The experience of the first sanitary revolution: Are there lessons for today's global sanitation crisis?
The stench and filth of 19th-century London, especially from the discharge of raw sewage into the Thames, broke through inhibitions concerning bodily wastes to prompt a sanitary revolution. In today's world, around 1 billion people in even more rapidly expanding towns - and many more in rural areas - face a similar crisis. They are without toilets, let alone mass waste disposal systems, to deal with daily requirements for personal convenience, human dignity, and threats to public health. Yet this excretarelated crisis is rarely aired, and appropriate solutions are hopelessly under-funded. Somehow the Victorians conquered their squeamishness and committed major resources to the cleansing of urban space. This experience coloured the subsequent history of public health engineering, mostly for good but not invariably so. What was the impulse that allowed the problem to be addressed, and are there lessons to be learned that could inform the sanitary revolution so needed elsewhere today?
Solutions to the quest for rapid WASH service spread, while at the same time consolidating service sustainability, still remain elusive. In the Democratic Republic of Congo (DRC), despite acute social and economic problems, depletion of infrastructure, ongoing civil war, and severe cholera outbreaks, a donor-supported Ministry of Health ‘Healthy village, Healthy school’ (Ecole et Village Assainis) programme has achieved remarkable results. After five years, over 2,300 villages have been declared ‘assaini’, as have 800 schools, as a result of genuine community-based action. Diarrhoeal disease has been reduced by 80 per cent, with assaini villages proving resistant to cholera infection. But the speed of programme take-up is far slower than needed to reach the MDG for 2015; and a longer and costlier process of input and follow-up is needed to sustain services and health gains. What will it take to boost take-up and consolidate the ‘clean and healthy’ lifestyle?