Why sanitation, spearhead of urban improvement in the 19th century, has become the laggard of the 21st

Drawing on a recently published paper in 'World Development', Gordon McGranahan considers why, given we seem to have the know-how, there are still so many people in cities without decent sanitation.

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4 March 2015

The lives of Vasanthi and Gopal have been transformed by the low-cost toilet provided as part of the Karnataka Urban Development and Coastal Environmental Management Project (Photo: Asian Development Bank, Creative Commons via Flickr)

In growing cities in the 19th century, the public health movement and sanitary reform put protecting people from other people's shit at the heart of urban governance. Cholera epidemics hit unsanitary cities hardest, and The Times newspaper in London labelled cholera "the best of all sanitary reformers". By the early 20th century, piped water and sewer networks had become emblematic of the modern, healthy and well-off city.

At the start of the 21st century, however, sanitation is one of the Millennium Development Goals (MDG) targets that is seriously off course. The share of the world's urban population without 'improved' sanitation facilities only fell slightly between 1990 and 2012, and the number of people actually increased from an estimated 547 to 748 million (PDF). Even more people are affected by bad sanitation.

Where conventional sewer connections are affordable and politically viable, as they were in the more affluent cities and towns of the early 20th century, the challenge of moving towards universal coverage is relatively straightforward. The sewerage system can be designed centrally, with engineers specifying the technological requirements and economists estimating the costs.

Given the political commitment, the financial requirements for moving towards universal coverage can be planned for. This centralised approach fits with the long history of government activism on sanitation, as well as providing a good basis for applying emerging rights-based approaches, which try to use legal means to hold governments to account for meeting the human right to sanitation (PDF).

It has been estimated (PDF), however, that in most of the countries where those lacking adequate sanitation are concentrated, less than one in ten urban households has a sewered flush toilet.

Lower-cost options that can in principle provide basic sanitation are available, but these are more decentralised, and generally require low-income users to play a major role in their operation and maintenance, particularly if the costs are to be kept down. This presents four critical challenges that create serious difficulties not only for markets and for planners, but also for rights-based approaches:

1. The local collective action challenge

Bad sanitation creates public problems that individuals cannot resolve on their own. If you live in a deprived neighbourhood, improving your own facilities won't prevent other latrines in the neighbourhood from overflowing in the rainy season, other people's poorly constructed latrines from contaminating your well, your children being exposed to open defecation, and so on.

In the name of the right to sanitation, neighbours using low-cost technologies (such as communal latrines or simplified sewers) need to make demands on each other, as well as on "higher" authorities. They need to cooperate with each other to achieve basic sanitation.  

2. The coproduction challenge

Nobel Prize-winning economist Elinor Ostrom used the concept of coproduction (PDF) to argue that for some public services it is a mistake to make a sharp distinction between private and public sectors, or between users and providers, as the services are best produced by local residents and public (or publicly regulated) agencies working closely together. She took low cost sanitation as one of her main examples.

Under most systems, residents need to take primary responsibility for how the sanitation facilities operate within their community, centralised public agencies need to take primary responsibility for the final disposal of faecal sludge, and both must be aware of, and responsive to, the challenges the other faces.

For some grassroots organisations, coproduction is not just a practical strategy for extending service provision, but a political strategy for securing more effective relations with authorities. Achieving the level of cooperation required for effective coproduction can be a real challenge, but the benefits can also be great.

3. The affordability challenge

Agreeing on improvements is complicated, since what is affordable in very low-income neighbourhoods is rarely considered acceptable to either the public authorities or the communities.

This is not surprising: people living on unacceptably low incomes cannot afford acceptable sanitation, and subsidies have been out of favour in recent decades.

Price controls with meagre subsidies often result in both subsidies and services going to a relatively affluent minority. Regulations simply requiring people to meet acceptable standards are more likely to drive out than to raise up residents living in poverty. Difficult compromises, supported by pressure from below, are needed to develop adequate, financially viable and locally affordable solutions.

4. The tenure challenge

In many of the urban neighbourhoods where sanitation is lacking, there are also tenure problems that can prevent both residents and public agencies from investing in improvements.

Residents do not want to invest in sanitation facilities if they may soon be forced to leave. Governments do not want to invest if they don't think the people should be living there: not only will the investment be lost if residents do leave, but the investments may entice them to stay.

The Bombay High Court, for example, rejected a petition to allow water to be provided to an 'illegal slum', noting that "you would not want to move away from that place if you have water and electricity". This sort of logic is likely to be more prevalent where authorities are concerned that too many low-income migrants are coming to cities.

Overcoming these obstacles

The simplified sewers of Karachi, developed through the Orangi Pilot Project (OPP), had as one of their building blocks lane committees that included representatives from every home that was connected to the sewer (collective action). The approach involved what came to be called component-sharing, with the simple sewers within the neighbourhoods the responsibility of the community, while the trunk sewer fed by the smaller sewers was the state's responsibility (coproduction).

The technologies selected were not necessarily what people wanted but what they could afford, with the state picking up the costs of the trunk sewer and any wastewater treatment, making them far cheaper than conventional sewers (affordability).

The resulting system made tenure in the settlements involved more secure by increasing their legitimacy (tenure). Over a few decades this model spread widely, and informed the national sanitation strategy in Pakistan.

The public toilets in Pune and Mumbai developed through Mahila Milan, SPARC and the National Slum Dwellers Federation of India (the Alliance) (PDF) grew out of local organising, through women's savings groups and slum dwellers associations (collective action).

The approach that emerged was presented to local authorities as a community-based solution that they could support (coproduction). The design of the public block toilets responded to local priorities, but also recognised local needs for affordability. As shared facilities they would not even be considered as improved sanitation in the international statistics used for monitoring the MDGs.

Again, the resulting sanitation facilities helped the communities become more secure, turning on its head the familiar adage that land tenure insecurity undermines the willingness to invest in better sanitation. Again, the model spread widely in Pune and Mumbai and went on to inform national strategies in India.

Such successes are the exception, not the rule, and unlike conventional sewers and utilities, they do not provide a model that can be rolled out in diverse locations with little modification.

Indeed, one of the underlying difficulties is that low-cost sanitation provides the sorts of challenges that the top-down government planning and markets, which have been rolled out around the world, are ill-suited to address.

As successful examples, however, both OPP and the Alliance provide important lessons that other demand-driven initiatives grounded in local organisation can learn from.

Gordon McGranahan (gordon.mcgranahan@iied.org) is principal researcher in IIED's Human Settlements Group and team leader on urbanisation.