“Intensive agriculture requires fertilizers, whose main component is phosphorus, yet where does our phosphorus go after it goes into crops and is digested?” said eThekwini Municipality Water and Sanitation director Neil MacLeod. “Into a toilet. And then it goes into a treatment works, then into a river, and it gets washed into the sea.”

With an estimated 30 percent of household water used to flush Durban’s toilets – water which the city has paid to pump and purify – MacLeod sees flushing toilets as unsustainable technology. Like much of Africa, South Africa is water-scarce, with water restrictions expected soon for this city of 3.7 million, whose population is swelling by some 150,000 people per year.

MacLeod sees salvation in an alternative toilet that uses no water at all. Called the Urine Diverting (UD) toilet, it separates urine from faeces so that nutrients can be recovered and returned to the earth. Nitrogen, potassium and phosphorus – aka NPK 5:3:1 – is an excellent fertilizer for growing vegetables.

Africa’s busiest port city started installing UD toilets in 2003. Some 70,000 are now in use in all its outlying areas. One of the largest dry toilet schemes in the world, eThekwini municipality’s effort is seen as offering a potentially replicable and sustainable sanitation model for municipalities elsewhere in Africa.

Backed by a four-year U.S.$3-million grant from the Bill & Melinda Gates Foundation, the city of Durban has started to harvest the urine from its UD toilets. Nutrients are being extracted with technical assistance from the Swiss Federal Institute of Aquatic Science and Technology (Eawag).

“Now we’re doing the research to see how we can turn the collection of urine into a business,” MacLeod explained. The city has found entrepreneurs who are prepared to remove the urine for processing. Efforts are underway to take small businesses to scale, as job creation is desperately needed in this city where about 40 percent of the population earns less than $2 a day.

Other areas that Durban’s sanitation project aims to research include finding ways to recycle sewage water, to grow algae in treated water and to use the biodegradable contents of waste to generate energy. “Then we solve our three problems,” concludes MacLeod. “We have sustainable water, agriculture and energy. You see how waste is the key to a sustainable future for developing countries? So treat it as a valuable thing, and not something nasty.”

Overcoming the nasty part remains a challenge. AllAfrica spoke to some residents of the informal settlements that are home to an estimated 900,000 people in eThekwini municipality to find out their views on dry toilets.

Agnes Mthethwa, 37, a domestic worker, had not heard about plans to build dry toilets from the ward councilor who represents her area. She uses a pit latrine outside the shack where she lives in Bester Camp, near the mainly Indian and African township of Phoenix, and says the municipality doesn’t care enough about people in the informal settlements.

Zwelibabanzi Ntombela, 42, was also unaware of the new sanitation plans.

“I haven’t heard about dry toilets, but it doesn’t sound like they would be suitable for people like us,” she said. “Maybe it’s something for people in rural areas.” Now that he found a training position with the city’s transport department, he has installed a flushing toilet in his house in Inanda Newtown township, on the outskirts of Durban.

Community leader Thembinkosi Qumbela, 45, uses communal ablutions and toilets in the Mayville shack settlement where he lives, just a few kilometers from the city centre. For him: “Toilets are not about saving water – they’re about the dignity of people living in informal settlements.”

Water and Sanitation head McLeod knows that these are the kinds of attitudes that eThekwini municipality will have to overcome. That’s why his department’s outreach goal is “how to make dry toilets sexy”.

“The flushing toilet was invented in 1860, for Queen Victoria, and we use practically the same toilets today,” says MacLeod. “If I gave you a cellphone that was made in 1980, you’d say, ‘I don’t want that thing, I want a Blackberry, or a Nokia or a smartphone,’ because the technology has advanced. So I want you to see a flushing toilet like the cellphone of 1980: clumsy, wasteful, not very clever.”

“I actually said to Bill Gates: ‘Bill, when you have a dry toilet in your $100-million dollar house, then I will have succeeded.’ I can say, ‘Even Bill Gates has a dry toilet in his house – it’s the toilet of the future’.”

http://allafrica.com/stories/printable/201106281257.html

PUPILS WHO STUDY IN SCHOOLS THAT, FOR INSTANCE, PROVIDE WATER AND SOAP ARE MORE LIKELY TO WASH HANDS THAN THOSE IN SCHOOLS THAT DO NOT HAVE THE FACILITIES

NAIROBI (Xinhua) — Schools that promote a healthy learning environment for pupils help to improve their academic performances, a team of researchers has said.

