Dr Rajiv Desai

SANITATION : 

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The picture above shows open defecation near railway track in India.

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Prologue:

After writing many articles on topics which concern us in our daily life; right from food, environmental pollution, water and clothing, I thought I must write on the most important and most neglected subject, namely sanitation i.e. safe disposal of human excreta (feces & urine). Till the age of 15 years, I did not have the luxury of private toilet as I was brought up in a middle class environment in Mumbai where shared toilet was the norm. During my childhood and early teen, I had to wait in a queue outside shared toilet for long as the toilet was shared by many tenants in my building. The toilet was dirty, foul smelling with flies & cockroaches and having no water; so I had to carry water in a bucket. During school vacation time, I used to visit our family native place in a village where there was no toilet at all and I used to defecate in the open field. What I experienced in childhood in India, is being experienced by 2.6 billion people worldwide due to lack of hygienic toilet and in fact 1.1 billion people defecate in open daily. This is their story. Ask any water supply board engineer and he will tell you that the bigger headache is sewage management and not water supply. Statistics will also show that almost all developing nations has access to water supply –of varying quantity and quality no doubt- but far too few have access to good sanitation. India is the world’s largest open air lavatory. Nearly 60 per cent of the people in the world who defecate in the open belong to India. Even neighboring countries like Bangladesh, Nepal, Pakistan and Afghanistan have better records than India. Mahatma Gandhi who said in 1923, “sanitation is more important than independence” but Indians neither value independence nor sanitation. 60 per cent women in India do not have access to toilets…India can launch missiles like Agni and satellites, but they cannot provide sanitation to their women. What can be a bigger blot on the nation than this? Every day, around 7500 people die worldwide because they drink water that has been polluted by sewage. One child dies every 20 seconds due to lack of sanitation. It is a crisis that we are facing, and since sanitation is a taboo issue, it’s something dirty that we want to hide; we don’t want to talk about it.    

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Story of Indian slum dweller Devi:

Devi, like the other women of her slum, lacks a toilet in her home. So she wakes up early when it’s still dark, walks toward the bushes on the edge of the slum and squats there to relieve herself. The daily humiliation is taking a toll on her dignity, she says. But open defecation is more than embarrassing. Often, men hide in the areas women commonly use to go to the bathroom, knowing that this is a position and time when they are vulnerable. “Once, a few men put a blanket over me and tried to kidnap me,” Devi says. “I shouted at the top of my voice, and somehow, I managed to escape. But everyone is not lucky like me.” Devi doesn’t live in poverty-stricken rural India, but right in the heart of the national capital, New Delhi. A few girls were raped on their way to the vacant park near the slum, where they had gone to defecate. Inadequate sanitation forces women in both rural and urban areas of India to defecate in the open, leaving them vulnerable to sexual violence. Lack of toilets or maintenance of them also creates health hazards. It forces girls to drop out of school and women to quit their jobs.

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Even without an understanding of germs, many ancient civilizations had a good understanding of the need for careful sewage disposal, but this knowledge was lost or ignored in the Middle Ages in Europe. The result was terrible sanitary conditions, polluted waterways, and periodic outbreaks of disease. One of the greatest advances of the modern era was the recognition that disease could be caused by pathogens, and that poor sanitary conditions were a prime culprit in the spread of disease. Sanitary engineers in the nineteenth century were in the forefront of the development of sanitary sewer systems that protected the public from epidemics of cholera and other water-borne illness. A survey conducted by the British Medical Journal in 2007 asked a group of experts and doctors what they consider the greatest medical advance since 1840. The answer, beating out antibiotics and modern surgical methods, was sanitation.

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According to various estimations there are approximately 2.6 – 3 billion people living without proper sanitation. These people have to decide on daily bases how to organize defecation without feeling ashamed, feel of fear or direct health problems due to lack of sanitation. Some relieve themselves during the night time while others hide in the bushes for defecation. Some people even defecate into plastic bags and then throw the bags as far as they can (this Flying Toilet example is from a slum district in Kenya). Providing that people are not accessible to proper toilets, they need to rely on solutions that are neither good for them nor the communities they live in nor for the environment. Due to inadequate water supply, sewerage systems and lack of sanitation, millions of people face death annually. Over 2 million people die annually only to diarrhea, where from most are under the age of five. Every day approximately 6000 children die to diarrhea related diseases. According to some estimates two thirds of the costs of medical treatment are used to nurse diarrhea related diseases.

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Before discussing safe hygienic disposal of human excreta, let me discuss few words about animal excreta.

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Animal excreta:

The hazards to human health represented by zoonotic pathogens in animal excreta remain poorly understood and inadequately addressed in the literature. These hazards present special challenges for authorities charged with maintaining the quality of surface waters used for recreation and as sources of drinking-water. Current water quality standards in most countries focus on control of human fecal contamination and do not reflect risk posed by fecal contamination from animal sources. Few studies have attempted to examine the relationship between swimming-associated health impacts and the quality of water contaminated by animals or birds, and that the evidence base is lacking to determine whether or not this type of exposure may result in excess illness. Furthermore, we do not know if the current regulatory response, with its focus on contamination by human excreta, is appropriate for animal or bird-contaminated waters. Human feces are frequently treated and may be disinfected before they are discharged into surface waters, whereas non-human fecal contamination is commonly neither treated nor disinfected. Moreover, the human derived pathogens are frequently viruses, whereas zoonotic pathogens are primarily bacteria and protozoans. A limited number of studies in a range of contexts have shown that their relative relationship to fecal indicator organisms varies widely. These key differences complicate the application of standards derived from studies on the health impacts of human feces to waters contaminated by animals or birds. The paucity of information in the literature on human health effects associated with exposure to recreational waters contaminated with animal and bird feces, combined with the limitations outlined above, leads to the conclusion that current standards and control measures may not be appropriate for maintaining the safety of recreational water contaminated with non-human feces. The implication is that other means of protecting the health of swimmers and other water users must be considered. It is better to define the risk posed by animal and bird fecal contamination and provide effective means to manage them.

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Form of Animal Wastes:

Based on the water content, the animal wastes can be considered into four forms: liquid, semi-liquid, semi-solid and solid. The methods adopted in the handling and management of the animal waste depends very much on the form in which the waste is existing. The dry matter content in the solid will be around 50%, in the semisolid 30%, in the semi-liquid 20% and in liquid 10%. The dry matter content is important in the waste management for two reasons.

i. Water can be evaporated, leaving the dry matter as the pollutant.

ii. If water is excluded, the solid is cheaper and convenient to handle and store since it needs less space.

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The manure production from the cattle ranges from 20 to 60 kg per day per animal depending on the size and breed of animal and the quantity of the fodder and feed consumed by the animal. Normally it amounts to 5 to 8 % of the body weight of the animal. The moisture content of this manure ranges from 80 to 88 % in fresh weight. The urine makes up about 30% of the weight of the manure. Average size cattle produce 10 to 18 tons of fresh manure and urine per year. The average amount of NPK (nitrogen, phosphate and potassium) from one ton of fresh manure is estimated to be 4.5, 1.8 and 4.0 kilograms respectively. Up to 50% or more of the nitrogen in the fresh animal dung may be converted into ammonia form which is lost into the atmosphere if it is allowed to decompose in the open air. The same is also true with the urine which starts decomposing after a two or three days. Hence for the manure purpose, the animal dung and urine including that of human beings should be processed in such a way that the volatile elements and compounds in them are preserved maximum. Composting, irrigating with liquid waste and biogas are the three ways of animal waste handling.

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Eating feces and drinking urine: 

Before starting discussion on safe disposal of excreta (feces & urine), let me start with coprophagia & urophagia. We all know that feces and urine are waste products of our metabolism. However, feces contain substantial amounts of semi-digested food (herbivores’ digestive systems are especially inefficient) and urine contain lot of water, so eating feces and drinking urine may provide nourishment and water to some animals. Coprophagia is the consumption of feces. Many animal species practice coprophagia as a matter of course; other species do not normally consume feces but may do so under unusual conditions. The most notable feces-eating insect is the dung-beetle and the most common is the fly. Pigs, like insects, will eat the feces of herbivores that leave a significant amount of semi-digested matter, including their own. Young elephants, pandas, koalas, and hippos eat the feces of their mothers or other animals in the herd to obtain the bacteria required to properly digest vegetation found on the savanna and in the jungle. When they are born, their intestines do not contain these bacteria (they are completely sterile). Without them, they would be unable to obtain any nutritional value from plants. As far as humans are concerned, consuming other people’s feces carries the risk of contracting diseases and bacteria spread through fecal matter, such as E. coli, Hepatitis A, Hepatitis E, pneumonia, polio, influenza and contracting intestinal parasites. However, fecal bacteriotherapy (fecal transplant) is used when feces from a close relative or spouse (healthy donor) are given to patients suffering from intractable diarrhea caused by Clostridium difficile. The purpose is to repopulate the intestines with the normal gut flora (intestinal bacteria) to decimate the clostridium. The healthy stool is administered by nasogastric tube, enema, or in a capsule. Urophagia is the consumption of urine. There are various reasons that humans may consume urine. Urine was used in several ancient cultures for various health, healing, and cosmetic purposes, practices which are still used by some people of these cultures today. In Euro-American culture, these practices are known as urine therapy, a form of alternative medicine. Other reasons for urophagia include attempting survival, if no other potable fluid is available, though numerous credible sources (including the US Army Field Manual) advise against it. These guides explain that drinking urine tends to worsen, rather than relieve dehydration due to the salts in it, and that urine should not be consumed in a survival situation, even when there is no other fluid available. Urine, 95% of which is water, 2.5% of which is urea, and 2.5% of which is a mixture of minerals, salts, hormones, and enzymes, is a blood byproduct and though it contains some body waste, it is non-toxic. Consuming one’s own urine is relatively low in risk. Bacterial infection of the urinating person’s urethra, or disease in the person urinating may pose a risk. 

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Toilet training:

A small human child passes urine & feces at any time and any place till he/she is trained by parents to urinate and defecate in toilet known as toilet training. Child is physically capable of being toilet-trained when he or she develops muscle control over the bowel and bladder. This rarely happens before 18 months of age. Some basic signs that your child has bowel and bladder control include the following:

• Bowel movements occur on a regular, somewhat predictable schedule.
• Bowel movements do not occur during the night.
• Diapers frequently are dry after waking from a nap or for at least 2 hours at a time.
• Facial expressions, grunting, or squatting show awareness that he or she is passing urine or stool.

Your child must also be able to climb and remove clothing. And he or she must be able to talk enough to communicate with you about the need to use the toilet. Your child must be both physically and emotionally ready for toilet training. Most children are ready when they are between 22 and 30 months of age, although every child is different. Toilet training usually becomes a long and frustrating process if you try to start it before your child is ready. A child is considered toilet-trained when he or she knows that it is time to go to the bathroom and is able to climb onto and use the toilet with little help. In a study of children who started training between 22 and 30 months of age, boys were fully trained at an average age of 38 months, while girls were trained slightly earlier, around 36 months. Your child will likely need help with wiping after a bowel movement until age 4 or 5. He or she may also need extra help in unfamiliar bathrooms, such as public restrooms, until about age 5 or 6.

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Food cycle:

A food web (or food cycle) depicts feeding connections (what eats what) in an ecological community and hence is also referred to as a consumer-resource system. Ecologists can broadly lump all life forms into one of two categories called trophic levels: 1) the autotrophs, and 2) the heterotrophs. To maintain their bodies, grow, develop, and to reproduce, autotrophs produce organic matter from inorganic substances, including both minerals and gases such as carbon dioxide. These chemical reactions require energy, which mainly comes from the sun and largely by photosynthesis, although a very small amount comes from hydrothermal vents and hot springs. Autotrophs produce more biomass energy, either chemically without the suns energy or by capturing the suns energy in photosynthesis, than they use during metabolic respiration. Heterotrophs consume rather than produce biomass energy as they metabolize, grow, and add to levels of secondary production. A food web depicts a collection of polyphagous heterotrophic consumers that network and cycle the flow of energy and nutrients from a productive base of self-feeding autotrophs. A gradient exists between trophic levels running from complete autotrophs that obtain their sole source of carbon from the atmosphere, to mixotrophs (such as carnivorous plants) that are autotrophic organisms that partially obtain organic matter from sources other than the atmosphere, and complete heterotrophs that must feed to obtain organic matter. The linkages in a food web illustrate the feeding pathways, such as where heterotrophs obtain organic matter by feeding on autotrophs and other heterotrophs. The food web is a simplified illustration of the various methods of feeding that links an ecosystem into a unified system of exchange. There are different kinds of feeding relations that can be roughly divided into herbivory, carnivory, scavenging and parasitism. Some of the organic matter eaten by heterotrophs, such as sugars, provides energy. Autotrophs and heterotrophs come in all sizes, from microscopic to many tons – from cyanobacteria to giant redwoods, and from viruses to blue whales.

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The figure above shows a simplified food web illustrating a three trophic food chain (producers-herbivores-carnivores) linked to decomposers. The movement of mineral nutrients is cyclic, whereas the movement of energy is unidirectional and noncyclic. Trophic species are encircled as nodes and arrows depict the links.

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water cycle:

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The Water cycle (also known as the hydrologic cycle) is the journey water takes as it circulates from the land to the sky and back again. The Sun’s heat provides energy to evaporate water from the Earth’s surface (oceans, lakes, etc.). Plants also lose water to the air (this is called transpiration). The water vapor eventually condenses, forming tiny droplets in clouds. When the clouds meet cool air over land, precipitation (rain, sleet, or snow) is triggered, and water returns to the land (or sea). Some of the precipitation soaks into the ground. Some of the underground water is trapped between rock or clay layers; this is called groundwater. But most of the water flows downhill as runoff (above ground or underground), eventually returning to the seas as slightly salty water. As water flows through rivers, it picks up small amounts of mineral salts from the rocks and soil of the river beds. This very-slightly salty water flows into the oceans and seas. The water in the oceans only leaves by evaporating (and the freezing of polar ice), but the salt remains dissolved in the ocean – it does not evaporate. So the remaining water gets saltier and saltier as time passes.

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How food cycle and water cycle are linked to sanitation?

We humans daily eat food derived from food cycle and drink water derived from water cycle for our survival. Our excreta (feces + urine) are waste products generating by our body after assimilating food & water. There are about 7 billion humans live on earth, each on average, excretes 130 gms of stool and 1 liter of urine daily. That comes to approximately 910,000 tons of feces and 7 billion liters of urine daily deposited in the environment. I have not calculated the quantity of feces and urine deposited by animals. Treated or untreated, these excreta will ultimately return back to food & water cycle. For example, bacteria will decompose excreta into CO2, methane, inorganics and water, which will ultimately return to ocean or rivers. The issue is how safely and hygienically we allow return of our excreta into food & water cycle without harming environment, without wasting nutrients and without spreading diseases. That is discussed later on in this article in ‘sustainable sanitation’ and ‘ecological sanitation’.  50,000 years ago, before advent of modern human behavior, our ancestors were all defecating in open air. As cultures and civilizations evolved, we learned to dispose of our waste products in a civilized hygienic way. The issue of sanitation is not only to prevent disease & save environment but development of culture, civility and modesty. When 626 million Indians defecate in open air even today, what kind of Indian culture is propagated?  Indian leaders & media must answer this question.

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History of sanitation:

The earliest evidence of urban sanitation was seen in Harappa, Mohenjo-daro and the recently discovered Rakhigarhi of Indus Valley civilization. This urban plan included the world’s first urban sanitation systems. Within the city, individual homes or groups of homes obtained water from wells. From a room that appears to have been set aside for bathing, waste water was directed to covered drains, which lined the major streets. Roman cities and Roman villas had elements of sanitation systems, delivering water in the streets of towns such as Pompeii, and building stone and wooden drains to collect and remove wastewater from populated areas – for instance the Cloaca Maxima into the River Tiber in Rome. But there is little record of other sanitation in most of Europe until the High Middle Ages. Unsanitary conditions and overcrowding were widespread throughout Europe and Asia during the Middle Ages, resulting periodically in cataclysmic pandemics such as the Plague of Justinian (541-42) and the Black Death (1347–1351), which killed tens of millions of people and radically altered societies. Very high infant and child mortality prevailed in Europe throughout medieval times, due not only to deficiencies in sanitation but to an insufficient food supply for a population which had expanded faster than agriculture. This was further complicated by frequent warfare and exploitation of civilians by autocratic rulers.

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The word “sanitation” only entered the English language in the nineteenth century, and the term is inextricably linked with integrated water and sewer systems. Lacking such technologies, early modern Europeans are often reckoned to have lived without sanitation. Their epidemiology of the time might seem to support this contention: three out of every ten babies born in Geneva between 1580 and 1739 died by their first birthday and the infant mortality rate in late seventeenth-century London was over one in four. Many of these deaths were caused by dirt-related infections like infantile diarrhea—what contemporaries termed “griping in the guts.” However, early modern Europeans possessed notions of public health and collective salubrity. Furthermore, scholars are now revealing the extent to which they sought to regulate and cleanse their environments. Such efforts were rarely entirely successful—early modern utopian writing appreciatively delineated the cleanliness of the ideal community—but civic authorities regularly commanded that streets be swept and nuisances removed. Such sanitary regulation was linked to wider conceptions of order. Noxious wastes shaped social and symbolic geographies. Offensive trades such as butchers and tanners were generally confined to particular districts, often downstream or outside city walls. Medical beliefs further encouraged sanitary care. Throughout the early modern period it was generally believed that plague and other epidemic diseases were caused or spread by corrupt airs or miasma produced by rotting organic matter. Environmental regulation thus sought to prevent evil smells. Perfumes and fumigants were used to purify infected spaces; street cleaning often intensified in periods of epidemic. In late-sixteenth- and early-seventeenth-century London, for instance, householders were required to sweep in front of their houses every morning and evening. During the early seventeenth century the boards of health of northern Italian states energetically sought to remove dunghills and other sources of miasma from the towns and villages under their jurisdiction. Early modern doctors knew of “miasma” from a range of classical works, especially those of the ancient Greek physician Hippocrates. From the mid-seventeenth century medical authors became preoccupied with one strand of his work—the relation between epidemics and the airs, waters, and weather of particular places. Population statistics derived from bills of mortality and parish registers revealed geographical variations in the incidence of fevers and other fatal diseases; eighteenth-century analyses of air by natural philosophers like the English chemist Joseph Priestley sought to isolate mephitic substances that caused disease. Many eighteenth-century doctors proposed ways of reducing mortality by draining marshes, ventilating buildings, and reorganizing the environments and the ways in which people lived. In the 1780s the French Royal Society of Medicine not only declared that the Cemetery of the Holy Innocents in Paris was so full that it was a threat to public health but also had it closed and all human remains removed from it. More generally there was a considerable extension of new forms of sanitation, bathing and hygiene in hospitals, barracks, and similar institutions. These reforms were restricted by the general scarcity of water in preindustrial Europe. The comparative scarcity of water remained a structural characteristic of European society throughout the early modern period. However, the sixteenth and seventeenth centuries saw the establishment of the first water companies piping supplies to the houses of private paying customers. Eighteenth-century water companies were among the first users of steam power, and thus laid the foundations for the subsequent industrialization of urban water supplies. In the nineteenth century the intellectual heritage of medical progress combined with such technological developments to produce the public reforms that are conventionally associated with the term sanitation.

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Right to sanitation:

Everyone has the right to an adequate standard of living for themselves and their families, including adequate food, clothing, housing, water and sanitation. The Habitat Agenda, adopted by consensus of 171 States at the Second United Nations Conference on Human Settlements (Habitat II), 1996 states so. Also, clean water and sanitation are not only about hygiene and disease; they’re about dignity, too. … Everyone, and that means all the people in the world, have the right to a healthy life and a life with dignity. In other words: everyone has the right to sanitation.

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Definition of sanitation:

There are many definitions of sanitation, basic sanitation, improved sanitation and environmental sanitation, proposed by UN bodies, Water Supply and Sanitation Collaborative Council (WSSCC), Joint Monitoring Program (JMP) of UNICEF and the World Health Organization (WHO), amongst others.

The following definition is adapted from the definition developed by the Millennium Task Force:

Sanitation is access to, and use of, excreta and wastewater facilities and services that ensure privacy and dignity, ensuring a clean and healthy living environment for all. ‘Facilities and services’ should include the ‘collection, transport, treatment and disposal of human excreta, domestic wastewater and solid waste, and associated hygiene promotion’, to the extent demanded by the particular environmental conditions.

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World Health Organization (WHO) defines sanitation as group of methods to collect human excreta and urine as well as community waste waters in a hygienic way, where human and community health is not altered. Sanitation methods aim to decrease spreading of diseases by adequate waste water, excreta and other waste treatment; proper handling of water and food and by restricting the occurrence of causes of diseases. Inadequate sanitation is a major cause of disease world-wide and improving sanitation is known to have a significant beneficial impact on health both in households and across communities. Sanitation refers to the safe disposal of human excreta. This entails the hygienic disposal and treatment of human waste to avoid affecting the health of people. Sanitation is an essential part of the Millennium Development Goals. The most affected countries are in the developing world. Population increase in the developing world has posed challenges in the improvement of sanitation. According to Zawari, Sowers, and Weinthal, lack of provisions of basic sanitation is estimated to have contributed to the deaths of approximately 3.5 million people annually from water borne diseases.

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The word ‘sanitation’ also refers to the maintenance of hygienic conditions, through services such as garbage collection and wastewater disposal. Hygienic means of prevention can be by using engineering solutions (e.g. sewerage and wastewater treatment), simple technologies (e.g. latrines, septic tanks), or even by personal hygiene practices (e.g. simple hand washing with soap). Sanitation is a system to increase and maintain healthy life and environment. Its purpose is also to assure peo­ple enough clean water for washing and drinking purposes. Typically health and hygiene education is connected to sanitation in order to make people recognize where health problems originate and how to better sanitation by their own actions. Essential part of sanitation is building & maintaining education on sewerage systems, wash up and toilet facilities. Sanitation is the hygienic means of preventing human contact from the hazards of wastes to promote health. Hazards can be physical, microbiological, biological or chemical agents of disease. Wastes that can cause health problems are human and animal feces, solid wastes, domestic wastewater (sewage, urine, sullage and grey water), industrial wastes, and agricultural wastes.

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According to American Heritage Dictionary, sanitation means:

1. Formulation and application of measures designed to protect public health.

2. Disposal of sewage.

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With respect to defining sanitation most professionals would agree that “sanitation” as a whole is a “big idea” which covers inter alia:

• Safe collection, storage, treatment and disposal/reuse/recycling of human excreta (feces and urine);

• Management/reuse/recycling of solid wastes (trash or rubbish);

• Drainage and disposal/reuse/recycling of household wastewater (often referred to as sullage or grey water);

• Drainage of storm water;

•Treatment and disposal/reuse/recycling of sewage effluents;

• Collection and management of industrial waste products; and

• Management of hazardous wastes (including hospital wastes, and chemical/ radioactive and other dangerous substances).

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Hygiene vis-à-vis sanitation:

The concepts of hygiene and sanitation have been introduced to us since we were young. Proper hygiene was always taught to us by our teachers, parents, and medical professionals such as doctors, dentists, and nurses. Are there any differences between hygiene and sanitation?  “Hygiene” is defined as a cumulative group of practices that is perceived by groups of people to be a way towards healthy living or good health. “Sanitation,” on the other hand, is defined as the way in which humans promote healthy living and good health by preventing human contact with wastes (excreta) and other forms of microorganisms that cause disease. In short, both words are meant for prevention of disease and health promotion. Hygiene is often associated with the human body. We use the word “hygiene” for our body by brushing our teeth, taking a bath, and so on and so forth. Hand washing is also part of hygiene and is considered as the universal precaution in preventing the transmission of microorganisms. “Sanitation,” on the other hand, is for human waste, environmental waste, and other forms of waste. Hygiene is for personal care of human body while sanitation is for the disposal of waste around us. 

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Sanitation vis-à-vis disinfection:

It is common to use the words disinfect and sanitize interchangeably as they are both cleaning terms that mean reducing the number of pathogens on a surface. But the words and their use are not interchangeable. Sanitize refers to a condition, while disinfection is the process used to reach sanitary conditions. Sanitation is the appropriate word used when describing what looks like a safe object. A sanitary home, for example, has germs. However, these germs are present at levels that will not harm the humans and animals that come in contact with the pathogens. The process of making the home sanitary is disinfecting. The term refers to the act of cleaning in a way to removes dust, dirt and pathogens from the area. Thus, baby bottles boiled in water are not sanitized but disinfected.

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Hand washing:

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Hand washing remains one of the best ways to prevent the spread of disease and infection. Many germs and contaminants cannot live if presented with warm, soapy water. Everything you touch during the day can be contaminated with something. While the germs might not make you ill, when touching someone with a weaker immune system such as a baby, you put the other person at risk. In addition, you put yourself at risk the longer you are exposed to whatever you have touched. Washing hands before and after you handle food especially before eating, after using toilet, when you go to the restroom or anytime you have come in contact with highly public surfaces such as handrails will help keep you healthy. Special attention should be paid that children wash their hands because of exposure to pathogens while playing with contaminated water and ground. If possible hands should be washed with soap and running water. Hand washing with soap, particularly after contact with excreta, can reduce diarrheal diseases by over 47 per cent and respiratory infections by 30 per cent. Diarrhea and respiratory infections are the number one cause for child deaths in developing nations. Hand washing with soap is among the most effective and inexpensive ways to prevent diarrheal diseases and pneumonia. There is no doubt that proper hand washing with soap water saves life. Washing hands with water alone is significantly less effective than washing with soap no mater of any type.

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The term “sanitation” can be applied to a specific aspect, concept, location or strategy, such as:

1. Basic sanitation is improved sanitation i.e. facilities that ensure hygienic separation of human excreta from human contact. This terminology is the indicator used to describe the target of the Millennium Development Goal on sanitation, by the WHO/UNICEF Joint Monitoring Program for Water Supply and Sanitation.

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2. On-site sanitation – the collection and treatment of waste is done where it is deposited. Examples are the use of pit latrines, septic tanks, and Imhoff tanks.

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3. Food sanitation – refers to the hygienic measures for ensuring food safety.

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4. Environmental sanitation – the control of environmental factors that form links in disease transmission. Subsets of this category are solid waste management, water and wastewater treatment, industrial waste treatment and noise & pollution control. Environmental sanitation are activities aimed at improving or maintaining the standard of basic environmental conditions affecting the well-being of people. These conditions include (1) clean and safe water supply, (2) clean and safe ambient air, (3) efficient and safe animal, human, and industrial waste disposal, (4) protection of food from biological and chemical contaminants, and (5) adequate housing in clean and safe surroundings. The World Health Organization (WHO) defines ‘Environmental Sanitation’ as “the control of all those factors in man’s physical environment which exercise or may exercise a deleterious effect on his physical development, health and survival.” Environmental sanitation/hygiene includes all the activities aimed at improving or maintaining the standard of basic environmental conditions affecting the well being of people.

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5. Ecological sanitation (vide infra) – an approach that tries to emulate nature through the recycling of nutrients and water from human and animal wastes in a hygienically safe manner.

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In this article, I am using the word ‘sanitation’ as safe & hygienic disposal of human excreta (feces & urine). Therefore food sanitation, environmental sanitation, garbage management, hospital sanitation and restaurant sanitation will not be discussed. The focus is on safe disposal of human excreta.

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To allow for international comparability of estimates for monitoring the Millennium Development Goals (MDGs), the World Health Organization/UNICEF Joint Monitoring Program (JMP) for Water Supply and Sanitation defines “improved” sanitation as one that hygienically separates human excreta from human contact.

Improved sanitation:

Flush toilet

Connection to a piped sewer system

Connection to a septic system

Flush / pour-flush to a pit latrine

Ventilated improved pit (VIP) latrine

Pit latrine with slab

Composting toilet

Ecological sanitation

Some special cases

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Sanitation facilities that are not considered as “improved” are:

Public or shared latrine

Flush/pour flush to elsewhere (not into a pit, septic tank, or sewer)

Pit latrine without slab

Open pit latrine

Bucket latrines

Hanging toilet / latrine

Excretion to environment (open air defecation or defecation in river etc)

No facility e.g. bus

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Scale of the crisis:

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The scale of the sanitation crisis is profound. The UN estimates that 2.6 billion people, 40 per cent of the world’s population, lack access to adequate sanitation. The global toll in human development terms is shocking: pervasive associated disease and death, chronic and inescapable poverty and the paths of opportunity through education and productive labor blocked.

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The urgency for action in the sanitation sector is obvious, considering the 2.6 billion people world-wide who remain without access to any kind of improved sanitation, and the 2.2 million annual deaths (mostly children under the age of 5) caused mainly by sanitation-related diseases and poor hygienic conditions. Further, in the developing world 50 per cent of the population is without adequate sanitation (World Bank, 2003) and suffer with diarrhea, trachoma and schistosomiasis (WHO and UNICIEF, 2000) leading to considerable loss and disabilities of human resources. Considering this, the international community set provision of sanitation as part of the Millennium Development Goals, to reduce to half by the year 2015, those without adequate sanitation facilities. So the United Nations, during the Millennium Summit in New York in 2000 and the World Summit on Sustainable Development in Johannesburg in 2002, developed a series of Millennium Development Goals (MDGs) aiming to achieve poverty eradication and sustainable development. The specific target set for the provision of water supply and sanitation services is to halve the proportion of people without access to safe drinking water and adequate sanitation by 2015. The Joint Monitoring Program 99 (JMP) of the WHO and UNICEF reported in 2004 that the number of people lacking basic sanitation services rose from 2.1 billion in 2001 to 2.6 billion by 2004. As the JMP and the UNDP Human Development Report (2006) have shown, the progress towards meeting the MDG sanitation target is however much too slow, with an enormous gap existing between the intended coverage and today’s reality especially in Sub-Sahara Africa and parts of Asia. Considering all parameters, this means that an additional 350,000 people have to be covered every day with improved sanitation services by 2015 (IRC, 2003). Unless huge efforts are made, the proportion of people without access to basic sanitation will not be halved by 2015. At current rates of progress, we will reach 67 per cent coverage in 2015, better than previous projections but still far from the 75 per cent needed to reach the target. Unless the pace of change in the sanitation sector can be accelerated, the MDG target may not be reached until 2026.

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Defined as a facility which removes excreta from the risk of human contact, “safe” sanitation encompasses covered pit latrines as well as flush toilets. Since its belated addition to the MDGs in 2002, the sanitation target has been the Cinderella of the cause, attracting little over 10% of funds earmarked for water and sanitation programs. More Africans have access to mobile phones than toilets. The same is true in India, a country which boasts nuclear weapons and a space program. Development agencies must accept some responsibility, their publicity cameras preferring to linger on happy children pumping water. Latrines offer less inspiring images and copy. Even the UN’s declaration of the period 2005-2015 as the “International Decade for Action – Water for Life” betrayed neglect of sanitation in presentation if not intent. The consequence is that global access to safe sanitation increased only from 49% to 63% in the period 1990-2010, leaving 2.5 billion people unprotected. This figure has barely changed in recent years and is projected to be 2.4 billion in 2015, dooming the MDG target of 75% to almost certain failure. Open defecation, the most degrading consequence, is still practiced by 1.1 billion people, including half the population of India. In sub-Saharan Africa, access to safe sanitation has advanced from 26% to just 30% over the last two decades, extrapolating to arrive at the MDG target sometime during the 22nd century.

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Official statistics from WHO and UNICEF suggest that about 3.8 billion people (60%) in 2004 have access to “improved” sanitation globally. The regions with the lowest coverage are sub-Saharan Africa (37%), Southern Asia (38%) and Eastern Asia (45%). Underlying issues that contribute to the challenging situation include lack of political will, inadequate financial resources, weak institutional frameworks, neglect of consumer preferences, and cultural beliefs. To reach the MDG target on sanitation, the global coverage should be at least 75% by 2015. This would mean an additional 1.6 billion people would have to be provided with sanitation systems. Meeting the MDG target would avert 391 million cases of diarrhea per year. Health gains from sanitation are incorporated in existing economic analysis which shows that every US dollar invested in sanitation would give a return of about US $9.

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In 2008, 2.6 billion people – 40 percent of the world’s population — had no access to improved sanitation facilities. The Millennium Development Goal (MDG) target is to reduce by half the proportion of people without access to basic sanitation by 2015. Progress has been slow and, at the current rate, the world will miss the MDG target.

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It is an incredible fact that 1 in 3 women and girls – that’s 1.25 billion – lack safe and adequate sanitation and of those 526 million don’t have a toilet at all.

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Below are a few examples of stunning sanitation statistics.

• An estimated 2.6 billion people — half of the developing world — lack access to improved sanitation.

