National Sanitation Policy White Paper: Draft

Foreword

Preface

A: Introduction

B: National sanitation policy

C: Immediate next steps

D: Summary

E: Annexure describing sanitation technologies

 

 

 

FOREWORD to this Draft White Paper

The Water Supply and Sanitation Policy White Paper of the Department of Water Affairs and Forestry addressed sanitation policy but acknowledged that further work was required. It also noted that the nature of sanitation was such that other Departments would have to be involved.

After subsequent Ministerial consultations, an inter-Departmental National Sanitation Task Team (NSTT) was established to initiate the process of policy formulation and the subsequent development of strategy proposals for implementing the policy.

The present document is the product of the first stage of the NSTT's work. It is intended to serve as the basis for the next stage of the policy formulation process: detailed consultation with interested parties.

It is intended to present and discuss the approaches described in the document in a series of meetings to be held in all provinces before the end of March 1996. Once these consultations have been concluded and the inputs processed, a National Sanitation Conference will be held at which the final draft will be presented and discussed. It will then be submitted to the respective principals for approval.

"Sanitation" can encompass a wide range of activities, many of which require government policy guidance. In order to make an immediate contribution, this document concentrates on the most pressing of issues namely the safe disposal of human waste and domestic waste water.

There are a number of related issues that require policy and direction, in particular, the management and disposal of domestic and other solid waste. Recognizing that there are constraints on the rate of progress that can be made, this document is intended only as one more step on the long road of improving the quality of life of the people of our country.

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PREFACE

This draft white paper addresses a subject that intimately affects every one of us. It is not simply a matter of government providing toilets.

To deal with sanitation requires the co-operation of a number of agencies and government departments.

That is why we have taken the unusual step of making this a draft white paper issued jointly by several ministries.

Prof. Kader Asmal, MP
Minister of Water Affairs and Forestry

Prof. Sibusiso Bengu, MP
Minister of Education

Dr. Dawie de Villiers, MP
Minister of Environmental Affairs and Tourism

Dr Nkosasana Dlamini-Zuma, MP
Minister of Health

Roelf Meyer, MP
Minister of Provincial Affairs and Constitutional Development

Dr Sankie Mthembi-Nkondo, MP
Minister of Housing

 

Republic of South Africa November 1995

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SECTION A: INTRODUCTION

This policy paper starts where the previous White Paper on Water Supply and Sanitation Policy ended. The first white paper acknowledged that there was more work to be done to clarify many items of policy, and then to develop a national sanitation strategy, hence the need for a white paper dealing exclusively with sanitation.

It is generally agreed that the White Paper on Water Supply and Sanitation Policy published in November 1994 was a significant contribution to development in South Africa. For the first time in this country the needs of all South Africans were being addressed, in a way that is sensitive to the aspirations of the people, and to the growing constraints on resources - both economic and environmental.

This paper addresses the same key issues: the needs and aspirations of ordinary people, in particular the need for healthy living conditions, and the constraints on service delivery, especially the economic and environmental ones. These issues are inextricably linked and require an integrated approach, which this paper attempts to portray.

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THE SANITATION ISSUE

The question of sanitation, perhaps more than most development issues, needs to be seen in the context of an integrated development strategy. The impact of inadequate sanitation services on a variety of sectors needs to be fully understood. These include the impact on the water resources of the country, particularly water quality, and the impact on the health and well being of the population. It is for these reasons that water supply and sanitation are inextricably linked to the broader development process, and that is why Government seeks to fulfill its responsibility of assuring that all South Africans have access to adequate sanitation services.

Several Departments have worked in close co-operation in formulating this policy. They will continue to work together in planning, implementing and monitoring subsequent programmes. Central Government will also work closely with Provinces to assist local authorities where necessary both to ensure that adequate services are developed and to ensure that water quality is not compromised through inadequate or ineffective waste treatment.

Sanitation goes far beyond the issue of toilets, although safe disposal of human excreta and other domestic waste water is a major and necessary requirement for safe sanitation. Personal, family and cultural hygiene practices and habits are critical. If these are unsound the upgrading of physical toilet facilities alone will not solve the problem. Therefore sanitation improvement encompasses an entire process, aimed at the home and the individual, which must include health and hygiene education as well as improving the physical infrastructure of toilet facilities, water supply and disposal of domestic waste water. (See Figure 1.)

An estimated 21 million South Africans do not have access to adequate sanitation facilities. The estimated number of people who do not have adequate sanitation in urban areas is 7,67 million (31%). Some 2 million people still have to rely on the bucket system which is generally not an acceptable system from a health perspective or in terms of community acceptance. Only rough estimates of service levels are available from the rural areas. It is estimated that in these areas 14,1 million people do not have adequate sanitation services which is 85% of the rural population.

Everybody uses some form of sanitation facility every day. Those millions numbered above who do not have "safe sanitation" may be using the inadequate bucket system, unimproved pit latrines or the veld. In addition there is a disturbing increase in inadequately designed or operated waterborne sewerage systems where the impact of failure on the health of the community and the pollution of the environment is extremely serious. Inadequate lower levels of services may well pose less of a threat than failed high level services.

These inadequate facilities, combined with unhygienic practices and a general lack of formal water supplies, as well as safe disposal of other domestic waste water, represents South Africa's sanitation problem.

The effects of the sanitation problem are threefold:

• Health impact - the impact of the conditions, represented by the statistics presented above, on the health of the urban and rural poor is significant in terms of the quality of life, and the education and development potential of communities, although difficult to determine accurately.
• Economic impact - the effect on household economies is serious, keeping families in the cycle of poverty, illness, illiteracy and lost income. The national cost of lost productivity, reduced educational potential and curative health costs is a major drain on the local and national economy.
• Environmental effects - inadequate sanitation leads to dispersed and diffuse pollution of water sources resulting in the water/faecal disease cycle for communities with untreated water supplies, and increased downstream water treatment costs.

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BACKGROUND TO THIS POLICY

Until recently policy thinking on sanitation in South Africa has been very limited due to simplistic thinking on the needs of the "haves" - those with full urban services, including waterborne sewerage, whether affordable to the consumer or not; and the "have-nots" - those with on-site solutions which were apparently not worthy of engineers' or planners' proper attention. Many mistakes have been made, at great cost in terms of money and human discomfort, but without much direct benefit to the neglected or abused "have-nots".

Some far-sighted persons sought to change this in recent years. The Water Research Commission stepped up its funding of research on sanitation for developing communities since about 1990, supported by the Water and Sanitation 2000 Group and SCOWSAS (Standing Committee On Water Supply And Sanitation). The SCOWSAS Sanitation Sub-committee began the development of policy options for the improvement of sanitation, and the Mvula Trust sponsored a review of rural sanitation and a series of pilot projects. These developments were recognised in the White Paper on Water Supply and Sanitation Policy, and by the authors of the original RDP Manifesto and subsequent white paper, where the improvement of household sanitation was accorded a high priority.

This policy work has been continued by the recently established National Sanitation Task Team whose terms of reference include the development of this white paper and subsequent strategies. It is recognised that sanitation is a broad subject, of concern to many departments and so the NSTT is an inter-departmental body which also includes experts from outside Government. It is also recognised that there are many unknowns in the business of improving sanitation for low income households. This policy paper is, therefore, not cast in concrete and whatever institutional arrangements are made must be structured so as to learn quickly from mistakes, through monitoring and evaluating their effectiveness, in order to adjust accordingly.

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SANITATION IS ABOUT HEALTH

The international Water Supply and Sanitation Collaborative Council Working Group on the Promotion of Sanitation has pointed out that millions of people die from diarrhoea every year. Many of these deaths could have been prevented by good sanitation. Diarrhoea is the primary cause of child deaths (1-4 years) in South Africa (27.4% in 1986), and the second greatest cause of infant deaths (under 1 year) after perinatal causes Furthermore, repeated episodes of diarrhoea result in a weak body, and can lead to malnutrition and stunted growth. Other major killer diseases such as typhoid and cholera and infections like parasites (e.g. worms, lice) and trachoma and conjunctivitis (eye infections) also result from poor sanitation and hygiene.

The major aim of national sanitation policy, and any consequent programme, is to contribute to improving the health and quality of life of the whole population. At present, significant investments are being made in the provision of safe water supplies for all. However, the health benefits that could result from this will be severely limited if adequate attention is not paid to the promotion of sanitation. Experience from national and international water and sanitation programmes has shown how essential it is to link water supply and sanitation with health and hygiene education. Only when all these are in place will real and lasting health benefits follow.

