Sanitation in South Africa remains a serious issue in 2016. According to the South African Human Rights commission, 1.4 million households in South Africa still do not have access to ‘adequate sanitation’. Furthermore, of households with access to sanitation, around 26% (3.8 million households) do not have access to sanitation facilities that meet the applicable minimum standards.
This is having serious consequences on, amongst many other concerns, the health of the nation. For example, one of the strongest metrics of poor sanitation is death due to diarrhea since 88% of diarrheal deaths globally are attributable to unclean water, inadequate sanitation and insufficient hygiene.
In 2013, 15,760 deaths (3.4% of all deaths in South Africa) were attributed to diarrhea and gastroenteritis of presumed infectious origin (noting that a portion of these are likely to be misdiagnosed HIV/AIDS deaths). This is equivalent to 29.54 deaths per 100,000 people, a rate that is almost a third higher than the international average of 20.9 deaths per 100,000 people, and dramatically higher than countries at a similar level of economic development. For example, according to the IMF, in 2013 Colombia had nearly the same GDP per capita as South Africa, yet only has a rate of deaths due to diarrhea of 1.76 deaths per 100,000 people. Importantly, diarrhea is responsible for between 8% to 20% of deaths of children under the age of 5 in South Africa.
What is particularly worrying is that many municipalities are providing a communal stand block as a means of providing sanitation facilities to communities, but this has no statistical link to a reduction in incidences of diarrhea. Rather, it appears that a household requires access to a standalone sanitation facility in order for the incidence of diarrhea to be reduced (β coefficient of -0.589). Noting this, arguably communal facilities should only be used in emergency situations.
Equally as worrying is the issue of wastewater treatment, given that this is a direct metric of how well the state is managing to cope with existing wastewater. At present, 57% of wastewater treatment works are already classified as being at a critical or high risk of failing, and 77.8% (and possibly more) of existing design capacity is already being used. Furthermore, most local governments are failing to adequately budget for maintenance. While they should be spending at least R4 billion per sector on maintenance and capital renewal, actual spending is only in the order of R700 million per annum. The deferred maintenance costs mean that every six years one year’s maintenance is foregone.
Given these dual issues, it is clear that we need to reconsider how we do sanitation in South Africa. In particular, there is a very real need to consider making dry and/or ecological sanitation technology the dominant form of sanitation provision for both the wealthy and the poor in all new and refurbished buildings in South Africa. This form of sanitation is cheaper since it is managed by the household, substantially reducing the sanitation provision and wastewater treatment burden the state experiences. In addition, it can substantially reduce the water used for sanitary purposes, and decentralizes the maintenance of sanitation to the household, thus reducing the amount of wastewater treated by the municipality and the number of pipes that need to be maintained. Furthermore, it provides the main benefit of flush toilets, namely clean and hygienic disposal of human waste, and a reduction in diarrhea related deaths.
Already, a major portion of South Africa is using dry sanitation of some form or another: 11.3% of households in South Africa are using sanitation that is a not flush toilet, but which meets the minimum applicable standards. However, this is primarily the poor and not the wealthy, with more than 99% of households earning more than R600, 000 a year in the metropolitan cities of South Africa using flush toilets, according the 2011 census.
For this technology to be accepted, it is necessary that both the poor and the wealthy use it. This will remove the stigma of dry sanitation as being a ‘second rate’ type of sanitation, thus encouraging greater acceptance of this technology by the poor. This could be potentially achieved by an amendment to the Water Services Act No 108 of 1997, or by individual municipalities through by-laws. And, importantly, it must be noted that ‘high end’ dry sanitation facilities have already been developed, both for single storey and multi storey dwellings. This further nullifies any excuses wealthy households might have with regard to being forced to use such systems.
If we wish to maintain the significant progress made towards achieving adequate sanitation for all in South Africa, then we need to get radical and to start thinking differently about water and sanitation. Mandating use of dry sanitation in South Africa in all new developments could be one big step forward in this regard.
(This article is based on a comment submitted in response to the call for comments on the draft National Sanitation Policy.)
Stuart Denoon-Stevens is a professional planner, a junior lecturer at the University of the Free State, and a researcher focusing on municipal land management, with a particular emphasis on pro-poor approaches.
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