Domestic Water and Sanitation

May 1982

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Summary I. Introduction II. Rationale for USAID Support of Water and Sanitation Programs III. Current Situation in Developing Countries and the Role of International Donors IV. Guidance for the Development of the Drinking Water and Sanitation Programs in Developing Countries: Major Issues V. Water in the Context of General Economic Development 32     [Download original document] IV. Guidance for the Development of the Drinking Water and Sanitation Programs in Developing Countries: Major Issues The issues in water supply and sanitation programs in developing countries can be divided into three categories: technical issues; social and cultural issues; and issues concerning the implementation and administration of programs. A. Technical Issues 1. Convenience, Reliability, Quantity, and Quality These four characteristics are key to the success of water supply programs; the first two apply to sanitation programs as well. Safe water supplies and sanitary means of excreta disposal must be both convenient (as perceived by the consumer) and reliable (in good working order throughout the year). Water should be available in at least some minimum quantity, which will vary among regions and even within countries, but should fall within the range of 20-40 liters per capita per day for the domestic uses defined above if health improvements are to be sustained.1 This range may be too high for certain and zones, where limited availability of water may dictate more modest objectives. The importance of water quality must be weighed not only against the diseases prevalent in the region but also- against other factors such as cost, quantity, and reliability (e.g., the ability of a system to operate continuously, during reasonable periods every day, throughout the year). 2 Water quantity: Domestic water should be available in adequate quantity to satisfy minimal requirements for drinking, cooking, and food preparation as the highest priority. Ten liters per capita per day is the minimum estimated for these requirements. Second in priority is sufficient water for bathing, personal hygiene, and washing utensils, for which 10-15 liters per capita per day is the minimum. Third, if feasible, domestic water should be available for washing clothes, and for watering small garden plots and/or small numbers of livestock or poultry. 3 Water quality: Water treatment should be introduced where needed to improve water quality, especially for drinking, cooking, and food preparation. Water treatment to improve the quality of water for bathing, personal hygiene, clothes washing, or garden plots should only be introduced where treatment does not prejudice the reliability of the water supply and where water quality can be improved at a reasonable cost. Simple household treatment may be sufficient to assure adequate quality for domestic use. Education (particularly for mothers and school-age children) can help ensure maintenance of the water's quality during its storage and transportation from point of collection to point of use (see pp. 11-13 below). Where these minimum standards of quantity and quality cannot be assured, investments in water supply are not likely to achieve completely their desired health impact. 2. Site Selection and Source Development In selecting the site and the appropriate method of developing and providing the water for domestic uses, attention should be given to potential future demands on the system, which should be designed with a view of possible future expansion if population growth or other conditions require it. These considerations lead to several guidelines: Water and sanitation surveys should be con-ducted to aid project designers and the commun-ity in selecting the most appropriate water sources among available alternatives and to iden-tify feasible, efficient and appropriate methods of waste disposal. Social and cultural factors should be taken into account in site selection and source development (e.g., location of communal washing areas, identification of cultural norms pertaining to the tasks of fetching water, cleaning, etc.; and consideration of water laws and current patterns of ownership, allocation and access to water). Where feasible the beneficiaries themselves should be actively consulted and involved in the development of the project activity. In most cases, groundwater should be the first possible source of water considered, since it is often the least costly and most reliable source that is relatively free of bacteria and does not normally require treatment. However, where surface water can be easily treated, and where sufficient quantities are available year round, surface water may be the least-costly and most reliable source for systems that require large quantities of water. Gravity-fed systems that require no pumping are less costly and less susceptible to mechanical failure than alternative methods. When surface water is used, its variable quality requires monitoring throughout the year. It should be treated when necessary to meet minimum standards of safety for purposes of drinking, cooking, and food preparation. 