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. 2019 Oct;44(1):287-318.
doi: 10.1146/annurev-environ-101718-033327. Epub 2019 Jul 23.

Sanitation for Low-Income Regions: A Cross-Disciplinary Review

Christopher Hyun  1 , Zachary Burt  2 , Yoshika Crider  1 , Kara L Nelson  3 , C S Sharada Prasad  4 , Swati D G Rayasam  5 , William Tarpeh  6 , Isha Ray  1
Affiliations

Sanitation for Low-Income Regions: A Cross-Disciplinary Review

Christopher Hyun et al. Annu Rev Environ Resour. 2019 Oct.

Abstract

Sanitation research focuses primarily on containing human waste and preventing disease; thus, it has traditionally been dominated by the fields of environmental engineering and public health. Over the past 20 years, however, the field has grown broader in scope and deeper in complexity, spanning diverse disciplinary perspectives. In this article, we review the current literature in the range of disciplines engaged with sanitation research in low- and middle-income countries (LMICs). We find that perspectives on what sanitation is, and what sanitation policy should prioritize, vary widely. We show how these diverse perspectives augment the conventional sanitation service chain, a framework describing the flow of waste from capture to disposal. We review how these perspectives can inform progress toward equitable sanitation for all [i.e., Sustainable Development Goal (SDG) 6]. Our key message is that both material and nonmaterial flows-and both technological and social functions-make up a sanitation "system." The components of the sanitation service chain are embedded within the flows of finance, decision making, and labor that make material flows of waste possible. The functions of capture, storage, transport, treatment, reuse, and disposal are interlinked with those of ensuring equity and affordability. We find that a multilayered understanding of sanitation, with contributions from multiple disciplines, is necessary to facilitate inclusive and robust research toward the goal of sanitation for all.

Keywords: Sustainable Development Goals; gender and sanitation; health and sanitation; human right to sanitation; sanitation service chain; waste treatment and reuse.

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Figures

Figure 1
Figure 1
The conventional sanitation service chain, showing the functions of capture (e.g., toilets, pits), storage (e.g., pits, septic tanks), transport (e.g., trucks, pipes), treatment (e.g., centralized or on-site), reuse (e.g., fertilizer), and final disposal (e.g., discharge to environment). Figure adapted from References and .
Figure 2
Figure 2
Disciplinary perspectives on sanitation. The size of a circle (not to scale) illustrates the amount of literature that we encountered within that perspective compared to others. The arrows represent a relatively high level of one perspective contributing to—or being referenced by—another (e.g., public health literature is heavily cited in social science, economics, and planning literature). Double arrows represent approximately equal referencing between perspectives. We have omitted connections consisting of few references.
Figure 3
Figure 3
An augmented sanitation service chain. This augmented chain expands the material functions (blue boxes) and flows (blue arrows) of the conventional service chain by including the environment (bottom), social functions (orange boxes) and flows (orange arrows), and main stakeholders. Social flows include decision making and financial power, and/or ability to affect others. Stakeholders are grouped as community members (households, etc.), decision makers (donors, governments, utilities/service providers, NGOs), and workers (construction workers, truck and plant operators, sewer workers, farm laborers, domestic workers, etc.). OD refers to open defecation. The various material and social functions, flows, and actors of the chain determine the goals (right), although not part of the chain.
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References

LITERATURE CITED

    1. World Health Organization, United Nations Children’s Fund (WHO/UNICEF). 2017. 2017 Annual Report: WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP). Geneva: UN-Water
    1. Baum R, Luh J, Bartram J. 2013. Sanitation: a global estimate of sewerage connections without treatment and the resulting impact on MDG progress. Environ. Sci. Technol 47(4):1994–2000 - PubMed
    1. Hutton G 2013. Global costs and benefits of reaching universal coverage of sanitation and drinking-water supply. J. Water Health 11(1):1–12 - PubMed
    1. Sommer M, Figueroa C, Kwauk C, Jones M, Fyles N. 2017. Attention to menstrual hygiene management in schools: an analysis of education policy documents in low- and middle-income countries. Int. J. Educ. Dev 57:73–82
    1. Nelson KL, Murray A. 2008. Sanitation for unserved populations: technologies, implementation challenges, and opportunities. Annu. Rev. Environ. Resour 33(1):119–51

RELATED RESOURCES

    1. Bill & Melinda Gates Foundation. Reinvent the Toilet: https://www.gatesfoundation.org/what-we-do/global-growth-and-opportunity...
    1. Citywide Inclusive Sanitation: https://www.globalwaters.org/resources/assets/water-currents-citywide-in... (with USAID and the World Bank)
    1. Eawag. MOOC sanitation courses by EAWAG: https://www.eawag.ch/en/department/sandec/e-learning/moocs/
    1. Furtado J 2007. Saneamento Básico, O Filme. Youtube, https://www.youtube.com/watch?v=I5yE1YPIZx0
    1. IRC. WASHCost. https://www.ircwash.org/washcost

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