Because healthy and hygienic practices are so important for achieving lasting health benefits, sanitation improvement programmes can never be confined to the provision of toilets by government agencies. People must be convinced of the need for sanitation improvements; so much so, that they will invest their own resources into those improvements and then be concerned that all members of the family are using the facilities and using hygienic practices.

Under the Interim Constitution, the obligation upon central government is to ensure that :

"Every person shall have the right to an environment which is not detrimental to his or her health or well-being."

This paper confirms Government's commitment, at the highest level, to an appropriate, sustainable strategy for the improvement of health and quality of life through improved household sanitation and protection of the environment throughout the nation.

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KEY WORDS USED IN THIS PAPER

There has been much debate about the precise meaning of the key words used in discussions on sanitation. The following meanings have been adopted for the purposes of this paper. They are not the last word on the subject, but they are the results of the kind of compromises that take place when several professional disciplines co-operate to meet a common goal.

What is meant by the term "sanitation"? It means different things to different people. It could simply refer to the provision of toilets, but this may not produce any improvement in public health. For this we would need to add health education aimed at changing personal attitudes and practices. Is that sufficient? What about the disposal of wastewater, either at household or at municipal level? And what about solid wastes (household refuse, industrial waste)? Must we then also include the whole range of environmental issues? It is acknowledged that all these issues are inter-related and equally important. Therefore this paper adopts a broad definition.

For the purposes of this policy document:

The term SANITATION refers to the hygienic principles and practices relating to the safe collection, removal or disposal of human excreta, refuse and waste water, as they impact upon users, operators and the environment.

What is "adequate sanitation"? Opinions vary widely on this. We shall use a meaning which is about both physical facilities (toilets and associated system requirements) and practice.

For the purposes of this policy document:

The term ADEQUATE SANITATION for a household means the provision and ongoing operation and maintenance of a safe and easily accessible means of disposing of human excreta and waste water, providing an effective barrier against excreta-related diseases, which is used by all members of a household, and does not have an unacceptable impact on the environment.

This refers not only to facilities on the site of a household (toilets) and to any pipes, treatment works etc which may be part of a public or communal disposal system, but also to the successful operation of the facilities and system. While the general term "sanitation" includes reference to refuse disposal, it is omitted from this meaning since coverage statistics generally refer only to the disposal of human excreta.

What is a "Basic Level Of Service"? Can it mean different technologies in different areas? In extreme cases, yes, but these would be exceptional.

For the purposes of this policy document:

The term BASIC LEVEL OF SERVICE for a household means a VIP (Ventilated Improved Pit) latrine (in its various forms, to agreed standards) or its equivalent in terms of cost, robustness, health benefits and environmental impact; together with ongoing exposure to readily understandable information about correct hygiene practices.

It is acknowledged that some conditions of high population density or extremely adverse geological conditions may require something other than the basic LOS (Level OF Service) described above, but this would need to be carefully assessed in the case of low income households in view of the higher running costs of other systems. (Guidelines will be needed for this.)

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POLICY PRINCIPLES

The eight Policy Principles stated in the previous White Paper on Water Supply and Sanitation Policy form our initial points of departure. The following are a few points of enlargement or clarification of those principles, with the addition of two more.

1. Development should be demand driven and community based.

For household sanitation, not only do communities need to accept responsibility but particularly individual households must do so. The term demand driven needs to include the concept of communities and households demonstrating their priorities by a willingness to pay (in cash or kind) a significant portion of the costs involved in providing and running a sanitation system.

2. Basic services are a human right.

In fulfillment of its obligation, Government can provide access to services and support people in obtaining those services; but in the end, it is individual people who are responsible. Although individual householders are ultimately responsible, communities may require a degree of conformity for the sake of public health in order to achieve the "healthy environment" envisaged in the constitution. A careful balance needs to be achieved in keeping with the affordability of households, of communities and of the national economy.

3. "Some for All" rather than "All for Some".

This does not imply a rigid uniformity, and some areas may need or be able to afford different levels of service, but the use of scarce public funds must be confined to assisting those who are presently inadequately served to attain a basic level of service.

4. Equitable regional allocation of development resources.

The limited national resources available to support the provision of basic services should be equitably distributed throughout the country, taking into account population and level of development.

5. Water has an economic value.

The way in which sanitation services are provided must take into account the growing scarcity of good quality water in South Africa, in a manner which reflects the full value of these services, and does not undermine long term sustainablility and economic growth. The pollution of water resources also has an economic cost.

6. The user pays.

Sanitation systems must be sustainable which means they must be affordable to the service provider, and user payments are essential to ensure this.

7. Integrated development.

Sanitation development is not possible in isolation from other sectors, and special note should be taken of the relationships between water supply and sanitation and their synergistic impact on health. Co-ordination is necessary between different departments and between all tiers of government, and with other involved parties.

8. Environmental integrity.

The natural environment must be considered in all development activities, and appropriate protection applied, including prosecution under the law. Sanitation services which have unacceptable impacts on the environment cannot be considered to be adequate.

9. Sanitation is about health.

Sanitation is far more than the construction of toilets, it is really a process of improvements which must be accompanied by promotional activities and health and hygiene education which aim to encourage and assist people to improve their health and quality of life.

10. Sanitation is a social responsibility

Significant improvements in health in a particular community through improved sanitation are most likely to be achieved when the majority of households is included. Sanitation therefore is a social responsibility, and sanitation promotion must emphasise this.

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SECTION B: NATIONAL SANITATION POLICY

The provision, improvement and ongoing operation of adequate sanitation affects all members of society. It must therefore be addressed in a coherent and consistent way in all contexts. The policy principles should apply in rich and poor communities, in rural and urban areas, whether sanitation is for individual households or provided as a system for an entire community.

Viewed from this perspective, there are a number of dimensions to sanitation services which would form the framework for a general sanitation policy. These are:

• the institutional and organisational frameworks required;
• the financial and economic approach;
• the technical issues, particularly those related to environmental protection; and
• the social context and educational support needed to ensure that sanitation programmes achieve real health improvements through community mobilisation.

These dimensions must be sufficiently detailed to provide a comprehensive policy but flexible enough to allow for locally determined approaches. At the same time, they must ensure that adequate attention will be given to the key objectives of achieving lasting health benefits within the resource constraints of the economy and the environment.

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INSTITUTIONAL & ORGANISATIONAL FRAMEWORKS

The institutional arrangements for the promotion and provision of effective sanitation must be guided by the Interim Constitution which stipulates that:

• provision of services such as water supply and sanitation is the responsibility of local government;

• provincial government has the constitutional responsibility for the establishment and effective functioning of local government;

• national government has the powers and the duty to intervene in matters of provincial and local competence to ensure that minimum standards are maintained.

Recognising the different stages of development of local government it is clear that institutional arrangements will vary in several ways: approaches in developing areas will be different from those in well established areas; and rural areas will generally have different requirements from urban areas. The factors which influence this are noted below.

Factors determining institutional arrangements

Financial and economic constraints

Institutional arrangements will be different in those communities with a strong local economy and financially sound local government from those in which local government does not have the financial means to ensure the provision and ongoing maintenance of services.

Technical and environmental issues

The technologies used where sanitation systems serve an entire community (waterborne sewerage systems for instance) will be different from those sanitation systems which serve only individual households. Environmentally vulnerable areas will need special care.

Management requirements

A communal sewerage system requires a dedicated management system to ensure its ongoing operation and maintenance. This is less so for household on-site systems which may only require emptying or replacement once every five years (but will still be needed if they are to be effective).

Promotion and support requirements

Programmes in developing areas may require more attention to "software" elements such as promotion, health education and financial assistance to households. Other support may be needed to assist emerging entrepreneurs to participate.

Linkages with other programmes

Certain other programmes have a direct impact on sanitation provision. These include:

• national housing programme in urban areas ie those served by Transitional Local and Metroplitan Councils (the current housing subsidy provides for sanitation infrastructure to serve households in receipt of the subsidy);

• the land reform programme (which includes settlement grants to provide domestic infrastructure);

• the municipal infrastructure programme of the Department of Constitutional Development, directed towards the financing of infrastructure (including sanitation) in areas where the local government needs financial support to provide it;

• the national public works programme, which aims to create employment, entrepreneurial opportunities and capacity building while providing infrastructure assets;

• environmental health programmes of the Department of Health which promote sanitation improvements as an essential contribution to improved health;

• the integrated pollution control initiative of the Department of Environmental Affairs and Tourism;

• water supply and water resource management programmes of the Department of Water Affairs and Forestry, which provide the water needed for sewerage systems but also impose constraints by requiring that sanitation be provided in a manner which is not detrimental to the quality of the nation's water resources;

• specifically, the Department of Water Affairs and Forestry's community based water supply programmes provide a platform for the implementation of sanitation activities through local water and sanitation committees and local government structures.

