest presenteditself as a challenge to be overcome. Itwas therefore considered necessary andeven urgent to promote the use of a low-cost latrine that could be distributedthroughout Niger. The project choseSanPlat (sanitary platform) pit latrines.

Promoting SanPlat latrinesA key strategy of the sanitation projectin Niger is the promotion of new low-cost technologies that the populationcan easily acquire and learn to maintain.

The project to construct SanPlatlatrines developed as follows: a regionalworkshop on SanPlat technology, organ-ized by the UNICEF Regional Office forWest and Central Africa, took place inNigeria in 1996, attended by both thewater and sanitation programme admin-istrator from UNICEF Niger and theprincipal technical adviser for the villagewater supply project in Dosso province(funded by the Netherlands Govern-ment). After the workshop, the follow-ing actions were taken in the field:

1. Village training units provided train-ing and education to their communi-ties to increase their awareness ofhygiene.

2. The Government trained technicalofficers to build SanPlat latrines—specifically, how to manufactureSanPlat slabs and how to reinforce

the walls of latrine pits after excava-tion, because the soil is usually sandyand tends to crumble.

3. Government officers trained localmasons in SanPlat latrine construc-tion techniques.

4. The skills of NGOs and private-sec-tor labourers were supported andstrengthened.

5. Various personnel from Niger (thestaff of local NGOs such as VNVP,government technical officers,UNICEF personnel) attended the1997 regional workshop on SanPlatsin Ouagadougou, Burkina Faso,which made it possible to share expe-rience and improve participants’expertise.

A pilot project went into action atthe end of 1996 in the Saguia district ofNiamey city. The aim was to test SanPlatslabs of all shapes and sizes, so that userscould express their preferences, andthen adapt the slabs to suit the culturaland climatic conditions in Niger.

Modifying the SanPlat slabsfor NigerDuring the testing of family latrines,several modifications were introduced tothe original SanPlat slab, to adapt thetechnology to Niger’s extremely hotclimate and make it more acceptable tolocal users.

First change: thickening the slabsThe thickness of the slab in Niger is 6cm instead of the original 4 cm. Thismodification was introduced to makethe slab more acceptable to users, whofound that the original slabs were notsupporting their weight.

Second change: reinforcing theconcreteThe circular slabs were reinforced bytwo steel rods, 0.6 cm in diameter, laid

During the testing of familylatrines, several modificationswere introduced to the original

SanPlat slab, to adapt thetechnology to Niger’s extremely

hot climate and make it moreacceptable to local users.

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in an outer ring 3.50 m long and aninner ring 1.90 m long. The reinforce-ment was needed for several reasons:

■ In rural areas the materials used tomake the slabs are not always stand-ardized: the gravel is not alwaysclean, and is sometimes the wronggrade (12 mm preferred).

■ The users have more confidence inreinforced concrete than standardconcrete.

■ The mixing of the cement, sand andgravel to make the slabs is carried outwith varying degrees of precision bythe masons.

The cost of these modifications—600 francs CFA per slab, or nearly $1—is small compared to the advantages:they increase the users’ sense of safetyand make the SanPlat latrines moreacceptable.

These first two modifications weremade after observing people’s reactionswhen the latrines were introduced, andafter assessing the quality of the materi-als available in the villages.

Third change:ventilating the slabsA third modificationwas made two yearsafter the latrine con-struction project began.This modification,which does not affectthe cost of the latrines,is very important forthe users, women inparticular, and espe-cially so during the hotdry season, which lastsalmost 10 months inNiger.

The SanPlat slab is perforated by twoventilation holes, 4 cm in diameter,which release the hot air trapped in thelatrine pit. The openings are placed oneither side of the slab’s central axis, be-hind the drop hole, and centred betweenthe two steel reinforcement rings.

This improvement to the slab isimportant, particularly for women, whowere experiencing discomfort whenusing the latrines. In the hot season hotair is trapped in the latrine pit: when

users took the lid off the drop hole torelieve themselves, they received a blastof heat escaping from the pit. This isunpleasant and off-putting, particularlyfor women who are menstruating orpregnant.

To try to solve the problem, thefamilies with latrines altered the shape ofthe drop hole, which had been scientifi-cally tested, and reduced it to a smaller,round hole. This modification failed to

other UN agencies, international NGOs,government institutions and donoragencies such as the German Agency forTechnical Cooperation (GTZ). Theevents included field visits to waterschemes in the east of the country—aregion with serious water supply prob-lems—and an exhibition of photos andother relevant items.

The activities culminated on 22March with a well-attended seminar at aKigali hotel on the problems of water inthe world in general and in Rwanda inparticular. Among the participants werehigh-ranking government officials (no-tably the ministers heading MINERENA,the Ministry for Youth and the Ministryof Education); the Director-General ofElectrogaz (the parastatal in charge ofwater and electricity distribution); rep-resentatives of UN agencies, local andinternational NGOs, and local authori-ties; and journalists.

The debate was lively, and the group

agreed on the following strategies forbetter management of water resources:

■ Support the rational utilization ofwater through water collection sys-tems, treatment and storage mecha-nisms.

■ Protect the environment to avoidpollution and ensure a clean environ-ment.

■ Develop an urbanization master planso as to plan distribution accordingto anticipated needs.

■ Increase water infrastructures on asustainable basis involving commu-nities, and develop regional solidaritymechanisms.

■ Set up community-based mecha-nisms for the protection and man-agement of water systems.

Recognizing that ‘everybody livesdownstream’, UNICEF’s programme of

cooperation with the Government ofRwanda currently features support tocommunity-based water and sanitationmanagement systems in 32 communes,and support for national policy devel-opment.

IRAQZaid Jurji, WES-officerBagdadRehabilitation works inAl-Rashid plant started in Dec 1998 andwere completed in March 1999. Theinauguration ceremony took place on 22March 1999 as part of celebrations of theInternational Water Day and was at-tended by the Mayor of Baghdad andUNICEF Representative.

For further information on World WaterDay, see its website hosted by the IRCInternational Water and SanitationCentre at http://www.irc.nl/products/advocacy/wwd/.

■ World Water Day from page 6


Slab manufacture, showing ventilation holes.

9


solve the problem, since hot air was stilltrapped in the pit; indeed, it actuallycreated a hygiene problem.

The problem was evident to theusers as soon as the first SanPlat latrineswere constructed, but since all problemsinvolving people’s privacy are sensitiveissues, they did not immediately voicetheir discomfort. It took time for a cli-mate of confidence to be establishedamong all involved, so that womencould explain the problem clearly.

Once the problem was identified, itwas necessary to find a solution. Theproblem was duly solved by introducingthe two ventilation holes to allow hot airto escape continuously from the latrinepits so that users could feel at ease whenusing them.

To make the ventilation holes whenthe slabs are being manufactured, twoPVC pipes 4 cm in diameter and 30 cmlong are placed in the sand in the sur-rounding mould before the concrete ispoured. The pipes serve as the mould formaking the holes and should be re-moved before the cement hardens (15 to20 minutes).

The SanPlat slab has been improvedby adapting it to Niger’s extremely hotclimate, reinforcing its potential forsafeguarding the users’ health. The fami-lies have welcomed the improvementsenthusiastically.

The latrine programmeDuring the pilot phase of the project inDecember 1996, 20 latrines were con-structed in Saguia district. In the follow-ing year 797 latrines were built in six

districts, and a total of 1,925 latrineswere built in 1998. At the time of writingsome 1,200 latrines are under construc-tion. The plans for 1999 projected a totalof 3,649 latrines, but by year’s end theactual total was due to reach 6,391 la-trines, all constructed with the help ofUNICEF Niger.

At present the usage rate for thelatrines is 100%, but only 50% of thelatrines are well maintained. The inad-equate maintenance is due to families’lack of awareness and also the dearth ofwater for cleaning out the latrines.

Costs of SanPlat latrines in NigerCircular SanPlat slab, 1.20 m in diam-eter: 5,500 CFA or about $9Circular SanPlat slab, 1.50 m in diam-eter: 6,750 CFA or about $11Square SanPlat slab, 60 cm by 60 cm:2,250 CFA or about $3.50

So far, 98% of the families have cho-sen the round 1.20 m slabs, and 2% havechosen the round 1.50 m slabs. Thesquare slabs are being used to upgradeschool latrines.

A SanPlat latrine costs 25,000 CFAor about $40, not including the externalstructure. In the first phase of theprojects, UNICEF contributes 40% ofthe cost of the latrines, i.e. 10,000 CFAor about $16: the beneficiaries supplythe remaining 60% plus the externalstructure, which is made in the materialof their choice (banco—the localadobe—or straw).

The 60% paid by the beneficiaries inthe first phase is distributed as follows:24% in cash (6,000 CFA or $10) and

36% in labour (9,000CFA or $15): thefamily memberscontribute both bricksand labour to theconstruction.

After about 40sample latrines havebeen built in a village,UNICEF assistanceduring the secondphase of the projectgoes down to 25% ofthe cost of the latrine.In the third and final

phase, families take on the total cost ofthe latrine.

Factors for successThe success of the project is due to thestrengthening of the skills of communitymembers, government officers, andprivate-sector masons. Training work-shops have been organized for a widerange of personnel:

■ 120 community masons have beentrained in constructing SanPlatlatrines.

■ 21 government technical officers(technicians and sanitation agents,hydraulic technicians and rural man-agement technicians) have also beentrained in construction.

■ The staff of three NGOs (VNVP,CDR and SAPHTA) have receivedconstruction training.

■ Some 300 members of village train-ing units are now at work to raiseawareness among the population.

■ In the city of Agadez, 160 women on16 health committees have beentrained to raise awareness of hygieneamong their communities, with par-ticular emphasis on the use of latrinesby all members of the family and onwashing hands at critical times.

■ In Maradi province, each village inthe project has a village training unitof three members, two of themwomen. These village units have beentrained in communication techniquesby UNICEF information/communi-cation personnel, to raise awarenessof hygiene in their community.

■ A member of SAPHTA, a women’sNGO, has been trained in construct-ing SanPlat latrines. She will be re-sponsible for training womenmasons in her unit.

■ A further 66 community masons andsix government officers are due tocomplete training by the end of 1999.

To facilitate the distribution of theSanPlat slabs, five production centreshave been set up in Agadez and Arlit,Completed slab.

10


and more centres will be established inother towns. In the villages, masonsmanufacture the slabs on site.