• Urban & rural population globally using improved sanitation in 2004: 80% (urban) vs. 39% (rural)

• Despite major progress in South Asia, little more than a third of its population use improved sanitation; access to adequate sanitation in sub-Saharan Africa is only 37%.

• According to UNICEF, number of children under 5 living in households without access to improved sanitation facilities is 280 million

• 2.2 million People die every year from diarrheal diseases (including cholera); 90% of all deaths caused by diarrheal diseases are children under 5, mostly in developing countries.

• 88% of all diarrheal deaths is attributed to unsafe water supply, inadequate sanitation and hygiene.

•Improved water sources reduce diarrhea morbidity by 21%; improved sanitation reduces diarrhea morbidity by 37.5%; and the simple act of washing hands at critical times can reduce the number of diarrhea cases by as much as 47%. Improvement of drinking-water quality, such as point-of-use disinfection, would lead to a 45% reduction of diarrhea episodes.

• Improving access to safe water sources and better hygiene practices can reduce trachoma morbidity by 27%.

• An estimated 160 million people are infected with schistosomiasis; basic sanitation reduces the disease by up to 77%.

•According to the United Nations and UNICEF, one in five girls of primary-school age are not in school, compared to one in six boys. One factor accounting for this difference is the lack of sanitation facilities for girls reaching puberty. Girls are also more likely to be responsible for collecting water for their family, making it difficult for them to attend school during school hours. The installation of toilets and latrines may enable school children, especially menstruating girls, to further their education by remaining in the school system.

• 11% increase in girls’ enrolment mainly due to the provision of sanitary latrines.

•Even if the United Nations’ Millennium Development Goal for basic sanitation is reached by 2015, it will still leave: An estimated 1.8 billion people (25% of the world’s population) without access to adequate sanitation.  

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The graph above shows distribution of 2.6 billion people not using improved sanitation in 2008. That means forty percent of people do not have improved sanitation facilities in developing countries.

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1) 17per cent of them practiced open defecation – the most risky sanitation practice of all;

2)11 per cent used an unimproved sanitation facility – one that does not ensure hygienic separation of excreta from human contact; and,

3) Another 11 percent used otherwise acceptable sanitation facilities but shared a facility between two or more households, or used a public toilet facility.

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A joint study by the World Health organisation and UNICEF ‘Diarrhoea: Why Children Are Still Dying and What Can Be Done’, also pointed out that India has the largest number of persons that defecate in the open worldwide. The United Nations estimates that 2.5 billion people were still without improved sanitation in 2010 and around 1.1 billion practice open defecation. Out of a total of 1.1 billion people worldwide that defecate openly, 626 million belong to India. The figure below shows countries with the largest numbers of people without access to improved sanitation (millions).

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Sanitation is a major problem in developing countries such as India and China. The government is unable to provide proper sanitation through underground drainages. Also, lack of knowledge and of money, illiteracy, large population and lack of social awareness results in improper sanitation. To avoid these problems, low-cost onsite sewage disposal systems should be used. These systems collect human excreta and store it in a hole or a pipe, and later direct it to a sewage treatment plant. In the absence of a proper sanitation network, people can use some other mechanism for sewage disposal. The other mechanisms are septic tanks, chemical toilets, composting pits and vermi-processing toilets.

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The state of sanitation remains a powerful indicator of the state of human development in any community. Access to sanitation bestows benefits at many levels. Cross-country studies show that the method of disposing of excreta is one of the strongest determinants of child survival: the transition from unimproved to improved sanitation reduces overall child mortality by about a third. Improved sanitation also brings advantages for public health, livelihoods and dignity-advantages that extend beyond households to entire communities.

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The map below shows percentage of people using improved sanitation in 2010:

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The objective of the UN-Water Global Analysis and Assessment of Sanitation and Drinking-Water (GLAAS) is to monitor the inputs required to extend and sustain, sanitation and hygiene (WASH) systems and services. WASH means Water, Sanitation, and Hygiene. The table below shows results achieved by four multilateral organizations engaged in WASH sectors in poor nations:

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A review of the evidence suggests that there is “strong evidence” that WASH interventions have a demonstrable impact on health outcomes, particularly in terms of reducing morbidity and mortality associated with diarrheal diseases, which are the biggest cause of death of children in Africa.

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WASH statistics on sanitation:

1. At any given time, nearly half of the population of the developing world suffers from illness caused by lack of access to safe water and sanitation.
   Stockholm International Water Institute. Making Water a Part of Economic Development: The Benefits of Improved Water Management Services, 2005.
2. Two in five people do not have the security and dignity of a hygienic latrine or toilet.
   World Health Organization and United Nations Children’s Fund Joint Monitoring Program for Water Supply and Sanitation. Progress on Drinking Water and Sanitation: Special Focus on Sanitation (New York: UNICEF; Geneva: WHO, 2008).
3. If even just a small portion of a displacement community is practicing open defecation, the whole population is at greater risk of diarrheal diseases, worm infestations and hepatitis.
   World Health Organization, Environmental Health in Emergencies and Disasters, 2003.
4. While access to safe water can decrease childhood water-related deaths by 15 to 20 percent, improved hygiene practices such as hand washing reduces deaths caused from diarrhea by 35 percent, and access to adequate sanitation reduces rates by 40 percent.
   WaterAid, “Integrated Projects”.
5. Every $1 spent in the sector creates on average another $8 in costs averted and productivity gained.
   United Nations Development Program, Beyond Scarcity: Power, Poverty and the Global Water Crisis, Human Development Report (2006).
6. A dollar invested in water and sanitation could give an economic gain of between $3 USD and $34 USD, depending on the nation.
   Hutton, Guy and Laurence Haller. Costs and Benefits of Water and Sanitation Improvements at the Global Level. World Health Organization, 2007.
7. A recent Water and Sanitation Program study showed that the lack of sanitation has cost countries anywhere from 1 percent to 7 percent of their GDP.
   WHO AND UNICEF Joint Monitoring Programme for Water Supply and Sanitation. Progress on Drinking Water and Sanitation. UNICEF, New York and WHO, Geneva, 2008.
8. Once girls reach puberty, lack of access to sanitation becomes a central cultural and human health issue, contributing to female illiteracy and low levels of education, in turn contributing to a cycle of poor health for pregnant women and their children.
   United Nations University Institute for Water, Environment and Health. Sanitation as a key to global health: voices from the field. (Hamilton, Ontario, Canada: 2010)
9. By simply providing a separate latrine facility for girls, school enrollment rates for girls have been shown to improve by over 15 percent.
   UN WATER, “Sanitation: a wise investment for health, dignity, and development”, Key Messages for the International Year of Sanitation, 2008.
10. Of all the primary school-aged girls worldwide who are not enrolled in school, 41 percent live in South Asia and 35 percent reside in Sub-Saharan Africa.
    Fisher, Julie. “For Her it’s the Big Issue: Putting Women at the Centre of the Water Supply, Sanitation, and Hygiene. Water, Sanitation, and Hygiene Evidence Report. Water Supply and Sanitation Collaborative Council, March 2006.
11. If access to improved sanitation increased, diarrheal disease could subside, providing much need relief to those suffering from HIV/AIDS. In a study of HIV/AIDS individuals done in Uganda, the presence of a simple latrine reduced the risk of diarrheal disease by 31 percent.
    Weinger, Maurice. Dignity for All: Sanitation, Hygiene and HIV/AIDS. USAID, 2008
12. Nearly 40 million people currently live with HIV/AIDS.
    USAID. Background on Integrating HIV/AIDS into Hygiene Improvement Program. May 2008.
13. In 2007, there were 2.7 million new HIV infections and 2 million HIV-related deaths.
    The Joint United Nations Program on HIV/AIDS. 2008 Report on the global AIDS epidemic.
14. Access to adequate sanitation is extremely limited in many communities with a high prevalence of HIV/AIDS. Those with compromised immune systems, such as HIV/AIDS patients, are more prone to common illnesses and diseases, especially diarrhea.
    Obi, CL, B. Onabolu, M.N.B. Momba, J.O. Igumbor, J. Ramalivahna, P.O. Bessong, E.J. van Rensburg, M. Lukoto, E. Green, and T.B. Mulaudzi. The interesting cross-paths of HIV/AIDS and water in Southern Africa with special reference to South Africa. South African Water Research Commission, Vol. 32 No. 3, July 2006.
15. According to research studies by the United Nations Environment Program; coastal habitats, fisheries, and marine wildlife in the South Asian Sea are threatened by untreated sewage discharge into coastal waters.
    WHO AND UNICEF Joint Monitoring Program for Water Supply and Sanitation. Progress on Drinking Water and Sanitation: Special Focus on Sanitation. UNICEF, New York and WHO (Geneva, 2008).
16. In developing nations, approximately 90 percent of sewage systems are being emptied into rivers, lakes, and nearby streams that communities use for drinking water.
    A. Carius, G. Dabelko, and A. Wolf. Water Conflict and Cooperation, Policy Briefing, United Nations Foundation (2005).
17. Sub-Saharan Africa loses about 5% of GDP, or some $28.4 billion annually, a figure that exceeded total aid flows and debt relief to the region in 2003.
    Water and Sanitation Program. Economic Impacts of Sanitation in Southeast Asia: Summary. 2007.
18. Many children in the developing world live with constant diarrhea caused by lack of safe water and sanitation, and each year over 1.5 million children die from diarrheal diseases.
    WHO AND UNICEF Joint Monitoring Program for Water Supply and Sanitation. Progress on Drinking Water and Sanitation. UNICEF, New York and WHO, Geneva, 2008.
19. 2.6 billion people – 72 percent and 21 percent of whom live in Asia and Sub-Saharan Africa, respectively – do not use improved sanitation facilities. Improved sanitation facilities ensure hygienic separation of human excreta from human contact.
    World Health Organization and United Nations Children’s Fund Joint Monitoring Program for Water Supply and Sanitation. Progress on Drinking Water and Sanitation: 2010 Update.

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An estimated 2.6 billion people lack access to adequate sanitation globally. If the current trend continues, by 2015 there will be 2.7 billion people without access to basic sanitation. The regions with the lowest coverage are sub-Saharan Africa (31%), southern Asia (36%) and Oceania (53%). Underlying issues that add to the challenge in many countries include a weak infrastructure, an inadequate human resource base and scarce resources to improve the situation. Every day, 6,000 children die from diseases associated with inadequate sanitation, poor hygiene, and unsafe water. Diarrhea alone kills one child every 20 seconds. To reduce the transmission of the deadly bacteria that cause diarrhea, people need an understanding of the disease transmission process and the steps that can break it, such as washing their hands at critical times, as much as they need toilets and washbasins.

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Sanitation disparities:

Whereas 99% of people living in industrialized countries have access to improved sanitation, in developing countries only 53% have such access. Within developing countries, urban sanitation coverage is 71% while rural coverage is 39%. Consequently, at present the majority of people lacking sanitation live in rural areas; this balance will shift rapidly as urbanization increases. Worryingly, over the past two decades, provision of improved sanitation has barely kept pace with increasing populations while most other social services, including water supply, have outpaced population growth.

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Do hazards of poor sanitation affect mainly poor people?

Yes, according to a research study which estimated inequities in sanitation-related disease burden and estimated the potential impacts of pro-poor targeting. Its findings are as follows:

• The health burden of poor sanitation falls disproportionately on children living in the poorest households

• This increased health burden is the result of both greater exposure to infection and increased susceptibility among children in these households

• The increased exposure among these children is a function of their increased likelihood of having no access to a private facility, having to use shared facilities and being more likely to live in an area with a high density of people without sanitation

• Children in poor households are more likely to be susceptible (resulting from lower nutritional status) to diarrheal diseases and suffer higher mortality

• Improvements in sanitation for households in the poorest quintile may bring significantly greater health benefits than improvements in the richest quintiles

• The sanitation-related burden differs between rural and urban settings, but children in poor households in both settings consistently suffer disproportionately

• While rural populations generally have lower levels of access, the sanitation associated risk may be greater for the urban poor due to the increased likelihood of these households being in areas with a high density of people without sanitation

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Lack of sanitation as a source of inequality worldwide:

Improving sanitation and building more toilets could save millions of lives around the world and would remove an important source of inequality, the UN says. Eliminating inequalities can start in the most unlikely of places: a toilet. More than 2.2 million people die each year due to lacking sanitation, and most of them are under five years of age, the UN expert told reporters in Geneva. Access to sanitation facilities around the world, more than any other service, provides a window into the vast difference between the “haves” and the “have-nots”,” pointing out that not having a toilet was almost exclusively the burden of the poor. Only one in three people worldwide have access to suitable toilet facilities, while more than one billion people still defecate in the open. Lacking sanitation not only made poor people sick; it also shrank their already limited possibilities by forcing them to stay away from school and work. Each year, children miss a total of 272 million school days due to water-borne or sanitation-related diseases, according to the UN. Women forced to look for a place to hide at the time of defecating also often fell victim to sexual harassment and sexual assault. This is not only about ensuring the right to sanitation, but it is also critical for the enjoyment of numerous other rights, such as the right to health, the right to education, the right to work and the right to lead a life in dignity.

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Lack of sanitation will keep these same poor people sick, away from school and work, victims of violence when trying to find a place to hide to ‘do their business,’ and not able to break the cycle of poverty and exclusion, in which they are trapped. So poverty leads to poor sanitation and poor sanitation leads to poverty and people are trapped in a vicious cycle.

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For practical purposes sanitation can be divided into on-site and off-site technologies. On-site systems (e.g. latrines), store and/or treat excreta at the point of generation. In off-site systems (e.g. sewerage) excreta is transported to another location for treatment, disposal or use. Some on-site systems, particularly in densely populated regions or with permanent structures, will have off-site treatment components as well.

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On-site disposal:

In many places, particularly in areas with low population densities, it is common to store and treat wastes where they are produced – on-site. There are a number of technical options for onsite waste management which if designed, constructed, operated and maintained correctly will provide adequate service and health benefits when combined with good hygiene. On-site systems include: ventilated improved pit (VIP) latrines, double vault composting latrines, pour-flush toilets, and septic tanks. Dry sanitation or eco-sanitation is an onsite disposal method that requires the separation of urine and feces. Building and operating these systems is often much less expensive than off-site alternatives. Some on-site systems (e.g. septic tanks or latrines in densely packed urban areas) require sludge to be pumped out and treated off-site. Composting latrines allow waste to be used as a fertilizer after it has been stored under suitable conditions to kill worm eggs and other pathogens. In many suburban and rural areas, households are not connected to sewers. They discharge their wastewater into septic tanks or other types of on-site sanitation. On-site systems include drain fields, which require significant area of land. This makes septic systems unsuitable for most cities.

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Off-site disposal:

In more densely packed areas sewerage systems are frequently used to transport wastes off-site where they can be treated and disposed. Conventional centralized sewerage systems require an elaborate infrastructure and large amounts of water to carry the wastes away. This type of approach may work well in some circumstances but is impractical for many other locations. The cost of a sewerage system which can be as much as 70 times more expensive than on-site alternatives and its requirement of a piped water supply preclude its adoption in the many communities in less-industrialized countries that lack adequate sanitation. In specific circumstances, cost-effective alternatives to conventional sewerage systems have been developed including small diameter gravity sewers, vacuum and pressure sewers. Simplified sewer systems have been successfully used in Brazil, Ghana and other countries.

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The figure below shows types of sanitation:

 

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Bad sanitation practice:

Bad sanitation practices and lack of adequate facilities may allow pathogens found in human feces to be ingested by humans through being passed along by animals, flies and insects, on food, and on hands. All of these can provide a pathway for pathogens to move from feces to mouth. This is the rationale behind the WASH concept (Water, Sanitation, and Hygiene). Clean water, adequate sanitation, and good hygiene practices must be integrated into our daily lives and utilized together in order to block all the potential pathways through which disease can be transmitted. In the least developed areas of the world, it is still a common practice to defecate on the ground. This is definitely a bad sanitation practice. This is open defecation and it is the worst scenario for transmission of disease. In addition to this, another bad sanitation practice is when people urinate or defecate in a river or other water source.  Men pee with their backs turned. Women often go behind bushes for privacy. Children have the tendency to go anywhere!

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Overhung Latrine:

In this type of latrine, the excreta drops directly into a water body like river, sea etc. The strong current water takes away the excreta. The local communities must be aware about the higher level for health risks associated with this type of latrine and must take the preventive measures. This is a very cheap option of sanitation but leads to pollution of river/sea.

Bucket Latrines:

This type of latrine contains a bucket or other container located immediately below the squatting hole for collection of excreta. These buckets are periodically removed for treatment or disposal by a night soil labourer called scavenger. This system requires very low initial cost but has a very high health risk for those who collect the night soil. It is also against human dignity and has been given up in most places.

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From bad to good sanitation:

At the very least, human feces should be buried so that ground surface activity won’t spread the feces and the pathogens it contains around the community.  The definition of “improved sanitation facilities” is those facilities that hygienically separate human excreta from human contact. However, sanitation facilities are not considered improved when shared with other households, or open for public use. So, sanitary facilities need to keep human excreta separate from other activities. They need alleviate bad sanitation by keeping excreta contained and confined. They need to isolate excreta from any water source.  But also, good sanitary facilities need to address human needs such as privacy, security and protection from the elements. If these requirements are met, people will more likely find that using an improved sanitary facility is more desirable than not using it. This will result in a decrease of bad sanitation.

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Shallow Pits:

This method comprises the digging of a shallow hole and covering the faeces with soil. Pits dug once can be utilized for longer durations also. The excavated soil is heaped beside the pit and some portion of it is put over the faeces after each use. Decomposition of faeces is quite rapid. The method costs nothing and is a good source of fertilizer to the farmers. However, this method creates a lot of fly nuisance and leads to spread of hookworm larvae over the ground, if the pit is not dug unto one-meter depth.

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Pit latrine: Low Tech Human Waste Disposal Method:

The simplest methods of disposing of human waste (beyond just the simple burial routine) use a pit of some kind or a bucket. The pit of a simple pit latrine as shown in the figure below is dug in a location where soil suitability and permeability are favorable for waste disposal. The pit walls may be shored up with boards, bricks, or stones, if needed. Pit latrine slab construction, shelter construction, and pit construction methods are fairly simple. Improvements can also be made to simple pit latrines. This is a low cost technique, which requires no water. This type of latrine gives a bad smell and may create fly and mosquito nuisance, if the tight fitting cover over the squatting hole is not provided. When the pit is full up to half, a new pit has to be dug.

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Ventilated Improved Pit Latrine:

The ventilated improved pit (VIP) latrines are the improved version of simple pit latrine, where the pit is provided with a vent pipe extending above the latrine roof. The inside of the super structure is kept dark. The vent pipe is provided with a netting to prevent flies and mosquitoes. This type of sanitation system is hygienic, low cost method, which requires no water. The system controls the fly and mosquito nuisance with minimal requirement of user care and involvement. The other advantage is the smell control. However, this type of latrine is highly unsuitable for high-density areas and may pollute ground water. Ventilated improved double pit latrine is another latrine of this type, but with two pits. One pit would be used until full and then sealed while second pit is in use. The first pit is emptied after filling up the second pit and used again.

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Pour Flush Latrine:

Pour flush latrine have a trap providing water seal beneath the squatting plate. The water seal is cleared of faeces by pouring sufficient quantities of water to wash the solids into the pit. The water seal prevents the flies, mosquitoes and smell reaching the latrine from the pit. The pit is usually connected with the latrine through a short length pipe. It is convenient to have two pits instead of one pit. Both of these pits can be utilised alternatively. This type of latrine is low cost sanitation measure, which also controls the odour, fly and mosquitoes. This type of latrine can be upgraded by connecting it to sewer, when sewerage becomes available. The only drawback is that this system requires large quantity of water.

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Composting Toilets:

Another method of clearing human waste is by the process of composting pits. A composting toilet collects human waste and converts it to a fertilizer resource for plant growth without polluting water bodies or groundwater. A composting toilet is a system that converts human waste into organic compost and usable soil. This happens when micro-organisms, such as bacteria and fungi, and macro-organisms, such as earthworms, oxidize organic waste to break it down into essential minerals. In the composting latrines, excreta fall into a watertight tank to which inorganic materials like ash or vegetable waste is added. A careful control over moisture content and chemical balance decomposes the excreta into good manure, which can be utilised as fertilizer. The pathogens are killed during the decomposition process. The compositing latrines are two types. First is the continuous compositing while the second one is with containers used to do the compositing in batches. The method requires very small quantity of water and produces safe and stable humus. The technique is not for high population density areas and requires good quantities of inorganic biodegradable matter. For using this method extremely high degree of user care and motivation is a must.

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Water is essential for life: it affects human life and humans affect the water cycle. Every year, approximately 16 km³of water are flushed out in conventional flushing toilets. In the majority of the cases, it is drinking water which is used in flushing toilets. This water must be treated in water-treatment plants before discharged in the environment. The use of dry composting toilet can save up to 40 liters per capita/day. But most of these systems present several shortcomings, such as unpleasant odors and the necessary manual manipulation of latrine waste. How to control odor from compost is discussed later on in the article. Urine diverting composting toilets are a superior choice. They eliminate odor, use almost no electricity, have more capacity, never leak, and are less expensive! 

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Vermi-Composting Toilets:

A vermi-composting toilet is a process that involves earthworms, which treat human excreta. This process is low cost. Moreover, the entire human waste is converted into of vermi-compost.

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Various on-site household latrines:

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Septic Tanks:

Septic tanks are suitable for places such as hospitals, isolated buildings and clusters of houses where there is no sewage. Local governments or private corporations usually provide septic tanks in areas that have no direct connection to main sewage pipes. The septic tank system consists of a small sewage treatment system. A septic tank is a rectangular watertight settling chamber, located below the ground level. The septic tank receives both excreta and flush water from latrines and the raw sewerage from the other household activities. The retention time in the tank is usually 1-3 day, during which the solid particles settle down to the bottom, where they get digested and a thick layer of scum is formed over the surface. The effluent from the septic tanks is usually discharged to soakways of leaching fields. This system works very effectively in the permeable soil conditions and in the areas free from flooding and waterlogging. Now a day the septic tanks with two compartments are commonly used. The septic tanks are usually used for the individual household but can also be used at small community level. The septic tanks require large areas, higher costs and high level of user attention.

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I believe a substantial portion of the water from the septic system moves up to the surface and evaporate. I remember living in a house where it was very easy to see where the runs were for the septic system. I suppose that would depend greatly on the soil type but nonetheless, escape of waste water from septic tank on the surface is definitely very unhygienic way of sewage disposal. Such septic tank systems cannot be considered as improved sanitation and India houses millions of such septic tank systems.

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Aqua-Privy:

Aqua privy has a watertight tank immediately under the squatting hole. The excreta drop down into the tank through a pipe. The bottom of the pipe is submerged into the water in the tank thus preventing the smell, flies and mosquitoes entering the latrine. The tank functions like a septic tank. The effluent usually drains out through a soak pit. A vent pipe is also provided for ventilation. The water level must be maintained by adding sufficient quantities of water after every use to check the losses due to evaporation and leakage. The sludge so formed must be removed regularly. This system is less expensive than the septic tanks and there is no need for piped water supply. The technique is applicable in permeable soils to dispose of the effluent and dislodging requires careful handling by municipality staff. A significant amount of water is also needed.

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Bio-toilet:

 The bio toilets is really a self-contained device (not really attached to the septic or even sewer program) that breaks-down as well as dehydrates human being waste materials to some composting which may be put into earth. The bathroom may contain a location in order to sit down (that will probably appear nearly the same as every other bathroom), the composting step that stops working as well as sanitizes the actual sewage, along with a drying out step or even holder that enables dampness to flee, decreasing the actual sewage quantity. Bio-toilets are available in versions, electrical (warmed as well as power-vented) versions as well as non-electric versions. 

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Bio-toilet:

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A consortium of anaerobic bacteria has been formulated and adopted to work at temp as low as 5 degree C. This is the component which acts as inoculums (seed material) to the bio digester and converts the organic waste into methane and carbon-dioxide. The anaerobic process in- activates the pathogens responsible for water born diseases. Bio digester serves as reaction vessel for bio methanation and provides the anaerobic conditions and required temp for the bacteria. The optimum temp is maintained by microbial heat, insulation of the reactor and solar heating. Bio digester tank is a cylindrical structure with the provision of inlet for human waste and out let for Bio gas. Temp in the bio – digester is maintained between 5-30 degree C. A person can use the toilet which is connected to the bio-digester. Night soil degradation occurs through microbial reaction which converts it into bio gas. The smell of night soil, the disease causing organisms in the night soil and the solid matter are eliminated totally. On dry weight basis 90% of the solid waste is reduced. The anaerobic bacteria inside the toilets consume waste material and convert it into water and gas in the bio-toilet system. The water passing through chlorine tank is discharged as clean water and the gas generated evaporates into the atmosphere. Bio Gas can be used for various energy incentive activities like cooking water and room heating. Liquid effluent can be drained to any surface or soak pit without any environmental hazards.  

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Remember, composting toilet uses aerobic digestion of waste matter to produce compost & CO2 while bio-toilet uses anaerobic digestion to produce biogas methane, CO2, water and some compost. As you can see there is overlap between composting toilet and bio-toilet.   

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Biogas toilets:

The households converted the existing biogas plants in two pit toilets and constructed additional biogas toilets. The system consists of household toilets with offset twin pit outside. Construction material could partly be found (bricks) or produced (concrete ring, pan) locally. As it is a wet toilet system, feces are flushed away with water. There is an additional inlet where the cow dung is mixed with water. This cow dung slurry is transported to pit through clay pipe. In the pit flushed away feces are left for decomposition. During decomposition the released methane gas is captured and the outlet is directly connected to the kitchen for use. The slurry of the pit is used as manure when dry. 

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Chemical Toilets:

Aeroplanes and trains usually have chemical toilets. A chemical toilet uses chemicals to disinfect human waste and remove its bad odor. That is why trains and aeroplanes do not have elaborate plumbs and sewage.

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Vault and Cartages System:

The vault latrines consist of a watertight tank to store the excreta until a vacuum tanker removes them. The vaults are emptied on regular intervals, when they are nearly full. The performance requires and efficient service along with an efficient infrastructure. Irregular collection can lead to tank overflow and may create unhygienic conditions. This is not a commonly used method.

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Incinerating Toilets:

 Instead of breaking down waste biologically, these toilets torch it. They send the waste to an incinerator, where it’s burned to sterile ash. You’ll empty the ashes every three to six months. And you can throw the sterile ashes in the trash.

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Waterless Urinals:

You’ll find waterless urinals in crowded public restrooms. Building owners saw that by using dry urinals, they’d save money on water and sewer charges for thousands of flushes. Waterless urinals look like regular urinals without a pipe for water intake. Men use them normally, but the urinals don’t flush. Instead, they drain by gravity. Their outflow pipes connect to a building’s conventional plumbing system. In other words, unlike a composting toilet, which leaves you to deal with your waste, these urinals send the urine to a water treatment plant.   

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Sulabh Toilets:

Organizations such as Sulabh International (NGO) have developed a twin-pit pour flush toilet system that is being used by ten million people every day in India. The waste from these toilets flows through covered drains into a biogas plant for the generation of biogas and bio-fertilizers. Biogas plants offer safe and hygienic disposal of wastes. Biogas has great advantage, i.e. it is used as a source of low-cost fuel. It can be used for heating, cooking running heat engines, generating mechanical or electrical power (vide infra). 

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Sewerage System:

The sewerage system is designed to transport a mixture of excreta and wastewater from households to the central treatment plant through a network of underground pipes. The system provides highest level of user convenience for all type of wastewater disposal, involving no health risks and a very minimal maintenance. The standard sanitation technology in urban areas is the collection of wastewater in sewers, its treatment in wastewater treatment plants for reuse or disposal in rivers, lakes or the sea. Sewers are either combined with storm drains or separated from them as sanitary sewers. Combined sewers are usually found in the central, older parts or urban areas. Heavy rainfall and inadequate maintenance can lead to combined sewer overflows or sanitary sewer overflows, i.e. more or less diluted raw sewage being discharged into the environment. Industries often discharge wastewater into municipal sewers, which can complicate wastewater treatment unless industries pre-treat their discharges. The high investment cost of conventional wastewater collection systems are difficult to afford for many developing countries. Some countries have therefore promoted alternative wastewater collection systems such as condominial sewerage, which uses smaller diameter pipes at lower depth with different network layouts from conventional sewerage. The treated water can be utilized for irrigation purpose. The major hurdle is the very high initial cost, skilled labourer, large amount of water requirements making the system more urbanized and water intensive. If discharged into a water body it requires adequate pre-treatment.

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The figure below shows summary of advantages and disadvantages of various types of sanitation.

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The figure below shows sanitation ladder where health benefits are directly proportional to improvement in sanitation.

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Basic sanitation was defined in UN’s World Summit on Sustainable Development (WSSD) in 2002. By definition basic sanitation consists:  

• Development and implementation of efficient household sanitation systems

• Improvement of sanitation in public institutions, especially in schools

• Promotion of safe hygiene practices

• Promotion of education and outreach focused on children, as agents of behavioral change

• Promotion of affordable and socially & culturally acceptable technologies and practice

• Development of innovative financing and partnership mechanisms

• Integration of sanitation into water resources management strategies in a manner which does not have negative impact on the environment

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Affordable sanitation:

 Sanitation services, including construction, emptying and treatment of fecal matter, must be available at a price that everyone can afford without compromising their ability to acquire other basic goods and services, including food, housing, health services and education. In urban areas, a connection to the sewerage system will almost always be the cheapest and most convenient option for the user. However, as with water connections, often the price of a connection to the sewerage system will be prohibitive. Governments should provide subsidies where necessary for the emptying of septic tanks or pit latrines and the safe transport, transport, treatment and disposal of excreta. Governments should also provide assistance to households unable to afford soap for hygiene practices, and sanitary towels for women.

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Culturally acceptable sanitation:

Sanitation must be of a culturally acceptable quality. In many cultures, use of toilets is a highly sensitive subject and the construction, positioning and conditions for use will need to be taken into account in planning services. In most cultures, it will be necessary to separate women’s and men’s use of toilets where public toilets are being constructed, (or boys’ and girls’ facilities in schools) to ensure privacy and dignity. Care needs to be taken that good menstrual hygiene can be practiced. Many cultures and religions require that washing facilities be available for cleaning of anal and genital areas after the use of a toilet. Manual emptying of pit latrines is generally culturally unacceptable, so mechanized alternatives that limit contact with feces should be used. Sanitation should be ensured in a nondiscriminatory manner and include vulnerable and marginalized groups. There must be no distinction based on prohibited grounds such as race, gender, health status or color that leads to unequal access to sanitation. Non-discrimination also includes proactive measures to ensure that the particular needs of vulnerable and marginalized groups are met. According to the OHCHR Report, priority in allocating limited public resources should be given to those without access or who face discrimination in accessing sanitation. A particular example of discrimination in the delivery of services is where informal settlements do not receive services due to their lack of legal status. The lack of delivery to such settlements is particularly discriminatory against the vulnerable and marginalized groups who are most in need of assistance to access sanitation services.

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Setting standards for sanitation in different environments:

There are vastly different conditions within and between countries, which means that standards need to be carefully modified accordingly. While recognizing the shades of grey between ‘rural’ and ‘urban’, there are some generalized pointers:

Rural:

In rural areas, on-site household level toilets, for both collection and treatment are generally sufficient to avoid contamination of the water supply, as long as toilets are not built in the vicinity of a water source. Wastewater drainage and solid waste management require less attention in low-density rural settings, as some forms of wastewater can be used for watering kitchen gardens. Stormwater may require programs such as reforestation, or anti-soil erosion measures. Affordability of sanitation services in rural areas cannot generally be defined as a percentage of household expenditure, as many rural economies in developing countries are often not monetarised – services are more often secured through self-help processes, payment in kind or through government subsidies.

Urban:

In high population areas, there is frequently insufficient space for household level on-site latrines, thus requiring short or medium term solutions such as condominial sewerage systems or shared or public on-site facilities. Treatment of excreta will generally not be possible on-site, although small-scale localized treatment plants can be an effective option. It is necessary to understand cities and small towns as a sanitary whole, requiring safe transport, treatment and disposal of excreta, solid waste management and provision for stormwater (which may include reserving urban wetlands for flood waters). In urban areas, access to services generally requires payment. The affordability of the costs to individuals and households of sanitation services, including operation, maintenance, treatment and disposal of excreta and wastewater and management of solid waste depends on other household needs. A global standard for affordability of sanitation has not been established to date. Affordability of water has been suggested to be between 3-6 per cent of household expenditure, but this will vary between different States. Small towns may have characteristics of either rural or urban areas, or both, and will require standards relevant to their setting and the institutional arrangements.