3. Selection of a Suitable Technology Experience in many developing countries has shown that the selection and adaptation of technologies suitable to the local setting is crucial in finding a balance among desirable characteristics of water and sanitation systems: convenience, reliability, costs and, in water systems, quantity and quality. There is some evidence that utilizing LDC private sector enterprise for the manufacture and installation of water and sanitation systems is not only cost-effective, but also stimulates the private sector and promotes employment. There are now a large number of alternatives to Western style water and sanitation systems, including pit latrines and water-sealed latrines (pour-flush commodes).4 Selection of a suitable technology should take into consideration local preferences as well as social and cultural factors, the repair and maintenance support systems, availability of labor and management, appropriate institutional structures, the level of investment and recurrent cost implied, and the willingness and ability of beneficiaries to cover the expected costs. Although the selection process is not an easy one, the factors discussed in this section should serve as a guide. The local manufacture of parts and equipment can significantly ease the operation and repair of the system, and often with substantial cost savings. A simple well screen that would cost $10-30 per foot to manufacture in the United States may cost only $2-3 per foot in many developing countries, because of lower production costs. A hand pump costing $300 to produce in the United States may be manufactured for $40-$60 in a country like Indonesia. In estimating potential cost savings through local manufacture of parts and equipment, however, it is necessary to assure that locally manufactured equipment is of sufficient reliability and durability, and is as easy to install properly and maintain as the more expensive foreign equipment, or else the cost differential may involve no savings at all. USAID has been active in the development and testing of technologies suitable for local manufacture (e.g., improved handpumps and well screens) and has also sponsored comparative reviews of other locally producible equipment and machinery (eg., non-sewered excreta disposal devices, desalinization devices, small diameter pipe, and well-drilling equipment). The Agency's guidelines for the promotion of appropriate technologies for water and sanitation projects include the following: USAID supported water supply and sanitation programs should encourage LDCs to use efficient technologies that can be maintained and operated easily and are acceptable within the local culture. 5 USAID should investigate the potential of private firms in LDCs to develop and operate efficient water and sanitation systems. USAID should stimulate local manufacture and field testing of simple equipment. In specific instances (where local capacity is not adequate or where a small market is involved), manufacture on a regional level may be preferable. Instead of introducing a new system, USAID should support the improvement of traditional systems, where local preferences or cost considerations indicate system upgrading is the most desirable approach. USAID recognizes that success of water and sanitation programs depends in large measure on the ability and commitment of people to use, operate, and maintain the system properly. Thus, USAID should also support programs to train maintenance and other personnel and to educate current and potential users of the services. USAID should promote standardization of water and sanitation equipment and parts, even while seeking technologies in which hardware can be produced efficiently on a small scale. USAID's efforts to eliminate wastage and maintenance failure currently caused by a pro-liferation of mechanical designs and specifications will necessitate closer coordination among donors and local private investors, and may on occasion require a procurement waiver. 4. Water Conservation and Reuse In most LDCs, potable water is neither cheap nor abundant, and with continued rapid population growth, water shortages may affect significant proportions of LDC populations. Certain areas of the world (e.g. The Sahel) have already experienced grave water crises. Water conservation is playing an increasingly important role development planing, not only because water recognized as a scarce resource but also because wastage of water contributes to health problems: pools of water that collect around taps present health hazards, and saturation of the soil with waste water (such as has been observed in rural Egypt) can contaminate the aquifer.6 Water metering in urban areas, safe restricted flow measures, increasing block rates,7 reduction of leakage by proper installation and regular repair and maintenance, and reuse of waste water for agricultural and industrial purposes are among the means that can contribute to water conservation. B. Social and Cultural Issues Water and sanitation programs are most likely to succeed when the respond to the needs of the community. Those needs -- and how they are perceived by the community -- will differ greatly depending on the country, whether the setting rural or urban, the current availability and adequacy of water and sanitation, and other factors. A thorough understanding of social, cultural and institutional factors and relationships is therefore a basis for developing and implementing effective water and sanitation programs. 