The SanPlat latrines have a promis-ing future in Niger. During a trainingsession for communities in Maradiprovince, villagers were asked why therewas such a contrast between their greatdesire for a latrine and the painfully slowprogress in building latrines fully fi-nanced by the families. The womenreplied that household improvementsand building chores are the responsibil-

ity of the men: the men, meanwhile,replied that the women are the oneswith the financial means, because theyown the small livestock to be seenaround every village. The upshot: themen authorized the women to takecharge of constructing the latrines. Theresolving of this debate enabled thewomen to become aware of their hus-bands’ standpoint and become involvedin building the latrines. This transfer ofresponsibility from men to womencould lead to rapid progress in spreadingthe use of latrines in the area.

The collaboration between personnelof various UNICEF programmes hasalso been a factor for success: for exam-ple, sanitation and education stuff havebeen working together to promote theconstruction of school latrines.

UNICEF is also collaborating withother development partners who havemade basic sanitation a priority, such asthe Evangelical Church of the Republicof Niger, the water supply project ofArnagou village in Aguié district, andthe Dosso village water supply project.The Dosso project has adopted the

SanPlat technology, and has fundedapproximately 2,015 SanPlat latrines inproject villages.

Lessons learnedThe introduction of a new technologysometimes requires modifications inorder to adapt it to the realities on theground and make it acceptable to theusers.

The use of SanPlat latrines is rela-tively recent in Niger. Technical follow-up on how the latrines are being built,used and maintained should continueover quite a long period, in order tomake sure that all the problems aresolved and good hygiene practicesadopted.

Basic techniques must be transferredproperly. In the course of supervisoryvisits, it was noted that during the train-ing of local masons by government of-ficers, some information was omittedthat needs to be included.

Sanitation problems touch on issuesof individual privacy. There should begood collaboration between techniciansand the target populations so that prob-lems can be identified, discussed andsolved.

ConclusionsThe first point worth noting is the im-provement of the slabs following theinformation supplied by the womenusers, which led to the introduction ofthe ventilation holes to release heat andso eliminate users’ discomfort.

The second notable point is the highpercentage of the population choosingthe round slabs over the square one,which costs less. The users were willingto pay extra for an option they pre-ferred. The fact that families have beenwilling to cover a large part of the costsof the latrines—60% on average, count-ing contributions both in cash and inlabour—also bodes well for the project’ssustainability.

Future outlookThe long-term objective is to encourage100% of the families in project areas,both rural and urban, to acquire a pri-vate latrine, use it, and maintain it in

Sanitation problems touch onissues of individual privacy.

There should be goodcollaboration between

technicians and the targetpopulations so that

problems can be identified,discussed and solved.

good condition, with UNICEF fundingeventually phasing out altogether. Forthis to happen, the following approachesare recommended:

■ Continue to provide a high level ofattention and support to basic sani-tation.

■ Reinforce follow-up and evaluation.

■ Use participatory approaches toprovide hygiene education in thecommunity.

■ When developing a hygiene aware-ness programme, take into accountthe specific problems of each village(villages may suffer primarily fromlack of food, for example, or showresistance to adopting good hygienehabits).

■ Encourage the training of women inrural areas in techniques for con-structing SanPlat latrines.

■ Encourage the changing of the cul-tural norms that make the men fi-nancially responsible for householdimprovements (though not thebuilding of the family home itself).The women in rural areas are betterable to pay because they work yearround: they grow crops, raise ani-mals, run small businesses, and con-sequently are somewhat better offthan the men, who work only duringthe three months of the rainy seasonwhen they cultivate the fields.

Contributions, please:school sanitation andhygiene education

We are planning a special WATERfrontissue on integrated school sanitationand hygiene education programmes forpublication in 2000. If you have an in-teresting project you wish to write about,please contact Lizette Burgers, WESSection, UNICEF New York,[email protected].

11


Throughout many parts of the world,high concentrations of fluoride occur-ring naturally in groundwater and coalhave caused widespread fluorosis—aserious bone disease—among localpopulations. We purposely fluoridate arange of everyday products, notablytoothpaste and drinking water, becausefor decades we have believed that fluo-ride in small doses has no adverse effectson health to offset its proven benefits inpreventing dental decay. But more andmore scientists are now seriously ques-tioning the benefits of fluoride, even insmall amounts. This paper gives a briefintroduction to fluoride issues, particu-larly as they relate to the quality ofdrinking water.

Basic facts about fluorideFluoride exists fairly abundantly in theearth’s crust and can enter groundwaterby natural processes; the soil at the footof mountains is particularly likely to behigh in fluoride from the weatheringand leaching of bedrock with a highfluoride content.

According to 1984 guidelines pub-lished by the World Health Organiza-tion (WHO),1 fluoride is an effectiveagent for preventing dental caries iftaken in ‘optimal’ amounts. But a single‘optimal’ level for daily intake cannot beagreed because the nutritional status ofindividuals, which varies greatly, influ-ences the rate at which fluoride is ab-sorbed by the body. A diet poor incalcium, for example, increases thebody’s retention of fluoride.

Water is a major source of fluorideintake. The 1984 WHO guidelines sug-

Fluoride in water: An overviewBriefing note compiled by Jingjing Qian (WES Section, UNICEF New York) with contributions fromDr. A.K. Susheela (Director, Fluorosis Research and Rural Development Foundation of India),Arun Mudgal (WES Section, UNICEF India) and Greg Keast (WES Section, UNICEF New York)

gested that in areas with a warm climate,the optimal fluoride concentration indrinking water should remain below 1mg/litre (1ppm or part per million),while in cooler climates it could go up to1.2 mg/litre. The differentiation derivesfrom the fact that we perspire more inhot weather and consequently drinkmore water. The guideline value (per-missible upper limit) for fluoride indrinking water was set at 1.5 mg/litre,considered a threshold where the benefitof resistance to tooth decay did not yetshade into a significant risk of dentalfluorosis.2

In many countries, fluoride is pur-posely added to the water supply, tooth-paste and sometimes other products topromote dental health. It should benoted that fluoride is also found in somefoodstuffs and in the air (mostly fromproduction of phosphate fertilizers orburning of fluoride-containing fuels), sothe amount of fluoride people actuallyingest may be higher than assumed.

It has long been known that excessivefluoride intake carries serious toxic ef-fects. But scientists are now debatingwhether fluoride confers any benefit at all.

Fluoride: good or badfor health?Fluoride was first used to fight dentalcavities in the 1940s, its effectivenessdefended on two grounds:

■ Fluoride inhibits enzymes that breedacid-producing oral bacteria whoseacid eats away tooth enamel. Thisobservation is valid, but some scien-tists now believe that the harmfulimpact of fluoride on other usefulenzymes far outweighs the beneficialeffect on caries prevention.

■ Fluoride ions bind with calcium ions,strengthening tooth enamel as it formsin children. Many researchers nowconsider this more of an assumptionthan fact, because of conflicting evi-dence from studies in India and sev-eral other countries over the past 10to 15 years. Nevertheless, agreementis universal that excessive fluorideintake leads to loss of calcium fromthe tooth matrix, aggravating cavityformation throughout life ratherthan remedying it, and so causingdental fluorosis. Severe, chronic andcumulative overexposure can causethe incurable crippling of skeletalfluorosis.

Symptoms of fluorosisDental fluorosis, which is characterizedby discoloured, blackened, mottled orchalky-white teeth, is a clear indicationof overexposure to fluoride duringchildhood when the teeth were develop-ing. These effects are not apparent if theteeth were already fully grown prior tothe fluoride overexposure; therefore, thefact that an adult may show no signs ofdental fluorosis does not necessarilymean that his or her fluoride intake iswithin the safety limit.

Chronic intake of excessive fluoridecan lead to the severe and permanentbone and joint deformations of skeletalfluorosis. Early symptoms include spo-radic pain and stiffness of joints: head-ache, stomach-ache and muscle weaknesscan also be warning signs. The next stageis osteosclerosis (hardening and calcify-ing of the bones), and finally the spine,major joints, muscles and nervous sys-tem are damaged.

Whether dental or skeletal, fluorosisis irreversible and no treatment exists.The only remedy is prevention, by keep-ing fluoride intake within safe limits.

1. ‘Fluorine and fluorides’, EnvironmentalHealth Criteria 36, IPCS InternationalProgramme on Chemical Safety, WHO,1984. The WHO guideline values forfluoride in drinking water were reevaluatedin 1996, without change, and the issue iscurrently under further review.

2. The WHO guideline value for fluoride inwater is not universal: India, for example,lowered its permissible upper limit from1.5 ppm to 1.0 ppm in 1998.

12


Fluorosis worldwideThe latest information shows thatfluorosis is endemic in at least 25 coun-tries across the globe (see map). Thetotal number of people affected is notknown, but a conservative estimatewould number in the tens of millions. In1993, 15 of India’s 32 states were identi-fied as endemic for fluorosis.2 In Mexico,5 million people (about 6% of the popu-lation) are affected by fluoride ingroundwater.3 Fluorosis is prevalent insome parts of central and westernChina, and caused not only by drinkingfluoride in groundwater but also bybreathing airborne fluoride releasedfrom the burning of fluoride-ladencoal.4 Worldwide, such instances ofindustrial fluorosis are on the rise.

Some governments are not yet fullyaware of the fluoride problem or con-vinced of its adverse impact on theirpopulations. Efforts are thereforeneeded to support more research on thesubject and promote systematic policyresponses by governments.

Fluoride in waterSince some fluoride compounds in theearth’s upper crust are soluble in water,fluoride is found in both surface watersand groundwater. In surface freshwater,however, fluoride concentrations areusually low—0.01 ppm to 0.3 ppm.

In groundwater, the natural concen-tration of fluoride depends on the geo-logical, chemical and physicalcharacteristics of the aquifer, the poros-ity and acidity of the soil and rocks, thetemperature, the action of other chemi-cal elements, and the depth of wells.Because of the large number of vari-ables, the fluoride concentrations ingroundwater can range from well under1 ppm to more than 35 ppm. In Kenyaand South Africa, the levels can exceed

25 ppm.5 In India, concentrations up to38.5 ppm have been reported.6

Preventing fluoride poisoningFluoride poisoning can be preventedor minimized by using alternative watersources, by removing excessive fluoridefrom drinking water, and by improvingthe nutritional status of populationsat risk.

Alternative water sourcesThese include surface water, rainwater,and low-fluoride groundwater.

Surface water. Particular caution is re-quired when opting for surface water,since it is often heavily contaminatedwith biological and chemical pollutants.Surface water should not be used fordrinking without treatment and disin-fection. Many water treatment technolo-gies are available, but the most effectiveare usually too expensive and complexfor application in poor communities.Simple and low-cost technologies, suchas sand filtration, ultraviolet water disin-fection or chlorine water disinfection,are adequate in some but not all cases.Community capacity is an essentialfactor in ensuring successful utilizationof these technologies. Water chlorina-tion at household level is widely usedonly in emergencies.

