tag:theconversation.com,2011:/au/topics/sanitation-4167/articlesSanitation – The Conversation2024-02-15T13:43:44Ztag:theconversation.com,2011:article/2230472024-02-15T13:43:44Z2024-02-15T13:43:44ZGhana’s new vehicle tax aims to tackle pollution – expert unpacks how it’ll work and suggests reforms<p><em>Ghana has introduced an <a href="https://gra.gov.gh/implementation-of-new-tax-laws-and-amendments/">annual carbon levy on vehicles and industrial emissions</a>. It’s only the third <a href="https://carbonpricingdashboard.worldbank.org/">African country</a> to introduce an explicit carbon tax, after <a href="https://www.tandfonline.com/doi/pdf/10.1080/0376835X.2023.2171366">South Africa and Mauritius</a>. The tax is intended to address <a href="https://mofep.gov.gh/sites/default/files/budget-statements/2024%20Budget%20Statement_v2.pdf">harm</a> associated with vehicle emissions. But it has prompted a <a href="https://www.ghanaweb.com/GhanaHomePage/NewsArchive/Inconsiderate-vehicle-emissions-tax-won-t-prevent-carbon-emission-Ben-Boakye-1914538">pushback</a> from various citizens, civic and consumer groups.</em></p>
<p><em>The Conversation Africa’s Godfred Akoto Boafo spoke to Theophilus Acheampong, an energy economist who has consulted for Ghana’s finance ministry on environmental fiscal reform, about the impact and implementation of this kind of levy.</em></p>
<h2>Why is the government taxing emissions?</h2>
<p>The proposed vehicle emissions tax under the <a href="https://gra.gov.gh/implementation-of-new-tax-laws-and-amendments/">Emissions Levy Act, 2023</a> is one of several environmental fiscal reform measures being introduced by the government. I am among several consultants who have worked on these proposed reforms since 2010. </p>
<p>Environmental tax reform <a href="https://www.eea.europa.eu/highlights/environmental-tax-reform-increasing-individual">aims</a> to shift the burden of taxation to environmentally damaging activities, such as pollution. </p>
<p>Reforms like this can help raise domestic revenue, protect the environment by meeting country climate targets under the <a href="https://www.ciwf.org.uk/research/environment/paris-climate-agreement-2030-sustainable-development-goals/#:%7E:text=Paris%20Climate%20Agreement%20%26%202030%20Sustainable%20Development%20Goals,-Implementing%20the%20Paris&text=The%20goals%20include%20zero%20hunger,lifestyles%20in%20harmony%20with%20nature">Paris Agreement and the Sustainable Development Goals</a>, and reduce poverty. These benefits have been confirmed in many <a href="https://doi.org/10.3390/su10020501">studies</a> but with mixed results.</p>
<p>Ghana’s government believes the vehicle emissions tax is a more cost-effective and equitable way to make sure the <a href="https://www.sciencedirect.com/topics/earth-and-planetary-sciences/polluter-pays-principle">polluter pays</a>, <a href="https://www.gov.uk/government/publications/environmental-principles-policy-statement/environmental-principles-policy-statement#:%7E:text=Description%3A%20The%20prevention%20principle%20means,%5Bfootnote%206%5D%20is%20avoided.">prevent harm</a> and <a href="https://eur-lex.europa.eu/EN/legal-content/glossary/precautionary-principle.html">protect the public</a>. </p>
<p>Ghana’s energy sector is the <a href="https://unfccc.int/sites/default/files/resource/gh_nir5_15052022_final.pdf">major source</a> (46%) of the country’s greenhouse emissions. Within this, mobile combustion emissions <a href="https://unfccc.int/sites/default/files/resource/gh_nir5_15052022_final.pdf">accounted</a> for 34% of the total energy emissions and 15% of the total national emissions in 2019. Transportation emissions, predominantly from road transport, have <a href="https://unfccc.int/sites/default/files/resource/gh_nir5_15052022_final.pdf">increased</a> by 47% compared to 2016 levels due to growing vehicle ownership and the associated traffic congestion in cities and peri-urban areas.</p>
<p>Lower respiratory <a href="https://www.cdc.gov/globalhealth/countries/ghana/default.htm#death">infections</a>, which are linked to air pollution, are among the top five causes of <a href="https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/ghe-leading-causes-of-death">death</a> in the country. Some <a href="https://www.cleanairfund.org/geography/ghana/">28,000</a> Ghanaians died prematurely from air pollution in 2020. Air pollution-related deaths cost Ghana 0.95% of gross domestic product, according to a <a href="https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(22)00090-0/fulltext">2021 Lancet study</a>.</p>
<h2>What has been done so far to reduce air pollution?</h2>
<p>In 2021, the government introduced a sanitation and pollution levy on petrol and diesel under the <a href="https://atugubaassociates.com/file/Energy%20Sector%20Levies%20(Amendment)%20Act.pdf">Energy Sector Levies Act</a> to raise revenue to improve air quality, among other goals. The levy accrued <a href="https://mofep.gov.gh/sites/default/files/reports/economic/Final_%202022-Annual-ESLA-Report.pdf">GHS452 million</a> (US$55 million) in 2022. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ghana-wants-fewer-polluting-old-cars-on-the-road-but-its-going-about-it-the-wrong-way-198805">Ghana wants fewer polluting old cars on the road. But it’s going about it the wrong way</a>
</strong>
</em>
</p>
<hr>
<p>In 2018, the government also <a href="https://mofep.gov.gh/sites/default/files/news/Notice-Luxury-Vehicle.pdf">introduced</a> a luxury vehicle tax on vehicles with engine capacities of three litres or more, except for commercial vehicles. However, following a public outcry, the government <a href="https://www.graphic.com.gh/business/business-news/govt-withdraws-vehicle-luxury-tax.html">suspended</a> the tax in July 2019. There were <a href="https://www.graphic.com.gh/news/politics/bring-back-luxury-vehicle-tax-upsa-to-government.html">subsequent calls</a> for it to be reintroduced. </p>
<p>These measures weren’t well designed from a tax policy point of view as they were not tied to actual vehicular emissions. Hence the need for an vehicle emissions tax. </p>
<h2>How should an emissions tax work and how does the new tax work?</h2>
<p>Ghana’s <a href="https://gra.gov.gh/implementation-of-new-tax-laws-and-amendments/">proposed</a> emissions tax is based on internal combustion engine capacities. Charges range from GHS75 (US$6) for motorcycles and tricycles to GHS150 (US$12) for motor vehicles, buses and coaches up to 3 litre engine. A higher threshold of GHS300 (US$24) applies for motor vehicles, buses and coaches above 3 litre engine capacity, and cargo trucks and articulated trucks. </p>
<p>Ideally, the tax should be based on the actual carbon dioxide and other pollutant emissions from a vehicle, measured in grams of carbon dioxide per kilometre. A threshold of tailpipe CO₂ is set. Each car owner would pay an annual tax for the amount of CO₂ their car emits above that threshold.</p>
<p>The <a href="https://caura.com/blog/why-does-an-mot-include-an-exhaust-emissions-test#:%7E:text=An%20exhaust%20emissions%20test%20ensures,a%20visual%20test%20is%20applied">tailpipe emissions test</a> would be done during the annual roadworthiness check by Ghana’s <a href="https://www.dvla.gov.gh/">Driver Vehicle and Licensing Authority</a>. It would also collect the amounts and then remit them to the Treasury. </p>
<p>There is scope in Ghana’s case to tie it to actual tailpipe emissions and also revise the upper end of the tax as it is prohibitive. This would make the tax more equitable and better reflect the “polluter pays” principle. </p>
<h2>What are the objections to the tax and can they be accommodated?</h2>
<p>The main objection is that it amounts to double taxation. Critics point to the existing pollution levy. There is also no clear plan for what the tax will be used for after it is collected. </p>
<p>Several critics, especially in the<a href="https://www.graphic.com.gh/news/general-news/emissions-levy-premature-antibusiness-food-and-beverage-association.html"> manufacturing</a> and <a href="https://citinewsroom.com/2024/02/emissions-levy-well-increase-our-fares-accordingly-gprtu/">transport sector</a>, say there are already too many taxes. A new one adds to the cost of operating a business. This cost will be passed on to consumers in an already struggling economy. </p>
<p>Some have <a href="https://citinewsroom.com/2024/02/withdraw-emissions-levy-itll-worsen-already-acidic-business-environment-fabag-to-govt/">urged </a>the government to develop environmentally friendly power sources like nuclear and solar energy.</p>
<p>But the government is under pressure to <a href="https://theconversation.com/ghana-and-the-imf-have-struck-a-deal-but-hard-choices-lie-ahead-206240">raise domestic revenue</a> as part of its International Monetary Fund conditionalities. It is therefore difficult to predict whether it will accommodate the concerns that have been raised.</p>
<h2>How does Ghana’s tax compare with others in Africa?</h2>
<p>Ghana, Zambia, South Africa and Namibia have various environmental taxes covering energy, transport, air pollution and waste. </p>
<p>For example South Africa <a href="https://www.reuters.com/article/us-safrica-carbontax-idUSKCN1SW0K6/">introduced</a> a carbon emissions tax on vehicles in 2010. This was updated in 2019 and 2022. The tax applies when cars have emissions above 120g CO₂ per km as well as 3litre engine capacity. The former is about the typical emission from a Ford Fiesta 1.0T EcoBoost or KiaPicanto 1.0. The rate is adjusted for inflation every year. The tax rate ranges from R132 (US$7; GHS86) to R176(US$9; GHS115) for every gram of carbon dioxide per kilometre above the threshold. A 2018 <a href="https://www.tandfonline.com/doi/abs/10.1080/10291954.2018.1505265">study</a> indicated that South Africa’s CO₂ emissions tax had failed to influence which new cars consumers were buying. This is understandable given <a href="https://www.statssa.gov.za/?p=15473">low income levels</a> and that <a href="https://www.statssa.gov.za/?p=14063">35% of households</a> used public transport, according to the 2020 National Household Travel Survey.</p>
<p>Ghana’s proposed emissions tax for vehicles up to 3 litre engine capacity is not unreasonable when benchmarked to South Africa’s. </p>
<p>However, the tax for engines above 3 litres is steep. It targets the main means of transport for many citizens. The 2012 Ghana National Transport Household Survey showed that <a href="https://www2.statsghana.gov.gh/docfiles/publications/Second%20National%20Household%20Transport%20Survey%20Report%202012.pdf">90%</a> of commuters used shared public transport (known locally as “tro-tro”); this figure may have declined in recent times. </p>
<h2>Can the tax be implemented and will it meet its objectives?</h2>
<p>Ghana is already implementing several environment tax reforms across different sectors, with varying degrees of success. There is the potential to harmonise these instruments to improve environmental outcomes and behavioural incentives. </p>
<p>The existing sanitation and pollution levy must first be scrapped and replaced with the vehicle emissions tax. This should be based on actual carbon dioxide, nitric oxide and other tailpipe emissions to maximise efficiency. The tax bands should conform to emission standards set by the <a href="https://www.gsa.gov.gh/">Ghana Standards Authority</a> and the vehicle licensing authority. </p>
<p>Having both the sanitation and pollution levy and vehicle emissions tax operating at the same time amounts to double taxation. </p>
<p>Ghana must also agree to earmark and allocate an agreed proportion of the proceeds to address environmental issues. </p>
<h2>What is the tax collection picture in Ghana?</h2>
<p>Ghana tax collection is currently <a href="https://www.oecd.org/tax/tax-policy/revenue-statistics-africa-ghana.pdf">around</a> 14% of GDP. Its aim is to get to 18% by 2028, comparable with its <a href="https://www.oecd.org/tax/tax-policy/brochure-revenue-statistics-africa.pdf">peers</a> such as Senegal, Namibia, Togo and Rwanda. Other revenue generation avenues have been met with stiff resistance. A recent value added tax on electricity has just been <a href="https://www.bbc.com/news/world-africa-68236869?ns_mchannel=social&ns_source=twitter&ns_campaign=bbc_live&ns_linkname=68236869%26Ghana%20suspends%20controversial%20power%20tax%20after%20uproar%262024-02-08T17%3A42%3A01.000Z&ns_fee=0&pinned_post_locator=urn:bbc:cps:curie:asset:af7380e7-a5ab-4afb-9364-57740148921b&pinned_post_asset_id=68236869&pinned_post_type=share">suspended</a>. </p>
<p>In 2024, Ghana plans to improve revenue performance through <a href="https://mofep.gov.gh/sites/default/files/budget-statements/2024%20Budget%20Statement_v2.pdf">extending</a> the electronic VAT system to cover 600 large taxpayers and more than 2,000 small and medium-sized taxpayers, as well as taxing industrial and vehicle emissions, among others.</p><img src="https://counter.theconversation.com/content/223047/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Theophilus Acheampong is affiliated with the IMANI Centre for Policy and Education in Accra, Ghana. He has also consulted for the Government of Ghana on environmental fiscal reform in a private capacity. </span></em></p>Critics have described Ghana’s emissions tax as premature.Theophilus Acheampong, Associate Lecturer, University of AberdeenLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2168382023-11-22T14:35:36Z2023-11-22T14:35:36ZPatients’ beliefs about illness matter: the case of elephantiasis in rural Ghana<p>Would you take medication for an illness you didn’t believe you had? Or if you disagreed with healthcare workers about the cause of your condition? </p>
<p>This is the dilemma of many people who live in areas of Ghana where a mosquito-borne disease called <a href="https://www.who.int/news-room/fact-sheets/detail/lymphatic-filariasis#:%7E:text=Lymphatic%20filariasis%2C%20commonly%20known%20as,damage%20to%20the%20lymphatic%20system">lymphatic filariasis</a>, often referred to as elephantiasis, continues to spread. </p>
<p>Lymphatic filariasis, or LF as it is commonly known, is a neglected tropical disease which spreads through repeated bites by parasite-carrying mosquitoes. This infection results in the painful and debilitating swelling of legs, arms and genitals, and increases vulnerability to injury and secondary infections. </p>
<p>Although little known, lymphatic filariasis is a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3246437">significant</a>
and <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30323-5/fulltext">under-addressed</a> global cause of disability. According to the World Health Organization at least<a href="https://www.who.int/news-room/fact-sheets/detail/lymphatic-filariasis"> 51 million</a> people are infected with lymphatic filariasis. </p>
<p>The World Health Organization’s <a href="https://www.who.int/teams/control-of-neglected-tropical-diseases/lymphatic-filariasis/global-programme-to-eliminate-lymphatic-filariasis">Global Programme for Elimination of Lymphatic Filariasis</a> has greatly reduced the burden of the disease through preventive mass drug campaigns, mosquito control, veterinary public health and sanitation and hygiene measures.</p>
<p>Despite this concerted effort, however, lymphatic filariasis continues to be endemic and require mass drug administration in <a href="https://academic.oup.com/inthealth/article/13/Supplement_1/S22/6043665">31</a> African countries. The challenges to eradicating it are not well understood, and may hinge on better understanding how people with this disease view their condition. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-its-hard-to-end-elephantiasis-a-debilitating-disease-spread-by-mosquitoes-166627">Why it's hard to end elephantiasis, a debilitating disease spread by mosquitoes</a>
</strong>
</em>
</p>
<hr>
<p>Our research team brings together specialists in epidemiology, public health and human rights. In our recently published paper in <a href="https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0002476">PLOS Global Public Health</a> we take a different approach to the conventional medical focus that dominates research and interventions for this disease. </p>
<p>We examined the local perceptions and beliefs about the disease
and the personal experiences of those living with it in three rural communities in Ghana’s Ahanta West district. This coastal district in Ghana’s Western Region has a high rate of lymphatic filariasis infection and many people living with advanced stages of the disease. </p>
<p>Members of our research team had worked in this area for more than a decade, establishing the trust relationships that made this research possible.</p>
<p>Our findings may help provide insight into why lymphatic filariasis persists in certain settings and how best to tackle it.</p>
<h2>Cold, rain and curses</h2>
<p>We found that only <a href="https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0002476">18%</a> of respondents understood lymphatic filariasis as a disease. Fewer than 7% believed it to be a disease spread by mosquitoes. </p>
<p>Instead, people held a range of alternative beliefs attributing the condition to other sources, including spiritual causes (curses, witchcraft, evil spirits), cold or rainy weather, and other illnesses. In subsequent interviews, people described how, from their perspective, they encountered the disease. </p>
<p>One person explained, “When you are cold, then your leg gets swollen.” </p>
<p>Another noted, “There are some who just get jealous of and develop hatred for people for just walking and going about their normal duties and decide that they do not want this person or that person to progress, hence they buy the disease for them spiritually.” They added, “I strongly believe and have the conviction that someone bought mine for me spiritually.”</p>
<p>In contrast with these beliefs, which show very limited overlap with medical explanations, nearly half (<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6709921">45.8%</a>) of respondents reported receiving information about the disease from healthcare workers or drug campaigns. </p>
<p>These findings suggest we need to learn more about local beliefs in health and wellbeing in order to achieve more effective communication with patients. </p>
<p>Our research also demonstrates lymphatic filariasis is not only a medical condition, but also a social and economic one. </p>
<h2>Ashamed and stigmatised</h2>
<p>Almost <a href="https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0002476">80%</a> of respondents reported feeling ashamed or stigmatised by their condition. Some said it restricted their social lives and their willingness to go out in public. </p>
<p>Infection also limited the ability to earn a living. More than a third (<a href="https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0002476">36.2%</a>) said they could no longer work due to their condition. Many reported a need to depend on others for financial support. </p>
<p>Among those surveyed less than 3% reported that they were “doing well”. </p>
<p>These findings show an urgent need to address the unmet social, mental health and economic impacts of lymphatic filariasis.</p>
<h2>What needs to be done</h2>
<p>Drug campaigns are important but cannot be done in isolation. Existing research shows us that these <a href="https://academic.oup.com/inthealth/article/13/Supplement_1/S55/6043672">are more successful when offered in a broader context of care</a>. </p>
<p>Healthcare workers must be trained to avoid stigmatising patients. But eliminating stigma is not a simple task, nor can it be left to healthcare workers alone.</p>
<p>Further research is needed to better understand local beliefs about lymphatic filariasis, and to understand how stigma affects patients’ access to treatment and quality of life. This must include the strong links between the disease and poverty. </p>
<p>Lymphatic filariasis follows <a href="https://www.who.int/publications/i/item/WHO-IER-CSDH-08.1">the “social gradient”</a>. Those who are poorest are most likely to be affected. Factors associated with poverty increase the chances of being infected and of developing complications. These factors include poor quality housing, limited access to methods of prevention (mosquito nets, good quality footwear), difficulty getting medical care, living in remote rural communities, and working as subsistence farmers.</p>
<p>The disease also pushes poor people <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-10170-8">further into poverty</a> as it progresses.</p>
<p>As the number of people affected by it decreases, those who are left behind are more and more likely to be isolated, marginalised, stigmatised and impoverished. </p>
<p>As we argue in a <a href="https://www.taylorfrancis.com/chapters/edit/10.4324/9781003207672-15/examining-research-positionality-understanding-self-first-step-transnational-research-colleen-mcmillan-alexander-kwarteng-kristi-kenyon-mary-asirifi">recent book chapter</a>, these factors underscore the need for interdisciplinary research teams who are able to address lymphatic filariasis holistically. We need an approach that merges healthcare, health promotion, health systems, spiritual beliefs, social and cultural context, gender dynamics and economic impact. </p>
<p>We must put people with lymphatic filariasis – and their dignity – at the centre of research.</p><img src="https://counter.theconversation.com/content/216838/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kristi Heather Kenyon receives funding from the Canadian Institutes for Health Research.</span></em></p><p class="fine-print"><em><span>Alexander Kwarteng receives funding from the Canadian Institutes of Health Research</span></em></p><p class="fine-print"><em><span>Dr Colleen McMillan receives funding from the Canadian Institutes of Health Research. </span></em></p><p class="fine-print"><em><span>Mary Asirifi works for MacEwan University. She receives funding from CIHR. </span></em></p><p class="fine-print"><em><span>Regiane Garcia receives funding from Canadian Health Institutes Research</span></em></p>In rural Ghana, only 18% of patients believe elephantiasis is a disease. Some others think it is caused by curses or even rain. Only by understanding local beliefs can it be treated effectively.Kristi Heather Kenyon, Associate Professor, Human Rights, University of WinnipegAlexander Kwarteng, Senior Lecturer in Immunology of Infectious Diseases, Kwame Nkrumah University of Science and Technology (KNUST)Colleen McMillan, Scientific Co-Director and Associate Professor, University of WaterlooMary Asirifi, Assistant Professor, Department of Nursing Foundations, MacEwan UniversityRegiane Garcia, Research Associate, focus on health rights, laws and policies, Simon Fraser UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2173052023-11-16T14:46:31Z2023-11-16T14:46:31ZThere are too few toilets in Africa and it’s a public health hazard – how to fix the problem<p>Imagine you are miles from the nearest restroom, and nature’s call is urgent – a situation that might raise a mild panic during a hike or at a music festival. Now, picture that same scenario, not as a one-off inconvenience, but as a daily reality. This is the case for about <a href="https://tropmedhealth.biomedcentral.com/articles/10.1186/s41182-022-00416-5">half a billion</a> people globally. </p>
<p>In African countries, the issue of open defecation often goes unaddressed by society and policymakers despite its negative impact on health, economic development, dignity and the environment. </p>
<p>Led from Queen’s University Belfast, a team of multidisciplinary researchers aimed to evaluate how prevalent the practice is in African countries and which social factors are driving it. We also aimed to establish which communities were in most urgent need of interventions. </p>
<p>We used demographic and health surveys, alongside World Bank data. In a <a href="https://link.springer.com/article/10.1007/s10668-023-03992-6">recent paper</a> we set out our findings. </p>
<p>Our main ones were that in Nigeria, Ethiopia, Niger, the Democratic Republic of Congo, Burkina Faso and Chad, a large number of people engaged in open defecation. </p>
<p>We found that as few as ten countries could account for 247 million Africans defecating in the open by 2030 if critical and emergency actions are not taken.</p>
<p>The biggest driver is lack of access to proper sanitation facilities. The poorest individuals, particularly in rural areas, are more likely to resort to open defecation than people in urban areas. In regions with the most critical need, the poorest are 43 times more likely than the wealthy to resort to open toileting. </p>
<p>We recommend tackling poverty, and intervening in regions and communities that urgently need improved sanitation infrastructure and programmes. West Africa needs special attention since many of its communities are in the critical category.</p>
<h2>A systematic approach</h2>
<p>Sanitation has far-reaching implications for food safety. Contaminated water sources and unsanitary conditions can spread waterborne diseases, which can contaminate food and put millions at risk. Addressing open defecation is a step in ensuring the safety and hygiene of the food chain.</p>
<p>The link between poor sanitation and health is well <a href="https://www.who.int/news-room/fact-sheets/detail/sanitation">documented</a>. But our study casts this relationship in a new, alarming light: the likely role of open defecation in antimicrobial resistance. </p>
<p><a href="https://www.who.int/health-topics/antimicrobial-resistance">Antimicrobial resistance</a> is the ability of microbes, such as bacteria, viruses and fungi, to resist the effects of medications that were once used effectively against them. It is a looming crisis, threatening to make antibiotics ineffective. Common infections could once again become deadly. </p>
<p>Our research suggests a probable link between open defecation and antimicrobial resistance. When people defecate outdoors, resistant bacteria from human waste can contaminate water and food. This <a href="https://doi.org/10.1093/jtm/taad069">often leads</a> to faecal-oral diseases and urinary tract infections.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/gutter-to-gut-how-antimicrobial-resistant-microbes-journey-from-environment-to-humans-189446">Gutter to gut: How antimicrobial-resistant microbes journey from environment to humans</a>
</strong>
</em>
</p>
<hr>
<p>However, there is a need for more research to clarify the relationship, its implications and prevention. A clear recommendation from our research is that data about antimicrobial resistance should be integrated into health surveys.</p>
<p>While the full breadth of the study’s findings is huge, its conclusions are clear: open defecation is a challenge in Africa that requires actions. Our research doesn’t just ring the alarm bell; it provides a blueprint for change, identifying specific regions where the practice is most prevalent and where interventions could have the greatest impact.</p>
<h2>What needs to be done</h2>
<p>Addressing open defecation across a continent as vast and diverse as Africa is no small feat. We made a number of recommendations in the study.</p>
<p><strong>A pragmatic three-tier priority system</strong> </p>
<p>This will categorise regions based on the urgency of need for intervention: critical, high, and medium. Regions marked as critical are those with the highest prevalence of open defecation (more than 80% of the population) and the least access to sanitation facilities. These areas need immediate attention with the deployment of resources and sanitation infrastructure. The high priority regions have some access to sanitation. Here, the strategy is a combination of infrastructure development and community education. For medium priority areas (40%-59%), where some sanitation infrastructure may exist, the focus should be on sustainable practices, behavioural change and maintenance of existing facilities.</p>
<p>The system above is just to cut the high rates and inequalities among communities in a country. There is also a lot to do in communities with an open defecation rate of less than 40%. The goal is to reinforce positive behaviour and ensure facilities are maintained and improved. </p>
<p>Policy support, such as incentives for building private toilets or community sanitation blocks, may also help. This tiered strategy hinges on continuous assessment and reallocation of resources. Interventions should respond to the changing landscape as regions improve or decline. </p>
<p><strong>Support sanitation projects and policies</strong></p>
<p>Advocacy is important to increase awareness and donations to organisations that build toilets and provide sanitation programmes in affected areas. </p>
<p><strong>Educate and spread awareness</strong></p>
<p>Learning about the cultural and socio-economic factors that contribute to this practice must be encouraged and the knowledge shared with others. Campaigns that focus on the importance of sanitation for health and the environment are key.</p>
<p><strong>Encourage sustainable sanitation practices</strong></p>
<p>This includes using toilets properly, not littering, and understanding local challenges. The use of compostable toilets and other sustainable waste management practices where traditional toilets are not feasible must be encouraged.</p>
<p><strong>Foster global partnerships for sanitation</strong></p>
<p>Global partnerships can amplify efforts to end open defecation. Collaborations between governments, NGOs, private sector stakeholders and international organisations must be encouraged. Pooling resources and sharing knowledge can lead to more effective and sustainable solutions.</p><img src="https://counter.theconversation.com/content/217305/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The struggle with open defecation is a silent emergency, undermining the continent’s efforts towards sustainable development goals.Omololu Fagunwa, Research Fellow, Queen's University BelfastHelen Onyeaka, Associate Professor, University of BirminghamLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2162502023-10-30T12:32:38Z2023-10-30T12:32:38ZCollaborative water management can be a building block for peace between Israelis and Palestinians<figure><img src="https://images.theconversation.com/files/556353/original/file-20231027-30-ejjbrv.jpg?ixlib=rb-1.1.0&rect=24%2C6%2C4015%2C2677&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Palestinians fill drinking water containers at a distribution site in Khan Yunis, south Gaza, on Oct. 8, 2023. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/october-2023-palestinian-territories-khan-yunis-news-photo/1731176176">Mohammed Talatene/picture alliance via Getty Images</a></span></figcaption></figure><p>Water is a central element of the war between Israel and Hamas in the Gaza Strip. Israel <a href="https://www.cnn.com/2023/10/24/middleeast/gaza-water-war-climate-intl-cmd/index.html">controls several water pipelines entering Gaza</a>, much as it controls <a href="https://theconversation.com/the-gaza-strip-why-the-history-of-the-densely-populated-enclave-is-key-to-understanding-the-current-conflict-215306">most of life there</a>. But water can also be a source of hope for an alternative future. </p>
<p>The Middle East is an arid region that is highly vulnerable to the effects of climate change. There is an essential need for solutions that offer equitable access to water and sanitation, and that protect Israel and the Palestinian territories’ shared water resources. </p>
<p>We study approaches to <a href="https://scholar.google.com/citations?user=JZBqTFcAAAAJ&hl=en">managing water</a> and <a href="https://scholar.google.co.th/citations?user=X778XU0AAAAJ&hl=en">other environmental resources</a> and conduct work at the <a href="https://arava.org/">Arava Institute for Environmental Studies</a>, a
nonprofit teaching and research center in the south of Israel. At the institute, students and academics from Israel, the Palestinian territories and Jordan come together to learn from each other and work together, developing technologies and programs that meet the region’s water needs.</p>
<p>Our experience has shown us that working together creates understanding and friendships that defy the ongoing conflict. </p>
<p>We are not naïve. We recognize that water is central to the struggle between Israelis and Palestinians. Yet, as we see it, continuing to weaponize water will not make peace more likely. What it will do is amplify the suffering that is already taking place.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/yaHvpovpMoc?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The Middle East is facing a water crisis, and divisions between Israelis and Palestinians have only exacerbated the problem. Experts argue that regional cooperation is the only practical strategy.</span></figcaption>
</figure>
<h2>A dry region with a growing population</h2>
<p>The combined population of Israelis and Palestinians living in Israel, Gaza and the West Bank is roughly 14 million. Both populations are growing at <a href="https://www.cia.gov/the-world-factbook/countries/israel/">nearly 2% annually</a>, compared with <a href="https://fred.stlouisfed.org/series/SPPOPGROWOED">0.4% per year for high-income countries</a>. As the populations grow, so does demand for water. </p>
<p>The average yearly per capita water supply for the region is less than 500 cubic meters per capita. According to the United Nations and other experts, this amount is at the <a href="https://archive.unescwa.org/absolute-water-scarcity">upper threshold of absolute water scarcity</a> – the level at which nations can’t meet all demand, especially the large amounts needed for agriculture, and have to restrict water use. </p>
<p>For comparison, in 2015 the U.S. used <a href="https://www.statista.com/statistics/263156/water-consumption-in-selected-countries/">1,207 cubic meters of water per capita</a>. One cubic meter is equal to 264 gallons.</p>