1. Community Participation Recent project impact evaluations and other project reviews of USAID's experience have documented the importance of community participation to effective water supply and sanitation programs in developing countries.8 Local residents must have a strong interest in keeping the system functioning. They must use the system, and be able to support the bulk of the costs of operating and maintaining the system,9 whether in the form of cash, labor, or in-kind contributions. It is their contribution that can help ensure commitment to maintaining the system over the long-term. 10 Participation of the community is for these reasons often crucial in rural areas, small communities and low-income urban areas served by communal facilities such as standpipes. USAID-funded programs intended for such areas should adhere to the following guidelines. These guidelines may need to be modified or relaxed in the case of higher income urban residential or commercial areas served by building-to-building connections where a high degree of community participation is not practical. However, even in such situations some indication of community interest is desirable. USAID should require a request by community leaders or by a representative community group, or some other formal evidence of community support, and the community should be involved in the program from the outset. Communities where support is lacking will be bypassed unless a compelling public health need exists. Wherever possible, the community must be fully aware of the costs and benefits of alternative systems, and should help select the site, level of service, and technology employed. Communities must understand and agree to water rates and other fees at the outset. They must be consistent with the beneficiaries' ability to pay. The project should where feasible include a plan to train community workers in the construction, operation, and maintenance of systems. Women as well as men should be trained. (See p. 13.) Wherever possible, the project will use the existing indigenous organizations to assure community participation and to institutionalize maintenance, management and administration of the system. Social analysis, especially at the initial stage of project design, is essential to determine whether or not these conditions have been or can be met. 2. User Education The provision of basic sanitation and a reliable supply of safe, convenient water is not sufficient to guarantee improved health. A variety of social and cultural attitudes affect the pattern of usage of water and sanitation facilities: people must use facilities and use them property to discourage environmental contamination (particularly with fecal material) and disease transmission. In some areas, for instance, children are not encouraged to use the latrines, which are dark and distant from the home, because children's feces are considered harmless. In other areas, men and women prefer not to share the same latrines, which tends to limit use of household latrines to female members of the family. As a recent study noted: "Decisions about drinking water are often based on sensory perception - color, taste or smell - rather than technical purity."11 Water supply and sanitation interventions can be most effective in improving health when they are coordinated with other primary health care activities, especially health and hygiene education, and maternal and child health services. Examples of user education which seem obvious but which are often overlooked include: advice on the protection of stored household water from microbial contamination and mosquito breeding; promotion of handwashing (particularly by food handlers); promotion of hygienic food preparation, including the proper use of water for cleaning utensils; promotion of breastfeeding, especially during the first six months of life; promotion of safe excreta disposal by all family members; and instruction on preparing water for use in oral rehydration therapy, infant formula, where used, and weaning foods. Consumers must be encouraged to transport water in clean containers, and store it under sanitary conditions. They must know how to wash their hands and bathe properly to break the fecal-oral cycle of many diarrheal diseases. Hygiene education can be provided in a variety of ways: by community-based, primary health care workers or other health personnel; by "promoters" working with a water agency through primary schools; or by extension workers in other sectors. Evidence from evaluations of development projects suggests that sporadic information and education campaigns do not result in real behavioral changes. Therefore hygiene education associated with water and sanitation programs must be incorporated in continuous education program efforts. Effective hygiene education is almost always a necessary complement to the provision of safe water supplies and adequate sanitation in USAID-sponsored programs. Whenever possible, proper hygiene should be taught in primary schools, and water and latrines should be provided in schools and their use encouraged so that children may begin to practice the normative hygiene behavior they are taught. Mothers should be a main target of hygiene education programs, since they are primarily responsible for the health and training of their children; and women will be