An essay on the benefits of sanitation in developing countries.

INTRODUCTION
This essay seeks to highlight with references four of the major benefits of sanitation in developing countries. Sanitation is the hygienic means of promoting health through prevention of human contact with the hazards of waste. In public health terms, the main source of this hazard is from human and animal feaces. Other sources include solid waste and domestic wastewater. Therefore, any intervention that seeks to separate these waste from humans is termed sanitation. Sanitation or sanitation interventions could be in form of hardware e.g. hygienic latrines or software in form of hygiene practice such as handwashing with soap. Mara et. al. (2010) opined that “Sanitation is the safe disposal of human excreta” defining ‘safe disposal’ as the hygienic containment or treatment of the excreta to avoid adversely affecting human health. Available 2010 figures show that 2.6billion people, mainly in the developing countries lack access to improved sanitation.It also showed that about 1.2billion people lack even an unimproved sanitation facility and practice open defeacation. (WHO, UNICEF, 2010). Statistics from various studies conducted have pointed to the enormous number of people that lack adequate sanitation worldwide and this has prompted some interventions and target setting by organisations across the world. Of such targets is the Millennium Development Goal (MDG) of the United Nations on sanitation which seeks to halve the population of people without adequate sanitation by 2015 using 1990 figures as baseline and also World Health Organisation (WHO) and United Nations Children’s Fund (UNICEF) target of ‘Water and Sanitation’ for all by 2025. These targets underscores the importance of sanitation among human population and is geared at creating awareness through all levels of government to the burden that lack of sanitation poses to the people. This essay shall describe the benefits that comes with sanitation in developing countries with references to buttress the importance of achieving this targets and what is at stake to be gained.
DISCUSSION

Sanitation has many benefits but one of the most important (if not the most important) is its contribution to the healthy living of a community or society. Health is wealth as it is commonly said. So, the health status of a community or family has a great role to play in their livelihood. Diarrhoeal diseases are mainly of feaco-oral route and they account for around 1.6 – 2.5million deaths annually. (Mathers C. D. et. al. 2006). Many of these deaths are under five children in developing countries. From the work of Black K. et. al. (2010), diarrhoeal was the leading cause of death among children under five years of age in sub-saharan Africa, resulting in 19% of all deaths in this age group. Eventhough studies carried out has not rigorously separated the specific effect of sanitation from the overall effect of water and sanitation intervention, systematic reviews has suggested that improved sanitation can reduce the rates of diarrhoeal diseases by 32% – 37% (Fewtrell I. et. al., 2005). Apart from diarrhoeal diseases, other diseases such as Schistosomiasis, Trachoma and Intestinal helminths causes lots of morbidity episodes and death in a lot of cases. The table below shows the morbidity and mortality rates of selected water, sanitation and hygiene related diseases.
Source: Maggie A. et al (2007). American Chemical Society.
It can be seen from the table that all these high morbidity and mortality causing diseases are related to unsanitary disposal of excreta. With good sanitation practice, a very good substantial reduction to these figures can be achieved and the general health situation in the developing world would be greatly improved. The popular ‘F’ diagram (Figure 1 overleaf) showing transmission routes of feaco-oral diseases clearly shows also how sanitation could substantially reduce the spread of diseases. Even in a situation of good water supply, without sanitation in place, high risk of contamination in households still exist.
Figure 1: Feaco-oral diseases transmission routes and interventions to stop them
Source: Feachem R. G. et. al. (1983). Sanitation and disease.
Apart from feaco-oral diseases, sanitation lowers considerably the risk of children’s exposure to malnutrition and other infections that might not be directly feaco-oral but that becomes prevailent with increasing episodes of diarrhoeal. (Isabel Gunther et. al., 2011). Overall, sanitation directly improves the health of a community or household by reducing morbidity and mortality. These health improvements indirectly translate to economic benefits.