Rainwater. Rainwater is usually a muchcleaner water source and may provide alow-cost simple solution. The problem,however, is limited storage capacity incommunities or households. Large stor-age reservoirs are needed because annualrainfall is extremely uneven in tropicaland subtropical regions. Such reservoirsare expensive to build and require largeamounts of space.

Low-fluoride groundwater. Fluoride con-tent can vary greatly in wells in the samearea, depending on the geological struc-ture of the aquifer and the depth atwhich water is drawn. Deepeningtubewells or sinking new wells in an-other site may solve the problem. Thefact that fluoride is unevenly distributedin groundwater, both vertically andhorizontally, means that every well hasto be tested individually for fluoride inareas endemic for fluorosis: extrapolat-ing sample tubewell tests to a larger areadoes not provide an accurate picture.

Defluoridation of waterThere are basically two approaches fortreating water supplies to remove fluo-ride: flocculation and adsorption.

Flocculation. The Nalgonda technique(named after the village in India wherethe method was pioneered) employs thisprinciple. Alum (hydrate aluminiumsalts)—a coagulant commonly used forwater treatment—is used to flocculate

Mexico

Argentina

Morocco

Algeria

Libya

Egypt

Senegal

TurkeySyria

JordanPalestine

Iraq

Iran

EthiopiaUganda

KenyaTanzania

Japan

China

Thailand

Australia

New Zealand

Pakistan

Sri Lanka

India

Bangladesh

Countries with endemic fluorosis due to excess fluoride in drinking water

2. Prevention and control of fluorosis inIndia, Rajiv Gandhi National Drinking WaterMission, 1993.

3. ‘Endemic fluorosis in Mexico’, Fluoride,vol. 30, no. 4, 1997.

4. Data from a national research projectunder the eighth Five-Year Economic andSocial Development Plan, 1995.

5. ‘Fluorine and fluorides’, see note 1 above.

6. Information supplied by UNICEF India. continued on next page

United ArabEmirates

13


fluoride ions in the water. Since theprocess is best carried out under alkalineconditions, lime is added; bleachingpowder can also be added to disinfectthe water. After a thorough stirring, thechemical elements coagulate into flocsthat are heavier than water and settle tothe bottom of the container. The opera-tion can be carried out on a large or smallscale, and the technique is suitable forboth community or household use. Onehousehold version uses a pair of 20-litrebuckets, with a settling time of one hourand not more than two hours: aftercoagulation and settling are complete,the treated water is withdrawn through atap 5 cm above the bottom of the firstbucket, safely above the sludge level, andstored for the day’s drinking in the sec-ond bucket.

Adsorption. The other approach is tofilter water down through a columnpacked with a strong adsorbent, such asactivated alumina (Al2O3), activatedcharcoal, or ion exchange resins. Thismethod, too, is suitable for both com-munity and household use. When theadsorbent becomes saturated with fluo-ride ions, the filter material has to bebackwashed with a mild acid or alkalisolution to clean and regenerate it. Theeffluent from backwashing is rich inaccumulated fluoride and must there-fore be disposed of carefully to avoidrecontaminating nearby groundwater.

Both the community and householddefluoridation systems have pros andcons. Defluoridation equipment con-nected to a community handpump istheoretically cheaper per capita than ahousehold unit because of economies ofscale; but ensuring proper maintenanceof a commonly owned facility is oftenproblematic, so good community or-ganization is necessary. The householdunits are more convenient for filteringthe small amounts of water intended fordrinking only, and people usually takebetter care of them; but an extensive andefficient service system is required toensure that the filters are replaced orregenerated at the right time. Technol-ogy is only part of the issue: local capac-

ity building, including entrepreneurialcapabilities, can be a far more criticaland difficult task.

Better nutritionClinical data indicate that adequatecalcium intake is clearly associated witha reduced risk of dental fluorosis. Vita-min C may also safeguard against therisk. In consequence, measures to im-prove the nutritional status of an affectedpopulation—particularly children—appear to be an effective supplement tothe technical solutions discussed above.

Defluoridation and UNICEFUNICEF has worked closely with theGovernment and other partners indefluoridation programmes in India,where excessive fluoride has beenknown for many years to exist in muchof the nation’s groundwater. In the1980s, UNICEF supported the Govern-ment’s Technology Mission in the effortto identify and address the fluorideproblem: the Government subsequentlylaunched a massive programme, stillunder way, to provide fluoride-safewater in all the areas affected.

Over the past five years, UNICEF’sfocus in the India programme has beenon strengthening the systems for moni-toring water quality, facilitating watertreatment by households, and advocat-ing alternative water supplies when

necessary. Education—both of house-holds and communities—is key to thestrategy. A number of demonstrationprojects have been initiated in fluorosis-affected areas, with the emphasis cur-rently on introducing householddefluoridation. UNICEF has also spon-sored research and development on theuse of activated alumina for removal offluoride from water.

Since fluoride must now be consid-ered an issue of worldwide importance,the years of experience in India shouldhelp UNICEF and its partners providefour types of assistance towards an even-tual solution:

■ Promoting a better understandingof the problem and its impact onchildren;

■ Raising the awareness of relevantgovernments and the public on thefluoride issue in particular and theimportance in general of monitoringwater quality;

■ Demonstrating, through pilotprojects, the efficacy of low-costfluoride removal technologies;

■ Strengthening community and gov-ernment capacity for fluorosis pre-vention, including a credible systemfor risk assessment that comprisesboth water quality monitoring andhealth monitoring.

■ The Night Mitch Hit from page 4

many months after Mitch’s departure.Immediately after the emergency and

throughout the recovery period, it hasbeen the organized families, villages andbarrios, schools and universities thathave sustained Honduran social infra-structure. With their strong base incommunity consultation and responsi-bility, village water boards and othergroups provided the fastest response,even before central Government wasable to regroup and mobilize assistancenationwide.

The new spirit of community or-ganization is impacting everything fromnational politics to village sanitation.Tegucigalpa’s new mayor, VilmaCastellanos, who took over from her late

husband, notices the change: “SinceMitch, many barrios have organizedtheir own sanitation committees andrubbish collection. We hear from moreand more of them, saying they are readyfor the municipality to help them haulaway the trash that they are collectingevery week now.”

The recovery of Honduras demon-strates the vital role of civil society indisasters. All assistance the outsideworld can provide should be directed atenabling the Honduran people and theircommunity organizations to rebuildtheir lives and renew their difficult pathto development and social equality.There is much to be done, and organ-ized Hondurans are providing a solidsocial base from which to start.

14


Water for Panama’s poorestBy Ileana Gólcher, Consultant, UNICEF Panama

“The people in our communities havealways been reluctant to participate inactivities that seemed to offer solutions,because the solutions never happened, orthey happened only for a select group ofpeople. They all refused to even fill out thesurvey questionnaires. ‘Why bother,’ theysaid, ‘since it never solves our problems.’But with this water and sanitation project,things are different…. The answers havealready been given, and some aqueductsand water pumps have already been built.”

he speaker is Alvaro Rodríguez,voluntary health worker inHorconcitos, in the province of

Chiriquí. The Municipal Water andSanitation Project, an initiative in Pana-ma’s 15 poorest districts, has been verywell received by its beneficiarypopulations, located mostly in indig-enous areas such as eastern Chiriquí,Bocas del Toro, northern Veraguas,Darién and Kuna Yala.

A brief historyThe project was inspired by a regionalprogramme—in the area where Guate-mala, Honduras and El Salvador share

borders—which is backed by the Euro-pean Union and the Central AmericanParliament and managed by the regionalsubministry for water and sanitationservices; the communities collaboratedirectly with the authorities to find waysof meeting their basic needs.

Encouraged by the success of theregional programme, UNICEF Panama,with the support of the Spanish andBasque Committees for UNICEF andthe Central American Parliament, calledon the Panama Government to form acommission to establish the new waterproject as a joint undertaking with com-munity leaders, local authorities, andcommunity members.

Water for low incomecommunitiesTo find out how the project was pro-gressing and to hear the views of theinhabitants, we visited several localitiesin eastern Chiriquí. These areas are hardto reach. A case in point is the village ofSoloy (San Félix district), almost twohours away from the PanamericanHighway—a place one reaches slowly ina four-wheel-drive vehicle, skirting

precipices and bumpingover all sorts of obstaclesin order to lurch forwardon a narrow, deeplyrutted dirt road. In winterthe road conditions are sobad that it is virtuallyimpossible to travel fromone village to another.

The populationpractises subsistenceagriculture. Their incomeis too low, and so are theirlevels of health and educa-tion. Without the basicsof electric light andpotable water, they havemanaged to survive bywhat amounts to realheroism. They belong to

the Ngobe and Buglé ethnic groups, andthey have to trek many kilometers toreach a river or ravine for water.

The social and health surveys carriedout as part of the project revealed seri-ous need. For example, in the 48 com-munities of Remedios district, 48% ofthe population lacks access to latrines;

people defecate in the mountains andrivers. These are the same rivers thatsupply the communities’ drinking water,which indicates that more than half thepopulation could be consuming highlycontaminated water.

The consequences are predictable—communities suffering frequent sicknessfrom gastrointestinal, respiratory andnutritional problems. In 1995, four ofthe 40 districts of eastern Chiriquí weredeclared social emergency zones: SanLorenzo, San Félix, Tolé and Remedios.

Three different surveys have made itpossible to identify the cultural patternsinfluencing environmental and healthpractices. Information was also obtainedon the current state of aqueducts andthe chances of the communities involvedbeing able to meet the conditions fordeveloping workable drinking watersystems.

The surveys showed current watercoverage—in Chiriquí, much lower thanthe national average—and provided thebasic information needed for environ-mental and health education at commu-

T…in the 48 communities of

Remedios district, 48% of thepopulation lacks access to

latrines; people defecate in themountains and rivers. These arethe same rivers that supply thecommunities’ drinking water.

continued on next pagePlaying with the new water supply: children of Chiriquí

15


nity level. The project budget was calcu-lated at $1.8 million for building 86aqueducts and 488 water pumps toreach a population estimated at 31,000.

Following the standard proceduresestablished by the Ministry of Health,World Bank and UNICEF, and takinginto account the current conditions ofthe target population, it was decided tobuild aqueducts for communities of 25households and up, while communitiesof fewer than 25 households would beserved by a water pump. Since the coor-dinating team’s fieldwork indicated thatthe mountainous terrain and poor roadconditions would add to the difficultiesand also raise the costs for constructionmaterials, equipment and transport,gravity-feed aqueducts were chosen asthe most practical option.