<p>Israel and the Palestinian territories’ main fresh water resources are the Jordan River system and two groundwater aquifers – one along the Mediterranean coast and the other beneath the central Judean mountain range. Palestinians in the West Bank have access mainly to the mountain aquifer system, and those in Gaza to the coastal aquifer. Israel uses both. </p>
<p>The 1993 Oslo peace accords included provisions <a href="https://www.europarl.europa.eu/thinktank/en/document/EPRS_BRI(2016)573916">allocating water between Israelis and Palestinians</a>, but ongoing conflict and continued disagreements have hindered updating these agreements to reflect rising water demand.</p>
<h2>Unequal access to water</h2>
<p>From the foundation of the state of Israel, access to water resources has been as central to the nation’s conflict with the Palestinian people as competing claims to land. Israel has partially decoupled itself from water scarcity by <a href="https://theconversation.com/what-arizona-and-other-drought-ridden-states-can-learn-from-israels-pioneering-water-strategy-212816">building desalination plants</a> along the Mediterranean coast. </p>
<p>In the West Bank, Israel’s continued occupation has impeded Palestinians’ ability to develop their own water network that could distribute water across the population. The situation in Gaza is even more dire. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/556354/original/file-20231027-21-hypzuz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Map of Gaza showing population centers and water treatment plants." src="https://images.theconversation.com/files/556354/original/file-20231027-21-hypzuz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/556354/original/file-20231027-21-hypzuz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=846&fit=crop&dpr=1 600w, https://images.theconversation.com/files/556354/original/file-20231027-21-hypzuz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=846&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/556354/original/file-20231027-21-hypzuz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=846&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/556354/original/file-20231027-21-hypzuz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1063&fit=crop&dpr=1 754w, https://images.theconversation.com/files/556354/original/file-20231027-21-hypzuz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1063&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/556354/original/file-20231027-21-hypzuz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1063&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Gaza has only a handful of desalination and wastewater treatment plants. Due to the ongoing war with Israel, all of these main plants now lack fuel and many are inoperable.</span>
<span class="attribution"><a class="source" href="https://www.un.org/unispal/document/auto-insert-200679/">United Nations</a></span>
</figcaption>
</figure>
<p>Even before the Israel-Hamas war, Gaza had a massive water deficit. Its main source is groundwater, which has been significantly overpumped, and now is <a href="https://www.unicef.org/sop/stories/175000-additional-parents-and-children-are-getting-access-safe-drinking-water-gaza-strip">so salty as to be undrinkable</a> due to <a href="https://theconversation.com/what-is-seawater-intrusion-a-hydrogeologist-explains-the-shifting-balance-between-fresh-and-salt-water-at-the-coast-214620">seawater intrusion into the aquifer</a>. </p>
<p>Before the war, most Gazans relied on <a href="https://www.newscientist.com/article/2398073-why-the-gaza-water-crisis-is-decades-in-the-making/">private water vendors and a few small desalination plants</a> for drinking water. Israel also piped about 10 million cubic meters of water each year into Gaza. But all told, the water supply is not large enough to meet the entire population’s needs. Now, because of the war, <a href="https://www.cnn.com/2023/10/24/middleeast/gaza-water-war-climate-intl-cmd/index.html">no fuel is entering</a> Gaza to run the desalination plants, leaving them inoperable. </p>
<h2>Weaponizing water</h2>
<p>Israel has <a href="https://www.aljazeera.com/news/2023/10/9/israel-announces-total-blockade-on-gaza">turned off water and fuel shipments to Gaza</a> in order to punish Hamas. We believe this strategy has turned a disaster into a catastrophe that is only likely to get worse. </p>
<p>We do not expect that lack of access to drinking water and sanitation will cause Hamas to lay down its arms. But it already is bringing <a href="https://apnews.com/article/israel-palestinians-gaza-hamas-water-4cc305b209437eec7235e975cf4c47d6">additional misery to the civilians of Gaza</a> and giving them further reason to hate Israel, and will add to international condemnation of Israel. </p>
<p><a href="https://apnews.com/article/gaza-israel-water-humanitarian-crisis-cfeabcda00fefdd03c2877495c4dcd09">U.N. officials are warning</a> that lack of water and sanitation will precipitate an enormous health crisis that will particularly affect women and children. It could lead to outbreaks of waterborne disease that will spread rapidly across Gaza’s crowded and besieged population. Gazan <a href="https://theconversation.com/decades-of-underfunding-blockade-have-weakened-gazas-health-system-the-siege-has-pushed-it-into-abject-crisis-215679">hospitals are already overwhelmed</a> with casualties, and lack water and electricity.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/556355/original/file-20231027-23-ugjv4g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A line of large containers on wagons, one pulled by a horse" src="https://images.theconversation.com/files/556355/original/file-20231027-23-ugjv4g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/556355/original/file-20231027-23-ugjv4g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/556355/original/file-20231027-23-ugjv4g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/556355/original/file-20231027-23-ugjv4g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/556355/original/file-20231027-23-ugjv4g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/556355/original/file-20231027-23-ugjv4g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/556355/original/file-20231027-23-ugjv4g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A drinking water treatment station in Deir al Balah, central Gaza, Oct. 27, 2023.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/IsraelPalestinians/cc5cd331870c432db02dc04e786f5b42/photo">AP Photo/Hassan Eslaiah</a></span>
</figcaption>
</figure>
<h2>Collaborative water projects</h2>
<p>From 2019 until 2023, the Arava Institute worked together with a Palestinian nonprofit group, which we are not naming here out of concern for its members’ safety; an <a href="https://www.watergen.com/">Israeli water tech company called Watergen</a>; and the <a href="https://arava.org/about-our-community/about-fai/">Friends of the Arava Institute</a>, a U.S.-based nonprofit, to install seven <a href="https://arava.org/bringing-new-atmospheric-water-generators-to-gaza/">atmospheric water generators</a> to Gaza. These devices, which pull humidity from the atmosphere and turn it into high-quality drinking water, run on solar power to ensure around-the-clock operation in the energy-poor Gaza Strip. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/556356/original/file-20231027-26-owtpe1.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A mad carries a large water container past a cube-shaped machine." src="https://images.theconversation.com/files/556356/original/file-20231027-26-owtpe1.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/556356/original/file-20231027-26-owtpe1.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/556356/original/file-20231027-26-owtpe1.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/556356/original/file-20231027-26-owtpe1.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/556356/original/file-20231027-26-owtpe1.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/556356/original/file-20231027-26-owtpe1.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/556356/original/file-20231027-26-owtpe1.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A water generator installed by the Arava Institute in Gaza.</span>
<span class="attribution"><span class="source">Arava Institute</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>We installed the first generator in a small municipality in central Gaza, along the border with Israel, in 2019. The second, larger generator was installed in a major hospital in central Gaza in 2020. During May 2021 hostilities between Hamas and Israel, when water supplies were cut off to many communities, these generators were the only sources of drinking water for many people in the surrounding communities.</p>
<p>In 2023, we raised funds to install five more water generators at medical facilities throughout Gaza. According to <a href="https://arava.org/david-lehrer/">David Lehrer</a>, director of the Arava Institute’s Track II Environmental Forum, two generators in south Gaza are still working and are the only sources of clean drinking water in the region. The fate of the other units is unclear. </p>
<h2>Treating wastewater</h2>
<p>In a separate project in 2020, we and our Palestinian partners installed a pilot mobile wastewater treatment plant in a Gazan village. The plant treats about 26,500 gallons (100 cubic meters) of wastewater per day, serving around 1,000 residents, and produces treated wastewater that is of sufficiently high quality to be used in agriculture. We estimate that about 25 of these mobile treatment plants could cover all of the village’s needs.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/556357/original/file-20231027-28-n69su.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A large cube-shaped machine on the open roof of a building." src="https://images.theconversation.com/files/556357/original/file-20231027-28-n69su.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/556357/original/file-20231027-28-n69su.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/556357/original/file-20231027-28-n69su.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/556357/original/file-20231027-28-n69su.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/556357/original/file-20231027-28-n69su.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/556357/original/file-20231027-28-n69su.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/556357/original/file-20231027-28-n69su.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An atmospheric water generator on a building in Gaza.</span>
<span class="attribution"><span class="source">Arava Institute</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>Many rural villages in Gaza have no centralized wastewater treatment system. Wastewater is collected in unsanitary cesspits in the middle of the road between houses. Raw sewage runs in open ditches from homes to the cesspits, which residents pump out around once a month. </p>
<p>Sewage then would normally be transported to a wastewater facility to be treated. But now, because of the war, without fuel for electricity, wastewater plants in Gaza are not working. Raw sewage is being dumped into ecologically important <a href="https://whc.unesco.org/en/tentativelists/5722/">coastal wetlands, called wadis</a>, and <a href="https://news.un.org/en/story/2023/10/1142882">into the Mediterranean Sea</a>. </p>
<p>This environmental and public health catastrophe also affects Israel. The Israeli seawater desalination plant in Ashkelon is only a few kilometers north of Gaza and cannot operate if it risks pulling in polluted seawater. Over the years, lack of adequate sewage treatment in Gaza has caused the plant to <a href="https://www.middleeastmonitor.com/20190604-israeli-report-warns-of-environmental-implications-of-gaza-crisis/">periodically halt operations</a>. </p>
<p>Working closely with Israeli and Palestinian partners is not easy. People from all sides have histories of trauma and grief, and in most cases, very little experience of the other. But working together on shared water challenges can bring people together. </p>
<p>We know that an alternative future is possible – a future that is grounded in a sense of shared humanity and respect. Indeed, we believe it is the only future that is possible for the intertwined reality of Israelis and Palestinians.</p><img src="https://counter.theconversation.com/content/216250/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Clive Lipchin directs the Center for Transboundary Water Management at the Arava institute for Environmental Studies. He receives funding from private, national and international funding and donor organizations, including USAID and the European Union. He is affiliated with Tel Aviv University where he serves as adjunct faculty at the Porter School for Environmental Studies and at the School of Conflict Management and Mitigation.</span></em></p><p class="fine-print"><em><span>Richard Friend is an Associate Professor in Human Geography and Environment at the University of York (UK). He has received funding from the British Council to support research partnership with the Arava Institute for Environmental Studies. He currently receives funding from Worldwide Universities Network for research in Thailand.</span></em></p>As the war between Hamas and Israel grinds forward, two experts explain how Israelis and Palestinians have cooperated to tackle their region’s water challenges.Clive Lipchin, Adjunct Professor of Environmental Studies, Tel Aviv UniversityRichard Friend, Senior Lecturer in Human Geography, University of YorkLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2110102023-09-13T12:29:41Z2023-09-13T12:29:41ZShelters can help homeless people by providing quiet and privacy, not just a bunk and a meal<figure><img src="https://images.theconversation.com/files/547349/original/file-20230910-21-o3aq3b.jpg?ixlib=rb-1.1.0&rect=21%2C28%2C4745%2C3258&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">As July temperatures soared to triple digits, hundreds of homeless people lived on the street outside Phoenix's largest shelter.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/in-an-aerial-view-people-walk-through-a-section-of-the-the-news-photo/1573445837">Mario Tama/Getty Images</a></span></figcaption></figure><p>The city of Phoenix set heat records in summer 2023, with high temperatures that topped 110 degrees Fahrenheit (43 degrees Celsius) for <a href="https://www.npr.org/2023/08/01/1191238086/phoenix-ends-31-day-streak-of-highs-at-or-above-110-degrees-by-reaching-108">31 consecutive days</a> and <a href="https://www.theguardian.com/us-news/2023/sep/09/phoenix-breaks-heat-record-as-city-hits-110f-for-the-54th-consecutive-day">at least 54 days in total</a>. In such conditions, providing basic services – including cool spaces – for people experiencing homelessness is lifesaving. </p>
<p>In 2022, 420 people – many of them unsheltered – <a href="https://www.npr.org/2023/07/09/1186694722/as-heat-threatens-phoenixs-homeless-city-is-under-pressure-to-move-large-encampm">died in Phoenix from heat-related causes</a>. Estimates are not yet available for summer 2023, but given this year’s extreme conditions, the toll is expected to be higher. </p>
<p>For the past two years, we have worked as researchers with the <a href="https://hsc-az.org/">Human Services Campus</a>, a 13-acre complex in Maricopa County, Arizona, where 16 nonprofit organizations work together to help people who are experiencing homelessness. The campus includes <a href="https://www.cassaz.org">Central Arizona Shelter Services</a>, or CASS, Phoenix’s largest homeless emergency shelter, which assists 800 people experiencing homelessness on any given night. </p>
<p>Our work includes talking with staff and clients to better understand their challenges and identify possible solutions that draw from our work in the fields of <a href="https://www.researchgate.net/scientific-contributions/Natalie-Florence-2230988387">architecture</a>, <a href="https://scholar.google.com/citations?user=V2E0rIAAAAAJ&hl=en">health and social innovation</a>. </p>
<p>Dormitories at CASS protect residents from extreme heat with a bunk to sleep in, day rooms for socializing, case management services, and sanitary shower and restroom facilities. But CASS struggles to provide dignified spaces that offer privacy, storage space and quiet environments. People need this kind of environmental support in order to battle recurring physical and mental health issues that often accompany homelessness and can hinder or prevent healing. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/jKHGV5Q9YqY?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Homelessness spiked in 2023 in major U.S. cities with the end of pandemic eviction moratoriums.</span></figcaption>
</figure>
<h2>Overflowing shelters</h2>
<p>As of 2022, the U.S. Department of Housing and Urban Development estimated that the U.S. had nearly 600,000 homeless people nationwide, with about 60% living in emergency shelters, safe havens or transitional housing. The other 40% lived outdoors or in places such as <a href="https://www.huduser.gov/portal/sites/default/files/pdf/2022-ahar-part-1.pdf">abandoned buildings and public transit stations</a>.</p>
<p>Homeless centers must conform to <a href="https://www.taylorfrancis.com/chapters/edit/10.4324/9780429279027-2/short-history-homelessness-architectural-responses-yelena-mclane">architectural standards for emergency shelter</a>. These standards have historically been influenced by institutional building design, which prioritizes attaining minimum conditions needed to keep people alive. Today, many homeless shelters struggle to provide even that level of care. </p>
<p>The Human Services Campus was originally constructed in 2003 to provide consolidated services and a coordinated entry plan for people experiencing homelessness. However, it was intended to be part of a larger system of shelters, not the sole service provider for Phoenix’s estimated 9,000 homeless people. </p>
<p>The city’s homeless population has grown, in part because of <a href="https://www.azcentral.com/story/money/real-estate/catherine-reagor/2022/01/09/investors-pay-record-prices-metro-phoenix-apartments-rents-rise/9108972002/">unprecedented rent increases</a> and a <a href="https://des.az.gov/sites/default/files/dl/2022-Homelessness-Annual-Report.pdf?time=1691606062005">lack of affordable housing</a>. During this summer’s heat wave, <a href="https://www.goldwaterinstitute.org/a-wasteland-of-corpses-living-and-dead-a-devastating-inside-look-at-phoenixs-homeless-zone/">nearly 1,200 unsheltered homeless people</a> lived on sidewalks surrounding the campus, many in tents, with limited access to bathrooms and sanitation facilities.</p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/Cto17WLvVHT/?utm_source=ig_web_copy_link\u0026igshid=MzRlODBiNWFlZA==","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<h2>Homelessness and mental health</h2>
<p>When asked about causes of homelessness, policymakers and members of the public often point to <a href="https://bipartisanpolicy.org/blog/us-opinions-homelessness-poll/">mental illness and addiction</a>, as well as a <a href="https://homelesslaw.org/wp-content/uploads/2018/10/Homeless_Stats_Fact_Sheet.pdf">lack of affordable housing</a>. They tend to pay less attention to the underlying impacts of past trauma other than noting that many women become homeless to <a href="https://homelesslaw.org/wp-content/uploads/2018/10/Homeless_Stats_Fact_Sheet.pdf">escape domestic violence</a>.</p>
<p>In a 2005 study, an alarming 79% of homeless women seeking treatment for mental illness and substance abuse reported experiencing a past traumatic event such as <a href="https://doi.org/10.1016/j.jsat.2004.08.009">physical or sexual abuse</a>. More recently, a 2020 study showed that nearly two-thirds of homeless women and almost half of homeless men reported that they were homeless <a href="https://doi.org/10.1080/10530789.2020.1852502">because of trauma</a>. Shelter design can affect homeless people’s ability to recover from past trauma and to battle addiction and other mental health issues that perpetuate cycles of homelessness. </p>
<p>For example, one woman who currently lives in CASS told us about trying to get a full night’s sleep while living in a day room where the lights were kept on around the clock and there was constant activity. Because she had several bags of personal items that were too big to store in the dormitory, she could not get a bed there. </p>
<p>“When they don’t turn the lights down at night, I start to feel like my body is vibrating,” she said. “I start to see people walking around, and I’m not sure if they are even really there.” </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/5hauwKR-KIM?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Brandi Tuck, founding executive director of Portland Homeless Family Solutions in Oregon, explains how trauma-informed design can transform shelters.</span></figcaption>
</figure>
<p>Routinely sleeping less than seven hours per night can be <a href="https://doi.org/10.5665/sleep.4716">harmful to health</a>. It lowers immune function, increases chronic pain and raises the risk of heart disease, high blood pressure, diabetes, stroke and death. For homeless people battling mental health challenges, addiction and past trauma, rest and recovery are essential to getting back on their feet. </p>
<p>CASS staff have tried to create healthier sleep spaces, such as dorms that remain dark, quiet and cool at all times. Priority access goes to people with jobs. These sections can house only about a third of CASS’s residents, leaving others to sleep in dorms where there is more noise and light.</p>
<h2>More supportive spaces</h2>
<p>Simply feeding people and providing them with places to sleep is a major challenge for shelters in cities where homelessness is rising. But some have found ways to think more broadly.</p>
<p>In San Diego, <a href="https://my.neighbor.org/about-us/">Father Joe’s Villages</a>, a nonprofit network with a central campus and scattered-site programs, houses more than 2,000 people nightly. San Diego’s more temperate climate makes it less urgent to maximize the number of people they shelter indoors, so staff at Father Joe’s can use its decentralized design to create shelters with private and quiet spaces. </p>
<p>The Father Joe’s network includes multiple smaller-scale facilities where clean bathrooms are easily accessible and homeless people can use basic amenities like laundry and storage. One example is Mary’s Place, a collection of diverse shelters that provides emergency and long-term support in smaller facilities modeled after the simplicity and comfort of a home. </p>
<p>People experience less stress and can more easily navigate the challenge of ending their own homelessness when they can get a restful night’s sleep in a quiet environment, with spaces that allow them some privacy. We are encouraged to see other U.S. shelters <a href="https://www.theguardian.com/us-news/2023/jun/26/us-homeless-shelters-redesign">moving in this direction</a> – but there’s a long way to go.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/547454/original/file-20230911-7318-b3mmo6.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man sits on a bed in a large room divided into individual spaces with low partitions. His area has storage compartments with locks and a skylight provides daylight." src="https://images.theconversation.com/files/547454/original/file-20230911-7318-b3mmo6.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/547454/original/file-20230911-7318-b3mmo6.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=445&fit=crop&dpr=1 600w, https://images.theconversation.com/files/547454/original/file-20230911-7318-b3mmo6.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=445&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/547454/original/file-20230911-7318-b3mmo6.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=445&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/547454/original/file-20230911-7318-b3mmo6.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=559&fit=crop&dpr=1 754w, https://images.theconversation.com/files/547454/original/file-20230911-7318-b3mmo6.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=559&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/547454/original/file-20230911-7318-b3mmo6.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=559&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">This homeless shelter in Wilmington, Calif., a neighborhood of Los Angeles, provides residents with natural daylight, storage and privacy.</span>
<span class="attribution"><span class="source">Natalie Florence</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>Steps toward better design</h2>
<p>To address the lack of privacy at CASS, we have proposed subdividing the day room into more private spaces to accommodate activities like online telehealth appointments, counseling and job interviews. To tackle long-term impacts of overcrowding, we also have recommended introducing sanitation amenities, such as laundry facilities, “<a href="https://tessa2.lapl.org/digital/collection/COVID-19/id/296/">hot boxes</a>” to sanitize clothing and bedding, more bathroom facilities and reliable trash removal to reduce the spread of infection and pests such as bedbugs and lice. </p>
<p>For new facilities, designers could consider small changes, such as increased storage and more diligent regulation of temperature, light and noise. </p>
<p>Hospitals, nursing homes and <a href="https://generations.asaging.org/trauma-informed-practices-elder-care">retirement communities</a> have found many ways in recent decades to use design to <a href="https://blogs.cdc.gov/publichealthmatters/2022/05/trauma-informed/">support patients’ health</a>. Many of the same concepts can be applied to emergency shelters and help turn these facilities from institutional warehouses into spaces of health and opportunity.</p><img src="https://counter.theconversation.com/content/211010/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Heather Ross receives funding from the Arizona Alzheimer's Consortium and Public Interest Technology - University Network. She is affiliated with the Arizona Democratic Party and multiple healthcare professional organizations including American Nurses Association, American Association of Nurse Practitioners, and American College of Cardiology. </span></em></p><p class="fine-print"><em><span>Natalie Florence does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>As US cities struggle to reduce homelessness, two scholars explain how planners can reform shelter design to be more humane and to prioritize mental health and well-being.Natalie Florence, PhD Candidate in Humanitarian Design and Infrastructure Studies, Arizona State UniversityHeather Ross, Clinical Associate Professor in Nursing and Clinical Associate Professor, School for the Future of Innovation in Society, Arizona State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2106922023-08-06T08:46:58Z2023-08-06T08:46:58ZGhana’s housing policy and regulation is failing - COVID proved as much<figure><img src="https://images.theconversation.com/files/540659/original/file-20230802-23-ctgz3u.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Affordable housing in Ghana is unavailable for most people</span> <span class="attribution"><span class="source">Wikimedia Commons</span></span></figcaption></figure><p>Access to decent housing is a fundamental human right. Across sub-Saharan Africa, however, this right remains an elusive <a href="https://theconversation.com/inequality-in-access-to-basic-services-is-a-major-problem-in-sub-saharan-africa-but-progress-is-being-made-192884">dream</a> for many households. </p>
<p>In Ghana, for example, <a href="https://www.mwh.gov.gh/reduction-in-national-housing-deficit-reassuring-to-addressing-housing-challenges/">the government estimates a staggering deficit of 1.8 million homes</a>. Many households don’t get basic services either: 28.6% rely on wells for water, over a third use public latrines and <a href="https://www.statsghana.gov.gh/gssmain/fileUpload/pressrelease/GLSS7%20MAIN%20REPORT_FINAL.pdf">one in ten dispose of waste indiscriminately</a>. </p>
<p>Ghana’s housing market suffers from inadequate regulation. Landlords often demand <a href="https://link.springer.com/article/10.1007/s10901-021-09926-w">exorbitant rents</a> of 2-5 years in advance, even for poor accommodation. Both first-time and regular tenants save over <a href="https://www.tandfonline.com/doi/full/10.1080/10511482.2020.1782451">seven months of their incomes</a> to raise the advance rent. The burden of unaffordable housing weighs heavily on renters of all income levels. </p>
<p>Against this backdrop, the March 2020 <a href="https://crisis24.garda.com/alerts/2020/03/ghana-authorities-impose-lockdown-on-two-regions-due-to-covid-19-from-march-30-update-3">announcement</a> of a lockdown in the Greater Accra and Greater Kumasi metropolitan areas due to the COVID-19 pandemic raised concerns about how households would cope. </p>
<p>We are urban and housing studies scholars who research issues of housing in Ghana. Immediately after the lockdown restrictions were lifted, we conducted a study to explore how housing characteristics and households’ circumstances affected adherence to COVID-19 health and safety protocols in Kumasi, Ghana. We <a href="https://api.repository.cam.ac.uk/server/api/core/bitstreams/ef0d8975-988f-45d7-8743-804c0e67fdb6/content">found</a> that residents struggled to comply with the lockdown in their homes. The reasons they gave included lack of access to sanitation, ventilation and space. We propose the formulation of a pro-poor housing policy and enforcement of provisions in both the existing Rent Act and the Building Code to prevent landlords from charging rent advance beyond six months, and compel landlords to provide toilets in all habitable dwellings, respectively. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-accra-tackled-complex-challenges-in-an-urban-slum-144239">How Accra tackled complex challenges in an urban slum</a>
</strong>
</em>
</p>
<hr>
<h2>Findings</h2>
<p>We conducted interviews with 27 household heads across eight suburbs in Greater Kumasi. The Ashanti region, with Kumasi as its capital, has the highest proportion of compound houses in Ghana <a href="https://www.statsghana.gov.gh/gssmain/fileUpload/pressrelease/GLSS7%20MAIN%20REPORT_FINAL.pdf">(62.8% against a national average of 57.3%)</a>. Compound houses refer to a traditional form of housing where multiple dwelling units, typically single rooms and/or chamber and hall arrangements, are grouped together in a single or multi-storey building. These units are organised in two main layouts: single-banked, where the units surround an open courtyard, and double-banked, also known as “face me I face you”, where units are situated on both sides of a common lobby, with the courtyard at the rear. The courtyard serves as a significant space for social interactions and inter-household activities. Households within the compound share common facilities such as toilets, kitchens, drying lines, water, and electricity meters. The sharing of toilets and bathrooms raised concerns during the lockdown. </p>
<p>The areas studied were Old Tafo, Kentinkrono, Manhyia, Adiebeba, Santase, Kwadaso, Deduako and Appiadu. We selected these areas because of their different characteristics and prevalence of traditional family homes, which are <a href="https://api.repository.cam.ac.uk/server/api/core/bitstreams/89d06a86-7ab5-4bf1-94fe-c0937fc2b585/content">collectively owned and occupied by between 10 and 15 households</a>. Additionally, we sought expert insights from five housing professionals representing the Ghana Institute of Architects, Rent Control Department, Kumasi Metropolitan Assembly, and the Ministry of Works and Housing.</p>
<p>Our study uncovered realities that hindered households’ ability to comply with COVID-19 protocols during the lockdown. And even after the pandemic, what we’ve learnt can be used to address Ghana’s housing crisis.</p>
<p><strong>Lack of water</strong>: People living in compound houses disconnected from public water mains were unable to benefit from the government’s suspension of water tariff payments. They had to buy water from commercial vendors for essential activities. Cooking, bathing and laundry left little water for regular hand-washing.</p>
<p><strong>Inadequate sanitation</strong>: The absence of toilet facilities in some compound houses forced households, including children, to rely on public toilets. This increased their potential exposure to the coronavirus as they queued to use these facilities.</p>
<p><strong>Poor ventilation</strong>: Being confined to the house during the lockdown was uncomfortable where ventilation was poor. Some homes had small, blocked and poorly oriented windows. Cooking within confined spaces, such as terraces or porches, made it worse for some people, and increased the risk of virus transmission.</p>
<p><strong>Limited space for isolation</strong>: Some households were compelled to share rooms with family members who had contracted the virus because there were no spare rooms. Inability to isolate increased the risk of infection among household members.</p>
<p><strong>Distracting work environment</strong>: Some formal sector workers such as consultants and teachers had to work from home. They faced challenges such as a distracting environment, lack of suitable work spaces, and unreliable internet connectivity.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/policymakers-have-a-lot-to-learn-from-slum-dwellers-an-accra-case-study-96940">Policymakers have a lot to learn from slum dwellers: an Accra case study</a>
</strong>
</em>
</p>
<hr>
<h2>The way forward</h2>
<p>Our research underscores the urgent need for policy changes and regulation to tackle Ghana’s housing crisis.</p>
<p>A recent <a href="https://www.repository.cam.ac.uk/items/9e8ee939-9d1b-4e79-ad20-1130f46282ba">seminar</a> involving policymakers and stakeholders in Ghana’s housing sector yielded a consensus that housing policy and supply should put the needs of the poor first. Poor households found it difficult to comply with the COVID-19 protocols. The existing <a href="https://www.mwh.gov.gh/wp-content/uploads/2018/05/national_housing_policy_2015-1.pdf">pro-market housing policy</a> does not help the poor to get decent accommodation.</p>
