Sanitation
Access to safe, clean water is a pre-requisite for human health. However when water is contaminated with human waste it presents a serious risk to human health. Insufficient sanitation and poor hygiene therefore pose a severe obstacle to development.
A World Health Organisation study group defined sanitation as "the means of collecting and disposing of excreta and community wastes in a hygienic way so as not to endanger the health of individuals and the community as a whole" (WHO 1987) Poor sanitation is a major cause of disease and improving sanitation has a significant beneficial impact on health both in households and across communities. The WHO and UNICEF have established a sanitation ladder, similar to the Water Supply Ladder, which can be used to monitor access to sanitation services (see box below).
The Sanitation Ladder
Improved sanitation - Facilities that ensure hygienic separation of human excreta from human contact. They include:
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Flush or pour flush toilet/latrine;
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Piped sewer system;
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Septic tank;
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Pit latrine;
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Ventilated improved pit (VIP) latrine;
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Pit latrine with slab;
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Composting toilet.
Shared sanitation facilities - Sanitation facilities of an otherwise acceptable type shared between two or more households. Shared facilities include public toilets.
Unimproved sanitation facilities - Facilities that do not ensure hygienic separation of human excreta from human contact. Unimproved facilities include pit latrines without a slab or platform, hanging latrines and bucket latrines.
Open defecation - Defecation in fields, forests, bushes, bodies of water or other open spaces, or disposal of human faeces with solid waste.
Source: WHO and UNICEF 2008
Improved sanitation - a ventilated improved twin pit (VIP) latrine.
Source: Image courtesy of WEDC. © Rod Shaw
( click to enlarge )
Hygiene
Access to, and the use of, sanitation can greatly reduce the incidence of diarrhoeal and other excreta related diseases. However experience has shown that it is the combination of improving hygiene behaviour, through hygiene promotion, and improving access to sanitation that can have greatest effect on health (see figure below).
The goal of hygiene promotion is to help people understand and develop good hygiene behaviours to prevent disease and promote positive attitudes towards good health practices. Hygiene promotion can be complex and its uptake difficult to measure directly. Despite its potential impact on health, the uptake of improved hygiene behaviour is not monitored in the same way as access to sanitation is monitored. However the impact of poor hygiene can clearly be seen in health statistics, particularly in the prevalence of diarrhoea.
Median percentage of diarrhoea reduction through different interventions.
Source: Esrey et al. 1991
( click to enlarge )
Sanitation and Hygiene in the Basin Countries
In rural areas in Angola estimates from 2008 suggest that 18 % of the population were using improved sanitation, 29 % had unimproved and 53 % were defecating in the open. The situation is considerably better in urban areas with 86 % of the population having access to improved sanitation, 13 % to unimproved and that 1 % practicing open defecation (WHO and UNICEF 2010).
Angola has the highest rate of diarrhoeal disease in the world with 114 years of life lost to for every 1,000 Angolans (USAID 2010). Cholera is a particular danger with serious outbreaks occurring repeatedly throughout the country over the last few years.
Estimates for 2008 for Namibia suggest that 73 % of the rural population have no sanitation and defecate in the open, 6 % have access to unimproved sanitation, 4 % use shared toilets and 17 % use improved sanitation (WHO and UNICEF 2010).
Poor access to sanitation and poor hygiene causes public health problems and cholera outbreaks have occurred in the basin over the last few years, particularly in 2006.
See Water Related Diseases and Cholera and Wastewater Infrastructure for more information.
