MDGs

This week’s issue of The Lancet has a paper and a couple of commentaries on the MDGs, all free-to-view and doubtless in preparation for next week’s UN Summit on the Millennium Development Goals in New York:

The Millennium Development Goals: a cross-sectoral analysis and principles for goal setting after 2015 by The Lancet and the London International Development Centre Commission (the ‘webappendix’ to this paper is a particularly good review of progress/lack of progress on all the MDGs, though nothing new on WatSan),

The MDG decade: looking back and conditional optimism for 2015 by Jeffrey Sachs, and

Africa faces an uphill struggle to reach the MDGs by Wairagala Wakabi.

Sachs says:
All of the estimates [of costs needed to implement a basic primary health system in a low-income setting], when appropriately updated to 2010 conditions, suggest a cost of around US$50–60 per person per year in current dollars … [whereas] the plausible level of domestic resource mobilisation for public health is of the order of $15 per person per year. … That leaves a financing gap of around $40 per person per year to be filled by external donors. … Many large donors are letting poor regions down. … Most poor countries are ready to lead domestically, and have the management and technical capacities to do so with local skills
and internal technical support when needed. The key limiting factor for success is external aid. If the high-income countries build on their successes of the past decade, and deliver a mere 0.1% of GDP for health-sector official development aid as part of a larger overall aid programme, they and their low-income partners will celebrate great MDG successes as of 2015.

So, if low-income countries don’t meet all the health targets of the MDGs, then it’s all the fault of the high-income donor countries? I don’t think so!

Wakabi, a Ugandan journalist, certainly doesn’t put the blame on donor countries, more on the low-income countries: “Despite scoring some notable successes, funding shortfalls and a sapping of political will are stymying progress towards attaining the health MDGs in Africa” – shortfalls, that is, in local funding and a lack of local political will.

Toiling for toilets

There’s a “feature” article in this week’s British Medical Journal: Toiling for toilets by Rebecca Coombes (a BMJ associate editor) – quote: “Sanitation has been the poor relation of the millennium development goals, but without it the chances of meeting many of the other goals are much reduced”. Nothing new, but a useful piece of advocacy (and good for medics to read).

CLTS and STEPS

The STEPS [Social, Technological and Environmental Pathways to Sustainability] Centre at the University of Sussex has just published a working paper on CLTS: The Dynamics and Sustainability of Community-led Total Sanitation: Mapping Challenges and Pathways. Here’s a quote:

Even though CLTS has the makings of a development success story, many obstacles remain before it can truly be said to offer a viable route to meeting the MDGs. For example: How does CLTS accommodate dynamism and complexity inherent in social-technological-ecological systems? How are women’s, children’s and men’s often diverging needs accounted for? How can CLTS be scaled up to become a major force rather than an approach characterised through piecemeal, scattered projects? Are there lingering assumptions and power relations that hinder or obstruct the spread of CLTS? In short – how sustainable is CLTS, and in what ways is the notion of sustainability understood? This paper offers some perspectives that may help structure thinking around these questions.

Good down-to-earth stuff!

The list of all STEPS working papers is here. A few of the WatSan-relevant ones are:

Liquid Dynamics: Challenges for Sustainability in Water and Sanitation

Going with the Flow? Directions of Innovation in the Water and Sanitation Domain

On the Edge of Sustainability: Perspectives on Peri-urban Dynamics

Back-end users

Here’s an interesting commentary on sanitation: Back-end users: the unrecognized stakeholders in demand-driven sanitation by Ashley Murray and Isha Ray of UC Berkeley (recently published online in the Journal of Planning, Education and Research). This is the Abstract:

Inadequate wastewater and fecal sludge treatment, disposal, and end use systems are arguably the greatest obstacles to achieving sustainable urban sanitation in unserved regions. Strategies for planning and implementing urban sanitation are continually evolving. Demand-driven sanitation with household and community participation is broadly thought to be the way forward. We are skeptical that more time and resources spent garnering household and community demand for sanitation will amount to the much-needed improvements in the treatment and end use components of sanitation systems. We propose shifting the incentives for sanitation from “front-end users” to “back-end users,” thereby leveraging demand for the products of sanitation (e.g., treated wastewater, fertilizer, alternative fuel) to motivate robust operation and maintenance of complete sanitation systems. Leveraging the resource value of wastewater and fecal sludge demands a reuse-oriented planning approach to sanitation, an example of which is the Design for Service approach presented in this commentary.

