1. IEES Dr. Johannes Heeb Bahnhofstraße 2, CH-6110 Wolhusen, Schweiz Phone: +41-(0)79-3666850 Fax: +41-(0)41-4904070 email: johannes.heeb@seecon.ch Network for the Development of Sustainable Approaches for Large Scale Implementation of Sanitation in Africa NETSSAF Coordination Action Proposal/Contract Number: 037099 A Coordination Action supported by the European Commission under the Sixth Framework Programme within the " GLOBAL CHANGE AND ECOSYSTEMS " Programme Starting Date: 1st June 2006 Face-to-Face Training Course “Capacity Building for Ecological Sanitation” Ecosan and Health

2. This training material has been compiled by seecon international gmbh and Ecosan Services Foundation (ESF), for face-to-face capacity building courses in the field of ecological sanitation. Following the open-source concept for capacity building and non-profit use, copying is allowed provided proper acknowledgement of the source is made. We apologize in advance if references are missing or are incorrect, and welcome feedback if errors are detected. We encourage all feedback on the composition and content of this training material. Please direct it either to johannes.heeb@seecon.eu or ecosanindia@gmail.com.johannes.heeb@seecon.eu ecosanindia@gmail.com seecon international gmbh Dr. Johannes Heeb Bahnhofstrasse 2, 6110 Wolhusen, Switzerland Phone:+41-(0)79-3666850 Email:johannes.heeb@seecon.eu Web:http://www.seecon.ch/ Ecosan Services Foundation (ESF) Mr. Dayanand Panse "Vishwa Chandra", 1002/42 Rajendra Nagar, Pune – 411030, Maharashtra, India Phone:+91-(0)20-64000736 Email:ecosanindia@gmail.com Web:http://www.ecosanservices.org/ Credits

3. Introduction source: (1)

4. Sanitation system boundary conditions A sanitation system encompasses:  the users of the system,  collection,  transport,  treatment and  management of end products of: human excreta greywater solid waste industrial wastewater and storm water  so much more than just a toilet!

5. Direct and Indirect Transmission of Diseases Direct transmission Touching (i.e. shaking hands, hugging etc.) Airborne, short distance (via droplets, coughing, sneezing) Kissing Sexual intercourse Other contact Transfusion (blood) Transplacental Indirect transmission Vehicle-borne (contaminated food, water, towels, farm tools etc.) Vector-borne (insects, animals, worms) Airborne, long distance (dust, droplets) Parenteral (injections with contaminated syringes) Source: (1)

6. Characteristics of Flowstreams fractioncharacteristic 1. faeceshygienically critical consists of organics, nutrients and trace elements improves soil quality and increase its water retention capacity 2. urineless hygienically critical contains the largest proportion of nutrients available to plants may contain hormones or medical residues 3. greywaterof no major hygienic concern volumetrically the largest portion of wastewater contains almost no nutrients (simplified treatment) may contain spent washing powders etc.

7. Health Related Organisms in Faeces From a risk perspective, the exposure to untreated faeces always is considered unsafe. A range of pathogenic organisms are present in faeces, i.e. Bacteria: gastrointestinal illnesses Viruses: more than 120 different types of Viruses may be excreted in faeces. Mostly lead to enteritis. Other viruses include Hepatitis A & E, Parasitic Protozoa: intestinal diseases such as diarrhoea and malaise Helminth infections: Eggs (ova), of especially Ascaris and Taenia are very persistent Hookworm disease: can exaggerate malnutrition Schistosomiasis: parasitic flatworms, commonly called blood flukes. Sources: (4),( 5)

8. Characteristics of Urine Urine is usually sterile and poses a risk only in special cases. The major pathogens found in urine: Leptospirosis (influenza-like symptoms) typhoid, paratyphoid Bilharzia (=Schistosomiasis) However, pathogens in urine rarely sufficiently common to constitute a significant public risk Exception: Schistosoma haematobium (But: low risk due to its lifecycle) Main risk: faecal cross-contamination Faecal cross-contamination Source: (13)

9. Major Places of Exposure in ecosan Systems Area/procedure leading to exposure Technical MeasureBehavioural Measure ToiletWater for hand washing; elevated collection chamber; lined collection chamber  no seepage to groundwater Washing hands; keeping toilet area clean Primary handling – collection and transport Ash, lime or other means of reducing microorganisms at toilet; informed persons collecting and transporting excreta Wearing gloves; washing hands; addition of ash, lime or other means of reducing the microbial content during use TreatmentSuitable choice of location; treatment in closed systems; information signs in place Wearing gloves and protective clothing; washing hands; avoid contact Secondary handling – use, fertilizing Informed farmers reusing excreta; special equipment available Wearing gloves; washing hands; washing the equipment used Fertilized FieldWorking excreta into the ground; information and signs Avoid newly fertilized fields Fertilized CropChoice of suitable cropProper preparation and cooking of food products; cleanliness of kitchen surfaces and utensils source: (32)

10. Environmental Transmission Routes and Barriers source: [3] Transmission routes for enteric pathogens barriers to prevent the transmission of disease/spread of pathogens provision of water for hand washing, elevated or lined collection chamber, using ash, lime, etc., informed persons collecting and transporting excreta, suitable choice of location, treatment in closed systems, information signs in place, informed farmers reusing excreta, special equippment available, working excreta into the ground, choice of suitable crops, washing hands, keeping toilet area clean, wearing cloves and protective clothing while handling excreta, washing the equipment used, avoid newly fertilized fields, proper preparation and cooking of food products, cleanliness of kitchen surface & utensils

