In an ideal world, each household would have their own toilet for privacy, practicality, and a sense of ownership—you’re much more likely to clean and maintain the facility if the toilet is yours. A toilet, latrine, or sanitation facility—these are several words to describe the same thing, namely the safe disposal of human waste, whilst providing privacy, dignity, and easy accessibility to all that need it (including young children or less abled individuals). According to the latest report from the Joint Monitoring Programme managed by WHO and UNICEF, 13% of the world’s population do not have access to a toilet—irrespective of it being a shiny water closet, a pour-flush squat latrine, or a basic dry pit with a bamboo superstructure. In addition, 9% of the global population have access to some sort of toilet, but have to share it with other families, their landlord, or the general public. The reasons for the need to share a toilet are vast and numerous, and include lack of space to build a toilet, lack of money or materials to construct one, or because it is not seen as a priority for the household.
Despite this, toilets are important. In fact, the British Medical Journal voted sanitation to be the most important medical advance since 1850. The reasons for households to build their own toilet can range from improved privacy, dignity and household pride, and convenience, such as was shown in rural Benin. But in areas with limited space and uncertain land tenure (urban slums, for example), building a toilet exclusively for your household is often not feasible. Some slums have large public sanitation blocks, which can be used for a fee such as the Sulabh public toilet complexes in in India. However, these may be unaffordable for large families, may be quite some distance from the home, or may not be open at all times, such as in the middle of the night. Alternative options may include sharing a facility with the landlord or with neighbours, which may increase accessibility, but potential cause complications with responsibility for cleaning and maintenance. Lastly, people may resort to open defecation, or the use of ‘flying toilets’.
So the provision and use of sanitation facilities for all slum residents is complicated—cost, ownership, distance to facility, accessibility, and safety for all users (think about elderly people, young children, or pregnant women) all play a role. A household may not be willing to invest in building or maintaining a toilet, as they don’t know if they may be evicted next week, or perhaps believe it is the responsibility of the landlord to provide the facility. The maintenance of the toilet in the slum may be particularly tricky—toilets with (septic) tanks may have to be emptied manually if the lanes are too narrow for a desludger. Slums often consist of a mixture of people from a range of places, with different customs and cultural and religious beliefs. This, together with the transitory nature of slum-life, makes the formation of ‘sanitation management committees’ or similar units who could collect funds and manage and maintain the sanitation facilities difficult.
The health benefits of sanitation—the safe disposal of human faeces—together with hand washing with soap after using the toilet are undisputed. However, do these health benefits still exist when a toilet facility is shared with many households, with potentially limited cleaning and maintenance of the facility? And what if not everyone in the household uses the toilet (and instead practices open defecation) or does not use it all the time (for example using a ‘flying toilet’ during the night)? The difficulty in measuring a health benefit, together with the complexities of slum life mean there is no easy answer. A recent study in Orissa, India showed that within a selection of slums, households which had their own toilets were wealthier and more educated, and their toilets were cleaner and had fewer flies and faecal matter in or near the cubicle. A follow-up study, which focused on the households sharing sanitation facilities, showed that households using communally-managed facilities (frequently used by large numbers of households) were poorer and less educated, and the facilities were less clean and maintained as compared to households sharing a sanitation facility with only their neighbours or landlord. Thus it seems that the more ‘localised’ form of sharing, with individuals known by the household using the toilet, increases cleanliness, as well as accessibility.
So what does this mean for shared sanitation in slums? Some have argued that shared sanitation facilities are the only solution in slums, due to space and cost limitations. But the discussion continues—some research argues that the focus should be less on the user of the shared facility, and more on the facility itself. Others note that sanitation provision needs to go beyond technology or user-numbers, and include factors of culture, affordability and ownership. Overall, research shows that a simple statement of ‘shared sanitation’ does not account for the diversity of shared sanitation found in different settings—the different ‘forms’ of shared sanitation and the lack of consensus on definitions complicates monitoring for international targets.
With increasing urbanisation, sanitation in slums will become a more pressing issue. Providing adequate, safe and accessible sanitation for all users in slums is a public health priority which requires a multifaceted approach, considering the actual facilities as well as increasing education and empowerment among the potential users. In addition, accountability from landlords and local government is essential. In order for shared sanitation facilities to be a sustainable step on the sanitation ladder, policy makers, programme implementers, and target communities must join forces to ensure the facilities are culturally appropriate, affordable, well-maintained, and user-friendly. Then hopefully, we can ensure that all facilities—whether shared or used by one household—provide the health, comfort, and privacy benefits that a toilet really should.
Featured image: Large pay-per-use sanitation block. Photo by M. Heijnen. Bhubaneshwar, India, 2013.