Sanitation Services Research Articles

Vulnerability Analysis of Potable Water Supply and Sanitation Services in The Municipality of Rio Branco-Acre Applied to The Sunshine Regulation Model

Resumo estruturado – Objetivo: avaliar o desempenho e a vulnerabilidade dos serviços de água e esgoto no município de Rio Branco, Acre, no período de 2018 a 2019, aplicados ao modelo Sunshine. Referencial teórico: A realidade do saneamento básico no Brasil é marcada por desigualdades regionais e sociais na prestação dos serviços de abastecimento de água potável e sistema de esgoto. A fim de melhorar o acesso aos serviços de Saneamento Básico no Brasil, foi estabelecido o Novo Marco Regulatório, sancionado pela Lei nº 14.026/2020, atualizando a Lei Federal. A cidade de Rio Branco é marcada por um forte processo de diversificação da produção rural e de infraestrutura urbana marcando, fortemente, a dinâmica de implementação dos serviços de saneamento na cidade. Método: Foram utilizadas informações do primeiro ciclo de auditoria, conforme metodologia ACERTAR, dos serviços prestados pelo então Departamento Estadual de Água e Saneamento do Acre - DEPASA. A avaliação ocorreu com base nos indicadores de desempenho, em suas dimensões de acesso, eficiência e qualidade. Resultados e conclusão: As informações obtidas através dos indicadores analisados revelaram que a prestação dos serviços de água e esgoto em todas as dimensões avaliadas é insatisfatória, muito aquém do que se pretende para a universalização dos serviços, necessitando de um aperfeiçoamento no que tange aos mecanismos e procedimentos de avaliação e monitoramento dos serviços prestados.

Institutional arrangements for improving water and sanitation services in the rural villages of India: a systems thinking approach

AbstractThis study examines the impact of institutional arrangements on water and sanitation (WATSAN) services in a village context in India. Data from households in Nagla Chandi village in Uttar Pradesh state were used to assess the situation. A systems thinking approach was employed to identify intervention points and improve access. The study identified under‐resourced local institutions, a lack of village‐level WATSAN rules and regulations, a lack of participation by both public institutions and communities, and trust issues as the critical barriers to accessing WATSAN services. It advocates for setting up a local WATSAN fund to ensure sustainable service delivery and a better understanding of the broader governance environment for sustainable WATSAN delivery in rural communities.

KAALO, OXFAM Somalia Install First Water Desalination Plant in El-dahir, Somalia

This article outlines the installation of the first water desalination plant in El-dahir, Somalia, a collaborative effort led by KAALO Aid and Development Organization, OXFAM Somalia, and the El-dahir Water Company. The project aimed to alleviate chronic water scarcity in the region, a pressing issue exacerbated by drought, conflict, and waterborne diseases. Through rigorous site-selection processes and engagement with stakeholders, Eldahir village was chosen as the project's beneficiary, emphasizing community involvement. A Public-Private Partnership (Triple-Ps Agreement) was established to ensure the sustainability of water, hygiene, and sanitation services, reflecting a strategic approach to infrastructure development. Community engagement played a pivotal role, with residents actively participating in discussions on water pricing and quality, underscoring their commitment to positive change. The project's allocated budget of $132,609, inclusive of infrastructure development and capacity-building efforts, reflects the dedication of all stakeholders involved. Lessons learned highlight the transformative impact of collaboration among humanitarian organizations, the private sector, and governmental agencies in addressing water scarcity effectively. This article aims to provide valuable insights for future projects and inspire similar partnerships for sustainable development, ultimately serving as a beacon of hope for communities worldwide.

