The Importance of Sanitation and the Relevance of a Water Security Approach

‘In a world of 7.3 billion people, 2.3 billion lack access to adequate sanitation, of which 892 million have no choice but to defecate in the open’ (WSSCC, 2016).

‘Sanitation generally refers to the provision of facilities and services for the safe disposal of human urine and faeces’ (WHO, 2017).

Access to sanitation is a fundamental determinant of a healthy human life and its absence is a major cause of disease. It is of particular importance to children with largely preventable diarrheal diseases claiming 561,000 aged under 5 every year (WSCC,2016). The majority of these deaths occur in sub-Saharan Africa.

Why the lack of attention?

Until relatively recently, sanitation drew little specific consideration in efforts for development. In part this is because issues surrounding hygiene and sanitation were intimately tied to those of water. In her 2008 book, Rose George suggests that ‘sanitation was an after thought, if considered at all’ (George, 2008:76). Indeed it is true that adequate sanitation practices are near impossible without clean water, but to amalgamate the two dismisses crucial differences. Simply securing an adequate water supply does by no means guarantee an adequate level of sanitation. Sanitation, by the WHO definition above, is more than just a reliable tap. It is structural – it requires disposal, washing facilities etc. but it is also cultural in the sense that its realisation must entail a certain level of social desire and understanding. With this in mind, it is clear that a water security approach, discussed in my previous post, may actually find limited success in achieving desired sanitation outcomes. Bartram & Bradley (2013:3) demonstrate this in the data from the table below:

Table 1: The table depicts the changes in the numbers and proportions of people in Sub-Saharan Africa with an improved water supply and improved sanitation between 1990 and 2010.

The data indicates a disconnect between access to an improved water source and access to sanitation. Despite a total of 522 million with access to water in 2010, less than half of those have adequate sanitation. Also highlighted is an interesting disparity between improvements in the number of people served and per cent coverage – this may go some way to explain the failure to meet certain targets (I plan to discuss this in my next post).

So why the disconnect?

The obvious answer to this question is one of infrastructure. As previously mentioned, good sanitation requires more than just taps and pipes but sewers, toilets and showers alongside social infrastructures of care and maintenance. Issues of right and capability present unclear questions of public/private provision that are best answered contextually. Indeed local milieus often dictate specificities that I will explore with case studies in later posts. Yet, a common theme across Africa is a divided Geography of sanitation infrastructure matching relations of power both within the city itself and outside it. Of particular note, is the glaring urban bias to which I hope to look more closely.

Yet, perhaps a more significant constraint on sanitation is education. People need to understand why sanitation is important and how to engage with it. Sandy Cairncross goes further to make the point that ‘people will not practise hygiene or maintain sanitation facilities unless they want to’ (Cairncross, 2003:195). Indeed this notion of a ‘felt need’ is prevalent across wider development projects to instigate engagement and long-term maintenance. The success of Unilever’s lifebuoy soap in South India demonstrates that an understanding of the need for hygiene can bring about meaningful change in sanitation access. Through the ‘Health in your Hands’ marketing strategy, Unilever partnered with local government to raise awareness and foster demand (Cross & Street, 2009:7). This project gets to the heart of the issue of sanitation in Africa and its clear differences to those of water. People understand their need for water. They know how to use it and are willing to pay for it. This is not the case for sanitation. ‘Health in your Hands’ changed this by challenging the way people thought about hygiene. The result was a demand for sanitation and a shifting of habit, a shift in societal norms and the lifestyle of the everyday. This is a change not to be underestimated and one that is necessary for meaningful sanitation improvements in Africa.

To conclude, it is clear that adequate sanitation can drastically improve public health. Yet, it is fundamentally constrained by its limited understanding both in need and provision. It is crucial that the misconception of more water equals more sanitation (Cairncross, 2003:194) be dismissed to recognise the importance of education and ‘felt need’. Indeed, the high sanitation levels in the face of water insecurity in many North African nations are testament to this.

In my next blog I will look at what is being done to remedy the lack of understanding and raise awareness of the importance of sanitation.