WHO decides what is meant by 'improved'?

In my last post I highlighted some of the concerns regarding the effectiveness of 'improved' water and sanitation services in meeting UN targets of providing safe and affordable drinking water and adequate and equable sanitation and hygiene for all. In this post I want to unpick the term 'improved' even further, by looking at who decides whether a source of water or sanitation is 'improved' and on what criteria this decision is based.

Figure 1

The task of monitoring the provision of water and sanitation services supplied by the Millennium Development Goals and the Sustainable Development Goals is the responsibility of the Joint Monitoring Programme (JMP) which is run jointly by the WHO and UNICEF. It is the JMP that decides how drinking water and sanitation services are classified (Figure 1). In Annex 1 of the UN report "25 Years Progress on Sanitation and Drinking Water" the JMP is described as having "benefitted enormously from the support and advice of experts, policymakers and practitioners working in the field of drinking water, sanitation and hygiene"..."to provide technical advice on specific issues and methodological challenges related to monitoring the MDGs" (p50). Although these experts have undoubtedly provided a wealth of useful information to the JMP, there appears to be no mention of any advice provided by those targeted by the goals themselves.

The concept of participatory development has been prominent within developmental rhetoric since the early 1990s. Guijt and Shah define participatory development as the involvement of "socially and economically marginalised peoples in decision making over their own lives" (1998: p1). It advocates for a bottom-up approach to development practice in which the views of those targeted by the practice are used to ensure that development plans are in-keeping with the needs and wants of the local people.

In a study conducted by Schouten and Mathenge (2010) based on the results of a case study in the Kibera slum attached to Nairobi, concern was raised regarding the lack of inclusion of local people in determining what does, and what does not, constitute an improved sanitation facility. A key issue for prospective sanitation providers in slum areas is determining the most appropriate sanitation facility given the circumstances of the area. For the Kibera slum, a number of potential facilities are identified such as VIP latrines, pour-flush latrines, WC toilets and biogas toilets. Whether or not one of these facilities is more appropriate than another is determined by the prevailing local conditions and environmental, social and economic considerations. However, since this decision is in the hands of the service provider, there is a risk that it will be made without the consultation of the local community, with whom the decision should ultimately lie. Evidence provided in the study indicates that in many cases, the opinions of those who stand to gain/lose the most from these decisions are often not listened to. Instead it appears that providers tend to fall back on the JMP definition of what constitutes an 'improved' sanitation facility when making their decisions, regardless of whether this is the best option for the individual location in question. In the case of Kibera, this involves ignoring the option of communal toilets because they do not officially fall within the classification of an 'improved' sanitation facility. Yet as noted by Schouten and Mathenge and others, communal toilets are often the only viable option for sanitation provision in slums where piped sewage systems are simply not possible to install. Furthermore, the biogas toilets that were found to be widely advocated by government organisations for Kibera, proved to be very unpopular with the local people because they smelt far worse than the other facilities.

Perhaps then the WHO/UNICEF should reconsider their classifications of water and sanitation services. If the existing classification is holding back the progress of service provision, as in the case of Kibera, a more inclusive system should be adopted that uses local knowledge to determine which service options are the most appropriate. Treating locals as 'experts in their own realities' rather than relying on the views of experts in the traditional sense, may prove to be the most effective way of supplying water and sanitation services in a format that benefits the local people to the greatest extent.