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Toilet:

A toilet is a sanitation fixture used primarily for the disposal of human excrement and urine, often found in a small room referred to as a toilet/bathroom/lavatory. Flush toilets, which are common in many parts of the world, may be connected to a nearby septic tank or more commonly in urban areas via “large” (3–6 inches, 7.6–15 cm) sewer pipe connected to a sewerage pipe system. The water and waste from many different sources is piped in large pipes to a more distant sewage treatment plant. A pit toilet is a dry toilet system which collects human excrement and urine in a large container or trench and ranges from a simple slit trench dug in the ground to more elaborate systems with seating and ventilation systems (vide supra). They are more often used in emergency, rural and wilderness areas as well as in much of the developing world. I will not discuss advantages & disadvantages of sitting toilet (western) versus squatting toilet (eastern) as the point of discussion is sanitation, and as far as sanitation is concerned, both are equal.

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Army units typically use a form of pit toilet when they are in the field and away from functional sewerage systems. The use of correctly located pit toilets was found to prevent much of the spread of various diseases which used to kill many more soldiers than the bullets and artillery used in pre-1940 warfare.

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Anal cleansing:

Anal cleansing is the hygienic practice of cleaning the anus after defecation. The anus and buttocks may be cleansed with toilet paper or similar paper products, especially in many Western countries. Elsewhere, water may be used (using a jet, as with a bidet, or splashed and washed with the hand). In other cultures and contexts, materials such as rags, leaves (including seaweed), corn cobs, sponges or sticks are used. With modern flush toilets, using newspaper as toilet paper is liable to cause blockages. This practice continues today in parts of Africa; while rolls of Western-style toilet paper are readily available, they can be fairly expensive, prompting less well-off members of the community to use newspapers. In India and the Indian subcontinent, over 95% of the population use water with or without soap for cleansing the anal area after defecating. In places where water is scarce or not closely available, a stone or similar hard material is used instead. The cleaning of hands after anal cleansing is mandatory and is done using soap & water. If soap is not available, soil, ash or sand could be used to clean the used hand or both hands.The use of water in Muslim countries is due in part to Islamic toilet etiquette which encourages washing after all instances of defecation. Further, Islam has made flexible provisions for when water is scarce; stones or papers can be used for cleansing after defecation and in ablution. I have seen in Saudi Arabia, poor tribal using sand for cleaning anus after defecation as thousands of years ago there was no water in desert for drinking much less for cleaning and so the habit of cleaning anus with sand continued. In many countries, a hand-held bidet or pail of water is used in lieu of a pedestal. In the U.S. and UK bidets are not yet as popular as in continental Europe and the Middle East, but are slowly becoming more common. Attachable stainless steel or plastic bidets that are fixed to existing toilets are gaining popularity as they are easy to use and cheap.

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Table: Correlation of Sanitation Technology to Anal Cleansing Method
Method of anal cleansing	Sanitation technology
	Dry toilets	Flush toilets
Water	Double chamber ecological toilet with urine and wash water diversion	All types
Natural materials	Simple pit toilet. Double pit or double chamber ecological toilet with or without urine diversion	All types as long as the materials are not disposed of in the toilet
Paper	Simple pit toilet, Double pit or double chamber ecological toilet with or without urine diversion	All types as long as only toilet paper is used for anal cleansing; for papers other than toilet paper, the paper should not be disposed of in the toilet. Even toilet paper cannot be flushed out in Latin American countries where sewer size is narrow & it will get blocked.

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As illustrated in the table above, solid materials used for anal cleansing must be safely collected and disposed of. When the preferred anal cleansing method involves the use of solid materials, a container with lid should be provided in the toilet area for the safe disposal of these. The lid is essential to prevent flies from coming in contact with human feces and potentially transmitting disease. If adolescent girls and women in the school use disposable pads or materials during menstruation, the containers should also be appropriate for the collection of those. Once the anal and/or menstruation cleansing materials are safely collected in a container with lid, those containers have to be regularly emptied and cleaned.

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Anal cleansing with hand using water:

Disadvantages: – (1) Direct and disgusting contact with the feces (2) Soiled fingers can become disease spreading vehicles (3) Improper and inadequate following of the instructions provided for sanitation may lead to dangerous hazards like GI infections, various hepatitis, worm infestations , (4) The not-so-pleasant foul odor emanating from the fingers used to do the work (5) Must keep nails of hands trimmed as untrimmed nails will leave empty space between nail & pulp of finger which may harbor microscopic feces particle even after hand-washing.

Complications: – (1) Abrasions due to overgrown fingernails on the delicate skin of the concerned area. (2) During the act, fingers in use might get stuck (3) Rupture and bleeding from the hemorrhoids (4) Skin infections of the hand in use may get transmitted to the skin of the peri-anal area.

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In other words, using a jet of water (bidet) is better than using hand to clean anus after defecation.

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Bidet:

A bidet is a low-mounted plumbing fixture or type of sink intended for washing the genitalia, inner buttocks, and anus after defecation and/or urination. Instead of using toilet paper or hand, a bidet cleans your posterior using a jet of water. Some bidets also provide an air-drying mechanism. It is generally understood that the user should sit on a bidet facing the tap and nozzle for washing the genitalia, and should sit with back to the tap and wall when washing the anus and buttocks. A dedicated towel or wipe is often available for drying. A bidet may also be a nozzle attached to an existing toilet, or a part of the toilet itself. In this case, its use is restricted to cleaning the anus and genitals. These bidet toilets have been popular in European and Latin American countries as the use of just dry toilet paper to clean the peri-anal area is considered dirty and unhygienic. Bidet and toilet can be separate in bathroom or integrated as one piece fixture.

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The picture below shows bidet in front and toilet in the back:

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Bidets eliminate toilet Paper and increase your Hygiene:

I now consider bidets to be a key green technology, because they eliminate the use of toilet paper. They also provide important health benefits. These include increased cleanliness, and the therapeutic effect of water on damaged skin (think rashes or hemorrhoids). But let’s look at some figures on toilet paper usage: One tree produces about 100 pounds (45 kg) of toilet paper and about 83 million rolls are produced per day. Global toilet paper production consumes 27,000 trees daily. The average American uses 50 pounds (23 kg) of tissue paper per year which is 50% more than the average of Western countries or Japan. The higher usage in America may be explained by the fact that in many non-American countries people utilize bidets or spray hoses to clean themselves. Americans use 36.5 billion rolls of toilet paper in the U.S. each year; this represents at least 15 million trees pulped. This also involves 473,587,500,000 gallons of water to produce the paper and 253,000 tons of chlorine for bleaching purposes. The manufacturing process requires about 17.3 terawatts of electricity annually. Also, there is the energy and materials involved in packaging and transporting the toilet paper to households across the country. Toilet paper also constitutes a significant load on the city sewer systems, and water treatment plants. It is also often responsible for clogged pipes. In septic systems, the elimination of toilet paper would mean the septic tank would need to be emptied much less often. Many who commented on bidets were concerned about the electricity and water that bidets consume. However, it seems to me that the consumption is minimal, when compared to the amount of energy, water, trees destruction and chemicals consumed in the production of toilet paper.  Also, many models of bidet use no electricity or hot water.

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Is cleaning yourself with toilet paper cleaner than using water after defecation?

I am unaware of any scientific studies about this question. Logically, I can’t see that toilet paper is the best option. It doesn’t seem like it cleans as thoroughly, and can even contribute to things like anal fissures, yet most of America and large portions of Europe use it and often scoff at other methods. My view is that cleaning peri-anal area with dry toilet paper does not remove microscopic feces particles which may be carrying germs. Therefore after anal cleansing, these microscopic feces particle will come in contact clothing and inadvertently hands and may lead to feco-oral transmission of pathogens to the same individual (auto-infection) or to the community. I feel that anal cleansing first with dry toilet paper followed by wet toilet paper would suffice for hygienic cleaning. Toilet paper, however, disintegrates upon contact with water, which makes it more flushable. So only moisten the toilet paper ever so slightly. Wipe from front to back. Wiping from back to front may spread bacteria to the urethra and to the genitals, a risk most significant for women. Wipe thoroughly but gently. Too much friction may cause microtears, which are more prone to infection if fecal matter gets inside them. On the other hand, cleaning with a jet of water is even better, environment friendly and more hygienic. When cleaning with water, don’t use soap. If even the slightest soap residue is left, it may irritate skin and dry out the sensitive area. Only use soap in a shower or bidet when you may thoroughly rinse. According to a news report by The Epoch Times in 2004, 37.5% of toilet paper tested from Guangdong and Jiangsu provinces in china showed high levels of bacteria commonly found in human waste. A manager from one of the agencies involved in testing, Guangdong Consumer Associates, blamed “unsanitary raw materials used in production” for the high bacteria counts. Chinese hospital experts have warned that use of contaminated toilet paper can result in skin and gynecological infections.

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Are you supposed to throw used toilet paper down the toilet or in the trash can?

In some countries, like many rural parts of Mexico or Latin America, the plumbing is so poor that it cannot flush large items through the pipes. So, tissue and/or toilet paper do not flush through, instead it clogs the pipes ultimately causing a backup in the pipes. Therefore, in many of those countries, it is customary to put tissue (i.e. toilet paper) in a waste basket or at least in a separate bin rather than flushing it. However, in the U.S., the plumbing and sewage systems can accommodate tissue and/or toilet paper, so, as it is hygienically better, one should flush toilet (tissue) paper in the toilet!  Dry toilet systems can take all kinds of paper and solid objects and still function well. A dry system can even be adapted to cope with the use of water for anal cleaning. During the process in a composting toilet, paper breaks down, but not in a dehydrating toilet – the paper does not decompose. This paper will, however, break down during secondary processing if the process used is either composting or carbonization/ incineration.

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It might be a bit difficult to do a placebo-controlled, randomized, double-blind trial for different methods of anal cleansing. In my opinion, wet napkins (as long as they are made of a sturdy, feces-proof material) are probably the best bet. The wet napkin will cleanse anal area thoroughly and will not allow microscopic feces particles to be attached to peri-anal area. The only issue is that it will be expensive and used wet napkins have to be disposed off in hygienic manner. Obviously, it cannot be flushed down like tissue papers.

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In a nutshell, even though wet napkins are best, I recommend use of bidets (jet of water) as the best way for anal cleansing both hygienically and environment friendly. I discourage use of hands (with water) or toilet paper for anal cleansing. Nonetheless, whatever method you choose, you must clean your hands with soap & water after the process of anal cleansing.  

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Sewerage:

Sewerage refers to the infrastructure that conveys sewage. It encompasses components such as receiving drains, manholes, pumping stations, storm overflows, and screening chambers of the sanitary sewer. Sewerage ends at the entry to a sewage treatment plant or at the point of discharge into the environment. Sewage is the waste matter carried off by sewer drains and pipes. Sewerage refers to the physical facilities (e.g., pipes, lift stations, and treatment and disposal facilities) through which sewage flows.

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Sewage:

It is waste form a community containing solid and liquid excreta. It is derived from houses, street and yard washings, facto­ries and industries. Sewage contains 99.9% water and 0.1% solids. The solids contain inorganic and organic matter and also disease producing organisms (vide infra).

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Silage:

It is the waste water which does not contain human excreta. It includes waste water from kitchens and bathrooms (not from toi­lets).

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Domestic sewage (sanitary sewage):

It is sewage originating primarily from kitchen, bathroom, and laundry sources. It contains waste from food preparation, dishwashing, garbage-grinding, toilets, baths, showers, and sinks.

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Different particular wastewater streams are forming the domestic wastewater as seen in the figure above. The wastewater originating from toilets is called black water and can be further divided into yellow water (urine with or without flush water) and brown water (toilet wastewater without urine). Additionally, grey water is that part of domestic wastewater which originates from kitchen, shower, wash basin and laundry.

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Sewage:

Sewage is water-carried waste, in solution or suspension that is intended to be removed from a community. Also known as wastewater, it is more than 99% water and is characterized by volume or rate of flow, physical condition, chemical constituents and the bacteriological organisms that it contains. Classes of sewage include sanitary, commercial, industrial, agricultural and surface runoff. The wastewater from residences and institutions, carrying body wastes, washing water, food preparation wastes, laundry wastes, and other waste products of normal living, are classed as domestic or sanitary sewage. Liquid-carried wastes from stores and service establishments serving the immediate community, termed commercial wastes, are included in the sanitary or domestic sewage category if their characteristics are similar to household flows. Wastes that result from an industrial process or the production or manufacture of goods are classed as industrial wastewater. Their flows and strengths are usually more varied, intense, and concentrated than those of sanitary sewage. Surface runoff, also known as storm flow or overland flow, is that portion of precipitation that runs rapidly over the ground surface to a defined channel. Precipitation absorbs gases and particulates from the atmosphere, dissolves and leaches materials from vegetation and soil, suspends matter from the land, washes spills and debris from urban streets and highways, and carries all these pollutants as wastes in its flow to a collection point. Most sewage eventually flows into lakes, oceans, rivers, or streams. In many cities, almost all sewage is treated in some way before it goes into the waterways as a semiclear liquid called effluent. All categories of sewage are likely to carry pathogenic organisms that can transmit disease to humans and other animals; contain organic matter that can cause odor and nuisance problems; hold nutrients that may cause eutrophication of receiving water bodies; and can lead to ecotoxicity. In this article on ‘sanitation’, sewage essentially means domestic or sanitary sewage.

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Pathogens:

When assessing the risk of pathogen occurrence in groundwater, it is important to bear in mind that pathogens may be transmitted via a number of routes other than ingestion from water, including direct contact with excreta, food, flies or from aerosols emanating from excreted wastes. In developed countries, because of their infectivity, small size, persistence and low adsorption to solid surfaces, viruses can be regarded as the most critical microorganisms with respect to groundwater contamination and the related health risks. In developing countries, viral exposures may be much greater through other routes, notably related to poor hygiene and sanitation and the residual risk presented by viruses in groundwater is very low in comparison. Bacterial contamination of groundwater in these situations remains common and prevention of this may take precedence. Table below provides data on the microbial content of untreated sewage entering into two sewage treatment works in the Netherlands and waste stabilization ponds in Brazil.

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Composition of sewage waste water:

When On-site latrines are used and no other wastes are disposed into the on-site system, contaminants are expected to be derived wholly from excreta. The major risk will therefore be from nitrate contamination. Nitrate is formed by the sequential, microbially-catalysed oxidation of ammonia to nitrite and then to nitrate. Most nitrogen is excreted as urea, which readily degrades to ammonium. The person specific nitrogen load daily excreted amounts to 11-12 gms. With respect to manure, storage times and conditions will affect ammonium losses due to volatilization. Most relevant for groundwater, microbial oxidation may convert ammonium to nitrate, which is conserved in oxidizing subsurface environments. As nitrate is highly soluble in water and very mobile it readily poses a risk to groundwater. However, it should be noted that in reducing conditions nitrogen remains in a reduced form (ammonia and nitrite) and this has been noted in groundwater underlying several cities dependent on groundwater. Wet sanitation systems, especially those which serve household waste water as well as excreta, likely contain a more complex mix of chemicals including those derived from household use such as laundry detergents. Sewage that has centralized management, and serves both residential and industrial users, is likely to contain a complex mixture of organic and inorganic chemicals mainly used in manufacturing and processing. Industrial contaminants will depend on the types of industry in the catchment of the sewerage system, and their mixture in sewage is typically very variable and complex. If released to the subsurface, their persistence and mobility determines the potential to contaminate groundwater. The concentrations of dissolved constituents in sewage depend both on the household consumption of water and the relative proportion of industrial effluent in relation to domestic sewage in municipal sewers. The average composition of organic and inorganic substances found in domestic sewage is shown in the table below.

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Characteristics of domestic sewage:

The design of a sewage treatment works will be dependent on the quality and quantity of the waste to be treated. The following are some of the important characteristics of domestic sewage:

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Organic Matter: Organic matter is the most important polluting constituent of sewage in respect of its effects on receiving water bodies. It is mainly composed of proteins, carbohydrates and fats. Organic matter is commonly measured in terms of BOD and COD (vide infra). If untreated sewage is discharged into natural water bodies, biological stabilization of organic matter leads to depletion of oxygen in water bodies.

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Nitrogen & Phosphorus: Nitrogen and phosphorus are also very important polluting constituents of sewage because of their role in algal growth and eutrophication of water bodies. Nitrogen is present in fresh domestic sewage in the form of proteinaceous matter urea (i.e. organic nitrogen). Its decomposition by bacteria readily changes it into ammonia. In aerobic environments ammonia nitrogen is oxidized into nitrites and nitrates. Nitrates can be used by algae to form plant proteins. Nitrogen is commonly measured as TKN (organic + ammonical) as sewage characteristics. TKN is Total Kjehldahl nitrogen (total concentration of organic nitrogen and ammonia). Nitrate and nitrite forms of nitrogen are also measured when quality of receiving/affected water (streams, underground water) is monitored. Phosphorus is usually present in orthophosphate, polyphosphate and organic phosphate forms. Organically bound phosphorus is of little importance in domestic sewage whereas polyphosphate forms undergo hydrolysis to revert into the orthophosphate forms, although this conversion is quite slow.

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Suspended Solids: Suspended solids represent that fraction of total solids in any wastewater that can be settled gravitationally. Suspended solids can further be classified into organic (volatile) and inorganic (fixed) fractions. Organic matter is present in the form of either settleable form or non-settleable (dissolved or colloidal) form. If the organic fraction of suspended solids present in sewage is discharged untreated into streams, it leads to sludge deposits and subsequently to anaerobic conditions.

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Dissolved Oxygen: Dissolved oxygen, as such, does not have any significance as a sewage characteristic. However, it is the most important pollution assessment parameter of the receiving water bodies. Stabilization of organic matter, when discharged untreated or partially treated in receiving waters, leads to depletion of their dissolved oxygen. Most methods used to treat sewage convert organic wastes into inorganic compounds called nitrates, phosphates, and sulfates. Some of these compounds may serve as food for algae and cause large growths of these simple aquatic organisms. Nutrients (nitrogen and phosphorus) addition due to discharge of untreated or treated sewage may lead to algal growth in streams. During day time, algae undergo photosynthesis process and the oxygen released by this process is much more than their respiration requirements resulting in a net addition of dissolved oxygen to water. However, during night time photosynthesis process is stopped whereas respiration requirement continues. This leads to depletion of dissolved oxygen in waters. Also, after algae die, they decay. The decaying process uses up oxygen. Thus, it is observed that all the polluting constituents of sewage explained above have their direct or indirect effect on dissolved oxygen of receiving waters.

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Any oxidizable material present in a natural waterway or in an industrial wastewater will be oxidized both by biochemical (bacterial) or chemical processes. The result is that the oxygen content of the water will be decreased. Basically, the reaction for biochemical oxidation may be written as:

Oxidizable material + bacteria + nutrient + O₂ = CO₂ + H₂O + oxidized inorganics such as NO₃^– or SO₄^–

Oxygen consumption by reducing chemicals such as sulfides and nitrites is typified as follows:

S^– + 2 O₂ = SO₄^–

NO₂^– + ½ O₂ = NO₃^–

Since all natural waterways contain bacteria and nutrients, almost any waste compounds introduced into such waterways will initiate biochemical reactions (such as shown above). Those biochemical reactions create what is measured in the laboratory as the Biochemical oxygen demand (BOD). Such chemicals are also liable to be broken down using strong oxidizing agents and these chemical reactions create what is measured in the laboratory as the Chemical oxygen demand (COD). Both the BOD and COD tests are a measure of the relative oxygen-depletion effect of a waste contaminant. Both have been widely adopted as a measure of pollution effect. The BOD test measures the oxygen demand of biodegradable pollutants whereas the COD test measures the oxygen demand of oxidizable pollutants.

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Biochemical oxygen demand (BOD):

The amount of organic material that can rot in the sewage is measured by the biochemical oxygen demand. BOD is the amount of oxygen required by micro-organisms to decompose the organic substances in sewage. Therefore, the more organic material there is in the sewage, the higher the BOD. It is among the most important parameters for the design and operation of sewage treatment plants. BOD levels of industrial sewage may be many times that of domestic sewage. Dissolved oxygen is an important factor that determines the quality of water in lakes and rivers. ‘Higher the concentration of dissolved oxygen, the better the water quality’. When sewage enters a lake or stream, micro-organisms begin to decompose the organic materials. Oxygen is consumed as micro-organisms use it in their metabolism. This can quickly deplete the available oxygen in the water. When the dissolved oxygen levels drop too low, many aquatic species perish. In fact, if the oxygen level drops to zero, the water will become septic. When organic compounds decompose without oxygen, it gives rise to the undesirable odors usually associated with septic or putrid conditions. The BOD is an important measure of water quality. It is a measure of the amount of oxygen needed (in milligrams per liter or parts per million) by bacteria and other microorganisms to oxidize the organic matter present in a water sample over a period of 5 days. The BOD of drinking water should be less than 1. That of raw sewage may run to several hundred.

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In a nutshell, higher the BOD of sewage waste water, greater is the organic matter in it which needs to be decomposed by bacteria. Greater the decomposition of organic matter by bacteria, lesser will be dissolved oxygen. When sewage with very high BOD enters the river or lake, it will lead to reduction in dissolved oxygen leading to death of many aquatic species, in addition to transmitting pathogenic organism to humans who may happen to drink water from such a water source.

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Wastewater constituents:

The composition of wastewater varies widely. This is a partial list of what it may contain:

Water (> 95%) which is often added during flushing to carry waste down a drain;

Pathogens such as bacteria, viruses, prions and parasitic worms;

Non-pathogenic bacteria;

Organic particles such as feces, hairs, food, vomit, paper fibers, plant material, humus, etc;

Soluble organic material such as urea, fruit sugars, soluble proteins, drugs, pharmaceuticals, etc;

Inorganic particles such as sand, grit, metal particles, ceramics, etc;

Soluble inorganic material such as ammonia, road-salt, sea-salt, cyanide, hydrogen sulfide, thiocyanates, thiosulfates, etc;

Animals such as protozoa, insects, arthropods, small fish, etc;

Macro-solids such as sanitary napkins, nappies/diapers, condoms, needles, children’s toys, dead animals or plants, etc;

Gases such as hydrogen sulfide, carbon dioxide, methane, etc;

Emulsions such as paints, adhesives, mayonnaise, hair colorants, emulsified oils, etc;

Toxins such as pesticides, poisons, herbicides, etc;

Pharmaceuticals and other hormones.

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Amount of sewage:

The amount of sewage which flows into the drainage system depends on:

1. Habit of people e.g. if more water is used, sewage will be more.

2. It sewage is combined with rain water, the amount will be more. In some countries, industrial waste water is drained into sewers.

3. Time of the day – it is more in the morning and less in the afternoon.

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The aims of sewage treatment are:

1. To breakdown organic matter by aerobic or anaerobic bacterial action. It results in simple substances which will not decompose further.

2. To produce an effluent which is free from harmful organisms. So it can be safely disposed.

3. To utilise the water and solids without harmful effect on health (reuse/recycle).

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Collecting sewage:

A system of sewer pipes (sewers) collects sewage and takes it for treatment or disposal. The system of sewers is called sewerage or sewerage system in British English and sewage system in American English. Where a main sewerage system has not been provided, sewage may be collected from homes by pipes into septic tanks or cesspits, where it may be treated or collected in vehicles and taken for treatment or disposal. Properly functioning septic tanks require emptying every 2–5 years depending on the load of the system. Sewage and wastewater is also disposed off to rivers, streams, and the sea in many parts of the world. Doing so can lead to serious pollution of the receiving water. This is common in third world countries and may still occur in some developed countries, where septic tank systems are too expensive.

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Wastewater is carried from its source to treatment facility pipe systems that are generally classified according to the type of wastewater flowing through them. If the system carries both domestic and storm-water sewage, it is called a combined system, and these usually serve the older sections of urban areas. As the cities expanded and began to provide treatment of sewage, sanitary sewage was separated from storm sewage by a separate pipe network. This arrangement is more efficient because it excludes the voluminous storm sewage from the treatment plant. It permits flexibility in the operation of the plant and prevents pollution caused by combined sewer overflow, which occurs when the sewer is not big enough to transport both household sewage and storm water. Another solution to the overflow problem has been adopted by Chicago, Milwaukee, and other U.S. cities to reduce costs: instead of building a separate household sewer network, large reservoirs, mostly underground, are built to store the combined sewer overflow, which is pumped back into the system when it is no longer overloaded.

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Sewage Treatment:

Sewage treatment is the process of removing the contaminants from sewage to produce liquid and solid (sludge) suitable for discharge to the environment or for reuse. It is a form of waste management. A septic tank or other on-site wastewater treatment system such as biofilters can be used to treat sewage close to where it is created. Sewage water is a complex matrix, with many distinctive chemical characteristics. These include high concentrations of ammonium, nitrate, phosphorus, high conductivity (due to high dissolved solids), high alkalinity, with pH typically ranging between 7 and 8. Trihalomethanes are also likely to be present as a result of past disinfection. In developed countries sewage collection and treatment is typically subject to local, state and federal regulations and standards. Industrial sources of sewage often require specialized treatment processes.

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Sewage treatment generally involves three stages, called primary, secondary and tertiary treatment.

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Primary Treatment:

Primary treatment consists of temporarily holding the sewage in a quiescent basin where heavy solids can settle to the bottom while oil, grease and lighter solids float to the surface. The settled and floating materials are removed and the remaining liquid may be discharged or subjected to secondary treatment. The wastewater that enters a treatment plant contains debris that might clog or damage the pumps and machinery. Such materials are removed by screens or vertical bars, and the debris is burned or buried after manual or mechanical removal. The wastewater then passes through a comminutor (grinder), where leaves and other organic materials are reduced in size for efficient treatment and removal later.

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Secondary Treatment:

Having removed 40 to 60 percent of the suspended solids and 20 to 40 percent of the BOD5 in primary treatment by physical means, the secondary treatment biologically reduces the organic material that remains in the liquid stream. Secondary treatment removes dissolved and suspended biological matter. Secondary treatment is typically performed by indigenous, water-borne micro-organisms in a managed habitat. Usually the microbial processes employed are aerobic—that is, the organisms function in the presence of dissolved oxygen. Secondary treatment actually involves harnessing and accelerating nature’s process of waste disposal. Aerobic bacteria in the presence of oxygen convert organic matter to stable forms such as carbon dioxide, water, nitrates, and phosphates, as well as other organic materials. The production of new organic matter is an indirect result of biological treatment processes, and this matter must be removed before the wastewater is discharged into the receiving stream. Several alternative processes are also available in secondary treatment, including a trickling filter, activated sludge, and lagoons. Secondary treatment may require a separation process to remove the micro-organisms from the treated water prior to discharge or tertiary treatment.

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Advanced Wastewater Treatment (tertiary treatment):

If the receiving body of water requires a higher degree of treatment than the secondary process can provide, or if the final effluent is intended for reuse, advanced wastewater treatment is necessary. The term tertiary treatment is often used as a synonym for advanced treatment, but the two methods are not exactly the same. Tertiary, or third-stage, treatment is generally used to remove phosphorus, while advanced treatment might include additional steps to improve effluent quality by removing refractory pollutants. Tertiary treatment is sometimes defined as anything more than primary and secondary treatment in order to allow ejection into a highly sensitive or fragile ecosystem (estuaries, low-flow rivers, coral reefs). Processes are available to remove more than 99 percent of the suspended solids and BOD5. Treated water is sometimes disinfected chemically or physically (for example, by lagoons and microfiltration) prior to discharge into a stream, river, bay, lagoon or wetland, or it can be used for the irrigation of a golf course, green way or park. If it is sufficiently clean, it can also be used for groundwater recharge or agricultural purposes. If the wastewater is to be reused, disinfection by ozone treatment is considered the most reliable method other than breakpoint chlorination. Most advanced wastewater treatment systems include de-nitrification and ammonia stripping, carbon adsorption of trace organics, and chemical precipitation. Evaporation, distillation, electro-dialysis, ultra-filtration, reverse osmosis, freeze drying, freeze-thaw, floatation, and land application, with particular emphasis on the increased use of natural and constructed wetlands, are being studied and utilized as methods for advanced wastewater treatment to improve the quality of the treated discharge to reduce unwanted effects on the receiving environment. Other disinfection options include ultraviolet light. Application of these and other advanced waste-treatment methods is likely to become widespread in the future in view of new efforts to conserve water through reuse.

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Liquid Disposal:

Sanitation in urban areas: wastewater disposal:

The standard sanitation technology in urban areas is the collection of wastewater in sewers, its treatment in wastewater treatment plants for reuse or disposal in rivers, lakes or the sea. In developed countries treatment of municipal wastewater is now widespread, but not yet universal. In developing countries most wastewater is still discharged untreated into the environment. For example, in Latin America only about 15% of collected sewerage is being treated. The ultimate disposal of the treated liquid stream is accomplished in several ways. Direct discharge into a receiving stream or lake is the most commonly practiced means of disposal. Every year, trillions of gallons of raw sewage are dumped into the world’s creeks, rivers, lakes, and oceans. Sewage plants are strained to capacity and populations are still expanding. Human wastes are building up. How can a huge inland city like Mexico City exist without an ocean to receive its wastes? Reportedly, its 20 million people flush 10,000 gallons a second, enough to fill an Olympic-sized pool every minute!  The wastes generated by some 60% of the U.S. population are collected in sewer systems and carried along by some 14 billion gallons (~53 billion liters) of water a day. Of this enormous volume, some 10% is allowed to pass untreated into rivers, streams, and the ocean. The rest receives some form of treatment to improve the quality of the water (which makes up 99.9% of sewage) before it is released for reuse. In areas of the United States that are faced with worsening shortages of water for both domestic and industrial use, municipalities and state and federal agencies are turning to reuse of appropriately treated wastewater for groundwater recharge, irrigation of nonedible crops, industrial processing, recreation, and other uses.

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Eutrophication:

When fresh water is artificially supplemented with nutrients, it results in an abnormal increase in the growth of water plants. This is known as eutrophication. The discharge of waste from industries, agriculture, and urban communities into water bodies generally stretches the biological capacities of aquatic systems. Chemical run-off from fields also adds nutrients to water. Excess nutrients cause the water body to become choked with organic substances and organisms. When organic matter exceeds the capacity of the micro-organisms in water that break down and recycle the organic matter, it encourages rapid growth of algae. When they die, the remains of the algae add to the organic wastes already in the water; eventually, the water becomes deficient in oxygen. Anaerobic organisms (those that do not require oxygen to live) then attack the organic wastes, releasing gases such as methane and hydrogen sulphide, which are harmful to the oxygen-requiring (aerobic) forms of life. The result is a foul-smelling, waste-filled body of water. This has already occurred in such places as Lake Erie and the Baltic Sea, and is a growing problem in freshwater lakes all over India. Eutrophication can produce problems such as bad tastes and odors as well as green scum algae. Also the growth of rooted plants increases, which decreases the amount of oxygen in the deepest waters of the lake. It also leads to the death of all forms of life in the water bodies.

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When industry, hospitals, and households send their waste to wastewater treatment plants, the plants remove as many contaminants as possible from the water and then discharge the water as effluent. The leftover solids are sludge.

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Sludge:

Sludge refers to the residual, semi-solid material left from industrial or domestic sewage treatment processes. Sewage sludge is produced from the treatment of wastewater and consists of two basic forms — raw primary sludge (basically fecal material) and secondary sludge (a living ‘culture’ of organisms that help remove contaminants from wastewater before it is returned to rivers or the sea). The sludge is transformed into biosolids using a number of complex treatments such as digestion, thickening, dewatering, drying, and lime/alkaline stabilization.

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Digestion:

Many sludges are treated using a variety of digestion techniques, the purpose of which is to reduce the amount of organic matter and the number of disease-causing microorganisms present in the solids. The most common treatment options include anaerobic digestion, aerobic digestion, and composting.

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Anaerobic digestion (vide infra):

Anaerobic digestion is a bacterial process that is carried out in the absence of oxygen. The process can either be thermophilic digestion in which sludge is fermented in tanks at a temperature of 55°C or mesophilic, at a temperature of around 36°C. Though allowing shorter retention time, thus smaller tanks, thermophilic digestion is more expensive in terms of energy consumption for heating the sludge. Anaerobic digestion generates biogas with a high proportion of methane that may be used to both heat the tank and run engines or microturbines for other on-site processes. In large treatment plants sufficient energy can be generated in this way to produce more electricity than the machines require. The methane generation is a key advantage of the anaerobic process. Its key disadvantage is the long time required for the process (up to 30 days) and the high capital cost. Under laboratory conditions it is possible to directly generate useful amounts of electricity from organic sludge using naturally occurring electrochemically active bacteria. Potentially, this technique could lead to an ecologically positive form of power generation, but in order to be effective such a microbial fuel cell must maximize the contact area between the effluent and the bacteria-coated anode surface.