These technical decisions are consid-ered to render the water schemes cost-effective in terms of capital outlay andbenefits to the target population.

Capacity-building andparticipation workshopsThe different levels of community organ-ization have always been the greatestobstacle encountered by project manag-ers in Panama’s rural areas. Paternalism,combining with villagers’ traditionalpassivity and sense of dependency, hascreated a tendency for projects to beorganized from outside by external tech-

nical experts, who wouldinterpret the situation accordingto their own point of view andwould then design and imposesolutions which were ultimatelyrejected by the communities.Recognizing this pitfall, thestrategy developed by theMunicipal Water and SanitationProject singles out communityparticipation as the key factor inguaranteeing the project’ssuccess.So it was that 664 people—both

municipal and local authorities,and community members—tookpart in a series of 13 workshopsto raise awareness. Over severalmonths, the workshopparticipants learned about

strengthening existing institutions, newtechniques of community organization,and how to involve community groupsin carrying out surveys. Additionalworkshops were organized to train localleaders how to identify water sourcesand employ low-cost technologies forsupplying water; how to build smallgravity-feed aqueducts; how to draw upconstruction plans for water storage and

The workshops made it possible forcommunity leaders to carry out surveys(based on a total 3,127 questionnaires)of 145 communities with aqueducts and405 communities without.

Felipe Palacios Rodríguez is one ofthe indigenous voluntary sanitationworkers who received training. Felipelives in Plan de Chorcha, a village fourhours’ walk away from Soloy. With hiswife María, a community midwife, athis side, he tells his story with greatsatisfaction:

“For me this has been a great experience,because we were able to help provide aservice to the community through thedifferent water schemes. We have carriedout surveys in villages that do not havewater and given them the information onhow to obtain it.

“I learned how to use an altimeter,an instrument I always carry with menowadays, and now I can locate watersources where we can build aqueducts.I am happy because I designed the Plande Chorcha aqueduct myself, and now wewill have water for more than 50 people.”

The women organizeIn Panama, women play a fundamentalrole in the family and could be said to bethe hub around whom all the most im-portant decisions revolve. Accordingly,the new project involved women in theentire process.

The task was not easy, particularly inthose indigenous areas where for cul-tural reasons women have always beenexcluded. But tradition need not prevail,says Macarina Bejerano, Soloy villagedeputy:

“The community is more than ready tocontribute and to collaborate with theproject teams, so that people come to valuewater and protect it well. We women havebeen active participants. I have organizedthem and spoken with them so that we allknow we are an important part of thecommunity and its solutions.”

Bejerano’s legendary leadership andtenacity have been key in motivating her

Paternalism, combining withvillagers’ traditional passivityand sense of dependency, hascreated a tendency for projects

to be organized from outside byexternal technical experts, who

would interpret the situationaccording to their own point

of view and would thendesign and impose solutions

which were ultimately rejectedby the communities.


Women’s achievement in Chiriquí: one of the newwater taps

rainwater harvesting; and how to usehandpumps. Gender workshops werealso developed, and all the communitiesinvolved wrote a collective account oftheir community history.

16


The risk to groundwater supplies fromon-site sanitationBy the ARGOSS project team—research scientists working in the British Geological Surveyand the Robens Centre for Public and Environmental Health, United Kingdom

The potential for on-site sanitation tocause significant pollution ofgroundwater has been known for manyyears. These impacts have led variousworkers to suggest minimum safe dis-tances separating latrines andgroundwater sources. In truth, the im-pact on groundwater from on-site sani-tation is likely to be site-specific andtherefore a universal minimum safedistance is unlikely to be appropriate.Such an approach would be over-cau-tious in some environments, which mayadversely affect the ability of communi-ties to improve the quality of the envi-ronment within which they live.

Although some contamination ofgroundwater may be derived from on-site sanitation, should this preclude itsuse in vulnerable areas? Many workershave pointed out the potential healthbenefits of improved sanitation andhighlight the fact that the risks of notimproving sanitation, particularly inhigh-density low-income communities,may outweigh the risks of groundwaterpollution.

There is clearly much debate associ-ated with this topic, a debate that can beencompassed by the following series ofquestions:

1. What is the extent and nature ofcontamination of groundwatercaused by on-site sanitation?

2. What level of priority should begiven to protecting groundwaterquality in relation to sanitation im-provement?

3. How can contamination from on-sitesanitation be limited?

4. What implications does groundwatercontamination have for water supplytechnologies?

Ongoing researchAn ongoing research project, funded bythe UK’s Department for InternationalDevelopment, is attempting to addressthe first of the questions above. Theproject, entitled ‘Assessing Risk toGroundwater from On-site Sanitation’or ARGOSS, is being carried out by theBritish Geological Survey and the RobensCentre for Public and EnvironmentalHealth, in collaboration with a networkof researchers in Africa, Asia and Latin

America. The project will result in amajor scientific review of the topic. Inaddition, a manual of guidelines will beproduced for fieldworkers involved inwater supply and sanitation programmesto aid the siting of on-site sanitation inrelation to groundwater sources.

Whilst the types of pollutant thatmay result from contamination ofgroundwater by on-site sanitation arewell known, it has often proven difficultto quantify the degree of contaminationthat has occurred. As part of the project,two major case studies are being carriedout in Bangladesh and Uganda. Thesehave provided some interesting resultsto date on the extent and nature of con-tamination of groundwater.

BangladeshThe case study in Bangladesh centres ontwo peri-urban areas of Dhaka on an

alluvial aquifer. The potential for con-tamination of groundwater supplies hasbeen identified by sanitary surveys car-ried out at 100 borehole sites: 95 out of100 boreholes have a pit latrine within15 m, with two latrines within 15 m asthe average, and 38 of the boreholeshave a pit latrine within 5 m. However,results to date do not indicate that seri-ous microbiological contamination ofthe groundwater is widespread; mostboreholes sampled show faecal indicatorbacteria (see endnote) to be absent or inlow numbers, with serious contamina-tion present only sporadically.

Where contamination has occurredit is most likely to have moved to theborehole via more direct routes—e.g.inadequate or deteriorated wellheadworks—or through the use of pol-luted water for pump priming, a wide-spread practice. It is possible that pitlatrines could be a source of contamina-tion. Though it is unlikely that thepathogens could survive for the time itwould take them to move from the pitlatrine through the body of the aquiferto the screen of a borehole, it is possiblethat they could reach breaks in theborehole casing through lateral move-ment of leachate at shallow depths, par-ticularly where the unsaturated zonebeneath the latrine is thin and the per-meability of shallow layers is high. Thehand-operated drilling method usedextensively in Dhaka precludes the in-stallation of a good cement seal behindthe casing.

On-site sanitation is also a source ofchemical pollution, in particular chlo-ride and nitrate. Analysis of samplesfrom a range of depths at the two sitesindicates widespread chemical pollutionof the aquifer at shallow depths. It

…the risks of not improvingsanitation, particularly inhigh-density low-income

communities, may outweigh therisks of groundwater pollution.


17


would appear that the ‘front’ of modernhigh-chloride water has not reached thedeeper aquifer but in time, as waterdemands grow and abstractions fromthese deeper aquifers increase, this situa-tion is likely to change. Of note is thefact that the risk from nitrate ingroundwater appears negligible as aresult of anaerobic conditions whichpromote the natural reduction of nitrateto harmless nitrogen gas by micro-or-ganisms present in the subsurface.

UgandaIn Uganda the aquifer of interest is theweathered crystalline basement. Thetwo areas under study, Iganga and Kam-pala, have contrasting groundwater flowsystems.

Iganga, a medium-sized town, is inan area of low topography on a relativelythick layer of shallow weathered rock(~30 m). The majority of the water sup-plied here is obtained from wells andboreholes. For this study, hand-pumpedboreholes are being sampled. Theboreholes penetrate to the top of thefractured basement and draw waterfrom storage at the base of the weath-ered zone which may be regarded as aregional aquifer. Preliminary data dem-onstrate several important points. Chlo-ride (Cl) and nitrate (NO3) values aregenerally high in Iganga compared torural groundwater, and the ratio of thetwo suggests the source is likely to be pitlatrines. Analyses show a general absenceof faecal indicator bacteria—not surpris-ing as the length of time of travel frompit latrine to borehole screen is likely tobe greater than the survival time of thebacteria.

Kampala lies in an area of pronouncedtopography that gives rise to a thinweathered zone. This produces shallowlocalized groundwater flow systems inthe aquifer. Much of the groundwaterused in low- and middle-income areas isobtained from protected springs tappingthis shallow flow system. In Kampala,two groups of sites are being studied.The first is in an area of high-densitypopulation and low income, and thesecond is an area of low-density popula-tion and low-to-middle income, with

urban agriculture a major activity.

■ At the high-density population sitethe springs show high levels of bacte-ria and also raised levels of nitrate.Sanitary inspections suggest a majorpathway for faecal contamination tobe direct localized penetration ofcontaminated waters through dam-aged or poorly constructed springprotection works. The raised nitratelevels suggest an additional contribu-tion from on-site sanitation.

■ At the low-density population sitesampling has again revealed thewidespread presence of faecal indica-tor bacteria, but little contaminationby nitrate. Sanitary inspection againsuggests localized direct contamina-tion but the low population densityand rapid groundwater flow systemsprevent high nitrate concentrationsbuilding up.

Although more research is planned,the preliminary conclusion that can bedrawn from the work in Bangladesh andUganda is that, where microbiologicalcontamination of small systems isfound, more attention should be placedon improving the protection works andwellheads than on latrine proximity. Thework also illustrates how on-site sanita-tion can be a major contributor to inor-ganic chemical pollution of groundwaterin low-income countries and in particu-lar contribute nitrate and chloride. Ni-trate has been linked to stomach cancerand methaemoglobinaemia; chloride

does not in itself have any direct impacton health, but may cause rejection ofotherwise good-quality water supplies.

Protecting groundwater versussanitation improvementA question that was posed at the begin-ning of this article is what level of prior-ity should be given to protectinggroundwater quality in relation to sani-tation improvement? Many people pointto work that suggests improvement ofsanitation provides much greater healthgain than improving water quality atsources. The problem is it is often diffi-cult to reliably predict the health gainsfrom individual interventions given thehighly integrated nature of the impact ofwater and sanitation. It is also true thatthe reasons for improving the waterquality at sources often relate moredirectly to the prevention of epidemicsrather than simply health gain. Evidencefrom research suggests that contribu-tions from latrines are less importantthan other routes of contamination indeteriorating groundwater quality, andtherefore concerns over groundwatercontamination should not prohibit thedevelopment of on-site sanitation. How-ever, there is a major qualification onthe findings of this research because ofthe uncertainties about the value ofindicator bacteria in groundwater (seeendnote). The indicators used do dem-onstrate that recent contamination hasoccurred and therefore pathogens ininfective doses are likely to be present.However, we know that some pathogenswill survive in groundwater at infectivedoses for far longer than the indicatorbacteria. Sole reliance on current micro-biological indicators may not always besufficient to gauge whether faecal con-tamination has occurred, specifically inrelation to viruses.