Assessment of Basic Services and Handling of Infectious and Highly Infectious Waste in Health Facilities

Introduction: Safe handling and disposal of medical waste are important aspects of ensuring epidemiological safety of medical activities. Objective: To analyze performance of republican health facilities in rendering basic services for hazardous infectious and highly infectious waste management. Materials and methods: This work is a part of a study of basic water, sanitation, and hygiene services rendered. The materials covered information about medical waste handling and management in 350 health facilities in terms of epidemiological safety. Data were collected from November 2020 to January 2021 using a checklist. Results: In most healthcare facilities (56 %), medical wastes, both infectious and highly infectious, are properly separated into three containers: emergency, infectious, and non-infectious wastes. The most common problems observed were related to labeling or color, and compatibility, with the type of waste in the bins. Health facilities still use open burning or other forms of hazardous disposal (24 %). The process of disposal of hazardous and infectious wastes in healthcare facilities shows that safe waste handling is not ensured by the management. Provision of basic waste management services in the coverage areas is at a low level (in the Districts of Republican Subordination/Dushanbe – 35.8 %, in the Gorno-Badakhshan Autonomous Region, Sughd and Khatlon Regions – 11.1 %, 43.3 %, and 36.4 %, respectively), which requires making urgent decisions and establishing procedures for the safe disposal of sharps and infectious wastes. Conclusion: The study results revealed significant shortcomings and unsafe practices, as well as deviations from the basic level that ensures epidemiological safety in health facilities and protects health of patients and medical personnel.

Promotion of market-based sanitation in Ethiopia: a case study from Wolaita zone.

Ethiopia increased the availability of latrines notably, but the sanitation facilities rarely meet hygienic standards. Therefore, the market-based sanitation (MBS) programme has been implemented across the country for nearly a decade to expand the market and boost the demand for hygienic sanitation products and services. While it does not seem that the MBS would bring any notable change in sanitation conditions so far, its implementation challenges are not adequately understood. To address this gap, this article delves into the grassroots-level implementation of MBS in the Wolaita zone. The study relies on qualitative data gathered through interviews with various stakeholders, examining both demand- and supply-side challenges. Some issues identified were external to MBS implementation, such as high inflation and an unstable political and security situation in Ethiopia. Additionally, the study reveals that more general deficiencies of the Ethiopian health extension program, including the stress and discouragement of local change agents (health extension workers, health development army members) due to workloads and low remuneration, have adversely impacted MBS delivery. The implementation of MBS has also not effectively addressed the affordability of hygienic sanitation products. On the supply side, economic constraints and organizational inefficiencies have hindered the development of the sanitation market, preventing it from reaching a critical mass. Our research suggests that MBS alone will not suffice to improve sanitation in Ethiopia.

Socio-economic determinants of public healthcare

The main socio-economic mission of the healthcare system is to participate in the formation of workforce, strengthen the labor potential of society, and promote economic growth. The national health serves as an important economic resource. The COVID-19 pandemic has proven that losses due to illness and absence of employees from the workplace have negative economic consequences. The bibliometric study conducted via the VOSViewer bibliometric analysis of Scopus publications in 2014-2024 for the query “socio-economic determinants of public healthcare” allowed to structure the scientific work within 8 clusters. The latter showed leading researchers from the USA, the UK, India, Australia, Canada, Germany, Italy and Spain. In 2020-2023, due to the pandemic, publication activity in this area increased significantly. The article conducts a regression analysis of the impact of socio-economic determinants on the level of public healthcare. The public healthcare index is the population life expectancy. Among socio-economic determinants, there are nine components as factor attributes: current healthcare expenditures per capita; income shares of the richest and poorest – 10% and 20%; mortality rates up to 5 years and from suicide; number of people using at least basic sanitation and safe drinking water services, etc. The data for Ukraine from the World Bank statistical base for 2002-2019 were used as an information fundament. The multiple regression generation by the method of stepwise exclusion of variables was implemented using the MS Excel software. The article formulates a list of recommendations for increasing life expectancy. It includes measures to ensure the sanitary and epidemiological well-being of the population, development of healthcare infrastructure. The research also ensures availability of medical services to the population. The study educates and informs the population about the hygiene importance, proper use of sanitation and the consequences of inadequate sanitary conditions for health. Relevance of affordable sanitation improvement programmes for the poor is discussed.

Thirteen-year surveillance results of acute flaccid paralysis cases in Southeast Turkey and the effect of refugee movements on surveillance results.