In addition to the benefits sanitation brings to health, it also generates economic benefits. The benefits include direct cost reduction in catering for health due to less sickness especially from diarrhoeal diseases, less days lost at school or at work due to sickness or having to care for sick people and also convenience time savings from walking or queuing at shared sanitation facilities or open defeacation (Hutton G. et. al, 2007). Hutton et. al. interprets the benefits of water and sanitation improvements as being in three categories. ‘Direct economic benefits of avoiding diarrhoeal diseases, indirect economic benefits related to health improvements and non-health benefits related to water and sanitation improvements.’ These benefits are summarised in table 2 below. The benefits were valued to monetary terms using economic methods for valuation.
Table 2: Economic benefits arising from water and sanitation improvements
Source: Hutton G, Haller L, Bartram J (2007)
The prevention of sanitation and water related diseases could save some $7billion per year in health system costs and an additional $3.6billion per year savings in averted deaths based on discounted future earnings (Hutton et. al., 2007). In many of the developing countries, around half of the hospital beds are occupied by people with diarrhoeal diseases at any one time. This shows the amount of burden that these preventable diseases bring to the developing countries. Sanitation practices can reduce these occurrences to a very minimal level. Figures from Lao People’s Democratic Republic shows that poor sanitation and hygiene cost the country 5.6% of her annual GDP (Gross Domestic Product) per year when expressed on a national scale. (Hutton et. al., 2009). Ghana and Pakistan figures also suggest that general improvement in environmental conditions could save 8% – 9% of GDP annually. (WHO, 2008). All these statistics and figures show the potential economic gains that is set to be derived or gained through sanitation practices.
The Disease Control Priorities Projects has found sanitation as the second most cost effective health intervention in the world at $11.15 per DALY (Disability Adjusted Life Year) loss averted, coming behind hygiene promotion which is at $3.35 per DALY averted. (Cairncross et. al., 2006).
Table 3: Economic benefits resulting from meeting the MDG sanitation target and from achieving universal sanitation access.
Source: Hutton G. et. al., 2007.
Table 3 (previous page) shows the cost-benefit ration that is potentially attributed with achieving the Millennium Development Goal (MDG) sanitation target of halving the number of people without improved sanitation by 2015 to 1999 baseline figure and with achieving universal sanitation access in the non OECD (Organisation for Economic Co-operation and Development) countries. This means a one dollar investment on sanitation could bring up to ten dollars worth of economic return gained from the productive work of not being sick. (Mara D.D. et. al., 2010). Therefore, sanitation practices brings about economic development on a national scale through all the averted deaths, avoided DALY losses and money saved in disease treatment that can be used efficiently in other areas of the economy. At the household and community level, the household has more productive time from the ones saved from attending the sick, more children time at school which indirectly translates to better income generation for the family or community and therefore a better living standard.
Even though health seems to be the strongest point for the spread and campaign of sanitation practices, it is not always the main reason why people want to have clean and hygienic way of practicing sanitation. Other needs to have a good sanitation practice may include: privacy, safety, comfort, cleanliness and respect (Jeff Conant, 2005). Therefore the social benefits that come with good sanitation practice too are enormous and very important in maintaining a good social stratification and integrity within a community. Engaging in good sanitation practice because of the economic gains and health benefits comes most handy in respect to the government. Sourcing of funds and prioritising investment in sanitation improvement projects or infrastructure are the areas where arguments sell and allowing the government to understand the benefits that comes with sanitation improvement. But, when it comes to the people themselves, social factors such as privacy, dignity etc. as mentioned earlier seems to be the stronger reason why they will want to have good sanitation. The billions who must defeacate in bushes and open places face daily assaults to their human dignity and safety. Jon Lane, 2008, noted that “the humble toilet can speed social development by:
aiding progress towards gender equality
promoting social inclusion
increasing school attendance
building community pride and social cohesion
and contributing to poverty eradication.”