<p>Regulation should focus not only on the advance rent period but also on the provision of basic facilities. Toilets and bathrooms should be provided before properties are rented. The ongoing pilot of the <a href="https://www.nras.gov.gh/how-it-works">National Rental Assistance Scheme</a> is a start. This involves the government paying the rent advance on behalf of renters and receiving payback in the form of monthly loan payments. It presents an opportunity to ensure landlords can benefit from the scheme only if their rented properties meet these basic sanitary requirements and are decently equipped.</p>
<p>The <a href="https://documents1.worldbank.org/curated/en/510751563906548492/pdf/Building-the-Market-for-Urban-Sanitation-in-Ghana.pdf">affordable toilet programme</a> in which local authorities, with support from the World Bank, build decent toilet facilities for households should be extended beyond the Greater Accra and Greater Kumasi areas. Poorer households could be offered flexible payment arrangements so they could participate. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/cities-are-central-to-our-future-they-have-the-power-to-make-or-break-societys-advances-207317">Cities are central to our future – they have the power to make, or break, society's advances</a>
</strong>
</em>
</p>
<hr>
<p>We also propose a rethink of house design, construction materials and their sourcing. The growing preference for imported construction materials, such as doors, windows and roofing, without considering local weather conditions increases the cost of construction and can result in unpleasant housing conditions such as excessive space heating. Thus it is crucial to initiate a conversation about sustainable and context-specific housing design, and use of local construction materials.</p>
<p>The housing crisis in Ghana demands immediate action. Our research highlights the underlying issues of inadequate housing, limited access to basic services, and the unequal burden borne by the poor. As Ghana navigates the path to recovery from the pandemic, it should seize this opportunity to transform Ghana’s housing landscape to ensure most if not all households have access to safe, decent, and affordable housing.</p><img src="https://counter.theconversation.com/content/210692/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Richmond Juvenile Ehwi receives funding from the UKRI All Councils Harmonised Rapid Response Grant for the Impact Activity based on which this article is written. </span></em></p><p class="fine-print"><em><span>Lewis Abedi Asante does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Ghana’s housing deficit needs immediate attention.Richmond Juvenile Ehwi, Research Associate, University of CambridgeLewis Abedi Asante, Lecturer, Kumasi Technical UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2069482023-07-10T14:45:16Z2023-07-10T14:45:16ZNearly a third of Nigerians don’t have access to a basic supply of water. This is partly because of loopholes in a law<figure><img src="https://images.theconversation.com/files/535764/original/file-20230705-29-crz55s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Access to clean water is a major issue in Nigeria. </span> <span class="attribution"><span class="source">Getty Images </span></span></figcaption></figure><p>Water, sanitation and hygiene facilities are essential for health and welfare. Providing them is one of the core duties of the state.</p>
<p>In Nigeria, funding for these projects comes from the government’s budget and from development partners. UNICEF, the UK’s Foreign Commonwealth and Development Office, the European Union, and the US Agency for International Development all provide aid. </p>
<p>A <a href="https://www.unicef.org/nigeria/media/2986/file/Evaluation%20Report%20on%20WASH%20Programme%202014%20-%202017.pdf#page=12">UNICEF report</a> shows that between 2014 and 2017, international development partners and the government invested a total of US$188.3 million in sanitation projects in Nigeria. </p>
<p>But the report <a href="https://www.unicef.org/nigeria/media/2986/file/Evaluation%20Report%20on%20WASH%20Programme%202014%20-%202017.pdf#page=12">shows</a> that Nigeria is still one of the top three countries globally in terms of the number of people living without safe water and sanitation. It <a href="https://www.unicef.org/nigeria/media/2986/file/Evaluation%20Report%20on%20WASH%20Programme%202014%20-%202017.pdf#page=12">adds</a> that only 68% of the Nigerian population have access to a basic water supply, 19% use safely managed sanitation facilities and 24% practise open defecation. </p>
<p>Unsafe water and poor sanitation and hygiene are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4199018/">some of the major causes</a> of Nigeria’s high rates of mortality and morbidity among children under five. They increase vulnerability to water-related diseases such as cholera, typhoid and diarrhoea.</p>
<p>There have been public procurement reforms that seek to regulate abuse of rules, processes and standards in the awarding and delivery of public-sector contracts. But despite the reforms, eliminating the massive deficits in the water and sanitation sector through competitive, transparent, accountable and cost-effective procurement processes has become increasingly difficult. </p>
<p>In <a href="https://www.tandfonline.com/doi/full/10.1080/03056244.2023.2194164">a recent paper</a> we analysed data from selected local government areas where there were UNICEF-funded sanitation projects. Based on this, we argue that procurement regulation has been subverted to make money in the service delivery sector. </p>
<p>Our findings provide an explanation of the deplorable state of sanitation facilities in Nigeria. The problem is not just a lack of funding or capacity, as has been argued before, but a legal choice. </p>
<h2>Procurement in Nigeria</h2>
<p>Nigeria enacted a procurement law in 2007. <a href="https://www.bpp.gov.ng/wp-content/uploads/2019/01/Public-Procurement-Act-2007pdf.pdf">The Public Procurement Act 2007</a> brought a sense of regulation to the procurement process in the country. Before this, there was no law either at the state or federal level guiding public procurement. It was intended to check abuse in the awarding and delivery of public-sector contracts. </p>
<p>Section 24 (3) of the Public Procurement Act sets out that contracts must be awarded to the bidder with the lowest bid that meets the contract’s terms and conditions. </p>
<p>Our study focused on how this practice undermined the delivery of sanitation projects in Nigeria.</p>
<p>We drew on field data from sanitation projects in states across the country: Akwa Ibom, Anambra, Bauchi, Bayelsa, Benue, Jigawa, Katsina, Rivers and Yobe. The procuring entities were ministries, extra-ministerial offices, government agencies, parastatal organisations and corporations. They awarded UNICEF-funded projects to the lowest responsive bidders (contractors) between 2013 and 2019. The projects were meant to provide water and sanitation facilities. </p>
<p>We observed that four firms were accused of committing a procurement offence. They subcontracted their commitments to other firms at prices lower than the sums in the contract. </p>
<p>We saw that influential individuals under-quoted contract sums, apparently to keep a hold on procurement processes. They then won contracts and diverted contract sums or subcontracted to third parties who either failed to do the work or delivered substandard work. The poor standard could be seen from the reports of the procuring entities.</p>
<p>Contrary to the expectation that the procurement legislation would promote broader participation in contract management, this study found that accepting the lowest bid limited the involvement of credible, trusted and tested firms known for the delivery of quality work, goods and services. Quality work would necessarily cost more than the lowest bid. </p>
<p>The procurement law could have provided, instead, for bidding that emphasised quality, experience and reputation. It appears lawmakers made sure that the law left loopholes.</p>
<p>Reputable firms are seemingly incapable of getting contracts because they lack access to powerful state actors. Highly placed individuals use the bidding mechanism to engage in sharp practices.</p>
<p>The result is low quality service delivery. </p>
<h2>How Nigeria got here</h2>
<p>For decades, poor sanitation and hygiene facilities in Nigeria were connected to weak project execution, paucity of funds and limited government capacity. Corruption, overvaluation of projects and favouritism in contract awards added to the problems. Attempts to prevent these challenges provided the basis for public procurement reforms. </p>
<p>The reforms were supposed to improve accountability on the part of government and others in public procurement. Fairness, value for money and cost effectiveness were also expected. </p>
<p>But the lowest evaluated bid system is more susceptible to manipulation than a qualifications-based bidding mechanism.</p>
<p>The reforms have not had the desired impact in the water and sanitation sector. </p>
<h2>Appropriate reform</h2>
<p>An appropriate reform of the service delivery sector should enhance participation in procurement processes by civil society organisations, the media, beneficiary communities and relevant professional bodies. </p>
<p>Contract sums must also be in line with market realities. Tested and trusted contractors must be engaged to manage procurement of works and services.</p><img src="https://counter.theconversation.com/content/206948/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Nigerians lack access to safe water, sanitation and hygiene facilities despite investment in these areas. Procurement law contributes to this inadvertently.Aloysius-Michaels Okolie, Professor of Political Science, University of NigeriaChikodiri Nwangwu, Senior Lecturer, Department of Political Science, University of NigeriaKelechi Elijah Nnamani, Lecturer and Researcher, Department of Political Science, University of NigeriaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1940652022-11-14T02:51:36Z2022-11-14T02:51:36ZTempted to buy a UV light disinfection gadget? Some can be dangerous – here’s what you need to know<figure><img src="https://images.theconversation.com/files/494987/original/file-20221114-12-tzfevs.jpg?ixlib=rb-1.1.0&rect=0%2C53%2C5443%2C3467&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">MBLifestyle/Shutterstock</span></span></figcaption></figure><p>The COVID-19 pandemic has fundamentally changed many of our behaviours and attitudes towards infection control.</p>
<p>Hand hygiene was one of the earliest and most adopted measures to counteract the spread of disease, but there have been more technology-based approaches, too.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/vodka-wont-protect-you-from-coronavirus-and-4-other-things-to-know-about-hand-sanitizer-133593">Vodka won't protect you from coronavirus, and 4 other things to know about hand sanitizer</a>
</strong>
</em>
</p>
<hr>
<p>One example is the booming industry of devices that use ultraviolet radiation (UV) to kill germs. While UV can successfully sanitise the air, or objects such as your smartphone, it can also come with cancer risk if the radiation is not behind a proper barrier.</p>
<p>Here’s what you need to know about UV sanitation devices.</p>
<h2>How does UV sanitation work?</h2>
<p>Ultraviolet light is light with wavelengths just short enough that most humans can’t see it under normal conditions. The most ubiquitous source of UV is the Sun, which radiates everything from vacuum UV to far UVC, UVC, UVB and UVA rays (see below).</p>
<p>The last two can pass the ozone layer in our atmosphere, while the first three are blocked – good news for life on Earth, since UVC in particular can be harmful to living things.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/494983/original/file-20221114-2672-jwwh8z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A chart showing the wavelengths of ultraviolet light" src="https://images.theconversation.com/files/494983/original/file-20221114-2672-jwwh8z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/494983/original/file-20221114-2672-jwwh8z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=204&fit=crop&dpr=1 600w, https://images.theconversation.com/files/494983/original/file-20221114-2672-jwwh8z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=204&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/494983/original/file-20221114-2672-jwwh8z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=204&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/494983/original/file-20221114-2672-jwwh8z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=256&fit=crop&dpr=1 754w, https://images.theconversation.com/files/494983/original/file-20221114-2672-jwwh8z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=256&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/494983/original/file-20221114-2672-jwwh8z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=256&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Ultraviolet light is invisible to the eye, and spans from 10 to 400 nanometres in wavelength.</span>
<span class="attribution"><span class="source">petrroudny43/Shutterstock</span></span>
</figcaption>
</figure>
<p>At a wavelength of 250–260 nanometres, energy generated by UVC rays can penetrate through microbes to break their DNA and RNA, disrupting their cell functions and killing them. </p>
<p>This is useful for germicidal (germ-killing) UVC radiation technology, although its efficacy depends on radiation intensity, the distance from light source to target, the type of surface being sanitised, and the wavelength at which the UVC is operating.</p>
<p>The blue light you often see on such devices is either decorative, or the visible light emitted by the chemicals used to produce UVC – remember, the UV light itself is invisible.</p>
<p>According to research, sanitation devices that emit high doses of germicidal UVC are an efficient means of killing fungi, viruses, bacteria and protozoa – single-celled organisms. They have been successfully used in treating <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/fsn3.1412">water</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2789813/">air</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/29124707/">sewage</a>, for <a href="https://www.sciencedirect.com/science/article/abs/pii/S1385894720342005">food safety</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7644456/pdf/IJHS-14-52.pdf">medical settings</a>, <a href="https://visionasia.com.sg/uvc-disinfection-robots-in-public-transport/">public transport</a> and more. </p>
<p>The key is to have the UVC source fully enclosed and automatically stop if the device is open, so there’s no risk of exposing people to the radiation, which can cause severe burns and even increase the risk of cancer. </p>
<p>UV sanitation gadgets that operate without enclosure present serious health risks. Unfortunately, current lack of regulation means such devices are readily available for consumers to buy – and potentially be harmed by.</p>
<figure class="align-center ">
<img alt="A stock photograph of an electric toothbrush next to a white container with a blue light in the centre" src="https://images.theconversation.com/files/494985/original/file-20221114-18-gppq8f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/494985/original/file-20221114-18-gppq8f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/494985/original/file-20221114-18-gppq8f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/494985/original/file-20221114-18-gppq8f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/494985/original/file-20221114-18-gppq8f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/494985/original/file-20221114-18-gppq8f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/494985/original/file-20221114-18-gppq8f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">An electric toothbrush head steriliser that’s fully enclosed should be perfectly safe to use.</span>
<span class="attribution"><span class="source">grandbrothers/Shutterstock</span></span>
</figcaption>
</figure>
<h2>A serious lack of regulation</h2>
<p>Numerous companies have researched and developed safe, efficient and fully enclosed UVC devices.</p>
<p>However, the market is unregulated, with serious concerns about the quality and safety of some dubious devices available for consumers. In 2020, the lighting industry body <a href="https://www.globallightingassociation.org/images/files/publications/GLA_UV-C_Safety_Position_Statement.pdf">Global Lighting Association</a> raised its concerns:</p>
<blockquote>
<p>“[I]n the midst of a global COVID-19 epidemic, GLA is concerned at the proliferation of UVC disinfecting devices – particularly being sold on the internet – with dubious safety features and inadequate safety instructions”.</p>
</blockquote>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ultraviolet-light-can-make-indoor-spaces-safer-during-the-pandemic-if-its-used-the-right-way-141512">Ultraviolet light can make indoor spaces safer during the pandemic – if it's used the right way</a>
</strong>
</em>
</p>
<hr>
<p>UVC products without enclosure, such as the “<a href="https://www.fda.gov/medical-devices/safety-communications/do-not-use-ultraviolet-uv-wands-give-unsafe-levels-radiation-fda-safety-communication">disinfection wands</a>” you might see on the internet, <a href="https://www.cnet.com/home/smart-home/uvc-light-wands-kill-viruses-experts-warn-major-safety-issue-coronavirus-covid-19/">can be very unsafe</a>. They can affect exposed skin, eyes and mucous membranes.</p>
<p>Due to health risks, any non-enclosed UVC device should only be remote-controlled or automatic. It should also be equipped with safeguards, such as a sensor that turns it off if it detects anyone in the room.</p>
<p>To ensure the safety and efficacy of UVC devices available on the consumer market, we need watchdog bodies to urgently introduce rigorous global regulations.</p>
<h2>Is far UVC safer?</h2>
<p>Recently, <a href="https://www.nature.com/articles/s41598-022-08462-z">far UVC has been proposed as a possible solution</a> to this challenge. Radiating at a wavelength of 207–222 nanometres, far UVC has a <a href="https://www.nature.com/articles/s41598-020-67211-2">“shallow” skin entrance</a>. However, the research with far UVC is very recent and so far mostly focused on animals.</p>
<p>Very few human studies have been performed, and some have been funded by companies prototyping far UVC devices, which can introduce a bias. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7894148/">Literature search reviews</a> report different analytic parameters, which makes comparisons difficult to interpret.</p>
<p><a href="https://www.dundee.ac.uk/stories/research-investigates-safety-uv-technology-covid-19-inactivation">Some trials</a> have started, but there are few to date, and with small sample sizes.</p>
<p>We will need trials with rigorous ethical approvals to investigate the full far UVC impact on humans. There is a lack of understanding how far UVC might affect people with thinner outer skin layers, affected by cuts, light sensitivity, or various medical conditions.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ultraviolet-radiation-is-a-strong-disinfectant-it-may-be-what-our-schools-hospitals-and-airports-need-142277">Ultraviolet radiation is a strong disinfectant. It may be what our schools, hospitals and airports need</a>
</strong>
</em>
</p>
<hr>
<h2>What to look out for if you still want a UV sanitation device</h2>
<p>When it comes to buying a UVC gadget, buyer beware. Never buy anything that claims you can disinfect hands, the body, or a whole room while people are around. Skin cancers like <a href="https://link.springer.com/article/10.1007/s42764-020-00009-8">basal cell carcinoma and squamous cell carcinoma</a> are attributed to UV exposure.</p>
<p>Check the documentation. Is there evidence the device is effective against microorganisms? What’s the length of exposure, and how far from the source is the target being sanitised?</p>
<p>You also need to be aware that the cost of efficient and safe new technology and efficient UVC-producing LEDs is very high. Therefore, you may need to question the effectiveness of a relatively “cheap” device.</p>
<p>In the absence of a global regulatory body within the UVC market, the rule of thumb is to purchase only a fully sealed, enclosed UVC device operating with strict safety and efficiency to harm microbes, not you.</p><img src="https://counter.theconversation.com/content/194065/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lotti Tajouri is affiliated with Dubai Police Scientist Council.</span></em></p><p class="fine-print"><em><span>Simon McKirdy has provided scientific advice to Glissner.</span></em></p><p class="fine-print"><em><span>Matthew Olsen and Rashed Alghafri do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Ultraviolet radiation at specific wavelengths is great at killing germs – but when used incorrectly, it can also cause health risks.Lotti Tajouri, Associate Professor, Genomics and Molecular Biology; Biomedical Sciences, Bond UniversityMatthew Olsen, Assistant researcher, Bond UniversityRashed Alghafri, Honorary Adjunct Associate Professor, Health Sciences and Medicine, Bond UniversitySimon McKirdy, Professor of Biosecurity, Murdoch UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1906672022-09-25T20:03:46Z2022-09-25T20:03:46ZBackcountry visitors are leaving poo piles in the Australian Alps – and it’s a problem<p>Spring has arrived in Australia’s Snowy Mountains. The snow is starting to melt. Wildflowers are emerging in a variety of colours: blues, yellows, whites … hang on. Those aren’t white flowers. They’re scrunched up bits of toilet paper left behind by skiers, boarders and snow-shoers.</p>
<p>When you think of backcountry snow adventures, you think of pristine wilderness. But unfortunately, there’s a problem: what to do with your poo. Many backcountry adventurers just squat, drop and don’t stop. The result, as we saw ourselves on an overnight ski trip, is a surprisingly large amount of poo and toilet paper. It’s <a href="https://themountainjournal.com/2016/06/05/lets-talk-about-poo">become a bigger problem</a> in recent years, as backcountry trips have boomed in places like the Main Range section of the Snowy Mountains.</p>
<p>Our <a href="https://www.tandfonline.com/eprint/YNUSDDMTKCR7KJEZQEDS/full?target=10.1080/14486563.2022.2105409">new research</a> explores this issue to find out how to better protect these wild areas. We surveyed backcountry visitors to Kosciuszko National Park in New South Wales and found a minority of visitors were carrying out their waste from overnight trips, as recommended. To combat the alpine poo scourge, we recommend building more toilets in strategic locations, making their location readily known, and giving out poo transport bags at entry points and gear shops. </p>
<p>If you’re sceptical, take heart – it wasn’t so long ago many people believed dog owners would never agree to scoop up their pet’s poo and bin it. But for the most part, they did.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/485769/original/file-20220921-26-86cwmb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="snowy mountain lake" src="https://images.theconversation.com/files/485769/original/file-20220921-26-86cwmb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/485769/original/file-20220921-26-86cwmb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/485769/original/file-20220921-26-86cwmb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/485769/original/file-20220921-26-86cwmb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/485769/original/file-20220921-26-86cwmb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/485769/original/file-20220921-26-86cwmb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/485769/original/file-20220921-26-86cwmb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">As the snow melts, it can carry poo down to watercourses or lakes like Blue Lake in the popular Main Range section of the Snowy Mountains.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>So what are you meant to do with snow poo?</h2>
<p>You might wonder why this matters. After all, aren’t our snow-covered mountains full of possums, wombats and wallabies, all of which poo? And can’t you bury your poo, like you can in other parts of Australia? The problem here is the snow. Human poo deposited in winter won’t decompose until spring. In popular areas, poo and toilet paper can pile up, which is an unpleasant visual for other visitors. And as the snow melts, it can carry poo into creeks, depositing cold-resistant viruses, bacteria like <em>E. coli</em>, and parasites such as giardia. If another skier eats contaminated snow or drinks the stream water, they can be infected. </p>
<p>That’s why backcountry visitors to Kosciuszko National Park are <a href="https://www.nationalparks.nsw.gov.au/safety/alpine-safety/kosciuszko-back-country-camping#take-human-waste-with-you">urged to carry out</a> their poo in biodegradable bags or a home made poo tube (basically a <a href="https://cccsc.asn.au/home/info/poo-tube/">sealable plastic pipe</a>). </p>
<p>This, our survey of 258 visitors found, is not hugely popular. Only a third of highly experienced skiers on multi-day trips carry their poo out, while only a fifth of less experienced visitors did the same. </p>
<p>The options our multi-day skiers preferred were using a toilet at a hut, if available, or burying poo in the snow. This is not ideal – if you can’t carry it out, it’s preferable to bury it in exposed soil (ideally, at least 50 metres away from any water courses). Some visitors reported covering their waste with rocks. </p>
<p>Day visitors largely used toilets at the entry and exit points or at a resort, though around 10% reported burying their poo in the snow or using toilets at huts. </p>
<p>This means overall compliance with the carry-it-out policy is low. </p>
<p>But as one longtime backcountry visitor <a href="https://themountainjournal.com/2016/06/05/lets-talk-about-poo/">points out</a>, it’s not actually hard – or disgusting – to carry it out: </p>
<blockquote>
<p>It was easy. It was the most satisfying experience I have had, knowing that I had left no trace for the entire journey; the view, the ground, the creeks, the plants had been left unspoilt. No-one would have ever known I had been there. Carrying and taking it out went without mishap and finally disposing of my waste was not a problem.</p>
</blockquote>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-need-our-alps-so-why-arent-we-looking-after-them-3831">We need our Alps, so why aren't we looking after them?</a>
</strong>
</em>
</p>
<hr>
<h2>What can be done?</h2>
<p>People prefer toilets as a tried and true method of removing poo. Installing new toilets is the most effective way to prevent open defecation. The problem is where to put them. Installing toilets in remote areas is a delicate matter, as many visitors may see them as taking away from the natural experience which is the major drawcard for backcountry visitors. It’s also expensive to maintain toilets in the snow, as they require helicopters or trucks to pump out the waste. </p>
<p>Other options include digging pit latrines, disposing of it into crevasses, burying in soil, snow or rocks, leaving it on the ground, burning it, or carrying it out in <a href="https://lnt.org/poop-tube-101/">poo tubes</a> or <a href="https://www.youtube.com/watch?v=EbLjgOk5zZg">biodegradable bags</a>. You can see why park authorities prefer carrying it out. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/485773/original/file-20220921-25-1wjkec.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="main range signboard" src="https://images.theconversation.com/files/485773/original/file-20220921-25-1wjkec.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/485773/original/file-20220921-25-1wjkec.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/485773/original/file-20220921-25-1wjkec.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/485773/original/file-20220921-25-1wjkec.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/485773/original/file-20220921-25-1wjkec.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/485773/original/file-20220921-25-1wjkec.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/485773/original/file-20220921-25-1wjkec.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Toilets are the gold standard - but they’re hard to come by in remote areas of Kosciuszko National Park.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>So how can we make it more inviting for visitors to pack their poo? Clearly, the present messaging isn’t fully effective. It’s time for a new approach, especially given the numbers of people heading to the backcountry is <a href="https://www.destinationnsw.com.au/wp-content/uploads/2019/08/snowy-mountains-factsheet-ye-mar-2019.pdf">growing</a>.</p>
<p>We recommend a two-pronged approach: better communication and targeted infrastructure at entry points. </p>
<p>Friends, websites and outdoor recreation clubs are important sources of information about how to undertake a backcountry trip. To harness these sources, parks authorities could work with the wider backcountry community on the issue, with simple, targeted messages. </p>
<p>By itself, messaging won’t be enough. That’s why we need more and improved toilets – and bins – at key locations, to make it as easy as possible for visitors to do the right thing with their poo. </p>
<p>Authorities should also make these locations clearly known on visitor maps and online, as well as making biodegradable bags or poo tubes available at entry points, information centres and gear shops. </p>
<p>If we get this right, backcountry skiers will once again be able to enjoy the wildflowers. Let’s aim for spring has sprung – not spring has dung. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/it-is-not-easy-how-science-and-courage-saved-the-stunning-australian-alps-141658">'It is not easy': how science and courage saved the stunning Australian Alps</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/190667/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Pascal Scherrer has conducted research that has received funding from the New South Wales National Parks and Wildlife Service (NPWS) and has served on Regional Advisory Boards of the NPWS.</span></em></p><p class="fine-print"><em><span>Isabelle Wolf has conducted research that has received funding from the University of Wollongong and the New South Wales National Parks and Wildlife Service (NPWS) </span></em></p><p class="fine-print"><em><span>Jen Smart conducts research that receives funding from New South Wales National Parks and Wildlife Service (NPWS) Hawkweed Eradication Program and the University of Wollongong. </span></em></p>You’re meant to carry out your poo, if you visit Australia’s alpine backcountry. But not many people do – and it’s leaving plenty of evidence.Pascal Scherrer, Senior Lecturer, School of Business and Tourism, Southern Cross UniversityIsabelle Wolf, Vice Chancellor Senior Research Fellow, University of WollongongJen Smart, PhD student, University of WollongongLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1896592022-09-13T07:18:18Z2022-09-13T07:18:18ZSouth Africa’s increasing water stress requires urgent informed actions<figure><img src="https://images.theconversation.com/files/482949/original/file-20220906-16-51rjed.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">South Africa's water situation is a complex issue. </span> <span class="attribution"><span class="source">Ab Rahman Awang / EyeEm / Getty Images</span></span></figcaption></figure><p>Progress has been made since 2015 on a global scale in terms of increasing access to water of an acceptable quality and to sanitation services. But 2 billion people still lack safely managed drinking water and 3.6 billion people still lack safely managed <a href="https://unstats.un.org/sdgs/report/2021/The-Sustainable-Development-Goals-Report-2021.pdf">sanitation</a>.</p>
<p>At a regional level, drinking water from improved sources is not necessarily a guarantee of good or acceptable <a href="https://static.pmg.org.za/120904review.pdf">quality</a>. Some regions have lacked continued progress. Sub-Saharan Africa is one of them. It has the highest proportion of people still lacking safely managed drinking water and using unimproved <a href="https://static.pmg.org.za/120904review.pdf">sanitation</a>. </p>
<p>Since the mid-1990s, South Africa has made headway in expanding water and sanitation services, especially in rural areas. Yet this doesn’t mean an overall improvement. In some areas there has indeed been an improvement. But in many there has been a <a href="https://theconversation.com/basic-water-services-in-south-africa-are-in-decay-after-years-of-progress-185616">deterioration</a>.</p>
<p>In 2008, 5 million people still did not have adequate supplies of water while 15 million lacked basic <a href="https://www.dbsa.org/sites/default/files/media/documents/2021-03/DPD%20No10.%20Municipal%20compliance%20with%20water%20services%20policy-%20A%20challenge%20for%20water%20security.pdf">sanitation</a>. Most people affected live in rural communities in South Africa’s poorest provinces.</p>
<p>A number of factors are driving this state of affairs. These include <a href="https://theconversation.com/south-africa-has-had-lots-of-rain-and-most-dams-are-full-but-water-crisis-threat-persists-178788">natural limitations</a> such as below average annual rainfall, as well as lack of financing and technologies. But often the most cited cause of the country’s water crises is <a href="https://www.oecd.org/about/impact/addressing-water-scarcity.htm">poor water governance</a>. </p>