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Aerobic digestion:

Aerobic digestion is a bacterial process occurring in the presence of oxygen. Under aerobic conditions, bacteria rapidly consume organic matter and convert it into carbon dioxide. Once there is a lack of organic matter, bacteria die and are used as food by other bacteria. This stage of the process is known as endogenous respiration. Solids reduction occurs in this phase. Because the aerobic digestion occurs much faster than anaerobic digestion, the capital costs of aerobic digestion are lower. However, the operating costs are characteristically much greater for aerobic digestion because of energy costs for aeration needed to add oxygen to the process.

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Composting:

Composting is also an aerobic process that involves mixing the wastewater solids with sources of carbon such as sawdust, straw or wood chips. In the presence of oxygen, bacteria digest both the wastewater solids and the added carbon source and, in doing so, produce a large amount of heat. Both anaerobic and aerobic digestion processes can result in the destruction of disease-causing microorganisms and parasites to a sufficient level to allow the resulting digested solids to be safely applied to land used as a soil amendment material (with similar benefits to peat) or used for agriculture as a fertilizer provided that levels of toxic constituents are sufficiently low. The largest composting site in the world that also processes sewage is the Edmonton Composting Facility, in Edmonton, Canada. During composting, your excrement and the organisms in it are transformed by the temperature, moisture, oxygen, nutrients and bacteria in the compost pile into mature compost, a fertilizer containing microbes different from those that left your digestive tract. Different systems accomplish composting differently. For example, most commercial toilets are set up for slow, low-temperature composting (below 98.6 F or 37 C), which kills most disease-causing organisms in months, giving you fertilizer that’s safe for ornamental gardens. For fertilizer that’s safe for food-producing gardens, you’d need a high-temperature composting system where the compost cooks at a temperature from 131 F to 140 F (55 C to 60 C) for several hours so that it basically kills all human pathogens.

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Biosolids:

Biosolids are treated sewage sludges. Sewage sludge is the solids that are collected from the wastewater treatment process but which have not undergone further treatment. Sludge normally contains up to around 3 % solids. Biosolids are a product of the sewage sludge once it has undergone further treatment to reduce disease causing pathogens and volatile organic matter significantly, producing a stabilized product suitable for beneficial use. Biosolids, normally contain between 15 % to 90 % solids. Biosolids are carefully treated and monitored and they must be used in accordance with regulatory requirements. Biosolids can be applied as a fertilizer to improve and maintain productive soils and stimulate plant growth. They are also used to fertilize gardens and parks and reclaim mining sites. In many of the developed countries biosolids have been used for:

• Co-generation/power production/energy recover
• Land application in agriculture (vine, cereal, pasture, olive)

• Road base
• Land application in forestry operations
• Land rehabilitation (including landfill capping)
• Landscaping and topsoil
• Composting
• Incineration
• Landfill
• Oil from sludge (experimental).

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Solid waste disposal:

Disposal of solid waste is most commonly conducted in landfills, but incineration, recycling, composting and conversion to biofuels are also avenues. In the case of landfills, advanced countries typically have rigid protocols for daily cover with topsoil, where underdeveloped countries customarily rely upon less stringent protocols. The importance of daily cover lies in the reduction of vector contact and spreading of pathogens. Daily cover also minimizes odor emissions and reduces windblown litter. Likewise, developed countries typically have requirements for perimeter sealing of the landfill with clay-type soils to minimize migration of leachate that could contaminate groundwater (and hence jeopardize some drinking water supplies). For incineration options, the release of air pollutants, including certain toxic components is an attendant adverse outcome. Recycling and biofuel conversion are the sustainable options that generally have superior life cycle costs, particularly when total ecological consequences are considered. Composting value will ultimately be limited by the market demand for compost product.

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Finally treated sewage, both in liquid water from and solid sludge form are disposed off, as seen in the figure below.

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Night soil:

Night soil is a euphemism for human excrement collected at night from cesspools, privies, etc. and sometimes used as a fertilizer. Night soil is produced as a result of a waste management system in areas without community infrastructure such as a sewage treatment facility, or individual septic disposal. In this system of waste management, the human feces are collected in solid form. Feces are excreted into a container or bucket, and are sometimes collected in the container with urine and other waste. The excrement in the pail was often covered with earth/dirt/soil. This may have contributed to the “soil” part of the term night soil. Often the deposition or excretion occurs within the residence, such as in a shop-house faced with overpopulation. This system is used in isolated rural areas and is important in developing nations or in areas that lack the adequate infrastructure to have running water. The use of human feces as fertilizer is a risky practice as it may contain disease-causing pathogens. Nevertheless, in developing nations it is widespread. Common parasitic worm infections, such as ascariasis, in these countries are linked to night soil, since their eggs are in feces. There have also been cases of disease-carrying tomatoes, lettuce, and other vegetables being imported from developing nations into developed nations. Human waste may be attractive as fertilizer because of the high demand for fertilizer and the relative availability of the material to create night soil. In areas where native soil is of poor quality, the local population may weigh the risk of using night soil. The safe reduction of human waste into compost is possible. Many municipalities create compost from the sewage system biosolids, but then recommend that it only be used on flower beds, not vegetable gardens. Some claims have been made that this is dangerous or inappropriate without the expensive removal of heavy metals.

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Sewage treatment in Septic Tank:

A sewage treatment process commonly used to treat domestic wastes is the septic tank: a concrete, cinder block or metal tank where the solids settle and the floatable materials rise. The partly clarified liquid stream flows from a submerged outlet into subsurface rock-filled trenches through which the wastewater can flow and percolate into the soil where it is oxidized aerobically. The floating matter and settled solids can be held from six months to several years, during which they are decomposed anaerobically.

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The figure below shows hygienically functioning septic tank system.

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In conventional systems (centralize or on-site) Nitrogen, Phosphorus and Potassium as well as the energy contained in human excreta are “eliminated” with high technical and energy inputs in wastewater treatment plants or simply lost in latrines, discharging these valuable nutrients into the water bodies. However, in order to assure food production worldwide, artificial fertilizers are produced with a high input of non-renewable energy sources. The uncontrolled application of chemical fertilizers into agricultural land has accelerated the lost of fertility of soils and increased the salinization, when at the same time it has contributed dramatically to the contamination the receiving water bodies thanks to the ruff-off from the cultivation fields.  

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Sewage odor control:

Any place or process in which wastewater is collected, conveyed or treated has the potential to generate and release nuisance odors to the surrounding area. However, most odor problems occur in the collection system, in primary treatment facilities and in solids handling facilities. In most instances, the odors associated with collection systems and primary treatment facilities are generated as a result of an anaerobic or “septic” condition. This condition occurs when oxygen transfer to the wastewater is limited such as in a force main. In the anaerobic state, the microbes present in the wastewater have no dissolved oxygen available for respiration. This allows microbes known as “sulfate-reducing bacteria” to thrive. These bacteria utilize the sulfate ion (SO4-) that is naturally abundant in most waters as an oxygen source for respiration. The byproduct of this activity is hydrogen sulfide (H2S). This byproduct has a low solubility in the wastewater and a strong, offensive, rotten-egg odor. In addition to its odor, H2S can cause severe corrosion problems as well. Due to its low solubility in the wastewater, it is released to the atmosphere in areas such as wet wells, headworks, grit chambers and primary clarifiers. There are typically other “organic” odorous compounds, such as mercaptans and amines, present in these areas, but H2S is the most prevalent compound. There are many different technologies that can be applied to control odors from wastewater collection and treatment systems. These technologies can be split into two main groups: vapor-phase technologies, used to control odorous compounds in the air or gas; and liquid-phase technologies, used to control odorous compounds in the liquid wastewater itself. Vapor-phase technologies typically are used in point-source applications such as wastewater treatment plants and pump stations or for the treatment of biogas. Liquid-phase technologies typically are used in collection systems where control of both odors and corrosion are concerns and/or where multiple point odor control is an objective.

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Compost odor control:

According to “The Humanure Handbook,” written by Joseph Jenkins, who claims to have 30 years of human waste composting experience, all you need to extinguish stench is healthy compost. To achieve that, you must:

• Keep the compost moist (like a wrung-out sponge).
• Throw in sawdust or a carbonaceous alternative after each use.
• Aerate the compost using one of many methods.
• Maintain the right temperature.
• Maintain the right carbon-to-nitrogen ratio.  

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Sanitary sewer overflow:

Sanitary sewer overflow (SSO) is a condition whereby untreated sewage is discharged into the environment prior to reaching sewage treatment facilities. When caused by rainfall it is also known as wet weather overflow. By far the most common cause of Sanitary Sewer Overflow is heavy rainfall events, which can cause massive influx of stormwater into sewerage lines. The combined flow of wastewater and stormwater exceeds the capacity of the sewer system and sewage is released into local waterways to prevent flooding in homes, businesses and streets. Other modes of system failure can include power outage, which may disable lift station pumps or parts of the treatment plant operations themselves (in fact, any mechanical system failure within a treatment plant can create a circumstance leading to overflow); breakdown of rotating arms of trickling filters; jamming of line gates; clogging of filters or grates, etc. Furthermore, some forms of human error can infrequently lead to diversion of sewage and result in an overflow event. Decentralized failures in dry weather mainly occur from collection sewer line blockages, which can arise from a debris clog, line rupture or tree root intrusion into the line itself. Human health impacts include significant numbers of gastrointestinal illness each year. Additional human impacts include beach closures, swimming restrictions and prohibition of the consumption of certain aquatic animals (particularly certain molluscs) after overflow events. Ecological consequences include fish kills, harm to plankton and other aquatic microflora and microfauna. Turbidity increase and dissolved oxygen decrease in receiving waters can lead to accentuated effects beyond the obvious pathogenic induced damage to aquatic ecosystems.

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Mixing of untreated sewage with waterways:

Sewage refers to liquid wastes containing a mixture of human feces and wastewater from non-industrial human activities such as bathing, washing, and cleaning. In many poor areas of the world, sewage is dumped into local waterways, in the absence of practical alternatives. Untreated sewage poses a major risk to human health since it contains waterborne pathogens that can cause serious human illness. Untreated sewage also destroys aquatic ecosystems, threatening human livelihoods, when the associated biological oxygen demand and nutrient loading deplete oxygen in the water to levels too low to sustain life. Improved sanitation facilities are those that eliminate human contact with fecal material and include flush or pit toilets/latrines and composting toilets. Even where water based toilets are available, the wastes are far too often just discharged into drains and streams, in the absence of (expensive) collection and treatment systems. As a result, surface waters in many urban areas are highly contaminated with human waste. In areas with pit latrines, seepage into local groundwater is often a major problem, since many communities rely on shallow wells for drinking water. Sewage can be intentionally discharged to waterways through pipes or open defecation, or unintentionally during rainfall events. When humans use these waterways for drinking, bathing or washing, they are exposed to the associated pathogens, many of which can live for extended periods of time in aquatic environments. Humans then become ill by ingesting contaminated water, by getting it on/in skin, eyes or ears, or even from preparing foods with contaminated water. Sometimes humans can even become ill from inhaling contaminated water droplets.

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Mixing of bore well water and sewage:

In India, majority of rural population and population of small towns get drinking water from bore wells and it is often found that bore well water is polluted with sewage waste water. If a bore well water is contaminated due to construction of a soakpit close to the bore well, naturally if there are leaks, the septic effluents soak into the soil and travel into the bore well water depending upon the geological and subsoil conditions.

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A comparative study on the physicochemical and bacterial analysis of drinking, bore well and sewage water in the three different places of Sivakasi was conducted in 2007. The drinking, bore well and sewage water in the Sanmugasikamani Nadar (S.N) street, Naivatti Nadar (N.N) Street and Thiruthangal area of Sivakasi has been studied. The various constituents monitored include the physicochemical characters like pH, total solids, total dissolved solids, total suspended solids; chemical parameters like total alkalinity acidity free CO2, dissolved oxygen, total hardness, calcium, magnesium, chloride, salinity and bacterial parameters like standard plate count (SPC), total coliform count (TCC), fecal coliform count (FCC), fecal streptococcal count (FSC). Most of the physicochemical characters of drinking and bore well water were within the ISI permissible level. However in water samples from all the sites, bacterial count exceeded the recommended permissible level of WHO. Introduction of sewage into the drinking and borewell water was the main reason for the bacterial contamination. The boiling of water is therefore advisable before consumption. The physicochemical and bacterial characters of the sewage water were unworthy. The sewage water recycling was necessary to minimize the water born diseases.

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Groundwater is getting increasingly polluted from domestic sewage, pit latrines, leaking septic tanks and contaminated surface water reaching aquifers. Once regarded as one of the safest sources of water, deep bore wells are now increasingly susceptible to bacterial contamination and this phenomenon has been reported in bore wells as deep as 600 feet. Since bore wells are also a source of drinking and domestic water, here are a few tips to check water and treat it for bacterial contamination.

1. It is important not to allow surface contaminants direct access into or near the casing. The casing and the surrounding should be sealed and surface water not allowed to stagnate. Sometimes casings get old and rusted. They should be replaced preferably by a PVC casing. New bore wells should invariably have a good quality PVC casing.

2. No septic tank leach pit or toilet pits should be located close to the casing. Leaking sewage lines should be attended to and the authorities pressured to act.

3. The casing itself should be higher than the ground level. This is to ensure that in case of a flood, water does not enter from the top.

4. Use a basic H2S strip test bottle to find out the presence or absence of bacteria. This bottle has to be filled to a line marked and then observed for 36 hours. If the water turns black inside the bottle, the presence of E.Coli bacteria is indicated and the water sample can be sent to a laboratory for detailed analysis.

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Conventional on-site wastewater disposal systems have also their shortcomings. Very often, they lead to groundwater contamination, which gets worse with increasing population densities. In many densely populated areas this has led to nitrate concentrations in groundwater, which exceed the maximum level recommended by the WHO for drinking water and which have been linked to serious health problems, particularly for babies. Shallow groundwater is still a major source of water supply in rural and peri-urban areas, especially for the poor. The design of the conventional “drop and store” pit-latrine is not compatible with this practice as it deliberately aims to retain only solid matter in the pit and infiltrate as much of the liquids as possible into the subsoil. As these liquids contain all the soluble elements of the excreta as well as viruses and pathogens, this type of sanitation, depending on the hydro-geological situation, can be a highway to groundwater contamination. There may also be topographical constraints against the construction of pit latrines, for example where the ground is rocky or on sites that are subject to flooding.  

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Links and differences between water and sanitation interventions:

Links:

1. Without adequate sanitation and improved hygiene behavior, water provision does not have such a strong health outcome. Where water is provided, wastewater must be removed.

2. Sanitation is necessary to ensure water quality.

3. Water and sanitation services both require good hygiene to be effective.

Differences:

1. Water provision is generally a simpler process than sanitation provision, which requires a wide range of services, particularly for options other than sewerage systems.

2. Responsibility for sanitation services is normally spread among many different departments and ministries, and is delivered by a wide range of service providers.

3. The timeframe for the delivery of sanitation services and particularly hygiene promotion tends to be longer.

4. Due to the nature of their delivery, when water services fail, they tend to fail in a geographic area, sparking immediate public demand for improvement or replacement services. However, when sanitation services fail, they are more likely to fail by household (full pit or septic tank), so the public demand for improvement is more localized and therefore not as effective.

5. Even where only a few people lack sanitation, all feel the health impact.

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Water pollution (vide infra):

Water pollution has many sources. The most polluting of them are the city sewage and industrial waste discharged into the rivers. The facilities to treat waste water are not adequate in any city in India. Presently, only about 10% of the waste water generated is treated; the rest is discharged as it is into water bodies in India. Due to this, pollutants enter groundwater, rivers, and other water bodies. Such water, which ultimately ends up in households, is often highly contaminated and carries disease-causing microbes. Agricultural run-off, or the water from the fields that drains into rivers, is another major water pollutant as it contains fertilizers and pesticides.

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Before Bradley’s classification can be applied to diseases (rather than transmission routes), it requires a small adjustment (Cairncross and Feachem 1993) to allow for the fact that practically all potentially waterborne infections that are transmitted by the feco-oral route can potentially be transmitted by other means (contamination of fingers, food, fomites, field crops, other fluids, flies, and so on) all of which are water-washed routes. In addition to the feco-oral infections, a number of infections of the skin and eyes can be considered water washed but not waterborne. The final classification is shown in table above.

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Water-Related Vector Diseases:

Millions of people suffer from infections that are transmitted by vectors—insects or other animals capable of transmitting an infection, such as mosquitoes and tsetse flies—that breed and live in or near both polluted and unpolluted water. Inadequate sanitation leads to collection of waste water on surface which breeds vectors of diseases. Such vectors infect humans with malaria, yellow fever, dengue fever, sleeping sickness, and filariasis. Malaria, the most widespread, is endemic in about 100 developing countries, putting some 2 billion people at risk. In sub-Saharan Africa malaria costs an estimated US$1.7 billion annually in treatment and lost productivity.

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Water-Scarce Diseases:

Many other diseases—including trachoma, leprosy, tuberculosis, whooping cough, tetanus, and diphtheria—are considered water-scarce (also known as water-washed) in that they thrive in conditions where freshwater is scarce and sanitation is poor. Infections are transmitted when too little fresh water is available for washing hands. These diseases, which are rampant throughout most of the world, can be effectively controlled with better hygiene, for which adequate freshwater is necessary.

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The scope of water-related diseases can be enlarged to include WASH diseases as seen in the table below:

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Clean water vis-à-vis sanitation:

Studies conducted by Dr. Feachem of the London School of Health and Tropical Medicine indicated the relative importance of alternative preventive strategies concerning water supply, sanitation and health education. The studies gave a rough guide to the relative importance of the preventive measures considered; excreta disposal 25, excreta treatment 15, personal and domestic cleanliness 18, water quality 11, water availability 18, drainage and sullage disposal 6 and food hygiene 17. The studies concluded that the health impact of supplying clean water alone is limited. However, carefully designed programs which combine water quality with good sanitation and hygiene education have the potential to make enormous differences in the quality of life. A similar study conducted by the All-India Institute of Hygiene and Public Health, Calcutta (1944-1953) in its Rural Health Centre at Singur revealed that the number of morbidity and mortality cases due to gastro-enteric diseases and helminthic infection were lowest in the villages where both hand-pumps or tubewells for safe water and pour-flush toilets were provided. The next in order were villages where such toilet facilities had been made available, although those villages had no safe water. Still next were those with only hand-pumps or tube-wells but no toilet facilities; and lastly were those villages with neither facility. The obvious fact is that the future of the country largely depends on sanitation which is the most important thing, next to population control. We have to accept this fact in order to raise production and create a clean and civilized society. 

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Progress in water & sanitation Combined:

For the first time, an analysis has been carried out of the proportion of people who use both improved water sources and improved sanitation facilities, and those who use neither. Using data from 59 countries as seen in the figure below, it was found that five out of six users of improved sanitation also use improved water sources, but it is less likely that users of improved water also use improved sanitation. Only half the population of the 59 countries uses both. A quarter use improved drinking water only, and 9 per cent use improved sanitation only. A remaining 16 per cent use neither improved drinking water sources nor improved sanitation facilities.

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 Reductions in Diarrheal Disease:

In summary of the discussion of health effects vis-à-vis water supply, sanitation, and hygiene promotion, a study was conducted to determine assumed reductions in diarrheal disease morbidity which is shown in table below. These reductions are considered to be independent of one another, so that the relative risks for several interventions can be multiplied.

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Another study estimated that diarrheal morbidity can be reduced by an average of 6-20 per cent with improvements in water supply and by 32 per cent with improvements in sanitation. In India, approximately 72.7 per cent of the rural population does not use any method of water disinfection and 74 per cent have no sanitary toilets.

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So in a nutshell, both clean drinking water and improved sanitation prevent diseases but in between these two, improved sanitation is more important than water quality for prevention of diseases. More importantly, when both clean drinking water and improved sanitation co-exist, the transmission and spread of water-related diseases is least.

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Sanitation and health:

Sanitation is vital for health. Of the approximately 120 million children born in the developing world each year, half will live in households without access to improved sanitation, at grave risk to their survival and development. Poor hygiene and lack of access to sanitation together contribute to about 88% of deaths from diarrheal diseases, accounting for 1.5 million diarrhea-related under-five deaths each year. The WHO projects that achieving the MDGs in Africa would result in 173 million cases of diarrhea being avoided every year and that providing a basic level of access to all would result in 245 million avoided cases.

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“We find that 80 percent of diseases in India are water borne, and open defecation is the root cause,” explains S N Dave, Project Officer, Water Environment and Sanitation, UNICEF, Kolkata. “It also contaminates water sources.”

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Esrey et al (1991) reviewed all the available evidence and concluded that latrine ownership could reduce:

• Diarrhea incidence by 37%
• Ascariasis (round worms) prevalence by 28% (range 0 to 83%)
• Hookworm prevalence by 4% (range 0 to 100%)

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The discharge of untreated wastewater and excreta into the environment affects human health by several routes:

• By polluting drinking water;

• Entry into the food chain, for example via fruits, vegetables or fish and shellfish;

• Bathing, recreational and other contact with contaminated waters;

• By providing breeding sites for flies and insects that spread diseases;

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Human excreta have been implicated in the transmission of many infectious diseases including cholera, typhoid, infectious hepatitis, polio, cryptosporidiosis, and ascariasis. WHO estimates that about 2.2 million people die annually from diarrheal diseases where 90% are children under five, mostly in developing countries. Poor sanitation gives many infections the ideal opportunity to spread: plenty of waste and excreta for the flies to breed on, and unsafe water to drink, wash with or swim in. The importance of the isolation of waste lies in an effort to prevent diseases which can be transmitted through human waste, which afflict both developed countries as well as developing countries to differing degrees. The effects of sanitation have also had a large impact on society. The results of studies published in Griffins Public Sanitation show that better sanitation produces an enhanced feeling of wellbeing.

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Lack of sanitation facilities forces people to defecate in the open, in rivers or near areas where children play or food is prepared. This increases the risk of transmitting disease. The Ganges river in India has 1.1 million liters of raw sewage dumped into it every minute, a startling figure considering that one gram of feces may contain 10 million viruses, one million bacteria, 1000 parasite cysts and 100 worm eggs. Examples of diseases transmitted through water contaminated by human waste include diarrhea, cholera, dysentery, typhoid, and hepatitis A. In Africa, 115 people die every hour from diseases linked to poor sanitation, poor hygiene and contaminated water. Studies show that improved sanitation reduces diarrhea death rates by a third. Diarrhea is a major killer and largely preventable: it is responsible for 2.2 million deaths every year, mostly among under-five children living in developing countries. Hygiene education and promotion of hand washing are simple, cost-effective measures that can reduce diarrhea cases by up to 45%. Even when ideal sanitation is not available, instituting good hygiene practices in communities will lead to better health. Proper hygiene goes hand-in-hand with the use of improved facilities to prevent disease.

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Fecal-oral route of disease transmission:

Excreta disposal is an important part of overall environmental sanitation. Inadequate and unsanitary disposal of infected human excreta leads to the contamination of the ground water and sources of drinking water supplies. It provides shelter to breed flies to lay their eggs and to carry infection from feces to other human beings. Man is the reservoir of infection for several diseases. Fecal borne diseases and worm infestations are the main cause of deaths and morbidity in a community where they go for indiscriminate defecation. It is interesting to note that all such diseases are controllable or preventable through good sanitary barriers through safe disposal of human excreta.

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Of human excreta, feces are the most dangerous to health. One gram of feces can contain 10 million viruses, one million bacteria, 1,000 parasite cysts and 100 parasite eggs. The major feco-oral disease transmission pathways are demonstrated in the figure below which illustrates the importance of particular interventions, notably the safe disposal of feces in preventing disease transmission.

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As may be seen in the figure above, there are many ways by which disease-producing pathogen spreads or reaches the new host – the human being. Depending upon the hygiene behavior of the individual, the causative agent or pathogen from feces takes different mode to reach the host. The technical objective of sanitary disposal of human excreta is therefore to isolate or segregate human feces so that the disease-producing organisms in feces cannot possibly get into a new host through the common modes of transmission. The figure above shows places at which technology is applied to break the chain of transmission from human excreta. Feco-oral disease cycle can be broken at various levels by:

• Segregating feces

• Providing protected drinking water supply

• Keeping foods clean

• Improving personal hygiene

• Controlling files and

• Disposing waste water safely

These are various methods of breaking the fecal borne disease cycle. Of these, the most effective method is the segregation of feces and its proper disposal. This method is called “Sanitary Barrier”.

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Poor sanitation is far worse than poor water quality:

It is often said that much of the disease in low-income countries is caused by bad water. Water-related diseases, so we are told, cause the deaths of many millions of children each year and occupy most of the hospital beds in developing countries. Diarrhea in its various forms is a killer, as well as causing pain and suffering. Water quality is unfairly blamed for all these problems. However, nearly all so-called water-carried diseases, from quick-killing cholera to uncomfortable stomach-ache, are really spread through poor hygiene and sanitation practices. Lack of sanitation may mean that water is contaminated but these diseases are also passed on in other ways without contaminating water.

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Flies:

Flies are also responsible for much of the spread of disease. Cockroaches are sometimes to blame too, but flies are the real villains. The trouble is that they like feeding on feces. They can also travel long distances. Flies have spikes on their legs, so particles of whatever they feed on are carried away. If their food is feces of someone suffering from a diarrhea-type disease such as cholera (rare) or gastroenteritis (common), these particles may pass on the disease to others. Their next meal is quite likely to be on human food. So bits of feces are left behind on food or drink which is to be eaten by people. The disease is passed on.

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Control of Flies in latrine:

Fly-breeding in pits is a health hazard already described. This is not a great problem with a very deep pit with a small squat hole. But flies can be a serious problem with a shallow open pit or nearby full deep pit. There are three ways of controlling this fly nuisance.

1. The cheapest is to make a lid that fits exactly in the squat hole and to make sure it is always replaced when the latrine is not actually being used. In Mozambique a low-cost, slightly domed, unreinforced concrete slab is popular. The squat hole is keyhole-shaped. In the keyhole a lid is cast, made of concrete with a wood handle. This type of latrine can be made with a cheap shelter for privacy – grass matting is sufficient.

2. In Zimbabwe thousands of ‘Ventilated Improved Pit’ latrines (VIPs) have been built. VIPs require a latrine building with roof and cost much more than the Mozambique-type latrine. The pit is ventilated by a pipe or chimney with fly-proof netting at the top. Hundreds of flies may hatch in the pit from eggs laid by one or two mother flies that manage to get in. They are attracted by light at the top of the vent, while the latrine building is darker. Unable to get through the netting, they die.

3. The third method of controlling the fly nuisance can be used where people use water instead of paper or leaves for cleaning themselves after defecation. A trap with a water seal is fitted below a shallow pan. The trap is like that in a WC but not so deep. It is flushed by pouring a small quantity of water. Flies, mosquitoes and smells in the pit are all effectively trapped by the seal, with obvious reduction of health risks.

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Also poor sanitation leads to surface collections of waste water leading to breeding of mosquitoes which leads to spread of diseases like malaria, filarisis, and dengue fever. So poor sanitation does cause spread of vector born diseases.

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Disease spread through soil:

Another route is in soil. This is very important for intestinal worms such as roundworms and hookworms. Children with roundworms often relieve themselves while crawling or playing in an unpaved compound. The feces are likely to contain roundworm eggs. Even if someone cleans the compound, some eggs probably remain in the ground. Other children get some soil on their hands – children everywhere get dirty when playing. Then fingers go in mouths because children everywhere suck their fingers. The roundworms are passed on. One of the problems with roundworm eggs is that they remain infective for a very long time – many months. When children (or adults) with roundworms defecate on the ground near food crops, soil containing eggs can also easily get onto the crops many months later. Roundworms can then be spread through the food.

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Pattern of intestinal parasites at open air defecation sites in Kathmandu Valley, Nepal:

The poor socio-economic status of street children leads to dangerous and unhealthy living environments. Also open defecation and regular contact with dogs, flies and contaminated soil, water, feces, foods and fomites; increase their chance of infestation by intestinal protozoa and helminths. This study intended to find out the intestinal parasites among the stools collected from openly-defecating street children in Kathmandu Valley, Nepal. A total of 93 stool samples were collected in plastic vial with spoon and tight-fitting lid from 93 of street children who were defecating in the roadside and air-bridge in different locations of Kathmandu Valley from May 2008 to July 2008. Stool microscopy included examination by direct wet mount in 2.5% potassium dichromate solution and confirmation techniques used for oocysts was Z-N (acid-fast) staining, oculo- stage micrometer and bisporulation assays. Analysis of the results shows that all stool specimens were positive for intestinal parasite (prevalence of 100.0%). It is therefore concluded that a program should be conducted to treat intestinal parasites in street children living in this environment. Government should implement strict laws and orders against indiscriminate defecation and support this by provision of improved sanitation to all.

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Human excreta and the lack of adequate personal and domestic hygiene have been implicated in the transmission of many infectious diseases including cholera, typhoid, hepatitis, polio, cryptosporidiosis, ascariasis, and schistosomiasis. The World Health Organization (WHO) estimates that 2.2 million people die annually from diarrheal diseases and that 10% of the population of the developing world are severely infected with intestinal worms related to improper waste and excreta management. Human excreta-transmitted diseases predominantly affect children and the poor. Most of the deaths due to diarrhea occur in children and in developing countries (WHO 1999). Proper excreta disposal and minimum levels of personal and domestic hygiene are essential for protecting public health. Safe excreta disposal and handling act as the primary barrier for preventing excreted pathogens from entering the environment. Once pathogens have been introduced into the environment they can be transmitted via either the mouth (e.g. through drinking contaminated water or eating contaminated vegetables/food) or the skin (as in the case of the hookworms and schistosomes), although in many cases adequate personal and domestic hygiene can reduce such transmission. Excreta and wastewater generally contain high concentrations of excreted pathogens, especially in countries where diarrheal diseases and intestinal parasites are particularly prevalent. Therefore for maximum health protection, it is important to treat and contain human excreta as close to the source as possible before it gets introduced into the environment.

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Sanitation Related Diseases:

Pathogen	Disease	Transmission Routes and Symptoms
Bacteria	Typhoid	Fecal-oral route. Some symptoms include: fever, headache, insomnia, constipation, diarrhea, stomach gurgles, abdominal pain or tenderness.
	Bacillary dysentery /Shigella/Shigellosis	Faecal-oral route.  It is the main cause of diarrheal (3 or more watery stools in 24 hours) and dysentery (diarrhoea with blood and mucus).
	Cholera	Fecal-oral route.  Profuse watery diarrheal and vomiting.  Cholera can kill people in hours due to severe dehydration.  Cholera is very contagious and easily spread.
	Eschericha Coli (E. Coli)	Fecal-oral. Acute watery diarrhea with or without blood.
Viruses	Hepatitis A & E	Fecal-oral route.  Hepatitis A could also be transmitted via food contaminated by infected food-handlers, uncooked foods, or foods handled after cooking.  Symptoms include: fever, body weakness, loss of appetite, nausea and abdominal discomfort, followed by jaundice. The disease may range from mild (lasting 1-2 weeks) to severe disabling disease (lasting several months).
	Rotavirus	Fecal-oral route. Diarrhea without blood.
Protozoa/Parasite	Giardiasis	Fecal-oral route. Nausea, flatulence, epigastric pain, abdominal cramps, diarrhea, large and smelly stools.
	Amoebiasis(Entamoeba  Histolytica)	Diarrhoea with blood and mucous, abdominal pain, fever.  Similar to Shigella.
Helminths  –Intestinal Parasitic Worms	Roundworms (Ascaris lumbricoides),, Whipworms/(Trichuris trichiura),, Hookworms (Necator americanus and Ancylostoma duodenale).	Infected people excrete helminth eggs in their feces, which then contaminate the soil in areas with inadequate sanitation or live in the sludge in a septic tank. Helminths in sludge can live for 6 months or more before they die (depends on temperature, humidity)  Other people can then be infected by ingesting eggs or larvae in contaminated food (fecal – oral route) or through penetration of the skin by larvae in the soil (hookworms).

Notes:

1. Fecal – oral route: diseases are spread through direct contact with dirty hands, food and water contaminated with stool.  If sludge is contaminated and dumped on fields (food contamination) or in water (drinking water contamination) disease can be spread.  If a person has dirty hands they can transmit to things they touch.  

2. People may not die from diseases, but they lose days or work being sick or caring for sick a family member which has an impact on the economy. Often diseases affect children and the elderly more because their immune systems are not as strong as adults.  Children and elderly also may have a lower nutritional status which makes diarrhea and vomiting more serious. 