Acute flaccid paralysis (AFP) is a major neurological problem. Turkey has accepted over 4 million refugees since 2011 due to the wars in neighbouring countries. In the long term, refugees can have adverse effects on the limited resources of health, sanitation, water supply, foodstuff, and shelter services of host countries, precipitating the transmission and spread of enteroviruses causing AFP. This study examines the 13-year surveillance and incidence of AFP cases in southeast Turkey, and questions possible impact of refugee movements on these parameters, comparing the periods before (2007-2010) and after (2011-2019) 2011, when the refugee movements emerged. The records of cases reported from southeast part of Turkey with suspected AFP between January 2007 and December 2019 were reviewed retrospectively. Of the patients, 121 (58.5%) were male. Mean age was 80.36 ± 46.67 months. Eighty-five (41.1%) were aged 60 months or younger. The number of patients under 60 months increased significantly after 2011. Mean incidence was calculated as 0.88 cases/100,000 person years versus 1.58 cases/100,000 person years in the period before and after 2011, respectively. Guillain-Barré syndrome (GBS) was the most common cause of AFP in both periods. As of 2011, however, the incidence of acute transverse myelitis increased approximately 4 times and GBS decreased proportionally. Non-polio enteroviruses were the most frequent isolates, detected from 9.1% of stool samples. Although refugee movements appear to may have adverse effects on AFP incidence and surveillance outcomes, larger studies involving the whole country, particularly at places where no refugees settled, are needed to achieve more conclusive evidence.

A Review of Sustaining Sanitation Services Approach

The service sector, including the sanitation service, currently occupies a prominent part of the economic and social development plans. The scale of development of this sector has become a criterion for measuring the progress and development in various countries of the world. Infrastructure services management has been introduced in many countries of the world including some of the leading experts in this field to ensure the sustainable development of the sanitation sector. The aim of this study is to systematically review the literature on sanitation to provide an overview of how researchers approach problem solving to achieve sustainability in sanitation services, it was also found that recent studies tend to use geographic information systems (GIS) to analyze sanitation services. Studies using GIS technology have provided maps that can be used as a decision support tool for governmental and non-governmental organizations to prioritize sanitation in underserved areas.

Are Brazilian water auction prices affordable for vulnerable families?

A recent regulatory framework reform implemented in Brazil aims to universalize water and sanitation services by 2033. For financing and speeding up the construction of infrastructure, the new law encourages private sector participation through auctions promoted with the support of the Brazilian National Development Bank. However, the first auctions, with billions of dollars in price and investment effects, have raised concerns among practitioners over the impact on vulnerable families. We analyze the concessions in Alagoas and Rio de Janeiro states in Brazil to demonstrate how low-income families will struggle to pay their bills based on auction prices via the tariff, which may invite discontent. This research can inform subsequent water and sanitation auctions by highlighting that awards should not be based exclusively on auction prices, and affordability assessments should be mandatory.

Beyond a facility: A cross-sectional survey on WASH service levels and informal social accountability in childcare centres in Nairobi's informal settlements

Abstract Access to clean water, sanitation, and hygiene (WASH) services is crucial for a healthy start in life. Social accountability has a potential for enhancing WASH services in childcare centres. However, there are inadequate studies to understand how informal social accountability mechanisms contributes to WASH service provision. To address this gap, we conducted a cross-sectional survey in Korogocho and Viwandani informal settlements in Nairobi, Kenya, to explore the relationship between different levels of WASH services (ranging from basic to limited or nonexistent) and indicators of informal social accountability, including rewards, sanctions, voice, and responsiveness. We employed multinomial regression analysis, utilizing a robust error variance estimator to account for potential biases. Our findings revealed disparities in WASH service provision between the two studied areas, with childcare centres in Korogocho exhibiting higher access to basic WASH services compared to those in Viwandani. Our analysis also highlighted a significant association between informal social accountability mechanisms and the provision of WASH services. Notably, the sanction mechanism exhibited a correlation with all WASH services, suggesting its pivotal role in shaping service delivery outcomes. In light of these findings, it is imperative to prioritize efforts aimed at reinforcing social accountability mechanisms in WASH service delivery frameworks.

