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.
Designing stakeholder consultations for institutional change: a case study from Ghana’s sanitation sector
This article evaluates the stakeholder consultation process that was undertaken to support decision-making for the new sanitation authority to be established in Ghana. This initiative of creating a specialized authority – currently referred to as the National Sanitation Authority (NSA) – emerges from the need to restructure the sector in Ghana, like in many other countries worldwide. From the learning of this study we seek to inform research and practice around the design of stakeholder consultation methods in institutional restructuration contexts. The consultation process gathered views on different aspects of the NSA, including its functions, the administrative level(s) at which it should operate, and its financing. A stakeholder analysis, a series of workshops, and key informant interviews were conducted. A tool was developed to track representativeness of participants involved in the process. Principles of stakeholder engagement developed by the Organisation for Economic Cooperation and Development informed the methodology. This consultation process highlighted the challenges of undertaking sector restructuration where responsibilities are shared between many entities, and with varying levels of interest in the planned reforms. Divergent opinions emerged on the proposed functions of the NSA, some of which represent direct conflicts of interest: for example, setting regulations, developing infrastructure, and financing. Key lessons from the consultation include the need for efficiency when targeting informants through rapid identification of key stakeholders. However, this must be balanced with inclusivity and representativeness, which require continuous tracking of who participates, paired with flexibility to maximize potential for reaching consensus that enables the strengthening of the sanitation sector.
‘Achieving sustained environmental health improvements in Freetown through faecal sludge management enterprises’ was a partnership project between Freetown City Council (FCC), International Water Association (IWA), and GOAL. This project aimed to improve faecal sludge management (FSM) through public – private partnerships and improved financial flows to ensure viability of businesses. A market assessment was conducted in Freetown which considered demand and supply for FSM services. This paper discusses findings from the household survey which was a key component of the market assessment. While the households felt that they were getting value for money for existing services, they were not satisfied with existing services and hence were willing to pay higher prices for improved services. This highlights the importance of quality service provision in relation to revenue generation. Improved pit emptying services was noted to be of high priority to households. In order to improve pit emptying services the FSM strategy proposed intermediate transfer stations and formation of a Sanitation Unit and Contact Centre within FCC.