scholarly journals Safely Managed On-Site Sanitation: A National Assessment of Sanitation Services and Potential Fecal Exposure in Indonesia

2021 ◽  
Vol 18 (15) ◽  
pp. 8204
Author(s):  
Mitsunori Odagiri ◽  
Ann Thomas ◽  
Maraita Listyasari ◽  
Freya Mills ◽  
Robert E. S. Bain ◽  
...  
Keyword(s):  
Population Density ◽  
Universal Access ◽  
Wealth Quintile ◽  
Multivariate Regression Analysis ◽  
Current Status ◽  
Septic Tank ◽  
Middle Income ◽  
Septic Tanks ◽  
Sanitation Services ◽  
Sanitation Systems

Sustainable Development Goal target 6.2 calls for universal access to adequate and equitable sanitation, setting a more ambitious standard for ‘safely managed sanitation services’. On-site sanitation systems (e.g., septic tanks) are widely used in low- and middle-income countries (LMICs). However, the lack of indicators for assessing fecal exposure risks presents a barrier to monitoring safely managed services. Furthermore, geographic diversity and frequency of disasters require a more nuanced approach to risk-informed decision-making. Taking Indonesia as an example, the purpose of this paper is to provide insights into current status and practices for on-site sanitation services in the contexts of LMICs. Using a dataset from a national socio-economic survey (n = 295,155) coupled with village census (n = 83,931), we assessed (1) household sanitation practices across Indonesia stratified by city-level population density and meteorological factors, (2) factors associated with septic tank emptying practice, and (3) inequalities in potential fecal exposure as measured by population density and WASH access by wealth quintile. We found a high reliance on on-site sanitation facilities (80.0%), almost half of which are assumed to be ‘uncontained’ septic tanks and one in ten facilities discharging untreated waste directly into the environment. The most densely populated areas had the highest rates of septic tank emptying, though emptying rates were just 17.0%, while in the lowest population density group, emptying was rarely reported. Multivariate regression analysis demonstrated an association between flooding and drought occurrence and septic tank emptying practice. Higher groundwater usage for drinking among poorer households suggests unsafe sanitation may disproportionally affect the poor. Our study underscores the urgent need to strengthen the monitoring of on-site sanitation in LMICs by developing contextualized standards. Furthermore, the inequalities in potential fecal exposure require greater attention and tailored support mechanisms to ensure the poorest gain access to safely managed sanitation services.

scholarly journals The how tough is WASH framework for assessing the climate resilience of water and sanitation

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Guy Howard ◽  
Anisha Nijhawan ◽  
Adrian Flint ◽  
Manish Baidya ◽  
Maria Pregnolato ◽  
...  
Keyword(s):  
Climate Change ◽  
Rural Communities ◽  
Universal Access ◽  
Small Towns ◽  
Water And Sanitation ◽  
Middle Income ◽  
Sanitation Services ◽  
Middle Income Countries ◽  
Measurement Framework ◽  
Low And Middle Income

AbstractClimate change presents a major threat to water and sanitation services. There is an urgent need to understand and improve resilience, particularly in rural communities and small towns in low- and middle-income countries that already struggle to provide universal access to services and face increasing threats from climate change. To date, there is a lack of a simple framework to assess the resilience of water and sanitation services which hinders the development of strategies to improve services. An interdisciplinary team of engineers and environmental and social scientists were brought together to investigate the development of a resilience measurement framework for use in low- and middle-income countries. Six domains of interest were identified based on a literature review, expert opinion, and limited field assessments in two countries. A scoring system using a Likert scale is proposed to assess the resilience of services and allow analysis at local and national levels to support improvements in individual supplies, identifying systematic faults, and support prioritisation for action. This is a simple, multi-dimensional framework for assessing the resilience of rural and small-town water and sanitation services in LMICs. The framework is being further tested in Nepal and Ethiopia and future results will be reported on its application.