The researchers said such schools, among other things, ensure that the institutions have access to water and sanitation facilities and teachers engage pupils frequently on discussions about health.

This promotes teaching and learning thus increasing student’s chances of excelling in their academics.

The researchers from the Nairobi-based African Population and Health Research Center (APHRC) worked with 22 primary schools in two informal settlements in Nairobi, Kenya under an initiative dubbed Health Promoting Schools ( HPS ).

As in other African countries, residents of slums in Kenya do not have access to water and sanitation.

The researchers divided the schools into two, one acted as the control group and the other as the intervention.

In the latter, the researchers helped the schools develop health policies, come up with health coordinators and health committees comprising of teacher, students and parents.

Thereafter, they trained teachers on health education, leadership, hygiene and life skills. In addition, they improved pupil’s water access by introducing water tanks, providing water points and liquid soap.

And with the help of teachers, they wrote health messages at places where pupils can read them easily. One such a message on a wall of a classroom at a school read, “Wash your hands for better living.”

According to the researchers, in schools that worked as control groups, they observed little or no change in health promoting activities like hand washing, which helps prevent communicable diseases particularly in school settings.

On the other hand, in the intervention schools, children, for instance, valued hand washing as an important health practice.

“When we started, the number of children who washed hands frequently was about six percent. This increased to over 80 percent in a period of 10 months that we carried the intervention mechanisms,” said Osnat Keidar, the lead researcher in the new research released recently.

She noted that pupils who study in schools that, for instance, provide water and soap are more likely to wash hands than those in schools that do not have the facilities.

The students, she noted, are less likely to suffer from respiratory infections and stomach related problems, which arise because of poor hygiene.

“Sanitation interventions help students to have time to focus on their studies. Many of them will also not absent from school because they have kept diseases at bay,” Osnat said.

During the study, they observed that girls are more likely to observe hygiene and other health practices than boys.

“This is because of the way girls are socialized as opposed to boys. It, therefore, makes it easier for them to practice hygiene especially when schools have adopted health programs,” she said.

Osnat said that the more teachers are engaged in promoting health activities in schools, the more students are likely to practice hygiene thus improving the learning environment and consequently their performance.

The researchers advised that schools should integrate health activities in both their curricular and extra-curricular activities.

“Schools can mainstream skill-based health education focusing on hygiene and life skills into the curriculum and extra-curricular activities using story books, drama, poems, song and health clubs, “ they said.

Judy Maina, a teacher at Super Action Center in Korogocho slum, Nairobi, which participated in the research said pupils are now conscious about hygiene than they were before.

“The students now mind the water they drink to avoid diseases.

“They clean the filters to remove dust for them to always have clean water. They clean them after every three days using boiled water and disinfectants,” she said.

She added that the students have also learned other purification processes like using chlorine and boiling to make water clean.

They also wash hands after visiting the toilet or before eating.

http://www.coastweek.com/3425_31.htm

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Abebe Damte, Steven F. Koch. University of Pretoria

The heavy dependence and inefficient utilization of biomass resources for energy have resulted in high depletion of the forest resources in Ethiopia, while the use of traditional cooking technology, one source of inefficient biomass resource use, has been linked to indoor air pollution and poor health. In response, the government and other institutions have pushed for the adoption of new cooking technologies.

This research examines the speed of adoption of some of these technologies – Mirt and Lakech cook stoves – in urban Ethiopia. The duration analysis suggests that adoption rates have been increasing over time, that income and wealth are important contributors to adoption, and that substitute technologies tend to hinder adoption. However, it was not possible to consider prices or perceptions related to either the technologies or biomass availability in the duration models, and, therefore, further research is needed in order to further inform policy with respect to household technology adoption decisions.

Psutka R, Peletz R, Michelo S, Kelly P, Clasen T.

