1. Rural Sanitation Risks, Status & Vision
South Asia Regional Learning Event
Mark Ellery | 10th November, 2016

2. Activity 1: Identify the Health Risks
Rural Sanitation (by Country)

3. Fecal Rural Ingestion Risks
What are the greatest fecal ingestion risks for children <5 in rural areas?
Resize the size of the pictures according to the size of the risk!

4. Correlation of Open Defecation & Nutrition
Eradicating Open Defecation has significant health consequences
Bangladesh DHS
Pakistan DHS
Nepal DHS
Sri Lanka DHS
Source: ICF International, The DHS Program STATcompiler. Funded by USAID.

5. Lots of unknowns …. >2 SD below mean Chronic Acute Children <2
Normal
Weight & height
Wasted
Low weight for height
Underweight
Low weight for age
Stunted
Low height for age
Children <2
Implement sanitation & hygiene interventions with 99% coverage1
Reduce diarrhea by 30%
Reduce undernutrition by 2.4%
64.6%
Other factors by
Implement nutrition interventions
with 99% coverage2
Reduce undernutrition by %
Normal height for age
100%
Retarded mental & physical development
>2 SD below mean
Chronic
Acute
1 Humphrey J H, Child under-nutrition, tropical enteropathy, toilets, and handwashing; Lancet (2009)
2 Bhutta ZA, Ahmed T, Black RE; Interventions for maternal and child undernutrition and survival. Lancet (2008)

6. Individual Growth Charts
Do all children grow on the normal curve?
What about genetics?

7. Child <5 Growth Trends
Average Child Nutrition in Developing Countries
Child <5 Growth Trends
What is happening at 9 months of age?
Why is stunting (chronic) worse than underweight (acute)?
Developing Countries (2005)
Percentage Child Undernutrition in Bangladesh
Bangladesh MICS ( )

8. Fecal Transmission Risks for Children <5
How can we best protect children from fecal ingestion?
Fluids
Poor absorption of nutrients
Fingers
Feces
Food
Food
Flies
Unhealthy villi
Fields/ floors
Infected Intestine
No diarrhea

9. Activity 2: Identify the Bottlenecks
Rural Sanitation (by Country)

10. Where are the Rural Sanitation Bottlenecks?
Change the % safe?
Right click & then click on “edit data”

11. Sanitation Bottleneck Analysis
Rank 1-8 by scale
Sanitation Bottleneck Analysis #
Bottleneck
Describe why this bottleneck is significant or insignificant
Open
Defecation
Other
unimproved
Shared
facilities
Improved
Safe (wrt. soap for hands)
Safe (wrt. menstrual hygiene)
Safe (wrt. fecal effluent)
Safe (wrt. fecal sludge)

12. MoRES in Bangladesh

13. Do sanitation facilities have the provision for the washing of hands?
Handwashing
Do sanitation facilities have the provision for the washing of hands?
Are handwashing facilities proximate to the latrine?
Is there soap or detergent?
Is there water?
Is the soap & water used?
Is there drainage?

14. Menstrual Hygiene
Do sanitation facilities enable the safe management of menstrual hygiene?
Do sanitation facilities enable:
changing (i.e. space for changing pads within the latrine facility);
washing (i.e. water & soap for the cleaning of menstrual rags);
drying facilities (i.e. clothes lines & hooks for the drying of menstrual rags);
storage facilities (i.e. a place for keeping spare menstrual pads);
disposal facilities (i.e. a means for disposing of menstrual pads);

15. Do sanitation facilities contain effluent?
A septic tank without a leach drain doesn’t treat pathogens!
Scum
Sludge
Liquid / Effluent
Anaerobic Digestion
Aerobic Digestion
- Environmental Safety (Chemicals)
- Reduces Nitrogen & Phosphorous
- Public Safety (Pathogens)
- Reduces Fecal Bacteria & Viruses N2 H2
H2S
Leach Drain
Septic Tank

16. Is Faecal Sludge Safely Managed?
Are there health risks in the containment, emptying, transport, treatment & re-use / disposal of faecal sludge?
Dhaka Faecal Flow Diagram

17. ACTIVITY 3: Country Rural Sanitation Vision

18. You can change anything in safe sanitation & anything 2020–2030!
What are the 2020, 2025, 2030 Targets?
You can change anything in safe sanitation & anything 2020–2030!
Right click & then click on “edit data”

19. Describe these Targets
In words below provide some description on the nature of the targets (i.e. phasing etc…….
??????

20. MDG Sanitation Progress JMP Monitoring
Source: WHO and UNICEF (2015) Drinking Water Supply and Sanitation Joint Monitoring Programme (JMP)

21. MDG Sanitation Status JMP 2015 Update
Source: WHO and UNICEF (2015) Drinking Water Supply and Sanitation Joint Monitoring Programme (JMP)