Health, hygiene and appropriate sanitation: experiences and perceptions of the urban poor

Abstract

"Don't teach us what is sanitation and hygiene."This quote from Maqbul, a middle-aged male resident in Modher Bosti, a slum in Dhaka city, summed up the frustration of many people living in urban poverty to ongoing sanitation and hygiene programmes. In the light of their experiences, such programmes provide "inappropriate sanitation", or demand personal investments in situations of highly insecure tenure, and/or teach "hygiene practices" that relate neither to local beliefs nor to the ground realities of a complex urban poverty. A three-year ethnographic study in Chittagong, Dhaka, Nairobi and Hyderabad illustrated that excreta disposal systems, packaged and delivered as low-cost "safe sanitation", do not match the sanitation needs of a very diverse group of urban men, women and children. It is of little surprise that the delivered systems are neither appropriate nor used, and are not sustained beyond the life of the projects. This mismatch, far more than an assumed lack of user demand for sanitation, contributes to the elusiveness of the goal of sanitation and health for all. The analysis indicates that unless and until the technical, financial and ethical discrepancies relating to sanitation for the urban poor are resolved, there is little reason to celebrate the recent global declaration on the human right to water and sanitation and health for all.KEYWORDS gendered identities / mismatch / sanitation and hygiene priorities / spatial heterogeneity I. SANITATION FOR THE URBAN POOR: WHOSE AGENDA, WHOSE PRIORITIES?One would assume that at a minimum, planning initiatives relating to sanitation services for the urban poor would take into account the realities of urban poverty. Yet, as Verhagen and Ryan(1) point out, sanitation agendas are often not well informed of the complex realities of urban poverty. The common practice is to "…force the urban poor to accept, and even expect…limited support" and/or to leave out those who do not fit in. Among the multiple distinctions that differentiate the urban poor, the two most critical aspects related to sanitation are first spatial, where one lives, and second gender, or the complexities of gendered identities and related sanitation needs and responsibilities in these diverse settings. However, sanitation policies and strategies for the urban poor rarely analyze the diverse heterogeneity of the urban poor: who they are; where and how they live -as illegal, quasi-legal or, in rarer instances, as legal residents of the city; and what they perceive, need and mostly lack as sanitation. In

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