“Design for Service” is defined as “a five-step planning approach that results in a site-specific, reuse-oriented sanitation scheme. The ultimate reuse (or “service”) of the wastewater/fecal sludge is the starting point for the planning process”. The five steps are:

1. Generate a list of all of the potential “services” (e.g., irrigation, fertilizer, energy generation) that wastewater, fecal sludge, and treatment by-products can provide.
2. Assess the demand for these services in and around the city of interest.
3. Assess the business-as-usual performance of the provision of these services according to economic, social, and environmental indicators.
4. Design sanitation infrastructure for the provision of that service where it can have the greatest marginal impact.
5. Assess the intrinsic environmental and cost characteristics of the technology options available for rendering the wastewater/fecal sludge/treatment by-products suitable for the service of choice.

The paper details the rationale for each of these five steps.

As the authors say in their Conclusions, “designing for reuse exacts a nontrivial time and resource cost on sanitation planning processes” − but, if it increases the chance of system success/sustainability, then it’s clearly worth doing. Up to now we’ve concentrated on the “front-end users”. It’s clearly time to bring the “back-end users” into the sanitation planning process.

Energy and Monkeypox

There’s a good article on energy in the developing world − Power to the people – in the 4 September issue of The Economist. Quote: “Around 1.5 billion people, or more than a fifth of the world’s population, have no access to electricity, and a billion more have only an unreliable and intermittent supply.” Not too dissimilar to WatSan provision then.

The same issue has an article on emerging infections – No good deed goes unpunished. Smallpox is being replaced by monkeypox, at least in the DRC (see the original PNAS paper here). Similar to rotavirus and norovirus (see blog of 27 June 2009)?

Global Atlas of Helminth Infections

Check out the Global Atlas of Helminth Infections website (developed by the London School of Hygiene and Tropical Medicine and the Partnership for Child Development). This is “an open-access information resource on the distribution of soil-transmitted helminths and schistosomiasis”. Country maps are currently available only for Sub-Saharan Africa, but will eventually be available also for Latin America and Asia.

Note: there are better life-cycle diagrams on the CDC website – Ascaris, Trichuris, hookworms, and schistosomes.

World Water Week

Last week (5−10 September) was World Water Week in Stockholm – an annual event ably organized by the Stockholm International Water Institute (SIWI) and with now a good emphasis on sanitation. There were many parallel sessions and side events, so impossible to attend everything. Here are just some of the events I found interesting…

Sunday

Wastewater use in agriculture this afternoon and early evening. The afternoon session was
on “Reducing the Risks of Wastewater Irrigation: Strategies and Incentives” based, more or less, on the following three recent publications:

1. Improving Wastewater Use in Agriculture: An Emerging Priority (World Bank, 2010)
2. The Wealth of Waste: The Economics of Wastewater Use in Agriculture (FAO, 2010)
3. Wastewater Irrigation & Health: Assessing and Mitigating Risk in Low-income Countries (Earthscan/IDRC, 2010)

The early evening session was the launch of the Second Information Kit on the 2006 WHO Wastewater Use Guidelines – not yet online (but my part is here). My presentation was on choosing a sensible value for the maximum tolerable additional burden of disease – i.e., the maximum DALY loss per person per year (pppy). The default value used for this in the 2006 WHO Guidelines is 10−6 pppy for this, but this is very ‘extravagant’ and I recommended a value of 10−4 DALY loss pppy as it reflects epidemiological reality in developing countries and some industrialized countries (e.g., Australia and the USA) much more closely. [Actually this also applies to Drinking-water Quality Guidelines, but that’s a real can of worms – for WHO, US EPA and the EU, amongst others − waiting to be opened…]