Boiling is the most common method of disinfecting water in the home and the benchmark against which other point-of-use water treatment is measured. In a five-week study in peri-urban Zambia, we assessed the microbiological effectiveness and potential cost of boiling among 49 households without a water connection who reported “always” or “almost always” boiling their water before drinking it.

Source and household drinking water samples were compared weekly for thermotolerant coliforms (TTC), an indicator of fecal contamination. Demographics, costs and other information were collected through surveys and structured observations. Drinking water samples taken at the household (geometric mean 7.2 TTC/100ml, 95%CI 5.4-9.7) were actually worse in microbiological quality than source water (geometric mean 4.0 TTC/100ml, 95%CI 3.1-5.1) (p

Only 60% of drinking water samples were reported to have actually been boilded at the time of collection from the home, suggesting over-reporting and inconsistent compliance. However, these samples were of no higher microbiologial quality. Evidence suggests that water quality deteriorated after boiling due to lack of residual protection and unsafe storage and handling.

The potential cost of fuel or electricity for boiling was estimated at 5% and 7% of income, respectively. In this setting where microbiological water quality was relatively good at the source, safe-storage practices that minimize recontamination may be more effective in managing the risk of disease from drinking water at a fraction of the cost of boiling.

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Climate change is happening, and the urban poor are extremely vulnerable to its impacts. Demand for water and sanitation services in low-income urban areas is likely to increase, while flooding and water shortages may become more frequent.

This Practice Note outlines a rapid assessment method, developed for WSUP by Cranfield University, that can be used to plan the climate-proofing of a city’s water and sanitation services.

Download Full-text (pdf)

Recently developed tools that enable web-based geographical representation of data have exciting applications in the design and monitoring of WASH systems. This note introduces three tools currently being used in the sector.

Vast sums are wasted on programmes for free toilets, but the community-led total sanitation approach has helped millions avoid often fatal, faecally related infections.

Defecation mapping in progress in a village in the Democratic Republic of Congo, December 2010. This was set up by Tearfund and conducted by the CLTS team from Plan Kenya; 18 people attended this workshop, which 'triggered' action in six villages. Photograph: Philip Vincent Otieno/CLTS

Community-led total sanitation (CLTS) does not sound such a big deal, but it is revolutionary. We have so many “revolutions” in development that only last a year or two and then fade into history. But this one is different. In all the years I have worked in development this is as thrilling and transformative as anything I have been involved in. Let me explain.

Firstly, sanitation and scale: 2.6 billion people need improved sanitation and 1.1 billion defecate in the open. The millennium development goal (MDG) for sanitation is badly off track in most countries, which affects all the other MDGs.

Secondly, sanitation and hygiene matter much more than most people realise. Where they are lacking, the effects are horrendous. Faecally related infections are many. Everyone feels outrage because more than 2 million children are killed by diarrhoea each year. We hear about cholera outbreaks. But who hears about the guts of 1.5 billion people hosting greedy, parasitic, ascaris worms, about 740 million with hookworm voraciously devouring their blood, 200 million with debilitating schistosomiasis or up to 70 million with liver fluke? And what about dysentery, hepatitis, giardia, tapeworms, typhoid, polio, trachoma…?

On top of all these, many millions are affected by tropical enteropathy, where the gut wall is damaged and nutrient absorption is reduced – in effect, wasting food. All these can be dealt with through safe disposal of excreta and safe hygienic behaviour. We give undernourished children more, and better, food. Let that continue. But wouldn’t improved sanitation and hygiene also, in many cases, lead to more effective and longer-lasting solutions for tackling undernutrition?

The traditional approach to hygiene has been education and subsidy: people have to be taught, and poor people cannot afford toilets. But rural areas in developing countries are littered with the results of failed programmes: toilets not used, put to other purposes as stores, hencoops, shrines and the like, or dismantled and materials used elsewhere. Or the toilets go to those who are better off, not the poor. The dollars wasted run into billions; and in some countries like India very large sums continue to go, so to speak, down the drain.

CLTS turns these failed approaches on their heads. There is no standard design, no hardware subsidy, no teaching, no special measures for people unable to help themselves, and no use of polite words – “shit” is “shit” (India leads in the international glossary of words for shit, with Kenya following). Communities are mobilised into analysing their own sanitation and waste behaviour, making their own participatory social and shit maps, inspecting the shit in the areas of open defecation (OD), and analysing pathways from shit to mouth. Often children make their own analysis in parallel with adults and then present their findings to them. When people realise “we are eating one another’s shit”, that can ignite immediate action to dig pits and construct latrines with their own resources.