included among those employed to carry out the promotional and hygiene education activities associated with USAID-supported programs. C. Issues of Implementation and Administration 1. Costs and Financing of Water Supply and Sanitation Systems The long-term financing of water supply and sanitation systems is a matter of critical concern for developing countries and donor agencies. Per capita cost of water systems vary according to the country, characteristics and distance of the water source, and kind of technology used (e.g., communal standpipes or household connections).12 Most estimates of long-term operation and maintenance costs ignore indirect costs, including such factors as the cost of running regional and national offices and training middle management personnel, and therefore seriously underestimate the costs of water systems. Initial investment costs for water systems have been estimated to range from approximately $25 per capita for household connections in both urban and rural areas. The annual cost of installing and maintaining an adequate sanitation system also varies enormously, from about $20 per household per year (capital and recurrent costs) for single pour-flush toilets, to $400 per household per year for sewerage systems. 13 Where water and sanitation systems are provided through household connections, consumers must be charged fees which at least cover operating expenses, and preferably the full cost, possibly through loan arrangements. Where services are provided as public goods and no consumer can be excluded, as in the case of water standpipes or public sanitation services, their costs must be recovered through some other mechanisms such as increasing the price of water for house connections and raising the per unit cost of water as the volume used rises (increasing block rates). Other means of financing include the use of community funds or assessment of consumers based on ability or willingness to pay criteria.14 Whether in urban or rural settings, water and sanitation tariffs must be structured so that users can afford them. Charges for initial hook-ups and policies that compel all new users to purchase a tank or other equipment at a uniform price may effectively exclude poor households from the system. Such devices as a loan fund, long-term credit arrangements, or charges pegged to income can help ensure more broad-based participation in the system. Where charges do not cover the costs of at least maintaining the system, and where the difference cannot be guaranteed through general tax revenues, USAID will not, in general, support a major investment in domestic water supply. While most people in developing countries may be prepared to pay a significant portion of their income for improved water supply, in many areas they are less persuaded or even unaware of the need for improved sanitation facilities, especially when they do not understand or believe the importance of these improvements for health. Thus an education program to highlight the benefits of improved sanitation may have to be coupled with initial subsidization of sewerage systems or, in urban areas at any rate, sewerage charges may have to be subsidized by water users who have water piped to their household. The economic analysis of all water supply and sanitation projects will explicitly demonstrate a feasible means of financing the program over the long-term. USAID will not support water supply and sanitation programs whose operation and maintenance costs cannot be paid by the users through fees, taxes and/or contributed labor. Where possible, each user household should bear primary responsibility for covering all costs, and certainly recurrent costs, except in areas with extremely poor households where some level and combination of cross subsidy and/or allocation of general tax revenues may be required. USAID encourages adoption of methods, such as cross subsidies, which do not exclude the poorest members of the community. 2. Operation and Maintenance Too frequently the success of a water and sanitation project has been measured in terms of the total number of wells, handpumps, or latrines constructed, with little attention to actual operation, maintenance, or usage. Long-term success of these systems depends on the availability of supplies, parts, equipment, and the trained people needed to monitor, maintain, and repair the systems. In general, USAID will give preference to water supply and sanitation systems that are appropriate to the setting, inexpensive, and simple to install, operate, and maintain. In rural and village water and sanitation systems, revenues for operation and maintenance should be generated and controlled by the local community, which has a vested interest in maintaining the system, so that they are readily available when breakdowns occur. USAID-supported programs for water and sanitation systems should include training for regional and national level personnel in the operation, maintenance and repair of water supply and sanitation systems, and for community members when community participation is a major feature of a program. Special emphasis will be placed on training women, since they are the major users of the systems. Emphasis will be placed on short-term, in-service training of village-level personnel. 