Azara Blog: Water and sanitation in the developing world

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Date published: 2006/02/15

The second lecture of the university's Fourth Annual Lecture Series in Sustainable Development (2006) was given today by Sandy Cairncross of the London School of Hygiene and Tropical Medicine. His title was the rather long-winded "From hardware to hygiene behaviour: an engineering odyssey into water and sanitation". It was mainly his recollection of his experience working in water and sanitation in the developing world. He's an engineer so had something to say.

He mentioned examples from Losotho to Mozambique to Brazil to India to Ghana. One of his important observations was that you need a functioning local government in order to sustain a town's water supply. Needless to say this is a big problem in many parts of the developing world.

He pointed out that with water supply you can worry about quality and quantity. But it seemed that for people within half an hour of water, the quantity of water consumed was not correlated with the time it took to get the water. But he also gave a scary statistic that almost half the world is more than half an hour from a water supply.

He then went onto sanitation. Apparently almost by accident he helped design and market a slab used to cover latrines in Mozambique. Starting in 1980 the take-up grew slowly but by 1995 had reached sales of 25000 per year. It seems that health was not the selling point for latrines, rather other things like prestige, convenience and security (the latter in particular important for women). As Cairncross mentioned, this is not really any different from anywhere else, as in the developed world people don't buy shoes based on reasons of health but more based on fashion.

His tips gathered from his experience with this venture were:

It seems that the introduction of drains and sewers have been shown (not surprisingly) to reduce disease transmission around the world, but that this takes place in the public domain, which doesn't necessarily make things better in the private (domestic) domain (and there was evidence of that). So it was important to look not just at industrial plant but also at the situation of people in their homes (apparently something which many consultants miss).

Then he said that the most important thing for world health was to get people to wash their hands with soap. He showed various bits of evidence this was true. Perhaps the most interesting aspect of this idea was that it provided a big opportunity for public-private partnership. In particular soap manufacturers could work with government to improve health, and both sides would win. It seems the soap manufacturers thought of soap as a beauty rather than a health product, so in fact were happy to be seen to help save lives (and make money at the same time).

Someone asked about using ash or mud instead of soap, and Cairncross said that they were almost as effective, perhaps because of all the rubbing action you needed just to get the muck of your hands. No doubt the soap manufacturers wouldn't want to spread that message too far.

Someone else asked about other possible public-private partnerships. Cairncross said he thought the most likely new examples would be in sanitation, and he seemed fairly keen on this whole approach.

Amusingly at the end he said he had studied the behaviour of people at the London School of Hygiene and Tropical Medicine and found many did not wash their hands with soap after going to the toilet. Apparently the bureaucrats stopped this study because it was deemed unethical. But it just goes to show that many people do not really think about health issues, even in the developed world.

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