<p>This has led to a tendency to portray the country’s <a href="https://www.oecd.org/about/impact/addressing-water-scarcity.htm">water crisis as a governance crisis</a>. But we take issue with this emphasis on a <a href="https://www.tandfonline.com/doi/abs/10.1080/14650045.2017.1328407">crisis-based perspective</a>. We view it as too simplistic.</p>
<p>The water situation is a complex issue. The country’s freshwater resources are stressed on all fronts by unsustainable water consumption patterns, increasing water demands, failing water infrastructure, unreliable or non-existent water and sanitation services and continued <a href="https://theconversation.com/south-africa-has-had-lots-of-rain-and-most-dams-are-full-but-water-crisis-threat-persists-178788">pollution</a>. The added effects of increased climate variability with <a href="https://www.ipcc.ch/site/assets/uploads/2018/03/climate-change-water-en.pdf">changing rainfall patterns</a> will add significant additional stress, questioning the country’s current and future water security.</p>
<p>A big contributory factor is the governance issue. This includes the country’s fragmented water governance departments combined with continued inaction as well as non-accountability at various levels of government. This has led to questionable decisions as well as increased water scarcity and stress of South Africa’s already limited water resources and unreliable supply.</p>
<h2>What’s missing</h2>
<p>Not all municipalities are equal when it comes to local government management. Our research shows the stark difference between the situation in, for example, <a href="https://link.springer.com/chapter/10.1007/978-3-030-02517-5_3">Sekhukhune (Limpopo Province) and that of eThekwini (KwaZulu-Natal)</a>.</p>
<p>A number of reasons explain this. These include:</p>
<ul>
<li><p>rural-based municipalities do not have the same financial resources as the larger metropolitan municipalities </p></li>
<li><p><a href="https://journals.co.za/doi/epdf/10.4314/wsa.v42i4.21">skills</a> are often lacking in rural areas. Young science and technology graduates are often reluctant to work there. The lure of city life and higher incomes are contributing factors.</p></li>
<li><p>the mismanagement of funds</p></li>
<li><p><a href="https://journals.co.za/doi/epdf/10.4314/wsa.v42i4.21">no forward planning and problematic public</a> administration processes</p></li>
<li><p>disharmonious politics among various political actors, often within the same <a href="https://theconversation.com/africas-oldest-surviving-party-the-anc-has-an-achilles-heel-its-broken-branch-structure-150210">political party</a>.</p></li>
</ul>
<p>There are a number of additional gaps too.</p>
<p>South Africa has world class water resource management legislation and policies. But its overall <a href="https://www.sciencedirect.com/science/article/abs/pii/S2210422412000196">water governance and management practices</a> have been <a href="https://www.zef.de/uploads/tx_zefportal/Publications/jfoerster_download_F%C3%B6rster%20et%20al.%202017%20-%20When%20Policy%20Hits%20Practice%20Structure%20Agency%20and%20Power%20in%20South%20African%20Water%20Governance.pdf">criticised and found wanting</a>. </p>
<p>Cooperation, coordination and communication are major requirements for improved water governance. But these are lacking to varying degrees across government structures and across localities.</p>
<p>Resources are often either lacking or poor, not only within local government but within the Department of Water and Sanitation itself. </p>
<p>Another major gap is infrastructure. The state of the country’s wastewater treatment and water treatment works are of major concern as 56% and 44% are in poor or critical condition, with 11% not functioning at <a href="https://www.gov.za/documents/national-water-and-sanitation-master-plan-28-nov-2019-0000">all</a>. </p>
<p>Regular water quality monitoring and water infrastructure assessments are crucial to reducing the increased risk of the contraction of water-borne diseases, degradation of ecosystems and major physical water losses.</p>
<p>Unfortunately, this has not been done consistently. This is clear from lapses in the release of <a href="https://ws.dws.gov.za/IRIS/latestresults.aspx">blue and green drop reports</a>. The Blue Drop <a href="https://ws.dws.gov.za/IRIS/releases/2021_BD_PAT_report_final-28Mar22_MN_web.pdf">programme</a> measures elements that contribute to sustainable water services and safe water provisioning to citizens. The Green Drop reports focus on the performance of <a href="https://researchspace.csir.co.za/dspace/handle/10204/7257">wastewater infrastructure</a>.</p>
<p>In addition, the <a href="https://www.dws.gov.za/dnwrs/default.aspx">National Water Resources Strategy</a> isn’t being reviewed every five years as the legislation stipulates. The first was published in 2004, the second in 2013, and the third is now under consideration.</p>
<p>Inadequate or irregular monitoring and strategising means that the country can’t manage water resources, services and infrastructure in an informed manner.</p>
<p>Fixing failing infrastructure falls on municipalities which are already under massive financial constraints. The only route is to pass on the cost to residents through increased water prices and disrupted water supplies.</p>
<h2>Solutions</h2>
<p>There is a plan in circulation – the creation of a <a href="https://www.gov.za/speeches/dws-consultations-establishment-infrastructure-agency-set-motion-3-mar-2022-0000">National Water Resource Infrastructure Agency</a>. The idea has been on the cards since the mid-1980s and <a href="https://www.gov.za/sites/default/files/gcis_document/201409/297450.pdf">mooted on and off</a> since then. The <a href="https://www.gov.za/sites/default/files/gcis_document/201409/297450.pdf">agency’s purpose</a> is to fund, develop, maintain, operate and manage the country’s national water resources infrastructure.</p>
<p>Earlier this year President Cyril Ramaphosa mentioned the creation of the agency in his <a href="https://www.gov.za/SONA2022">2022 state of the nation address</a>. This indicated a paradigm shift in ameliorating the problems of water and sanitation services. It suggested there was political will at the highest level of government to fix the problems and create opportunities. </p>
<p>But the government has been bad at implementation. Take the catchment management agencies which were first suggested in the mid-1990s. Originally 19 were envisaged, but their configuration has changed quite a few times in the intervening years. They were <a href="https://dlc.dlib.indiana.edu/dlc/bitstream/handle/10535/5108/WARFSA_2001_schreiner.pdf?sequence=1">designed</a> to decentralise water management to the local level. But after more than two decades only two are operating: the <a href="https://www.ecologyandsociety.org/vol21/iss3/art26/">Breede-Gouritz and the Inkomati-Usuthu agencies</a>. </p>
<p>If the establishment of catchment management agencies is anything to go by, the National Water Resource Agency might not see the light of day very soon.</p>
<p>Finally, there is a worrying level of overall ignorance about the current state of South Africa’s water resources and what is required to ensure adequate and reliable supply. </p>
<p>Going forward, the key for water security will be for both the government and South Africans to become more knowledgeable and improve on the overall management of the country’s water resources, deteriorating infrastructure, poor water and sanitation service delivery as well as continued pollution of already stressed water resources.</p><img src="https://counter.theconversation.com/content/189659/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>South Africa’s water situation is complex. It needs better monitoring and implementation of plans.Richard Meissner, Associate Professor, University of South AfricaAnja du Plessis, Associate Professor and Research Specialist in Integrated Water Resource Management, University of South AfricaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1863362022-08-08T13:42:10Z2022-08-08T13:42:10ZThe environment is the silent casualty in the Cameroon Anglophone crisis<figure><img src="https://images.theconversation.com/files/476734/original/file-20220729-24-78zea6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Women displaced from rural villages in the Anglophone region gather to wash clothes in a stream. </span> <span class="attribution"><span class="source">Photo by Giles Clarke/UNOCHA via Getty Images</span></span></figcaption></figure><p>Most analysis of Cameroon’s Anglophone crisis has been skewed towards the socioeconomic, cultural and political ramifications of the conflict. </p>
<p>But, based on my work on natural, environmental hazards and disaster management in Cameroon over the past two decades, I would argue that the environment in the Anglophone region is a silent casualty of the conflict. And it has largely been ignored.</p>
<p>Our recently <a href="https://doi.org/10.1186/s41018-022-00114-1">published research</a> on the crisis showed that over 900,000 people had been internally displaced. Eighty percent of the inhabitants of villages that were conflict hot spots had fled into adjacent forests. The research investigated the consequences of the Cameroon Anglophone crisis and determined it to be an <a href="https://www.files.ethz.ch/isn/168071/research%20brief%20no%2016_final.pdf">acute complex emergency</a>. </p>
<p>These developments are leaving huge environmental footprints and causing serious damage. This will get worse if the armed conflict escalates into a <a href="https://doi.org/10.1186/s41018-022-00114-1">“complex disaster emergency”</a>. </p>
<p>I have identified six environmental consequences of the Cameroon Anglophone crisis. These range from failures in environmental governance to increases in deforestation, unmet measures in <a href="https://www.preventionweb.net/publication/cameroon-national-climate-change-adaptation-plan">Cameroon’s climate action plan</a>, poor municipal waste management, the effects of scorched earth tactics and the impact of improvised explosive devices. </p>
<p>There is a need to address these environmental oversights and build them into resolving the crisis. This would prevent the environmental legacies of the armed conflict from haunting the region’s population after the crisis has ended. </p>
<h2>The fallout for the environment</h2>
<p>One of the effects of the fighting <a href="https://www.hrw.org/world-report/2020/country-chapters/cameroon">since 2016</a> was that it brought conservation activities to a halt in the country’s biodiversity hot spots in the Anglophone regions. Cameroon has around <a href="http://www.parks.it/world/CM/Eindex.html">14 national parks</a>, 18 wildlife reserves, 12 forest reserves and three wildlife sanctuaries hosting rare and threatened species. </p>
<p>Before the crisis, many of these protected areas were still in a pristine condition because Cameroon had less tourism than other regions of Africa. </p>
<p>But the crisis has stalled several environmental projects. </p>
<p>For example, violence forced environmentalists and NGOS operating in the Tofala Hill Wildlife Sanctuary in Lebialem to flee. The Tofala Hill Wildlife Sanctuary is home to the critically endangered <a href="https://www.berggorilla.org/en/gorillas/general/ecology/articles-ecology/survey-of-the-cross-river-gorilla-at-the-tofala-hill-wildlife-sanctuary-in-cameroon/">Cross River gorillas</a> and other endangered wildlife like the African chimpanzee and elephant. </p>
<p>These gorillas are also under increased threat from militias such as the “Red Dragons” which have set up camps within the sanctuary (see Figure 1). </p>
<p>Likewise, efforts to protect the Mount Cameroon National Park, which hosts endangered primates, have been <a href="https://news.mongabay.com/2022/03/civil-conflict-in-cameroon-puts-endangered-chimpanzees-in-the-crosshairs/">hampered</a>. This poses a threat to the <a href="https://www.savetheelephants.org/about-elephants-2-3-2/elephant-news-post/?detail=cameroon-anglophone-crisis-environmentalists-express-fear-over-future-of-endangered-species-as-population-invade-forests">Nigerian-Cameroon chimpanzee</a>, which already faces extinction.</p>
<figure class="align-left ">
<img alt="A map" src="https://images.theconversation.com/files/472342/original/file-20220704-18-ezj1kc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/472342/original/file-20220704-18-ezj1kc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=379&fit=crop&dpr=1 600w, https://images.theconversation.com/files/472342/original/file-20220704-18-ezj1kc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=379&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/472342/original/file-20220704-18-ezj1kc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=379&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/472342/original/file-20220704-18-ezj1kc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=476&fit=crop&dpr=1 754w, https://images.theconversation.com/files/472342/original/file-20220704-18-ezj1kc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=476&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/472342/original/file-20220704-18-ezj1kc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=476&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Figure 1: Landscape of the Lebialem Highlands hosting the Tofala Hill Wildlife Sanctuary.</span>
<span class="attribution"><span class="source">GSAC (2022)</span></span>
</figcaption>
</figure>
<p>Insecurity in areas hosting wildlife has led to a rise in uncontrolled illegal hunting. <a href="https://alliance-gsac.org/archives/1644">Poaching</a> of endangered chimpanzees (see Figure 2) and elephants increased in the Tofala Hill Wildlife Sanctuary and the Takamanda and Korup National Parks after state rangers and eco-guards fled.</p>
<figure class="align-right ">
<img alt="An ape sitting on a tree." src="https://images.theconversation.com/files/472343/original/file-20220704-24-t8g5mh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/472343/original/file-20220704-24-t8g5mh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=351&fit=crop&dpr=1 600w, https://images.theconversation.com/files/472343/original/file-20220704-24-t8g5mh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=351&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/472343/original/file-20220704-24-t8g5mh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=351&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/472343/original/file-20220704-24-t8g5mh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=441&fit=crop&dpr=1 754w, https://images.theconversation.com/files/472343/original/file-20220704-24-t8g5mh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=441&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/472343/original/file-20220704-24-t8g5mh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=441&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Figure 2: Endangered ape species in Cameroon’s protected reserves.</span>
<span class="attribution"><span class="source">Photo by Julie Langford courtesy of the Limbe Wildlife Centre.</span></span>
</figcaption>
</figure>
<p>The rise in the number of internally displaced people has had a number of consequences.</p>
<p>Deforestation has risen as relocated communities have cut down trees to provide shelter and firewood. </p>
<p>They are also putting pressure on access to water. Toilet facilitates are inadequate in areas hosting large numbers of people. Drilling of wells, sometimes in unhygienic surroundings, and defecation in streams are also responsible for the <a href="https://www.aa.com.tr/en/africa/cameroon-s-english-speaking-region-facing-water-shortage-cholera-epidemic/2565585">poor water quality</a> in the region. </p>
<p>The southwest region has recently experienced a <a href="https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON374">cholera epidemic</a>. </p>
<p>Thirdly, measures in <a href="https://www.preventionweb.net/publication/cameroon-national-climate-change-adaptation-plan">Cameroon’s climate action plan</a> have been halted by the crisis. The measures include providing fertilisers and improved seeds to farmers; installing renewable energy in rural areas; and restoring mangrove forests along the Limbe coast.</p>
<p>Fourthly, the crisis has worsened the problem of municipal waste management.</p>
<p>Separatists have threatened to burn the garbage collection company, <a href="https://www.proparco.fr/en/ressources/hysacam-countrys-number-one-waste-management-contractor-cameroon-immersion-360deg">HYSACAM</a>. Some of its workers have been attacked. This has affected the collection of municipal waste in Bamenda and Buea, capitals of the Anglophone northwest and southwest regions.</p>
<p>Fifth, military forces are using <a href="https://onpolicy.org/scorched-earth-policy-in-the-anglophone-conflict-in-cameroon-a-crime-against-humanity/">scorched earth tactics</a> that could create serious environmental harm. The military has destroyed houses, crops and livestock in several villages perceived to be strongholds of militia groups.</p>
<p>Likewise, militias have destroyed property owned by the state and that of civilians suspected to be colluding with security forces. </p>
<p>Satellite images from February and March 2021 <a href="https://www.amnesty.org/en/latest/news/2021/07/cameroon-satellite-images-reveal-devastation-in-anglophone-regions/">confirm</a> the destruction of multiple villages in the northwest region. </p>
<p>Lastly, the use of improvised explosive devices by militia groups against Cameroon’s military vehicles has been <a href="https://www.voanews.com/a/africa_cameroon-military-says-rebels-turning-ieds-numbers-fall/6205704.html">increasing</a> and getting more sophisticated. </p>
<p>Explosive remnants and munitions can make the land uninhabitable, severely harm wildlife, and contaminate the soil and watercourses. Clearance of devices can also cause localised pollution, soil degradation and negative land use consequences.</p>
<figure class="align-center ">
<img alt="A destroyed military vehicle." src="https://images.theconversation.com/files/472349/original/file-20220704-3924-osguz3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/472349/original/file-20220704-3924-osguz3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/472349/original/file-20220704-3924-osguz3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/472349/original/file-20220704-3924-osguz3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/472349/original/file-20220704-3924-osguz3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/472349/original/file-20220704-3924-osguz3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/472349/original/file-20220704-3924-osguz3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Figure 5: Military vehicle destroyed by IED.</span>
<span class="attribution"><span class="source">Photo courtesy of SBBC (2022).</span></span>
</figcaption>
</figure>
<h2>Next steps</h2>
<p>Contingency plans being put in place by the Cameroon government for a potential complex disaster emergency should consider the environmental aspects of the conflict. </p>
<p>First it’s necessary to empirically diagnose the environmental ramifications and how they can be resolved. </p>
<p>When seeking political solutions to the crisis, stakeholders should also incorporate measures to mitigate the environmental consequences.</p><img src="https://counter.theconversation.com/content/186336/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Henry Ngenyam Bang does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Cameroon’s Anglophone crisis could escalate into a complex disaster emergency with dire environmental consequences.Henry Ngenyam Bang, Disaster Management Scholar, Researcher and Educator, Bournemouth UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1795772022-04-06T14:55:48Z2022-04-06T14:55:48ZWorrying insights from UN’s first-ever assessment of water security in Africa<figure><img src="https://images.theconversation.com/files/453540/original/file-20220322-15111-o05byu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Franck Metois/ GettyImages</span> </figcaption></figure><p>When it comes to water security – a reliable, good supply of safe water – just 29 African countries have made some progress over the past three to five years. Twenty-five have made none.</p>
<p>This data comes out of the <a href="https://inweh.unu.edu/publications/">UN’s first-ever assessment of water security</a> in Africa. Published by the <a href="https://inweh.unu.edu/">UN University’s Canada-based Institute for Water, Environment and Health</a>, the assessment used 10 indicators to quantify water security in Africa’s 54 countries. Such an assessment had been done before in the Asia-Pacific region, but never for Africa.</p>
<p>The UN’s concept of water security encompasses various needs and conditions. These include: water for drinking, economic activity, ecosystems, governance, financing, and political stability. Water security, therefore, is not just about how much natural water a country has but also how well the resource is managed.</p>
<p>The assessment is limited by very poor data on some issues – such as access to drinking water or sanitation. It nevertheless offers some preliminary, but obvious, conclusions. </p>
<p>Overall levels of water security in Africa are low. Not a single country, let alone a sub-region, is at the highest “model” stage of water security. The top five countries – Egypt, Botswana, Mauritius, Gabon, and Tunisia — are at best at a “modest” (just above average) stage of water security. </p>
<p>Without water security, people are exposed to environmental and health risks, increased susceptibility to water-related disasters and lack water for economic and social use. </p>
<p>The assessment team hopes that as this quantitative tool develops, it will help generate targeted policy recommendations and inform decision-making and public-private investments toward achieving water security in Africa.</p>
<h2>Key findings</h2>
<p>The assessment introduced five stages of water security: Emerging (a score of 0 – 45), slight (45 – 60), modest (60 – 75), effective (75 — 90), and model (90 – 100).</p>
<p>Except for Egypt, all countries scored below 70. Only 13 of 54 countries were found to have a “modest” level of water security. Somalia, Chad and Niger appear to be the three least water-secure countries in Africa. </p>
<p>Over a third of the 54 countries had “emerging” level water security, representing a large gap to be closed to reach an acceptable level. These countries are home to half a billion people. </p>
<p>The situation doesn’t appear to be improving very quickly. Between 2015 and 2020, the continent as a whole progressed only by 1.1% based on the indicators. </p>
<h2>Examining the indicators</h2>
<p>Here is an overview of how countries fared on each indicator.</p>
<p><strong>Access to drinking water</strong></p>
<p>Access to “at least basic” drinking water services ranged from 37% of the population in the Central African Republic to 99% in Egypt. Regionally it ranged from 62% in central Africa to 92% in north Africa. Africa’s average basic drinking water service is 71%. This leaves behind about 29% of the total population, or more than 353 million people. </p>
<p>“At least basic” means access to improved water sources – such as piped water, protected hand-dug wells and springs. These either need to be “safely managed” (accessible on premises, available when needed, and free from contamination) or can be collected in a trip of 30 minutes or less.</p>
<p><strong>Access to sanitation</strong></p>
<p>Access to sanitation – meaning access to, and use of, sanitation facilities and services – was broadly similar at the regional level. There’s an average of 60% access to limited sanitation. This means at least 40% of the total population (483 million people) are left behind. </p>
<p>A few countries – Seychelles and most countries in north Africa – have reached, or nearly reached, 100%. The most challenged countries are Chad and Ethiopia. </p>
<p><strong>Access to hygiene facilities</strong></p>
<p>This indicator refers to access to practices like hand washing. The greatest access was found in north Africa (67%), the least access was in west Africa. Liberia was the lowest in the region with less than 10% access. </p>
<p>Chad and the Central African Republic suffer from the highest number of deaths from diarrhoea, an indicator of ineffective hygiene practices.</p>
<p><strong>Per capita water availability</strong></p>
<p>The amount of water available per person was highest in central Africa, with the Republic of Congo considered Africa’s most water-rich country. At the other end of the spectrum, half of the countries in north Africa appeared to be absolutely water scarce. </p>
<p>Water availability has recently declined in west, central and southern Africa. This was most notable in Cote d'Ivoire, Cameroon, Somalia, Mozambique and Malawi.</p>
<p><strong>Water use efficiency</strong></p>
<p>This indicator assesses the economic and social value. The score is a sum of efficiencies – a measure of how well a country uses the water it has in its economy.</p>
<p>On this basis, water use efficiency appears to be lowest in north Africa (with Somalia lowest at the national level) and highest in central Africa (with Angola highest at a national level). </p>
<p><strong>Water storage infrastructure</strong></p>
<p>Water storage in large dams, measured in volume (m3) per capita, is deemed best in the southern Africa, worst in east Africa. </p>
<p>South Africa, with over 25% of all large dams in Africa, is outscored by Ghana, Zimbabwe, and Zambia, likely due to just one mega reservoir in those countries. </p>
<p>Half of all countries score very low, reflecting the continent’s low level of water storage development. Only Ethiopia and Namibia have increased their storage over recent years. </p>
<p><strong>Wastewater treatment</strong></p>
<p>Scores are highest in north African countries, lowest in east and west Africa, where 12 countries in each region treat less than 5% of wastewater. No country treats more than 75%. Only Tunisia, Egypt and Lesotho treat over 50% of wastewater.</p>
<p><strong>Water governance</strong></p>
<p>Governance takes into account the various users and uses of water with the aim of promoting positive social, economic, and environmental impacts. This includes the transboundary level. </p>
<p>Water governance appears to be most advanced in north and southern Africa and least advanced in central Africa.</p>
<p>Nationally, Ghana reported reaching 86% of integrated water resource management implementation in just two years – a significant improvement. </p>
<p>Liberia, Guinea-Bissau, and Comoros are the lowest-performing countries.</p>
<p><strong>Disaster risk</strong></p>
<p>Disaster risk is a measure of the potential loss of life, injury, or destroyed or damaged assets, which could occur to an ecosystem, or a community in a specific period of time. </p>
<p>North Africa appears to be the least risky sub-region (it has less exposure or high ability to adapt), with Egypt the least risky country. West Africa was the riskiest.</p>
<p>Some 49 of 54 African countries have seen increased disaster risk scores over five recent years.</p>
<p><strong>Water dependency on neighbouring nations and water resources variability</strong></p>
<p>Egypt stands out as Africa’s most water-dependent country. It relies on the Nile river which flows through 10 countries – Tanzania, Uganda, Rwanda, Burundi, Democratic Republic of Congo, Kenya, Ethiopia, Eritrea, South Sudan, and Sudan – before reaching Egypt. And the southern Africa sub-region has a wide disparity in the available water per year.</p>
<h2>Preparing for the future</h2>
<p>Our paper calls for a pioneering effort to create global standards for water security measurement data and assessment.</p>
<p>Some critical components of water security simply cannot be assessed without good data. For example, it’s not possible to estimate the percentage of the African population that will have access to safely managed drinking water services or safely managed sanitation by 2030, a key UN Sustainable Development Goal.</p>
<p>Our water security assessment tool is a work in progress, guided by a goal of an influential and nationally-owned tool used by all African countries and that it helps generate targeted policy recommendations and inform decision-making and public-private investments in Africa.</p><img src="https://counter.theconversation.com/content/179577/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>500 million people live in 19 African countries deemed “water insecure”.Grace Oluwasanya, Research Lead for Water, Climate and Gender, Institute for Water, Environment and Health (UNU-INWEH), United Nations UniversityDuminda Perera, Senior Researcher: Hydrology and Water Resources, Institute for Water, Environment and Health (UNU-INWEH), United Nations UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1644582021-07-15T14:17:35Z2021-07-15T14:17:35ZWhy are water companies dumping raw sewage in Britain’s rivers and coastal seas?<p>There were more than <a href="https://waterbriefing.org/home/company-news/item/18213-water-companies-discharge-raw-sewage-into-rivers-400000%20-times-over-3m-hours-in-2020">400,000 discharges of raw sewage</a> in 2020, together lasting more than three million hours, from water companies into rivers in England and Wales. One company, <a href="https://www.theguardian.com/environment/2021/jul/09/southern-water-fined-90m-for-deliberately-pouring-sewage-into-sea">Southern Water</a>, was recently fined a record £90 million for dumping up to 21 billion litres of untreated sewage over six years in protected seas off England’s southern coast.</p>
<p>To understand why this is happening, we need to understand the history of our sewer systems.</p>
<p>For most of human civilisation, sanitation was managed in a dry form. When people visited a latrine, their waste ended up in a drainage pit below or a cesspit nearby. Liquids were allowed to seep into the ground where nature would (hopefully) deal with any contaminants. The solids left over were often recycled directly to agriculture, providing nutrients for farmlands. This all changed, about 150 years ago, in the Victorian era.</p>
<figure class="align-center ">
<img alt="A stone sill overhanging a straight ditch with holes at regular intervals." src="https://images.theconversation.com/files/411450/original/file-20210715-27-16z0kle.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/411450/original/file-20210715-27-16z0kle.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/411450/original/file-20210715-27-16z0kle.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/411450/original/file-20210715-27-16z0kle.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/411450/original/file-20210715-27-16z0kle.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/411450/original/file-20210715-27-16z0kle.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/411450/original/file-20210715-27-16z0kle.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The remains of an ancient Roman latrine, excavated in Spain.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/remains-public-roman-latrines-archeological-excavation-1575106414">Kristof Lauwers/Shutterstock</a></span>
</figcaption>
</figure>
<p>People migrating from the countryside to Britain’s crowded industrial cities meant more waste and longer distances to transport it to farms. International trade brought higher quality fertilisers to the UK too, destroying the market for London’s cesspool waste, as farmers preferred South American guano (bird droppings).</p>
<p>Then, the water closet arrived. Toilet waste no longer filled a pit that someone had to empty, it magically disappeared with the pull of a chain. London’s water use in 1850 nearly <a href="https://www.thehistorypress.co.uk/publication/the-great-stink-of-london/9780750925808/">doubled in six years</a>, as waste was carried through rudimentary sewers and open drains into the Thames. Two years later, in 1858, the effect of these raw sewage discharges was fully felt during “<a href="https://www.theguardian.com/cities/2016/apr/04/story-cities-14-london-great-stink-river-thames-joseph-bazalgette-sewage-system">the Great Stink</a>”, when the Thames was so odorous it forced Parliament to stop meeting due to the smell.</p>
<p>The solution came from the engineer Sir Joseph Bazalgette, who designed an integrated sewer system to carry untreated waste and rain water from across London further down the Thames where it was dumped via two outfalls. This was one of the largest engineering works of the time, with over 1,100 miles of street sewers, 82 miles of mains sewers, and four pumping stations installed. </p>
<p>After creating his initial design, Bazalgette doubled the diameters of the pipes, <a href="https://www.ice.org.uk/what-is-civil-engineering/what-do-civil-engineers-do/london-sewer-system">stating</a>:</p>
<blockquote>
<p>We’re only going to do this once and there’s always the unforeseen.</p>
</blockquote>
<p>Direct river outfalls were later replaced by sewage treatment plants, but the sewer capacity, even after Bazalgette doubled the size of the pipes, was exceeded within his own lifetime. He may have been right, that such an enormous undertaking, at such huge public expense, could only be done once. But ever since we have been trying to patch and alter a system that continues to age and be overwhelmed.</p>
<figure class="align-center ">
<img alt="An aerial view of purification tanks and ponds at a waste water treatment works." src="https://images.theconversation.com/files/411454/original/file-20210715-15-1fadh97.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/411454/original/file-20210715-15-1fadh97.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/411454/original/file-20210715-15-1fadh97.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/411454/original/file-20210715-15-1fadh97.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/411454/original/file-20210715-15-1fadh97.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/411454/original/file-20210715-15-1fadh97.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/411454/original/file-20210715-15-1fadh97.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A modern sewage treatment plant.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sewage-farm-aerial-drone-photo-looking-619248512">Pxl.store/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Sewer systems in the 21st century</h2>