Tuesday

I attended the lunchtime side event on “What knowledge do we need to do better on Sanitation?” This was basically how the London School of Hygiene and Tropical Medicine and its partners see how their ‘Sanitation and Hygiene Applied Research for Equity’ (SHARE) research consortium, funded by DFID, will progress. Check out the SHARE website when it gets going by the end of the month (in the meantime there are some details here).

Then I went to the afternoon seminar on “Water quality issues and new approaches in Latin America”. Interesting couple of papers – one on water and wastewater problems in Mexico City by Dr Blanca Jiménez (UNAM). The other was by Professor Eduardo Jordão (Federal University of Rio de Janeiro) on the use in Brazil of UASBs + some form of secondary treatment serving populations of 20,000−1,500,000 – but little mention of costs or cost-effectiveness, and no mention of high-rate anaerobic ponds.

As I was rushing from the lunchtime session to the afternoon session my colleague Dr Jan-Olof Drangert (University of Linköping, Sweden) shoved a leaflet into my hand – all about his new website Sustainable Sanitation for the 21st Century, which comprises a free e-book and a set of PowerPoint presentations for training professionals in the sanitation and water sector. There’s a certain EcoSan emphasis, but it’s certainly very well worth taking a look. You can download the PowerPoints as ppt files, so you can use them as they are or select which slides you want to use in your own presentations. Excellent idea!

Wednesday

I went to the workshop on “Improved water use efficiency through recycling and reuse” and gave a presentation on Natural wastewater treatment and carbon capture. Professor Emeritus Takashi Asano (UC Davis), in a keynote presentation, told us all about water demand and wastewater recycling and reuse in California – a complex system necessitated by building a megacity (Los Angeles) in a desert and by California being the nation’s major table-food (vegetables, fruits) producer. Then Dr Ashley Murray (UC Berkeley) gave a really interesting paper on wastewater-fed aquaculture: set up a local business to grow fish in maturation ponds and the business returns half its net profit to the wastewater treatment works (waste stabilization ponds) to help pay for O&M – a very neat concept which she developed in Ghana.

Thursday

Interesting morning session on the “Five-Year countdown to the water and sanitation MDG targets: status, trends and challenges”. The main findings of the 2010 JMP Report and the 2010 GLAAS Report were presented, and there was considerable discussion on how WatSan monitoring should progress. Good data are, of course, essential but, while I think they can tell us what to do in some areas, they don’t/can’t in other areas. For example:

(1) While they tell us that there are still far too many open defecators and so helping communities to become OD-free (i.e., to move to fixed-place defecation) is really important, it’s equally important that the fixed defecation place they move to is at least improved sanitation, but so often it’s not.

(2) They can’t tell us a lot about the future, but we know from the World Urbanization Prospects: The 2009 Revision that almost all population growth in the next few decades will be in urban areas of developing countries (see blog of 28 August for the figure showing this). This means that, while we can’t forget about rural sanitation, we’re going to have to concentrate on sanitation in high-density low-income slum and non-slum urban areas. Is the world remotely prepared for this? No, it is not.

►One statistic that came out this morning was that, as we’re unlikely to meet the MDG sanitation target, there’ll be around 2.7 billion people at the start of 2016 who’ll need ‘improved’ sanitation. Now that’s a hideously sobering thought: in purely numeric terms we’ll be back where we started in 2000…

Not a brilliant note to finsh World Water Week on. Just, depressingly, more of the same. Clearly we’re going to need, and sooner rather than later, an annual World Water & Sanitation Week. Sanitation really does need to be mainstreamed more, not just mostly left to side-event organizers. Anyone in SIWI listening?

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PS: check out the World Water Week videoclips on the WaterCube!