Sanitation improvement programme

Given the factors described above, there is a need for a programme with the goal of achieving a situation in which all South Africans have access to adequate sanitation. To this end, three specific objectives must be met:

• to achieve coordination between the programmes of different Departments and tiers of government with respect to technical, financial, communications and other dimensions;

• to undertake pilot activities in support of the promotion of adequate sanitation systems;

• to provide technical, financial and communications support for the achievement of adequate sanitation to those communities which are not assisted by existing programmes (described above). This would focus on the needs of poor households in rural areas, small towns, peri-urban areas and informal settlements.

The range of inputs needed will require the proposed programme to continue to be based on an inter-Departmental approach. To be effective, it should fall under the tutelage of a national Department. Because of the close links between the Department of Water Affairs and Forestry's water supply programme and its commitment to promoting interventions to achieve access to basic services for all, as well as the impact of sanitation on water resources, it is proposed that the Department through its Community Water Supply and Sanitation Branch will continue to take the lead in the promotion of the programme.

The management of the programme will be guided by a Programme Steering Committee comprising representatives from the collaborating Departments. The programme should have a national identity in order to promote an integrated approach to improving health, sanitation facilities and the environment. It should stress that individual health and community health, including a community's environment, are inextricably linked. That integrated approach must include co-operation between all levels of government and between agencies at each level of government.

Where financial interventions are required, these may be delivered through the same mechanisms as the basic water supply programmes, using local water committees and local government structures, in programmes prioritised at provincial level and managed by implementing agents such as local government agencies, water boards or NGOs. The design of programmes will support and assist embryo institutions of local government, both technically and financially, to deliver services in a community based, sustainable, manner.

This white paper deals mainly with policy issues and does not to provide extensive details of the strategies, programmes and projects needed to achieve Government's policy objectives.

Role of the private sector

While the sanitation improvement programme described above may require a high degree of support from government agencies, it is intended that such a programme will be a full partnership between public and private sector organisations.

Private sector inputs will include:

• preparing guidelines
• technical assistance
• planning, design and contract supervision
• construction by large and small contractors
• preparation of communications materials
• training and capacity building
• materials supplies
• financing
• monitoring.

In addition to involvement in programme implementation, there is a growing appreciation of the potential role for private sector participation in the financing and operation of water supply and sewerage systems. Government has encouraged the preparation of guidelines to facilitate this process, together with whatever regulations are required.

Household responsibility

As mentioned before, primary responsibility for household sanitation provision rests with the household itself, and all levels of government are basically in the role of facilitating this, or of carrying out those functions which are more efficiently executed at a community level (or even larger grouping).

Local government level responsibilities

Local government responsibilities in respect of sanitation include:

• The provision of communal infrastructure (planning, programming, and financing)
• The operation and maintenance of infrastructure
• Relations with consumers (agreeing standards, setting tariffs, collecting revenues)
• The maintenance of public health (health education, pollution prevention and control)
• The promotion of development (facilitating community involvement)
• Technical assistance for upgrading on-site systems
• Assisting the setting up and capacity building of local water and sanitation committees (in rural areas)
• Co-operation with others to pool experience and generate consistent approaches.

Provincial government level responsibilities

In respect of sanitation, provincial responsibilities include:

• Technical assistance to local authorities (engineering advice, capacity building, training).
• Distribution of housing subsidies
• Environmental management
• Co-ordination of regional planning
• Mobilisation and co-ordination of regional training capacity
• Promotion of integrated development
• Inter-departmental co-ordination
• Allocation of provincial funding
• Monitoring.

National government level responsibilities

National responsibilities include:

• Co-ordination of all activities
• Policy and strategy
• Setting basic minimum standards and levels of service
• Changes to regulatory framework
• Allocation of national funds (funding criteria)
• Framework for grants, loans and technical assistance
• Preparation of guidelines
• Promotion and advocacy of sanitation improvements (support programmes)
• Monitoring and evaluation.

Other stakeholders

As will be seen in the following sections, there is a wide range of other stakeholders, all of whom have a vital role to play. The improvement of sanitation is everybody's business and cannot be seen as a Government-sponsored top-down programme. The many actors include:

• Householders (first and foremost)
• Local water and sanitation committees (or local equivalent)
• Water boards (on behalf of local government)
• Contractors (small and large)
• Materials and equipment suppliers (stocking or making special items)
• Non-Government Organisations (using existing networks)
• Consultants (technical, social etc.)
• Training Organisations (technical training and capacity building)
• Community workers (motivating community initiatives)
• Health workers (promoting, education)
• Financing institutions (micro-loans, big project funding)
• Private sector utility management companies
• Researchers (monitoring and improving equipment and approaches).

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FINANCIAL & ECONOMIC APPROACH

Household sanitation has always been a "poor cousin" of water supply. It is usually a lower priority of householders, understandably enough, but has also suffered badly from technical professionals and administrators. Debates over public investment in sanitation tend to be emotive and poorly informed, with concern over "standards", public health and "political considerations" tending to produce unsustainably high levels of provision for the chosen few and, because of limited resources, nothing for the rest - thus negating the original public health arguments.

Health benefits are a primary objective of sanitation improvements which must be measured against the costs involved. From a public health point of view there is no difference between a well-built, properly maintained VIP latrine and waterborne sewerage, but financially they are very different.

Put another way, there are no economic benefits of installing a more expensive system such as waterborne sewerage, the only added benefit is increased convenience. If anything, there is a real risk of incurring economic dis-benefits where low income households cannot afford the running costs of an expensive system and extensive subsidies are needed. Furthermore, where operational costs are not met for lack of consumer payments or ongoing subsidies, environmental problems and clean-up costs may follow.

Affordability

One key issue is that of affordability. When one looks critically at the costs of improved sanitation, and particularly at waterborne sewerage, and compares it with present levels of affordability of low income households, it becomes clear that large amounts of public investments would be needed to construct, operate and maintain sewerage systems for all households, or even for all urban residents. This raises the issue of affordability at other levels - that of each local authority area and that of the national economy.

While there is an urgent imperative to correct the wrongs of Apartheid and to redress the past unequal distribution of services, the speed at which this can be done must be in keeping with the capacity of local, regional and national economies to support it.

The enormous costs involved have forced Government to formulate ways of stretching its limited resources as far as possible. The choice of level of service and of technology must be within the affordability constraints of households, local authorities and central government; and Government must set short-term achievable goals in keeping with longer term objectives.

Prioritised investments and targeted subsidies

The recent report on the Municipal Infrastructure Investment Framework has indicated that Government cannot immediately embark on a programme to provide full services to all, but must devise ways of prioritising investments and targeting subsidies (for example to support only a basic level of service for all). Hence the derivation of certain policy principles such as "demand driven" and "the user pays".

These are essentially economic instruments to enable households to set priorities for themselves, based on their willingness to pay for a particular level of service, and so inform the planners who serve them. This means that households are not "condemned" to a particular level of service by the decision of an official, but are encouraged to be realistic about what level of service they can afford, on the understanding that they may upgrade their sanitation system as their affordability improves.

Government has now set limits on its ability to provide grants and subsidies for services and has clarified the roles of different levels of government in service provision. These can be summarised as follows:

• local governments will be responsible to finance the upgrading of sanitation services to existing households in their areas

• grant finance from central government may be made available to assist those areas in which local government cannot achieve a basic level of service for all households (largely confined to upgrading local infrastructure, but with some items of bulk and connector infrastructure, to a basic level only)

• sanitation for beneficiary households could, in terms of national housing policy, be either sewerage provided by the local authority as a trading service, or sanitation provided utilising a portion of the national housing subsidy, (or its equivalent in rural areas) as determined by affordability and financial sustainability, both in capital and recurrent terms

• last, but not least, the level of inter-governmental grants made available to subsidise the running costs of municipal services, including sanitation systems, will not be increased and should over time be reduced.

The various costs of sanitation services

It is useful to understand the various cost components of a sanitation system. The White Paper on Water Supply and Sanitation Policy identifies the types of costs associated with water supply and sanitation. These costs can be considered more specifically for sanitation, as follows:

Capital costs: the money required to construct the sanitation system, including:

• "On site" components such as the toilets themselves,
• "Internal infrastructure" such as the sewers in the streets and
• "Bulk and connector" infrastructure: the outfall sewers and treatment works, where these are required.