Evaluation of Human Resource Potential of Organizations of Sanitary and Epidemiological Service of the Republic of Kazakhstan

Main problem: At the present stage of life, workforce plays a special and very important role in the activities and development of any organization. Human resources need to be managed. Management itself is a process of streamlining, regulating a particular activity. Managing an organization means defining the main directions of its development, setting goals for it and contributing to their achievement. Human resources are the face of a company, a component derivative, without which its existence is impossible. Any promising and self-respecting company assigns the formation of its staff to one of the leading directions of its own policy. Currently, in the context of social and economic transformations, the management of the activities of healthcare organizations is changing significantly, and therefore it is necessary to improve personnel management approaches that contribute to improving the quality of services provided and labor productivity. Taking into account the peculiarities of personnel management of a medical institution at the present time, the issue of reforming the personnel policy of healthcare, improving the image of institutions, forming a corporate culture, developing and implementing criteria for the motivational process is acute. Solving these tasks will help managers in the personnel management process. Purpose of this article is to assess the state of human resources of organizations of the sanitary and epidemiological service in the Republic of Kazakhstan and identify the main problems in the personnel management system of the organization using the example of the activities of the State Institution “Committee for Sanitary and Epidemiological Control of the Ministry of Health of the Republic of Kazakhstan”. Methods: The work used general scientific methods of comparative systemic, vertical and horizontal analysis, structural and functional the method, analytical techniques, economic and statistical research methods. Results and their significance: the authors have defined the human resource management system of a healthcare institution, analyzed the current personnel management system using the example of the State Institution “Committee for Sanitary and Epidemiological Control of the Ministry of Health of the Republic of Kazakhstan”. The assessment of the state and movement of labor resources of the Sanitary and Epidemiological Control Committee was carried out. Based on the conducted research, the authors identified the main problems of human resource management of a healthcare institution and developed proposals that can be used as recommendations for further reform and development of the personnel management system in the healthcare sector.

Physical and Environmental Factors Influencing Accessibility to Sanitation and Hygiene Services Among People Living with Disabilities in Kitui County, Kenya

This study aimed to find out the physical and environmental factors influencing accessibility to sanitation and hygiene services among PLWD in Kitui County, Kenya. The study employed a cross sectional survey method. Disability status varied, with 44.2% having physical/mobility disabilities, 34.4% with visual disabilities, and 21.4% with hearing disabilities. In terms of physical and environmental factors, 95.6% had access to latrines, Improved pit latrines were the most common (52.3%). 93.3% reported sufficient space inside latrines, challenges included slippery floors (28.2%) and limited privacy (23%). Inferential statistics, employing logistic regression, identified significant associations. The logistic regression analysis elucidated significant factors influencing hygiene and sanitation accessibility among people with disabilities in Kitui County, Kenya. Socio-economic variables, including occupation (B = -0.212, p = 0.032), income (B = -1.068, p = 0.184), and education level (B = 0.457, p < 0.001), exhibited notable associations. Physical and environmental factors, such as latrine design for people with disabilities (B = -0.566, p = 0.077), played a crucial role. This study identified substantial challenges hindering people with disabilities (PLWD) from accessing adequate sanitation and hygiene, revealing critical issues related to physical and environmental barriers.

The global sanitary revolution in historical perspective

AbstractThis survey sheds light on the causes and consequences of the global sanitary revolution that resulted in the spread of waterworks and sewerage projects since the middle of the 19th century, by drawing on research from the fields of economic history, economics, and history. I begin with a discussion of the construction of these infrastructures during the period ca. 1850–1950 showing that their spread was relatively similar in major urban cities across the globe, while diffusion within and between countries, as well as within cities themselves, was markedly unequal. Second, I review research estimating the mortality impact of access to clean water and sanitation. Following the provision of these services, infant mortality declined between ca. 10 and 30 percent. Lastly, I examine the drivers of the sanitary revolution with a new framework that distinguishes between proximate factors (e.g., physical capital) and ultimate factors (e.g., institutions). I argue that the state of knowledge in the literature is insufficient to explain between‐ and within country differences in access to sanitary services and that more attention should be devoted to the interaction of political and economic factors within broader institutional, cultural and biogeographic contexts.

Multi-level factors associated with utilization of water, sanitation and hygiene services by mothers in Nepal.