<p>After the construction of London’s sewers, local authorities began installing their own across the country. In 1945 there were <a href="https://webarchive.nationalarchives.gov.uk/20150604030852/http://www.ofwat.gov.uk/publications/commissioned/rpt_com_devwatindust270106.pdf">over 1,400 sewerage companies</a> throughout England and Wales. These were merged in the Water Act of 1973, simplifying the structure to just ten regional water authorities.</p>
<p>Investment fell from £3.5 billion in 1974 to just <a href="https://www.waternz.org.nz/Attachment?Action=Download&Attachment_id=352">£1.8 billion in 1985</a>. The sector was privatised under the Water Act of 1989, and now 32 privately owned <a href="https://www.ofwat.gov.uk/regulated-companies/ofwat-industry-overview/">water and sewerage companies</a> operate in the UK today.</p>
<p>Privatisation has led to a balancing act, where water companies seek sufficient profit to attract investment, while also keeping water bills low enough to provide a public service. Both the bills water companies can charge their customers, and the performance measures they must meet, are agreed with government regulators. As the UK’s population grows, water usage increases, and climate change brings more rainfall in more intense bursts into sewers. This balancing act is becoming harder to maintain. </p>
<p>Water companies are allowed to release untreated waste water in rare circumstances when the system becomes overwhelmed, preventing damage to equipment and properties. This is often due to very heavy rainfall, blockages and unexpected equipment failures. Increasing sewage and rainwater flows mean these events are likely to become more frequent. </p>
<p>The amount of sewage companies are permitted to release is set by the regulators, but when companies fail to manage increased flows they may exceed the permits and be penalised with fines. If they try to hide or under-report these releases, the penalties are significantly larger. But the damage to the environment is often already done.</p>
<p>To reduce untreated releases and the environmental damage they cause, water companies are making efforts to address it. Thames Water recently spent £3.8 billion on a <a href="https://www.thameswater.co.uk/about-us/investing-in-our-region/thames-tideway-tunnel">new “supersewer” for London</a>, while not paying investors for the <a href="https://www.thameswater.co.uk/media-library/home/about-us/investors/our-finances-explained.pdf">last three financial years</a>. A bold move, but not one that will see future investors rush to provide capital for upgrades. Sewer systems are expensive and technically difficult to expand or change, and so it will be a slow and expensive process.</p>
<p>One way to ease pressure on the system – and save some of the <a href="https://www.thetimes.co.uk/article/eus-ideal-standard-for-lavatory-flushing-8x0fvj7ck9s">1.1 billion litres of water</a> homes flush down the toilet each year – might be to resurrect elements of waste treatment from before the Victorian era.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/eco-friendly-composting-toilets-already-bring-relief-to-big-cities-just-ask-londons-canal-boaters-96066">Eco-friendly composting toilets already bring relief to big cities – just ask London's canal boaters</a>
</strong>
</em>
</p>
<hr>
<p><a href="http://www.bluediversiontoilet.com/">Prototype</a> <a href="http://www.nanomembranetoilet.org/">flushless toilets</a> can treat waste without water and sewer connections, by filtering waste through special membranes and sterilising it with heat. This could keep a lot of sewage out of the sewer system and prevent waste entering rivers, without needing expensive technologies. These systems can even recover energy – in the form of biogas fuel – <a href="https://www.thenexusnetwork.org/wp-content/uploads/2014/08/MartinCruddasandHutchings_SewerlessSocietyNexusThinkpiece2015.pdf">and nutrients</a> from waste, to provide farms with fertiliser and homes with power.</p><img src="https://counter.theconversation.com/content/164458/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Cruddas received funding from the Economic and Social Research Council (ESRC) for work on "Imagining a Sewerless Society". </span></em></p><p class="fine-print"><em><span>Keiron Roberts has previously received research funding from Southern Water to investigate incorporating the circular economy into their wastewater practices (2016-2017). He has also received funding from EPSRC and FP7 to research biofuels from wastewater.</span></em></p>Victorian-era engineering is struggling under decades of underinvestment.Peter Cruddas, Senior Lecturer in Environmental Engineering, University of PortsmouthKeiron Roberts, Senior Lecturer in Sustainability and the Built Environment, University of PortsmouthLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1607162021-06-06T09:00:03Z2021-06-06T09:00:03ZHow The Gambia beat trachoma, an infection that causes blindness<figure><img src="https://images.theconversation.com/files/402320/original/file-20210524-21-1tzhvoe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A health worker examines a child for signs of trachoma </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/an-african-ministry-of-health-worker-with-opthamology-news-photo/72546415?adppopup=true">Joe McNally/Getty Images </a></span></figcaption></figure><p>The government of <a href="https://www.britannica.com/place/The-Gambia">The Gambia</a> recently <a href="https://www.iapb.org/news/the-gambia-eliminates-trachoma-as-a-public-health-problem/">announced</a> that the country had eliminated trachoma, a highly contagious eye disease, after years of hard work by health workers, nongovernmental organisations (NGOs) and communities. </p>
<p>In The Gambia, the disease <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1041660/">accounted</a> for 17% of the reported blindness in a national survey in 1986. The prevalence of trachoma has dropped from <a href="https://pubmed.ncbi.nlm.nih.gov/9828780/">0.1% to 0.02%</a> in the last 10 years. Current <a href="https://www.iapb.org/news/the-gambia-eliminates-trachoma-as-a-public-health-problem/">estimates</a> show a prevalence of less than 0.2% in adults aged over 15 years. This is about one case per 1,000 people.</p>
<p>Trachoma has been <a href="https://academic.oup.com/bmb/article/84/1/99/382442">described</a> as the most infectious cause of blindness in the world, <a href="https://www.who.int/news-room/fact-sheets/detail/trachoma">responsible for 1.4%</a> of blindness. It is <a href="https://idpjournal.biomedcentral.com/articles/10.1186/s40249-020-0630-9">one</a> of the 20 neglected tropical diseases that plague over a billion of the world’s poorest people. </p>
<p>As at <a href="https://www.who.int/news-room/fact-sheets/detail/trachoma">September 2020</a>, 13 countries had reported that they had eliminated it as a disease of public health concern. Others in Africa were Ghana and Morocco. Togo is <a href="https://endinafrica.org/news/its-time-to-take-togo-off-the-who-trachoma-list/">pending</a> validation from the World Health Organisation. The organisation has <a href="https://www.who.int/news-room/fact-sheets/detail/trachoma">validated</a> the claims of 10 of the 13 countries. </p>
<p>The WHO lists <a href="https://www.who.int/trachoma/resources/who_htm_ntd_2016.8/en/#:%7E:text=In%202012%2C%20Oman%20became%20the,as%20a%20%E2%80%9Cverification%E2%80%9D%20exercise.&text=The%20process%20for%20diseases%20targeted,been%20defined%20as%20%E2%80%9Cvalidation%E2%80%9D">strict guidelines</a> to determine whether trachoma has in fact been eliminated from endemic countries. One is that there must be a system in place to identify and, where necessary, manage any new cases in line with protocols. This means that once a country is confirmed as having eliminated trachoma, a resurgence is not expected. </p>
<p>As we are involved in the ongoing <a href="https://espen.afro.who.int/system/files/content/resources/NIGERIA_NTD_Master_Plan_2015_2020.pdf">Nigerian effort</a> to curb trachoma, my colleagues and I are studying countries like The Gambia closely for guidance.</p>
<p>Sario Kanyi, the coordinator of The Gambia’s trachoma elimination initiative, <a href="https://ehp.niehs.nih.gov/doi/10.1289/EHP2699">said</a> its success started in the community. He added that once people knew what trachoma was, they took charge and helped in communicating what had to be done.</p>
<h2>What is trachoma?</h2>
<p>Trachoma is an infection caused by the bacteria <em>Chlamydia trachomatis</em>. It can be spread through physical contact with the eyes, nose or throat of those infected. It can also be picked up from the items used by infected individuals, such as face towels.</p>
<p>Crowded conditions and poor sanitation have been identified as possible enabling factors. </p>
<p>The signs and symptoms of trachoma include: mild itching and irritation of the eyes and eyelids, a discharge of mucus and pus, eyelid swelling and sensitivity to light. </p>
<p>Others are ocular pain, redness of the eye and vision loss. Young children are the <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0009067">most susceptible</a> to trachoma infection. It usually progresses slowly, presenting with more painful symptoms at adulthood.</p>
<p>Repeated episodes of active trachoma can cause the eyelid to be scarred. In some individuals this leads to trachomatous trichiasis, in which the eyelashes turn inward and touch the eye, causing extreme pain. If left untreated it can lead to blindness. </p>
<p>Treating trachoma requires a strategy that integrates four steps known as <a href="https://www.trachomacoalition.org/prevention-and-treatment-strategy">“SAFE”</a>. The letters stand for surgery (to alleviate eye pain or prevent further complications), antibiotics, facial cleanliness and environmental sanitation.</p>
<h2>The Gambian success story</h2>
<p>The Gambia <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1041660/">established</a> an eye care programme in 1986. It also initiated policies that helped in combating the condition. </p>
<p>The country mobilised resources through partnerships with local and international specialists, such as the London School of Hygiene and Tropical Medicine.</p>
<p>A trachoma task force was created under the Gambian National Eye Programme. This was helped by the small size of the country’s population, <a href="https://www.worldometers.info/world-population/gambia-population/#:%7E:text=Gambia%202020%20population%20is%20estimated,(and%20dependencies)%20by%20population">2.4 million</a>, which allowed intervention to easily reach most citizens.</p>
<p>Clinical staff were trained and retrained to deliver surgical procedures to manage the disease. Lid surgeries were then carried out to correct turning in of scarred eyelids and damage to the cornea.</p>
<p>The Gambia undertook campaigns to educate the public on the risks posed by the disease, and about preventive measures like hygiene. Open defecation and proper face and hand hygiene were addressed by building latrines and boreholes for communities.</p>
<p>It also created a network of eye care units across the country with the sole aim of diagnosing and treating people with trachoma. High potency antibiotics were also mass administered to reduce the average bacterial load in the endemic areas of The Gambia.</p>
<p>Thousands of community health volunteers were trained to go from house to house to find people with the disease. The government had support from several NGOs. The Gambia also adhered to the World Health Organisation’s <a href="https://www.trachomacoalition.org/prevention-and-treatment-strategy">SAFE strategy</a> for eliminating trachoma. </p>
<p>A major component of the SAFE strategy is the mass distribution and administration of Azithromycin. This antibiotic was donated by Pfizer to national programmes that are implementing the trachoma strategy in The Gambia. This led to monitoring of the bacteria load in a community before and after treatment. </p>
<p>Recent <a href="https://www.nature.com/articles/s41598-017-15056-7#Sec6">studies</a> have been done in The Gambia on measuring the rate of reinfection after mass treatment programmes. The <a href="https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0004906">experts do not</a> foresee a reemergence of trachoma in the country even with the risk of infected individuals coming from Senegal to Gambia, where disease is endemic.</p>
<p>The Gambia’s success in eliminating trachoma prevents the occurrence of about <a href="https://pubmed.ncbi.nlm.nih.gov/9828780/">100,000</a> new cases, saving people pain and possible blindness. It also means that resources previously allocated to combating the disease can now be reallocated to other public health conditions.</p><img src="https://counter.theconversation.com/content/160716/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The Gambia’s success in eliminating trachoma means that resources previously allocated to combating the disease can now be reallocated to other public health conditionsMusa Mutali, Lecturer of Optometry, University of BeninLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1580272021-03-30T17:00:59Z2021-03-30T17:00:59ZIndigenous communities should dictate how $1 billion infrastructure investment is spent<p>We finally have a chance to get it right. </p>
<p>For the first time in history, Canada has <a href="https://www.bnnbloomberg.ca/canada/video/this-is-an-opportunity-to-help-close-the-gap-assembly-of-first-nations-bellegarde-on-cib-s-1b-indigenous-infrastructure-initiative%7E2168419">launched a $1 billion investment dedicated to First Nations, Métis and Inuit infrastructure</a>. The <a href="https://cib-bic.ca/en/">Canada Infrastructure Bank</a> (CIB) is establishing the <a href="https://www.newswire.ca/news-releases/the-canada-infrastructure-bank-launches-its-indigenous-community-infrastructure-initiative-to-accelerate-new-investment-and-reduce-the-infrastructure-gap-848675661.html">Indigenous Community Infrastructure Initiative (ICII)</a>, which will enable the building of new infrastructure projects in Indigenous communities and help generate investments in projects that are vital to economic growth and environmental protection. </p>
<p>For decades, the <a href="https://www.aptnnews.ca/national-news/water-infrastructure-drinking-water-first-nations-federal-government/">promise of investments and dedicated funding have fallen flat</a>. Limited to what the federal government can fund <a href="https://search.proquest.com/openview/0290b05c87697166e581861c29656f63/1?pq-origsite=gscholar&cbl=1996357">within their restrictive policies</a> and confined by an infrastructure funding process that is flawed, <a href="https://link.springer.com/article/10.1007/s11356-018-1258-1">sluggish and heavy regulated</a>. Resulting in lackluster infrastructure projects that limit Indigenous autonomy and self-determination. </p>
<p>This has forced Indigenous people to think outside the box, leverage their own funds and find solutions through their own means <a href="https://www.aptnnews.ca/national-news/minister-pledges-1-5b-to-fix-unacceptable-gap-in-indigenous-infrastructure-during-pandemic-recovery/">to the growing infrastructure gap</a> that has permeated Nations for decades. </p>
<h2>Process, mechanisms and sustained support</h2>
<p>While investments in infrastructure are important, what’s more important is the process and mechanisms through which Indigenous people access funding, sustained support and long-term funding needs. </p>
<p>The pandemic has shed light onto the influence of our built environment with regards to the health and well-being of Indigenous people, from <a href="https://nunatsiaq.com/stories/article/nunavut-mp-releases-report-on-territorys-housing-crisis/">overcrowded housing</a>, <a href="https://www.hrw.org/news/2019/10/02/canada-blind-eye-first-nation-water-crisis">insufficient water supply</a> and <a href="https://www.piquenewsmagazine.com/cover-stories/bad-water-sickens-first-nations-but-government-doesnt-track-the-toll-3515101">sanitation</a>, and <a href="https://globalnews.ca/news/7643288/broken-promises-first-nations/">inadequate water quality</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/indigenous-youth-are-playing-a-key-role-in-solving-urgent-water-issues-157251">Indigenous youth are playing a key role in solving urgent water issues</a>
</strong>
</em>
</p>
<hr>
<p>Over the past 20 years, while <a href="https://www.pppcouncil.ca/web/pdf/first_nations_p3_report.pdf">infrastructure gaps have widened</a>, with estimates placing them at $25 billion to $35 billion, new and existing infrastructure has continued to deteriorate at a rapid rate, fuelled by the <a href="https://www.oag-bvg.gc.ca/internet/English/parl_oag_202102_03_e_43749.html">chronic underfunding of operation and maintenance</a>. </p>
<p>In his role as Minister of Indigenous Services, Marc Miller <a href="https://www.canada.ca/en/indigenous-services-canada/news/2020/12/government-of-canada-announces-15-billion-in-new-investments-for-clean-drinking-water-in-first-nations-communities.html">has made substantial investments in Indigenous infrastructure</a>. But the reality is that the infrastructure need is so great, and the divide so deep, that it cannot simply be tackled by infusing dollars into the system. And while the <a href="https://www.bennettjones.com/Blogs-Section/The-Canada-Infrastructure-Bank-Launches-Indigenous-Community-Infrastructure-Initiative">investments announced this month represent important infusions into a dwindling pot</a> of money, it’s important to remember that increased funding is only one of the areas that has to be addressed. </p>
<h2>Not enough to tackle critical infrastructure deficit</h2>
<p>The <a href="https://www.cbc.ca/news/politics/indigenous-infrastructure-fund-1.5955719">funds are earmarked for revenue-generating projects</a>: providing loans of at least $5 million, for up to 80 per cent of total project costs to potentially tackle large infrastructure projects like investment in clean water, broadband, public transit, clean energy, trade and transportation. </p>
<p>The funds however, aren’t likely to address the long-standing critical infrastructure deficits like water and wastewater despite what the CIB says. </p>
<p>The Indigenous community infrastructure gaps across Canada aren’t only contained to drinking water, <a href="https://sencanada.ca/content/sen/Committee/412/appa/rep/rep12jun15-e.pdf">housing</a> and <a href="https://www.cbc.ca/news/canada/thunder-bay/first-nations-water-infrastructure-funding-1.5957217">wastewater treatment</a> crises that many Canadians are familiar with; these include a breadth of assets such as <a href="https://www.macleans.ca/news/canada/millions-needed-to-fix-roads-in-new-brunswicks-first-nation-communities/">roads</a>, bridges, <a href="https://www.theglobeandmail.com/business/article-infrastructure-bank-urged-to-help-indigenous-groups-take-equity-stakes/">energy</a>, <a href="https://thetyee.ca/News/2019/12/12/Closing-BC-Indigenous-Internet-Gap/">broadband connectivity</a>, <a href="https://policyoptions.irpp.org/magazines/december-2017/a-role-for-indigenous-peoples-in-canadas-trade-talks/">trade</a> and transportation. </p>
<h2>Three separate funding crises</h2>
<p>In order to address these infrastructure gaps, we must first address that the infrastructure gap creates three separate funding crises. </p>
<p>First, there has <a href="https://ppforum.ca/publications/the-opportunity-for-indigenous-infrastructure/">been widespread inadequate funding of infrastructure on reserve</a> resulting in sometimes no infrastructure at all. This lack of investment into building new infrastructure means that the gap to accessing infrastructure is greater for Indigenous people across the country. To rectify this we must bring all Indigenous Nations up to a standard that matches non-Indigenous Canadians. </p>
<p>Second, the infrastructure that is in place has not been adequately funded, resulting in systems that are <a href="https://www.jogc.com/article/S1701-2163(15)30703-9/pdf">dilapidated, unkept and have further deteriorated</a> past the point of repair. This means substantial investments are necessary to bring existing infrastructure to an acceptable level and standard.</p>
<p>Third, the first two funding needs are representative of existing and past infrastructure needs, and we have not even begun to address the future needs. These future needs will require <a href="https://ppforum.ca/publications/the-opportunity-for-indigenous-infrastructure/">substantial investments into both capital and long-term operations and maintenance</a>. </p>
<p>These three compounding crises mean the investments required for infrastructure are far greater than we believe.</p>
<figure class="align-center ">
<img alt="A man rides his ATV through a First Nations community" src="https://images.theconversation.com/files/392337/original/file-20210329-23-qld7q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/392337/original/file-20210329-23-qld7q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=410&fit=crop&dpr=1 600w, https://images.theconversation.com/files/392337/original/file-20210329-23-qld7q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=410&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/392337/original/file-20210329-23-qld7q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=410&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/392337/original/file-20210329-23-qld7q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=515&fit=crop&dpr=1 754w, https://images.theconversation.com/files/392337/original/file-20210329-23-qld7q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=515&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/392337/original/file-20210329-23-qld7q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=515&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A man rides his ATV in the northern Ontario First Nations community of Attawapiskat, in April, 2016.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Nathan Denette</span></span>
</figcaption>
</figure>
<h2>Colonial constructs limit First Nations’ ability</h2>
<p>In addition to these funding crises, the infrastructure funding process is riddled with colonial constructs that limit First Nations’ ability to meaningfully participate and make decisions on the infrastructure in their Nations. </p>
<p>The process is <a href="https://globalnews.ca/news/4890322/infrastructure-funding-canada/">lengthy, with a heavy reporting burden</a> that doesn’t provide First Nations with the autonomy to make decisions, nor the resources to fully participate in the process. The result can often be a process, disconnected from community needs, with accountability mechanisms that shift towards the funders, rather than the community. </p>
<p>Underscoring all of this is the reality that our funding programs, policies, and private sectors <a href="https://doi.org/10.1177/0263775819855404">are plagued with the systemic racism that seeps through all of our institutions</a>. These include policies and programs that dictate, administer and regulate, rather than enable, empower and facilitate real solutions for Indigenous infrastructure. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/not-in-the-past-colonialism-is-rooted-in-the-present-157395">Not in the past: Colonialism is rooted in the present</a>
</strong>
</em>
</p>
<hr>
<p>If we are to sign on to large scale funding opportunities, we must first address the colonial structures that run them, and through which much harm has been done. </p>
<p>Perhaps, disbursing those funds directly to Nations to decide how and where to spend them, rather than disbursing proposal-based funds or mandating funding-formulas that restrict Nations rights to self-determination is the answer. </p>
<p>In the spirit of reconciliation, an Indigenous-led process is the only way to address this. Allow Indigenous people from across the country to determine how to best to address their own infrastructure issues, rather than telling them where investments will be made. Let’s celebrate major investments, and what they mean for Indigenous people across the country; but while we celebrate, let’s put equal measure into rehabilitating the structure, and decolonizing the system that has stifled and restricted Indigenous communities for years.</p><img src="https://counter.theconversation.com/content/158027/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kerry Black receives funding from the Natural Sciences and Engineering Research Council as part of her academic research activities. These funds are unrelated to the comments presented in this article. </span></em></p>While investments are important, what’s more important is the process and mechanisms through which Indigenous people access funding.Kerry Black, Assistant Professor and Canada Research Chair, Integrated Knowledge, Engineering and Sustainable Communities, University of CalgaryLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1556892021-03-17T17:41:10Z2021-03-17T17:41:10ZCOVID-19 has decimated water systems globally, but privatization is not the answer<figure><img src="https://images.theconversation.com/files/389937/original/file-20210316-22-13th6b9.jpg?ixlib=rb-1.1.0&rect=162%2C89%2C3164%2C2142&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Men wade through an abandoned highway tunnel to repair a self-created water system in the Esperanza neighbourhood of Caracas, Venezuela, in June 2020. </span> <span class="attribution"><span class="source">(AP Photo/Matias Delacroix)</span></span></figcaption></figure><p>The financial impact of COVID-19 has been devastating for public water operators around the world. Millions of households and businesses have not been able to pay their water bills due to lost income, while operating expenses have risen sharply. </p>
<p><a href="https://www.worldbank.org/en/news/feature/2020/06/30/supporting-water-utilities-during-covid-19">Data collected</a> in June 2020 found that revenues had fallen by up to 40 per cent for some water operators. In the <a href="https://www.awwa.org/Portals/0/AWWA/ETS/Research/AWWA-AMWA-COVID-Report_2020-04.pdf?ver=2020-06-22-153757-187">United States</a> alone the financial impact on water utilities is expected to exceed $27 billion as a result of COVID-19.</p>
<p>This temporary financial crisis is made worse by long-term budget deficits, with at least <a href="https://www.worldbank.org/en/news/press-release/2017/08/28/millions-around-the-world-held-back-by-poor-sanitation-and-lack-of-access-to-clean-water">$150 billion a year</a> required to meet global backlogs for water and sanitation. As much as one might like to think that COVID-19 will be the contagion that finally wakes the world up to the need for adequate funding for these basic public services, there is no indication that the required public money will be forthcoming.</p>
<h2>COVID-19 and privatization</h2>
<p>Alarmingly, one possible consequence of COVID-19 may be an increase in privatization in the water sector. <a href="https://publicbankscovid19.org/index.php/publications">Our recent book</a>, co-edited with Daniel Chavez, a fellow at the Transnational Institute in Amsterdam, demonstrates how many governments are using the crisis to promote private sector participation in water and sanitation. </p>
<p>This pressure to privatize is particularly notable in places where there was already a push to do so, <a href="https://riotimesonline.com/brazil-news/sponsored/privatization-of-rios-water-utility-during-pandemic-raises-concerns-about-access-for-favelas/">such as Brazil</a>. In other cases, fiscal strains are pushing authorities to consider privatization, such as in <a href="https://www.inthepublicinterest.org/a-philly-suburb-wants-to-sell-its-water-offering-a-glimpse-of-post-covid-america/">Philadelphia</a>. In <a href="https://www.municipalservicesproject.org/sites/municipalservicesproject.org/files/publications/12-Jakarta.pdf">Jakarta</a>, COVID-19 has emboldened the state to retract its promise to reverse water privatization.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1248802799711731712"}"></div></p>
<p>Some multilateral organizations are also using COVID-19 to promote water privatization. The <a href="https://openknowledge.worldbank.org/handle/10986/34043">World Bank</a> has created a “blended financing” program that requires private sector participation before public water operators can receive financial support. <a href="https://bit.ly/2Gb82oO">UN-Habitat and UNICEF</a> are promoting public-private-partnerships to “engage and empower” small private water vendors.</p>
<p>Ironically, these calls for privatization contradict the warnings of a large group of <a href="https://www.theguardian.com/society/2020/oct/19/covid-19-exposed-catastrophic-impact-privatising-vital-services">UN Special Rapporteurs who recently published an op-ed</a> outlining how “COVID-19 has exposed the catastrophic impact of privatizing vital services” like water and sanitation, with private water companies putting profit ahead of basic needs and public health.</p>
<p>Nevertheless, private water companies are also on the offensive. As the CEO of one <a href="https://smartwatermagazine.com/news/smart-water-magazine/water-sectors-response-covid-19">private equity water company</a> noted in May 2020: “We believe water utilities are amongst the most resilient sectors to an epidemic.… Water consumption is rigid by nature and we think the sector will actually become even more attractive to investors.”</p>
<p>COVID-19 appears to be contributing to a rash of mergers and acquisitions in the sector, further concentrating the power of big multinational water firms. <a href="https://smartwatermagazine.com/bimonthly/3">Some analysts</a> are predicting a “complete restructuring of the water industry,” exemplified by one of the most dramatic potential takeovers of the past 50 years: a hostile <a href="https://www.reuters.com/article/us-suez-m-a-veolia-france-idUSKBN2A80MM">takeover bid</a> by French water multinational Veolia for rival company Suez.</p>
<figure class="align-left ">
<img alt="Veolia water logo on a wall" src="https://images.theconversation.com/files/389886/original/file-20210316-17-1jzeupf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/389886/original/file-20210316-17-1jzeupf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/389886/original/file-20210316-17-1jzeupf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/389886/original/file-20210316-17-1jzeupf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/389886/original/file-20210316-17-1jzeupf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/389886/original/file-20210316-17-1jzeupf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/389886/original/file-20210316-17-1jzeupf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The French water and waste-treatment company Veolia Environnement made its initial takeover bid for Suez in August 2020.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Another concern is that COVID-19 will deepen the trend towards <a href="https://www.researchgate.net/publication/290648498_To_corporatize_or_not_to_corporatize_and_if_so_how">commercializing public water services</a>, with budget cuts and neoliberal doctrine (such as small government, low corporate tax and deregulation) forcing public water agencies to act like private companies, charging market prices even when households cannot afford to pay. Many public water operators have relaxed these policies during COVID-19, but some have made it clear that market-based pricing will return once the health crisis is over. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-exactly-is-neoliberalism-84755">What exactly is neoliberalism?</a>
</strong>
</em>
</p>
<hr>
<p>In <a href="https://www.municipalservicesproject.org/sites/municipalservicesproject.org/files/publications/20-Cost-Recovery-Colombia_0.pdf">Colombia</a> Empresas Públicas de Medellín introduced emergency measures to make water affordable for the poor during COVID-19, but these are temporary reprieves from market-oriented policies. In <a href="https://www.municipalservicesproject.org/sites/municipalservicesproject.org/files/publications/8-Uruguay.pdf">Uruguay</a>, reforms introduced during the pandemic have intensified the trend towards the commercialization of their national water utility.</p>
<h2>Reclaiming public water</h2>
<p>Is this <a href="https://www.vice.com/en/article/5dmqyk/naomi-klein-interview-on-coronavirus-and-disaster-capitalism-shock-doctrine">disaster capitalism</a> at work with private business and their state backers pushing aggressively to normalize neoliberal relations and expand profitability in the wake of a crisis? There are certainly signs of it, but it is not a foregone conclusion. With progressive governments, unions, NGOs and community organizations continuing to <a href="https://www.ecowatch.com/fighting-water-privatization-2640206378.html">fight against privatization</a> while at the same time advocating for <a href="https://www.youtube.com/watch?v=BlSM1TPm_k8&feature=emb_logo">more progressive</a> forms of public water services.</p>
<figure class="align-right ">
<img alt="A drawing of houses in a city with water pipes and sewers underground" src="https://images.theconversation.com/files/389865/original/file-20210316-17-gwgxtv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/389865/original/file-20210316-17-gwgxtv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/389865/original/file-20210316-17-gwgxtv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/389865/original/file-20210316-17-gwgxtv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/389865/original/file-20210316-17-gwgxtv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/389865/original/file-20210316-17-gwgxtv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/389865/original/file-20210316-17-gwgxtv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Millions of households and businesses have not been able to pay their water bills due to lost income during the COVID-19 pandemic.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Our book provides a critical but optimistic overview of these “pro-public” forces, illustrating how public water operators have responded effectively to COVID-19 in the short-term while working towards improved democratic engagement and accountability in the long run. </p>