We also have to bear in mind thelong-term impacts on deterioratinggroundwater quality; the effects may notbe felt for several years or decades. Inthe short term, however, we may need toaccept that some contamination ofgroundwater is unavoidable if the healthgain from improved sanitation is to berealized.

Evidence from research suggeststhat contributions from latrinesare less important than other

routes of contaminationin deteriorating groundwater

quality, and thereforeconcerns over groundwatercontamination should notprohibit the development

of on-site sanitation.

18


Strategies to overcomegroundwater pollutionClearly, if we are to limit the degree ofpollution of groundwater from on-sitesanitation or minimize the impact onthe health of the users, we need to con-sider ways in which this can be achieved.One option is to establish protectionareas around boreholes in which on-sitesanitation or other polluting activitiesare not allowed. Whilst providing anadequate separation between watersources and latrines may be relativelyeasy to achieve in rural areas, this ismuch more difficult in the high-densityinformal settlements which form anintegral part of many modern towns andcities. Further, as chloride and (in manyaquifers) nitrate are conservative ingroundwater, the concept of safe-dis-tance protection becomes irrelevantunless the contaminant source is outsidethe catchment of the borehole or spring,unlikely in these settlements. Here asolution would be to ensure that pipedwater is accessible and it has been sug-

gested that this would be cheaper thanusing alternatives to on-site sanitation.Whilst this may be true, there are majorproblems in making piped water sup-plies available to informal settlements.Municipal planners may reject suchapproaches because they feel it wouldprovide formal recognition to what theysee as illegal settlement, and utilities maybe reluctant to invest in communitieswith limited security of tenure. Thecommunities themselves may not viewpiped water access as a priority if alter-natives that are lower-cost and sociallyacceptable are available and if they havelimited security of tenure.

We might also examine improve-ments in water and sanitation technolo-gies. There may be simple ways in whichpit latrines may be modified to reducethe risk of microbial contamination orwe could consider the options for treat-ment of groundwater sources at a com-munity level.

In conclusion, it is clear that to over-come the problems associated with the

contamination of groundwater suppliesfrom on-site sanitation there is a needfor integrated water and sanitation de-velopment and water resource manage-ment. One lesson the industrializedworld has learned is that ignoring long-term resource issues leads to spirallingcosts and loss of resources, things whichlower-income countries in the develop-ing world can ill afford to overlook,particularly if they are dependent ongroundwater for much of their waterneeds.

Endnote

The ideal manner of determining thepresence of waterborne pathogens wouldbe to analyse the water for the specificpathogens of concern. However, manytypes of micro-organisms have beenshown to be involved in waterborne dis-ease outbreaks. It is impractical to look forevery potential pathogen, so faecal indica-tor bacteria are used as a warning of possi-ble contamination.

■ Water for Panama’s Poorest from page 15

community to organize the building oftheir aqueduct. Her fellow villagers saynothing deters her, not even the longdistances she must travel to encouragethe neighbours to play their part andhaul building materials free of charge.

They have formed a water board tomanage and maintain the aqueduct. Asmall charge to households—25 or 50cents—will make it possible to recoversome of the costs and carry out repairsor extend construction.

Today, the villagers of Soloy enthusi-astically await the arrival of waterthrough their aqueduct, one of a net-work of 12 aqueducts due to go intooperation this year in their area.

Water and a healthyenvironment for allThroughout eastern Chiriquí the projecthas had to surmount numerous difficul-ties, including the widely dispersedpopulations, impassable roads, andmany long years of community apathy.

Project coordinators Clementina Gaytánand Dante Ramalli sum up the problemsand the successes achieved so far:

“In the beginning, when we first startedvisiting the communities, everyone thoughtthe project was just one more emptypromise. When we returned to those samecommunities less than eight months laterto build the aqueducts and water pumpswith their help, the response we got wastotal: great interest and participation;

everyone committing to the project andhauling the construction materials fromthe collection points to the building sitesnear their homes. These communities arebeginning to grow and the households areuniting in group solidarity, now that theyknow for certain that their aqueduct iscoming.”

The villages of eastern Chiriquí arebenefiting from a project to meet one oftheir most important needs—healthyliving conditions, especially for theirchildren. Before winter comes, say thevery poorest of the villagers, they haveagreed to work together to find moreways to improve health and upgradetheir communities.

Reproduced by permission of La Prensa,Panama.

In Panama, women play afundamental role in the familyand could be said to be the hub

around whom all the mostimportant decisions revolve.Accordingly, the new project

involved women in theentire process.

19


Honduras: Wastewater treatmentin poor urban neighbourhoodsBy Johannes Vijlbrief and Niels Willemsen, Delft University of Technology, Netherlands, and Anna Maria Mooijman,WES Section, UNICEF New York

he ‘Tegucigalpa model’ for watersupply in peri-urban areas, aftereight years of bringing safe water

to the city’s poor, embarked in 1995 on asecond phase: improving hygiene condi-tions by the installation of low-costsewerage systems. The first experienceswith these small-scale systems have beenpositive, and more are planned for thefuture. In the meantime, however, theextra wastewater generated by the newsystems is polluting the environment: incooperation with the Delft University ofTechnology, a study was undertakenbetween May and July 1998 to investi-gate the possibilities of small-scale, low-cost solutions to the problem.

BackgroundDuring the last days of October 1998,the violent waters of the Choluteca andChiquita rivers caused great damage inTegucigalpa. Swollen by the heavy rainsof hurricane Mitch, the rivers rose manymeters above their normal level, wash-ing away bridges and whole neighbour-hoods of the Honduran capital. Thedevastation of human lives and propertyshocked the world, and prompted manyto provide essential medical, logisticaland financial assistance.

Adding to the direct losses claimedby the fierce torrents, several water-borne and other diseases emerged soonafter. With 21,000 people crowded intomakeshift shelters, lacking drinkingwater and sanitary facilities, diseases likediarrhoea, respiratory infections, choleraand dysentery made their appearance.Fortunately, the quick and effectiveresponse of the authorities, assisted byinternational support, averted largeepidemics: for more detail see the articleby Anthony Brand in this issue.

Even under normal circumstances,

the rivers of Tegucigalpa were alreadyheavily polluted with organic materialand pathogens. The city does not have aplant for treating sewage, and all thesewage collector pipes discharge directlyinto the rivers. In the dry season whenthe rivers run low, the water is virtuallyundiluted sewage, making the riversunsuitable for any other use.

Water and sanitation in thebarriosMore than 400,000 people live in thepoor urban areas of Tegucigalpa. Since1987, UNICEF and SANAA, the Na-

tional Autonomous Water and SewerService, have been implementing a jointprogramme to improve health condi-tions in the barrios. So far, the pro-gramme has been very successful. Theinitial goal—installing safe drinking-water facilities in every barrio—hasalmost been reached. It is estimated thatby the year 2000 every community inTegucigalpa will have a water systemproviding water up to 34 times morecheaply than the private water vendors.The success of the programme can bepartly explained by the unique approach

towards community management andcost recovery. Many articles have beenpublished on the programme, generallyknown as the ‘Tegucigalpa model’; seefor example WATERfront issues 1, 8, 11and 12.

Since 1995, the focus of the pro-gramme has been gradually shiftingfrom the provision of drinking water tosanitation. The increased water avail-ability resulting from the newly installeddrinking-water systems has led to in-creasing problems with wastewater.Moreover, no provision has been madefor the ‘grey water’ that has been usedfor washing and runs freely onto thestreets causing unhygienic situations.The only sanitary facilities available,though not everywhere, are VIP latrines.Many of them are not used or are usedimproperly, because of lack ofknowledge or aversion to inconven-iences like smell and flies. Another prob-lem is the lack of space to relocate thelatrines once the pits are filled up (Hon-duras does not have a tradition of pitemptying). In poor urban settings thisspace is seldom available.

In 1995, the Executing Unit forBarrios in Development constructed itsfirst sewerage projects using low-costtechnologies—either a simplified stand-ard design or a small-bore design (solidssettled on site in a septic tank, with onlyfluids discharged through 4-inch pipes).These demonstrated that the installationof sewerage systems in the barrios is bothtechnically and financially feasible, andnow many other neighbourhoods areapplying for their own system.

The wastewater problemAlthough the sewerage systems will havea direct positive impact on health condi-tions in the barrios, the overall impact

T

Although the sewerage systemswill have a direct positive

impact on health conditions inthe barrios, the overall impact

on the environment is negative.The untreated sewage water isdisposed of in the rivers, simplymoving the problem elsewhere

instead of solving it.

20


on the environment is negative. Theuntreated sewage water is disposed of inthe rivers, simply moving the problemelsewhere instead of solving it.

In 1997, the nation’s first water qual-ity law set quality standards forwastewater discharged into surface wa-ters. In theory this means treating allsewage water before discharge, but asmentioned before, sewage has yet to betreated in Tegucigalpa, so it would be anunderstatement to say that the law is notyet fully implemented. The city’s masterplan for sanitation includes plans for alarge-scale sewage treatment plantdownstream, but because of financialconstraints this will probably not bebuilt in the foreseeable future.

The sewerage systems installed so farin the barrios have all been connected tothe existing main collector pipes. Butbecause of capacity problems in the col-lector network, this cannot be done forall the sewerage systems planned underthe programme. Moreover, the barriosare often sited in inaccessible locationsfar from the main collectors, whichmakes connection, even when physicallypossible, very expensive, and still doesnot solve the pollution problems. Toinvestigate the possibilities for independ-ent treatment at community level, astudy was undertaken by two studentsat Delft University of Technology.

Constraints and opportunitiesThe barrios are generally located onsteep hillsides and ravines. The lots aresmall, and the houses cramped together.Few open spaces are available. It isdifficult to find an appropriate vacantsite for a treatment plant.Furthermore, the financial plight of theurban poor does not allow the use ofexpensive technologies, since theconstruction costs will be partlycovered by the community. Thetreatment systems must be robust,cheap, and easy to operate andmaintain with minimal training.

But the uneven topography of thebarrios also has an advantage: gravitycan be used to handle the flow ofwastewater through the treatmentplants.