Recurrent costs which can be divided as follows:

• Operation and maintenance costs: the costs of keeping the services running. This includes costs of repairing broken pipes, emptying pits, unblocking sewers and paying for the staff and electricity needed to run treatment works.
• Administration costs: the costs of managing the sanitation system in the long term, including the cost of sending out accounts and collecting money from users.
• The programme costs: the health education, training, awareness and other support costs which are an essential part of sanitation provision.

Replacement costs: the money required to replace pipes, tanks and pits when they reach the end of their useful lives.

The way in which these costs are paid for is the subject of finance policy which is the topic of the following sections.

Key principles relating to finance

In setting a policy for financing sanitation provision, certain key principles addressed in the White Paper on Water Supply and Sanitation Policy need to be re-visited.

• Sanitation should be self-financing at a local and regional level. The only exception is that, where poor communities are not able to afford even a basic level of service, Government may subsidise the capital cost of basic minimum services.

• "The user pays" principle: where a local authority, or other service supplier, provides a user or a community with a sanitation service, the consumers must pay for this service. The amount to be paid by various consumer groups is covered under "tariff policy" below.

• Service providers should be responsible for recovering at least the recurrent costs associated with sanitation services at a local level. In particular, the extension or upgrading of a service should not result in a request for a larger recurrent cost subsidy from central government.

Subsidies to individuals

Based on the financial principles stated above, it is individuals that have prime responsibility for financing their own sanitation improvements. However, Government acknowledges that it has a role to play in assisting individuals to improve their sanitation. Part of this role is financial, in the form of subsidies, to cover some of the cost of improving sanitation. Recognizing the limited resources available, this must be a limited subsidy, set at a level which is affordable by Government.

The approval of any subsidies, deemed to be made available to individuals, should be linked to the National Housing Subsidy Database to avoid double subsidies at any time in the future.

At the present time, the way in which subsidies to individuals can be applied will differ, depending on whether the individual resides in an urban or rural area. The following sections, for consistency, use the terms "urban" and "rural" in the same way as the National Housing Board.

Financing urban sanitation

In urban areas, sanitation services are the responsibility of local authorities. In keeping with the above financial principles, these services must be provided (financed and built), operated and maintained in a manner which is financially viable throughout the life of that service. This means that the authority, or a service provider on its behalf, needs to raise sufficient income to cover expenditure at all times.

A PC-based Financial Modelling programme has recently been produced which helps service providers to undertake long term planning and to test the implications of those plans on the finances of the service provider and on the future tariffs for services. This can be used as a strategic planning tool for water supply and sanitation services and should assist service providers, and local decision-makers, to maintain the financial viability of the service concerned.

Guiding principles relating to the financing of urban sanitation are as follows:

• In general, local authorities need to raise their own finance, largely through loans. They need to be innovative in raising such loans from a wide range of financial institutions, and efficient in order to be able to repay loans. They will also need to raise income from consumers through tariffs charged for the sanitation service, which is covered under "tariff policy" below.

• In order to promote efficiency and clearly identify the expenditure and income relating to sanitation services, sanitation or sewerage departments in local authorities (possibly together with water departments) should be operated as independent units within local authorities with separate accounts and separate management structures. The various forms of private sector participation should also be considered within guidelines under preparation.

• No separate subsidy for sanitation will be provided for households where sanitation is covered by the housing subsidy.

• Where services are upgraded for existing households, this is the reponsibility of the household and local authority. Government at national and provincial levels will only provide grants to local authorities under exceptional circumstances. For example where a local authority has to provide for a disproportionately large number of people who do not have adequate sanitation and can demonstrate that it cannot afford the required expenditure, a capital grant to achieve the minimum acceptable basic level of service will be considered. This will only occur where agreement has been reached on responsibility for payment of operating and maintenance.

• Government would also consider the use of a subsidy to assist with alleviating a severe environmental problem, provided this was not the result of mismanagement or injudicious investments by the service provider.

Financing rural sanitation

The provision of sanitation services in rural areas is also the responsibility of the local authority. Currently, this means the new district authorities which have been established through the local government elections in November 1995. They will need personnel, and a budget, in each district to promote and facilitate sanitation.

Based on this institutional arrangement important issues for financing include:

• The principle of financial viability of local authorities also applies to rural areas. This may not be feasible in the short term, so in addition to capital grants (see below) Government is prepared to assist district authorities cover the cost of district "sanitation teams" in the early part of the envisaged sanitation improvement programme.

• Given the importance of sanitation at schools, Government will provide a subsidy to existing schools, as a fixed amount per pupil enrolled, and the school must contribute the balance required. Provisionally, the subsidy amount is set at R25 per pupil (in 1995 terms). New schools must budget for and provide appropriate and adequate sanitation facilities.

• Government will set up appropriate financial mechanisms for facilitating sanitation provision to farmworkers taking into account the problems associated with the tenancy status of farmworkers.

In the absence of a housing or general services subsidy for new or existing households, a capital subsidy designed to enable individual householders to improve their domestic sanitation, to achieve basic standards, will be introduced. This will be an interim arrangement until it can be integrated into future support programmes for rural households.

This subsidy will be based on the following principles:

• wherever possible, the capital subsidy should be made available directly to the individuals who are wishing to improve their sanitation, so that individuals have maximum say over how it is spent;

• the subsidy would apply to projects, where groups of individuals or communities have organised themselves, possibly with the support of district authorities or private sector bodies and planned a sanitation project;

• a project will only be supported with subsidies if at least 50% of households in the community have demonstrated their willingness to participate in the project;

• the subsidy would only be given to those who have agreed to contribute their own resources to sanitation improvement, particularly to the building of toilets. This contribution needs to be made "up front", e.g. by way of a cash deposit or accumulation of building materials;

• the amount of the subsidy will be set according to a clear framework, which will anticipate a substantial household contribution; the amount may be increased under exceptional circumstances, where the physical conditions for sanitation provision are particularly difficult. Guidelines will be required for this (the framework and possible variations);

• Subsidies made available to individuals should be linked to and recorded on the National Subsidy Housing Database.

It should be noted that there will be other costs associated with a sanitation improvement programme (promotion, training, health eduction, administration), which may be of a similar value to the direct subsidy to individuals. These may be regarded as an indirect subsidy.

Tariff policy

Government proposes to introduce a uniform tariff structure framework for services provided by local authorities which will enable service providers to set tariffs locally while meeting Government's socio-economic objectives. These objectives include the ongoing financial viability of services while also providing for the needs of the poor and conserving the environment. For sanitation services, the following principles apply:

• Affordability: The setting of tariffs should take household affordability into account.
• Fairness: Tariff policies should be fair and simple to understand. Individuals or groups of individuals should not be discriminated against and all people should be treated equally.
• Separate tariff: A separate tariff should be charged for sanitation, and will vary according to the level of service provided.
• Payment in proportion to the amount consumed: In general, as far as is practically possible, consumers should pay in proportion to the amount of the service they consume. Thus for waterborne sanitation the tariff could be based on the quantity of wastewater discharged to the sewer, possibly as a proportion of water used, or using some other measure which clearly relates to consumption.
• Full payment of operation and maintenance costs: In general, all households should pay the full operating and maintenance costs of the services consumed. Exceptions to this should only be made for truly indigent households for which separate welfare support should be sought.
• Life line tariff: Provision should be made for a "life-line" tariff for poorer people who use little of the service, but should at least cover operating and maintenance costs; and tariffs should be progressively more expensive for large consumers.
• Sustainability: Service suppliers' incomes must be sufficient to ensure that the service is sustainable. Tariff policies that are reliant on unsustainable subsidies will mean that essential maintenance of infrastructure is not carried out and that there will be inadequate services in the future.
• Efficient allocation and usage of resources: Tariff policies should help to facilitate the efficient usage and allocation of scarce resources (both renewable and non-renewable).
• Economic development: Tariffs applied to mining, industrial and commercial enterprises should take into account their impact on economic development. Excessive charges, to support cross-subsidies for instance, could negatively affect business and hence employment, lowering overall levels of affordability and increase pressure on the sustainability of urban services. Economic development must also be balanced against the conservation and sustainability of the physical environment.
• Transparent subsidies: Any subsidies which exist, including cross-subsidies between different categories of consumers, must be transparent (visible, quantified, and understood by all those affected)
• Financial viability of the local service agencies: It is essential that the service agencies remain financially viable, as failure to ensure this will result in the lack of sustainability of the services.
• Local determination of tariff levels: The actual levels of tariffs should be decided at local authority level within an agreed structure. In general, tariffs for urban services need not be uniform over a wide geographic area, but should reflect the relative costs (or comparative advantage) of supplying different areas.
• Consistent tariff enforcement: A consistent policy should be implemented whereby failure to pay (correctly) billed amounts for services results in the consumer's service being restricted or suspended.