<p>Examples include free water services for marginalized communities, moratoria on cutoffs, emergency services for vulnerable groups, remote technical support for households, finding ways for low-income communities to participate in decision-making, public education campaigns to assure residents their water and sanitation systems are secure, and child care for front-line workers.</p>
<p>To make this happen, hundreds of thousands of public water employees around the world have worked long hours to keep their systems running, with little in the way of public recognition. Many also engaged in <a href="https://www.municipalservicesproject.org/sites/municipalservicesproject.org/files/publications/9-Aqua-Publica.pdf">peer-to-peer learning</a> and knowledge sharing, deepening their sense of public purpose and expanding their <a href="https://www.municipalservicesproject.org/sites/municipalservicesproject.org/files/publications/10-WOPS.pdf">networks of solidarity</a>.</p>
<p>Hopefully, these examples of positive performance by public water operators will curtail pressures for privatization. They may even contribute to an acceleration of demands for <a href="http://www.remunicipalisation.org/">remunicipalization</a>, as cholera outbreaks did during the initial waves of making water services public <a href="https://doi.org/10.1080/1081602X.2018.1525755">in the 19th century</a>.</p>
<p>Despite the challenges they continue to face, many public water operators around the world have demonstrated not just the significance of public ownership in times of crisis but the value of public services that are transparent, democratic and oriented towards equity and sustainability. It is essential that we use this opportunity to <a href="https://www.municipalservicesproject.org/publication/future-public">reclaim and remake public water</a> in the post-pandemic period.</p><img src="https://counter.theconversation.com/content/155689/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David McDonald receives funding from Social Sciences and Humanities Research Council of Canada (SSHRC)</span></em></p><p class="fine-print"><em><span>Susan Spronk receives funding from Social Sciences and Humanities Research Council of Canada (SSHRC).</span></em></p>Water privatization is often seen as a solution to municipal budget shortfalls and aging water systems.David McDonald, Professor, Global Development, Queen's University, OntarioSusan Spronk, Associate Professor of International Development and Global Studies, L’Université d’Ottawa/University of OttawaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1505512020-11-24T15:02:14Z2020-11-24T15:02:14ZRiver of bacteria: a South African study pinpoints what’s polluting the water<figure><img src="https://images.theconversation.com/files/371020/original/file-20201124-23-9049u7.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Apies river downstream of the informal settlement and the village of Hammanskraal.</span> <span class="attribution"><span class="source">Author supplied</span></span></figcaption></figure><p>In 2010, the United Nations recognised access to clean water and sanitation as a fundamental human right. However, over <a href="https://www.worldtoiletday.info/">4.1 billion</a> people around the world, particularly in low- and middle-income countries, still do not have access to this human right.</p>
<p>Clean and safe water is necessary for basic life functions — for drinking, for cooking, for bathing, and more. When it is not available, people resort to alternative sources, which are often polluted with pathogenic bacteria arising from human waste. Using such water exposes people to waterborne diseases such as diarrhoea.</p>
<p>In cities, most households have access to treated water and good sanitation services. However, over <a href="https://www.unicef.org/esa/sanitation-and-hygiene">340 million</a> people in sub-Saharan Africa, mostly in rural communities and informal settlements, do not. They may rely on rivers, lakes, and streams for their. In addition, over <a href="https://www.unicef.org/esa/sanitation-and-hygiene">270 million</a> practise open defecation or have poorly constructed toilets. Most have no choice but to defecate outdoors, often disposing of their faeces directly into rivers — the same ones they use as sources of water.</p>
<p>We, a group of researchers in South Africa, wanted to know more about how different human activities around rivers in the country affected the microbial quality of the water. We wanted to understand the extent to which <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5664689/">informal settlements</a>, where access to basic sanitation and hygiene is limited or absent, affected the presence of waterborne bacteria.</p>
<p>We set out to explore how different human activities, such as sewage treatment plants, informal settlements and agriculture, affected the microbial quality of river water. We also used a mathematical model to show whether people could get sick from drinking untreated water from the river. We looked at <em>E. coli</em> as the indicator organism and <em>Vibrio</em>, <em>Salmonella</em> and <em>Shigella</em> as pathogenic organisms. Indicator organisms indicate the possible presence of pathogens, which are microorganisms that can cause disease. </p>
<p>Our <a href="https://pubmed.ncbi.nlm.nih.gov/26318680/#:%7E:text=Seasonal%20variations%20had%20an%20impact,coli%20concentrations">research</a> found that in <a href="https://pubmed.ncbi.nlm.nih.gov/26318680/#:%7E:text=Seasonal%20variations%20had%20an%20impact,coli%20concentrations.">informal settlements</a> where sanitation and waste management facilities were absent, a high number of bacteria were often present in the water of the river we studied. Some of these bacteria were pathogenic forms of <em>E. coli</em>, which, when consumed, could make people sick. We also observed that the people living there frequently used the river water, without any treatment, for personal hygiene such as bathing and brushing their teeth. The river was also often used for rituals, which involved immersing oneself several times into the water as a form of spiritual cleansing.</p>
<h2>Samples from before and after activities</h2>
<p>The <a href="https://www.sahistory.org.za/place/apiesrivier-river-which-flows-through-pretoria">Apies river</a> takes its source from the south of the city of Pretoria (one of South Africa’s three capital cities) and flows towards the north of the city, before joining the Pienaars River. Samples were collected at ten different sites along the river. These sites were situated upstream and downstream from the different human activities we looked at. We tested the water in the laboratory for the presence of microorganisms.</p>
<p>There are numerous sewage treatment facilities that <a href="https://rekordeast.co.za/315344/north-residents-protest-sewage-spill-into-apies-river/">discharge wastewater directly into the river</a>. At times the discharged water is <a href="https://ewn.co.za/2011/10/12/Untreated-sewage-flows-into-Apies-River_">not treated</a> due to system failure, or poorly treated when overloaded. The river also receives waste from informal settlements situated along the riverbanks, either directly through dumping or indirectly from surface runoff during heavy rainfall. These <a href="http://www.statssa.gov.za/census/census_2001/urban_rural/urbanrural.pdf">informal settlements</a> are unplanned and the houses are sometimes built on illegally owned land, usually not built according to regulations. So they do not have waste management services.</p>
<p>This river is also used for irrigation. Villagers in <a href="http://www.statssa.gov.za/census/census_2001/urban_rural/urbanrural.pdf">the rural communities</a> – areas that are subdivided into “tribal” areas and commercial farms and usually have few houses – use the river water for their cattle too. The informal and rural settlements use the river directly to dump their waste – including faeces – and for personal and household hygiene.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/371022/original/file-20201124-13-1rbwiyu.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Cattle and water" src="https://images.theconversation.com/files/371022/original/file-20201124-13-1rbwiyu.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/371022/original/file-20201124-13-1rbwiyu.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/371022/original/file-20201124-13-1rbwiyu.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/371022/original/file-20201124-13-1rbwiyu.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/371022/original/file-20201124-13-1rbwiyu.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/371022/original/file-20201124-13-1rbwiyu.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/371022/original/file-20201124-13-1rbwiyu.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Cows using the water from the rural community of Potwane in the North.</span>
<span class="attribution"><span class="source">Author supplied</span></span>
</figcaption>
</figure>
<p>We isolated all the tested organisms in the water and sediment samples collected from this river. We found that the number of bacteria isolated before the water passed through informal settlements was lower compared to the number when the river had passed through the settlement. This was because of the lack of toilets in the settlement, forcing the communities to use the river as a toilet. We also found higher numbers of bacteria when the river received wastewater from the sewage treatment facilities. This shows that the treatment plant was discharging poorly treated water containing faeces in the river.</p>
<h2>Getting sick is almost guaranteed</h2>
<p>The World Health Organisation (WHO) recommends that there should be <a href="https://www.who.int/water_sanitation_health/dwq/2edvol3a.pdf">zero</a> <em>E. coli</em> in water meant for drinking. But we found up to 1 million <em>E. coli</em> cells in 100ml of water collected downstream for the informal settlement and sewage treatment facility sites. According to the mathematical model, someone who ingested as little as 1ml of untreated water had almost a 100% chance of getting sick during the rainy season – leading to school absences and missed days of work. </p>
<p>People living in informal settlements and rural areas need to be made aware of the negative impact of open defecation, especially directly into rivers. Where there is no alternative water source, they should be advised to treat the water, for example by boiling it before use.</p>
<p>Governments need to ensure that people living in rural communities and informal settlements have access to toilets and clean water. This can be done by building community toilets or providing them with <a href="https://www.cambridge.org/core/journals/disaster-medicine-and-public-health-preparedness/article/waterless-portable-private-toilet-an-innovative-sanitation-solution-in-disaster-zones/365904320A86CB239EDB3DEDA44D89C6">mobile toilets</a>, where construction may not be possible. Governments also need to ensure that sewage treatment facilities, where available, are functioning correctly to avoid the discharge of poorly treated water containing harmful bacteria and faeces into rivers.</p>
<p>The Department of Water and Sanitation of South Africa must also ensure that wastewater treatment plants adhere strictly to Section 39 of the National Water Act, 1998, <a href="https://www.wqms.co.za/infopages/236">which provides guidance</a> for quality and management of wastewater.</p><img src="https://counter.theconversation.com/content/150551/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Akebe Luther King Abia is affiliated to the Aspen Institute through the Aspen New Voices Fellowship. He is also a member of the Antimicrobial Research Unit, University of KwaZulu-Natal. This work was funded by the Water Research Commission of South Africa, and was part of a larger project on the dynamics and health implications of microbial pathogens in South African water resource sediments under changing climates</span></em></p>Water at informal settlements, where sanitation and waste management facilities were absent, had high bacteria levels.Akebe Luther King Abia, Research Scientist, University of KwaZulu-NatalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1505402020-11-24T05:36:57Z2020-11-24T05:36:57ZWe should talk more about toilets<figure><img src="https://images.theconversation.com/files/370951/original/file-20201124-17-j4xabd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">We need a toilet design solution that suits local people's needs.</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/gender-88808/">Hafidz Alifuddin/Pexels.com</a></span></figcaption></figure><p>The United Nations (UN) designated 19 November as <a href="https://www.un.org/en/observances/toilet-day">World Toilet Day</a> to raise awareness that <a href="https://www.who.int/water_sanitation_health/publications/jmp-report-2019/en/">4.2 billion</a> people live without access to safe sanitation, including in Indonesia.</p>
<p>In Indonesia, around <a href="https://www.unicef.org/indonesia/water-sanitation-and-hygiene">25 million people</a> do not use the toilet when defecating. <a href="https://www.usaid.gov/actingonthecall/stories/indonesia-wash">One in three people</a> does not have access to flush toilets, latrines, or septic systems. Instead, they defecate in fields, bushes, forests, ditches, roads, canals, or other open spaces.</p>
<p>Research shows that poor sanitation <a href="https://www.ajtmh.org/content/journals/10.4269/ajtmh.18-0063">threatens children’s health, causing diarrhoea in Bandung, Indonesia</a> and <a href="https://doi.org/10.1016/j.ijpara.2016.07.005">infection with giardiasis</a> (digestive disorders due to parasitic infections in the small intestine) in Timor Leste.</p>
<p>Also, previous research in <a href="https://magdalene.co/story/poor-sanitary-and-hygiene-condition-at-schools-affect-female-students">Jakarta, East Nusa Tenggara and West Nusa Tenggara</a> shows that <a href="https://www.smeru.or.id/en/content/menstrual-hygiene-management-mhm-case-study-primary-and-junior-high-school-students">inadequate toilet facilities</a> and school infrastructure cause female students to change sanitary pads during menstruation rarely. Consequently, they are at risk of experiencing reproductive health problems. Some do not continue their studies.</p>
<h2>Health communication for toilet campaign</h2>
<p>Clean water and sanitation for all, which includes access to sanitary toilets, are part of the <a href="https://www.un.org/sustainabledevelopment/water-and-sanitation/">Sustainable Development Goals</a>.</p>
<p>Communication plays a vital role in changing the views and behaviour of individuals and communities who do not have or use toilets. But, campaigns on the importance of healthy toilets are lacking in Indonesia. </p>
<p>UNICEF provides a communication program campaign guide on sanitation using <a href="https://www.unicef.org/wash/%20files%20/%20com_e.pdf">the (ACADA: Assessment, Communication Analysis, Design, and Action)</a> model. Governments and non-governmental organisations can combine this model with the principle of health and risk communication involving <a href="https://www.who.int/risk-communication/training/Module-B5.pdf">community engagement</a>.</p>
<p>Governments and non-governmental organisations that hope to succeed in implementing sanitation programs need to understand the role of customs, beliefs, and community participation in constructing toilet facilities.</p>
<p>There is a myth developed in some areas, for example, <a href="https://ejournal.undip.ac.id/index.php/presapor/article/view/20782/14083">there should be no holes in the village</a>, so there are no toilets or WC in the village.</p>
<p>Therefore, program managers need to involve the community in creating a communication strategy before carrying out a campaign. Toilet health and sanitation promotion programs must avoid <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/dech.12075">shaming</a> local culture.</p>
<p>Communication between program managers and local communities can provide good opportunities in the toilet prototyping process from the beginning of the design process. Involving the local community in visualising toilet design has been successful in <a href="https://doi.org/10.1177/095624780301500202">public toilets in Pune and Mumbai, India</a>.</p>
<p>About 600 million people in India do not use toilets. To solve this problem, <a href="https://www.sparkarchitects.com/world-toilet-day-spark-is-working-with-an-indian-university-to-deliver-an-easily-transportable-3d-printed-toilet/">India</a> built <a href="https://www.dezeen.com/2018/11/21/big-arse-toilet-spark-architects-3d-printed-generates-electricity/">3D printed toilets</a> for local people.</p>
<p>For Indonesia, we need a toilet design solution that suits local people’s needs.</p>
<h2>Overcome obstacles</h2>
<p>To involve communities to create communication channels sensitive to local cultures and languages, program managers can use the <a href="https://pubmed.ncbi.nlm.nih.gov/9112096/">Health Belief Model</a> (HBM) theory.</p>
<p>Based on HBM, two main things influence whether a person will adopt certain behaviours to protect his/her health.</p>
<p>First, they must personally feel vulnerable to the disease, so they should perceive that they are at risk. Second, the person must believe that the recommended measures will be effective in reducing the risks and the benefits outweigh the <a href="https://pubmed.ncbi.nlm.nih.gov/9112096/">costs of contracting the disease</a>.</p>
<p>This model also identifies psychological, structural, or financial barriers that influence health behaviour. For example, HBM will help program managers identify <a href="https://www.tandfonline.com/doi/abs/10.1080/108107398127157">what attitudes, lack of access or resources</a> that stop a family from building a toilet at home.</p>
<p>In <a href="https://www.unicef.org/wash/files/Soap_Stories_and_Toilet_Tales.pdf">Slaeng, Cambodia</a>, a village leader used these strategies and tactics to change the community’s behaviours using toilets. </p>
<h2>Toilet can protect our health</h2>
<p>Every day <a href="https://www.cnnindonesia.com/gaya-hidup/20181119120953-255-347634/krisis-toilet-yang-mengganggu-kehidup-manusia">14 thousand tons</a> of faeces pollute water bodies in Indonesia.</p>
<p>This is caused by overflows and leaks from pipes and septic systems, improper disposal and handling cause untreated human waste to contaminate the environment as well as inadequate toilets and the behaviour of people who practice open defecation.</p>
<p>Increasing access to sanitation facilities and toilets can reduce infection and death rates, especially in <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0106738">maternal and child health</a>.</p>
<p>Also, hygienic bathrooms and toilets with clean running water, sinks, and soap can help women and <a href="https://www.hindawi.com/journals/jeph/2018/1730964/">girls through menstruation</a> safely and healthily.</p>
<h2>Toilet and sustainable sanitation</h2>
<p>The effects of climate change also threaten water infrastructure, sanitation, and hygiene. When floodwater <a href="https://www.weforum.org/agenda/2018/11/what-do-toilets-have-to-do-with-climate-%20change%20/">contaminate wells used for drinking water or damage toilets</a>, human waste can spread to the community and food plants.</p>
<p>We need <a href="https://orsociety.tandfonline.com/doi/abs/10.1057/s41275-017-0062-x">sustainable sanitation</a> that’s resistant to external shocks such as flooding, water shortages, and sea-level rise.</p>
<p>Approximately <a href="https://www.sciencedirect.com/science/article/abs/pii/S0378377413002163?via%3Dihub">80% of the community’s waste-water</a> flows back into the ecosystem without being treated or reused. Sustainable sanitation systems capture, transport, treat, dispose, and safely reuse human waste.</p>
<p>Managing human waste through safe and environmentally friendly toilets is the key to reducing the impact of untreated waste-water.</p><img src="https://counter.theconversation.com/content/150540/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Juhri Selamet tidak bekerja, menjadi konsultan, memiliki saham, atau menerima dana dari perusahaan atau organisasi mana pun yang akan mengambil untung dari artikel ini, dan telah mengungkapkan bahwa ia tidak memiliki afiliasi selain yang telah disebut di atas.</span></em></p>Communication between programmers and local communities can provide good opportunities in the toilet prototyping process from the beginning of the design process.Juhri Selamet, Lecturer, Universitas Multimedia NusantaraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1447692020-09-24T13:15:07Z2020-09-24T13:15:07ZHow US disease control shaped colonial power politics in the Caribbean<figure><img src="https://images.theconversation.com/files/357951/original/file-20200914-20-1lm7f26.jpg?ixlib=rb-1.1.0&rect=26%2C58%2C2959%2C2110&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A yellow fever ward in Havana in 1899. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mens-ward-yellow-fever-hospital-havana-787303600">Everett Collection/Shutterstock</a></span></figcaption></figure><p>A year ago, it would have seemed bizarre to suggest that a virus could reorder the global balance of power. But today, many are wondering whether the US failure to manage COVID-19 and the aggressive moves of the Chinese in the wake of their relative success in controlling the disease, <a href="https://www.foreignaffairs.com/articles/china/2020-03-18/coronavirus-could-reshape-global-order">marks a turning point in international relations</a>.</p>
<p>It wouldn’t be the first time that epidemics shaped geopolitics. When the US first emerged as an international power at the start of the 20th century, expanding into the Caribbean and Central America, disease control played a crucial part in its rise. Epidemics pulled the US into the region and weakened the European powers they were displacing. </p>
<p>In the late 19th century, outbreaks of yellow fever spread across the southern states of the US with devastating regularity, causing havoc and destruction. A particularly vicious case in <a href="https://www.jstor.org/stable/44450733">1878 in the Mississippi delta</a> caused mass flight from cities, economic destruction and tens of thousands of deaths. </p>
<p>Many Americans believed these epidemics originated in the black waters and unplumbed streets of Spanish-controlled Havana, closely connected through steamship commerce to the southern US, although the weakness of American sanitation at the time was also partly to blame. Efforts to quarantine US ports and disinfect vessels from Cuba failed to control the spread.</p>
<h2>Spanish plight</h2>
<p>Epidemic diseases, including yellow fever and malaria, were also weakening the Spanish grip on its Caribbean colonies. In 1895, Cuban rebels rose up against the Spanish crown and for three years fought a bitter struggle for independence. Spanish soldiers <a href="https://books.google.co.uk/books/about/Mosquito_Empires.html?id=rr7YuYU7ZZ8C&source=kp_book_description&redir_esc=y">lacked the immunity built up by local inhabitants</a> and by 1898 over 90% of their military deaths were due to disease rather than combat. Around half of Spain’s soldiers on the island were incapacitated.</p>
<p>Observing this, the <a href="https://press.uchicago.edu/ucp/books/book/chicago/E/bo8056086.html">US government concluded</a> that only putting an end to Spanish colonial rule would resolve the threat of tropical disease – and so it declared war on Spain. In the Spanish-American War of 1898 that followed, the Spanish forces, progressively weakened from fighting the Cuban insurgency, were quickly defeated, and the US seized Spain’s colonies in the Caribbean and Asia: Cuba, Puerto Rico, Guam and the Philippines.</p>
<p>During the subsequent occupation of Cuba, the US put disease control front and centre. As well as hoping to reduce the spread of yellow fever within the US, this was also a response to their soldiers’ experiences during the Spanish-American war. Within weeks of landing, the expeditionary force had been nearly crippled by tropical disease, just as the Spanish had been. Disease control was also a vital tool for international propaganda, suggesting that the US could deliver a healthier future than European imperialism.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1172526528959320064"}"></div></p>
<h2>Panama canal</h2>
<p>Epidemiology and international relations also intersected in Panama, which in 1903 the US <a href="https://books.google.co.uk/books?id=uVaeIXMxJpQC">successfully conspired to separate from Colombia</a>. </p>
<p>Panama was a major international trading route, but also notoriously unhealthy. The French had attempted to build a canal there in the 1880s, but couldn’t cope with <a href="http://www.kumc.edu/school-of-medicine/history-and-philosophy-of-medicine/panama-canal/french-panama-canal-failure.html">the hundreds of workers</a> dying a month from yellow fever, malaria and other diseases. News of the carnage travelled back to Europe and made it harder to recruit new workers.</p>
<p>In particular, French doctors and officials did not fully understand the role of mosquitoes in disease transmission. Unable to combat the spread, the project collapsed. When the Americans arrived in 1904 to begin their own canal-building effort, they found the rusting hulks of French machinery scattered across the country, the might of modern industry laid low by some of the tiniest organisms in nature.</p>
<p>At first, the US suffered from the same problems as the French, losing thousands of workers. However, it threw huge amounts of economic, scientific and human capital at the problem. Work conducted by both Cuban and US scientists, including Major Walter Reed, after whom the US Army’s <a href="https://tricare.mil/mtf/walterreed">flagship medical centre</a> is today named, began to improve understanding of the mechanics of disease transmission. This led to new models of <a href="https://www.jstor.org/stable/10.1086/529265">disease control for Panama</a>.</p>
<h2>Targeting mosquitoes</h2>
<p>The scale of this enterprise made America’s rivals sit up. The US targeted muddy ditches, stagnant pools of water, railroad sidings and other places where mosquito larvae were laid, spraying them with oil and chemicals. It also cut back huge areas of brush around living areas along the canal zone.</p>
<figure class="align-center ">
<img alt="Man spraying grass by a tree for mosquitoes." src="https://images.theconversation.com/files/357948/original/file-20200914-16-1ydmlz3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/357948/original/file-20200914-16-1ydmlz3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=440&fit=crop&dpr=1 600w, https://images.theconversation.com/files/357948/original/file-20200914-16-1ydmlz3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=440&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/357948/original/file-20200914-16-1ydmlz3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=440&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/357948/original/file-20200914-16-1ydmlz3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=553&fit=crop&dpr=1 754w, https://images.theconversation.com/files/357948/original/file-20200914-16-1ydmlz3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=553&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/357948/original/file-20200914-16-1ydmlz3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=553&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A mosquito exterminator in the Panama Canal zone around 1915.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Panama_Canal_Zone,_mosquito_exterminator_LOC_14798766631.jpg">Library of Congress via Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>The effort was far from perfect. In typical military fashion, the quartermaster’s department was more interested in maintaining perfectly crew-cut, manicured lawns around the officers’ buildings than cutting back the longer and more dangerous grasslands around the residences of lower-status American workers. In line with the racist beliefs of the time, Afro-Caribbean workers, who had been brought over in their thousands to work on the canal, were left to fend for themselves.</p>
<p>Nevertheless, improved scientific understanding of disease transmission helped the US succeed where the French had failed. When the canal opened in 1914, their triumph was as much an epidemiological success as a technological and organisational achievement.</p>
<p>In Cuba and Panama, disease control was a crucial theatre in the struggle for geopolitical supremacy. Then, as now, epidemics turned the microscope on the health of nations. Time will tell whether we will look back on our current time as a similar moment of transition.</p><img src="https://counter.theconversation.com/content/144769/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alex Goodall does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Will the COVID-19 pandemic change the global balance of power? It wouldn’t be the first time.Alex Goodall, Senior Lecturer in International History, UCLLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1442392020-09-23T14:25:54Z2020-09-23T14:25:54ZHow Accra tackled complex challenges in an urban slum<figure><img src="https://images.theconversation.com/files/358076/original/file-20200915-24-1spbyup.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The settlement of Old Fadama has reinvented itself </span> <span class="attribution"><span class="source">Wikimedia Commons</span></span></figcaption></figure><p>When I first heard about the community of Old Fadama in Accra, Ghana, I recognised something. A Ghanaian Catholic sister who visited the green market weekly in that neighbourhood told me about it. She worried about a community of vulnerable migrant women known as “head porters” or kayayei, who earned a pittance transporting heavy items balanced on their heads. </p>
<p>Old Fadama reminded me of Appalachia, the part of the US where I grew up in the late 1970s. Nearly everyone in my county lived below the poverty line. We learned to work together to solve our own problems, building bridges, repairing roads after floods, installing water and sanitation and, when necessary, even digging outhouse pits. </p>
<p>Old Fadama was the site for my <a href="https://www.cambridge.org/core/elements/redefining-development/B94D9871A966F00DE3812B73C064DCB3">first global project</a> as a participatory action researcher. In <a href="https://www.sciencedirect.com/science/article/abs/pii/027795369500127S">participatory action research</a> , researchers and participants work together to define problems and formulate research questions and solutions. </p>
<p>We wanted to see how, given the opportunity and supported with the evidence, stakeholders in a developing country would approach and resolve complex challenges.</p>
<h2>The research project</h2>
<p><a href="https://vimeo.com/222765076">Old Fadama</a> was established in the 1980s by northern migrants fleeing tribal violence. It has grown steadily, with spikes from intense domestic conflict in 1994 and drought conditions in 2015. Since 2009 the <a href="https://www.ohchr.org/Documents/Issues/EPoverty/Ghana/AmnestyInternational.docx">population</a> has grown from 80,000 to over 150,000. These include long-term settlers, multi-generational families, and seasonal sellers at the city’s largest green market. Migrants seek health care, education, and work. </p>
<p>In 2015, Old Fadama had virtually no water or sanitation. Excreta were collected in plastic bags and dumped in the river that bordered the slum, heavily silting a lagoon. Residents infilled the lagoon banks with waste materials to build housing on. This led to flooding that spread faecal matter to the green market. </p>
<p><a href="https://jhhsa.spaef.org/article/1915/Building-Cross-Sector-Collaboration-to-Improve-Community-Health">Outbreaks of cholera</a> were frequent in the area, resulting in hundreds of deaths. By 2015 the slum – locally known as “Sodom and Gomorrah” – had fallen into lawlessness and was a government “<a href="https://jphmpdirect.com/2018/06/04/qa-simpson-boateng/">no-go area</a>.” </p>
<p>To approach the problem, I looked for local organisations that were known for working on complex challenges. I was interested in scalability so I hoped that I could find local stakeholders with reach and access. The National Catholic Health Service and the municipal department of public health provided this. The public health department especially was interested in trying a new approach after the failure of the typical public health technical effort in the area.</p>
<p>Many short-term international development interventions had already failed. The stakeholders shared a different perspective that cut across technical sectors. Their goal was to address the root cause of the challenges facing the settlement. </p>
<p>Our process allowed government officials to interface with the elders of the 16 ethnic groups that made up Old Fadama. They identified the need to address sanitation, community violence, vulnerable populations of porters, solid waste management, and a clinic. </p>
<p>Every urban slum creates challenges too complex for governments to resolve when working alone. However, in cross-sector collaboration, communities and citizens articulate their needs and then partner with governments and NGOs to address these self-identified problems. </p>