3. People can transmit diseases even when they don’t have symptoms. For example, about 75% of people infected with cholera do not develop any symptoms. However, the pathogens stay in their faeces for 7 to 14 days and are shed back into the environment, potentially infecting other individuals. 

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Examples of consequences of lack of clean drinking water and proper sanitation services.

• Each year there are approximately 4 billion diarrhea cases that cause 2.2 million deaths, mostly among children under the age of five. This means a rate of one child every twenty second, which is 15 percent of all of the death causes among the children under the age of 5.

• Approximately 10 percent of the population in developing countries are affected by intestinal worms. Intestinal parasitic infections can lead to malnutrition, anemia and retarded growth. 1500 million people suffer from different types of intestinal parasites annually.

• 6 million people are blind from trachoma. It is the most common cause of blindness in the world.

• 200 million people in the world are infected with schistosomiasis, of whom 20 million suffer severe consequences.

• Over one million people die from malaria every year. Over 267 million people are infected by malaria.

• 16 – 17 million people suffer from typhoid annually.

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Diarrheal Diseases:

Diarrheal diseases are the most important of the feco-oral diseases globally, causing around 1.6–2.5 million deaths annually, many of them among children under 5 years old living in developing countries. In 2008, for example, diarrhea was the leading cause of death among children under 5 years in sub-Saharan Africa, resulting in 19% of all deaths in this age group. Systematic reviews suggest that improved sanitation can reduce rates of diarrheal diseases by 32%–37%. While many of the studies included in those reviews could not rigorously disaggregate the specific effects of sanitation from the overall effects of wider water, sanitation, and hygiene interventions, a longitudinal cohort study in Salvador, Brazil, found that an increase in sewerage coverage from 26% to 80% of the target population resulted in a 22% reduction of diarrhea prevalence in children under 3 years of age; in those areas where the baseline diarrhea prevalence had been highest and safe sanitation coverage lowest, the prevalence rate fell by 43% . Similarly, a recent meta-analysis that explored the impact of the provision of sewerage on diarrhea prevalence reported a pooled estimate of a 30% reduction in diarrhea prevalence and up to 60% reduction in areas with especially poor baseline sanitation conditions. Another longitudinal study in urban Brazil found that the major risk factors for diarrhea in the first three years of life were low socioeconomic status, poor sanitation conditions, presence of intestinal parasites, and absence of prenatal examination. The study concluded that diarrheal disease rates could be substantially decreased by interventions designed to improve the sanitary and general living conditions of households. Further, it is not just the provision and adult use of sanitation that is important. A meta-analysis of observational studies of infants’ feces disposal practices found that unsafe disposal increased the risk of diarrhea by 23%, highlighting the importance of the safe management of both adults’ and infants’ feces .

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Diarrhea statistics:

• 2.2 million People die every year from diarrheal diseases (including cholera); 90% are children under 5, mostly in developing countries.
• 88% of diarrheal disease is attributed to unsafe water supply, inadequate sanitation and hygiene.
• Improved water supply reduces diarrhea morbidity by 21%.
• Improved sanitation reduces diarrhea morbidity by 37.5%.
• The simple act of washing hands at critical times can reduce the number of diarrheal cases by up to 47%.
• Additional improvement of drinking-water quality, such as point of use disinfection, would lead to a reduction of diarrhea episodes of 45%.

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Neglected Tropical Diseases:

Neglected tropical diseases, while resulting in little mortality, cause substantial disability-adjusted life year (DALY) losses in developing countries. Many of these diseases have a feco-oral transmission pathway. Thus, improved sanitation could contribute significantly to a sustained reduction in the prevalence of many of them, including trachoma, soil-transmitted helminthiases, and schistosomiasis. Unfortunately, the current policy focus in most parts of the world is on treatment by medication, which, unlike good sanitation, is not a preferred solution because, in part, it is much more expensive. Trachoma is endemic in many of the world’s poorest countries. It is caused by the bacterium Chlamydia trachomatis and is the world’s leading cause of preventable blindness. Trachoma control is predominantly antibiotic-based despite the existence of the SAFE control strategy (surgery, antibiotics, face-washing, and environmental measures, namely sanitation promotion). However, a recent cluster-randomized control trial in Ghana found that the provision of toilets reduced appreciably the number of Musca sorbens flies (the vector for trachoma) caught on children’s eyes and by 30% the prevalence of trachoma, thus confirming the long-suspected role that sanitation could play in the control of trachoma.

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Soil-transmitted helminths such as the large human roundworm, the human whipworm, and the human hookworms cause many millions of infections every year and many individuals are infected with more than one of these geohelminths. Helminthic infections negatively impact the nutritional status of infected individuals, with consequent growth faltering in young children, and anemia, particularly in pregnant women. Adult helminths live in the human gastrointestinal tract where they reproduce sexually. Their eggs are discharged in the feces of the infected host and thus, mainly via open defecation, to other people. Ending the practice of open defecation with good sanitation can cut this transmission path completely, but most current helminth-control programs focus on medication, which must be repeated periodically in the absence of sanitation.

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Globally, some 200 million people are infected with schistosomiasis, which can result in chronic debilitation, haematuria, impaired growth, bladder and colorectal cancers, and essential organ malfunction. Adult schistosomes live in the portal veins where they pass their eggs into the environment via the urine (Schistosoma haematobium) or feces (the other human schistosomes). After passing part of their life cycle in aquatic snails where they multiply asexually, cercariae are discharged into the water where they come into contact with and infect their human hosts through their skin. Thus, sanitation (and water) interventions are essential to any long-term control and elimination of schistosomiaisis, whereas the current standard intervention is repeated medication.

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Acute Respiratory Infections:

With 4.2 million deaths each year (1.6 million among children under 5 years), acute respiratory infections are the leading cause of mortality in developing countries. Although sanitation is not directly linked to all acute respiratory infections, a recent study reported that 26% of acute lower respiratory infections among malnourished children in rural Ghana may have been due to recent episodes of diarrhea. Thus, sanitation could be a powerful intervention against acute respiratory infections.

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Undernutrition:

Poor sanitation, hygiene, and water are responsible for about 50% of the consequences of childhood and maternal underweight, primarily through the synergy between diarrheal diseases and undernutrition, whereby exposure to one increases vulnerability to the other.

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The figure below shows distribution of health impacts of inadequate sanitation by disease in India:

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Health benefits from improvements in water supply and sanitation: a meta-analysis:

The findings of a meta-analysis of 144 studies on the impact of improved water supply and sanitation facilities on diarrheal diseases, ascariasis, guinea worm, hookworm, schistosomiasis and trachoma are reported. Sanitation and water supply interventions included: excreta disposal facilities, personal hygiene, domestic hygiene, and drinking water quality. The effects of these interventions on morbidity and mortality from each disease are reviewed. It is shown that improvements in one or more components of water supply and sanitation can substantially reduce rates of disease morbidity and severity for all diseases under study except hookworm. Apart from hookworm, the median reductions in morbidity range from 26% for diarrhea to 78% for guinea worm. The median reduction in general diarrhea mortality was 65% and in child mortality 55%.

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Improving maternal health through water, sanitation & hygiene (WASH):

“Some very basic elements of human development related to water, sanitation and hygiene that were accepted in the 19th and early 20^th centuries are still unavailable to a large proportion of pregnant women in the 21st century”, write the authors of a new Simavi study. Each year 290,000 women die from complications during pregnancy, birth and the neonatal period; and, an estimated 10 to 20 million women suffer from related health complications. Almost 90% of the maternal deaths occur in Sub-Saharan Africa and South Asia. Much of this is preventable through practices that have long been established. The Simavi study reviews published literature describing the impact of water, sanitation and hygiene on maternal health and mortality. Two studies showed significant correlations between increased access to water & sanitation and reductions in maternal mortality. Specific evidence was found relating to the impact of water carrying and water & sanitation-related infections on pregnant women, and to the impact of hygiene during and after delivery. The study suggests that the educational/promotional aspects relating to WASH and (maternal and newborn) health should be improved and addressed from pregnancy up to child care. Similarly, health centers and hospitals should have running water, clean toilets, safe refuse disposal, clean beds and areas for deliveries. Consistent hygiene in clinics and hospitals should be ensured. More high-quality research is needed on the linkages between WASH and maternal health in the context of low-income countries.

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Sewage is virus haven to a myriad of unknown strains:

Well, it’s pretty obvious that the rotten, insalubrious sewage environment is perfect for fostering infectious diseases and virus cultures. What’s surprising however is actually the sheer number of viruses, most of them unknown, which biologists at University of Pittsburgh have described in a recently published study in the journal mBio. According to the researchers, there are around 1.8 million species of organisms on Earth. Each host untold numbers of unique viruses yet only about 3,000 have been identified to date. Actually, genomic studies have shown that it’s probably only a tiny fraction of the number that actually exist, a hypothesis backed up by the Pittsburgh researchers find consisted of a myriad of unknown viruses in the raw sewage. The scientists analyzed a sample of untreated wastewater. What they found was 234 known viruses that can infect people, plants, animals and other organisms, along with unknown viruses representing more than 50 different virus families. The researchers have noted that the raw sewage holds the most diverse array of bacteria of any place collected from so far. What was surprising was that the vast majority of viruses they found were viruses that had not been detected or described before. Their findings suggest the viruses stem from a variety of sources, including animal and human feces and urine and plant material from domestic and agricultural settings. DNA sequencing of the viruses from the wastewater lead scientists to believe many are yet to be discovered.

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How does sanitation prevent disease?

For a sanitation system to provide the greatest health protection to the individual, the community, and society at large it must:

• Isolate the user from their own excreta and the community from other’s excreta;

• Prevent nuisance organisms (e.g. flies) from contacting the excreta and subsequently transmitting disease to humans; and

• Inactivate the pathogens before they enter the environment or prevent the excreta from entering the environment.

It is important to understand that sanitation can act at different levels, protecting the household, the community and ‘society’. In the case of latrines it is easy to see that this sanitation system acts at a household level. However, poor design or inappropriate location may lead to migration of waste matter and contamination of local water supplies putting the community at risk. In terms of waterborne sewage, the containment may be effective for the individual and possibly also the community, but health effects and environmental damage may be seen far downstream of the original source, hence affecting ‘society’. The containment and treatment of human excreta – combined with hand-washing – protects humans from harmful bacteria, viruses and helminths. Sanitation dramatically reduces cases of diarrhea, cholera, typhoid and worm infections. This particularly guards children from additional malnutrition, anemia and stunted growth. Without such illnesses, the body is more resilient against acute respiratory diseases, like pneumonia. Sanitation protects the health of AIDS patients with a weakened immune system. By preventing unnecessary death and disease, sanitation alleviates the psychological burden of permanent fear for loved ones from many families and communities. Safe sanitation and clean water can save the lives of 5,000 children under the age of five per day.

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Non-infectious damage by waste water:

Infectious agents are not the only health concerns associated with wastewater and excreta. Heavy metals, toxic organic and inorganic substances also can pose serious threats to human health and the environment – particularly when industrial wastes are added to the waste stream. For example, in some parts of China, irrigation for many years with wastewater heavily contaminated with industrial waste is reported to have produced health damage, including enlargement of the liver, cancers and raised rates of congenital malformation rates, compared to areas where wastewater was not used for irrigation. Nitrates from waste water can build up to high concentrations in water sources underground. This is associated with methaemoglobinaemia (blue baby syndrome) when contaminated water is used to prepare infant feeds. Health problems from nitrates in water sources are becoming a serious problem almost everywhere. In over 150 countries nitrates from fertilizers have seeped into water wells, fouling the drinking water. Nutrients may also cause eutrophication in water sources. This can result in overgrowth of algae and harmful cyanobacteria. The toxins produced by some toxic cyanobacteria cause a range of health effects, from skin irritation to liver damage. Toxic substances that find their way into freshwater are another cause of water-borne diseases. Increasingly, agricultural chemicals, fertilizers, pesticides, and industrial wastes are being found in freshwater supplies. Such chemicals, even in low concentrations, can build up over time and, eventually, can cause chronic diseases such as cancers among people who use the water.

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Pesticides such as DDT and heptachlor, which are used in agriculture, often wash off in irrigation water. Their presence in water and food products has alarming implications for human health because they are known to cause cancer and also may cause low sperm counts and neurological disease. In Dhaka, Bangladesh, heptachlor residues in water sources have reached levels as high as 0.789 micrograms per liter—more than 25 times the WHO-recommended maximum of 0.03 micrograms per liter. Also, in Venezuela a study of irrigation water collected during the rainy season found that the water was contaminated with a number of pesticides. Examination of pregnant women in the area found that they all had breast milk containing DDT residues—toxins that can be passed to an infant. The seepage of toxic pollutants into ground and surface water reservoirs used for drinking and household use causes health problems in industrialized countries as well. In Europe and Russia the health of some 500 million people is at risk from water pollution. For example, in northern Russia half a million people on the Kola Peninsula drink water contaminated with heavy metals, a practice that helps to explain high infant mortality rates and endemic diarrhoeal and intestinal diseases reported there.

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Home toilets have as much bacteria as public ones, new research shows:

Your toilet at home probably has as much bacteria on its surface as a widely-used public one in a restaurant, shopping centre or petrol station, according to new research. The study showed that 82.5% of samples taken from the ceramic part of commercial toilets had detectable levels of bacteria against 85% for domestic. It was carried out by antibacterial technology specialist Microban. Using the standard scientific unit of measurement for bacteria – the number of colony forming units per square inch – an average of 108.5 were found on swabs from public toilets and 125.6 on the home equivalents. The study basically shows that a toilet in your home is as likely to be contaminated with the same amount and type of bacteria as a widely-used public one in a shop or restaurant. Possibly, many public toilets are kept cleaner than most people believe and conversely, perhaps their toilet at home is not as clean as they might imagine.

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Is the Air inside Public Bathrooms rife with Infectious Particles?

The potential risks associated with “toilet plume” aerosols produced by flush toilets are a subject of continuing study. A review examined the evidence regarding toilet plume bioaerosol generation and infectious disease transmission. The studies demonstrate that potentially infectious aerosols may be produced in substantial quantities during flushing. Aerosolization can continue through multiple flushes to expose subsequent toilet users. Some of the aerosols desiccate to become droplet nuclei and remain adrift in the air currents. However, no studies have yet clearly demonstrated or refuted toilet plume-related disease transmission, and the significance of the risk remains largely uncharacterized.

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Toilet psychology:

Excretion is a universal part of the human experience, but it is veiled in taboo. Psychologists have torn the veil off other taboos, such as sex and death, but they have largely ignored excretion. Nevertheless, it is linked to a rich assortment of intense emotions, mental disorders, personality traits, social attitudes and linguistic practices. From psychoanalysis to neurogastroenterology, and from bathroom graffiti to shameful fetishes, the psychology of the toilet offers surprising insights into mind–body connections, culture and gender. According to a 2010 survey, the British public considers the flush toilet to be the ninth greatest invention of all time, just above the combustion engine. Toilet paper, ranked 22nd, wipes the floor with trains, shoes and e-mail, and nappies, at 62nd, are a better thing than sliced bread (70th). Excretion figures in many kinds of mental disorder, from phobias, obsessions, compulsions and delusions through to tics, impulse-control problems and paraphilias. Intense fears surrounding public urination, dubbed ‘paruresis’, are common and often disabling, limiting people’s movements and causing humiliation and pain, as in one sufferer who blacked out and crashed to the tiles from the sheer effort of trying to find relief at a public facility. Although paruresis bears many hallmarks of social anxiety it is unique enough for one writer to propose a new class of ‘sphincteric phobias’. Milder forms of bashful bladder are widespread, a fact established by a study that used a periscope in an adjoining toilet stall to assess men’s urine-streams at a public urinal. Time to begin urinating increased steeply the closer another user stood to the unwitting participant (Middlemist et al., 1976). Farting in the consulting room is one form of unwelcome and out-of-place excretion. Another form is incontinence. Among children the acquisition of bowel and bladder control is a major developmental achievement and a focus of anxious concern for parents, to the extent that ‘accidents’ are a frequent occasion for child maltreatment. Parents often seem to understand toilet training as a paradigm case for developing self-control, an inference that is not entirely without merit, as shown by a recent study in which adults made to drink five cups of water and not permitted to urinate were better able to resist unrelated temptations, such as short-sighted financial decisions, than adults with empty bladders (Tuk et al., 2011). Gender is itself a social division that is intimately connected to excretion. Women tend to be more disgusted than men by bodily waste, more censorious of flatulence, more concerned about concealing their smells and sounds during bathroom visits and more likely to wash their hands afterwards. In one study (Goldenberg & Roberts, 2004), a female experimenter who excused herself to use the bathroom was evaluated more negatively than one who excused herself to get some paperwork: no such difference was found for a male experimenter.   

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Sanitation and economy:

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The figure below shows neglect of sanitation as far as financial aid is concerned.

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This disappointing sanitation picture defies the logic of the economics. World Bank’s Economics of Sanitation Initiative demonstrates convincingly that the cost of inaction is impossible to defend. This series of studies evaluates the losses within a national economy attributable to the lack of safe sanitation. These encompass the time spent fetching water, the loss of education of teenage girls who stay away from school due to the lack of toilet facilities, the expense of treating illnesses caused by poor sanitation and hygiene, and the human loss through untimely mortality. The results have been published for separate countries. In sub-Saharan Africa, the cost of inadequate sanitation ranges from 1%-2% of GDP. Corresponding figures for India and Bangladesh exceed a staggering 6% of GDP. The implication is that investment in safe sanitation will generate a return which is of similar order to a country’s spending on health services. An outcome on this scale was also suggested in a World Health Organization study which concluded that each $1 of investment in sanitation delivers a formidable $9 return. This type of analysis also illustrates the contribution of water and sanitation to other MDG targets such as child mortality, gender equity, universal education, and poverty reduction. Despite the compelling nature of this social and economic case, the proportion of total foreign aid allocated to the sector fell from 8% to just over 5% between 1997 and 2010. Less than half of the $8 billion figure in 2010 was directed to the two regions most in need – sub-Saharan Africa and South Asia. Furthermore, a 2008 commitment by African governments to allocate a minimum of 0.5% of GDP to sanitation has not been fulfilled.

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The economic benefits of sanitation are persuasive. Every US$1 invested in improved sanitation, translates into an average return of US$9. Those benefits are experienced specifically by poor children and in the disadvantaged communities that need them most.

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Promoting economic growth in the poorest countries of the world:

It is estimated that lack of access to adequate sanitation, alongside safe drinking water, costs sub-Saharan Africa 5 per cent of its Gross Domestic Product each year. Meeting the sanitation MDG target would yield economic benefits in the region of 63 billion dollars each year rising to 225 billion dollars if universal access to sanitation was achieved. Notably, the greatest economic benefits would accrue in the poorest regions of the world, in particular in sub-Saharan Africa. According to the 2006 UNDP Human Development Report, meeting the MDG for water and sanitation would require a sustained investment of 10 billion dollars per year.

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What is the economic cost of inadequate sanitation?

The health impact of inadequate sanitation leads to a number of financial and economic costs including direct medical costs associated with treating sanitation-related illnesses and lost income through reduced or lost productivity and the government costs of providing health services. Additionally, sanitation also leads to time and effort losses due to distant or inadequate sanitation facilities, lower product quality resulting from poor water quality, reduced income from tourism (due to high risk of contamination and disease) and clean up costs. Increases in female literacy (due to increased school attendance where proper sanitation facilities exist) contribute to economic growth. Every dollar spent on improving sanitation generates economic benefits (about nine times) that far exceed the required sanitation investments. The cost of inaction is enormous. Achieving the MDG for sanitation would result in $66 billion gained through time, productivity, averted illness and death. It is estimated that a 10 year increase in average life expectancy at birth translates into a rise of 0.3-0.4% in economic growth per year.

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Cost of sanitation:

The cost of sustaining sanitation services for 20 years can be 5-20 times the cost of building a latrine. The 20-year cost of sustaining a basic level of service with a basic pit latrine in WASHCost research areas is US$ 30-80 per person after construction. That is more each year than the construction cost per person which ranges from US$ 1-4. Sustaining sanitation is much more expensive than building latrines. This is one of the key findings on costing sustainable sanitation services, which are being highlighted in the WASHCost campaign. The campaign was launched on 24 October, and every month until March 2013, it brings a roundup of fast facts from the WASHCost research project, experiences from several organizations which are using the life-cycle cost approach and ways to get involved. The Millennium Development Goals target 75% global sanitation coverage by 2015. The cost to reach this milestone is estimated at US$14 billion annually through the period. Among other health gains, sanitation is estimated to reduce diarrhea cases by 391 million worldwide each year.  

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Sanitation reduces poverty and fosters economic growth:

Access to toilets saves time otherwise lost seeking secluded spots to defecate as well as creating a more healthy society. Adults have more time to work and increase family income. Healthy children spend more time in school and help create an educated society. Sanitation protects the water and soil resources from pollutions which increases the regional economic potential. Utilizing human excreta as a resource drives local economic development. Treated urine and feces are excellent fertilizers. Biogas provides renewable energy. Reuse of treated wastewater results in water savings. Sanitation should therefore be viewed as an opportunity, not as a problem. Each dollar invested into sanitation results in 9 dollars economic return.

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Sanitation is an investment with high economic returns:

Improved sanitation in developing countries typically yields about US$9 worth for every US$1 spent. Hand-washing and hygienic, private toilets in homes and schools bring economic benefits for households, communities, and nations in several ways:

By saving time

By reducing direct and indirect health costs

By increasing the return on investments in education

By protecting investments in improved water supply

By safeguarding water resources

By boosting tourism revenues 

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Cost of sanitation in India:

According to a World Bank report, simply meeting the MDG target would require total investments of $38 billion up to 2017, the end of India’s 12th Five-Year Plan. Annually, that would require about $2.2 billion for urban areas and $1.65 billion for rural areas. Recurrent expenditures of the same order of magnitude will also be required.  And this is just to satisfy the MDG target for “improved sanitation,” which can be met by constructing simple pit latrines—a fairly modest target. On the other hand, India is losing billions of dollars each year because of poor sanitation. Illnesses are costly to families, and to the economy as a whole in terms of productivity losses and expenditures on medicines, health care, and funerals. The economic toll is also apparent in terms of water treatment costs, losses in fisheries production and tourism, and welfare impacts, such as reduced school attendance, inconvenience, wasted time, and lack of privacy and security for women. Ecologically sustainable sanitation can have significant economic benefits that accrue from recycling nutrients and using biogas as an energy source.

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6.4% (at US $ 53.8 Billion) of India’s GDP is the cost of Inadequate Sanitation:

Inadequate sanitation caused a total of US$53.8 billion equivalent to 6.4 percent of India’s GDP in 2006, according to The Economic Impacts of Inadequate Sanitation in India, a new report from the Water and Sanitation Program (WSP), a global partnership administered by the World Bank. The report indicates that premature mortality and other health-related impacts of inadequate sanitation, were the most costly at US$38.5 billion (71.6 percent of total impacts), followed by productive time lost to access sanitation facilities or sites for defecation at US$10.7 billion (20 percent), and drinking water-related impacts at US$4.2 billion ( 7.8 percent). See the figure below:

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Illness, lost productivity and other consequences of fouled water and inadequate sewage treatment trimmed 1.4-7.2 percent from the gross domestic product of Cambodia, Indonesia, the Philippines and Vietnam in 2005, according to a study by the World Bank’s Water and Sanitation Program. The per capita loss on account of inadequate sanitation, for various Asian countries is shown in table below:

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Sanitation is a good economic investment:

Improved sanitation in schools lead to decrease in girl’s drop rate and increase in female literacy. Research shows that for every 10% increase in female literacy, a country’s economy can grow by 0.3 percent. Educated girls are more likely to raise healthy, well-nourished, educated children, to protect themselves from exploitation & AIDS and to develop skills to contribute to their societies. Children weakened by frequent diarrhea episodes are also more likely to be affected by malnutrition and opportunistic infections such as acute respiratory infections – the other major child killer. The WHO Commission established that reducing infant mortality is key to economic growth. Lowering infant mortality is associated with greater abilities of families to invest in health and education, in fewer dependents per worker and overall increase in per capita GNP and economic growth. Poor sanitation and water supplies are the engines that drive cycles of disease, poverty and powerlessness in developing nations. Action to improve sanitation is an important step to enable the poorest people to escape poverty. It is clear that investing in sanitation generates massive returns on health, the environment and the economy. In fact, the overwhelming evidence is that there is no single development policy intervention that brings greater public health returns than investment in basic sanitation and hygiene practices. The UN estimates that for every $1 spent on sanitation, the return on investment is around $9. The “Human Waste” report explains that the answer to the vast numbers of preventable deaths and illness is a simple one. For a very small amount of money, a person in the developing world could be provided with safe water and adequate sanitation—£11 (US$16) billion a year would halve the number of people living with no sanitation and save millions of lives.

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Sanitation and social development:

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Sanitation leads to social development. Schools that have water and sanitation attract and retain students, particularly girls. One in four girls does not complete primary school, compared with one in seven boys. Girls bear the burden of water collection, which can take many hours a day, leaving them with no time or energy for school. Secondly, girls, particularly those old enough to menstruate, are reluctant to attend schools without toilets, and their parents are reluctant to send them. In general, healthy children attend school more and get more out of it. The WHO estimates that 194 million schooldays, resulting from fewer incidents of diarrhea, would be gained annually if the MDGs for water and sanitation were met. Studies have shown that children with intense worm infestations perform poorly in learning ability tests, cognitive function and educational achievement and that heavy infestation can result in a six-month delay in development. Some infected children attend school only half as much as their uninfected peers.

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Indian minister’s outburst:

Days after he kicked up a row by stating that there are more temples than toilets in India, Indian Union Minister Jairam Ramesh (his portfolio changed due to his comments)  urged women not to get married into families which do not have toilets in their homes. “Don’t get married in a house where there is no toilet,” the Rural Development and Water & Sanitation Minister said while addressing locals, majority of whom were women, at Khajuri village near Kota and cited a slogan “No toilet, no bride”.  ”You consult the astrologers to know about suitability of stars before getting married. You should also look whether there is a toilet at your groom’s home before you decide to get married,” he said. The minister was trying to create awareness among people regarding importance of toilet in a country where 626 million people defecate in open air. He might have crossed the line in interaction but his intentions were honorable.

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Social Benefits:

Like water supply, sanitation offers a number of social benefits in addition to direct health gains, which tend to feature more prominently in the minds of the users. This outcome is illustrated by the responses given by a sample of householders in rural Benin when asked to rate the importance they ascribed to the various benefits of latrines on a scale of 1 to 4 (table below).

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The table above shows benefits of Latrine Ownership as perceived by 320 households in Rural Benin.

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With sanitation as with water supply, strong gender differences exist in the perception of the social benefits of sanitation. For male heads of household in Benin as in other countries around the world, enhanced social status figures highly among the benefits of latrine ownership, whereas for women; security, convenience, and aesthetic factors count for more. Women who lack sanitation often risk sexual harassment on the way to and from their defecation site. In some cultural settings, women are constrained to go out for defecation and urination only during the hours of darkness, effectively becoming prisoners of daylight. Though no systematic study has been made of the health implications of such practices, they are likely to include an increased prevalence of urinary tract infections. The emancipation that a latrine bestows on such women cannot lightly be dismissed.

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Did you know that women menstruate on an average for 3000 days in their lifetime? This requires very practical needs regarding the space for washing and cleaning. Especially for adolescent girls, clean and private toilet facilities at school strongly influence their performance, and increase the chance to complete their education. If girls are to stay in school to acquire the skills to excel in life, they need access to private and hygienic facilities. In many countries, girls stay home during their menstruation days because the absence of a safe place to change and clean themselves makes them feel unsecure. In India, recent research shows that 23% of girls drop out of school all together when they reach puberty. Besides the emotional stress, poor menstrual hygiene often leads to health problems such as abdominal pains, urinal infections and other diseases. Girls facing health problems are less able to concentrate and perform during their education. Girls and women make up almost half of the population, yet menstrual hygiene and its management receives little attention. This culture of silence is one of the largest taboos that still need to be broken. WASH programs for schools provide a major opportunity to address girls’ needs, by focusing on the practical dimensions such as appropriate girl friendly latrine facilities as well as on hygiene education and general awareness of menstruation challenges.

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Social effects of lack of sanitation in youths: violence &drugs:

The effects of poor urban sanitary conditions and waste management on the well-being of city residents are often expressed in health and environmental terms. Of equal importance, which requires the attention of urbanists and other analysts of the urban environment, are the social consequences of poor sanitation. As earlier discussed, researchers recognized the severe health and environmental consequences of poor sanitation, and their direct and indirect links to the social consequences. The analysis here does not trivialize the environmental and health consequences of poor sanitation and waste management, but rather places more emphasis on the social consequences. For urban slums, the abundance of uncollected waste and its use as a weapon raises questions about community social cohesion. Poor urban communities are noted for their strong social cohesion. This is achieved through social networks, a process which tends to assist the poor to weather the storms and challenges associated with urban life. Interviews with key informants, adult women and men revealed some disquiet between the older and younger generations. In particular, poor sanitation in the community is partly blamed on the lack of discipline among youths with regard to their nonparticipation in the communal cleaning exercise (something the older people undertook frequently when they were young) and their indiscriminate dumping of refuse. Within the perception of the youths as undisciplined with regard to sanitation are the broader issues of violence and insecurity, and the contestation of open spaces at the neighborhood level. According to Bartlett, the quality of common space certainly influences social interaction. She adds that when people have reason to make frequent use of neighborhood space, the very level of activity can inhibit anti-social behavior. In the context of urban slums, that common space seems to be a contested space between those youths perceived to be deviants and older members of the community, with implications for community social cohesion. Some older community members’ challenge to these contested hijacked places attracts the bombardment of garbage. Related to community social cohesion is the role of adults as promoters of good social values and the moral upbringing of young community members. Under the fear of possible retribution of being bombarded with garbage, adults watch as some youths openly smoke marijuana and engage in other social vices in the community. In this context, adults’ role as guardians of the future generation of the community is greatly impeded. Researchers observed a group of youths at the end of the school compound smoking marijuana. Participants complained to researcher, telling of their disapproval of the practice, but they felt helpless about stopping the practice. What I am trying to highlight is that dumping refuse (inadequate sanitation), indiscipline, vagabond behavior, violence and drugs go hand in hand in urban poor youths.

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Sanitation culture:

Sanitation culture is affected by following matters:

• Psychological factors

• Religion

• Gender related factors

• Economical factors

• Social and institutional factors

Sanitation cultures vary remarkably according to countries, but big differences e.g. in religious habits and gender related factors can be also found inside a country. Cultural attitudes can occur towards sanitation but practical methods can be of different character of what the attitudes may suggest. Even though area is affected by certain religion, local practical methods can be of different than methods required by the religion. Therefore cultural assumptions of local sanitation are not to be made merely by looking into attitudes and values but find out local methods in practice.

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Sanitation and dignity:

Sanitation has a strong connection not only with personal hygiene but also with human dignity and well-being, public health, nutrition and even education. Urinating and defecating are basic human needs just like eating, drinking, sleeping or breathing. Every human being should be able to fulfill that need in dignity. Sanitation provides privacy and protects everyone in the community. It is time we recognize the potential of sanitation for human development and act concertedly to make a difference. Improving access to sanitation is a critical step towards reducing the impact of these diseases but it also helps create physical environments that enhance safety, dignity and self-esteem.

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Sanitation contributes to gender equality and access to education:

Toilet facilities provide privacy and prevent women from experiencing abuse while defecating openly. As domestic caretakers of the sick in many societies, women benefit the most from a healthy community. Their own health is safeguarded while they gain time to further their education and contribute to their family’s well-being. Clean toilets contribute to poverty eradication by protection one’s health and ability to work. Good school sanitation is essential for keeping children in school particularly girls during menstruation. Education is the foundation for development. 194,000,000 school days could be gained every year, if sanitation improved. Safety issues are particularly important for women and children, who otherwise risk sexual harassment and assault when defecating at night and in secluded areas. Also, improving sanitation facilities and promoting hygiene in schools benefits both learning and the health of children. Child-friendly schools that offer private and separate toilets for boys and girls, as well as facilities for hand washing with soap, are better equipped to attract and retain students, especially girls. Where such facilities are not available, girls are often withdrawn from school when they reach puberty.