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TECHNICAL ISSUES

For many years, the history of sanitation provision in South Africa could be characterised by extreme solutions: for some (the lucky few), there was only one "proper' system, that of waterborne sewerage. For others, with no say in the matter, the bucket system was installed. For the many others, outside of formal arrangements, they had to help themselves, with very little guidance or assistance.

Both sewerage and the servicing of bucket toilets require a costly, high degree of organisation to function efficiently and safely for both users and the environment. The necessary income and organisation was frequently lacking during the Apartheid years (and still is) in those areas which housed the majority of our people. Consequently, other sanitation systems have been introduced in developing areas, with varying degrees of success, by administrations attempting to provide sanitation more cost-effectively.

Unfortunately, these have frequently been provided with inadequate specifications, or proper testing, and almost always without consultation with the intended users. Such top-down approaches have some notorious examples, not least being the poorly planned "toilets-in-the-veld" events.

There are many lessons from the past which must be applied to-day, in particular the need to treat the choice of sanitation system as more than a technical decision, based on a preconceived idea of what "the people demand" or what is the "proper solution". This section attempts to bring together all the issues that influence the choice of sanitation technology and provides a framework for making that choice.

Technology types and their costs

A wide variety of sanitation systems is currently in use in South Africa, some more commonly than others, and with varying degrees of success. There are many different versions of the various systems, but the main types include:

• traditional unimproved pits
• Sanplats
• VIP latrines
• buckets toilets
• portable chemical toilets
• low flow on-site sanitation (LOFLOS)
• septic tanks and soakaways
• septic tank effluent drainage (STED) systems
• full waterborne sewerage.

Several of these technologies do not meet this policy's criteria for adequate sanitation:

• Traditional unimproved pits, except in rare cases, do not provide a barrier against flies, besides their other defects which are usually related to quality of construction.

• The bucket system, as commonly operated in South Africa, does not provide adequate sanitation, as well as being socially unacceptable to most people. It should therefore be phased out over a peiod of five years and replaced by an appropriate system such as upgrading to a VIP or some other option within the affordability of users.

• Portable chemical toilets are also not encouraged, except in emergency situations, and then only for short periods, due to the high running costs involved which frequently leads to over-utilisation.

The remainder of the options mentioned above can all provide an adequate level of sanitation, if they are properly designed, built and maintained. They comprise a hierarchy of upgradeable options available to users, depending on their economic means. The "Basic Level of Service" is therefore the first stage, the vital one of meeting basic functional, health and environmental requirements, in a process of gradual improvement of the health and standard of living of all South Africans.

Table 1: Hierarchy of Sanitation Technologies

 

System	Degree of Complexity	Approx water use (I/flush)
Sanplat	Very simple; slab over pit needs proper design; periodic desludging or relocation	Nil
VIP	Simple, but needs proper design and construction; periodic desludging or relocation	Nil
LOFLOS	Some types use mechanical flushing; soakaway or soakpit needs proper design; periodic desludging	0,5 to 1
Septic tank	Soakaway needs proper design and construction; periodic desludging	6 to 15
STED	Needs reticulation and treatment works; periodic desludging	3 to 15
Sewerage	Needs reticulation and treatment works	6 to 15

This hierarchy of sanitation options can be viewed in different ways. From the point of view of the user, it is generally associated with increasing costs (initial and ongoing), increasing use of water for flushing and increasing convenience and status. From the point of view of the organisation responsible for managing the system, it is associated with both increasing costs to be recovered from users, and increasing complexity (See Table 1).

Apart from the degree of complexity and water use, sanitation systems vary enormously in terms of capital cost and running cost. Table 2 shows the order of magnitude and ranking of those costs. In the cases where a continuous water supply is required, this cost has been included. The capital cost to the household includes the cost of a superstructure or room to house the toilet, and, where necessary, the water and sewer lines in the adjacent street, which cost is usually included in the sale price of a newly developed site.

The costs to a service supplier, for what is usually known as bulk infrastructure, is for large diameter water and sewer pipes, and treatment works. These costs are normally recovered through the tariff. All costs are very approximate and represent 1995 prices.

Table 2: Costs of Sanitation Technologies (1995 Rands)

System	Approx. capital cost to household	Approx. capital cost to service provider (Bulk)	Approx. running cost per month
Sanplant	400 - 1 500	Nil	0 - 5
VIP	600 - 2 500	Nil	0 - 5
LOFLOS	1 200 - 3 500	Nil	5 - 10
Septic tank	2 500 - 4 000	Nil	15 - 20
STED	2 500 - 5 000	3 000 - 5 000	30 - 40
Sewerage	2 000 - 5 000	4 000 - 6 000	40 - 60

Sanitation improvement is a process

The range of costs quoted above, and Goverment's financial contraints, make it clear why government financial support will be limited to only a basic level of service. Beyond that, the improvement of household sanitation should be a process which keeps pace with a household's aspirations and willingness to pay to fulfill those aspirations. Households should be enabled by local authorities or their agents, through technical support and financial assistance if needed, to upgrade their sanitation facilities where this is feasible, through a series of investments.

For example: a low income family may need to start with a VIP latrine but aspires to some form of facility within the house. When that householder has reached the point of affording an in-house system, it is unlikely that all the nearby households will be in a similar position to afford waterborne sewerage at the same time, so it might be best to install a low-volume flush toilet, a septic tank and a soakaway (assuming soil conditions allow it). As the number of septic tanks increases, these might be connected to a STED system. If the STED system becomes overloaded it would be time for a full sewerage system.

Factors influencing technology choice

Until very recently, the choice of sanitation technology has been regarded as the exclusive preserve of engineers who, naturally enough, concentrated on technical issues. However, in reality there are numerous factors that must be considered, in a transparent manner in close contact with prospective consumers, when deciding on the most appropriate technology for a particular situation. The following list is not exhaustive but should address most of the issues.

Affordability: By far the most important factor influencing the choice of technology is affordability - at household, local and national levels. This is dealt with at length in the section on the Financial and Economic Approach. As far as it affects technology choice, it must be clear who is willing to pay what amounts for a particular level of service, or quality of product. This is especially important when it comes to the need for regular payments for operations and maintenance. Various grants or subsidies may reduce the initial cost to a household, but there will be very little subsidy available, if any, to reduce the running costs. When comparing the costs of systems, it is important to ensure that all costs are considered.

Institutional needs: The more complex systems may require substantial community-level organisation and institutional support both for delivery and for operation and maintenance. This may not be available in smaller towns and rural areas. In such areas the technologies promoted should be as technically simple, robust and durable as possible. Any sanitation improvement programme should include resources to develop the necessary local institutional capacity to manage the ongoing programme and future operational needs. In some circumstances there may be considerable merit in engaging the private sector to carry out certain functions on behalf of a local authority. Government will encourage local authorities to consider the various options in this regard, using the guidelines presently under preparation.

Environmental impact: All sanitation systems should be designed to reduce the environmental impact of unmanaged human waste disposal. Nevertheless, most systems will cause some degree of environmental impact, particularly if they are not managed as well as the designer intended. The general risk of environmental problems and the specific risks resulting from system failure (and the likelihood of failure) must be considered at the time of selection. This is treated more fully in the following section on environmental issues.

Social issues: Social and cultural practices and preferences vary considerably from area to area. These will affect the range of options acceptable to consumers, and must be catered for, so that facilities are used effectively and health benefits gained by users and the community as a whole. Users should be given choices, wherever possible, based on their willingness to pay for a particular choice.

Water supply service levels: Water is a scarce and costly resource in most parts of South Africa. Higher water supply service levels imply not only increased water usage and cost, but also a sanitation system which must take care of waste water. This means some form of soakaway or even a piped system. Conversely, in areas where water supplies are limited or unreliable, water-dependent systems should be discouraged.

As the cost of water supply increases, it becomes increasingly uneconomic to treat, pump and store large quantities of water simply to flush down the toilet. In keeping with the National Water Conservation Campaign and international trends, Government will promote the development and widespread use of water-saving toilets.