A follow-up of encouragement, emphasising handwashing and hygiene as well as construction, is important. Ideally and often, those unable to dig and build for themselves are helped by others. It is in the common interest. When a community can declare itself ODF (open defecation free), external verification takes place, and then there is a celebration.

The CLTS approach was pioneered in Bangladesh in 2000 by Kamal Kar, a development consultant from India. Since then he has been joined by many others to promote it including Plan International, Unicef, the Water and Sanitation Programme of the World Bank and Water Aid. The approach has been adopted in more than 40 countries. In a few it has stalled, but in most it is spreading and is already widespread in parts of south and south-east Asia. Sierra Leone, Mali, Kenya, Ethiopia, Zambia and Malawi stand out in Africa. In more and more countries CLTS has been adopted as hardware subsidies to individual households have been stopped. Worldwide, after discounting heavily for misleading reports of targets achieved, more than 10 million people are now living in communities that have credibly been declared ODF.

CLTS is not a magic wand. It faces serious obstacles: entrenched, and large, budgets for hardware subsidies; professional and bureaucratic sceptics and vested interests; training of facilitators in classrooms when it needs to be done hands-on, in real time, in communities; programmes with targets that are then reported “achieved”; myths of success; donor and lender agencies insisting on subsidies; and the corruption that so often goes with hardware programmes.

But it is driven by passionate champions. Many become energetically committed once they have experienced the power of CLTS – how it enhances human wellbeing. For women and girls, in particular, it has helped with menstrual hygiene, self-respect, and the bodily wellbeing of being able to defecate during daylight, in private – which is a transformation for women in South Asia.

It is thrilling. It is an international movement, itself a community of like-minded people who are inspired by the vast potential of the CLTS approach. And it has applications, too, for solid and liquid waste management, and perhaps other domains.

While the focus for CLTS was initially in rural areas, in India, Kenya, Mauritania and Nigeria it is being advocated for urban slums. Kenya is rolling out a big programme and has set itself the target of making all rural areas ODF by 2013. Other countries are doing likewise. The questions now are how well it can be taken to scale, and whether enough people at all levels – from policy-makers to local leaders and facilitators – have the vision, guts and commitment to make it happen widely and well. The MDG for sanitation is badly off-track in almost all countries, but with CLTS it need not be.

By 2020, say, could it be not 10 million but hundreds of millions who benefit? Is it hyperbole to say that the opportunity is brilliant? What do you think?

Robert Chambers is a research associate at the Institute of Development Studies, Sussex, working on community-led total sanitation. This blog post also appears on From poverty to power

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Order information: http://www.researchandmarkets.com/reportinfo.asp?report_id=1772268&t=d&cat_id=

Authors:  David Vlahov,  Jo Ivey Boufford, Clarence Pearson

Table of Contents

1. Urban Health in a Global Perspective (David Vlahov and Jo Ivey Boufford).
2. Globalization (Ted Schrecker and Ronald Labonté).
3. The Demographics of Urbanization in Poor Countries (Mark R. Montgomery).
4. Migration, Health Systems, and Urbanization (Ndioro Ndiaye, Manuel Carbhallo, and Rougui Ndiaye-Coïc).
5. Immigrant Health in Amsterdam, the Netherlands (Arnoud P. Verhoeff and Roel A. Coutinho).
6. City Case Studies: Global Climate Change and Cities (Tord Kjellstrom and Patricia Monge).
7. Age-Friendly New York City (Ruth Finkelstein and Julie Netherland).
8. Global Infectious Diseases and Urbanization (Thomas C. Quinn and John G. Bartlett).
9. City Case Studies: Confronting the New Epidemics in Our Cities (Stephen Leeder, Angela Beaton, Cathie Hull, Ruth Colagiuri, and Michael Ward).
10. Chronic Disease Care in Nairobi’s Urban Informal Settlements (Catherine Kyobutungi and Alex Ezeh).

