Sanitation for Low-Income Regions: A Cross-Disciplinary Review

Abstract

Nearly two decades after sanitation was identified as a global priority under the Millennium Development Goals, more than 4 billion people still lack access to safely managed sanitation and two-thirds of all human waste generated remains unsafely disposed. While the Sustainable Development Goals include ambitious targets for sanitation coverage, the current pace of progress will bring us far short of these aims. Despite sanitation's economic promise of 9-fold investment returns and numerous cross-sectoral benefits --from girls' education to environmental health --realizing universal and sustainable sanitation access is proving to be an elusive task.Over the past 20 years, sanitation research has grown broader in scope and deeper in complexity through diverse disciplinary approaches. Originally, sanitation research was entirely focused on containing fecal waste and preventing diarrheal diseases --placed squarely in the domain of environmental engineering and public health. However, the literature on sanitation has since expanded into economics, urban planning, cultural studies, gender studies, and beyond. While this diversity has extended the scope of traditional sanitation research, adding richness to our understanding of this complex topic, it has also rendered the term "sanitation" more nebulous. Such diverse perspectives have led to myriad, and even contradictory, definitions of what sanitation is, what it does, and what it is good for. As a result, we find that ideas about the designated functions of sanitation systems and the priorities of sanitation policy vary widely among academics, policymakers, NGOs, and community members.We review the full range of disciplines that now houses sanitation research with the goal of understanding the overlaps and disparities among and between these perspectives. Our review:(1) examines and systematically summarizes the interdisciplinary conversation around sanitation;(2) facilitates within-disciplinary understanding of cross-disciplinary definitions and priorities; and (3) recommends a more complete framework for sanitation for decision makers as well as for future research. Our aim for this work is to help those in the sanitation sector avoid the pitfalls and disciplinary silos that contributed to the failure to meet the Millennium Development Goals for sanitation as well as the current shortcomings in meeting SDG 6.2.

Understanding Open Defecation in the Age of Swachh Bharat Abhiyan: Agency, Accountability, and Anger in Rural Bihar

“…. " [35] 2/21/2020 3:49:00 PM (p. 694) is central to understanding the social determinants of health, and is a constant theme in the planning literature on sanitation [42,60,61]. For example, Hindu notions of purity and pollution have been well documented as a reason for persistent OD and a reluctance to handle one's own fecal waste [32,62], and explain why people much prefer to build large pits.…”

“…While this approach has had some success in reducing OD in the short term, there is little evidence that it leads to sustained improvement [33,34]. This pushes us to look to the broader structural (i.e., political and social) determinants that are equally essential for latrine adoption [28,42]. Doing so can generate new insights into the associations between social determinants and disparities in latrine ownership and use in India, and thus generate critical knowledge on how to design better sanitation interventions.…”

Taking Container-Based Sanitation to Scale: Opportunities and Challenges

“…In places where water tables are high or infiltration is slow, there could be significant standing water and contamination issues. There has been substantial research by the VUNA project among others on urine resource recovery, but these technologies have not been integrated into CBS services (Simha and Ganesapillai, 2017;Hyun et al, 2019;Nagy et al, 2019) 12 . Applied research that achieves a value-add proposition for integrating urine and graywater solutions in CBS services is an area of great interest.…”

Exploring barriers to the adoption and utilization of improved latrine facilities in rural Ethiopia: An Integrated Behavioral Model for Water, Sanitation and Hygiene (IBM-WASH) approach

“…Of these deaths, nearly 361,000 (over 1000 deaths per day) occurred in children below the age of five [ 8 ]. In 2015, the pooled global economic loss attributed to sanitation-related premature deaths, health care expenditure for treating sanitation correlated diseases, output lost due to illness, and time lost to access sanitation facilities was estimated to be 222.9 Billion Dollars [ 9 ].…”