Reliability: It is extremely important that those households with least to spend on sanitation are not supplied with unreliable technology. Only proven designs should be used in large programmes, and ideally consumers should be able to exercise choice within a range of approved designs. In particular, innovative and proprietary systems must be tested against performance criteria and evaluated in terms of operational requirements, value-for-money and customer satisfaction, before they become part of an extensive programme. To this end, Government will identify appropriately qualified and objective bodies to carry out such evaluations against agreed criteria.

Upgradeability: As previously stated, sanitation improvement is a process. It is therefore desirable to consider upgrading sequences, where this is likely in the foreseeable future, and to design accordingly, within today's cost constraints.

Site-specific issues: The geology, hydrology and topography of an area may influence the choice of technology, insofar as they may affect ease of excavation, percolation rates and sewer gradients, amongst other factors.

Use of local resources: The local availability of materials and skills has an important bearing on the choice of technology or construction method. The design of facilities should maximise these resources, in order to stimulate local economic activity and create jobs in keeping with the aims of the RDP.

Settlement patterns:The density and layout of a settlement are important factors in selecting technology. Sewered systems become more cost effective in denser areas, with more linear layouts, while on-site systems are generally more viable where plots are larger.

Hand washing, sullage disposal and laundry facilities

As previously mentioned, the full health benefits of improving sanitation facilities will only be realised through accompanying behavioural change, in particular through the regular washing of hands after using the toilet. In those areas without individual plot connections to a water supply, Government will actively promote easier handwashing through the design of appropriate facilities to be included in toilet structures.

One disadvantage of many on-site systems of sanitation, including all types of pit latrine and LOFLOS, is their inability to handle large quantities of water (except in cases where soil percolation rates are high). This may mean that sullage or "grey water" generated by the family has to be disposed of separately through a sullage soakaway. Government will encourage the increased use of sullage soakaways which should be designed on the same basis as that for septic tank systems.

Areas without house connections for water supply and sewerage commonly lack suitable places for householders to wash their laundry. This frequently leads to unsanitary conditions around sources of water. Government will encourage the inclusion of simple, purpose-made laundry facilities near to water supply points as part of a sanitation improvement programme.

Technical support for sanitation provision and improvements

A vital element of the national sanitation improvement programme will be ensuring that sound sanitation systems are implemented. Considerable good work has already been done to prepare appropriate guidelines, with support from the Water Research Commission, CSIR and the Department of Housing. These guidelines include:

• "Planning and implementation of water and sanitation projects - Guidelines for developers and local authorities" (WRC)
• "Guidelines for the provision of engineering services and amenities in residential township development" (Dept. of Housing)
• "Guidelines for provision of low flow on-site sanitation systems (LOFLOS)" (WRC)
• "Septic tank systems" (CSIR)
• and others in preparation on VIP latrines and the STED system.

Government will provide or promote the development of the following (where they do not yet exist):

• Guidelines for the planning and implementation of rural sanitation projects
• Guidelines for the selection of appropriate sanitation systems
• Guidelines for the design and construction of different sanitation technologies
• Guidelines for the evaluation of innovative approaches
• Guidelines for private sector participation in municipal water supply and sanitation services
• Capacity to monitor construction standards
• Training and development of local entrepreneurs on sanitation programmes.

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ENVIRONMENTAL ISSUES

A basic requirement is that sanitation systems, whether on-site or waterborne sewerage, must be environmentally sound. Lack of suitable sanitation or inappropriate or non-functioning systems present pollution risks to the general environment, especially to surface and groundwater resources, which in turn pose a threat to health.

The environment should be addressed in a holistic manner and therefore all natural resources, of which water is the most important in the South African context, should be conserved and protected. All resources, and especially water, should be used in a sustainable manner, and there are limits to the amounts of polluting matter that our water systems can sustainably deal with. This section of the white paper cannot address every environmental issue facing South Africa, but will confine itself to those that relate directly to water supply and sanitation systems.

The provision and ongoing operation of sanitation systems must be both environmentally and economically sustainable. Environmentally, they should create, wherever possible, positive environmental impacts, preventing or at least minimising pollution of natural resources. At the same time, for a system to be sustainable it must be affordable, both financially and economically, and continue to be affordable to the users and the economy which supports it, or failure may subsequently occur. For this reason a sophisticated system which is poorly maintained can be just as great an environmental hazard as no system at all.

Every degradation of the environment has a cost, even where it cannot be quantified; but where it can be calculated, this should be done in order to evaluate alternative approaches to a problem by looking at total system costs. For example: water resources are often at risk of pollution from sanitation systems, but before a decision is made to invest heavily in changing the sanitation system, the extra costs of water treament, and other environmental impacts, should be estimated. This can then be compared with the costs of the options for sanitation improvement, phased over time if necessary, to establish which is the best course of action, both now and in the future.

Monitoring environmental impacts

All methods of waste disposal must be subject to on-going monitoring for compliance with regulating standards particularly in regard to constituents such as heavy metals and nutrients which could have a permanent negative environmental impact. The increasing stress on our water resources makes this ever more necessary, and Government will be reviewing monitoring procedures, and the institutional arrangements for them, in order to make them as efficient and as effective as possible.

Water quality management

A comprehensive water quality management policy has been developed by the Department of Water Affairs and Forestry. It embodies the principles of:

• pollution prevention,
• a precautionary approach and
• a receiving water quality objective that will meet user requirements.

The strategies resulting from this sanitation policy must be completely consistent with the water quality management policy.

The Department of Water Affairs and Forestry has also recently published "Guidelines for groundwater protection in community water supply and sanitation programmes" which will guide planners and water engineers in the protection of groundwater sources. The use of this guideline will be carefully monitored and improvements periodically made as more information becomes available.

Integrated Environmental Management (IEM)

The design of sanitation improvement projects should ensure that the environmental consequences are adequately considered during the planning process. The risk of pollution through different sanitation approaches should be assessed in order to use the option which will minimise impacts on the environment in the most cost-effective way. Guidelines have been prepared on what level of impact assessment to use in different types of project.

Where it is envisaged that a significant environmental change may result, public awareness and participation is essential. Information must be presented in an even-handed manner in order to convey the potential costs and trade-offs, for example comparing the costs of pollution avoidance with those of remediation, accompanied by an explanation of, and agreement to, the receiving water quality objective.

Environmental Impact Assessment (EIA) procedures should be followed during the siting of waste-water treatment works and waste disposal sites. The degree of complexity may vary according to the anticipated risk and Government will establish a classification system to identify degrees of risk and so avoid unnecessarily expensive procedures.

Waste recycling and beneficiation

A holistic approach should be followed regarding the management of wastes from sanitation systems. Where economically viable and sustainable, both the liquid and solid constituents of the sewage disposal end products should be recycled for further uses and for environmental beneficiation. In fact, in the precarious balance of our water resources, the return of treated effluent to the water cycle is considered to be essential; and deviations from this would need special motivation.

Environmental education

In order to establish sound environmental principles and to create an environmental ethic among communities, emphasis must be placed on formal as well as non-formal environmental education activities. This education must form part of the "information transfer" that is to accompany, or even precede, all sanitation projects. To accompany this, Government will encourage communities to get involved in monitoring the quality of their own water resources in order to increase the incidence of monitoring and heighten awareness through identifying and pressurising polluters. This approach has proved highly effective in other parts of the world.

Economic instruments

The principle of "the polluter pays" must be upheld and full economic user charge systems should be developed to ensure full recognition by users of the costs of environmental protection.

This will be tied in with present deliberations on the treatment of water as an economic good which should be valued according to its scarcity and quality. Thus any reduction of receiving water quality could have a value assigned to it and the source of pollution charged accordingly.

Environmental legislation

The Integrated Pollution Control (IPC) programme of the Department of Environmental Affairs and Tourism will review existing environmental legislation, and government structures and functions, in order to produce a more effective pollution control system. There will also be changes to the Water Act which will affect such issues as: those pertaining to ground water quality, the recycling of sewage sludge and the marine disposal of effluent.

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SOCIAL AND EDUCATIONAL ISSUES

The policy principles discussed at the beginning of this paper stress the point that sanitation is far more than the construction of toilets, it is really a process of improvements which must be accompanied by promotional activities and health and hygiene education which aim to encourage and assist people to improve their health and quality of life.

To undertake such a process of improvements, and achieve lasting benefits to health and quality of life, within today's economic contraints, needs the commitment not only of Government but of every individual household. However, not every household head is aware of the damaging effects of poor sanitation on his or her family and community, and so they are not yet prepared to commit their time, energy and money to this process.

