Exploring exposure risk and safe management of container-based sanitation systems: a case study from Kenya
Little has been studied about the potential risks and hazards arising from the use and operation of container-based sanitation (CBS) systems. Building on existing risk assessment frameworks, this case study aimed to identify exposure risks from faecal pathogens and relevant control measures in a CBS service chain. The case study employed a mixed-methods approach that included environmental sampling, key informant interviews, and direct observation. This inclusion of a behavioural dimension reflects a socio-cultural approach to risk analysis that is less evident in overtly quantitative approaches to risk assessment that are typical of the health risk field. Data from this case study was collected in Naivasha, Kenya in July 2016. The hazard intensity and role of specific transmission routes was validated by environmental sampling, which found a high level of faecal contamination on toilet surfaces and a consequent high risk of hand-to-mouth infection for users and operators. The hazard analysis identified nine critical control points where exposure risks may be either prevented or reduced via the implementation of relevant control measures. We discovered that the production of exposure risks was related to multiple, inter-related causal mechanisms and risk factors, findings we expect will guide approaches to exposure risk management in the future.
Classifying occupational exposure risks and recommendations for their control in container-based sanitation systems
This practice paper concerns the management of occupational exposure risks during the operation of container-based sanitation (CBS) systems. The paper reports on findings based on three different CBS systems. An exposure risk assessment was conducted in each case study following a methodology adapted from the WHO Sanitation Safety Planning (SSP) Framework. The specific methods of data collection comprised a risk assessment workshop, as well as in-depth interviews and sanitary surveys to support and explain the findings from the risk assessment workshops. The analysis of the occupational exposure risks classified exposure risks into four categories of ‘drivers’ of exposure risk. These ‘drivers’ were supported by relevant secondary literature of exposure risk studies. The classification of hazardous events and exposure risks in CBS systems recognized: (1) the role of technical design and maintenance and condition of facilities, as well as manual aspects of labour; followed by (2) human behaviour; (3) system performance; and (4) physical environment. This classification is expected to simplify the exposure risk management process and provides a framework for the subsequent identification and management of occupational exposure in CBS systems. The framework is an additional tool within the sanitation safety planning toolkit to measure and manage exposure risks and thereby ensure safe sanitation performance. This research addresses a current knowledge gap in occupational exposure risks in CBS systems. The integration and use of these results in an adapted SSP framework may build a stronger business case for the adoption of CBS systems in city-wide urban sanitation sector planning.