Providing improved water, sanitation, and hygiene (WASH) at a household level remains one of the major public health challenges in Nepal. Household mothers are likely to have limited access to combined WASH services, this is influenced by individual, and community factors. Individual components of an improved water source, sanitary toilet, fixed place for handwashing, and availability of soap and water were merged into one and called combined WASH. This paper aimed to identify the individual and community factors associated with combined WASH facilities and practices among mothers with children under five years in Nepal. A cross-sectional study was conducted using data from the Nepal Demographic and Health Survey (NDHS), 2016. The weighted sample size of this study was 4887 mothers with children under five years. The independent variables within the mothers included age, education, occupation, and caste/ethnicity in addition to education of the husband, wealth index, exposure to the newspaper, radio and television, residence, ecological zones, provinces, distance and participation in health mother groups were analyzed with the outcome variable of combined WASH. A multi-level mixed effects logistic regression model was used to assess the relationship of explanatory variables with WASH. At an individual level, a rich wealth index was positively associated with combined WASH (AOR = 6.29; 95%CI: 4.63-8.54). Higher education levels and exposure to television had higher odds of having combined WASH. At the community level, the hill zone, urban residence, and Sudurpashim Provinces were positively associated with combined WASH while Madesh and Karnali Provinces and distance to water source greater than 31 minutes were associated with lower access to combined WASH. Educated and rich household have positive association with combined WASH. It is recommended that both the health and other sectors may be instrumental in improving the combined WASH service for mothers at households.

Medical and social aspects of the activities of local self-government and the medical community of Yekaterinodar in the late XIX – early XX century

The purpose of the study: to study the medical and social aspects of the activities of public institutions of the city of Yekaterinodar in the early twentieth century, as a reflection of global trends shaping the public health system. Materials and methods: historical-descriptive, comparative-historical, problem-chronological, biographical methods were used in the work. The article is based on published sources and archival materials available to the authors. Results. Currently, there is no doubt that the level of public health depends not only on the activities of medical institutions, the qualifications of doctors, medical staff, but also on the timely comprehensive solution of many social issues with the participation of public and state institutions. The article presents some examples of the formation of such interaction and original solutions to urgent medical and social problems in Yekaterinodar (now Krasnodar) at the end of the XIX – beginning of the XX century. The issues of financing medical institutions, medical salaries and pensions, the organization of measures to combat epidemics, the formation of sanitary services, the opening of new specialized hospital departments, and services for the poorest segments of the population were touched upon. The elements of educational work, ways to solve the problem of high infant mortality and the organization of the first Consultation for infants are shown. Many doctors actively participated in the work of local city government, being “public” of the City Duma and the City Council, thereby contributing to the solution of many social and medical issues, including problems of payment for treatment, different categories of the population and “hospital arrears”. Conclusion . Thus, without having a clear state concept and program for the development of healthcare, the city administration, together with the medical community, demonstrated the desire and possibility of jointly solving many medical and social problems of the city of Yekaterinodar. That is, during this period, the potential properties and understanding of the need for the development of the public health system and sphere were formed in the regional society.

Social-Economic Factors Affecting Accessibility to Sanitation and Hygiene Services Among People Living with Disabilities in Kitui County, Kenya

Persons living with disabilities refer to individuals with persistent mental, physical, sensory or intellectual deterioration while interacting with varied barriers may prevent equal participation in society compared to other population. People living with disabilities (PLWD) are greater than five times probable to be found in the position of being unable to access sanitation and hygiene services as compared to normal people in the same community. There are significant gaps and limited knowledge in implementation of WASH policies across the country. This study aimed was to determine the social-economic factors affecting accessibility to sanitation and hygiene services among PLWD in Kitui County, Kenya. The study employed a cross sectional survey method. Socio-economic status indicated a high proportion of participants with limited education (51.1% with no formal education, 35.2% with primary education), and a pervasive low income (98.6% earning less than 10,000) and unemployment (85.3%). Socio-economic variables, including occupation (B = -0.212, p = 0.032), income (B = -1.068, p = 0.184), and education level (B = 0.457, p < 0.001), exhibited notable associations. This study identified substantial challenges hindering people with disabilities (PLWD) from accessing adequate sanitation and hygiene, revealing critical issues related to socio-economic factors, physical and environmental barriers, communication gaps, and institutional shortcomings.