Integrated Assessment of the Feasibility of Community Based Sanitation Options: A Case Study from East Java, Indonesia

2010 ◽  
Vol 5 (4) ◽  
Author(s):  
M. Starkl ◽  
I. Bisschops ◽  
A. Norström ◽  
A. Purnomo ◽  
A. Rumiati
Keyword(s):  
Rural Areas ◽  
Integrated Assessment ◽  
Community Based ◽  
Septic Tanks ◽  
Sanitation Services ◽  
Biogas Plants ◽  
The One ◽  
Sanitation Systems ◽  
Risk Potential

In Indonesia 66 million people practice open defecation, which is the second highest number of people in one single country following India. Indonesia lacks sanitation services, in particular in rural areas. Data from the national statistics bureau show that almost 33% of the population in rural areas have no sanitation facilities. This study looked at alternative sanitation options in a community in East Java. Its aim was to evaluate the feasibility of different sanitation options, to conduct an integrated assessment of those options, and to identify the community perceptions of those options. The investigated technologies encompassed on the one side locally widely spread and accepted technologies (such as septic tanks), and on the other, new but promising concepts which have not yet been well established in Indonesia (such as biogas plants or ecosan systems). The study has shown that despite the high costs (NPV), the high hygienic risk potential and low environmental performance, septic tanks were most preferred by the community. Generally, those options which performed best in the assessment (community and decentralized sanitation systems) were least preferred by the community.

scholarly journals Access to Water and Sanitation Services in Brazilian Vulnerable Areas: The Role of Regulation and Recent Institutional Reform

Water ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 787 ◽  
Author(s):  
Daniel Antonio Narzetti ◽  
Rui Cunha Marques
Keyword(s):  
Universal Access ◽  
Institutional Reform ◽  
Public Authorities ◽  
Water And Sanitation ◽  
Middle Income ◽  
Sanitation Services ◽  
Middle Income Countries ◽  
Access To Water ◽  
The Impact

Access to water and sanitation services (WSSs) in low- or middle-income countries is constrained by the poverty and vulnerability conditions of the population. In this context, it is urgent to establish public policies for WSSs that will increase the economic access to these services so that they will be more comprehensive and comprise the entire population, ensuring a balance between social and financial objectives. This paper contributes to a better understanding of the provision of WSSs in vulnerable areas and of the difficulty in achieving universal access using Brazil as a case study. The role of regulation in the provision of WSSs in vulnerable areas and the impact of the recent institutional reform that took place last year in that country is discussed. The different experiences analyzed provide interesting lessons that contribute to the improvement of the Brazilian status quo and that, at the same time, can be good practices that can be applied in other countries. One of the main conclusions of this research is related to the contributions that regulation should provide in the universalization of WSSs, mainly when the provision of these services is ruled by a contract. Furthermore, we observed that public authorities have resigned their role in this scope and that they must be more effective and, particularly, more proactive so that universalization can be achieved.

scholarly journals Infrastructure governance in the post-networked city: State-led, high-tech sanitation in Addis Ababa’s condominium housing

2021 ◽  
pp. 239965442110370
Author(s):  
Liza Rose Cirolia ◽  
Tesfaye Hailu ◽  
Julia King ◽  
Nuno F da Cruz ◽  
Jo Beall
Keyword(s):  
Addis Ababa ◽  
Methodological Approach ◽  
Mass Scale ◽  
The State ◽  
Rapid Expansion ◽  
High Tech ◽  
Middle Income ◽  
Lower Middle Class ◽  
City State ◽  
Sanitation Systems

Ethiopia’s mass-scale subsidized housing delivery programme has driven the rapid expansion of middle-income, mid-rise settlements on the outskirts of Addis Ababa, requiring the provision of infrastructure to newly developed areas. In the case of the Kotari housing project, established sanitation systems were deemed inappropriate for the site, resulting in the deployment of novel technology, a Membrane Bioreactor (MBR). Such decentralised technologies contribute to the heterogenous infrastructure configurations which characterise Addis Ababa’s sanitation landscape, reflected not only in material configurations but also in how they are governed. In this paper, we use the concept of ‘infrastructure interfaces’ as an analytical device to identify the key material connection points in the system. Working across scales, we scrutinise the governance arrangements at these critical junctures: the household, the block, the condominium, and the city. Our analysis challenges established understandings of infrastructural heterogeneity driven by the private sector, either through financialized elite infrastructures or informal survivalist practices. In Kotari, the state is the driver and the target is the lower middle class. Centring the state in these infrastructure configurations provides nuance to our understanding of how heterogeneity emerges. Our methodological approach accounts for governance at various scales, providing fresh insights into the relationality of infrastructure, particularly the human/technology interface and infrastructural failures. The case shows the importance of transcending binary readings of infrastructure configurations, such as on/off grid, state/private and formal/informal. Future work on the post-network city must go beyond simply denigrating or valorising alternative modes of service delivery.