<h2>A path to success</h2>
<p>The stakeholders identified multiple community needs, and reached consensus to focus first on installing community latrines. As one community member said, “cholera is killing us today.” </p>
<p>We convinced city authorities to grant permits for the latrines, not an easy thing since it involved changing policy. As local sanitation businesses, private sector companies in the business of providing public sanitation facilities in Accra, learned of our project, they saw it as workable and facilitated the policy change themselves. </p>
<p>On their own initiative and with their own resources, these businesses installed the first new public latrines and bathhouses in Old Fadama. All of our stakeholders contributed resources – enough that our sanitation project came in under budget. This early, visible success convinced people we were on to something, and it freed our stakeholders to address their next priorities. </p>
<p>Next the stakeholders worked together to scale up the participatory action research intervention. We applied it to a new challenge, head porters. Head porterage is a major form of transport of goods in Ghana. It is practised by young women and teenagers who are mostly migrants from the northern region of the country.</p>
<p>The research team used observation and continuous data collection and conducted interviews and focus groups. Strategies and projects were updated as new stakeholders joined the collaboration. </p>
<p>This process resulted in a programme of interventions to address the root causes of the challenges facing the kayayei. They included health screening, vaccination, school enrolment, microfinance and skills development.</p>
<p>The stakeholders invited clinic staff to be partners. The clinic bought vaccines at a discounted rate. Nurses from the Catholic Health Guild provided volunteer medical services. The National AIDS Control and Tuberculosis Control Programmes saw an opportunity to provide services to a population they had been unable to reach and shared some costs. </p>
<p>In this way, the collaboration expanded the number of beneficiaries from 300 to 1,534 head porters. The National Health Insurance Scheme was similarly invited to get involved and met some costs. As a result, instead of 300, 1,789 indigent kayayei were enrolled in national health insurance in three locations – Old Fadama, Madina, and Ashanti Region. Now, in all, more than 8,000 head porters have received essential services through this project. </p>
<h2>Opportunities for expansion</h2>
<p>No one sector – including government – can address these kinds of complex development challenges. Complex challenges are largely social, and affect many people, systems, and sectors. The challenges can seem difficult or impossible to resolve, and typical top-down intervention strategies are not sufficient. Incorporating multiple stakeholders and viewpoints is necessary to create effective solutions. </p>
<p>Our intervention method provides developing-country governments with a low-cost, locally designed process that dramatically improves participation and results in projects that impact the public good. As our <a href="https://www.cambridge.org/core/elements/redefining-development/B94D9871A966F00DE3812B73C064DCB3">evidence base</a> develops, it is clear that this approach is working. </p>
<p>The national government is poised to significantly expand the intervention on new complex challenges throughout the country. From a research perspective, it will be interesting to see if this approach works as well as the locally driven approach of the first five years of the project.</p><img src="https://counter.theconversation.com/content/144239/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jessica Kritz receives funding from the Conrad N. Hilton Foundation for the project in Accra described in this article. </span></em></p>In cross-sector collaboration, communities and citizens articulate their needs and then partner with governments and NGOs to address these self-identified problems.Jessica Kritz, Assistant Professor--Research Track, Georgetown UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1461502020-09-17T14:30:42Z2020-09-17T14:30:42ZWhy access to decent toilets could help reduce sexual violence in South Africa<figure><img src="https://images.theconversation.com/files/358335/original/file-20200916-20-11dxkt9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many women in South Africa still don't have access to safe toilets.</span> <span class="attribution"><span class="source">Frédéric Soltan/Corbis via Getty Images</span></span></figcaption></figure><p>South Africa has exceedingly high rates of rape of women and girls by non-partners. It’s estimated that between <a href="https://www.sciencedirect.com/science/article/abs/pii/S0277953601002428?via%3Dihub">5% and 12%</a> of women may have been raped by a man who is not a romantic partner. This, however, could be an underestimate. In earlier research, <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0029590">21% of men</a> reported perpetrating non-partner rape in their lifetime. Rape is a human rights violation. It also has a negative impact on the mental health and social wellbeing of women and <a href="https://apps.who.int/iris/bitstream/handle/10665/85239/9789241564625_eng.pdf">girls</a>. </p>
<p>An important but overlooked factor adding to the risk of rape by a non-partner is the issue of toilets. </p>
<p>Studies globally have made the link between the <a href="https://journals.sagepub.com/doi/10.1177/0956247814564528">lack of adequate sanitation</a> – particularly open defecation (outdoors) or shared community toilet facilities – and the increased risk of women and girls being raped. This can happen when women and girls walk during the day, and particularly at night, to use toilets. Poor maintenance of shared toilet facilities poses additional risks.</p>
<p>In South Africa, not everyone has a private secure toilet facility. A government survey in 2015 showed that access to private toilet facilities had improved. But a quarter (25.6%) of households only had access to shared <a href="https://www.gov.za/speeches/statistics-south-africa-ghs-series-viii-water-and-sanitation-2002-2016-report-23-nov-2016">toilets</a>. Most shared toilets were within 200 metres of the household. But 6.1% of households reported having to go more than 200 metres to access toilets. Among those who had to use shared toilets, concerns included physical safety, poor lighting, lack of water to flush or wash hands, and poor infrastructure. </p>
<p>These challenges are particularly clear in communities where infrastructure has not kept pace with rapid growth. And it may be that women and girls who do not have private secure toilet facilities are more likely to be raped than those who do have decent facilities. We set out to examine whether this was the case.</p>
<h2>Link between toilet type and non-partner rape</h2>
<p>Our <a href="https://www.tandfonline.com/doi/full/10.1080/17441692.2020.1813787">study</a> was conducted in the South African provinces of KwaZulu-Natal and Gauteng. We looked at four health districts. In each of these four districts we identified communities with particular challenges related to HIV, where community partners work. We conducted a cross-sectional quantitative survey, designed to be representative of young women in these communities. The primary study was for a wider analysis exploring young women’s vulnerability to HIV, and we re-purposed the data for our own analysis. Our analysis included 10,635 young women between the ages of 18 and 24, who were asked about their household’s access to toilet facilities.</p>
<p>We found that only half of the women in our study had access to their own indoor toilets. A fifth had their own outside toilet (such as a pit latrine), and approximately one third of the women reported that they only had access to shared toilet facilities. In addition, a small proportion (0.6%) reported they had no access to any toilet facilities.</p>
<p>Overall, we found that one in 20 (5.7%) of the young women in our study had been a victim of non-partner sexual violence in the past year. The highest rate of past year non-partner sexual violence was observed in women who only had access to shared toilet facilities (7.2%) and those without any toilets (7.1%), compared to 5.5% and 4.8% in those with their own outdoor and indoor toilets. </p>
<p>After controlling for a variety of factors which may confound the association, including poverty, we observed that women who use shared toilets were at a 45% increased risk of past year non-partner sexual violence compared to those with their own indoor toilets. A similar increase in risk for past year non-partner rape was also seen for those with no toilets (43%), but because of the small numbers reporting this, it was not statistically significant.</p>
<p>Our findings importantly demonstrate that the lack of access to adequate private toilet facilities for young women and girls is increasing their risk of being raped by a non-partner. </p>
<p>Sustainable development goal 6, <a href="https://www.sdg6monitoring.org/indicators/target-6-2/">indicator 6.2</a>, is specific about this: “By 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations.”</p>
<p>As our study showed, despite a <a href="https://www.gov.za/speeches/statistics-south-africa-ghs-series-viii-water-and-sanitation-2002-2016-report-23-nov-2016">growing number</a> of young women and girls having access to sanitation, this is not safe for them.</p>
<h2>Preventing non-partner sexual violence</h2>
<p>Addressing the significant public health and human rights burden of non-partner rape requires integrating these insights into urban planning, as well as focusing on social transformation. There needs to be continued effort by government and non-governmental organisations to address men’s perpetration of rape, including improved policing, and holding men accountable for this. </p>
<p>Our study also highlights that improving access to sanitation facilities which are private and secure must be central to discussions on the prevention of sexual violence. Addressing the abhorrent level of non-partner rape in South Africa requires such a multi-sectoral approach, with those involved in urban upgrading and the provision of water and sanitation working closely with communities.</p><img src="https://counter.theconversation.com/content/146150/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Gibbs receives funding from South African Medical Research Council, and the Research and Innovation (UKRI) through the Global Challenges Research Fund. </span></em></p><p class="fine-print"><em><span>Tarylee Reddy does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Studies globally have made the link between the lack of adequate sanitation, particularly open defecation or shared community toilet facilities, and the increased risk of women and girls being raped.Andrew Gibbs, Senior specialist scientist: Gender and Health Research Unit, Medical Research Council, South African Medical Research CouncilTarylee Reddy, Specialist Statistician, Biostatistics Research Unit, South African Medical Research CouncilLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1432182020-08-05T14:52:10Z2020-08-05T14:52:10ZBritain’s public toilet shame: time for equal access to decent facilities for all<figure><img src="https://images.theconversation.com/files/351294/original/file-20200805-16-kzmokt.png?ixlib=rb-1.1.0&rect=4%2C2%2C1647%2C1204&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The coronavirus lockdown has amplified the problem of access to clean and safe public toilets for everyone.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/funny-wc-restroom-symbols-266672837">Shutterstock</a></span></figcaption></figure><p>As lockdown began to be relaxed in England from mid-May and people started venturing out for the first time since March, crowds flocked to parks, beaches and other beauty spots to take exercise, enjoy the outdoors and reunite with friends and family. While the taste of freedom may have been sweet, the smell often wasn’t.</p>
<p>At the time, with most public toilets still closed, <a href="https://www.lincolnshirelive.co.uk/news/local-news/long-queues-toilets-coast-people-4150562">queues around the block</a> for those that had opened and other options out of use (in shopping centres, cafes and pubs), people who were “caught short” turned to the only places on offer. <a href="https://www.theguardian.com/world/2020/jun/10/closure-of-public-toilets-causing-anxiety-distress-and-frustration-across-uk">Parks, bushes and residential streets</a> were left with smelly deposits from the general public.</p>
<p>Our work, which explores sustainable ways of managing human waste, points to an important topic for reflection post lockdown: the inadequate provision of safe, clean public toilets in the UK that are fit for purpose. </p>
<p>Most non-disabled people from affluent countries don’t often need to plan their day around toilets: it’s a case of “flush and forget”. Lack of toilet access is more frequently associated with <a href="https://blogs.lse.ac.uk/southasia/2018/08/08/book-review-where-india-goes-abandoned-toilets-stunted-development-and-the-costs-of-caste-by-diane-coffey-and-dean-spears/">low and middle-income countries</a> (LMICs), where an <a href="https://www.who.int/news-room/fact-sheets/detail/sanitation">estimated two billion people</a> still lack access to safely managed toilets, leading to deaths from diarrhoea and other sanitation-related diseases such as cholera, typhoid and polio. But inadequate toilet access has long been a feature of life for many people in the UK, too.</p>
<h2>Toilet inequity in the UK</h2>
<p>Long before the COVID-19 crisis, disabled people and those with gastrointestinal disorders such as <a href="https://www.nhs.uk/conditions/crohns-disease/">Crohn’s disease</a> and <a href="https://www.nhs.uk/conditions/ulcerative-colitis/">colitis</a>, have been forced to navigate toilets that are inaccessible, restricted and policed. This impedes their participation in everyday activities that non-disabled people take for granted.</p>
<p>The pandemic has <a href="https://inews.co.uk/news/coronavirus-covid-19-public-toilets-lockdown-lifted-crohns-asda-433318">amplified this problem</a>. Sanitation is more than just a means of disposing of bodily waste – it facilitates participation in society. Accessible toilets mean <a href="https://journals.sagepub.com/doi/10.1177/0038026119854255">citizenship, dignity and belonging</a>.</p>
<figure class="align-center ">
<img alt="Toilet signs for disabled, pregnant and elderly people" src="https://images.theconversation.com/files/351302/original/file-20200805-475-1fjb9wz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/351302/original/file-20200805-475-1fjb9wz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/351302/original/file-20200805-475-1fjb9wz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/351302/original/file-20200805-475-1fjb9wz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/351302/original/file-20200805-475-1fjb9wz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/351302/original/file-20200805-475-1fjb9wz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/351302/original/file-20200805-475-1fjb9wz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People with disabilities or special health conditions and needs have long had to deal with poor toilet provision across the country.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/signs-showing-public-toilets-special-people-1732705589">Shutterstock</a></span>
</figcaption>
</figure>
<p>Apart from <a href="https://www.accessliving.org/newsroom/blog/ableism-101/">ableism</a>, other important discriminatory dimensions are sex and gender. Women’s toilets are <a href="https://www.sciencedirect.com/science/article/pii/0277539595800946?via%253Dihub">frequently undersized</a> compared to men’s – despite menstruation, pregnancy and caring responsibilities for small children which all necessitate more frequent and longer bathroom use. This design flaw is a standard that has existed for decades and has only <a href="https://www.researchgate.net/profile/Clara_Greed/publication/228916130_A_Code_of_Practice_for_Public_Toilets_in_Britain/links/55bf109008ae9289a099e004/A-Code-of-Practice-for-Public-Toilets-in-Britain.pdf">recently been reviewed</a>.</p>
<p>While secrecy around menstruation is often <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0235339">highlighted in other societies</a>, it is easy to overlook the culture of silence around periods in the UK, which <a href="https://journals.sagepub.com/doi/10.1177/0038026119854253">compounds inadequate provision</a> of facilities for women and menstruating people. Public toilets can also be <a href="https://www.theguardian.com/commentisfree/2018/oct/03/public-bathrooms-are-gender-identity-battlefields-what-if-we-just-do-it-right">uncomfortable or even hostile</a> environments for trans and non-binary people – particularly when gender-neutral facilities aren’t available. </p>
<p>This sort of discrimination is compounded by the <a href="https://www.bbc.co.uk/news/uk-45009337">reduction of public toilet provision</a> over the past decade, and can result in the digestive system and periods becoming a “<a href="https://www.tandfonline.com/doi/abs/10.1080/713668884">leash</a>”, preventing some people from venturing far in case there is no access to a toilet.</p>
<p>Cleaning and maintenance of toilets is vital. But sanitation workers and cleaners remain largely <a href="https://washmatters.wateraid.org/blog/the-unsung-heroes-of-the-covid-19-pandemic">unrecognised and undervalued</a>, even though their public health contribution should <a href="https://leftfootforward.org/2020/08/after-pay-rise-luton-hospital-cleaners-still-wont-earn-a-living-wage/?mc_cid=04ababaf1e&mc_eid=07f10b9f05">arguably receive similar</a> appreciation to that of porters and cleaners in hospitals. Instead of being protected, toilet cleaners – among other typically low-paid but essential workers – are <a href="https://theconversation.com/coronavirus-class-divide-the-jobs-most-at-risk-of-contracting-and-dying-from-covid-19-138857">more at risk</a> of contracting and dying from COVID-19.</p>
<p>This highlights another humbling truth for the UK: discriminatory treatment of sanitation workers is not an issue reserved only for <a href="https://www.who.int/news-room/detail/14-11-2019-new-report-exposes-horror-of-working-conditions-for-millions-of-sanitation-workers-in-the-developing-world">LMICs</a>, but occurs within our society too.</p>
<h2>A better future</h2>
<p>Easing of lockdown has prompted urgent discussion about how to reopen public toilets safely. <a href="https://www.bbc.co.uk/news/uk-52774794">Innovations</a> such as foot-operated flush pedals, one-way systems and sensors for water, soap, paper towels and bins reduce shared touchpoints and proximity. But this is a timely opportunity to consider how <a href="https://journals.sagepub.com/doi/10.1177/0038026119854274">equitable</a> and suitable provision for women, trans and non-binary people, and the needs of disabled people can be addressed. The economic and societal benefits of adequate public toilets have never been clearer.</p>
<p>The crisis also highlights the importance of responsible attitudes towards the <a href="https://blog.bham.ac.uk/business-school/2020/04/22/how-societies-respond-to-social-distancing-orders/">collective</a> good. Many actions can be taken by individuals to reduce asymptomatic spread, from wearing a mask to diligent handwashing and <a href="https://www.telegraph.co.uk/global-health/climate-and-people/put-seat-flushing-toilet-avoid-spread-covid-19-scientists-urge/">closing the toilet lid</a> after use.</p>
<p>As <a href="https://www.telegraph.co.uk/global-health/science-and-disease/coronavirus-news-lockdown-end-uk-hairdressers-pubs-reopen-hotels/">bars, pubs, and other places reopen</a>, a sense of personal responsibility towards societal health, and respect for sanitation workers who facilitate it, will be more<a href="https://doi.org/10.1016/j.envint.2020.105790"> important</a> than ever.</p>
<p>Toilets function as a bridge between public and private spaces, signifying who should and shouldn’t be present. They stand as <a href="https://www.jstor.org/stable/24461652">political symbols of power and inclusion</a>. With COVID-19 reshaping how we move and interact in public spaces, it is time to recognise the importance of public toilets – and the people who look after them – to equitable, dignified and healthy participation in public life. Now more than ever, we must appreciate that nature’s call can only be put on hold for so long.</p><img src="https://counter.theconversation.com/content/143218/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Natalie Boyd Williams receives funding from NERC for her PhD. </span></em></p><p class="fine-print"><em><span>Heather Roxburgh receives funding from NERC, the Parkes Foundation, and the Royal Geographical Society for her PhD. </span></em></p><p class="fine-print"><em><span>Jennifer Dickie received funding from the Scottish Alliance for Geosciences, Environment & Society (PECRE award) to investigate the links between energy and sanitation in India and NERC funding for Natalie Boyd Williams' PhD studentship. </span></em></p>Coronavirus has amplified the fact that inadequate toilet access has long been a feature of UK life for many, including women and the disabled. Vulnerable people deserve better.Natalie Boyd Williams, PhD Researcher, University of StirlingHeather Roxburgh, PhD student, University of StirlingJennifer Dickie, Lecturer in Environmental Geography, University of StirlingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1412712020-06-24T08:41:14Z2020-06-24T08:41:14ZFrom hospitals to households, we can all be better at remembering to wash our hands<figure><img src="https://images.theconversation.com/files/343648/original/file-20200624-56963-oylt04.jpg?ixlib=rb-1.1.0&rect=5%2C17%2C3836%2C2540&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">F. Cary Snyder/Unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>While Australia gradually opens up from COVID-19 lockdown, Victoria is still struggling to contain the outbreak. The Black Lives Matter protest in Melbourne on June 6, which attracted thousands of face-masked and hand-sanitised protesters, <a href="https://www.sbs.com.au/news/did-australia-s-black-lives-matter-protests-cause-a-spike-in-covid-19-cases">did not prove</a> to be the public health nightmare many commentators (particularly politically conservative ones) had predicted. But Melbourne is nevertheless contending with a <a href="https://www.abc.net.au/news/2020-06-22/coronavirus-hotspot-suburbs-in-melbourne-victoria-darebin-hume/12379090">worrying spike</a> in case numbers arising from infection clusters around staff working in quarantine sites and extended family gatherings.</p>
<p>From the beginning of the COVID-19 pandemic, we were told two behaviours were crucial to keeping us safe: <a href="https://www.technologynetworks.com/immunology/articles/the-rationale-behind-social-distancing-and-hand-washing-332559">social distancing and handwashing</a>. The coronavirus crisis has brought the mundane act of washing our hands into public discussion, and the internet is now awash (ahem) with advice, from the <a href="https://www.youtube.com/watch?v=4hrFmYXCU04&feature=youtu.be">practical</a> to the <a href="https://www.youtube.com/watch?v=NAsTmxF9m9s">surreal</a>.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/NAsTmxF9m9s?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Judi Dench on hand with some helpful, if mildly unsettling, advice.</span></figcaption>
</figure>
<p>If there’s one place where you would expect hand cleanliness to be beyond reproach, it’s hospitals. But this isn’t necessarily the case.</p>
<p>Surprisingly, hand hygiene is a vexing issue in hospitals all over the world. Repeated studies have shown it is common for hospital staff to follow hand hygiene protocols <a href="https://www.cdc.gov/handhygiene/">less than 50% of the time</a>. This is as true in <a href="https://pubmed.ncbi.nlm.nih.gov/29778435/">Australia</a> and <a href="https://search.informit.com.au/documentSummary;dn=435246019845891;res=IELNZC">New Zealand-Aotearoa</a> as it is globally. As any infection control nurse will tell you, specialist doctors are <a href="https://www.fiercehealthcare.com/healthcare/doctors-are-worst-hand-hygiene-offenders">often among the worst offenders</a>.</p>
<h2>Who teaches hospital staff how to handwash?</h2>
<p>Like most Western-style hospitals, all Australian hospitals have infection control experts, typically nurses, whose job is to educate, advise and monitor compliance on infection control protocols among hospital workers. This is lifesaving work, because hospitals are <a href="https://www.ncbi.nlm.nih.gov/books/NBK441857/">prime breeding grounds</a> for deadly <a href="https://www.chkd.org/Patients-and-Families/Health-Library/Way-to-Grow/Multi-Drug-Resistant-Organisms,-a-Few-Facts-about/">antibiotic-resistant bacterial strains</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/washing-our-hands-of-responsibility-for-hospital-infections-10652">Washing our hands of responsibility for hospital infections</a>
</strong>
</em>
</p>
<hr>
<p>The main line of defence in hospitals against these potentially fatal infections is <a href="https://www.cdc.gov/infectioncontrol/guidelines/mdro/prevention-control.html">prevention</a>, hence the strict protocols around hand hygiene, and widespread use of gloves, robes, masks and safety googles.</p>
<p><a href="https://www.cdc.gov/handhygiene/providers/index.html">Proper hospital hand hygiene</a> involves using gloves, hand sanitiser, and frequent handwashing. Protocols dictate that gloves should be used in situations where health workers might expect to come into contact with blood, bodily fluids or other contaminants. Staff should wash or sanitise their hands before and after every patient contact, and in all situations where there has been contact with potentially contaminated material. </p>
<p>Infection control nurses undertake routine hand hygiene audits, and hospital staff can be disciplined if they fail to comply with the protocols.</p>
<h2>Three types of handwashers</h2>
<p>What makes hospital staff more or less likely to comply? It turns out there are different categories of handwasher, and therefore different ways to help people remember to do it.</p>
<p>While working on a project looking at communication in a <a href="https://www.tandfonline.com/doi/abs/10.5172/hesr.2006.15.2.156">multidisciplinary hospital team</a>, infection control education became one of the areas of interest. Part of the study focused on the hand hygiene habits of hospital staff in a ward with particularly high infection risks.</p>
<p>Based on observations, interviews and informal conversations, we discovered nursing staff tended to fall into one of three broad categories: “hero healthworkers”, “family members”, and those who were “working for the whitegoods”.</p>
<p>Overall, most health-care workers practised good hand hygiene most of the time. But when there was time pressure — such as during short-staffed shifts, or when multiple patients were in particular need at the same time — nearly everyone had moments of non-compliance. But, fascinatingly, there were patterns to this non-compliance.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/343695/original/file-20200624-132951-1i3xtnh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/343695/original/file-20200624-132951-1i3xtnh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/343695/original/file-20200624-132951-1i3xtnh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/343695/original/file-20200624-132951-1i3xtnh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/343695/original/file-20200624-132951-1i3xtnh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/343695/original/file-20200624-132951-1i3xtnh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/343695/original/file-20200624-132951-1i3xtnh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Kelly Sikkema/Unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>No matter how busy things were, “hero healthworkers” always practised hand hygiene before approaching a patient’s bed. But if time was short, sometimes they did not wash or sanitise their hands on leaving the patient. Nurses (and doctors) who exhibited this behaviour tended to make comments suggesting they valued patients’ health above their own. </p>
<p>“Family members” always practised good hand hygiene when leaving a patient, but sometimes missed out on washing or sanitising before interacting with a new one. In each case, these staff members had vulnerable people in their household – mostly young children, and in a couple of cases older relatives. Interviews and informal discussions revealed deep concern around infection risks and “taking something home”. </p>
<p>The third group was mostly meticulous in their practice when observed by a superior, but much less conscientious when only peers were around. Nurses who fitted this pattern tended to be disparaged by their colleagues as “working for the whitegoods” – treating nursing less as a professional vocation and more as “just” a job to earn money.</p>
<p>These patterns were observed — sometimes with minor variations — in more than a dozen wards over three different hospital sites during subsequent research projects.</p>
<h2>How to improve things</h2>
<p>None of these behaviours appear to have been conscious, even among the least conscientious “whitegoods” group. Many staff recognised their own behaviour patterns when they were pointed out, but said they had not been explicitly aware of them. </p>
<p>Identifying these characteristic behaviour patterns allowed the infection control educator to target education efforts more effectively. “Hero healthworkers” were educated on the risks to other staff by potentially transmitting infection to work surfaces and other places in the hospital by not handwashing after seeing a patient. “Family members” were reminded of the risks to patients of transmitting infections in the opposite direction. And those who only complied when being directly supervised were counselled on the need to have high standards at all times. </p>
<p>This shift in education strategy was employed along with a number of other infection control interventions, resulting in a significant reduction in multidrug-resistant infections.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-clean-is-your-hospital-room-to-reduce-the-spread-of-infections-it-could-probably-be-cleaner-122185">How clean is your hospital room? To reduce the spread of infections, it could probably be cleaner</a>
</strong>
</em>
</p>
<hr>
<p>One insight we can take from this for our day-to-day realities in the middle of COVID-19 is to be reflective about our own handwashing practices. When are we conscientious, and when do we let our standards slip? Is there a pattern in our own behaviours that we can identify, and what are the subconscious beliefs driving those practices? Can we use that knowledge to change our behaviours? </p>
<p>The simple act of handwashing is perhaps more complex than we realise. But it is one of the things that will determine how well we fare in the current pandemic.</p><img src="https://counter.theconversation.com/content/141271/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Debbi Long does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Even in hospitals, where hand hygiene is vital, staff don’t always remember to wash their hands. What hope is there for the rest of us? Thankfully, research on handwashing behaviours has some answers.Debbi Long, Senior Research Fellow, RMIT UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1152462020-06-09T05:00:02Z2020-06-09T05:00:02ZScientists around the world are already fighting the next pandemic<figure><img src="https://images.theconversation.com/files/331776/original/file-20200430-42908-63fdob.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/tiny-native-african-schoolgirl-bringing-tap-1654121194">Riccardo Mayer/Shutterstock.com</a></span></figcaption></figure><p>If a two-year-old child living in poverty in India or Bangladesh gets sick with a common bacterial infection, there is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4775002/">more than a 50%</a> chance an antibiotic treatment will fail. Somehow the child has acquired an antibiotic resistant infection – even to drugs to which they may never have been exposed. How?</p>
<p>Unfortunately, this child also lives in a place with limited clean water and less waste management, bringing them into frequent contact with faecal matter. This means they are regularly exposed to millions of resistant genes and bacteria, including potentially <a href="https://www.thelancet.com/pdfs/journals/lanplh/PIIS2542-5196(18)30186-4.pdf">untreatable superbugs</a>. This sad story is shockingly common, especially in places where pollution is rampant and clean water is limited.</p>
<p>For many years, people believed antibiotic resistance in bacteria was primarily driven by imprudent use of antibiotics in clinical and veterinary settings. But <a href="https://www.sciencedirect.com/science/article/pii/S016041201832587X?via%3Dihub">growing evidence</a> suggests that environmental factors may be of equal or greater importance to the spread of <a href="https://theconversation.com/to-defeat-superbugs-everyone-will-need-access-to-clean-water-95202">antibiotic resistance</a>, especially in the developing world. </p>
<p>Here we focus on antibiotic resistant bacteria, but drug resistance also occurs in types of other microorganisms – such as resistance in pathogenic viruses, fungi, and protozoa (called antimicrobial resistance or AMR). This means that our ability to treat all sorts of infectious disease is increasingly hampered by resistance, potentially including coronaviruses like SARS-CoV-2, which causes COVID-19.</p>