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Sanitation and schools:

Adequate sanitation encourages children to be at school, particularly girls. Access to latrines raises school attendance rates for children: an increase in girls’ enrolment can be attributed to the provision of separate, sanitary facilities. It has long been recognized that investments in school sanitation and hygiene education together can create improved learning environments, thereby facilitating increased attendance and retention of students. The impact is most pronounced among girl students, when their special needs of adequacy and privacy are catered to. Children are effective change agents and serve to spread their best practices into their homes and communities. The overall long term impact of improved water and sanitation facilities in schools are thus phenomenal. However, mere creation of infrastructure, that does not assign due importance to students’ needs, can cater only to short term solutions and are by and large unsustained. It is important to recognize and distinguish between the needs of girls and boys separately, of children of different age groups and the special needs of the physically challenged. Development of infrastructural facilities needs to be combined with raised awareness about the importance of proper hygiene and the various ways of preventing water related ailments. Also needed is the evolved attitude of the adults i.e. teachers, school authorities and parents, who should systematically support the initiatives with a positive disposition towards safe water and sanitation and healthy habits of children.

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The CBSE (India), in collaboration with Ministry of Human Resource Development (MHRD), Ministry of Urban Development (MOUD) and Deutsche Gesellschaft fur Internationale Zusammenarbeit, GmbH (GIZ), has introduced the `National School Sanitation Initiative (NSSI)’. The program was started to inculcate good sanitation habits among school children to acquaint, inspire and celebrate excellence towards School Sanitation at the national level.

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School Sanitation and Hygiene Education (SSHE) is a very attractive issue not only from the political but also from a social perspective. It is based on the premise that children have a right to basic facilities such as school toilets, safe drinking water, clean surroundings and information on hygiene. If these conditions are created, children come to school, enjoy learning, learn better and take back to their families concepts and practices on sanitation and hygiene. In this way, investment in education is more productive. Such conditions have an even greater positive outcome for girls who often stay away from or drop out of schools which do not have toilet facilities.

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Expected impacts of improved Sanitation in children: Where adequate sanitation is provided coupled with improved hygiene behaviors, the following improvements could be expected:

1. Lower morbidity rates in the population.
2.  Lower mortality rates due to diarrhea.
3. Better nutrition among children.
4. Cleaner environment.
5.  Safer food and increased impact of improved water supplies.
6.  Better learning and retention among school children.
7. More dignity and privacy for everybody especially women and girls.
8.  Increased awareness of the importance of sanitation and hygiene and the need to develop a more permanent strategy.

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Sanitation and environment:

Sewage Water Pollution:

Sewage water pollution is one of the major problems in cities. Improper handling of waste water is the main reason behind the pollution of water. It creates a lot of health issues as well as environmental pollution. If the water is treated properly, it can prove to be beneficial. Sewage water is often drained off into rivers without treatment. The careless disposal of sewage water leads to a chain of problems, such as spreading of diseases, eutrophication, increase in Biological Oxygen Demand (BOD), etc. Following are important causes of Sewage water pollution.

• Overflow, spill, or release of raw or partially-treated sewage from a sanitary sewer collection system.
• Pipes are blocked by tree roots, grease and debris in sewage.
• The private or public sewer lines are cracked.
• An aging sewer infrastructure also increases the occurrence and severity of overflows.
• Storm flows received may be in excess of system capacity which can result in overflows from the sewerage pipe network.
• Overflows caused by rainwater getting into the sewer through faults in pipes or illegal connections, exceeding the capacity of the system.
• Poorly fitting cracked or broken inspection holes on the mains sewer system can let water into the sewerage system.

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Water pollution occurring from sewage is mainly observed in developing countries. In these countries, disposal of sewage is not carried out in a proper manner. In developed nations, a network of sewage pipes takes the sewage away from cities. Treatment of the waste minimizes the pollution caused by sewage water. Effluents contained in sewage water contain innumerable pathogens and harmful chemicals. The detergents that release phosphates in water allow growth of algae and water hyacinths which increase BOD thereby, reduction in the number of aquatic creatures. It also causes health problems, for example, diarrhea. Stagnant water fosters the growth of mosquitoes, which in turn causes malaria. Water bodies in their natural form contain many different chemical compounds like bicarbonates, nitrates, chlorides, sulfates, etc. Increase in the amount of these compounds causes many problems. For example, water becomes unsuitable for drinking and irrigation. The Total Dissolved Solids (TDS) present in water should be less than 500 mg/lit for the water to be considered potable. Water that contains salts is not useful for irrigation either. Use of such type of water for agricultural purpose leads to salinization of soil, which in turn causes soil erosion.

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Some cities dump their wastes into large lakes which undergo eutrophication (vide supra) as nutrient levels, especially phosphorus, build up. Sewage-contaminated water causes eutrophication, which is the increase in concentration of chemical elements required for life. The nitrates, phosphates, and organic matter found in human waste serve as a food for algae and bacteria. This causes these organisms to overpopulate to the point where they use up most of the dissolved oxygen that is naturally found in water, making it difficult for other organisms in this aquatic environment to live. The bacteria are basically strangling the other organisms. Some of the organisms that do overpopulate from this can also be disease-causing microorganisms. Phosphates are also found in soaps and detergents, but there are other household products that we use every day that can be toxic to many animals and humans if they are dumped directly into a water body. During this process, a lake changes from being a clear blue oligotrophic lake (nice for boating) to a cloudy, often smelly, brown eutrophic one — its phytoplankton change as blue green algae take over. This leads to changes in the zooplankton and fish inhabiting the lake. An oligotrophic lake supports desirable fish like trout, whereas only trash fish such as carp can live in a eutrophic lake.

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Impacts of Sewage water in environment:

• Use of untreated sewage water poses a high risk to human health and other living organisms.
• Wastewater contains salts that may accumulate in the root zone with possible harmful impacts on soil health and crop yields.
• Wastewater application has the potential to affect the quality of groundwater resources in the long run through excess nutrients and salts.
• When drainage water drains particularly into water bodies and surface water the remains of nutrients may cause eutrophication.
• Natural resource concerns such as pollution of vital water resources, loss of fish, wildlife, exotic species, etc.

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In regions where a large proportion of the population is not served with adequate water supply and sanitation, sewage flows directly into streams, rivers, lakes and wetlands, affecting coastal and marine ecosystems, fouling the environment and exposing millions of children to disease. Particularly in the context of urbanization, domestic wastewater, sewage and solid waste improperly discharged presents a variety of concerns from providing breeding grounds for communicable disease vectors to contributing to air, water and soil pollution. The results of poor waste management also contribute to a loss of valuable biodiversity. In the case of coral reefs, urban and industrial waste and sewage dumped directly into the ocean or carried by river systems from sources upstream, increase the level of nitrogen in seawater. Increased nitrogen caused overgrowths of algae, which in turn, smother reefs by cutting off their sunlight. Improved sanitation reduces environmental burdens, increases sustainability of environmental resources and allows for a healthier, more secure future for the population.

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The current global water and sanitation crisis has a profoundly negative impact on the environment. Water is a fundamental part of ecosystems, and everything within a watershed is connected. In developing nations, nearly all sewage systems are being emptied into rivers, lakes, and nearby streams that communities use for drinking water. Along with polluting drinking water sources, discharging untreated sewage pollutes the environment and affects plant and aquatic life. According to research studies by the United Nations Environment Program, coastal habitats, fisheries, and marine wildlife in the South Asian Sea are threatened by untreated sewage discharge into coastal waters. Improving sanitation improves the environment by safely disposing human waste and creates healthier living conditions for plants, animals, and humans. If the 2.6 billion people presently living without adequate sanitation gain access to even a simple latrine, environmental sustainability and health will improve dramatically.  

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Good Sanitation protects the environment:

Toilets, washing facilities, garbage removal, wastewater disposal, stormwater drainage: sanitation services such as these are a prerequisite for clean, healthy household and community living environments, particularly in dense settlements. Such sanitation services are also vital to safeguard environmental quality more broadly, especially the quality of water resources. Toilets and latrines that isolate and sanitize human excreta are necessary for a clean, healthy community living environment; they also safeguard overall ecosystem health by keeping biological pathogens from contaminating waterways and land. At present, each year more than 200 million tons of human waste – and vast quantities of waste water and solid waste – go uncollected and untreated around the world, fouling the environment and exposing millions of children to disease and squalor. Improved sanitation leads to less environmental degradation, increased sustainability of environmental resources and a more secure future for children. Safe collection and treatment of human waste and other various wastewaters protects drinking water sources and eco-systems. Sanitation creates clean and healthy living environments, particularly in urban areas. Sanitation can make agricultural production sustainable, by returning treated human excreta to the fields as a fertilizer. This practice saves energy and protects the world’s finite reserves of phosphorous, which are required for artificial fertilizer production. The treatment of feces, manure and organic waste also produces biogas, a renewable energy, which reducesCO2 emissions. Global sanitation coverage could treat over 375,000 tons of feces per day, which are currently being discharged untreated into nature.   

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Reuse of waste water:

Treated wastewater can be reused as drinking water, in industry (cooling towers), in artificial recharge of aquifers, in agriculture (70% of Israel’s irrigated agriculture is based on highly purified wastewater) and in the rehabilitation of natural ecosystems (Florida’s Everglades). The reuse of treated wastewater in landscaping, especially on golf courses, irrigated agriculture and for industrial use is becoming increasingly widespread.

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 Use of untreated wastewater by agriculture:

Around 90% of wastewater produced globally remains untreated, causing widespread water pollution, especially in low-income countries. Increasingly, agriculture is using untreated wastewater for irrigation. Cities provide lucrative markets for fresh produce, so are attractive to farmers. However, because agriculture has to compete for increasingly scarce water resources with industry and municipal users, there is often no alternative for farmers but to use water polluted with urban waste directly to water their crops.

Health hazards of polluted irrigation water:

There can be significant health hazards related to using the water in this way. Wastewater from cities can contain a mixture of chemical and biological pollutants. In low-income countries, there are often high levels of pathogens from excreta, while in emerging nations, where industrial development is outpacing environmental regulation; there are increasing risks from inorganic and organic chemicals. The World Health Organization, in collaboration with the Food and Agriculture Organization of the United Nations (FAO) and the United Nations Environmental Program (UNEP), has developed guidelines for safe use of wastewater. The International Water Management Institute has worked in India, Pakistan, Vietnam, Ghana, Ethiopia, Mexico and other countries on various projects aimed at assessing and reducing risks of wastewater irrigation. They advocate a ‘multiple-barrier’ approach to wastewater use, where farmers are encouraged to adopt various risk-reducing behaviors. These include ceasing irrigation a few days before harvesting to allow pathogens to die off in the sunlight, applying water carefully so it does not contaminate leaves likely to be eaten raw, cleaning vegetables with disinfectant or allowing fecal sludge used in farming to dry before being used as a human manure.

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Conversion to fertilizer:

Sewage sludge can be collected through a sludge processing plant that automatically heats the matter and conveys it into fertilizer pellets (hereby removing possible contamination by chemical detergents, …) This approach allows to eliminate seawater pollution by conveying the water directly to the sea without treatment (a practice which is still common in developing countries, despite environmental regulation). Sludge plants are useful in areas that have already set-up a sewage-system, but not in areas without such a system, as composting toilets are more efficient and do not require sewage pipes (which break over time).

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Sewage sludge regularly tests positive for a host of heavy metals, flame retardants, polycyclic aromatic hydrocarbons, pharmaceuticals, phthalates, dioxins, and a host of other chemicals and organisms. Sewage sludge is typically treated to remove some–but not all–of the contaminants. In recent decades, the sludge lobby has rebranded the treated sludge as “biosolids.”  Often, but not always, the various contaminants are found in sewage sludge at low levels. What happens to them once the sludge is applied to the soil is anyone’s guess. Some chemicals bind to the soil; others do not. Some chemicals leach into groundwater; others are insoluble in water. Some chemicals are taken up by plants–perhaps into the roots only, or into leaves, or all the way into fruits. Some chemicals break down into harmless components, others break down into dangerous components, and others don’t break down at all. Understanding the path that low levels of thousands of chemicals take in the environment is a daunting task.

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Triclosan:

To provide a more concrete example, take the chemical triclosan. It has been used for several decades in antibacterial products like soaps, deodorants and cosmetics. It is also nearly universally found in sewage sludge. A recently published study found that soybeans planted in soil containing triclosan took the triclosan up into their beans. Triclosan is a suspected endocrine disruptor and recent CDC reports show more than a 40 percent increase in triclosan levels in the urine of Americans over a recent two-year period. The amount in our bodies isn’t entirely due to sewage sludge; humans can absorb triclosan through their skin and those who use triclosan-containing toothpastes put the chemical directly into their mouths. Nonetheless, fertilizers synthesized from sludge may contain triclosan and taken up by plants. 

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Hazards of reuse of sewage in agriculture:

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Sweden, Switzerland, France and Holland are among the countries that have either banned or introduced tougher standards on the use of biosolids as fertilizer. Instead, they are burning more of it in energy-from-waste plants. One of the few is a recently published report by researchers from the University of Toledo in Ohio, which found a significant increase in problems such as abdominal bloating, jaundice and weight loss among residents exposed to treated fields. The 2005 study surveyed 613 people over one month and researchers noted an increased risk for respiratory, gastrointestinal and some chronic diseases such as multiple sclerosis. Four hundred and thirty-seven of the people surveyed lived within 1.6 kilometers of fields treated with biosolids, 176 lived further away.

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Using contaminated sewage for fertilizer can result in epidemics of such diseases as cholera. These diseases can even become chronic where clean water supplies are lacking. In the early 1990s, for example, raw sewage water that was used to fertilize vegetable fields caused outbreaks of cholera in Chile and Peru. The increasing use of bio-solid or human sewage as fertilizer in farms is posing great environmental and health risks. Sewage is well known for its nutrients and cheap price. The use of sewage sludge as fertilizers can be a solution for disposal problems. Nevertheless, heavy metals such as lead are likely to be found in sewage: such materials can be absorbed by plants (the amount absorbed varies among different plants, details of which are found in fact sheet “Is your yard lead safe” by The Lead Group) and can, in turn, significantly impair functions of human organs.

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On the other hand, agriculture is suffering from lack of soil nutrients, and production of chemical fertilizers is energy-intensive. Theoretically, the nutrients in domestic wastewater and organic waste are nearly sufficient to fertilize crops to feed the world population, and, depending on soil and plant type, the excreta of one person can provide enough nutrients for 200 to 400 sq.m. of agricultural production area. Within a few decades, the world reserves of phosphate are expected to be mined, and access to phosphate sources is likely to cause conflict. 74% of phosphorus in wastewater is found in toilet waste, most of it originating from urine. Yet, nutrients and energy in human excreta go largely unused. Ecological sanitation insists on maximum possible re-use of nutrients from human excreta. Urine uncontaminated by feces requires minimal processing and can easily be re-used in farming and gardening. In order to avoid spread of pathogens, human feces requires composting, either in a dry toilet without water, or if mixed with small volumes of wash or flushing water in a separate composting module, possibly dehydrated with the help of solar energy, or is to be digested in a biogas plant for recovery of methane gas and subsequent use of the dried sludge as fertilizer.

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Sewage farms comprise agricultural land irrigated and fertilized with sewage. Modern sewage farms are usually combined with such plant, so that they irrigate the land with reclaimed water. Some types of untreated sewage can be used on a sewage farm, or filtered through a constructed wetland.

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Many types of organic compost are really packaged human sewage:

More than half of the 15 trillion gallons of sewage flushed annually by Americans ends up in a fertilizer product. Compost adds organic matter and helps to make nutrients available in the soil, and most of the compost available in American market is from sewage and many people are unaware of it.

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Human Waste used by 200 million farmers, study says:

Facing water shortages and escalating fertilizer costs, farmers in developing countries are using raw sewage to irrigate and fertilize nearly 49 million acres (20 million hectares) of cropland, according to a new report—and it may not be a bad thing. While the practice carries serious health risks for many, those dangers are eclipsed by the social and economic gains for poor urban farmers and consumers who need affordable food, the study authors say. Nearly 200 million farmers in China, India, Vietnam, sub-Saharan Africa, and Latin America harvest grains and vegetables from fields that use untreated human waste. Ten percent of the world’s population relies on such foods, according to the World Health Organization (WHO). Agriculture is a water-intensive business, accounting for nearly 70 percent of global fresh water consumption. In poor, parched regions, untreated wastewater is the only viable irrigation source to keep farmers in business, and in some cases, water is so scarce that farmers break open sewage pipes transporting waste to local rivers.

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Astronauts drink recycled urine aboard Space Station and so you do:

NASA first began recycling urine aboard the International Space Station in 2009, and after a few stops and starts, the system appears to be working. Right now, if you want to go on a space mission, you better be ready to drink your own urine. Because of the high costs involved with sending anything into space, including water, recycling has become a priority for NASA, which has been researching such technologies since the 1960s. The goal is to capture all the moisture released aboard the space station — whether urine or condensation — and then reuse that to provide astronauts with potable water. Unlike the recycling system on earth which involves filtering wastewater through a membrane, NASA distills its water. Basically, heat is applied to separate water from waste. It’s a technology that NASA believes could eventually be used for a wide range of recycling efforts on Earth as well as in space. People often don’t understand that they’re already drinking their own urine. You flush the toilet, that water goes into a sewage treatment plant, into the river, and ultimately into the ocean. The sun heats it and turns it into vapor, which becomes a cloud and rains on you.

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Drinking Recycled Water:

Drinking treated sewage is a proposition as emotionally wrought as it is scientifically feasible. People naturally say no to drinking ‘recycled sewage’. But ‘purified recycled water’ is OK.

Where do they do it?

In Namibia, since 1968, the town of Windhoek has used recycled sewage directly for drinking water during droughts or emergencies. Orange County in North Virginia, USA, and the South African cities of Scottsdale, Pretoria and Cape Town rely on indirect schemes, where recycled sewage is introduced back into a river, dam or aquifer where it mixes with the rest of the water before being retreated for drinking. In Singapore, about 1% of recycled sewage water is used for drinking. A new sewage treatment plant in China Chongqing has successfully extracted drinking water from wastewater and household sewage. The plant is the first of its kind in the nation to be capable of treating wastewater and producing clean drinking water from it. A local government official even tastes a bottle of this drinking water to support the achievement. Sewage treatment requires physical, chemical, and biological processes to remove contaminants, using advanced technology it is now possible to re-use sewage effluent for drinking water. This is really amusing, it seems like nobody know China has the technology and experience to recycle wastewater into drinking water

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Toilet to tap: The cleansing process:

Despite the not-so-pleasant nickname — “toilets to tap” — given to the technology, only about 10% of household wastewater typically comes from toilets, while the rest comes from showers, sinks and laundry machines. This waste water flows through sewer pipes to a treatment plant, where solids and certain bacteria are removed before it’s discharged into the ocean or further treated so it meets or exceeds federal drinking standards. To make the water potable, Singapore and Orange County use several steps. First, during a process called microfiltration, the water passes through a membrane with tiny holes — hundreds of times smaller than a human hair — that trap bacteria. It then undergoes a reverse-osmosis process in which it’s pushed through a second, semi-permeable membrane that blocks salt, viruses and pharmaceuticals. Finally, the water is zapped with high-intensity ultraviolet light and hydrogen peroxide to kill any trace organics. The resulting water is often cleaner than what you can buy in a store as mineral water bottle.

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Chlorination and UV irradiation as well as ozone treatment are effective disinfectants that can be effectively and safely used to disinfect wastewater, reclaimed water, and drinking water.

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Non-potable Reclaimed water:

Typically when we hear the term “recycled water” or “reclaimed water” it means wastewater that is sent from our home or business through a pipeline system to a treatment facility where is treated to a level consistent with its intended use. It is then routed directly to a recycled water system for uses such as irrigation or industrial cooling. The recycling and recharging is often done by using the treated wastewater for designated municipal sustainable gardening irrigation applications. In most locations, it is intended to only be used for non-potable uses, such as irrigation, dust control, and fire suppression. The cost of reclaimed water exceeds that of potable water in many regions of the world, where a fresh water supply is plentiful. However, reclaimed water is usually sold to citizens at a cheaper rate to encourage its use. As fresh water supplies become limited from distribution costs, increased population demands, or climate change reducing sources, the cost ratios will evolve also. Using reclaimed water for non-potable uses saves potable water for drinking, since less potable water will be used for non-potable uses. It sometimes contains higher levels of nutrients such as nitrogen, phosphorus and oxygen which may somewhat help fertilize garden and agricultural plants when used for irrigation. The usage of water reclamation decreases the pollution sent to sensitive environments. It can also enhance wetlands, which benefits the wildlife depending on that eco-system. For instance, The San Jose/Santa Clara Water Pollution Control Plant instituted a water recycling program to protect the San Francisco Bay area’s natural salt water marshes.

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Energy from sewage:

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Experts estimate that about 3% of all the energy in developed countries is used to treat sewage. That’s a lot, and much of that energy is the result of burning fossil fuels. That may all change, however, as researchers claim to have devised an efficient process that will convert wastewater into clean energy. The new method would not only allow treatment plants to power themselves, but would enable them to sell excess energy at a profit. If proven feasible outside the lab, this breakthrough would represent a radical shift for this oft-unmentioned, but sizable segment of the global economy.

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Current Technologies for Energy Production:

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Sewage Sludge as a Biomass Resource for the Production of Energy:

Treatment of municipal wastewater results worldwide in the production of large amounts of sewage sludge. The major part of the dry matter content of this sludge consists of nontoxic organic compounds, in general a combination of primary sludge and secondary (microbiological) sludge. The sludge also contains a substantial amount of inorganic material and a small amount of toxic components. There are many sludge-management options in which production of energy (heat, electricity, or biofuel) is one of the key treatment steps. The most important options are anaerobic digestion, co-digestion, incineration in combination with energy recovery, co-incineration in coal-fired power plants, co-incineration in combination with organic waste focused on energy recovery, use as an energy source in the production of cement or building materials, pyrolysis, gasification, supercritical (wet) oxidation, hydrolysis at high temperature, production of hydrogen, acetone, butanol, or ethanol, and direct generation of electrical energy by means of specific micro-organisms. Incineration and co-incineration with energy recovery and use of sewage sludge in the production of Portland cement are applied on a large scale. In these processes, the toxic organics are destructed and the heavy metals are immobilized in the ash or cement. The energy efficiency of these processes strongly depends upon the dewatering and drying step. It is expected that these applications will strongly increase in the future. Supercritical wet oxidation is a promising innovative technology but is still in the development stage. With the exception of biogas production, the other biological methods to produce energy are still in the initial research phase. Production of biogas from sewage sludge is already applied worldwide on small, medium, and large scales. With this process, a substantial experience exists and it is expected that this application is getting more and more attention. Besides the increasing focus on the recovery and reuse of energy, inorganics, and phosphorous, there is also an increasing focus to solve completely the problem of the toxic organics and inorganic compounds in sludge. In the assessment and selection of options for energy recovery by means of biological methods, this aspect has to be taken into account.

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Sludge Incineration:

Most of the sewage sludge produced at sewage treatment plant is applied to agricultural land as a soil conditioner, reducing the need for fertilizer. Sludge may also be incinerated, with the option of energy recovery. However, to incinerate sludge, it must be dry enough to burn with no extra energy input other than that needed to fire up the incinerator. It therefore needs dewatering, using energy intensive processes such as centrifugation or thermal dehydration. Centrifugation requires less energy but surplus heat from incineration that can be used for thermal dehydration. There has been strong opposition from some sections of the public over incineration of wastes due to fears about impacts on human health. At present, reuse of sludge via application to land is generally considered a more acceptable option.

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Biogas:

Biogas production from sewage sludge treatment, via a process called anaerobic digestion, is already a well established means of generating energy in many developed countries. Bacteria are used to metabolize organic matter of sludge into production of a mixture of methane (CH4 of 60 – 65%), carbon dioxide (CO2 of 35 – 40%) and trace gases. Impurities, such as hydrogen sulfide and water, are removed and the resulting biogas is then commonly used in boilers or combined heat and power systems. Biogas may also be used for other applications, such as vehicle fuel, if CO2 is also removed. Anaerobic digestion also reduces the solids content of sludge by up to 30%, reducing the energy costs involved in its transport. The electricity generation using biogas in landfills fulfills the electricity requirements of the plant and a surplus of energy can be delivered to the grid. In the agricultural sector, the biogas produced from manure residues can provide energy surplus to, depending on the number of animals and the technology used to treat their residues. The amount of biogas that can be yielded from human waste is limited in comparison with livestock manure and other feedstocks. Our stomachs are just too efficient! David House states in his excellent book that 1000 lbs of human waste produces about 0.6 cubic meters of biogas (enough cooking fuel for about 1 to 2 persons). But that amount quickly adds up. In sewage treatment plants the biogas use to electricity production allows a reduction of 20% in electricity consumption. This relation between the electricity production and consumption don’t change due the size of the facilities.

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Methane as Biogas – A renewable source of green energy to be encouraged for generation:

Anaerobic digestion of wastes provides biogas. Biogas contains about 60% methane that can be used to generate electricity or used for heat or for fuel for vehicles. Any animal manure, human sewage or food waste will produce methane during anaerobic digestion. Natural gas is methane. Biogas can be “cleaned” to yield purified methane that can be used in the natural gas pipelines. Methane from biogas is an excellent alternative energy source. Methane is important for electrical generation by burning it as a fuel in a gas turbine or steam boiler. Compared to other hydrocarbon fuels, burning methane produces less carbon dioxide for each unit of heat released. In many cities, methane is piped into homes for domestic heating and cooking purposes. In this context it is usually known as natural gas, which is considered to have an energy content of 39 megajoules per cubic meter, or 1,000 BTU per standard cubic foot. Methane in the form of compressed natural gas is used as a vehicle fuel and is claimed to be more environmentally friendly than other fossil fuels such as gasoline/petrol and diesel. Using methane for energy helps the environment by replacing the use of non-renewable fossil fuels with renewable energy. Methane is a greenhouse gas that has 21 times the heating effect as of carbon dioxide. So using methane to generate energy will reduce greenhouse gas effects and thereby reduce global warming. Biogas methane is renewable unlike natural gas which is mined from underground wells and is a non-renewable fossil fuel. Methane biogas is about to become much more important as an energy source than it has been in the past, due to the ever rising cost of natural gas. Treating human waste through Anaerobic Digestion is an incredibly ethical sanitation technology. Anaerobic Digestion occurs in biodigesters and produces a fuel (biogas), removes Biochemical Oxygen Demand (BOD) from sewage, conserves nutrients (especially nitrogen compounds) and most importantly reduces pathogens.

Some facts about methane biogas:

(a) Millions of cubic meters of methane in the form of swamp gas or biogas are produced every year by the decomposition of organic matter, both animal and vegetable.

(b) It is almost identical to the natural gas pumped out of the ground by the oil companies and used by many of us for heating our houses and cooking our meals.

(c) Many countries have for years been steadily building anaerobic digestion facilities for generating electricity from methane produced from manure, sewage and garbage.

(d) Villagers in many undeveloped countries use very simple technology to convert animal and human wastes to biogas for cooking and heating.

(e) Recently hundreds of farms in India, Mexico and South America have installed anaerobic digesters to collect and use methane from manure to provide energy for farm use. Many of these digesters have been paid for by a company that aggregates and sells carbon credits to factories and utility companies in countries that signed agreements under the Kyoto protocol to reduce greenhouse emissions. Carbon credits are earned by reducing greenhouse gas emissions such as carbon dioxide and methane. These credits have considerable value.

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Anaerobic Digestion (vide supra):
Anaerobic digestion is a process in which microorganisms in the absence of oxygen break down biodegradable material to produce biomethane. The environmental benefits of anaerobic digestion include:
• Collection of methane providing a source of renewable energy that is carbon neutral, i.e., providing energy with no net increase in atmospheric CO2.
• The production of biosolids, which offer farmers a safe, sustainable source of nutrients that supply crop nutrients and enrich land with organic matter.
• Reduction in the sludge volumes that have to leave the site.
• Significantly lowers carbon footprint of the operating site.
• Less smell than more conventional processes.

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Benefits of anaerobic digestion:

• Generation of renewable energy from a waste material through cogeneration / CHP
• Reduction in carbon emissions especially compared to aerobic sewage treatment
• Economical onsite electrical power production & reduced transmission losses
• Production of a low-carbon fertilizer / soil improver
• Cost effective, proven technology

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Interesting Facts about biogas-methane:
• Enough Biogas is produced at Avonmouth to send a car to the moon and back 119 times or around the world 2,287 times
• You can drive a car for 5.3 miles per m3 of biogas.
• Waste flushed down the toilet of just 70 homes is enough to power a car for one year based on an annual mileage of 10,000 miles.
• In Sweden more than 11,500 vehicles run on methane produced from sewage plants.
• To use biogas as vehicle fuel, the gas needs to be treated – a process called biogas upgrading. It involves carbon dioxide being separated from the biogas. In the past methane hasn’t been “clean” enough which has meant it has affected the car performance.

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Future Technologies for Energy Production:

There are several novel technologies that produce energy or fuel as a by-product of sewage treatment, although further work is needed to improve performance, reliability and cost-effectiveness.

(a) Conversion of sludge to oil and gas – Under carefully controlled conditions and extreme temperatures (450 – 1000 degree Celsius), sludge may undergo chemical reactions to produce fuels that may be used for energy production. Processes include gasification, which produces syngas (similar to natural gas), and pyrolysis, which produces bio-oil (similar to diesel oil). There is interest in these as potential alternatives to incineration of sludge. However, operational costs are high, particularly those of maintaining high temperatures, and conditions must be carefully controlled to prevent formation of harmful by-products, such as hydrogen cyanide.

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(b) Biomass Crops – In some of the European countries, sewage sludge is applied as fertilizer to willow plantations. The trees are periodically coppiced and the wood used for fuel. Research into applying partially-treated, liquid sewage to biomass crops is also underway. Passage of the sewage through the soil acts as a final polishing step for treatment & degrading organic matter, reducing nitrogen & phosphorus and producing a cleaner effluent. Little energy is required and capital and operational costs are low. However, it is not yet known how efficient this system will be at removing pollution and there must be appropriate land available.

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(c) Hydrogen from Sewage – There is much interest in hydrogen as a fuel, because it can be produced from a wide range of materials and provides power with minimal air pollution. Bacteria use organic matter to produce hydrogen by fermentation. However, applications for hydrogen, such as fuel cells, are not yet in widespread use. A solar powered toilet that breaks down water and human waste into hydrogen gas for use in fuel cells has won first prize in a competition for next-generation toilets to improve sanitation in the developing world.

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(d) Microbial Fuel Cells – These devices offer the possibility of simultaneous sewage treatment and energy production, with water, CO2 and inorganic residue as by-products. Bacteria use organic matter to produce electricity. Fuel cells are a promising new energy technology. Simply put, a fuel cell converts hydrogen and oxygen into water. This chemical reaction releases electricity & heat energy and produces only water as a by-product. There are many kinds of fuel cells. A microbial fuel cell uses a chemical reaction inside bacteria as the source of its electrons. So far, that means you’ve got a fuel cell powering your electric grid, and bacteria powering the fuel cell that powers the electric grid. But now you need something to power the bacteria. Prior to this study, pure chemicals like glucose or acetate were common candidates. Unfortunately, making a big pool of bacteria in a glucose solution is kind of complicated, especially for those looking for a simpler and cheaper way to get electricity. That’s why Logan’s study is significant. His microbial fuel cells work in regular old sewage water skimmed from a tank in a treatment plant. The bacteria digest the organic compounds in the sewage. A chemical reaction in this digestive process generates electrons that reach the bacterial cell’s outer membrane. These electrons are siphoned off into the fuel cell, which uses the electrons to generate electricity. To date, only lab-scale microbial fuel cells have been developed in some of the developed countries that are able to power small devices.

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(e)Bio-diesel from sewage:

A thermochemical process can convert lipids from sewage sludge into biodiesel, according to a new study (Environ. Sci. Technol., DOI: 10.1021/es3019435). The low cost and high yield of the sludge process may make it economically feasible as a source of biofuel, the researchers say. Today, biofuel producers use vegetable oils or animal fats to derive biodiesel, a mixture of fatty acid methyl esters. Biodiesel is compatible with existing diesel engines, burns with less pollution than petroleum-derived diesel does, and comes from renewable resources. But the high cost of biodiesel production limits its widespread use. Much of its cost stems from the price of raw materials to make biodiesel, such as refined soybean or rapeseed oil. Kwon and his colleagues found a cheaper feedstock for biodiesel production: sewage sludge, the semisolid material left over from wastewater treatment. This sludge is a rich source of lipids, the starting material for biodiesel. Most of sludge’s lipids come from bacteria living in it.

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(f)Ethanol from sewage:

The Q microbe, a lollipop-shaped organism that naturally breaks down and converts plant matter into ethanol, is now being used to make biofuel from sewage. For the past year, Qteros has been feeding the mix to its ethanol-producing organism, the Q microbe, a bacterium that naturally eats plant material and ferments cellulose into ethanol using its own enzymes. Researchers found that the Q microbe produced 120 to 135 gallons of ethanol per ton of waste mix, compared with 100 gallons of ethanol per ton of conventional feedstocks like corn stover.