Legislation and Policies for the City of Windhoek to Carry on With Water and Sanitation Service Delivery in Havana Informal Settlement

Legislation and Policies for the City of Windhoek to Carry on With Water and Sanitation Service Delivery in Havana Informal Settlement

Environmental injustice in the privatization of Brazilian sanitation: an empirical analysis

This study analyzes whether the low rate of universalizing water supply and sanitation services in Brazil is related to the low participation of private companies in the concession of these services in municipalities in the country. To this end, it discusses basic sanitation in Brazil and its current scenario, its problems from the point of view of environmental injustice, and the existing public/private conflicts. The empirical analysis conducted a data survey of eight municipalities defined in four population groups, comparing data from 13 operational, efficiency, quality, and cost indicators of the services provided. Each population group compared two municipalities providing water and sewerage services, one provided by a public company and the other by a private company. The compared data were from 2021, obtained through the Brazilian National Sanitation Information System (SNIS). As a result of the comparative analyses, it was shown that the performance of public companies was more positive for most indicators, compared to private companies. It is concluded that the main challenge to overcome the social and environmental injustice resulting from the deficit in basic sanitation coverage lies in the promotion of public management instruments that enable the articulation of public and private investments in the expansion of basic sanitation services, in the improvement of the quality of services with the inclusion of social control through popular participation.

Episootological features of tularemia in the Donetsk region

Objective: to evaluate epizootic monitoring of tularemia in the Donetsk region.Materials and methods: methods of retrospective, statistical, and comparative analysis were used. The sources of infection were investigated using serological and biological methods. The data of industry statistical reporting on form No. 40-annual of the department of especially dangerous infections of the Donetsk regional Sanitary and Epidemiological Station (since 2013 — SSESU, since 2015 — Republican Center for Sanitary and Epidemiological Surveillance of the State Sanitary and Epidemiological Service of the Ministry of Health of the DPR) were used. 20 "Maps of epizootological and epidemiological examination of the focus of zoonotic disease" (F.391/y) were studied.Results: since 1987, the number of enzootic territories in the Donetsk region has increased annually: from 2 settlements in 1987 to 79 (in 4 cities and 16 districts) in 2023. With the beginning of active hostilities, the epidemic process of tularemia in Donbass has sharply intensified. Antibody titers (1:80 and 1:160) for tularemia were detected in environmental samples: in the North Steppe zone — 6.2%, Donetsk-Kryazhnaya — 10.4%, Primorsko-steppe — 15.8%. In the study of mouse-like rodents, 6 cultures of Francisella tularensis holarctica biovar II era R were isolated, resistance of the strain to ampicillin, cefotaxime, erythromycin, clindamycin, polymyxin was established; sensitivity to gentamicin, fluoroquinolones, rifampicin, doxycycline, levomycetin.Conclusions: the activation of epizootic processes of tularemia in the DPR is associated with the conduct of hostilities. High titers of antibodies to tularemia in environmental samples are noted in the south of the Donetsk region.

Water in Circular Economy and Resilience (WICER) Framework

Circular economy has emerged as a response to the unsustainable linear model of “take, make, consume, and waste”. Yet so far, the water sector has not been systematically included in high-level circular economy strategy discussions and has not fully reaped the potential benefits. Circular economy principles offer an opportunity to recognize and capture the full value of water - as a service, an input to processes, a source of energy, a carrier of materials - and to make the sector more sustainable financially and environmentally, while enhancing resilience to climate change and mitigating emissions. This paper presents the Water in Circular Economy and Resilience (WICER) Framework to establish a common understanding of circular economy and resilience principles in the water sector. The Framework grew out of a literature review and was informed by lessons learned from global case studies and from the knowledge of the World Bank. The paper aims to clarify how circular economy principles can be applied in the water sector, and to guide practitioners, especially from governments in low- and middle-income countries, with a clear long-term plan to become circular and resilient. The framework describes the nine key actions needed to achieve three main outcomes: (1) deliver resilient and inclusive water services; (2) design out waste and pollution; and (3) preserve and regenerate natural systems. The novelty of the proposed framework is that it goes beyond reusing and recovering resources from wastewater, and it presents a more holistic approach for water and sanitation services, considering a water basin approach and including resiliency principles, climate mitigation strategies and inclusiveness – all of which are particularly relevant in the context of developing countries.