What is shared sanitation and why does it matter?
Shared sanitation facilities —those used by two or more households—are excluded from the definition of “”improved sanitation”” regardless of the service level. The reason stems from concerns that shared facilities may be unacceptable in terms of cleanliness (shared toilets may not be as hygienic as private ones or they may result in increased contact with human waste) and accessibility (facilities may not be available at night, or during periods of high demand). However, shared facilities represent a large and growing proportion of sanitation options available in low-income countries, with approximately 761 million people using such facilities worldwide. As such, shared sanitation (including communal, public and neighbour-shared facilities) are considered by some to be the only realistic option for high-density populations in many urban slums.
The Joint Monitoring Programme, Coordinated by the WHO and UNICEF, is considering a revision to its policy that would include shared sanitation as “improved”—and thus scored toward the Millennium Development Goals and future targets— if the facility otherwise meets the definition of improved sanitation and is shared among no more than 5 families or 30 persons, whichever is fewer, and if the users know each other. While this proposed change is based on advice from an expert committee, a recent systematic review (see below) and analysis of DHS data that show shared sanitation to be associated with adverse health outcomes raise questions about the evidentiary basis for the change in policy.
Key reserach and contributions to this area:
A systematic review was done to assess the evidence of shared sanitation use and any health outcome. Studies included show a pattern of increased risk of adverse health outcomes associated with shared sanitation compared to individual household latrines. A meta-analysis of 12 studies reporting on diarrhoea found increased odds of disease associated with reliance on shared sanitation (odds ratio 1.44, 95% CI: 1.18-1.76). Therefore evidence to date does not support a change of existing policy of excluding shared sanitation from the definition of improved sanitation used in international monitoring and targets. However, such evidence is limited, does not adequately address likely confounding, and does not identify potentially important distinctions among types of shared facilities. As reliance on shared sanitation is increasing, further research is necessary to determine the circumstances, if any, under which shared sanitation can offer a safe, appropriate and acceptable alternative to individual household latrines.
Current reserach in this area:
Geographical and Demographic Scope of Shared Sanitation
This study aims to describe the prevalence and scope of households that report relying on shared sanitation and to characterize them in terms of selected socioeconomic and demographic covariates. The analysis includes 85 household surveys.
Cross Sectional Survey of Slums in Orissa, India
PhD student Marieke Heijnen has been conducting a cross sectional survey in 30 slum areas in Cuttack and Bhubaneshwar, Orissa, India. The aim of this research is to assess the actual types of shared sanitation facilities used in this context and how these users differ from people with private latrines, taking into account socio-economic, microbiological and demographic factors.
Shared Sanitation and Diarrhoea
A piece of work which is done in collaboration with members of the EHG aims to assess the association between shared sanitation use and diarrhoea prevalence in children under 5 years, using household survey data from 50 Demographic and Health Surveys.
Publications related to shared sanitation:
- Heijnen, M., Cumming, O., Peletz, R., Ka-Seen Chan, G., Brown, J., Baker, K., Clasen, T. Shared Sanitation versus Individual Household Latrines: A Systematic Review of Health Outcomes 2014, PLoS One, 9(4): e93300. doi:10.1371/journal.pone.0093300
- Fuller J, Clasen T, Heijnen M*, Eisenberg J (2014). Shared sanitation and the prevalence of diarrhea in young children: evidence from 51 countries, 2001-2011. Am. J. Trop. Med. Hyg pii: 13-0503.
- Exley JL, Liseka B, Cumming O, Ensink JH. The sanitation ladder, what constitutes an improved form of sanitation? Environ Sci Technol. Jan 20 2015;49(2):1086-1094. Click here to view a a presentation on this paper.