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(g)Algae to turn Sewage into Fuel:

Many experts see algae as the biofuel source of the future for several reasons. Algae’s biofuel yield could range from 1,000-4,000 gallons per acre each year, compared to just hundreds of gallons per acre annually from oil palm, sunflower and soybeans, according to a U.S. Department of Energy (DOE) report. The DOE added that algae alone could theoretically take care of transportation fuel demands for the entire United States. The OMEGA system consists of algae grown in flexible plastic bags floating offshore, where cities typically dump their wastewater. Oil-producing freshwater algae would naturally clean the wastewater by feeding on nutrients in the sewage. The cleansed freshwater could then release into the ocean through forward-osmosis membranes in the sides of the plastic bags.

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The figure below shows how bio-fuel is generated from sewage:

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(h)Energy from sewage heat:

About 350 billion kilowatt hours of energy are flushed down drains every year — in the form of warm wastewater, according to the U.S. Department of Energy. But King County, where Israel works, hopes to be among the first in the nation to try to harness that wasted heat and use it in buildings. People flush a lot of hot water, a lot of energy down the drain and researchers are trying to figure out how to capture that and use it in buildings. Israel sees warm sewage water as energy. The average temperature of the water rushing through hundreds of miles of sewage and wastewater pipes in the county is a pretty constant 65 degrees. King County is looking for partners in the private sector who want to harness that heat and use it in buildings.

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(i)Using a system developed by FuelCell Energy, methane gas produced by sewage in the treatment facility is put through a fuel cell and reformed into hydrogen. The electricity produced by the fuel cell is used to power the treatment plant, while leftover hydrogen is sent to a hydrogen fueling station, managed by Air Products, that will be able to fuel between 25 and 50 fuel cell electric cars per day.

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Smart sanitation:

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Sustainable sanitation:

The problem of conventional sewerage systems is the mixing of the food and water cycles. Central sewerage systems not only consume high amounts of freshwater but also dilute nutrients (phosphorus, nitrogen) and organic substances to such an extent that only a small part can be reclaimed for agricultural use. The nutrients are washed away with the purified wastewater and are emitted to rivers and the sea where they are extremely harmful (eutrophication). In turns, more nutrients have to be produced for agriculture, causing depletion of fossil resources and high energy demand. The purpose of sustainable sanitation systems is the closing of the water and nutrients cycles, taking into account that the main task of sanitation is to assure highest hygienic standards in a cost- effective, environmental sustainable way, saving both water and energy and keeping soils fertile. This can be achieved by separating different qualities of waste from human settlements: Blackwater (toilet wastewater), greywater (washing, cleaning), stormwater runoff, biodegradable and non- biodegradable waste. Sustainable sanitation reduces the freshwater consumption considerably and produces fertilizer for agriculture instead of waste. Maximum recycling of nutrients is the basis of sustainable food production and sanitation systems.

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The figure below shows non-sustainable sanitation system.

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Classification of Domestic Waste and Wastewater for Sanitation

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-Kitchen waste and blackwater (group 1) contain nearly all of the nitrogen and phosphorus nutrients. In blackwater, the majority of nutrients are concentrated in urine thus making separate treatment feasible.
-Greywater (group 2) contains few nutrients as long as phosphorous free detergents are used. It can easily be treated to a reusable quality as it had no contact with toilet wastewater. Biofilm systems like trickling filters, rotating disk or sand filters (technical or as constructed wetland) can recycle nutrients released by of biomass.
-Stormwater (group 3) infiltration has become increasingly popular in many countries in recent years. The advantages – the recharging of groundwater, maintenance of the local water cycle, smaller sewerage system and cost reduction – are obvious.
-If collected separately non-biodegradable solid waste (group 4) can be reduced and easily recycled.

Sanitation systems, based on this classification and on source control can be designed in many variations to meet local demand and technologies. Their principles are easy to understand and their performance meets highest standards of hygiene and economy.

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The figure below shows sustainable sanitation system:

Figure above illustrates a possible scenario for closing the nutrients cycles and simultaneously preserving fresh water from pollution. This scenario can be achieved with the application of ecological sanitation based on ecological principal. It allows closing and separating the cycles of water and nutrients, thus avoidance of hygienic problems due to the separation of feces from the water cycle. The sustainable sanitation system include:
-Reclamation of nutrients (phosphorus and nitrogen) for agricultural use and hence saving of resources and energy (for the production of artificial fertilizer)
-Considerable savings of freshwater through the use of water saving toilet systems (vacuum, separating or dry toilets)
-Energy production (biogas) instead of energy consumption (for carbon degradation in sewage plants)
-Savings of construction, operation and maintenance costs compared to the conventional central sewerage systems
-Sophisticated modular system, which can be adapted perfectly to local social, economical and environmental conditions
-Easier operation and maintenance compared to centralized technology; local job creation

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Ecological sanitation (ecosan): it is a type of sustainable sanitation discussed above.

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Disposal approach to sanitation:

The disposal approach to sanitation, in which human excreta are wasted, opens up the ecosystem to linear flows as seen in the figure below.  

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Chemical fertilizers and pesticides are used on crops, causing further pollution. The practice of feeding hormones and antibiotics to animals leads to large quantities of manure, hormones and pharmaceuticals polluting water supplies. Ultimately, opening up the ecosystem to linear flows leads to:

• Loss of soil fertility (reducing food production);

• Destruction of marine life (declining fish populations, reducing a major source of protein for human consumption);

• Loss of biodiversity on land and in water;

• Global warming and ozone depletion, when nutrients form gases that escape into the atmosphere.

All of these problems place people at risk of a multitude of health problems, and increase the risk of becoming food insecure, not just for the poor and vulnerable, but also for the more well-to-do. 

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Ecological sanitation offers an alternative to conventional disposable sanitation, and it attempts to solve some of society’s most pressing problems: infectious disease, environmental degradation and pollution, and the need to recover and recycle nutrients for plant growth. In doing so, ecological sanitation helps to restore soil fertility, conserve freshwater and protect marine environments –which are sources of water, food and medicinal products for people. Ecological sanitation is different from conventional approaches in the way people think about and act upon human excreta. First, those promoting and using ecological sanitation take an ecosystem approach to the problem of human excreta. Urine and faeces are considered valuable resources, with distinct qualities, that are needed to restore soil fertility and increase food production. Thus, sanitation systems should be designed to mimic ecosystems in that the “waste” of humans is a resource for microorganisms that help produce plants and food. Second, ecological sanitation is an approach that destroys pathogens near where people excrete them. This makes reuse of excreta safer and easier than treatment of wastewater that often fails to capture the nutrients it transports to downstream communities. Third, ecological sanitation does not use water, or very little water, and is therefore a viable alternative in water scarce areas. Fourth, ecological sanitation can provide hygienic and convenient services at a much lower cost than conventional sanitation, and therefore, should be considered both in developing and developed countries.

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Ecological sanitation is sometimes presented as a radical alternative to conventional sanitation systems. Ecological sanitation is based on composting or vermicomposting toilets where an extra separation of urine and feces at the source for sanitization and recycling has been done. It thus eliminates the creation of blackwater and eliminates fecal pathogens. If ecological sanitation is practiced municipal wastewater consists only of greywater, which can be recycled for gardening. However, in most cases greywater continues to be discharged to sewers.

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Ecological sanitation can be viewed as a three-step process dealing with human excreta: (1) Containment, (2) Sanitisation, (3) Recycling. The objective is to protect human health and the environment while limiting the use of water in sanitation systems for hand (and anal) washing only and recycling nutrients to help reduce the need for artificial fertilizers in agriculture. Ecological sanitation (ecosan) is based on the nutrient cycle. In the modern centralized waste water solutions, human feces are considered more of a resource than waste. Excrement is treated in situ and the formed end product can easily be used as fertilizer in agriculture. Ecological sanitation techniques take into consideration the surrounding environment by decreasing contamination as well as keeping it clean and safe.

Following characters can be found in Ecological Sanitation principles and implementation:

• Aim is to decrease contamination of the environment caused by human excretion and prevention of diseases deriving from excreta

• Human feces are considered as a resource, not as waste

• Recovery of nutrients from excreta and utilization of the end product as fertilizer and soil enrichment material

• In situ or close by treatment of the excreta

• Avoiding utilization of water in the transportation of excreta

• Use of decentralized waste treatment methods and services (e.g. collecting, recycling and preserving)

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The typical characteristics of the streams of domestic wastewater, shown in table below clearly show that yellow and brown water contains most of the nutrients discharged to sewers in the conventional sanitation. This means that they are generally wasted instead of being used as fertilizers (except the small portion of nutrients being contained in sludge which is used sometimes as fertilizer after sanitization).

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Yellow water as fertilizer:

Urine is usually considered sterile, free of pathogens. Only a few disease organisms are passed through urine. In this regard its reuse has an advantage over feces. Separate collection of yellow water is possible with urine-diversion (UD) toilet, a suitable technology to separate the urine and feces at source. Usually, the toilet has two bowls, the front one for urine and the rear one for feces. Each bowl has its own outlet from where the respective flow is piped out. The flush for the urine bowl needs little water (0.2 lit per flush) or no water at all whereas flushing water for feces bowl can be adjusted to the required amount (about 4 to 6 lit per flush) or no water in case of Urine-diverting dehydration/composting toilets. In urine – diverting toilets, however, cross-contamination from feces to urine may occur. In the Swedish experience of mostly middle and upper middle class family homes, fecal cross-contamination is infrequent. If urine is stored in tanks, as found in Sweden, then the nitrogen in urine converts to ammonia, and the pH rises to about 9. This elevated pH helps to kill off possible contamination. Among the flows of wastewater, yellow water contains most of the nutrients. One person produces on average 3.92 kg of nitrogen, 0.38 kg of phosphorous and 0.97 kg of potassium per year. These nutrients, such as nitrogen in the form of urea, phosphorus as super phosphate and potassium as an ion, are in forms which are ideal for uptake by plants. Beneficially, urine contains very low levels of heavy metals and pathogens. These heavy metal concentrations are much lower than those of most chemical fertilizer. In Sweden, for instance, urine contains less than 3.2 mg cadmium per kg of phosphorus compared to 26 mg Cd/kg of phosphorus in commercial fertilizer and 55 mg Cd/kg of phosphorous in sludge. 

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Urine contains few disease-producing organisms, while feces may contain many. Storing undiluted urine for one month will render urine safe for use in agriculture. Undiluted urine provides a harsher environment for micro-organisms, increases the die-off rate of pathogens and prevents the breeding of mosquitoes. At the homestead level, where crops are intended for the household’s own consumption, urine can be used directly. It is recommended, however, that there should be 1 month between urine application and harvesting. When urine is collected from many urban households and transported for re-use in agriculture, the recommended storage time at temperatures of 4–20 °C varies between 1 and 6 months depending on the type of crop to be fertilized.

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Brown water as soil conditioner:

Soil degradation caused by human activities is alarming worldwide. The main causes of soil degradation are: erosion, fertility decline, overcropping and use of synthetic fertilizer. Since synthetic fertilizer does not contain organic matter which prevents soil erosion, reuse of brown water as soil conditioner plays important role to reduce the soil degradation as brown water contains most of the organic solids in domestic wastewater.

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Sanitation in hospitals:

Health-care facilities need proper sanitation and must practice good hygiene to control infection. Worldwide, between 5% and 30% of patients develop one or more avoidable infections during stays in health-care facilities.

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In health-care facilities, safe disposal of human waste of patients, staff and visitors is an essential environmental health measure. This intervention can contribute to the reduction of the transmission of health-care associated infections which affect 5% to 30% of patients.

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Sanitation and disasters:

Each year more than 200 million people are affected by droughts, floods, tropical storms, earthquakes, forest fires, and other hazards. Sanitation is an essential component in emergency response and rehabilitation efforts to stem the spread of diseases, rebuild basic services in communities and help people return to normal daily activities.

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Sanitation in public places:

Where a large number of people are using one area, such as a bus station or school, especially when they are eating food from the same source, there is a greater risk of the spread of diseases such as cholera, hepatitis A, typhoid and other diarrhoea1 diseases. There are several basic rules for sanitation in public places:

• There should be sufficient toilet facilities for the maximum number of people using the area during the day. This normally means one toilet compartment for every 25 users. The toilet facilities should be arranged in separate blocks for men and women. The men’s toilet block should have urinals and toilet compartments; the women’s block, toilet compartments only. The total number of urinals plus compartments in the men’s block should equal the total number of compartments in the women’s block.
• Toilet facilities should not be connected directly to kitchens. This is in order to reduce the number of flies entering the kitchen and to reduce odors reaching the kitchen. It is important that people using the toilet facilities cannot pass directly through the kitchen.
• There must be a hand-washing basin with clean water and soap close to the toilet facilities. There should be separate, similar facilities near to kitchens or where food is handled.
• There must be a clean and reliable water supply for hand-washing, personal hygiene and flushing of toilet facilities. The water supply should meet quality standards and be regularly tested to ensure that any contamination is discovered quickly and that appropriate remedial action is taken.
• Refuse must be disposed of properly and not allowed to build up, as it will attract flies and vermin.

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Train sanitation:

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The important dimension of the sanitation is the Indian Railways which is really the largest open toilet in the world. 11 million passengers travel every day. The problem of environmental degradation and corrosion of tracks due to night soil has been engaging the attention of railways for a long time. Apart from the issue of hygiene, this has several serious safety implications arising out of corrosion of rails and related hardware as well as poor maintenance of under carriage equipment due to inhuman unhygienic conditions. Indian Railways will set up three bacteria generation plants as part of its effort to equip more coaches with bio-toilets in trains for eco-friendly waste disposal. Railways have set a target of installing bio-toilets designed by DRDO in 2,500 coaches in the current fiscal year. In bio-toilets, anaerobic bacteria convert human waste into water and gases (methane and carbon dioxide). The success of this technology depends on proper usage by the passengers since throwing all kinds of waste material into the Bio-toilets, which does have adequate safeguards against malfunction, cannot handle non bio-degradable waste like plastic bottles, “gutkha” pouches, etc. in large quantities. So passengers’ education & awareness is a must for success of bio-toilets in Indian railways.    

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Ship sanitation:

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The largest democracy India and sanitation:

There is compelling evidence to suggest that sanitation and hygiene services are almost nil in India. Sixty-six per cent of the women in Delhi slums are verbally abused, 46 per cent are stalked and more than 30 per cent are physically assaulted while accessing toilets. Over 50 million people in urban India defecate in the open every day. Eighty per cent of India’s surface water pollution is on account of sewage alone. As many as 4,861 of 5,161 cities across the country do not have even a partial sewerage network. These findings are from a new survey conducted across the country by Dasra, a strategic philanthropy foundation. With services related to sanitation and hygiene for the poor almost missing, the foundation says organizations involved in philanthropic work should now focus on these areas.

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According to a World Bank study, lack of toilets and other proper sanitation facilities costs India nearly $54 billion a year through hygiene-related illnesses, lost productivity and other factors stemming from poor sanitation.  Poor sanitation and the illnesses it causes cost the Indian economy Rs 12 billion a year, according to Indian health ministry. According to WHO report, the deaths due to diarrheal disease in India is about 1.2 million per year. In India, more money is being spent on fighter jets than on toilets. The total amount of money required for installing 100,000 bio-toilets is equal to what is spent for one Rafale fighter jet India is buying from France.

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India’s sanitation is execrable. By one estimate, only 13% of the sewage its 1.2 billion people produce is treated. Sixty per cent of the “global total” who do not have access to toilets live in India, and hence are forced to defecate in the open. In actual numbers, sixty per cent translates to 626 million. This makes India the number one country in the world where open defecation is practiced. Indonesia with 63 million is a far second! A report by the non-government organization, Centre for Science and Environment (CSE), Delhi, based on surveys of wastewater profiles of 71 Indian cities, highlights lack of infrastructure and neglect of sewage with less than 30 percent of the country’s officially recorded sewage being treated in proper facilities. The CSE survey, released earlier this year, shows that 70-80 percent of India’s wastewater was ending up in its rivers and lakes. “We are drowning in our excreta,” Sunita Narain, director of CSE, told IPS. According to the World Health Organization, more than 87 percent of people in India’s cities (compared with 33 percent in rural areas) now have access to a toilet, but leaking and incomplete sewage systems contaminate rivers and lakes. At 949 million in 2010 worldwide, vast majority of people practicing open defecation live in rural areas. Though the number of rural people practicing open defecation has reduced by 234 million in 2010 than in 1990, “those that continue to do so tend to be concentrated in a few countries, including India,” notes the 2012 update report of UNICEF and the World Health Organization (WHO). For instance, of the 240,000 gram panchayats in the country, only a mere 24,000 are completely free of open defecation.  More than half of the 2.5 billion people without improved sanitation live in India or China. The high figure prevails even as four out of 10 people who have gained access to improved sanitation since 1990 live in these two countries. The toll on human health is grim. Every day, 1,000 children younger than 5 years old die in India from diarrhea, hepatitis- causing pathogens and other sanitation-related diseases, according to the United Nations Children’s Fund.

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More mobile phones than toilets in India !!!

A UN study in 2010 observed more people in India having access to a mobile phone than to a toilet. India’s mobile subscribers totaled around 894 million at the last count, enough to serve more than half of the country’s 1.2 billion people. But just 366 million people (30.5%) had access to proper sanitation. Half the country’s population may not have a toilet at home but they are not without a mobile phone. Bringing to light this feature of the population, Census 2011 data on houses, household amenities and assets released said 49.8 per cent Indian households defecate in open but in sharp contrast 63.2 per cent households own a telephone connection, 53.2 per cent of them a mobile. The data reflected the controversial remarks of Ex-Union sanitation Minister Jairam Ramesh who said that women demand mobile phones but they are not demanding toilets. According to the Census figures released by Union Home Secretary, only 46.9 per cent of India’s 246.6 million households have a latrine facility while 49.8 per cent go for open defecation and 3.2 per cent people use public toilets. 

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In India, water pollution comes from three main sources: domestic sewage, industrial effluents and run-off from agriculture. The most significant environmental problem and threat to public health in both rural and urban India is inadequate access to clean drinking water and sanitation facilities. Almost all the surface water sources are contaminated to some extent by organic pollutants & bacterial contamination and make them unfit for human consumption unless disinfected. The diseases commonly caused by contaminated water are typhoid, cholera, gastroenteritis, bacterial dysentery, hepatitis, polio, amoebic dysentery etc. It is estimated that 22,900 million liters per day (MLD) of domestic wastewater is generated from urban centers against 13,500 MLD industrial wastewater. The treatment capacity available for domestic wastewater is only for 5,900 MLD, against 8,000 MLD of industrial wastewater. Thus, there is a big gap in treatment of domestic wastewater. It’s a myth that industrial effluent is a bigger contributor towards pollution of water resources. The fact is that domestic waste is a bigger problem. For example, nearly 218 out of the 219 municipal bodies in the state of Maharashtra release untreated sewage in water bodies.

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Status of Sewage Treatment in the Ganga Basin:

The Ganga basin spreads over an area of 8,61,404 Km² covering the States of Uttaranchal, Uttar Pradesh, Haryana, Delhi, Madhya Pradesh, Rajasthan, Bihar, Jharkhand & West Bengal. There are 223 cities/towns (Municipalities/ Corporations) generating significant amount of sewage in the Ganga basin. These cities/towns generate about 8,250 MLD (million liter per day) of wastewater, out of which about 2,460 MLD is directly discharged into the Ganga river, about 4,570 MLD is discharged into its tributaries or sub- tributaries and about 1220 MLD is disposed on land or on low-lying areas. Out of 8,250 MLD wastewater generated in the Ganga basin, the treatment facilities available for only 3,500 MLD of wastewater. To know why 1,000 Indian children die of diarrheal sickness every day, take a wary stroll along the Ganges in Varanasi. As it enters the city, Hinduism’s sacred river contains 60,000 fecal coliform bacteria per 100 milliliters, 120 times more than is considered safe for bathing. Four miles downstream, with inputs from 24 gushing sewers and 60,000 pilgrim-bathers, the concentration is 3,000 times over the safety limit. In places, the Ganges becomes black and septic. Corpses, of semi-cremated adults or enshrouded babies, drift slowly by.

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A study done by the Central Pollution Control Board showed that around 70 percent of the pollution in the Yamuna is human excrement. In large metropolises such as New Delhi, 3.6 billion tons of sewage alone are dumped daily – but only half of that amount is effectively treated and the rest flows down the Yamuna, resulting in widespread waterborne illnesses such as diarrhea from drinking and bathing in the affected water. The problem lies mostly with poorly utilized waste water treatment plants and an outdated system of drainage. With over 300 plants, most are poorly located and treated waste is often combined with untreated sewage and deposited back into rivers. Half of the drains in India are considered inadequate.

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As per the latest WHO report, India still accounts for 626 million (59 per cent) of the 1.1 billion people in the world who practice open defecation. This is twice the number of the next 18 countries combined. Additionally, India recorded nearly 22 per cent of the total deaths of children under five and majority of those cases were due to diarrhea or sanitation-related diseases. Although government has been able to ramp up the toilet coverage, little efforts have gone behind changing the citizens’ behavior. A glimpse at the TSC portal gives information about the toilets constructed till date but fails to capture data on continued practice of open defecation despite the availability of toilets. The Government must understand that creating mere toilet structures will not lead to change. Instead, focus should also be on changing the behavior of the people. A massive educational campaign to explain the correlation between poor sanitation and its ill effect on health should be launched. Secondly, ignorance towards bathroom etiquette in public toilets by some could turn off others and divert them to open defecation. The school curriculum should touch upon these topics and at least train the future drivers of this country. The Government of India was able to wipe out polio by riding on the back of a massive campaign and participation at block, district, state and national levels. Similar awareness campaign in participation with local communities, NGOs and state governments can be launched to get the message across. Also, make the sanitation business attractive for the private sector by allowing them to generate income by providing sanitation services. Loan finance for sanitation support has shown some promising results for the micro finance companies. However, its effect at a large scale is yet to be hypothesized. Finally, allow innovation to reach the masses. E-toilets used in Kerala by the name “Delight” have shown excellent results because of its unique features and automatic functioning.

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Open defecation:

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Recent UNICEF report says 54 % people  defecate in the open in India as against just 7% each in Brazil and Bangladesh. Only 6% rural children below five years in India used toilets and about 50% of all Indians regularly wash their hands with soap after contact with excreta. The majority of those practicing open defecation (949 million) live in rural areas. Open defecation in rural areas persists in every region of the developing world, even among those who have otherwise reached high levels of improved sanitation use.

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Open defecation refers to any behavior that involves excretion of human waste in the open field. Elimination of waste is one of the basic needs of human beings. The term ‘’Defecation’’ is defined as a bowel movement in which feces are evacuated through the rectum and anus. Open air the defecation is passage of stool in an open environment. Villagers defecate in the open, on dry river beds, railway tracks, fields and even directly in water. This causes water and soil pollution. Moreover, it contaminates and affects ground water as well as surface water, resulting in diseases such as cholera, typhoid, polio, meningitis, hepatitis and dysentery. 

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Human excreta always contain large numbers of germs, some of which may cause diarrhea. When people become infected with diseases such as cholera, typhoid and hepatitis A & E, their excreta will contain large amounts of the germs which cause the disease. When people defecate in the open, flies will feed on the excreta and can carry small amounts of the excreta away on their bodies and feet. When these flies touch food, the excreta and the germs in the excreta are passed onto the food, which may later be eaten by another person. Some germs can grow on food and in a few hours their numbers can increase very quickly. Where there are germs there is always a risk of disease. During the rainy season, excreta may be washed away by rain-water and can run into wells and streams. The germs in the excreta will then contaminate the water which may be used for drinking. Many common diseases that can give diarrhea can spread from one person to another when people defecate in the open air. Disposing of excreta safely, isolating excreta from flies and other insects, and preventing fecal contamination of water supplies would greatly reduce the spread of diseases. In many cultures it is believed that children’s feces are harmless and do not cause disease. This is not true. A child’s feces contain as many germs as an adult’s, and it is very important to collect and dispose of children’s feces quickly and safely.

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The lack of sanitation facilities in India has several causes. The most obvious is the lack of money needed to install sewer or septic systems. The shortage of funds is compounded by a rapidly growing population and a lack of awareness about the dangers of open-air defecation. The societal acceptance of this practice has been integrated into India’s social structure through its caste system. Scavengers, men and women who remove human waste, are entrenched as untouchables – the lowest of India’s social classes. Although scavenging has been outlawed in India, the practice is still widespread in urban areas, and, to a lesser extent, in the countryside. Approximately four million scavengers remain in India today.

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A study was conducted by Amarjeeth Singh and Arvinder Kaur Arora with an objective of assessing knowledge, attitude and practices of villagers regarding sanitary latrines in North India .This survey was conducted by female social workers in Kheri and Raipur Rani villages of Amabala. The study reveals that fresh open air and opportunity for morning walk were told as main advantages of open air defecation by 51 to 64% responds in 2 villages.  Significantly more respondents (30-52%) in Kheri told that they were not accustomed to indoor defecation as compared to 15(25%) in Raipur Rani. More respondents in Kheri that is 13-22% told the reason as availability of plenty of space outside of compared to 2-3% in Raipur Rani. Few respondents (7-9%) told about fear of pit latrines, getting field early. Many respondents felt that it would smell and be filthy if indoor defecation is practiced (29%). Problem of water storage was also told by few respondents (5-9%).

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An observational study was conducted by Tina A Hassan to assess the attitude of the people towards open air defecation. The respondents were questioned regarding open air defecation and its hazards. The responses suggested that people have no shame or fear of the consequences of open air defecation in the society and also the people are forced to defecate in open places due to emergencies like running stomach and health problems like diarrhea. The study also stressed the need for health education programs on hazards of open air defecation.

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Open defecation is commonly practiced custom in rural areas and slum areas of cities where sanitation facilities are ignored. Human Excreta in open environment causes health hazards like hookworm infestation, diarrhea, cholera, dysentery and other health problems. Many inhabitants in the slum do not access to proper toilets facilities in their homes and there are accustomed with open air defecation. Many of these public latrines are in very deplorable states and can be best described as “death traps”. These facilities are nothing more than a haven of maggot’s and houseflies. One can hardly bear the stench that emanates from these pit latrines.  After visit to some of these public pits latrines one need to take a good shower in order to free himself from the strong scent that stains both body and dress. These public latrines do not have hand washing facilities, which is the major cause of the rampant diarrhea and cholera outbreak in the metropolis, especially among children. Inhabitants who live close to these facilities suffer from the hazards that it pose and can hardly breathe in fresh air. When it rains, these indiscriminate human wastes are washed into our water bodies which are main source of drinking water for both human and live stock. This inevitably leads to the outbreak of cholera, diarrhea and other perilous diseases which have claimed many precious lives in the past and is still claiming the lives of many poor children and adults who cannot afford portable accommodation and hygienic toilet facilities .This will go a long way to retard economic development since lot of money is wasted by the government in treating diarrhea and cholera yearly. 

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Human excreta are a source of infection .It is an important cause of environmental pollution. The health hazards of improper excreta disposal are 1) soil pollution 2) water pollution 3) contamination of foods   4) propagation of flies. The resulting diseases are typhoid, paratyphoid fever, dysenteries, diarrheas, cholera, hook worm disease, ascariasis, viral hepatitis and similar other intestinal infections and parasitic infestations. These diseases are not only burden in the community in terms of sickness, mortality and a low expectation of life, but basic deterrent to social and economic progress. Proper disposal of human excreta is a fundamental environmental health services without which there cannot be any improvement in the state of community health.

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Deadly job of a scavenger (untouchable) in India:

There are 2.1 million toilets in India which rely on manual scavengers to empty them. There are thousands of sanitation workers in India who work hard to keep the cities, towns and villages clean. Most of them come from the community of lower caste known as untouchables. Health experts working in the field said that most of these workers would die before their retirement because of the poor health and safety conditions they work in. Their life expectancy is thought to be around 10 years less than the national average. Dr Ashish Mittal, an occupational health consultant, did a survey of the working conditions of sewage workers. He found that most of the workers suffer from chronic diseases, respiratory problems, skin disorders and allergies. He said they are constantly troubled by headaches and eye infections. When scavenger enters into a manhole of sewage pipes to clear a blockage, he may be exposed to toxic fumes with a mixture of methane and hydrogen sulphide, both considered potentially fatal by the health experts.

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With the commencement of the International Water and Sanitation Decade, the Government of India drew up new policies with the support of the United Nations (UN) and other external agencies. As part of this, the Central Rural Sanitation Program(CRSP) was launched in 1986. Following this, various diversified programs were introduced by the Ministry of Rural Development in 1990s, to suit the local need. Finding sluggish progress in the implementation of CRSP, reforms were introduced and program was renamed as Total Sanitation Campaign (TSC), which includes latrines plus services such as, provision of latrines, disposal of liquid and solid waste and domestic as well as environmental hygiene. Government of India had set a target of universal household sanitation coverage by 2012 when it launched its flagship Total Sanitation Campaign (TSC) in 1991.The scheme is being implemented in 606 districts of 30 States and Union Territories. This approach is ‘demand driven’, the beneficiaries have to share a marginal capital cost and be part of its implementation (GOI, 2002). This new concept has been developed based on baseline survey findings ‘On Knowledge, Attitudes and Practices in Rural Water Supply and Sanitation’ by Indian Institute of Mass Communications (1996-97). According to survey results, 55 per cent of those with private latrines were self-motivated and 51 per cent of the respondents were willing to spend up to Rs1000/- to acquire sanitary toilets (GOI; 2002). But, a recent review report says that 22 states will not be able to meet the target. In fact, only five States – Tripura, Haryana, Himachal Pradesh, Kerala and Mizoram – will be able to meet the 2012 target, says the report ‘A Decade of the Total Sanitation Campaign (TSC)’, brought out by the World Bank’s Water and Sanitation Program and the Ministry of Rural Development. The government is working on increasing the allocation for toilet construction from the current 3,500 Rupees (US$ 65) to 9,900 Rupees (US$ 183) per toilet, of which 5,400 Rupees (US$ 100) would come from the new Total Sanitation Campaign and the remaining 4,500 Rupees (US$ 83) from the Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS). Ex-Minister Jairam Ramesh had requested 360 billion Rupees (US$ 6.6 billion) for rural sanitation in India’s 12th five-year plan, which starts in 2012-2013. The Indian government’s ambition is to achieve total rural sanitation coverage by 2017. According to data available up to September 2011, 115.3 million rural households have access to toilets, leaving 40.8 million households without sanitation facilities. A parliamentary standing committee on rural development is skeptical whether all rural areas will be open defecation free by 2017. The Centre has also decided not to allow houses under rural housing scheme ‘Indira Awas Yojana’ (IAY) without toilets. It implies that allocation of funds for construction of an IAY house would compulsorily be accompanied by construction of a toilet.

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Towards Rural Sanitation Sulabh (NGO) sets new trends:

Sulabh has taken up a program of rural sanitation in 350 districts of India, where volunteers have been trained in the technology, methodology implementation and follow-up work. Masons have been trained. Pans and waterseals have been made available at various centers so that people of the area can have the facility to construct toilets to suit their income and choice. The cost ranges from US$ 10 to US$ 600. A campaign has been launched to make the people in rural areas aware of the fact that they should not go barefoot for open defecation; should put soil on human excreta after defecation so that flies do not sit on excreta and, in turn, on the food, which is the main cause of diarrhea, dysentery, cholera etc. Literature has been published in 18 languages of the country and social workers distribute them to the beneficiaries. The mass communication workers perform dramas, monoacts, and hold painting competitions in schools, to promote awareness. A full-fledged two-hour feature film has been made to make the people aware of the importance of sanitation. The film will also provide entertainment. In rural areas, most children suffer from worm infestation viz. hookworm, roundworm, tapeworm etc. Most schools in rural areas do not have toilets for children. Consequently, boys and girls face a lot of difficulty. This increases drop-out rates particularly of girl students. Apart from the Government programs, Sulabh has initiated a program to get toilets constructed in schools by taking donations from private people as well as NRIs. Within 10 years, every school in India will be provided with Sulabh toilet facilities in this way. Teachers and students are also taught how to keep the toilets clean. Children are given responsibility by turns to maintain the toilets and teachers also inspect and supervise by turns. The number of toilets is as per the strength of the students.

