Sanitation in Urban Slums

During the past week, I have been reading about sanitation in urban slums. The rates of slum formation and urbanisation are almost equal across Sub-Saharan Africa, 4.58% and 4.53%, respectively (UN-Habitat 2009), and thus slums are an increasingly important feature of urban space. I hope to show in this post, how slums provide a useful lens through which to better understand how the urban context creates very particular and complex sanitation challenges. 

I first of all want to think a bit about the problems associated with poor sanitation, and the reasons why this issue is addressed. An overarching focus in the literature is associated with public health concerns. The relationship between poor sanitation and health is widely researched; I will just try to give two examples of how poor sanitation in urban areas is understood to cause increased public health risks. First, poor sanitation is linked to a prevalence of vector borne disease such as malaria, which often is transmitted by mosquitos. In a study by De Silva andMarshall (2012) the prevalence of urban malaria is partly explained by the presence of mosquito breeding areas that are unintentionally created from, for instance, blocked drains. The blocked drains result in an artificial accumulation of stagnant water, a perfect environment for mosquito breeding. A second set of issues related to health are concerned with the contamination of drinking water. Surface water may for instance be contaminated with pathogenic Escherichia coli from human or animal wastes, which are not managed or disposed of in satisfactory way. Pathogenic E. coli is linked to diarrhoea, which in low- and middle-income countries is estimated to be the cause of 15% of all deaths in children below the age of five (Isunju et al.2011).

The growth of slums is linked to rapid urban population growth stemming from natural growth and rural-urban migration. Cities grow faster than infrastructure is provided and informal settlements with very little access to services arise (Katukiza et al. 2012). In the figure below I have tried to summarise some of the factors that are limiting and challenging the provision of improved sanitation in urban slums.

Figure 1: Sanitation challenges in urban slums

The formation of slums is often the result of an illegal occupation of government land, which means that the settlements lack legal recognition. This informal nature means that there is an overhanging risk of eviction and demolition that according to Katukiza etal. (2010) discourages investment in more long-term and permanent infrastructures such as provision of sanitation. The second issue of accessibility relates to the unplanned nature of urban slums. Sanitation facilities in urban slums are very rarely connected to a central sewer system, which means that facilities such as pit latrines, which are the most common in African slums, need to be emptied on occasion. It is however very difficult for cesspool trucks to reach some areas because of the narrow corridors between houses and other structures in the settlement. To keep the pit latrines operational Katukiza et al. (2012) reports that locals might instead empty the facility by making a hole in the storage wall, resulting in uncontrolled disposal of the excreta. A third contributing factor limiting sanitation improvements is the inadequate funding put towards improving sanitation. Isunju et al. (2011) report that out of the total 2003/2004 budget for investments in water and sanitation in Kenya, only 2.6% was directed towards sanitation. This skew reflects priority patterns where water supply is prioritised above sanitation, instead of viewed as part of the same process. The final limiting factor I want to highlight is the tenant system in urban slums. As governments are unable to provide the necessary infrastructure, responsibility is left with individuals and families, however, their agency is complicated because most slum dwellers are tenants. Insunju et al. (2011) find that the perception of tenants being consumers and landlords being providers does not fit many slum contexts. Rather, demand for housing in urban slums is high, which creates favourable market conditions for landlords. Tenants in turn have very little say in what is prioritised and improved and are moreover “less likely to express their demands is this could reduce their chances of finding suitable housing” (Insunju et al. 2011:373).

Having grown up, and lived all my life in Western Europe it is very difficult to grasp what poor sanitation really is, how it impacts everyday life and why it is so difficult to improve. Starting to explore sanitation through urban slums has brought me a tiny step closer and I am really impressed by the complexity of this issue. I am especially humbled by the question of establishing underpinning institutions and structures that enable continued service, maintenance and management. There are so many things I want to try to understand better including issues around the sharing of facilities, gender specific perspectives and the role of NGOs in sanitation provision. Stay tuned and I will try to get through as much as possible. 

Zooming in on East Africa

In my previous post I leaped without further ado into the process of reviewing literature on the topic of urban water and sanitation. I am eager to continue doing that, but after a bit of consideration, I realise the need to focus my exploration of the topic a bit. My first attempt to do this is deciding that the geographical focus of the blog is going to be on East Africa, mainly the countries Uganda, Tanzania and Kenya. By narrowing down the scope I am hoping that my posts will be richer in detail and enable a greater consideration of place-specific contexts. In this post I will attempt to introduce my chosen area by considering a few physical and socio-economic characteristics that distinguish this region. Finally I'll take a look at some statistics of rural and water access in East Africa. This will inevitably be an incomplete introduction, but lets see how we get on, and remember, that the goal is to set the scene for further analysis.