3. Management and Logistics: The Administration of Water Supply and Sanitation Programs Effective institutional support for water supply and sanitation programs is essential. However, in many LDCs, the administration of water supply and sanitation programs is divided among numerous ministries and coordination among them is often deficient. In some LDC settings, there may be no clearly demonstrated capacity anywhere in the public sector to initiate and support water and sanitation programs. The participation of the private sector in both the construction and operation of water and sanitation systems can increase the efficiency of such efforts, especially where water and sanitation services are provided directly to households willing to pay for services. However, where the services are not provided directly to households but are "public goods" in the form of standpipes or other communal facilities, special private sector incentives or public sector involvement may be necessary to ensure broad access to water. 15 Given the fact that utilities such as water supply tend to be natural monopolies, some public sector oversight is required to set service standards and tariff structures, to endorse operation and maintenance procedures and schedules, and billing and collection activities, and, most important, to plan for efficient and equitable water use. Relatively small, individual communities can generally take direct responsibility for management of water systems, but larger jurisdictions normally require a local or national water agency (either public or private), and where private firms are involved, public oversight is necessary. A thorough analysis of existing and potential institutions, including private sector entities, should be part of any project analysis for water supply and sanitation projects. USAID-supported water supply and sanitation programs should include technical assistance and/or training to improve the efficiency and effectiveness of program administration by government institutions and private firms. An established, national or regional level unit responsible for domestic water supply and sanitation programs is a prerequisite for substantial USAID assistance for domestic water supply programs. The public water authority can be governmental or parastatal, but must be responsible for assessing long term water and sanitation needs, planning for effective utilization of national local water resources, assessing and monitoring environmental hazards, rate setting, the establishment of standards, and, where applicable, oversight of private sector activities in water and sanitation. In terms of implementation of the other aspects of water supply and sanitation systems, the governmental agency and/or private firms must have responsibility for at least the following: administering national/local water and sanitation systems; establishing technical requirements for water supply and sanitation; ensuring operation and maintenance of the system, including procurement and distribution of equipment and supplies; assessing manpower needs, and providing appropriate training for operations and maintenance. 4. Role of the Private Sector USAID endorses the role of private enterprise in water supply and sanitation activities, particularly with respect to operations and management. Where private entrepreneurs are interested, franchises can be auctioned by the public sector for building and/or operating urban water systems. The public water and sanitation authority would then set rates based on acceptable rate of return criteria and ensure that where necessary public goods stands and, where relevant, sanitation systems are financed through some combination of innovative community financing, common central government revenues, or cross-subsidies. Opportunities for private businesses to operate and maintain water supply systems and waste disposal (including cartage) exist, and USAID should fully explore the feasibility of expanding and improving these activities. However USAID recognizes that, given the high cost and modest returns as well as the uncertainty and risk associated with such investments in LDCs, the private sector is generally reluctant to finance establishment of water and sanitation systems. 5. Program Evaluation and Applied Research Careful evaluation of water supply and sanitation programs is needed to ascertain which types of water supply and sanitation systems work best under particular field conditions. To date, USAID-supported applied research has stressed the development of technical and engineering aspects of water supply and sanitation programs. In the future, USAID will give much more attention to social, economic, and administrative considerations, and will evaluate regularly the water and sanitation programs it supports. Programs that involve major innovations -- either a new technology or a new combination of interventions -- will have a built-in evaluation component. USAID will also continue to support applied research studies. 