In fully developed areas, decisions on the initial level of service have already been made, but in developing areas (both urban and rural) community members will have a strong interest in choosing a level of service for which they are willing to pay, and in understanding the benefits of such an improvement. Making an informed choice, and being committed to that choice, will only happen when ordinary community members have become involved and discover for themselves what they can do to help themselves and their families break out of the cycle of disease and poverty.

Social context of sanitation

Helping people to help themselves requires a knowledge of, and sensitivity to, the social context of a sanitation improvement programme. Government programmes must adopt people-oriented strategies in which community members play an active role in the planning and organisation so that they incorporate local social values to ensure that the resulting programme is:

• relevant
• appropriate
  • acceptable
  • accessible
• affordable
• equitable
  • empowering, and
  • using indigenous knowledge and local skills.

Community involvement

As emphasised above, community involvement is essential for long term success. Urban local governments need to develop the capacity to involve people in local decision-making. In rural areas existing bodies such as Local Development Committees or Water and Sanitation Committees, assisted by local government or water boards where possible, will be involved in promoting sanitation programmes.

It is the responsibility of each community to safeguard public health, and to reach consensus as to the sanitation system that is affordable and acceptable to the majority. The improvements that can be made to existing systems will be promoted as part of the education process, and consideration should always be given to the potential for upgrading any option.

A programme will not succeed unless the whole community is mobilised, not only the family decision-makers, but particularly women and children. Involvement in an initial "public health survey" is an excellent way to start the process. This can be followed by establishing special points of concern such as: security needs, privacy for women and cultural taboos such as those around age and gender. From these an "agenda for action" can emerge.

Primary Environmental Health Care should become a collective responsibility. As part of the community empowerment process, self-monitoring should be encouraged, where records are kept of hygiene-related illnesses within the household, and notes are made of environmental improvements, such as the regular removal of refuse. This generates a strong awareness of the real implications of an improved quality of life.

Schools are a natural focal point for sanitation and hygiene education, encouraging the adoption of good hygiene practice from an early age. For this reason it is important that theory and practice coincide: that all schools should have hygienic, attractive, appropriate toilets and washing facilities, and the use of these facilities be linked to lessons on personal hygiene and health.

The special requirements of small children are often ignored in the design and construction of toilets. To counter this trend, it is proposed that South Africa will promote child-friendly toilet facilities, with children's views on design being specifically sought and acted upon. This will start with school facilities, as they are often a child's first experience of toilets. All schools will be charged with ensuring that their toilets are maintained clean and child-friendly, for example by the employment of a specific caretaker for this purpose.

The promotion and building of sanitation facilities can result in a good deal of local business development and can help stimulate the local economy and provide employment. Government will seek to forge working partnerships with NGOs and the private sector to enhance local business capacity to respond to these opportunities.

Health and hygiene promotion

Improved sanitation facilities will only achieve a parallel reduction in diarrhoeal diseases if they are developed alongside hygiene programmes. Hygiene aims at the prevention of the transmission of excreta-related diseases (see Figure 2 - not available). It seeks to promote measures whereby barriers can be created between the sources of pathogens, the intermediate hosts (vectors) and people.

Hygiene messages: Hygiene information, education and awareness programmes will be developed hand in hand with toilet-building projects, and will be targeted at all levels:

• Personal Hygiene : such as washing hands after going to the toilet or changing the nappies of babies, and before the preparation of food.
• Household Hygiene: keeping the home clean, particularly those areas where food is stored and prepared, and ensuring that food and drinking water is kept covered and uncontaminated.
• Community Hygiene: vectors do not respect household boundaries. To achieve improved public health the whole community must be mobilised to work together for better health and a cleaner environment.

Raising awareness: Despite the strong links between sanitation and health, there is little public awareness of this, and sanitation is commonly low on peoples' priorities for improved services. The national sanitation improvement programme will aim to redress this through information and education to promote awareness of the role of sanitation in health and to stimulate the demand for toilets.

Health personnel will play a strong role in the promotion of health and hygiene, particularly at the local level, where a network of Environmental Health Officers already exists. Sanitation will become a strong element of all primary health care programmes. As a focal point for access to primary health care information, it is essential that all clinic staff set the highest standards for themselves in maintaining hygienic sanitation facilities. Clinics should have appropriate facilities for out-patients' use, of a type that could be affordably copied or modified for household use.

Dialogue: Hygiene promotion requires far more than message-giving and demonstration. The starting point is to understand current beliefs, perceptions and practices within any particular community. Based on these, relevant messages can be developed so that desirable behaviour change is understood, through dialogue, within the context of people's everyday lives. Hygiene problems can then be identified by the community, and remedial actions be designed by them.

Two basic elements: The national programme will have two basic elements - the promotion of improved hygiene practices, and the promotion of toilets themselves. Forms of social marketing would be used, for instance highlighting privacy and status to enhance popularity. These have been shown in other countries to be stronger selling points than only the health benefits. Peer pressure can also be an effective motivating force for ensuring increased coverage.

At a local level, personnel must ensure that all relevant technological options are explained and discussed, enabling informed decisions to be made. Where expectations may be impossibly high, this will also be the opportunity to explain the costs involved, and the most likely options available.

The education programme will proceed on many different levels - national and provincial, with strong media coverage and publicity, and most importantly at a local level, through existing structures such as Development Committees. The use of participatory training materials will be promoted and encouraged wherever appropriate. Traditional channels for information will be employed where suitable, particularly communal forms such as drama and song. Schools in particular will be targeted, as children are often the most direct route for information to enter households.

It is important to ensure that the programme is very high profile and maintains its momentum - achieving mass behaviour change is a very slow process, and immediate results cannot be expected. It is anticipated that the programme will be phased over several years, depending on the initial capacity found in any given area. Sanitation-related educational material should be developed for use in pre-primary classes and in adult basic education (ABE) programmes.

Links to other programmes: The improvement of water supplies in an area frequently stimulates communities to look at other improvements needed such as sanitation. The implementation of new water supply systems should thus be accompanied by, or preceded by, a sanitation and hygiene education programme.

Human resources development

The proposed sanitation improvement programmes will depend largely on the quality and training of the people involved in carrying them out. This element cannot be sufficiently stressed. Training and/or retraining at every level is needed.

Training and capacity building at community level has already been highlighted as a universal need in South Africa. There is, at present, a dire shortage of suitable persons to undertake this. Government has committed itself to redress this through a variety of programmes.

Training of health personnel will be reworked to develop the required skills for the promotion of sanitation and hygiene. Support will be provided on a national as well as a regional level, and the programme monitored closely to ensure good coverage. Re-orientation of personnel to a more 'people-centred' approach is vital, as is a commitment to this policy shift at every level.

Training of small-scale builders in the construction of appropriate sanitation facilities will improve the quality of products and ensure the ongoing nature of programmes through private sector activity.

Retraining of professionals of many kinds: planners, engineers, administrators, communicators etc, will introduce a degree of professionalism into a much-neglected sector.

Monitoring health impacts

To determine the success of the sanitation programme, progress will be monitored on a regional basis, and drawn together at a national level. The starting point for the monitoring will be the "Basic Subsistence Facilities&uot; programme of the Environmental Health Directorate, of the Department of Health. That system records the quality and quantity of water supply and toilets, and will be expanded to include popularity, frequency of use, problems encountered, high risk areas, and so on. By recording this information it is intended to make the provision of sanitation a "user-driven" process, which is continually being refined. It will also be used to assist infrastructure planning at district and provincial level.

Selective monitoring of hygienic practices and incidences of diarrhoea and other hygiene-related infections such as trachoma, conjunctivitis and parasites will also take place. The education and information programme will also be monitored for continual improvement. This will include 'child-friendliness' and the percentages of women being involved in decision-making processes at all levels (the Water Supply and Sanitation Policy white paper proposed a minimum of 30% women in all forums).

Monitoring programme effectiveness: Communities participating in sanitation improvement programmes will be encouraged to report serious diarrhoeal incidences to clinics. These statistics can be compiled at regional and provincial level, and ultimatley at national level. In this way the effectiveness of the sanitation programme can be established; and health messages continually improved as required.

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SECTION C: IMMEDIATE NEXT STEPS

For the purposes of this draft, this section includes a description of the process to be followed in finalising the draft.

PROCESS FOR THE DRAFT WHITE PAPER

This draft white paper will be widely circulated both within and outside Government for comment. It will be presented at a series of provincial level workshops which will aim to inform key stakeholders and canvass opinion as broadly as possible within the time and resources available.