In the absence of adequate sanitation, women and girls are usually the most affected. Women are the ones that care for children and bear the highest risk of direct contact with faeces. Women and young ladies alike are the ones that bear most, the risk of assault and in some cases rape when seeking privacy in the dark at night to defeacate. This problem affects their well-being and limits their free and equal participation in the economic and social life of the community in which they find themselves. When there are no toilets in school or no separate toilet for boys and girls, girls enrolment and stay in school are most affected. They have to stay back home during their menstruation and generally loose motivation for school attendance. “Globally, one in four girls do not complete primary school compared to one in seven boys” (Jon lane, 2008). Also studies in Alwar district of India shows that sanitation increased girls school enrolment by one-third and improved academic performance for boys and girls by a quarter. So, sanitation brings about more gender equality and lessens the burden and risks on women and girls.
Another strong social benefit that comes with sanitation is community cohesion. The act and practice of collectively keeping streets and the environment clean (environmental sanitation) and also, the joint effort communities put in improving their sanitation practice (e.g. eradication of open defeacation) brings a bond and a sense of belonging to the members of a community. It makes them share a common pride of cleanliness. This brings about a change in social attitude that they can boast of. “For example some villages residents have painted signs that read: daughters from our village are not married into villages where open defeacation is practised” (Jon Lane, 2008). All the social factors that gets affected by the extent of sanitation practice are indirectly linked to the subject of poverty profile. Poor people tend to be the ones that are not able to access good sanitation hardwares. This deprives them of their major asset – physical health and ability to work thereby making their situation worse. But interventions in sanitation can help them keep healthy at all times and help them divert their resources to other critical areas, raising their economic status and reducing the gap between the rich and poor in developing countries.
Sanitation practices assist in environmental sustainability. It can be used to strike a nutrient balance in the present world where there is so much stress on our available resources. Human waste gets into water courses and land from open defeacation, disposal of untreated sewer effluents into river channels and leakages from not well designed pit latrines. “In the developing world, roughly 90% of sewage is discharged untreated into rivers, polluting waters and killing plants and fishes” (United Nations Water, 2008). Also “In Asia alone, 13million tonnes of feaces are released to inland water sources each year, along with 122millionm3 of urine and 11billion3 of greywater” (United Nations Water, 2008). This is a major for people using streams as their primary water source and economic risk for people that depends on aquatic life (e.g. fishing) for their livelihood. Figures from United Nations also suggest that “water pollution arising from poor sanitation costs south east Asia more than US$2billion per year, and in Indonesia and Vietnam creates environmental costs of more than US$200million annually primarily from the loss of productive land”
Sanitation practices contain human waste with the option of safe treatment for disposal or maintaining the containment. Therefore sanitation stops this trend of environmental degradation and avoids the losses associated with it. Human excreta contain valuable nutrients (Nitrogen, Phosphorus and Potassium). “We produce 4.56kg Nitrogen, 0.55kg Phosphorus, and 1.28kg Potassium per person per year from feaces and urine. This is enough to produce wheat and maize for one person every year” (WSSCC in Mara D.D., lecture material, IPH, 2011). Going by the fact that conventional mineral fertiliser are mainly of Nitrogen, Phosphorus and Potassium constituents, farmers in developing countries can use the nutrients in excreta to enhance agricultural output at lower costs. The practice of “Ecological Sanitation” can be used to achieve this. That is, practice sanitation for environmental sustainability while at the same time turning waste (excreta) into a resource. The ranges of practices include “Arboloos” (where a tree is planted on the latrine pit in succession), “Urine diverting latrines” (that produces fertilisers from urine and composted feaces) and “Biogas toilets” (that produces methane from anaerobic digestion of feaces). By using this technology, a three way benefit can be derived from sanitation. Environmental sustainability, increase in crop yield leading to better economic benefit while at the same time satisfying the health benefits that comes with sanitation.
CONCLUSION
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