Possible technologiesStabilization ponds. These ponds, inwhich the wastewater is treated by bacte-ria and sunlight in natural processes, arethe best technology for treating waste-water in tropical climates. The methodhas many advantages: the ponds arecheap, easy to construct, operate andmaintain, and very effective. However,they require a lot of space, which is notavailable in Tegucigalpa.

Artificial wetlands. These wetlands (orhelophyte filters), another technologythat has proven successful in Nicaraguaand the Honduran city of San PedroSula, cannot be used in Tegucigalpa,again for lack of space. In these wetlandsthe polluting components are extractedfrom the wastewater by plants that usethem as nutrients. These can be floatingplants, but also bottom-rooted plantslike bamboo. In a helophyte filter thisprinciple is combined with a filter me-

dium in which the plants root. A bonusis that the plants can be harvested andsold: since any fast-growing plant can beused, a saleable species can be selected togenerate some income.

Upflow anaerobic sludge blanket (UASB)reactors. This is a more sophisticatedsystem that treats the wastewater using ablanket of sludge in suspension onwhich bacteria grow. The conditions in aUASB reactor have to be constantlymonitored to create the ideal conditionsfor certain types of bacteria. In Brazil,small-scale reactors have been successfulin treating industrial wastewater. Theadvantages of this technology are itscompactness and the production ofgases that can be reused as fuel. Theobvious disadvantage is that it requiresfairly expert knowledge and skills, andconsequently carries high operation andmaintenance costs.

Trickling filters. A technology that isrelatively compact, simple and requireslittle maintenance is the trickling filter.This is a cylindrical bed of coarse rock orother material over which thewastewater is sprinkled: a thin film de-velops on the rocks, consisting of slimein which bacteria grow that take upbiodegradable components from thepercolating water. Sizes vary, but a filterbed might be 10 m in diameter and 2.5m deep. Because the bacteria need oxy-gen, the filter bed must never be coveredby water, and the water should be aer-

…besides the good examples,there are also many sewagetreatment plants that functionpoorly or not at all. Almost

without exception, this is causedby the insufficient technical

knowledge of the operators,or by the insufficient attention

given to durability in the design.


The pilot plant design.

21


Headlining sanitation in Uganda’s newspapersBy Agnes Bitature, Project Officer, Sanitation, UNICEF Kampala

anitation News’ is the title of aregular feature on sanitationcarried by two of the nation’s

leading English-language newspapers,The Monitor and New Vision, and avernacular daily, Bukedde. The full-pagefeature first appeared in April 1999 inThe Monitor. Now all three newspapershave undertaken to run it twice a monthfor a year, as part of a mass media cam-paign to give sanitation the high profileit currently needs in Uganda.

The idea for ‘Sanitation News’sprang from the realization that unlessthe movers and shakers of the countryare informed and educated about sanita-tion – especially the fact that it is a re-sponsibility for all and not just a privateaffair – sanitation will continue to lagbehind, always the last of the prioritieswhen human and financial resources areallocated.

The news feature has a children’scorner, and sections for cartoons, practi-cal tips, and readers’ letters. Contribu-tions are welcomed from all readers, butpeople working in the areas of sanitation

and health are encouraged to contributeregularly.

The print run for The Monitor isabout 20,000 copies, reaching some200,000 people, and about 35,000 copiesfor New Vision, reaching about 280,000people. The cost to UNICEF of support-ing materials development for a year’sworth of ‘Sanitation News’ is estimatedat roughly $33,000, to be shared betweenthe Water and Sanitation Section andthe Communication Section.

A special push on sanitation isplanned for October 1999, to belaunched by the President. The activitieswill include widespread distribution ofleaflets, posters, and children’s gamesand puzzles.

The communication strategy as awhole has made extensive use of marketresearch and testing: the mini-manualson hygiene promotion that haveemerged from this process supply theguidance for putting the strategy intopractice.

A particular concern is improvingsanitation in schools, which has reallydeteriorated with the increasedenrolments from the Government’sdrive towards universal primary educa-tion. Although most schools have someform of latrine, the numbers fall wellshort of the need, and quality is poor: ina recent mini-survey it was found thatonly 2% of schools had adequate latrines

For further information, [email protected] or [email protected].

S‘

ated by sprinkling it from a height sev-eral metres above the filter bed. Trick-ling filters need very little maintenance,especially when the water is drippedover the filter bed by stationary sprinklersinstead of rotating ones. In El Salvador,experiments with trickling filters usingonly gravity have been very successful.

All these technologies perform well inremoving organic pollution, but onlythe stabilization pond removes enoughpathogens to have a full impact on pub-lic health. For optimal pathogen re-moval using the other technologies,chemical disinfection of the effluentcould be considered, but of course thatis quite costly.

Sewage treatment plants in other

Central American countries have usedmost of these technologies with positiveresults. It is, however, important torecognize that besides the good examples,there are also many sewage treatmentplants that function poorly or not at all.Almost without exception, this is causedby the insufficient technical knowledgeof the operators, or by the insufficientattention given to durability in the de-sign. Many of these plants are designedand financed by international donors:the design is often based on experiencein industrialized countries rather thanthe conditions existing in the beneficiarycountry, and the plants are supplied as acomplete package without looking at theneeds and capabilities of the beneficiar-ies. Moreover, the operators are rarely

given enough training in the skills foroperation and maintenance. To ensuredurable proper functioning, a clear op-eration and maintenance manual, and atraining programme for operators,should be integral parts of any designsfor treatment plants.

The pilot plantAfter a thorough study of the pros andcons of each technology in theTegucigalpa context, it was concludedthat a trickling filter was the most prom-ising. A pilot plant was designed, to testthis proposition in practice. Construc-tion was planned for 1999, but has beendeferred for reconstruction works afterhurricane Mitch.

■ Honduras: Wastewater Treatment from previous page


22


Sanitation consumers in Benin:Understanding the marketBy Marion (Mimi) Jenkins, Research Engineer, Department of Civil and Environmental Engineering, University of Californiaat Davis; formerly WES Officer, UNICEF Cotonou, Benin

The sanitation community now recog-nizes the need for a more demand-fo-cused and household-centred approachto sanitation promotion and program-ming. On a concrete and practical levelthis means that before we can developstrategies and design programmes, weneed to understand the ‘market’ forsanitation and the behaviour of house-hold consumers in that market. Thisarticle summarizes some findings fromresearch on how consumers make theirsanitation choices and the factors thatgenerate or suppress demand for im-proved sanitation (Jenkins 1999a). Theresearch uses consumer theory to under-stand the decisions of households toinstall a latrine in central Benin, WestAfrica, covering over 500 communities,from small towns to isolated villages.

Most of the limited research on de-mand for sanitation has looked at will-ingness-to-pay (WTP) for a particularsanitation product or service(Whittington et al. 1993; Altaf 1994;Altaf and Hughes 1994). While provid-ing information on the potential de-mand that might be expressed byconsumers for a particular product orservice, contingent valuation studies ofWTP tend to limit diagnosis of weakdemand to a narrow focus on cost as thedriving issue. They also often miss outon what really drives consumers’ choicesand why many are unwilling to pay. Byfailing to integrate the issue of cost witha host of other factors that influenceconsumers’ preferences and choicesregarding sanitation in developingcountries, these studies can leave us withfew if any strategies to stimulate demandapart from reducing cost. In contrast,consumer behavioural approaches tostudying demand go deeper into theattitudes and beliefs, motives and prefer-ences that determine an individual’s

choice, revealing many possible andinterlinked strategies to stimulate de-mand on local and regional scales, someexamples of which are included later inthis article.

The key elements of the researchframework used to analyse a consumer’schoice to install a latrine consist of drivesand constraints. A drive is the desire forchange that motivates the decision toinstall a latrine or adopt a sanitationproduct or service. Drives are the under-lying reasons why consumers choose to

change their sanitation situation orbehaviour and are best understood as a‘dissatisfaction from a perceived differ-ence between an ideal (or desired) stateand the actual state’. Ideal states reflectpersonal values and individual lifestyledifferences, and include such things ascomfort, convenience, privacy, prestige,status, health, safety, religion or ideol-ogy, and cleanliness, for example. Actualstates reflect individuals’ physical andsocial environments and circumstances.Unless a person is dissatisfied to a suffi-cient degree with some aspect of his orher life in relation to something theyvalue, they are unlikely to feel any rea-son to change behaviour. This is, ofcourse, true for any significant change inbehaviour.

Thus, to understand sanitation de-mand, we must begin by asking, “What

are the drives that motivate consumersto choose new or improved sanitation?”In rural Benin, the research revealed 11different drives shown in Table 1, repre-senting prestige and well-being valuesand two particular situations. House-hold heads with aroused prestige driveswere the most likely to install a latrine,followed by those with aroused conven-ience and comfort drives. Prestige, con-venience, comfort, and safety were themost widespread reasons for desiring alatrine. The prevention of infectiousdiseases was a small component of thedrive to protect family health and safety.While this desire contributed to somehouseholds’ decision to adopt sanitation,preventing infectious diseases was theleast important of the perceived healthand safety concerns, and infectious dis-ease transmission was misunderstood.

The action of constraints makes upthe other element of consumer sanita-tion choice. Constraints are factors that,when negative, act to hinder or preventadoption. By contrast, when such factorsare positive for an individual, they facili-tate adoption as long as drives arearoused. The research framework identi-fied four types of constraints on latrineadoption shown in Table 2, with exam-ples from Benin. Lack of awareness andmisunderstanding act early in the deci-sion process, preventing consumersfrom recognizing latrines as a potentiallysatisfying solution to their arouseddrives. Psychosocial constraints tend toact later, creating negative attitudestoward latrines that reduce preference.Implementation-related constraints, ifsevere and perceived as permanent, actearly in the decision process, makinglatrines appear completely infeasible asan option. When less severe or perceivedas temporary, implementation-relatedconstraints act later in the decision

Prestige, convenience, comfort,and safety were the most

widespread reasons for desiringa latrine. The prevention of

infectious diseases wasa small component….

23


process, delaying a consumer’s decisionto adopt until the constraint can beovercome or accommodated, whichsometimes requires many years. Opera-tional and performance constraints alsoact later in the decision process, oftenfor consumers with better awareness andunderstanding of latrines. Perceptions ofpoor operation or performance canreduce preference, delay adoption, orcause a consumer to actively reject la-trines in favor of a competing option.Interestingly, options that compete withlatrine installation in the decision toadopt improved sanitation in Benin andelsewhere often have nothing to do withsanitation and involve other housing-related investments.

