Indicators for Sanitation Quality in Low-Income Urban Settlements: Evidence from Kenya, Ghana, and Bangladesh

Abstract

In recent years, shared facilities have contributed substantially to increased access to sanitation in urban areas. While shared sanitation is often the only viable option in densely-populated, low-income urban areas, it is currently considered a “limited" solution by the international community. In this paper, we analyze the conditions under which shared sanitation could be considered of adequate quality and propose a set of indicators associated with sanitation quality to be included in national household surveys. We conducted a survey with 3600 households and 2026 observational spot-checks of shared and individual household toilets in Kisumu (Kenya), Kumasi (Ghana), and Dhaka (Bangladesh). We develop a composite sanitation quality outcome measure based on observational data. Using regression analysis, we identify self-reported indicators that correlate with the spot-checked composite measure and are, therefore, robust with regard to reporting bias. Results show that (pour-) flush toilets are a highly informative indicator for sanitation quality compared to other toilet technologies. In contrast to previous arguments and depending on the context, sharing a toilet has a comparatively lower correlation with sanitation quality. Toilets still show good quality if shared among only 2–3 households. Toilet location and lighting, as well as the presence of a lockable door, are equally strong indicators for sanitation quality and could serve as alternative indicators. The findings suggest that the sanitation service levels defined by the WHO and UNICEF might be reconsidered to better capture the quality of sanitation facilities in low-income urban settlements.

Water, sanitation and hygiene at sex work venues to support menstrual needs

“…However, the majority of venues assessed in our study were bars (with and without lodging), which is in keeping with the national key population hotspot estimation exercise, where they comprised 75% of hotspots; streets/alleys/highways accounted for 5%, guest house/lodging 4.4%, and brothels (1.6%). Another strength of our study was the use of direct observation, as self-reported measures of sanitation have been shown to have low reliability ( 45 ).…”

Urban settlements quality in Kotabaru Village, Gondokusuman Subdistrict, Yogyakarta City

“…Settlements in urban areas are generally dense, so there is not enough land to provide standard environmental roads [20], the characteristics of residential buildings in Kampung Braga have high density, the distance of the buildings is close to each other and only separated by roads with a width of 0.5 m -1 m [21]. According to the Regulation of the State Minister for Public Housing of the Republic of Indonesia Number 25 of 2011 about the Implementation of Low-Cost Housing, environmental roads for pedestrians or two-wheeled motorized vehicles are at least 2-3.5 meters wide for the road body, 0.5 -0.75 meters for the road shoulder and has a road benefit area (damaja) between 360 -450 cm [22].…”

A Review of User Vulnerabilities Associated with Shared Sanitation Practices in Sub-Saharan Africa

“…Based on observations made in Kenya and Ghana, toilets shared by up to 3 households could be included in the basic service level. According to Meili et al [72] toilets shared among 2-3 households in Kenya and Ghana show good quality. On the other hand, the Sanitation Task Team's recommendation of a sharing limit of no more than five families or no more than 30 people [73] may also be considered even though their proposed maximum number of users is too high.…”