Drivers of sustained sanitation access: social network and demographic predictors of latrine reconstruction after flooding disasters

2021 ◽  
Vol 7 (10) ◽  
pp. 1861-1872
Author(s):  
Katherine G. Chambers ◽  
Amanda R. Carrico ◽  
Sherri M. Cook
Keyword(s):  
Social Network ◽  
Universal Access ◽  
Sanitation Services ◽  
Demographic Predictors

Flooding disasters pose a threat to sanitation services and can result in loss of access that exacerbates challenges to achieving universal access.

scholarly journals Medical Education and Training Within Congenital Cardiology: Current Global Status and Future Directions in A Post COVID-19 World

2021 ◽  
pp. 1-40
Author(s):  
Colin J. McMahon ◽  
Justin T. Tretter ◽  
Andrew N. Redington ◽  
Frances Bu’Lock ◽  
Liesl Zühlke ◽  
...  
Keyword(s):  
Medical Education ◽  
Vital Role ◽  
Current Status ◽  
Technology Enhanced Learning ◽  
Middle Income ◽  
Critical Reasoning ◽  
Professional Activities ◽  
Competency Frameworks ◽  
Medical Education And Training ◽  
Global Status

Abstract Despite enormous strides in our field with respect to patient care, there has been surprisingly limited dialogue on how to train and educate the next generation of congenital cardiologists. This paper reviews the current status of training and evolving developments in medical education pertinent to congenital cardiology. The adoption of competency-based medical education has been lauded as a robust framework for contemporary medical education over the last two decades. However, inconsistencies in frameworks across different jurisdictions remain, and bridging gaps between competency frameworks and clinical practice has proved challenging. Entrustable professional activities have been proposed as a solution but integration of such activities into busy clinical cardiology practices will present its own challenges. Consequently, this pivot toward a more structured approach to medical education necessitates the widespread availability of appropriately trained medical educationalists; a development that will better inform curriculum development, instructional design, and assessment. Differentiation between superficial and deep learning, the vital role of rich formative feedback and coaching, should guide our trainees to become self-regulated learners, capable of critical reasoning yet retaining an awareness of uncertainty and ambiguity. Furthermore, disruptive innovations such as ‘technology enhanced learning’ may be leveraged to improve education, especially for trainees from low- and middle-income countries. Each of these initiatives will require resources, widespread advocacy and raised awareness, and publication of supporting data, and so it is especially gratifying that Cardiology in The Young has fostered a progressive approach, agreeing to publish one or two articles in each journal issue in this domain.

Midwifery leadership, advocacy and action to improve maternal health in PNG

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
H Hall ◽  
J Kep ◽  
J Brown ◽  
J Pyakalyia ◽  
R King ◽  
...  
Keyword(s):  
Maternal Health ◽  
Peer Support ◽  
Leadership Training ◽  
Maternity Care ◽  
Universal Access ◽  
Middle Income ◽  
Improvement Project ◽  
Middle Income Countries ◽  
Low Middle Income Countries ◽  
Innovative Model

