When is shared sanitation acceptable in low-income urban settlements? A user perspective on shared sanitation quality in Kumasi, Kisumu and Dhaka

Abstract

Shared sanitation facilities (SSFs) have contributed considerably to sanitation access in many low-income settlements. While many SSFs are of unacceptable quality, others have been found to be a hygienically safe and a socially and economically viable sanitation option. Within its framework, the WHO/UNICEF Joint Monitoring Programme (JMP), evaluating progress on the Sustainable Development Goals, considers shared sanitation as ‘limited sanitation’. Overall, there is uncertainty about the criteria to distinguish between unacceptable and acceptable quality of SSF. In our study, we used a user-centred qualitative approach in low-income urban settlements in Kumasi (Ghana), Kisumu (Kenya) and Dhaka (Bangladesh) and conducted 17 focus group discussions to evaluate how SSF users define the quality of an SSF and which aspects they consider as essential priorities for good-quality SSF. In a descending order, the user priorities identified are: immediate water access, cleanliness, gender-separated toilets, flush toilets, lighting for use at night, lockable/functional doors, tiling, handwashing stations and privacy. This list can serve as input to the sanitation guidelines, local building codes and the establishment of minimum national sanitation standards. SSFs that meet these minimal criteria can then be promoted as an incremental step when individual household facilities are not feasible.

Developing and Testing Strategies for Improving Cleanliness of Shared Sanitation in Low-Income Settlements of Kisumu, Kenya

“…It is therefore possible that levels of dissatisfaction may reduce when there is collective action and users have clean toilets. This assertion is supported by recent studies indicating that cleanliness, privacy, and safety/security are attributes that make shared sanitation facilities acceptable, 39 and which may eventually lead to other benefits such as mental well-being. 40 Our results therefore support the importance of focusing on behavior of users of shared sanitation facilities especially in low-income areas.…”

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

“…To analyze the relevance of self-reported, sanitation-related indicators in predicting observed sanitation quality outcomes, we relied on two primary data sources: a household survey questionnaire and spot-check observations of the toilet cubicles used by the interviewed households. Both the potential quality outcomes and the explanatory variables (candidate indicators) were identified through a combination of formative qualitative research and the WHO guidelines on sanitation (Schelbert et al, 2020;WHO, 2018).…”

“…For the case of Tanzania, on the other hand, Exley et al (2015) find no correlation between shared toilets and pathogen contamination when compared to individual household toilets. It is also critical to consider factors beyond lack of hygiene and its associated health risks, such as privacy and safety, in order to understand when shared sanitation is adequate for all users, especially for women, children, and the elderly (Giné-Garriga et al, 2017;Sclar et al, 2018;Kwiringira et al, 2014;Tidwell et al, 2018;Simiyu et al, 2017b;Schelbert et al, 2020).…”

“…3 The objective of this paper is to check the reliability of the leading indicators currently used in international surveys and to obtain improved indicators for sanitation quality. To this end, we first identified candidate indicators in a qualitative formative study (Schelbert et al, 2020). Based on these candidate indicators, we build a Sanitation Quality Index (SQI) that centers around the needs and preferences of the users.…”

Where Shared Sanitation is the Only Immediate Option: A Research Agenda for Shared Sanitation in Densely Populated Low-Income Urban Settings

“…Preliminary findings from this study show that in addition to toilet technology and sharing, other factors such as the location of the toilet, whether the door has a lock and whether the floor is tiled, significantly influence overall toilet quality. 48 Characteristics of sanitation infrastructure can be objectively and rapidly measured, and structural quality had more of an impact on observed cleanliness and reported satisfaction than cleaning behavior in a study in Zambia. 49 However, measuring infrastructure alone is insufficient.…”