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India will achieve sanitation goals only by 2054:

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The graph below shows reasons for dysfunctional toilets in India:

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The world has pledged to reduce by half the proportion of people without sustainable access to safe drinking water and basic sanitation by 2015 from 1990 figures. Though India has already achieved impressive results on water supply, with 85 per cent of its people having access to safe drinking water, 51 per cent or 626 million people in the country defecate in the open, accounting for 60 per cent of the world’s total open defecations. While it has made progress on water supply, a high percentage continues to defecate in the open. Going by the present pace of progress, India will achieve the millennium development goals (MDGs) on sanitation only by 2054. India has seen an improvement in the sanitation figures from 1990, when 75 per cent people defecated in the open as against 51 per cent in 2010. But this improvement is seen only in the urban settings, where 28 per cent had no access to toilets in 1990 as against 14 per cent in 2010. In the rural areas, 91 per cent had no access to sanitation in 1990 as against 67 per cent in 2010, indicating that it was the rich who had more access to sanitation.

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Missing toilets due to corruption in India:

In India, where the government is reeling with corruption scandals, the innocuous toilet made a brief swirl when many reportedly went missing. According to an April report in an Indian daily, the Telegraph, the federal government says it delivered about 87.1 million toilets to households across villages over the last decade. But the census shows that only about 51.6 million had toilets in 2011. That’s a case of 35 million missing toilets.

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Slums:

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Slum dwellers should be a priority for water and sanitation investment:

Investment in water and sanitation in the rapidly urbanizing cities of the developing world is key if we are to avoid uncontrollable poverty and ever worsening slums. We are seeing an explosion of poverty in the cities of the developing world. If we continue this way, the gross inequality between rich and poor could be almost impossible to reverse. But there is an opportunity to turn things around if we act now. Funding into urban water and sanitation infrastructure has a powerful impact on economic productivity, as well as driving down poverty. Water and sanitation have proved time and time again to be a critical factor in health and economic development. We only need to look at the development of the ‘Asian Tigers’ to see that long-term, reliable funding into urban water and sanitation infrastructure has a powerful impact on economic productivity, as well as driving down poverty. Cities in the developing world are expected to double in population size every 15 years, and two thirds of the world’s population will live in urban areas by 2030. The vast majority of these people will end up living in unplanned slums, with little or no access to fundamental services such as water, sanitation and electricity. Water and sanitation are fundamental to health and development, especially in densely packed urban areas, where outbreaks of diseases such as cholera can quickly turn into epidemics. At present diarrheal diseases caused by a lack of safe water and sanitation is the biggest killer of children under five in Africa, claiming more children’s lives than HIV/AIDS, malaria and measles combined. In South Asia it is the second biggest killer. Current investment into water and sanitation in the slums is inadequate and is failing to reach the poorest and most vulnerable people. Only 6% of World Bank sanitation-related commitments from 2000-2005 went to slums, with the vast majority going to more established urban areas. WaterAid’s new manifesto shows that to tackle urban poverty, the very poorest people need to be at the heart of water and sanitation investments and planning. They should also be encouraged to participate in the design and implementation of these plans.

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Safer sanitation in slums and emergency settings with ‘Peepoo’ bags:

In most of the urban slums of countries like Kenya and Bangladesh there is a huge lack of sanitation facilities like toilets, and this leads to problems of the safe disposal of feces and hence major public health problems. Public toilets are a long term solution but not always feasible in the short term and may be closed or too dangerous at night time. Recently, a novel idea has been tried – the use of a self-sanitizing, single-use, biodegradable ‘toilet bag’. Researchers have conducted two field tests in Kenya & Bangladesh and the results are reported here. The toilet bag, known as ‘Peepoo’ from the Swedish company Peepoople, is made from biodegradable plastic and each bag contains a small amount of urea granules. Users defecate into the bag and then close it tightly with a knot. Hand washing with soap is recommended after using the bag. The used bags are placed in buckets for daily collection by a collection service and then disposed by being composted or buried directly in the soil for use as a complete fertilizer with high nitrogen value. The bags work like “microtreatment plant” that kills pathogens in feces within two to four weeks via the toxicity of ammonia produced from the urea granules. Normally the used bags do not smell for 24 hours unless many of them are accumulated in a big pile and left in the sun for too long.

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Objectives of sanitary system:

The main objective of a sanitation system is to protect and promote human health by providing a clean environment and breaking the cycle of disease. In order to be sustainable, a sanitation system has to be not only economically viable, socially acceptable and technically & institutionally appropriate, but it should also protect the environment and the natural resources. When improving an existing and/or designing a new sanitation system, sustainability criteria related to the following aspects should be considered:

(1) Health: includes the risk of exposure to pathogens and hazardous substances that could affect public health at all points of the sanitation system from the toilet via the collection and treatment system to the point of reuse or disposal. The topic also covers aspects such as hygiene, nutrition and improvement of livelihood achieved by the application of a certain sanitation system, as well as downstream effects.

(2) Environment and natural resources: involves the required energy, water and other natural resources for construction, operation and maintenance of the system, as well as the potential emissions to the environment resulting from use. It also includes the degree of recycling and reuse practiced and the effects of these, for example reusing the wastewater; returning nutrients and organic material to agriculture, and the protecting of other non-renewable resources, for example through the production of renewable energy (e.g. biogas or fuel wood).

(3) Technology and operation: incorporates the functionality and the ease with which the system can be constructed, operated and monitored using the available human resources (e.g. the local community, technical team of the local utility etc.). It also concerns the suitability to achieve an efficient substance flow management from a technical point of view. Furthermore, it evaluates the robustness of the system, its vulnerability towards disasters, and the flexibility and adaptability of its technical elements to the existing infrastructure, to demographic and socio-economic developments and climate change.

(4) Financial and economic issues: relate to the capacity of households and communities to pay for sanitation, including the construction, maintenance and depreciation of the system. Besides the evaluation of investment, operation and maintenance costs, the topic also takes into account the economic benefits that can be obtained in “productive” sanitation systems, including benefits from the production of the recyclables (soil conditioner, fertilizer, energy and reclaimed water), employment creation, increased productivity through improved health and the reduction of environmental and public health costs.

(5) Socio-cultural and institutional aspects: the criteria in this category evaluate the socio-cultural acceptance and appropriateness of the system, convenience, system perceptions, gender issues and impacts on human dignity, the contribution to subsistence economies and food security, and legal and institutional aspects.

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Most sanitation systems have been designed with these aspects in mind, but in practice they are failing far too often because some of the criteria are not met. In fact, there is probably no system which is absolutely sustainable.

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The figure below shows that sanitation is a multi-disciplinary approach.

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Reasons for Slow Progress:

For many years, national governments, aid agencies, and charities have subsidized sewerage and toilet construction as a means to improve access. This approach has resulted in slow progress for two main reasons. First, the programs have tended to benefit the few relatively well-off people who can understand the system and capture the subsidies, rather than reach the more numerous poor people. Second, such programs have built toilets that remain unused because they are technically or culturally inappropriate or because the householders have not been taught the benefits of them. In India, for example, many toilets are used as firewood stores or goat sheds, and a recent study showed that about 50% of toilets built by a large government program are not used for their intended purpose. Even when appropriate toilets are promoted, their technical specifications frequently make them prohibitively expensive. Thus, a recent study in Cambodia found that while there is a strong demand for toilets, that demand remains mostly unrealized because people favor an unaffordable $150 design rather than simpler but still hygienic designs costing $5–$10. Another reason for slow progress is that disposal of children’s feces—the group most vulnerable to feco-oral disease transmission—is neglected and under-researched. A recent literature review that analyzed a wide range of disposal practices for children’s feces and the health gains that can result from them noted that this whole topic is significantly neglected. Finally, sanitation is not an inherently attractive or photogenic subject. Before 2008, the International Year of Sanitation, sanitation specialists had failed to persuade politicians, the media, and other influential people of the importance of the subject. During 2008, however, there were many political events related to sanitation—notably regional sanitation conferences across the developing world—that resulted in Regional Sanitation Declarations, which have moved sanitation up the political agenda.  

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Problems & constraints in Sanitation:

Political will has been sorely lacking when it comes to placing sanitation high on the international development agenda. This has pushed sanitation into the shadows of water supply projects. The lack of national policies is a major constraint to success in sanitation. Other constraints to success in sanitation are population growth and increasingly high population densities in urban and periurban areas of developing countries. Furthermore, most of the people who lack improved sanitation live on less than $2 per day, which makes high-cost, high-technology sanitation solutions inappropriate. Other problems which are responsible for this dismal situation are: lack of priority given to the sector, lack of financial resources, lack of sustainability of water supply and sanitation services, poor hygiene behaviors, and inadequate sanitation in public places including hospitals, health centers and schools. Providing access to sufficient quantities of safe water, the provision of facilities for a sanitary disposal of excreta, and introducing sound hygiene behaviors are of prime importance to reduce the burden of disease caused by these risk factors. Finally, although macroeconomic analysis shows that sanitation generates economic benefit, the benefit does not necessarily accrue to the person who invests in the improved sanitation. So the economics at the household level remain a constraint to success in sanitation—many people are simply unable or unwilling to invest, given all the other competing demands on their money.

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Better promotion of sanitation:

The United Nations Millennium Development Goals (MDGs) include a target to reduce by half the proportion of people without access to basic sanitation by 2015. Research from the Overseas Development Institute suggests that sanitation and hygiene promotion needs to be better ‘mainstreamed’ in development, if the MDG on sanitation is to be met. At present, promotion of sanitation and hygiene is mainly carried out through water institutions. The research argues that there are, in fact, many institutions that should carry out activities to develop better sanitation and hygiene in developing countries. For example, educational institutions can teach on hygiene, and health institutions can dedicate resources to preventative works (to avoid, for example, outbreaks of cholera). There are also civil society organizations providing the necessary infrastructure where national governments cannot do that on their own. The Institute of Development Studies (IDS) coordinated research program on Community-led Total Sanitation (CLTS) is a radically different approach to rural sanitation in developing countries and has shown promising successes where traditional rural sanitation program have failed (vide infra).

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Successful Approaches to Sanitation:

Recently, there has been a shift away from centrally planned provision of infrastructure towards demand-led approaches that create and serve people’s motivation to improve their own sanitation. Although sound technological judgment about appropriate solutions remains essential, appropriate programming approaches are now more important and contribute most to the success of sanitation work.

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1. Sanitation Marketing:

Sanitation marketing uses a range of interventions to raise householders’ demand for improved sanitation. The approach involves understanding householders’ motivations and constraints to sanitation adoption and use. These are then used to develop both demand- and supply-side interventions to ensure that appropriate sanitation products and services are available to match the demand. This strategy can be undertaken in a number of ways that are not feasible for the existing producers, mainly artisan builders and small component manufacturing workshops. Those interventions would aim principally at overcoming the constraints to the expression of effective demand for sanitation and could include the following:

• advertising and other forms of promotion
• facilitation of building regulation approval
• brokerage to put potential purchasers in touch with providers
• quality assurance and guarantee schemes
• training in low-cost construction techniques and in marketing
• centralized production of essential components
• provision of pit emptying and desludging services.

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2. Community-Led Total Sanitation (CLTS):

CLTS is an unsubsidized approach to rural sanitation that facilitates communities to recognize the problem of open defecation and take collective action to clean up and become ‘open defecation free’. It uses community-led methods such as participatory mapping and analyzing pathways between feces and mouth as a means of galvanizing communities into action. Community-led total sanitation (CLTS) is a communications-based approach that aims to achieve “open defecation–free” status for whole communities rather than helping individual households to acquire toilets. CLTS was developed in Bangladesh and uses external facilitators and community volunteers to raise (“ignite”) community awareness that open defecation contaminates the environment and the water & food ingested by householders. It encourages a cooperative, participatory approach towards ending open defecation and creating a clean, healthy, and hygienic environment from which everyone benefits. CLTS has spread from South Asia to Africa and South America in the past ten years and appears to be highly successful in certain communities. However, one recent study estimates that only 39% of ignited villages achieve open defecation–free status. The success or failure of CLTS may relate to its cultural suitability and to the degree to which it addresses supply-side constraints to sanitation adoption .

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Community-led Total Sanitation (CLTS) is an innovative methodology for mobilizing communities to completely eliminate open defecation (OD). Communities are facilitated to conduct their own appraisal and analysis of open defecation (OD) and take their own action to become ODF (open defecation free). At the heart of CLTS lies the recognition that merely providing toilets does not guarantee their use, nor result in improved sanitation and hygiene. Earlier approaches to sanitation prescribed high initial standards and offered subsidies as an incentive. But this often led to uneven adoption, problems with long-term sustainability and only partial use. It also created a culture of dependence on subsidies. Open defecation and the cycle of fecal–oral contamination continued to spread disease. In contrast, CLTS focuses on the behavioral change needed to ensure real and sustainable improvements – investing in community mobilization instead of hardware, and shifting the focus from toilet construction for individual households to the creation of “open defecation-free” villages. By raising awareness that as long as even a minority continues to defecate in the open, everyone is at risk of disease, CLTS triggers the community’s desire for change, propels them into action and encourages innovation, mutual support and appropriate local solutions, thus leading to greater ownership and sustainability.

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3. Community Health Clubs:

Community Health Clubs aim to change sanitation and hygiene attitudes and behavior through communal activities. The approach has proved effective and cost-effective in the Makoni and Tsholotsho Districts of Zimbabwe where villagers were invited to weekly sessions where one health topic was debated and then action plans formulated. In one year in Makoni District, for example, 1,244 health sessions were held by 14 trainers, costing an average of US$0.21 per beneficiary and involving 11,450 club members. Club members’ hygiene in both districts was significantly different (p<0.0001) from that of a control group, and the study’s authors concluded that if a strong community structure is developed and the norms of a community are altered, sanitation and hygiene behavior are likely to improve.

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4. Sanitation as a Business:

Traditionally, sanitation has been regarded as a centrally provided service with little role for the creativity or energy of business. However, the increased demand created by sanitation marketing, CLTS, and Community Health Clubs can be met by the development of a vibrant local private sector for producing, marketing, and maintaining low-cost toilets. For example, in Lesotho the national government organized and planned workshops for people to review toilet designs and building methods in its “local latrine builders” program. The local private sector can also be encouraged to become involved in pit-emptying, sale of safely composted human excreta as fertilizer, generation of methane from biogas toilets, and the operation of public toilets.

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5. Approaches Emphasizing Low Cost:

Many sanitation advocates now place the affordability of the toilets at the centre of the planning process. A common strategy is to encourage people to start with the simplest type of improved pit latrine and then to progress over time towards higher-specification and higher-cost toilets—the “sanitation ladder.”  The critical and most cost-effective step on this ladder, for both health and social reasons, is the first step from open defecation to fixed-location defecation; the subsequent steps up the ladder may yield smaller incremental benefits. 

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Approaches Specific to Urban Sanitation:

Most successful demand-led approaches have been developed in rural contexts. Urban sanitation is much more complex, mainly because of higher population densities, less-coherent community structures, and the absence of opportunities for open defecation. Urban sanitation must extend beyond the household acquisition of a toilet to a systems-based approach that covers the removal, transport, and safe treatment or disposal of excreta. For on-site urban sanitation systems, pit-emptying services are common in middle-income countries where householders can afford the cost, but less common in poorer countries. In densely populated low-income urban areas, community-managed sanitation blocks, used only by community members who pay a monthly fee for operation and maintenance, are an option. Public sanitation blocks that can be used by anyone, normally for a small fee per use, can be an acceptable alternative provided that they are well operated and maintained and have 24-hour access. For off-site or centralized systems, simplified or “condominial” sewerage systems, in which sewers are placed inside housing blocks and then discharged into conventional sewers if there are any nearby or led to a simple local wastewater treatment plant, can provide the same level of service as conventional sewerage but at around one-third to one-half of the cost.

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How Mobile Games can help improve Sanitation:

More than 2.5 billion people, many of them in Africa and South Asia, face grave sanitation challenges. In many of these countries, people are more likely to own a cell phone than a toilet. Therefore there is an obvious opportunity to use mobile technology to promote the use of sanitation and good hygiene in order to make a substantial impact. Hattery Labs has begun to explore how games might improve sanitation practices. The typical game-players in sub-Saharan Africa and South Asia are young urban males who own smartphones, but many of the communities that face the greatest sanitation challenges have less advanced technology. However, Javascript games built for Nokia S40 phones (among the most popular handsets in the developing world) provide an opportunity to send a compelling message on good behavior practices in sanitation and hygiene. 

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mWASH: mobile phone applications for the water, sanitation, and hygiene sector:

There is a potential of mobile phones to improve governance in the development sector – a field termed “mobile phone for development” or M4D – with a special emphasis on the water, sanitation, and hygiene or WASH sector. In particular, it focuses on “information interventions”: mobile phone usage for real-time, broad-based data collection and dissemination among and by multiple agents of change. Such information interventions are used not only to resolve immediate, short-term issues, but to facilitate the flow of information necessary for long term planning, monitoring, policy-making, and governance.

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World toilet organization:

The World Toilet Organization (WTO) is a global non-profit organization committed to improving toilet and sanitation conditions worldwide. WTO focuses on toilets instead of water, which receives more attention and resources under the common subject of sanitation. Founded in 2001 with 15 members, it now has 151 member organizations in 53 countries working towards eliminating the toilet taboo and delivering sustainable sanitation. WTO is also the organizer of the World Toilet Summits and World Toilet Expo and Forum. In 2001, the World Toilet Organization declared its founding day, 19 November, as World Toilet Day. Since then, 19 November has been observed globally by its member organizations.

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Concluding remarks and ongoing toilet research: 

In order to prevent spread of diseases from human excreta, following golden norms to be followed:

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A lack of sanitation, including the collection, treatment and disposal or re-use of excreta and wastewater can have a severe negative impact on people’s health and dignity and on the environment. Just a small number of people practicing open defecation can threaten the quality of water resources, which will in turn infringe the right to water and the right to health. The major burden of a lack of sanitation is borne by the very young. The safe disposal of excreta is one of the strongest determinants of child survival. Evidence suggests that in addition to causing child deaths by diarrhea, poor sanitation may also contribute to child deaths resulting from other health conditions, including malnutrition and acute respiratory infections. Further to this, millions of children are left physically stunted, mentally disabled and severely malnourished by excreta-related diseases and intestinal worm infections. Access to sanitation and good hygiene practices give protection from opportunistic diseases infecting people who are already sick. Women in particular suffer from infections caused by lack of access to hygienic facilities and lack of water for washing during menstruation. Sanitation-associated parasitic diseases have been shown to impede learning and child development.

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Non-health sanitation benefits:

While the main goal of agencies’ sanitation programming is to improve health, householders rarely adopt and use toilets for health-related reasons. Instead, the main motivations for sanitation adoption and use include the desire for privacy and to avoid embarrassment, wanting to be modern, the desire for convenience and to avoid the discomforts or dangers of the bush (e.g., snakes, pests, rain), and wanting social acceptance or status. Furthermore, for women, the provision of household sanitation reduces the risk of rape and/or attack experienced when going to public latrines or the bush to defecate, and for girls, the provision of school sanitation facilities means that they are less likely to miss school by staying at home during menstruation. Lack of adequate sanitation in schools, including the separation of girls and boys facilities, is a critical barrier to school attendance of girls, particularly after puberty. A failure to address sanitation in schools, including facilities for menstrual hygiene, perpetuates gender inequality widening the gulf between the opportunities afforded to girls and boys through education. The economic benefits of improved sanitation include lower health system costs, fewer days lost at work or at school through illness or through caring for an ill relative, and convenience time savings (time not spent queuing at shared sanitation facilities or walking for open defecation). Of course, 1 dollar investment in sanitation would lead to 9 dollar return. Sustainable sanitation & ecological sanitation suggests that waste water is not waste but a resource; resource to generate energy, compost, fertilizer, reclaimed water for non-potable use and even drinking water.

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The major global challenges faced by the sanitation sector are the many people without sanitation, the health effects of poor sanitation, water shortage and pollution, food insecurity, urban growth and the inadequacy of current sanitation options. Sewage discharges from centralized, water-borne collection systems are a major component of water pollution all over the world. Only about 300 million people in the world today have end-of-pipe treatment of sewage to a secondary level before the sewage is discharged into open bodies of water. Pollutants also leak into groundwater from sewers, septic tanks, pit toilets and cesspools. In today’s urban societies the flow of plant nutrients is linear: nutrients are taken up from the soil by the crop, transported to the market, eaten, excreted and discharged. In a sustainable society the production of food must be based on returning the plant nutrients to the soil. The use of chemical fertilizers is not sustainable, since their production relies on non-renewable resources.

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Over the next 15 years the world’s population is expected to reach 8 billion, with 5 billion living in urban areas. More than half of the 8 billion will face water shortages and 40% of the urban population might be living in slums. Already today billions of people, in urban as well as in rural areas, have no proper sanitation. With this in mind, an international group of planners, architects, engineers, ecologists, biologists, agronomists and social scientists have developed an approach to sanitation that saves water, does not pollute and returns the nutrients in human excreta to the soil. This approach is called ‘ecological sanitation’, or ‘eco-san’ for short.   

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When you think about it, the flush toilet is actually a pretty outdated sanitation solution. It was certainly an important breakthrough when it was created in 1775 by a Scottish mathematician and watchmaker named Alexander Cummings. Over the decades, it led to a sanitary revolution that helped keep deadly diseases like cholera at bay, saving hundreds of millions of lives. But the fact that four of every 10 people still don’t have access to flush toilets proves that—even today—it is a solution too expensive for much of the world. The flush toilets people use in the wealthy world are irrelevant, impractical and impossible for 40 percent of the global population, because they often don’t have access to water, and sewers, electricity, and sewage treatment systems. And in an era where water is becoming increasingly precious, flush toilets that require 10 times more water than our daily drinking water requirement are no longer a smart or sustainable solution. Bill Gates writes in his blog. A big part of the challenge is technological. In addition to building new toilets that are affordable and sustainable, we have to develop solutions to empty these new latrines and treat the human waste. We also have to work closely with governments, businesses, and communities to stimulate demand for better sanitation, encourage investment, and create supportive public policies that will allow these innovative solutions to succeed. Inventing new toilets is one of the most important things we can do to reduce child deaths and disease and improve people’s lives. It is also something that can help wealthier countries conserve fresh water for other important purposes besides flushing. World’s sanitation problems cannot be solved by building water latrines and sewerage systems. The building and maintenance costs are too high and furthermore this infrastructure cannot ensure clean environment. In a case of inadequate wastewater treatment, even more severe health and environmental risks than the use of bushes for defecation purposes can be created. Therefore it is necessary to develop cheap, technically simple and safe sanitation alternatives, which can be adjusted to meet the needs of different cultures and environ­ments. The bio-toilet lavatories, which are said to be eco-friendly, use bio-digester technology to compost waste. They also produce odorless and colorless biogas for use in stoves for cooking. The system’s biological process means that it requires no maintenance, sewage tank or emptying and the bacteria within it are claimed to eliminate the pathogens that cause water-borne diseases. These green, cost effective, flush and forget technology on mass scale can revolutionize sanitation in rural and semi-urban areas of poor nations. It is also necessary to increase sanitation and hygiene education for understanding of the connections to human and environment health.   

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Flush toilets waste tons of potable drinking water each year, fail to recapture reusable resources like the potential energy in solid waste and are simply impractical in so many places. The world, in fact, flushes up to 20 percent of its drinking water down various drains. That’s a lot of water going to waste. Modern flush toilets, which use 10 times the average daily drinking water requirement, are hopelessly unsuited to countries with poor access to water or sewerage networks. So the world’s finest scientists and inventors have been applying their technological know-how to the unglamorous but important issue, and coming up with some ingenious solutions. In 2011, the Bill & Melinda Gates Foundation launched the Reinvent the Toilet Challenge, awarding $3.2m in grants to promising entrants. Gates’ foundation is spending about $80 million a year on water, sanitation and hygiene issues, areas where it thinks it can make a marked difference in people’s lives. At the Reinvent the Toilet fair, hosted at its Seattle campus, designs included a lavatory that used microwave energy to turn feces into electricity, another turned excrement into charcoal, while a third used urine for flushing. Other projects on display were not so high-tech, including one from the London School of Hygiene and Tropical Medicine that sends black soldier fly larvae inside latrines and even home toilets to process waste, resulting in high quality, environmentally friendly animal feed at a cost of a penny a day. The Ecuador-based “Fundacion In Terris” group, talks about the “Earth Auger Toliet,” which is operated by a mechanical pedal and chain system was on display at the “Reinventing the Toilet” Fair. Most of the prototypes on display in the open courtyard of the foundation’s Seattle headquarters turn solid waste into energy. This is both a practical and pragmatic solution to the solid waste puzzle. Many recycle waste into other usable substances such as animal feed, water for irrigation, or even just energy and water to run their own systems. Some use chemistry and engineering to completely transform the waste. Cheap, waterless toilets that can turn human waste into clean water and fertilizer within 24 hours are being designed and built by eight engineering teams around the world.  

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The picture below shows one of the kind of newly invented toilets:

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No-mix toilet:

 ’No-Mix’ toilets, like the one shown in the figure above, collect urine and feces separately. They have gained wide support by consumers in Europe as a way to reduce pollution and conserve water. No-Mix toilet collects urine separately instead of mixing it together with feces as in conventional toilets. Urine contains 80 percent of the nitrogen and 50 percent of the phosphorus arriving at wastewater treatment plants. Separating it in advance could have a number of advantages. This includes a reduction in the amount of nitrogen and phosphorus nutrients that trigger algae blooms and in pharmaceutical residues, which can enter waterways and pose a threat to fish. Separating urine also allows its use as an agricultural fertilizer, the scientists note. However, scientists have not widely explored public attitudes about using this promising technology until now.

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No-Mix Vacuum Toilet:

The No-Mix Vacuum Toilet has two chambers that separate the liquid and solid wastes. Using vacuum suction technology, such as those used in aircraft lavatories, flushing liquids would now take only 0.2 liters of water while flushing solids require just one liter. The existing conventional water closet uses about 4 to 6 liters of water per flush. The No-Mix Vacuum Toilet will divert the liquid waste to a processing facility where components used for fertilizers such as nitrogen, phosphorus and potassium can be recovered. At the same time, the solid waste will be sent to a bioreactor where it will be digested to release bio-gas which contains methane. Methane is odorless and can be used to replace natural gas used in stoves for cooking. Methane can also be converted to electricity if used to fuel power plants or fuel cells

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Diversion toilet:

The diversion-toilet — a modern squatting toilet that works neither with water nor sewer connections, and can be installed in an informal settlement as well as in a weekend home in the country. In the foot underneath the toilet bowl the containers for urine and feces are mounted with the seal against odors. Behind the water-wall exists opportunities for hand-washing, anal-cleansing and cleaning the bowl. On top is the transparency indicator for the level of the cleansed water. The special features of the ‘Diversion‘ model are not only separation of urine and a clever seal against odors but, more important, the use of very little water, about 1 to 1.5 liter per individual use. This is absolutely decisive for cleaning the toilet, hand washing and the anal hygiene with water practiced by many communities. The new separation toilet needs no connection to a water supply. Every time a user operates a foot pedal, water flows into the small water reservoir and already used water is pumped upwards behind the toilet. Cleansed by means of a membrane filter, the used water is also guaranteed free of germs, thanks to electrolysis by a solar powered electrode.  

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The moral of the story:

1. About 2.6 billion People in the world lack adequate sanitation—the safe disposal of human excreta. Lack of sanitation contributes to about 10% of the global disease burden, causing mainly diarrheal diseases. 2.2 million deaths occur due to diarrhea worldwide yearly with 90 % under 5 years of age. Every 20 seconds, a child dies as a result of poor sanitation. That’s 1.5 million preventable deaths each year. Studies have shown that improved sanitation reduces diarrhea diseases by 37 %. The simple act of washing hands with soap and water after going to the toilet is estimated to reduce diarrheal diseases by 47 %.

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2.  Sanitation is more important than clean drinking water for prevention of disease even though combination of both is ideal. The health impact of supplying clean water alone is limited. However, carefully designed programs which combine water quality with good sanitation and hygiene education have the potential to make enormous differences in the quality of life.

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3. Most of the time, sanitation sits in the shadow of her more glamorous sister, water. The governments, the media and the populations are obsessed with provision of drinking water neglecting sanitation which is far more important that mere provision of potable water to masses.

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4. Even where only a few people lack sanitation (open defecation), the whole community feels the health impact.

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5. In developing nations, approximately 90 percent of sewage systems are being emptied into rivers, lakes, and nearby streams that communities use for drinking water.

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6. Without improved sanitation, people suffer from ill health, lost income, inconvenience and indignity. 

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7. Adolescent girls drop out of school when they menstruate, because without toilets at school, it is impossible to change sanitary napkins. By simply providing a separate latrine facility for girls, school enrollment rates for girls have been shown to improve by over 15 percent; and 1% increase in girls’ education gives 0.37 % increase in economic growth.  

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8. Women forced to look for a place to hide at the time of defecating often fell victim to sexual harassment and sexual assault. Sanitation is fundamental to gender equity as it protects women’s dignity.

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9. There is no single development policy intervention that brings greater public health returns than investment in basic sanitation and hygiene practices.

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10. According to the WHO study, improved sanitation delivers up to $9 in social and economic benefits for every $1 invested because it increases productivity, increase earnings from tourism, reduces healthcare costs, and prevents illness, disability, and early death. The implication is that investment in safe sanitation will generate a return which is of similar order to a country’s spending on health services. Investments in sanitation protect investments made in other sectors, such as education, tourism and health, and bring measurable economic returns.

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11. Most developing nations spend less than 0.5 % of GDP on sanitation and poor sanitation is costing these developing countries between 1 to 7% of GDP. 

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12. Poor sanitation and water supplies are the engines that drive cycles of disease, poverty and powerlessness in developing nations and therefore action to improve sanitation is an important step to enable the poorest people to escape poverty. There is a vicious cycle of lack of sanitation and poverty in the sense that poor sanitation leads to poverty and poverty leads to poor sanitation. Improved Sanitation reduces poverty and fosters economic growth.

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13. Anal cleansing using bidet (jet of water) is environment friendly (saves trees and energy) and hygienic method of cleaning anal area after defecation, better than use of toilet (tissue) papers. Anal cleansing using hand (with water) is the worst method of cleaning anal area after defecation. In my view, anal cleansing using wet napkins is the best method but it is expensive as every day new napkin will have to be used and also the issue of hygienic disposal of used napkins. Nonetheless, whatever method you choose, you must clean your hands with soap & water after the process of anal cleansing.  

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14. Best way to promote sanitation is to educate children in schools by providing them with improved sanitation for their use, make them learn benefits of sanitation and they will take home to their families concepts and practices on sanitation and hygiene.

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15.The biggest drawback of central sewerage systems of big cities is that it not only consume high amounts of freshwater but also dilute nutrients (phosphorus, nitrogen) and organic substances to such an extent that only a small part can be reclaimed for agricultural use. The nutrients are washed away with the treated wastewater and are emitted to rivers and the sea where they are extremely harmful (eutrophication). 

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16.Energy generated from biogas methane derived from anaerobic digestion of sewage is renewable, unlimited, environment friendly (reduce global warming), cost-effective, reducing carbon footprint of sewage plant, removes Biochemical Oxygen Demand (BOD) from sewage, reduces sludge volume, conserves nutrients (especially nitrogen compounds), produce safe fertilizers (reduces pathogens), saves non-renewable energy source (fossil fuel) and most importantly, can be applied in practice even in underdeveloped nations with little investment.

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17. Ecological sustainable sanitation considers human excreta more of a resource than waste where nutrients (phosphorus and nitrogen) are reclaimed for agricultural use saving resources & energy for the production of artificial fertilizer, reclaim water for non-potable & potable use, and also generate energy from biogas.

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18.Poor sanitation facilities in developing countries has little to do with lack of resources but more to do with ignorance & misconceptions, poor hygiene behaviors, lack of will and lack of priorities as sanitation is a taboo subject.

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19. World’s sanitation problems cannot be solved by building water latrines and sewerage systems but by developing cheap, technically simple and safe sanitation alternatives, which can be adjusted to meet the needs of different cultures and environ­ments. Instead of wasteful flush toilets replacing filthy pit latrines, innovation in toilet technology could provide billions of people with access to sanitation, while also creating economic opportunities and conserving water.    

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20. The state of sanitation remains a powerful indicator of the state of human development in any community. When 626 million Indians practice open defecation daily, it speaks poorly of human development in India.

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21. The future of the country largely depends on sanitation which is the most important thing, next to population control. The largest democracy India has neither sanitation nor population control and so its future is bleak.

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Dr. Rajiv Desai. MD.

December 1, 2012  

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Postscript:

In my website, year 2012 started with internet censorship and ended with sanitation, rather ironic, as on one hand world is utilizing technological advances and on the other hand, 1.1 billion people practice open defecation daily worldwide.