The most important constraints onlatrine adoption in Benin relate toawareness, understanding, implementa-tion (finance difficulties and technicalcomplexity), and operation/perform-ance (smell and safety). Extended fam-ily/social interaction, a psychosocialconstraint, was a contributing reason forlatrine rejection by some consumers. In

the research, high cost was measuredseparately from lack of finance (cash/credit) to install a latrine, an importantdistinction from a policy perspective.The results strongly show that lack offinance, the ability to acquire the lump-sum capital needed to build a latrine, isa widespread reason for so little latrineinstallation and a major barrier formany motivated households who wishto install a latrine. The finance problemis critical in expressed demand for manywater and sanitation projects in devel-oping countries and shows up in studies

…lack of finance, the ability toacquire the lump-sum capitalneeded to build a latrine, is awidespread reason for so littlelatrine installation and a major

barrier for many motivatedhouseholds….

Table 1 Drives motivating private latrine installation incentral Benin

Valuecategory Drive Key dissatisfactions and concerns

Prestige Affiliate with the urban elite Hospitality for important guests; avoidshame or embarrassment when urbanvisitors need to use the toilet

Prestige Express new experiences and Achieve the ‘good’ life; bring urbanlifestyle acquired outside village amenities back to village; differentiate

oneself from others

Prestige Leave a legacy for children and Secure post-mortem status; maternaldescendants instinct; obligations to/from

descendants in voodoo beliefs

Prestige Aspire to Fona royal class status Seek symbols of status/privilegeformerly exclusive markers ofroyal class

Well-being Increase or maintain cleanliness Perceived overload of faeces aroundhouse, flies, smell; difficulty finding aplace free of faeces to defecate; desirefor greater order/control over homeenvironment and members

Well-being Protect personal health and Avoid supernatural dangers associatedsafety (from supernatural dangers) with seeing/smelling faeces, seeing a

snake in bush, evil spirits at night;protect faeces from theft by enemieswho want to use it in sorcery

Well-being Protect family health and safety Concern for family members getting(from mundane accidents and bitten by snakes and other accidents/dangers, infectious diseases) problems using the bush that cause

lost time, expense, social conflicts;fear of crime at night; avoid diseasesspread by faeces left in the open

Well-being Increase convenience and comfort Avoid long distances, rain, hot sun, toreach open defecation sites; bush isuncomfortable, dirty, disagreeable;hassle of social conflicts fromdefecating on wrong site from limitedchoice of sites

Well-being Increase visual, social, or Difficulty finding defecation sites withinformational privacy visual privacy; uncomfortable mingling

(outsider) in public; want privacy forpossessions, activities, wives; restrictpersonal information

None: Ease restricted mobility Old age, blindness, illness, etc. makesituationalb it physically difficult or impossible to

defecate in bush

None: Increase rental income Renters pay more for unit with latrinesituationalb

a. The dominant ethnic group in the study area, where voodoo is the dominant cultural religion.

b. These situational drives are largely unrelated to value differences and reflect limited functional uses for latrinesdue to physical impairment or for commercial gain.


24


where willingness to pay monthlycharges is substantial and greater thanwillingness to pay one-time connectionfees (see Singh et al. 1993).

The framework, simply put, statesthat a sanitation product or service mustbe possible and a preferred choice for aconsumer. Using the framework, weakdemand for latrines or other sanitationimprovements can be explained by thefollowing causes, where those listedlower on the list are only possible aftereliminating ones listed above it:

1. No drive is sufficiently aroused;

2. The sanitation option is not recog-nized as relevant to the arouseddrive/s due to lack of awareness ormisunderstanding;

3. The sanitation option is excludedfrom consideration as impossiblebecause implementation-relatedconstraints are perceived to be per-manent and prohibitive;

4. Negative attitudes toward the sanita-tion option, induced by the action ofpsychosocial constraints or perceivedpoor performance of the option interms of outcomes for drive satisfac-tion, compounded by low implemen-tation feasibility, make the optionless preferred than a competing non-sanitation alternative; and

5. Latrines are preferred but the tempo-rary presence of constraints, mostlyimplementation-related, cause anindividual to do nothing (delaychoice) or choose another option.

This diagnosis of rejection has clearimplications for identifying many fruit-ful strategies to stimulate demand, asdemonstrated by the ideas at the end ofthis article. It also means that multiplestrategies must be used to stimulatedemand for different potential consum-ers. A single strategy to make latrinesmore affordable, for example, will havelittle or no effect on consumers whohave no aroused drives, who misunder-stand latrine technology, who perceiveserious performance problems, or wholack access to the capital or technicalsupport needed for latrine installation.

Design and selection of strategies tocorrect causes of weak demand must betargeted to appropriate groups of con-sumers based on the drives and con-straints that operate for each group. Inconsumer talk, these groups are oftencalled ‘market segments’ and arethought of as somewhat homogeneousgroupings of potential consumers forpurposes of developing ‘consumer-appealing’ products and effectively tar-

geting advertising messages, communi-cation techniques, promotional efforts,and product information.

In the analysis for Benin, householdsand villages in the study area were cat-egorized into market segments, based onsimilar latrine adoption drives and con-straints, in order to develop appropriatetargeted strategies for stimulating de-mand. Individual lifestyle differencesbased on such indicators as gender,

Table 2 Constraints blocking latrine installation incentral Benin

Constraints related to:

Implemen- Psycho- Operational/Examples in Benin Awareness tation social performance

Lack of awareness ■

Misunderstandings ■

Bad soil/water table ■

conditions for pit

Lack of space ■

Technical complexity/inaccess- ■

ibility (skilled labour, expertise,special tools or.materialsneeded and hard to get)

High cost ■

Lack of cash/credit (finance) ■

Poor latrine design and ■

performance (smell, structuraland child safety)

Lack decision-making capability ■ ■

Adhere to/identify with social ■

norms (fear disrupting socialrelations)

Extended family interaction ■

problems

Family or village disapproval ■

of latrines

Psycho-physical aversion to ■

latrines (intolerance of feces,fear, conditioned to opendefecation)

Perceived benefits of open ■

defecation (fertilize soil, freshair, social interaction, privacy,feed pigs)

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occupation, lifecycle stage (age andhousehold structure), mobility andtravel, social linkages, education, andwealth were used along with such villageconditions as availability of open defeca-tion sites, social structure heterogeneity,level of regional integration, isolationand information/technology exposureand access, and exposure to latrines, toidentify the likely presence or absence ofdifferent drives and constraints explain-ing latrine adoption behavior in Benin.

Each community segment requiresdifferent strategies, resources, and phas-ing of actions to stimulate demand forlatrines. Computer mapping using theGIS system (Geographic InformationSystem) played a key role in both theanalysis and mapping of market seg-ments and village conditions for stimu-lating demand (Jenkins 1999b). It alsoprovides a useful tool for planning,monitoring, and evaluation of market-ing programme actions.

Some key policy implications of theresearch to stimulate demand for la-trines and increase adoption in ruralBenin included the following:

■ Promotional messages should reflectthe cultural values that underlie thereal advantages consumers seek inchoosing to install latrines and drawattention to the inadequacy ofpresent physical/social conditions interms of these same advantages andvalues.

■ Prevention of infectious diseases isnot an effective motivator of latrineadoption and should not be used totry to promote consumer demand.While cultural notions of goodhealth can be used in latrine promo-tion, separate long-term publichealth educational programmes,especially in schools, should focus onincreasing understanding of infec-tious disease transmission and itsprevention.

■ A single set of promotional messages,communications strategies, and la-trine ‘products’ is unlikely to workfor all segments of the population,given that the underlying motives

A single set of promotionalmessages, communications

strategies, and latrine ‘products’is unlikely to work for all

segments of the population,given that the underlying

motives that drive demandfor sanitation are neitherhomogeneous nor static

across households.

that drive demand for sanitation areneither homogeneous nor staticacross households.

■ Technical design enhancements tothe odour production, structuralintegrity, and safety (especially forchildren) of latrines are needed inBenin and must be developed, dis-

seminated, and publicized throughoperational research, training ofprivate-sector latrine builders, andconsumer informational campaigns.

■ The single most effective supply-sidestrategy to stimulate demand forlatrines in Benin may well be some

kind of finance scheme to providecredit to households for latrine con-struction. Carefully targeting suchschemes to consumers with a strongpreference for latrines who lack capi-tal, is a necessary condition for theirsuccess.

■ GIS is a helpful tool to identify thelocation of communities havingfavourable latrine demand-stimulat-ing conditions. These communitiescan serve as ‘diffusion’ centres forsurrounding communities/neigh-bourhoods in the start-up of a mar-keting programme.

■ Bundling the promotion of latrinesand the delivery of constructionsupport activities to highly desiredhousing improvements may be aneffective way to improve the image oflatrines and increase access to criticalinformation, resources, and otherinputs. Bundling could include suchthings as offering loans for housingimprovements, such as rainwatercisterns in Benin, on condition thathousehold latrines are also built,targeting private builders of theseimprovements for training and infor-mation dissemination on latrine

GIS map of market segments for sanitation promotion in central Benin. The map pinpointsthe locations of the four market segments of communities for latrine promotion on a regionalscale identified from the 500+ communities studied.


26


design and construction, and linkinglatrines to these highly desired itemsin publicity campaigns.

The consumer-oriented frameworkused in this investigation for analysingsanitation choice and the policy implica-tions for market-based promotion areapplicable to sanitation demand in anysetting, whether rural, urban, or peri-urban, and any technology, from pitlatrines to sewer hook-ups. Becauseurban settings are diverse, market seg-ments requiring different sanitationproducts/services and promotionalstrategies will be needed to satisfy andstimulate demand among differentpopulation segments. GIS can be help-ful, along with community analysis, inmapping and analysing the differentneighbourhood environments and sec-tor conditions that affect sanitationdemand in terms of the most widely feltdrives for improved sanitation and themost critical constraints limiting de-mand. Lifestyle differences are crucialfor understanding the market and thesemust be understood and uncovered as

well, through dialogue with households,focus groups, attitudinal surveys, prod-uct testing, etc. Implicit in these ideasabout consumers and the market is therecognition that sanitation is in largepart a private consumer good, albeitwith important public externalities, andits provision can be achieved efficientlythrough regulated markets.

AcknowledgementThis research was accomplished withsupport from UNICEF Benin, MedicalCare Development, Inc. (Washington,D.C.), and the US National ScienceFoundation (Washington, D.C.).

References

Altaf, M.A. (1994) ‘Household demandfor improved water and sanitation in alarge secondary city’. Habitat Interna-tional, vol. 18, no. 1, pp. 45-55.