Abstract Background The SDG target for maternal mortality is less than 70 per 100,000 live births; in Papua New Guinea, it is estimated to be 145. PNG will require significant resources and strong leadership to meet the 2030 target. The PNG Midwifery Leadership Buddy Program (Buddy Program), funded and coordinated by Rotary, offers an innovative model to improve maternal health, which may be transferable to other low-middle-income countries. Objectives The Buddy Program aims to build midwifery leadership resulting in improved outcomes in PNG. As partners, midwives from PNG and Australia undertake leadership training in Port Moresby and enter a reciprocal peer support relationship. Over 12 months, they support each other in their professional roles and progress a quality improvement project. Results Three cohorts of midwives (18 from each country), have participated in the leadership training and the first group has completed 12 months of peer support. Participants have reported increased confidence for leadership, action and advocacy. There has been some communication challenges and variation in expectations, predominately due to cultural differences. The Buddy Program has resulted in a number of tangible projects including the introduction of family planning education at a local school and University, introduction of respectful care in pregnancy charter and increased surveillance and treatment of pregnant women with anaemia. Interestingly, a number of participants have continued to support each other beyond the initial 12-month commitment. Conclusions Supportive partnerships that grow midwifery leadership hold significant potential to increase the quality of maternity care and reduce preventable maternal deaths in low-middle-income countries. Key messages Midwifery leadership plays a vital role in addressing the SDG targets for maternal health. The Buddy Program offers an innovative model to progress the agenda for universal access to quality maternity care.

scholarly journals Rural–Urban Disparities in Access to Improved Sanitation in Indonesia: A Decomposition Approach

SAGE Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 215824402110299
Author(s):  
Sri Irianti ◽  
Puguh Prasetyoputra
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Universal Access ◽  
Decomposition Analysis ◽  
Multivariate Regression Analysis ◽  
Probit Regression ◽  
Decomposition Approach ◽  
Explanatory Variables ◽  
Improved Sanitation ◽  
The Government

One of the targets in the Sustainable Development Goals (SDGs), which is Target 6.2, aims to achieve access to adequate and equitable sanitation. The Government of Indonesia targets universal access to improved sanitation in 2019. However, almost two out of five households in Indonesia are without access to improved sanitation. Moreover, access to improved sanitation is lower in rural areas than that in urban areas. Studies examining the drivers of the disparity in Indonesia are also limited. Therefore, this study was aimed at assessing the characteristics associated with the rural–urban disparity in access to improved sanitation facilities among households in Indonesia. We employed data from the 2016 Indonesian National Socio-Economic Survey (SUSENAS) comprising 290,848 households. The analysis was twofold. First, we fitted multivariate probit regression models using average marginal effects as the measure of association. We then conducted a detailed non-linear decomposition of the rural–urban disparity attributable to all the explanatory variables. The multivariate regression analysis suggested that households living in rural areas were 11.35% (95% confidence interval = [10.97, 11.72]) less likely to have access to improved sanitation facilities than those residing in urban areas. The decomposition analysis suggested that 48.78% are attributable to spatial, demographic, housing, and socio-economic factors, which meant that almost half of the inequalities could be reduced by equalizing these factors. The results provide a decomposition of factors amenable to curtail urban–rural inequalities. Hence, equity-oriented approaches to increasing access to improved sanitation should be prioritized to achieve universal access in 2030 in line with SDG Target 6.2.

Securing 2020 vision for 2030: climate change and ensuring resilience in water and sanitation services

2010 ◽  
Vol 1 (1) ◽  
pp. 2-16 ◽  
Author(s):  
Guy Howard ◽  
Katrina Charles ◽  
Kathy Pond ◽  
Anca Brookshaw ◽  
Rifat Hossain ◽  
...  
Keyword(s):  
Climate Change ◽  
Drinking Water ◽  
Water Supply ◽  
Climate Changes ◽  
Water And Sanitation ◽  
Sanitation Services ◽  
Development Goals ◽  
Management Approaches ◽  
Sanitation Systems ◽  
Water Supply And Sanitation

Drinking-water supply and sanitation services are essential for human health, but their technologies and management systems are potentially vulnerable to climate change. An assessment was made of the resilience of water supply and sanitation systems against forecast climate changes by 2020 and 2030. The results showed very few technologies are resilient to climate change and the sustainability of the current progress towards the Millennium Development Goals (MDGs) may be significantly undermined. Management approaches are more important than technology in building resilience for water supply, but the reverse is true for sanitation. Whilst climate change represents a significant threat to sustainable drinking-water and sanitation services, through no-regrets actions and using opportunities to increase service quality, climate change may be a driver for improvements that have been insufficiently delivered to date.

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