Abstract
In recent years, shared facilities have contributed substantially to increased access to sanitation in urban areas. While shared sanitation is often the only viable option in densely-populated, low-income urban areas, it is currently considered a “limited" solution by the international community. In this paper, we analyze the conditions under which shared sanitation could be considered of adequate quality and propose a set of indicators associated with sanitation quality to be included in national household surveys. We conducted a survey with 3600 households and 2026 observational spot-checks of shared and individual household toilets in Kisumu (Kenya), Kumasi (Ghana), and Dhaka (Bangladesh). We develop a composite sanitation quality outcome measure based on observational data. Using regression analysis, we identify self-reported indicators that correlate with the spot-checked composite measure and are, therefore, robust with regard to reporting bias. Results show that (pour-) flush toilets are a highly informative indicator for sanitation quality compared to other toilet technologies. In contrast to previous arguments and depending on the context, sharing a toilet has a comparatively lower correlation with sanitation quality. Toilets still show good quality if shared among only 2–3 households. Toilet location and lighting, as well as the presence of a lockable door, are equally strong indicators for sanitation quality and could serve as alternative indicators. The findings suggest that the sanitation service levels defined by the WHO and UNICEF might be reconsidered to better capture the quality of sanitation facilities in low-income urban settlements.
Highlights
The Sustainable Development Goal (SDG) 6.2 calls for "adequate and equitable sanitation and hygiene for all" and to "eradicate open defecation" (UN-DESA, 2020)
We developed a Sanitation Quality Indicator (SQI), a composite index measuring the observed cleanliness, safety, and privacy of sanitation facilities, and analyzed its correlation with self-reported indicators of households’ toilets in cities in Kenya, Bangladesh, and Ghana
We first show that self-reported sanitation quality is only weakly correlated with observed sanitation quality
Summary
The Sustainable Development Goal (SDG) 6.2 calls for "adequate and equitable sanitation and hygiene for all" and to "eradicate open defecation" (UN-DESA, 2020). In 2017, more than an estimated two billion people—roughly 25% of the global population—did not have access to "adequate" sanitation services, of whom 627 million people relied on shared toilets instead of a private toilet facility (JMP, 2021). The JMP sanitation service ladder consists of five levels: open defection alongside unimproved, limited, basic, and safely managed sanitation. A toilet is only deemed basic or safely managed if the technology is improved, i.e., designed to hygienically separate excreta from human contact, and is used exclusively by a single household.. A toilet is deemed limited—even if it meets high technological standards—if used by two or more households. Toilets that do not hygienically separate excreta from human contact, i.e., are technologically unimproved, such as pit latrines without a cement slab, are categorized as unimproved, irrespective of the number of users
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