It is recognised that many of the principles and proposals in this paper will be regarded as politically unpalatable and difficult to sell.This is why the process is considered to be essential in order to promote debate, and eventual consensus, around a much-neglected topic.

FUTURE ACTIONS

Development of strategies

In parallel with the development of this White Paper, the NSTT is developing strategies for the detailed implemetation of these policies. Lessons learned from existing pilot sanitation projects will contribute to future strategies. These strategies will include:

• the preparation of guidelines
• the formation of appropriate institutional arrangements
• the planning of promotional and health education campaigns,
• setting up systems to learn continuously from experience, and
• the recruitment and training of a number of key personnel.

Regulatory changes

Future actions will also include proposals on dealing with the legal changes required, including relevant sections of:

• the Water Act
• Public Health Orders
• Environmental legislation and
• Local Government bye-laws.

Institution building

A key ingredient of success will be the creation of institutions, agencies, cadres of people who are dedicated to helping people to improve their way of life, and equipped to fulfill their calling. This must happen at every level of government, and is not confined to only the technical professions, or only the social or health professions. It will need an integrated, co-operative effort of the kind that is rarely seen in typical SouthAfrican government structures.

The National Sanitation Task Team, which includes members from at least six government departments with a keen interest in the subject, has taken the lead in co-operative action. This needs to be repeated at provincial and local level until narrow specialised fields are broadened into a new specialisation, that of a multi-disciplinary approach to problem solving in sanitation programmes.

It has been agreed that the Department of Water Affairs and Forestry will take the lead in establishing this institutional capacity, but this must be seen as a Government initiative and not a Departmental one. One of the major tasks ahead is to replicate the multi-disciplinary capacity required throughout local government, and Government commits itself to that task.

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SECTION D: SUMMARY

DRAFT WHITE PAPER ON SANITATION

This policy paper starts where the previous White Paper on Water Supply and Sanitation Policy ended and it addresses the same key issues: the needs and aspirations of ordinary people, in particular the need for healthy living conditions, and the constraints on service delivery, especially the economic and environmental ones. These issues are inextricably linked and require an integrated approach.

Sanitation goes far beyond the issue of toilets, although safe disposal of human excreta and other domestic waste water is a major and necessary requirement for safe sanitation. Personal, family and cultural hygiene practices and habits are critical. If these are unsound the upgrading of physical toilet facilities alone will not solve the problem. Therefore sanitation improvement encompasses an entire process, aimed at the home and the individual, which must include health and hygiene education as well as improving the physical infrastructure of toilet facilities, water supply and disposal of domestic waste water.

This paper confirms Government's commitment, at the highest level, to an appropriate, sustainable strategy for the improvement of health and quality of life through improved household sanitation and protection of the environment throughout the nation.

The provision, improvement and ongoing operation of adequate sanitation affects all members of society. It must therefore be addressed in a coherent and consistent way in all contexts. The policy principles should apply in rich and poor communities, in rural and urban areas, whether sanitation is for individual households or provided as a system for an entire community.

The application of these policy principles must be sufficiently detailed to provide a comprehensive policy but flexible enough to allow for locally determined approaches. At the same time, they must ensure that adequate attention will be given to the key objectives of achieving lasting health benefits within the resource constraints of the economy and the environment.

Primary responsibility for household sanitation provision rests with the household itself, and all levels of government are basically in the role of facilitating this, or of carrying out those functions which are more efficiently executed at a community level (or even larger grouping).

There is a pressing need for a national sanitation improvement programme with the goal of all South Africans having access to adequate sanitation.

One key issue is that of affordability. When one looks critically at the costs of improved sanitation, and particularly at waterborne sewerage, and compares it with present levels of affordability of low income households, it becomes clear that large amounts of public investments would be needed to construct, operate and maintain sewerage systems for all households, or even for all urban residents. This raises the issue of affordability at other levels - that of each local authority area and that of the national economy.

Government has now set limits on its ability to provide grants and subsidies for services and has clarified the roles of different levels of government in service provision. These can be summarised as follows:

• local governments will be responsible to finance the upgrading of sanitation services to existing households in their areas
• grant finance from central government may be made available to assist those areas in which local government cannot achieve a basic level of service for all households
• sanitation for beneficiary households could, in terms of national housing policy, be either sewerage provided by the local authority as a trading service, or sanitation provided utilising a portion of the national housing subsidy, (or its equivalent in rural areas) as determined by affordability and financial sustainability, both in capital and recurrent terms
• the amount of subsidy for rural households will be set according to a clear framework, which will anticipate a substantial household contribution; the amount may be increased under exceptional circumstances, where the physical conditions for sanitation provision are particularly difficult;
• last, but not least, the level of inter-governmental grants made available to subsidise the running costs of services, including sanitation systems, will not be increased and should over time be reduced.

In setting a policy for financing sanitation provision, certain key principles addressed in the White Paper on Water Supply and Sanitation Policy need to be re-visited.

• Sanitation should be self-financing at a local and regional level. The only exception is that, where poor communities are not able to afford even a basic level of service, Government may subsidise the capital cost of basic minimum services.
• "The user pays" principle: where a local authority, or other service supplier, provides a user or a community with a sanitation service, the consumers must pay for this service.
• Service providers should be responsible for recovering at least the recurrent costs associated with sanitation services at a local level. In particular, the extension or upgrading of a service should not result in a request for a larger recurrent cost subsidy from central government.

Government proposes to introduce a uniform tariff structure framework for services provided by local authorities which will enable service providers to set tariffs locally while meeting Government's socio-economic objectives. These objectives include the ongoing financial viability of services while also providing for the needs of the poor and conserving the environment.

Both sewerage and the servicing of bucket toilets require a costly, high degree of organisation to function efficiently, and safely for both users and the environment. Since this is not always available, other sanitation systems have been introduced in developing areas, with varying degrees of success, by administrations attempting to provide sanitation more cost-effectively.

There are many lessons from the past which must be applied to-day, in particular the need to treat the choice of sanitation system as more than a technical decision, based on a preconceived idea of what "the people demand" or what is the "proper solution". Factors affecting choice include:

• affordability
• institutional needs
• environmental impact
• social issues
• water supply service levels
• reliability

• upgradeability
  • site-specific issues
  • use of local resources and
  • settlement patterns.

The improvement of household sanitation should be a process which keeps pace with a household's aspirations and willingness to pay to achieve those aspirations. Households should be enabled by local authorities or their agents, through technical support and financial assistance if needed, to upgrade their sanitation facilities where this is feasible, through a series of investments.

A basic requirement is that sanitation systems, whether on-site or waterborne sewerage, must be environmentally sound. Lack of suitable sanitation or inappropriate or non-functioning systems present pollution risks to the general environment, especially to surface and groundwater resources, which in turn pose a threat to health.

The environment should be addressed in a holistic manner and therefore all natural resources, of which water is the most important in the South African context, should be conserved and protected.

The provision and ongoing operation of sanitation systems must be both environmentally and economically sustainable. A sophisticated system which is poorly maintained, due to lack of income, can be just as great an environmental hazard as no system at all.

Helping people to help themselves requires a knowledge of, and sensitivity to, the social context of a sanitation improvement programme. Government programmes must adopt people-oriented strategies in which community members play an active role in the planning and organisation so that they incorporate local social values. A programme will not succeed unless the whole community is mobilised, not only the family decision-makers, but particularly women and children.

Improved sanitation facilities will only achieve a parallel reduction in diarrhoeal diseases if they are developed alongside hygiene programmes. To determine the success of the sanitation programme, progress will be monitored on a regional basis, and drawn together at a national level. In this way the effectiveness of the sanitation programme can be established; and health messages continually improved as required.

The next steps for action after publication of this paper include:

• strategies
• regulatory changes
• institution building.

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SECTION E: ANNEXURE DESCRIBING SANITATION TECHNOLOGIES

The following four pages are extracted from the "Water & Sanitation Handbook - for community leaders - (urban and peri-urban areas)" by Palmer Development Group, October 1994, published by the Water Research Commission; and an extract from a draft of "Sanitation for Rural Communities - a handbook for community leaders" by Division of Water Technology, CSIR, also to be published by the Water Research Commission.

In the urban handbook, the term "Aqua-privy" is equivalent to the term LOFLOS (LOw FLow On-Site) used in this paper, and the term "Aqua-privy with solids free sewer" is equivalent to STED (Septic Tank Effluent Drainage) used in this paper.

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