11. Effectiveness of Interventions in Reducing Diarrhoea Morbidity Intervention Median reduction Source: (18)

12. Steps Of Hand Washing

13. Conclusion ecological sanitation as part of holistic project management : J. Heeb Construction and use of the toilet Handling of products Treatment, storage and reuse Hand washing Food hygiene Clean drinking water Access to health care  Only applied together can significant and sustainable impacts be achieved sanitation hygienic practices ++ …

14. new WHO guidelines for the safe use of wastewater, excreta and greywater (2006) 4 Volumes: Volume 1: Policy and regulatory aspects Volume 2: Wastewater use in agriculture Volume 3: Wastewater and excreta use in aquaculture Volume 4: Excreta and greywater use in agriculture With these new guidelines WHO … recognizes that the reuse of wastewater, greywater and excreta in agriculture and aquaculture is practiced worldwide on a large scale, however often without sufficient health production measures; recognizes the importance of reuse of wastewater, greywater and excreta for sustainable food production and improved livelihood; recognizes source-separation as a special and valid approach which can contribute to risk reduction and provides guidance on health protection measures for safe reuse.

15. Adapted protection level for wastewater/excreta use in agriculture in new WHO guidelines Disability Adjusted Life Years (DALYs) DALYs are a measure of population health in terms of the burden due to a specific disease or risk factor. DALYs attempt to measure healthy years of life lost because of disability or death from a disease. DALYs account for not only acute health effects but also for delayed and chronic effects. different health outcomes (e.g., cancer vs. diarrhea) can be compared and risk management decisions can be prioritized. adopted protection level for wastewater/excreta use in agriculture in the new WHO guidelines: tolerable additional disease burden = 10 -6 DALYs or 1 µDaly / person / year = only one of a million human life years expectancy will be lost due to the potential additional disease from wastewater/excreta reuse = same protection level as used in the WHO guideline for drinking water

16. Examples of health protection measures crop restriction: a)non-food crops such as cotton, “biodiesel” crops, etc; b)food-crops that are processed before consumption (e.g. wheat); c)food-crops that have to be cooked (e.g. potatoes, rice, etc.). wastewater application techniques: a)flood and furrow irrigation; b)spray and sprinkler irrigation; c)localized irrigation (e.g. bubbler, drip, trickle, ect.); d)cessation of irrigation with wastewater 1 or 2 weeks prior to harvest. pathogen die-off before consumption: food preparation measures: produce washing with water; disinfecting; peeling; cooking. human exposure control: field workers, consumers. wastewater treatment: primary/secondary/tertiary treatment, disinfection (chlorination, UV)

17. Zone of Safety - Pathogen Die-Off in Relation to Time & Temperature zone of safety

18. Pathogen reductions achievable by various health protection measures Health protection measurePathogen reduction (log units) Wastewater treatment1 - 6 Localized (drip) irrigation (low-growing crops)2 Localized (drip) irrigation (high-growing crops)4 Spray drift control (spray irrigation)1 Spray buffer zone (spray irrigation)1 Pathogen die-off0.5 - 2 per day Produce washing with water1 Produce disinfection2 Produce peeling2 Produce cooking6 - 7 (source: WHO)

19. Examples of options for pathogen reduction by different combinations of health protection measures (source: WHO)

20. Different Scales of Urine Reuse Systems Single households: the urine mixture can be used without storage for all type of crops, if crop is intended for the household’s own consumption; a withholding period of one month passes between fertilizing and harvesting; one reason for less stringent guidelines for single households is that the risk for person-to-person transmission will exceed the risk from urine-related environmental transmission! (photo: M. Wafler)

21. Different Scales of Urine Reuse Systems (contd.) Small domestic systems: direct use or use with short storage periods is applicable; in situations where the prevalence of some enteric infections is high, and where technical systems do not safeguard against faecal cross- contamination, an increased time of storage is recommended; (source: M. Wafler)

22. Different Scales of Urine Reuse Systems (contd.) Large scale systems: specific recommendations may need to be adapted, based on local conditions, and accounting for behavioural factors and the chosen technical system; based on the risk assessment calculations for urine, it can be concluded that a withholding time of a few weeks in the fields corresponds to the suggested storage time of one month at 20°C; the only difference when not requiring storage systems would thus be that the persons who apply the urine or who work in the fields are exposed to potentially higher concentrations of pathogens

23. Different Scales of Urine Reuse Systems (contd.) Inactivation of pathogens will also occur on agricultural land after application of the excreta as fertilizer Pathogens may even be inactivated in and on crops that may have become contaminated by fertilizer during the growth phase, or from splashes from the soil during heavy rains. The inactivation is dependent on ambient temperature, moisture and sunshine (that will increase the temperature, decrease the moisture and affect pathogens by UV-light). In the soil, the naturally occurring microorganisms will also compete with the introduced pathogens and enhance their die-off.

24. IEES Dr. Johannes Heeb Bahnhofstraße 2, CH-6110 Wolhusen, Schweiz Phone: +41-(0)79-3666850 Fax: +41-(0)41-4904070 email: johannes.heeb@seecon.ch Network for the Development of Sustainable Approaches for Large Scale Implementation of Sanitation in Africa NETSSAF Coordination Action Proposal/Contract Number: 037099 A Coordination Action supported by the European Commission under the Sixth Framework Programme within the " GLOBAL CHANGE AND ECOSYSTEMS " Programme Starting Date: 1st June 2006 Face-to-Face Training Course “Capacity Building for Ecological Sanitation” Ecosan and Health