Water and Sanitation in Africa, Introduction and Toilet Tech

“The hospitals refused to take in new patients, as they were already too full, even the verandas of the hospitals were filled with people. In some cases people burnt the dead with all their belongings, as they were afraid of the disease spreading” - recalled Father Joseph on Madagascar's Cholera epidemic

Cholera outbreaks like the one described above are facilitated by Inadequate sanitation. I chose to write about sanitation because it is fundamental to a healthy society, underpinning development(Tseole et al., 2022). Inadequate sanitation causes 115 deaths per hour in Africa, It is the main contributor to the crisis of diarrheal diseases- the leading factor in child mortality globally(Boschi-Pinto et al., 2006). 150,000 children die every year from such diseases in Nigeria alone(Jiwok et al., 2021). Africa has a sanitation crisis, a minority of people have access to adequate sanitation.

What is it? Sanitation pertains to those public health conditions concerning safe drinking water and the disposal of sewage. Good sanitation ensures a separation between human waste and water and food sources without which bacteria and viruses run rampant. There should be blocks to any faecal-oral route, see figure 1. Clearly, The importance of access to water, sanitation, and hygiene (WASH) cannot be underestimated. 

Figure 1: Fecal-oral transmission pathway. Based on Wagner & Lanoix, 1958

Figure 2: the percentage of people with access to improved sanitation, source

 Wainaina's scathingly satirical piece reminds us of the damaging narratives so common in western writing on Africa(Wainaina, 2005). Narratives that are rooted in neo-colonial imaginaries of the continent where white saviourism is predominant, portraying the continent in perpetual need for western intervention. In this blog, I will attempt to be cognizant of this neo-colonial perspective so common when looking at issues in Africa and utilise the work of African scholars.

Toilet tech 
Open defecation is the primary driver of sanitation related disease, toilets are key to separating the lived environment from faecal waste. 

Pit latrines reign supreme! or do they? They are a cheap and basic form of toilet, effectively an open hole in the ground. They can be vectors for dangerous flies called Chrysomya putoria-  the African latrine blowfly, which spread disease(Lindsay. et al, 2013), to avoid that requires building a special ventilated improved pit(VIP) latrine that prevents the flies entering and breeding.  Western style flushing toilets are often inappropriate, they use vast amounts of water and don't utilise faecal matter that could be productive. EcoSan toilets are the opposite, see Figure 3, the goal is to return excreta to the soil when its decomposed and safe, the nutrient rich excreta can improve crop productivity(Wirbelauer et. al, 2003). Maintaining that system can be too expensive for the rural poor in the long term, subsidies are likely necessary(ibid). These are inappropriate for the urban poor who don't have fields to use the excreta on. 

Figure 3, the operation of an EcoSan toilet: source