1White et. al., op. cit. (See also page 18). [return to text] 2The WHO's International Drinking Water Standards, are currently being reformulated. See also: Chamberlain, Charles E., et. al. Wholesome and Palatable Drinking Water: A Background Paper on Water Quality Aspects of Water Supply, Washington, D.C.. 1979; Woman, Abel, et. al., "A Panel Report to U.S. Agency for International Development on Sanitary Services During 1980-1990," Washington, D.C.: U.S.USAID, 1979. The issue was thoroughly reviewed by USAID during 1979, by an external panel of experts. Guidelines on water quality are based on findings in their report, which is available from USAID's Office of Health. (Chamberlain, et. al., op. cit.) [return to text] 3Donaldson, David, "Sanitation and Health: An Overview," in The Impact of Interventions in Water Supply and Sanitation in Developing Countries, U.S.USAID, April, 1981. [return to text] 4In many arid regions, traditional societies developed water supply and excreta disposal systems which were designed to fit within the constraints imposed by the environment. For example, in the Near East, huge cisterns were built to store rain water for the dry season. Dry toilets built within the homes provided an ecologically sound means of human waste disposal. Excreta deposited in an isolated chamber was readily available as a soil additive or fuel supplement. Planners should consider modifying time-tested traditional approached such as these, rather than automatically replacing them with modern methods that may waste resources already in short supply. New technologies, such as pumps and self-closing valves that curtail water waste, should also be considered. See Winblad, Uno and Wen Kilama, Sanitation Without Water, Stockholm: SIDA, 1980, Kalbermatten, John M, et. al., Appropriate Technology for Water Supply and Sanitation, Technical and Economic Options, Washington: World Bank, 1980. [return to text] 5The level of technology that is appropriate in a given situation should not be underestimated. The evaluation of USAID's potable water project in rural Thailand demonstrated that the best technology was not necessarily that which appeared to be the most capital saving technology. Villages perceived piped water systems with household connections as preferable to traditional sources of hand-pumps. They were therefore willing to finance and maintain the piped systems, while few of the handpumps have remained in operation. Dworkin, D. and B. L. K. Pillsbury, 1980, op. cit. [return to text] 6Varisco, Daniel and Max Kroeschel, "Rural Sanitation in the Arab Republic of Egypt," Washington, D.C.: Metametrics (for U.S.USAID), 1981. Pools of waste water may promote mosquito breeding (especially of Culex fatigans and Aedes egypti, vectors of filariasis and yellow (fever) and may create soil conditions favorable to transmission of geohelminthic diseases, e.g., hookworm and ascariasis. [return to text] 7Increasing block rates refers to the pricing structure where the first units of water are provided at low prices, with cost per unit increasing with the volume of water consumed. [return to text] 8Observations of Rural Water Supply and Sanitation Programs in eight Developing Countries. IBRD, Report no. PUN 42, 1978; Self, george, "Social Analysis of rural Potable Water Programs," USAID, 1979. UNICEF/WHO Joint Study on Water Supply and Sanitation Components of Primary Health Care, JC 22/UNICEF-WHO/79.3. [return to text] 9Larger and more complex systems will require full-time staff and supervisors. Even when systems can be operated and maintained by the users, access to the expertise of a central water authority will occasionally be necessary. [return to text] 10Social and Behavioral Aspects of Project Work in Water Supply and Waste Disposal, IBRD, Transportation, Water and Telecommunications Department Public Utilities Notes, 1980. [return to text] 11Elemdorf, M.L., and R. B. Iseley. "The Role of Women as Participants and Beneficiaries in Water Supply and Sanitation Programs," Washington: Mimeographed draft, 1981, p. 4. [return to text] 12The World Bank has recommended that (1) "minimum" water service be available to all and (2) the charge not exceed 5-6 percent of the income of the poorest household to be served. Unfortunately, the high cost of reaching isolated groups may make total coverage of populations in developing countries and impractical and perhaps unattainable objective. See The World Bank "Water Supply and Waste Disposal." op. cit. [return to text] 13Kalbermatten, John M., et. al., op. cit. Precise figures for recurrent costs of alternative water systems are unavailable, and estimates vary widely. The World Bank, "Water Supply and Waste Disposal," op. cit. In some unusual settings, such as Bangladesh (which has an alluvial delta, high water table, and high population density), the cost of shallow wells with handpumps may be as low as $3 per capita (F. Eugene McJunkin, personal communication). [return to text] 14Building on established community financing mechanisms is a useful starting point for developing financial schemes. In some instances leasing standposts or similar public sources of water to private entrepreneurs can improve operation and maintenance and simultaneously ensure the system's financial viability. However, problems encountered in the use of private vendors have included price fixing, failure to maintain water quality, and the use of insufficient technologies. [return to text] 15For example, where the private sector is encourages to provide public goods (for example, sanitation), incentives such as higher water fees could be allowed by the water authority to cover costs of sanitation services. [return to text]

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