11. Crime, Violence, Public Health, and Urban Life (Richard H. Schneider).

12. A Global Perspective on Disasters and Their Consequences in the Urban Environment (Maria Steenland, Godfrey Mbaruku, and Sandro Galea).
13. City Case Studies: Urban Terrorism (Robert J. Bunker and Pamela L. Bunker).
14. The Culture of Peace Against Violence in Zagreb (Stipe Oreskovic).
15. Urban Health Services and Health Systems Reform (Julio Frenk and Octavio Gómez-Dantés).
16. City Case Studies: Information Flow and Integrated E-Health Systems (Veronica Olazabal, Ticia Gerber, Beatriz de Faria Leao, Claudio Giulliano da Costa, Karl Brown, and Ariel Pablos-Méndez).
17. Governance for Health in London: Utilizing the Health Impact Assessment (Sue Atkinson).
18. Provision of Water and Sanitation Services (Jonathan Parkinson, Martin Mulenga, and Gordon McGranahan).
19. Urban Transportation (Rae Zimmerman and Carlos E. Restrepo).
20. Informal Settlements: In Search of a Home in the City (Vanessa Watson).
21. Urban Air Quality (Jonathan M. Samet).
22. Urban Planning and Aesthetics (Carola Hein, Kalala Ngalamulume, and Kevin J. Robinson).
23. Healthy Urban Governance (Scott Burris and Danielle Ompad).
24. Global Business at the Local Level (Nicholas Freudenberg).
25. Citizen Action for Urban Poverty Reduction in Low- and Middle-Income Nations (David Satterthwaite).
26. City Case Studies: Healthy Cities: Lessons Learned (Agis Tsouros and Geoff Green).
27. The Healthy City Program in Shanghai (Fu Hua).
28. Urban Health and Governance Model in Belo Horizonte, Brazil (Waleska Teixeira Caiaffa, Ana Luiza Nabuco, Amélia Augusta de Lima Friche, and Fernando Augusto Proietti).
29. Improving Population Health in a Rapidly Urbanizing World (Nicole Volavka-Close and Elliott D. Sclar).
30. Future Directions (Jacob Kumaresan).

CAMBRIDGE, Mass., May 10, 2011 /PRNewswire-USNewswire/ — Today one out of four urban residents in Latin America lives in a dwelling that does not have a legal title, or lacks urban services such as water and sanitation, or is constructed in a precarious location. Improving conditions in existing informal settlements and shantytowns in Latin American cities is a necessary and worthy goal, but the programs for “regularizing” these places have had mixed results so far, a new Lincoln Institute report says.

The two major approaches to regularization – legalizing parcels by awarding the occupants titles to the property as exemplified in Peru, and Brazil’s broader approach that combines titling with extensive upgrading of public services – both fall short of expectations. Titling by itself is relatively inexpensive but has not triggered neighborhood improvements, while upgrading is much more costly and can stimulate additional irregular development by those hoping to benefit from future upgrading.

The lack of revenue associated with regularization has inhibited the scaling up of such programs. Regularization programs can be more self-sustaining financially through property taxes and charges that capture some of the increases in land value caused by urban infrastructure and service improvements, according to Regularization of Informal Settlements in Latin America, the latest Policy Focus Report published by the Lincoln Institute of Land Policy.

“Customized, cost-effective, and sustainable approaches to upgrading have the potential to improve the lives of the many millions of people living in informal settlements,” said Gregory K. Ingram, president of the Lincoln Institute, “but regularization is a work in progress, and we need to learn more about what works.”

An estimated 127 million people in Latin American cities live in informal settlements, on public and private land, in many cases in neighborhoods that have existed for decades and physically resemble legal developments. Legal recognition is increasingly seen as the only realistic remedy for informal settlements, as evictions and massive relocations to new public housing are neither tolerated nor economically feasible in most countries.

Informality is attributed to many causes, including low income levels, unrealistic urban planning and building regulations, a lack of serviced land and social housing, and a dysfunctional legal system. It generates large costs for residents, including insecurity of tenure, lack of public services, discrimination by others, environmental and health hazards, and inequitable civil rights. It also poses both high direct costs for local governments when they undertake upgrading programs and substantial indirect costs when coping with other impacts of informality, such as public health, criminal violence, and related social problems.