Physical Map of East Africa (image from Encyclopædia Britannica) 

East Africa is characterised by varied physiography, with low coastal plains along the Indian Ocean in Kenya and Tanzania, central inland plateaus, mountain ranges (including both Mount Kenya and Kilimanjaro) and large inland water bodies such as Lake Victoria and Lake Tanganyika. Many areas are characterised by little annual variation in temperatures due to the near equator location, however, the varied physiography across East Africa gives rise to a range of temperatures and a number of local climates, both subtropical and temperate. Rainfall usually occurs in two rainy seasons (from March to May and from October to December) as the inter-tropical convergence zone passes the area (MetOffice, 2015; ILRI, 2010). 

Using the CIA World Factbook I have gathered a few recent metrics on the three countries (see table below). No country can or should be reduced to these simple statistics, but I think they are helpful here to just indicate that the three countries seem to match the trends outlined by Fox (2011), one of the articles I referred to in my previous post. In comparison to the world, these three East African countries have a low per capita GDP (PPP) and are all experiencing population growth, and particularly high levels of urban growth.

Table 1: Country metrics (data from The World Factbook)

	Kenya	Uganda	Tanzania
GDP per capita (PPP) in US dollars	3100	2000	2700
GDP per capita - country rank	187	209	204
Population (in millions)	45.9	37.1	51.0
Population growth rate (percentage)	1.93	3.24	2.79
Urban population (percentage)	25.6	16.1	31.6
Urbanisation (percentage annual rate of change)	4.34	5.43	5.36

Having looked a bit at the bigger picture, I want to refocus attention on the issue of water and sanitation. Through the WHO/UNICEF Joint Monitoring Program I found the latest 2015 statistics of use of drinking water sources and sanitation for each of the three East African countries. For now let’s just look at the data for the use of drinking water sources, which I have displayed in pie charts below.  

The data used is available in the 2015 WHO/UNICEF report; "Progress on Sanitation and Drinkning Water" pp. 56-77

From the charts it is clear that a greater proportion of urban populations across all countries have piped water on their premises, while a greater percentage of rural populations rely on surface or unimproved sources for drinking water. Piped water on premises means that there is a “water connection located inside the user’s dwelling, plot or yard”, unimproved sources refers to “unprotected dug well, unprotected spring, cart with small tank/drum, tanker, truck, bottled water”, while surface water sources include “river, dam, lake, pond, stream, canal, irrigation canals” (definitions are found on page 52 in the report). From looking at the charts, it seems that urban populations use better and safer drinking water sources. I do not want to agree or disagree with that, but instead challenge those numbers a little bit. The statistics report on where populations get their water, but say nothing about the process of getting it. We do not know if the household pipes or public taps are operational all day or if the sources are unreliable. Thinking back to the study by Thompson et al.(2000), the authors found that collection times in East Africa from 1967 to 1997 had increased (the average return time changed from 9.3 minutes to 21.4 minutes). The major reason for this increase was arguably queuing at the source due to functional failures and increasing demand due to population growth. The point I am trying to make is simple; numbers only tell us one part of the story. We have no idea how easy or cumbersome the process of getting that water actually is and how much or how little that process interferes with people’s daily life. 

One final point I want to make is related to sanitation. I want to question how improved the ‘improved sources’ actually are from a sanitation perspective, particularly diarrhoeal disease. The category ‘other improved drinking sources’ is defined as “public taps or standpipes, tube wells or boreholes, protected dug wells, protected springs, rainwater collection” (52). The name ‘improved’ implies that something is getting better and my first thought was that these sources were indeed better because they provide protected water access and higher water quality. That is indeed an improvement (!), but I think SandyCairncross’ (2003) article about water and sanitation misconceptions makes a very interesting point. She asserts that water quality improvements only have a small effect on reducing the incidences of diarrhoeal disease. Instead, by looking at historical improvements in public health, she argues that it is improved domestic hygiene achieved by household water supply and excreta disposal, which significantly reduces the incidents of (and deaths caused by) diarrhoeal disease. In all three countries, the improved water source category is the largest – the question is if these improved sources make significant changes to public health?