Altaf, M.A. and Hughes, J.A. (1994)‘Measuring the demand for improvedurban sanitation services: Results of acontingent valuation study inOuagadougou, Burkina Faso’. UrbanStudies, vol. 31, no. 10, pp. 1763-1776.

Jenkins, M.W. (1999a) Sanitation promo-tion in developing countries: Why thelatrines of Benin are few and far be-tween. Ph.D. dissertation, Departmentof Civil and Environmental Engineer-ing, University of California at Davis.

Jenkins, M.W. (1999b) ‘Using GIS tounderstand latrine adoption behaviorand promote improved sanitation indeveloping countries’. Infectious Dis-ease Review, vol. 1, supp. 2. Proceed-ings of the First International HealthGeographics Conference, Baltimore,Maryland, 16-18 October 1998.

Singh, B., Ramsasubban, R., Bhatia, R. etal. (1993) ‘Rural water supply inKerala, India: How to emerge from alow-level equilibrium tap’. WaterResources Research, vol. 29, no. 7, pp.1931-1942.

Whittington, D., Lauria, D.T., Wright,A.M. et al. (1993) ‘Household demandfor improved sanitation services inKumasi, Ghana: A contingent valua-tion study’. Water Resources Research,vol. 29, no. 6, pp. 1539-1560.

When it is built, the pilot plant willhave about the same capacity as thefuture community-scale treatmentplants. To avoid serious problemsshould it fail, a relatively underpopu-lated site was selected for it—a site nearthe river Choluteca, just outside a com-munity of 1,200 people where a sewer-age project had recently been completed.

The pilot design takes the wastewaterdown through several stages, using grav-ity only:

■ Pre-filtering through sand to removesolids;

■ A standard Imhoff tank (a two-com-partment treatment tank with diges-tion in the upper compartment andsettling in the lower);

■ A trickling filter with stationarysprinklers;

■ And finally, a post-sedimentationtank to remove sludge particles from

the effluent. A sludge-drying bed isalso included, so the plant will becompletely independent from exter-nal services.

The community itself can do theoperation and maintenance. The plantruns completely on gravity and has nomoving parts. To reduce the investmentcosts, cheap local materials and localconstruction techniques are used wher-ever possible. The construction costs areestimated at $18,000, or $15 per person.As with all the construction projects ofthe Tegucigalpa programme, the com-munity will provide manual labour toreduce the costs of construction evenfurther.

Follow-upIf the pilot project is successful it couldbe expanded to other communities. Butsince the conditions will probably varyin each community, the design might

require modifications, or another tech-nology might be more appropriate.

To monitor the overall effects on theenvironment, it will be important todevelop a programme for systematicmonitoring of the water quality in therivers. Although everyone agrees that thewater quality is poor, no reliable dataexist to prove this or to supply baselinedata against which to measure any im-provements that may result from thenew wastewater treatment plants.

While it makes sense for the city pri-orities to have shifted to reconstructionworks after hurricane Mitch, it would bea mistake to postpone the solving of thewastewater problem for too long. On thecontrary, integrated systems for water,sewerage and sewage treatment coveringthe whole urban water cycle shouldsupply the basis of the reconstructionworks, to create a healthy living environ-ment for Tegucigalpa’s children andtheir families.

■ Honduras: Wastewater Treatment from page 21

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management, it should also proveuseful to other interested profession-als, both in UNICEF and also in gov-ernment and civil society. Thehandbook is, above all, a practicalguide for implementing UNICEFstrategies in water and environmentalsanitation. As such it is an importanttool for all field professionals workingto accelerate progress towards thegoals established at the World Summitfor Children.

For more information, or to ordercopies, please contact the WES Section,UNICEF New York, [email protected].

Vers une meilleureprogrammation: Un manuelsur l’hygiène et l’assainisse-ment en milieu scolaire

Hacia una majorprogramación: Manual sobresaneamiento y higiene en laescuelaThese volumes are the French andSpanish editions of A manual on schoolsanitation and hygiene, featured in thelast issue of WATERfront.

This manual, a collaboration be-tween UNICEF and the IRC Interna-tional Water and Sanitation Centre inDelft, builds on the experience gainedfrom a number of country programmesto advocate integrated approachestowards clean, safe schools for allchildren. The issue is becoming all themore important as countries movetowards universal primary education:if the children entering school todayare given the right tools and knowl-edge, the generations of tomorrow willbe better equipped to safeguard theirfamilies’ and communities’ health andenvironment.

For more information, or to obtaincopies, please contact the WES Section,UNICEF New York, [email protected].

Out in the cold: Emergencywater supply and sanitationfor cold regionsBy Mark Buttle and Michael Smith,WEDC, 1999During the 1990s, events in the Bal-kans, the former Soviet Union coun-tries, Afghanistan and northern Iraqhave demonstrated that humanitariandisasters are not limited to ‘the South’,Africa or the tropics, but may strikeanywhere in the world. Relief agencieshave been tested in ways previouslyunimaginable. Aid workers have to beever more adaptable in order to pro-vide life-saving water supplies andsanitation facilities in areas wherefreezing conditions occur.

This pocket-sized 94-page hand-book is intended for aid workers oper-ating in cold or cool temperateregions. It is designed to provide sup-plementary information that can beused together with the informationgiven in more general emergencymanuals.

The handbook is available online athttp://www.lboro.ac.uk/departments/cv/wedc/out/contents.htm. For furtherinformation contact the Water, Engi-neering and Development Centre(WEDC), Loughborough University,Leicestershire LE11 3TU, UK, or [email protected].

Towards better programming:A water handbook

Vers une meilleureprogrammation: Manuelsur l’eau

Hacia una major programa-ción: Manual sobre el aguaThis water handbook—part of theUNICEF Programme Division techni-cal guidelines series on water, envi-ronment and sanitation—is the resultof wide collaboration within UNICEFand with its partners, tapping morethan three decades of lessons learnedfrom programming for waterthroughout the world.

The handbook provides a broadoverview of state-of-the-art program-ming for water management, protec-tion and supply. It provides extensivecoverage on key sectoral issues such ascommunity management and mainte-nance of water resources, the need forcost-effective solutions, and, perhapsmost importantly, how to promotecommitment and involvement inthese issues from the very highestlevels of government to the smallestcommunities. The handbook alsosummarizes the technologies andmethodologies applied in UNICEF-supported country programmes.

While A water handbook is in-tended primarily for UNICEF pro-gramme officers working in water

New Publications

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A newsletter for information exchange on Water,Environment, Sanitation, and Hygiene Education

UNICEFProgramme Division

Water, Environment andSanitation Section

Please send articles, illustrations and correspondence to:

The Editor, WATERfrontUNICEF Programme Division, WES Section

Three United Nations Plaza, TA 26ANew York, N.Y. 10017. U.S.A.

Telephone 1-212-824-6000Fax No. 1-212-824-6480e-mail: [email protected]

Printed on recycled paper

WATERfront

“The time for action is now”By Colin Davis, Chief, WES Section, UNICEF Ethiopia

Short version of a presentation at theconference on “Integrated development forwater supply and sanitation” organized byWEDC (Water, Engineering and Develop-ment Centre, University of Loughborough),Addis Ababa, 30 August 1999

The UNICEF ECC programme (EarlyChildhood Care for Survival, Growthand Development) is a cross-sectoralapproach with a holistic strategy to ad-dress the child’s right to survival, protec-tion, care and development. From aUNICEF programming perspective, theECC focus would be on:■ family conditions and practices■ community conditions and practices■ social policies■ laws and institutions■ cultural values and beliefs.

UNICEF takes the ECC approach asa major new thrust of its programmingwith the following rationales:

■ A social rationale: Child developmentshould be put at the front end ofhuman development—first thingsfirst. The Convention on the Rightsof the Child says that the child has aright to develop to the “maximumextent possible”.

■ A scientific rationale: There is nolonger any doubt that the early yearsin a child’s life are critical in the for-mation of intelligence, personalityand social behaviour.

■ A programmatic rationale: If childrendevelop better in their early years,education programmes directed tothem later on will have greater im-pact, and health programmes andservices will have a better chance ofsustainable success.

■ Force of numbers: More children aresurviving today than was the case inthe past. However, they are survivingin the same conditions of povertyand stress: growing urbanization,

industrialization, the spread of con-flicts and the relentless spread ofHIV/AIDS all mean there is a grow-ing imperative for new forms of at-tention to the way in which childrengrow and develop. With HIV/AIDSespecially, if there is to be a ‘windowof hope’ it is by working with theyoung children.

■ A firm base: There is a synergismbetween health status, nutritionalstatus and psychosocial well-being.Too many programmes have, in thepast, perhaps been too monofocal indesign, lacking the integration thatwould have so enriched and encour-aged a sustainable and improvedoutput.

In support of the ECC approach,there is perhaps a new and greater ur-gency than ever before, a challenge—thepromotion of programme integration.In this, families and communitiesshould, as a right, have access to infor-mation and services affecting care prac-tices, health, nutrition, hygiene,sanitation, education and socialization.

Integration is a critical programmingelement in creating an enabling environ-ment. Fostering a child’s developmentby better programme integration willpositively affect the child’s survival andgrowth. Where absolute integration ofprogramme delivery is difficult, thenconvergence of programmes in familiesand communities which have been iden-tified as being most in need should be apriority.

The title of this, the 25th WEDCconference, is “Integrated developmentfor water supply and sanitation”. Theimportance of integrating these two vitalservices is being stressed; it has perhapsnever been more urgent to ensure thatintegration, or at least convergence,actually takes place. There is no doubtthat sanitation lies at the heart of humandignity and is essential, along with safewater supply and hygiene, for the preven-

tion of about one quarter of all prevent-able deaths among children every year.

At a major workshop on environ-mental sanitation and hygiene whichwas held in June 1998 at UNICEF NewYork, a number of recommendations foraction were made, some of which are:

■ Stimulate and support governmentsto develop national policies for sani-tation and hygiene.

■ Access to sanitation in schools, espe-cially for girls and female teachers, isa priority.

■ Advocate community-based financ-ing initiatives.

■ Develop a communication frame-work to promote good sanitation andhygienic practices among childrenand care-givers. Implement thisframework throughout the primaryeducation period as part of an earlychildhood care and protection pro-gramme.

The time for action is now. The needfor early childhood care and develop-ment, in a programme of sanitation andhygiene education and as a right forchildren everywhere, has never beengreater. You are urged to consider this asyou participate in this WEDC confer-ence over the next five days.

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ISSUE 12ISSUE 13 FEBRUARY 1999DECEMBER 1999 WATERfront · waterfront issue 12issue 13 • february 1999december 1999 a unicef publication on water, environment, sanitation and hygiene