“Regularization programs need to be designed carefully to avoid either making conditions worse for the low-income residents the programs are intended to help, or stimulating the development of new informal settlements,” said the report’s author, Edesio Fernandes, a lawyer and international expert on regularization, who was a visiting fellow at the Lincoln Institute in 2008-2009.

The report first assesses the narrow legalization of tenure through titling, undertaken by Peru. This approach is inspired by Hernando de Soto’s hypothesis that tenure security is a trigger for development, stimulating access to finance, economic activity, and residential upgrading. From 1996 to 2006 Peru issued over 1.5 million freehold titles at an average cost of $64 per household. Evaluations indicate that the titling programs had little impact on access to credit, but yielded some investment in housing, and may have contributed to some poverty alleviation. The programs also increased property values by about 25 percent, well in excess of the titling cost.

Brazil’s broader regularization programs combine legal titling with the upgrading of public services, job creation, and community support initiatives. At $3,500 to $5,000 per household, these programs are much more costly than Peru’s titling system, and Brazil has had more modest coverage of households. Ironically, service upgrading occurs more often with little or no change in legal tenure status, although the number of titles is increasing. The few evaluations that exist indicate that the increase in property values associated with upgrading exceeds its cost, as in Peru, albeit at a lower rate than in new urban developments.

However, many residents in informal areas feel secure with de facto property rights of ownership based on customary practices. Residents in informal settlements developed on private land often have bills of sale or related documents, and such properties are bought and sold regularly. Some residents seem to prefer this system of informal titling and often do not embrace the legal titling system.

Regularization of Informal Settlements in Latin America, which will be translated into Spanish and Portuguese, includes the following recommendations for programs going forward:

– Evaluate the performance of regularization programs, based on collecting both baseline data before program implementation and subsequent data on program costs and outcomes.
– Customize policies and programs, because a single approach is unlikely to work well across all situations.

– Use appropriate titling systems (freehold, leasehold, cooperatives, land trusts, or communal ownership) to ensure the socioeconomic sustainability of the community.

– Seek the participation of both men and women to avoid building gender bias into the process and to increase its long-term effectiveness.

– Make regularization more self-sustaining financially through property taxes and charges on urban infrastructure and service improvements to capture part of the resulting land value increment. Payments for urban services in regularized areas should be equitable, follow the same principles as in formal areas, and be affordable to residents whose current payments for some services, such as truck-delivered water, may exceed the costs of regular services.

– Support more research and analysis to determine if the situation is improving or worsening in particular cities and to prevent the establishment of additional informal settlements, particularly when they are thought to be caused by regularization programs themselves.

“While full regularization has proceeded slowly in most cases and most programs fall short of original expectations, cities in Latin America are finding that addressing informality on site is now a political imperative. Not engaging in regularization policies is no longer an option,” said Martim O. Smolka, director of the Program on Latin America and the Caribbean at the Lincoln Institute of Land Policy. “The long-run challenge is to provide infrastructure and services in an affordable and sustainable manner, pre-empting illegal occupations.”

Addressing the worldwide issue of informal settlement has been a focus of international agencies including UN-HABITAT, which adopted a resolution in April calling for sustainable urbanization through equitable access to land, housing, basic services, and infrastructure. Installing infrastructure ahead of development is also a conclusion of another recent Lincoln Institute policy focus report, Making Room for a Planet of Cities by Shlomo Angel, issued in January 2011.

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An excerpt from the transcript: The private sector serves nearly 70 percent of Pakistan’s population. Yet, out of the estimated 40 million low-income families here, 99.3 percent of them don’t have health insurance.

The introduction of Naya Jeevan in Pakistan hopes to change that. This new program is simple and affordable for employers, sponsors and beneficiaries. The equivalent of just $2.50 a month provides access to private health care and, crucially, regular health checks for contagious or infectious diseases as a preventive measure for a country that is still battling polio, malaria and hepatitis.

And hundreds of local companies, restaurants and multinational corporations are signing up for the plan for their low-income employees.

Link to podcast, transcript and video: http://www.pbs.org/newshour/bb/world/jan-june11/pakistanhealth_05-23.html