<p>Overall, use of antibiotics, antivirals, and antifungals clearly must be reduced, but in most of the world, improving water, sanitation, and hygiene practice – a practice known as WASH – is also critically important. If we can ensure cleaner water and safer food everywhere, the spread of antibiotic resistant bacteria will be reduced across the environment, including within and between people and animals. </p>
<p>As <a href="https://www.who.int/water_sanitation_health/publications/wash-wastewater-management-to-prevent-infections-and-reduce-amr/en/">recent recommendations on AMR</a> from the Food and Agriculture Organization of the United Nations (FAO), the World Organisation for Animal Health (OIE), and World Health Organization (WHO) suggest, to which David contributed, the “superbug problem” will not be solved by more prudent antibiotic use alone. It also requires global improvements in water quality, sanitation, and hygiene. Otherwise, the next pandemic might be worse than COVID-19. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/329085/original/file-20200420-152597-vzwgw7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/329085/original/file-20200420-152597-vzwgw7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/329085/original/file-20200420-152597-vzwgw7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/329085/original/file-20200420-152597-vzwgw7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/329085/original/file-20200420-152597-vzwgw7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/329085/original/file-20200420-152597-vzwgw7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/329085/original/file-20200420-152597-vzwgw7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Untreated sewage.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/ilheus-bahia-brazil-march-5-2012-1580178892">Joa Souza/Shutterstock.com</a></span>
</figcaption>
</figure>
<h2>Bacteria under stress</h2>
<p>To understand the problem of resistance, we must go back to basics. What is antibiotic resistance, and why does it develop?</p>
<p>Exposure to antibiotics puts stress on bacteria and, like other living organisms, they defend themselves. Bacteria do this by sharing and acquiring defence genes, often from other bacteria in their environment. This allows them to change quickly, readily obtaining the ability to make proteins and other molecules that block the antibiotic’s effect. </p>
<p>This <a href="https://www.ncbi.nlm.nih.gov/pubmed/21711367">gene sharing process</a> is natural and is a large part of what drives evolution. However, as we use ever stronger and more diverse antibiotics, new and more powerful bacterial defence options have evolved, rendering some bacteria resistant to almost everything – the ultimate outcome being untreatable superbugs.</p>
<hr>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><strong><em>This article is part of Conversation Insights</em></strong>
<br><em>The Insights team generates <a href="https://theconversation.com/uk/topics/insights-series-71218">long-form journalism</a> derived from interdisciplinary research. The team is working with academics from different backgrounds who have been engaged in projects aimed at tackling societal and scientific challenges.</em> </p>
<hr>
<p>Antibiotic resistance has existed <a href="https://www.nature.com/articles/nature10388">since life began</a>, but has recently accelerated due to human use. When you take an antibiotic, it kills a large majority of the target bacteria at the site of infection – and so you get better. But antibiotics do not kill all the bacteria – some are naturally resistant; others acquire resistance genes from their microbial neighbours, especially in our digestive systems, throat, and on our skin. This means that some resistant bacteria always survive, and can pass to the environment via inadequately treated faecal matter, spreading resistant bacteria and genes wider.</p>
<p>The pharmaceutical industry initially responded to increasing resistance by developing new and stronger antibiotics, but bacteria evolve rapidly, making even new antibiotics lose their effectiveness quickly. As a result, new antibiotic development has almost stopped because it garners <a href="https://theconversation.com/big-pharma-has-failed-the-antibiotic-pipeline-needs-to-be-taken-under-public-ownership-126058">limited profit</a>. Meanwhile, resistance to existing antibiotics continues to increase, which especially impacts places with <a href="https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196%2818%2930186-4/fulltext">poor water quality and sanitation</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/big-pharma-has-failed-the-antibiotic-pipeline-needs-to-be-taken-under-public-ownership-126058">Big Pharma has failed: the antibiotic pipeline needs to be taken under public ownership</a>
</strong>
</em>
</p>
<hr>
<p>This is because in the developed world you defecate and your poo goes down the toilet, eventually flowing down a sewer to a community wastewater treatment plant. Although treatment plants are not perfect, they typically reduce resistance levels by well over 99%, substantially reducing resistance released to the environment. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/331443/original/file-20200429-51480-10fqgfq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/331443/original/file-20200429-51480-10fqgfq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/331443/original/file-20200429-51480-10fqgfq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/331443/original/file-20200429-51480-10fqgfq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/331443/original/file-20200429-51480-10fqgfq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/331443/original/file-20200429-51480-10fqgfq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/331443/original/file-20200429-51480-10fqgfq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Modern sewage treatment plants remove most AMR microbes. But they are currently not affordable in much of the world.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/aerial-view-solid-contact-clarifier-tank-1024670731">People Image Studio/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>In contrast, over <a href="https://www.unicef.org/reports/progress-on-drinking-water-sanitation-and-hygiene-2019">70% of the world</a> has no community wastewater treatment or even sewers; and most faecal matter, containing resistant genes and bacteria, goes directly into surface and groundwater, often via open drains. </p>
<p>This means that people who live in places without faecal waste management are regularly exposed to antibiotic resistance in many ways. Exposure is even possible of people who may not have taken antibiotics, like our child in South Asia.</p>
<h2>Spreading through faeces</h2>
<p>Antibiotic resistance is everywhere, but it is not surprising that resistance <a href="https://www.ncbi.nlm.nih.gov/pubmed/30177008%20and%20https://www.thelancet.com/pdfs/journals/lanplh/PIIS2542-5196(18)30186-4.pdf">is greatest</a> in places with poor sanitation because factors other than use are important. For example, a fragmented civil infrastructure, political corruption, and a lack of centralised healthcare also play key roles. </p>
<p>One might cynically argue that “foreign” resistance is a local issue, but antibiotic resistance spread knows no boundaries – superbugs might develop in one place due to pollution, but then become global due to international travel. Researchers from Denmark compared antibiotic resistance genes in long-haul airplane toilets and found <a href="https://www.nature.com/articles/srep11444">major differences in resistance carriage</a> among flight paths, suggesting resistance can jump-spread by travel. </p>
<p>The world’s current experience with the spread of SARS-CoV-2 shows just how fast infectious agents can move with human travel. The impact of increasing antibiotic resistance is no different. There are no reliable antiviral agents for SARS-CoV-2 treatment, which is the way things may become for currently treatable diseases if we allow resistance to continue unchecked. </p>
<p>As an example of antibiotic resistance, the “superbug” gene, blaNDM-1, was first detected in <a href="https://www.ncbi.nlm.nih.gov/pubmed/21478057">India</a> in 2007 (although it was probably present in other regional countries). But soon thereafter, it was found in a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2786356/">hospital patient in Sweden</a> and then <a href="https://academic.oup.com/jac/article/66/9/1998/768777">in Germany</a>. It was ultimately detected in 2013 in Svalbard in <a href="https://www.sciencedirect.com/science/article/pii/S016041201832587X?via%3Dihub">the High Arctic</a>. In parallel, <a href="https://www.ncbi.nlm.nih.gov/pubmed/24521347">variants</a> of this gene appeared locally, but have evolved as they move. Similar evolution has occurred as <a href="https://www.pnas.org/content/early/2020/04/07/2004999117">the COVID-19 virus</a> has spread. </p>
<p>Relative to antibiotic resistance, humans are not the only “travellers” that can carry resistance. Wildlife, such as migratory birds, can also acquire resistant bacteria and genes from contaminated water or soils and then fly great distances carrying resistance in their gut from places with poor water quality to places with good water quality. During travel, they defecate along their path, potentially planting resistance almost anywhere. The global trade of foods also facilitates spread of resistance from country to country and across the globe.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/329087/original/file-20200420-152597-x6u4kz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/329087/original/file-20200420-152597-x6u4kz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/329087/original/file-20200420-152597-x6u4kz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/329087/original/file-20200420-152597-x6u4kz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/329087/original/file-20200420-152597-x6u4kz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/329087/original/file-20200420-152597-x6u4kz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/329087/original/file-20200420-152597-x6u4kz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Resistant microbes don’t need planes to travel.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/J54DjpXYJuE">Nick Fewings/Unsplash</a>, <a class="license" href="http://artlibre.org/licence/lal/en">FAL</a></span>
</figcaption>
</figure>
<p>What is tricky is that the spread by resistance by travel is often invisible. In fact, the dominant pathways of international resistance spread <a href="https://www.ncbi.nlm.nih.gov/pubmed/30924539">are largely unknown</a> because many pathways overlap, and the types and drivers of resistance are diverse. </p>
<p>Resistant bacteria are not the only infectious agents that might be spread by environmental contamination. SARS-CoV-2 has been found in faeces and inactive virus debris found in sewage, but all evidence suggests water is <a href="https://www.who.int/publications-detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations">not a major route</a> of COVID-19 spread – although there are limited data from places with poor sanitation. </p>
<p>So, each case differs. But there are common roots to disease spread – pollution, poor water quality, and inadequate hygiene. Using fewer antibiotics is critical to reducing resistance. However, without also providing safer sanitation and improved water quality at global scales, resistance will continue to increase, potentially creating the next pandemic. Such a combined approach is central to the new WHO/FAO/OIE recommendations on AMR.</p>
<h2>Other types of pollution and hospital waste</h2>
<p>Industrial wastes, hospitals, farms, and agriculture are also possible sources or drivers of antibiotic resistance. </p>
<p>For example, about ten years ago, one of us (David) studied metal pollution in a Cuban river and <a href="https://pubs.acs.org/doi/abs/10.1021/es102473z">found</a> the highest levels of resistant genes were near a leaky solid waste landfill and below where pharmaceutical factory wastes entered the river. The factory releases clearly impacted resistance levels downstream, but it was metals from the landfill that most strongly correlated with resistance gene levels in the river. </p>
<p>There is a logic to this because toxic metals can stress bacteria, which makes the bacteria stronger, incidentally making them more resistant to anything, including antibiotics. We saw the same thing with metals in <a href="https://pubs.acs.org/doi/full/10.1021/acs.est.7b03797">Chinese landfills</a> where resistance gene levels in the landfill drains strongly correlated with metals, not antibiotics. </p>
<p>In fact, pollution of almost any sort can promote antibiotic resistance, including metals, biocides, pesticides, and other chemicals entering the environment. Many pollutants can promote resistance in bacteria, so reducing pollution in general will help reduce antibiotic resistance – an example of which is reducing metal pollution.</p>
<p>Hospitals are also important, being both reservoirs and incubators for many varieties of antibiotic resistance, including well known resistant bacteria such as Vancomycin-resistant Enterococcus (VRE) and Methicillin-resistant Staphylococcus aureus (MRSA). While resistant bacteria are not necessarily acquired in hospitals (most are brought in from the community), resistant bacteria can be enriched in hospitals because they are where people are very sick, cared for in close proximity, and often provided “last resort” antibiotics. Such conditions allow the spread of resistant bacteria easier, especially superbug strains because of the types of antibiotics that are used.</p>
<p>Wastewater releases from hospitals also may be a concern. <a href="https://www.ncbi.nlm.nih.gov/pubmed/31295654">Recent data</a> showed that “typical” bacteria in hospital sewage carry five to ten times more resistant genes per cell than community sources, especially genes more readily shared between bacteria. This is problematic because such bacteria are sometimes superbug strains, such as those resistant to <a href="https://www.ncbi.nlm.nih.gov/pubmed/28949542">carbapenem antibiotics</a>. Hospital wastes are a particular concern in places without effective community wastewater treatment.</p>
<p>Another critical source of antibiotic resistance is agriculture and aquaculture. Drugs used in veterinary care can be very similar (sometimes identical) to the antibiotics used in human medicine. And so resistant bacteria and genes <a href="https://www.ncbi.nlm.nih.gov/pubmed/30924539">are found</a> in animal manure, soils, and drainage water. This is potentially significant given that animals produce <a href="https://www.nature.com/articles/s41893-018-0167-0?WT.feed_name=subjects_environmental-sciences">four times more</a> faeces than humans at a global scale. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/329090/original/file-20200420-152558-wddm3x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/329090/original/file-20200420-152558-wddm3x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=442&fit=crop&dpr=1 600w, https://images.theconversation.com/files/329090/original/file-20200420-152558-wddm3x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=442&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/329090/original/file-20200420-152558-wddm3x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=442&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/329090/original/file-20200420-152558-wddm3x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=555&fit=crop&dpr=1 754w, https://images.theconversation.com/files/329090/original/file-20200420-152558-wddm3x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=555&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/329090/original/file-20200420-152558-wddm3x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=555&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Watch out for the cowpats.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/nKUkTnHMg48">Annie Spratt/Unsplash</a>, <a class="license" href="http://artlibre.org/licence/lal/en">FAL</a></span>
</figcaption>
</figure>
<p>Wastes from agricultural activity also can be especially problematic because waste management is usually less sophisticated. Additionally, agricultural operations are often at very large scales and less containable due to greater exposure to wildlife. Finally, antibiotic resistance can spread from farm animals to farmers to food workers, which has been seen in <a href="https://doi.org/10.2807/1560-7917.ES.2015.20.37.30021">recent European studies</a>, meaning this can be important at local scales.</p>
<p>These examples show that pollution in general increases the spread of resistance. But the examples also show that dominant drivers will differ based on where you are. In one place, resistance spread might be fuelled by human faecal contaminated water; whereas, in another, it might be industrial pollution or agricultural activity. So local conditions are key to reducing the spread of antibiotic resistance, and optimal solutions will differ from place to place – single solutions do not fit all. </p>
<p>Locally driven national action plans are therefore essential – which the new <a href="https://www.who.int/water_sanitation_health/publications/wash-wastewater-management-to-prevent-infections-and-reduce-amr/en/">WHO/FAO/OIE guidance</a> strongly recommends. In some places, actions might focus on healthcare systems; whereas, in many places, promoting cleaner water and safer food also is critical.</p>
<h2>Simple steps</h2>
<p>It is clear we must use a holistic approach (what is now called “<a href="https://www.cdc.gov/onehealth/basics/index.html">One Health</a>”) to reduce the spread of resistance across people, animals, and the environment. But how do we do this in a world that is so unequal? It is now accepted that clean water is a human right embedded in the UN’s 2030 <a href="https://sustainabledevelopment.un.org/sdg6">Agenda for Sustainable Development</a>. But how can we achieve affordable “clean water for all” in a world where geopolitics often outweigh local needs and realities?</p>
<p>Global improvements in sanitation and hygiene should bring the world <a href="https://www.who.int/water_sanitation_health/publications/wash-wastewater-management-to-prevent-infections-and-reduce-amr/en/">closer to solving the problem of antibiotic resistance</a>. But such improvements should only be the start. Once improved sanitation and hygiene exist at global scales, our reliance on antibiotics will decline due to more equitable access to clean water. In theory, clean water coupled with decreased use of antibiotics will drive a downward spiral in resistance.</p>
<p>This is not impossible. We know of a village in Kenya where they simply moved their water supply up a small hill – above rather than near their latrines. Hand washing with soap and water was also mandated. A year later, antibiotic use in the village was negligible because so few villagers were unwell. This success is partly due to the remote location of the village and very proactive villagers. But it shows that clean water and improved hygiene can directly translate into reduced antibiotic use and resistance.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/332752/original/file-20200505-83779-1ctcg3f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/332752/original/file-20200505-83779-1ctcg3f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/332752/original/file-20200505-83779-1ctcg3f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/332752/original/file-20200505-83779-1ctcg3f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/332752/original/file-20200505-83779-1ctcg3f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/332752/original/file-20200505-83779-1ctcg3f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/332752/original/file-20200505-83779-1ctcg3f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Public toilets in Haryana, India.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/gurugram-haryana-india-feb-14-2019-1331304905">Rinku Dua/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>This story from Kenya further shows how simple actions can be a critical first step in reducing global resistance. But such actions must be done everywhere and at multiple levels to solve the global problem. This is not cost-free and requires international cooperation – including focused apolitical policy, planning, and infrastructure and management practices.</p>
<p>Some well intended groups have attempted to come up with novel solutions, but those solutions are often too technological. And western “off-the-shelf” water and wastewater technologies are rarely optimal for use in developing countries. They are often too complex and costly, but also require maintenance, spare parts, operating skill, and cultural buy-in to be sustainable. For example, building an advanced activated sludge wastewater treatment plant in a place where 90% of the population does not have sewer connections makes no sense.</p>
<p>Simple is more sustainable. As an obvious example, we need to reduce open defecation in a cheap and socially acceptable manner. This is the best immediate solution in places with limited or unused sanitation infrastructure, such as <a href="https://blogs.lse.ac.uk/southasia/2018/08/08/book-review-where-india-goes-abandoned-toilets-stunted-development-and-the-costs-of-caste-by-diane-coffey-and-dean-spears/">rural India</a>. Innovation is without doubt important, but it needs to be tailored to local realities to stand a chance of being sustained into the future.</p>
<p>Strong leadership and governance is also critical. Antibiotic resistance is <a href="https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(18)30186-4/fulltext">much lower</a> in places with less corruption and strong governance. Resistance also is lower in places with greater public health expenditure, which implies social policy, community action, and local leadership can be as important as technical infrastructure.</p>
<h2>Why aren’t we solving the problem?</h2>
<p>While solutions to antibiotic resistance exist, integrated cooperation between science and engineering, medicine, social action, and governance is lacking. While many international organisations acknowledge the scale of the problem, unified global action is not happening fast enough.</p>
<p>There are various reasons for this. Researchers in healthcare, the sciences, and engineering are rarely on the same page, and experts <a href="https://theconversation.com/why-we-should-expect-scientists-to-disagree-about-antibiotic-resistance-and-other-controversies-82609">often disagree</a> over what should be prioritised to prevent antibiotic resistance – this muddles guidance. Unfortunately, many antibiotic resistance researchers also sometimes sensationalise their results, only reporting bad news or exaggerating results.</p>
<p>Science continues to reveal probable causes of antibiotic resistance, which shows no single factor drives resistance evolution and spread. As such, a strategy incorporating medicine, environment, sanitation, and public health is needed to provide the best solutions. Governments throughout the world must act in unison to meet targets for sanitation and hygiene in accordance with the UN Sustainable Development Goals.</p>
<p>Richer countries must work with poorer ones. But, actions against resistance should focus on local needs and plans because each country is different. We need to remember that resistance is everyone’s problem and all countries have a role in solving the problem. This is evident from the COVID-19 pandemic, where some countries have displayed <a href="https://ec.europa.eu/international-partnerships/topics/eu-global-response-covid-19_en">commendable cooperation</a>. Richer countries should invest in helping to provide locally suitable waste management options for poorer ones – ones that can be maintained and sustained. This would have a more immediate impact than any “toilet of the future” technology.</p>
<p>And it’s key to remember that the global antibiotic resistance crisis does not exist in isolation. Other global crises overlap resistance; such as climate change. If the climate becomes warmer and dryer in parts of the world with limited sanitation infrastructure, greater antibiotic resistance might ensue due to higher exposure concentrations. In contrast, if greater flooding occurs in other places, an increased risk of untreated faecal and other wastes spreading across whole landscapes will occur, increasing antibiotic resistance exposures in an unbounded manner.</p>
<p>Antibiotic resistance will also impact on the fight against COVID-19. As an example, secondary bacterial infections are common in seriously ill patients with COVID-19, especially when admitted to an ICU. So if such pathogens are resistant to critical antibiotic therapies, they will not work and result <a href="https://www.medpagetoday.com/infectiousdisease/covid19/86192">in higher death rates</a>.</p>
<p>Regardless of context, improved water, sanitation, and hygiene must be the backbone of <a href="https://www.who.int/water_sanitation_health/publications/wash-wastewater-management-to-prevent-infections-and-reduce-amr/en/">stemming the spread of AMR, including antibiotic resistance</a>, to avoid the next pandemic. Some progress is being made in terms of global cooperation, but efforts are still too fragmented. Some countries are making progress, whereas others are not. </p>
<p>Resistance needs to be seen in a similar light to other global challenges – something that threatens human existence and the planet. As with addressing climate change, protecting biodiversity, or COVID-19, global cooperation is needed to reduce the evolution and spread of resistance. Cleaner water and improved hygiene are the key. If we do not work together now, we all will pay an even greater price in the future.</p>
<hr>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=112&fit=crop&dpr=1 600w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=112&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=112&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=140&fit=crop&dpr=1 754w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=140&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=140&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><em>For you: more from our <a href="https://theconversation.com/uk/topics/insights-series-71218?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=InsightsUK">Insights series</a>:</em></p>
<ul>
<li><p><em><a href="https://theconversation.com/this-3d-printed-bone-brick-could-transform-how-we-treat-bomb-injuries-inside-story-114871?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=InsightsUK">This 3D printed ‘bone brick’ could transform how we treat bomb injuries – inside story</a></em></p></li>
<li><p><em><a href="https://theconversation.com/four-experts-investigate-how-the-5g-coronavirus-conspiracy-theory-began-139137?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=InsightsUK">Four experts investigate how the 5G coronavirus conspiracy theory began</a></em></p></li>
<li><p><em><a href="https://theconversation.com/rewilding-rare-birds-return-when-livestock-grazing-has-stopped-137948?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=InsightsUK">Rewilding: rare birds return when livestock grazing has stopped</a></em></p></li>
</ul>
<p><em>To hear about new Insights articles, join the hundreds of thousands of people who value The Conversation’s evidence-based news. <a href="https://theconversation.com/uk/newsletters/the-daily-newsletter-2?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=InsightsUK"><strong>Subscribe to our newsletter</strong></a>.</em></p><img src="https://counter.theconversation.com/content/115246/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David W Graham gives guidance to the World Health Organisation on local and global strategies for reducing AMR, especially in developing and emerging countries. </span></em></p><p class="fine-print"><em><span>Peter Collignon does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Superbugs spread through the environment – and it needs urgent attention.David W Graham, Professor of Ecosystems Engineering, Newcastle UniversityPeter Collignon, Professor of Infectious Diseases and Microbiology, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1401672020-06-08T07:51:45Z2020-06-08T07:51:45ZCOVID-19 heightens water problems around the world<figure><img src="https://images.theconversation.com/files/340018/original/file-20200605-176546-1vkao9j.jpg?ixlib=rb-1.1.0&rect=7%2C30%2C5081%2C3357&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Water is now a more precious, strategic and scarcer than ever before in human history.</span> <span class="attribution"><span class="source">www.shutterstock.com/greenaperture</span></span></figcaption></figure><p>COVID-19 will unquestionably delay achievement of the <a href="https://www.un.org/sustainabledevelopment/sustainable-development-goals/">Sustainable Development Goals (SDGs)</a>, the latest global attempt to improve the quality of life of billions of people around the world by 2030. </p>
<p>Increasing access to clean water and sanitation are among the 17 SDGs. During normal times, and even more during the present pandemic, access to clean water and proper sanitation is essential. </p>
<p>But we must now rethink how we achieve the goals laid out in the SDGS. First, we should stop looking at access to safe water as the problem of developing countries alone – it is a global problem that worsens under extreme conditions like the current pandemic. </p>
<h2>How COVID-19 heightens water problems</h2>
<p>During the current pandemic, a lack of clean water for drinking and proper hygienic practices has become a major concern for cities in the developing world, especially in slums, peri-urban areas and refugee camps. </p>
<p>Countries in Africa and South Asia, with some 85% of the world’s people live, face particularly daunting challenges to access clean, drinkable water. </p>
<p>But the problem is not confined to these areas. Developed countries are increasingly facing similar concerns. After catastrophic experiences with water utilities in <a href="https://www.theguardian.com/us-news/2019/dec/10/water-company-city-officials-knew-flint-lead-risk-emails-michigan-tap-water">Flint</a> in 2014 in the US, and in 2000 in <a href="https://www.cbc.ca/news/canada/inside-walkerton-canada-s-worst-ever-e-coli-contamination-1.887200">Walkerton, Canada</a>, which seriously affected the health of a large number of people, millions in these two countries are now using point of treatment systems in their homes to further purify city water. They are also buying bottled water because they perceive it to be cleaner and safer. In overwhelming percentage of cases of people in developed countries, from Japan and Singapore to western Europe and the US, are doing this out of choice and not because they have to.</p>
<p>But the financial impact of lockdown and growing unemployment means that spending extra on safe water has become a problem for many households – and millions are struggling to pay their utilities bills, including for water. </p>
<p>In the US, some 57 million people in <a href="https://www.cpuc.ca.gov/covid19protections/">several states</a> have been allowed to continue receiving water from their utilities even if they cannot currently pay for it. But there are still many poor and disadvantaged people who did not have access to water services before the pandemic, and <a href="https://www.azcentral.com/story/news/local/arizona-health/2020/04/18/navajo-nation-water-shortage-contributing-covid-19-spread/2992288001">still do not have them</a>.</p>
<p>In the European Union (EU), most member states need to increase their annual water supply and sanitation expenditure by more than 25% to comply with <a href="https://ec.europa.eu/environment/water/water-urbanwaste/legislation/directive_en.htm">EU Drinking Water and Urban Wastewater Treatment Directives</a>. This will also contribute towards reaching the SDGs. But in these uncertain times, the EU will have to rethink how best to make use of scarce financial resources to achieve their goals.</p>
<p>The pandemic has further worsened the living conditions and health of millions of people in both developed and developing countries, and it is unclear when this situation might improve. Even in the world’s richest country, USA, <a href="http://uswateralliance.org/sites/uswateralliance.org/files/Closing%20the%20Water%20Access%20Gap%20in%20the%20United%20States_DIGITAL.pdf">at least two million people still do not have access to piped water</a>.</p>
<h2>The need for leadership</h2>
<hr>
<p>
<em>
<strong>
Baca juga:
<a href="https://theconversation.com/how-to-make-water-issues-matter-to-world-leaders-110185">How to make water issues matter to world leaders</a>
</strong>
</em>
</p>
<hr>
<p>From the late 1970s, the United Nations have advocated for improved source of water. But this term does not mean clean and safe water, even though UN organisations use these terms interchangeably. </p>
<p>COVID-19 has focused global attention to clean water for frequent handwashing, drinking and personal hygiene. Political leaders will now have to give increasing attention not only to access to water but also to its quality. It will be an even more daunting task, in both developed and developing countries, to regain the trust of their people that water they are receiving is safe to drink and for personal hygiene because of <a href="https://www.tandfonline.com/doi/full/10.1080/07900627.2019.1670506">extensive past mismanagement in most countries of the world</a>.</p>
<p>The world needs leadership, long-term sustainable policies, robust legal and regulatory systems, strong institutions, and services that are reliable and provided irrespective of the circumstances. For example, Singapore ensured all these conditions were fulfilled from 1965 onwards. As a result, its water management is now <a href="https://www.routledge.com/The-Singapore-Water-Story-Sustainable-Development-in-an-Urban-City-State/Tortajada-Joshi-Biswas/p/book/9780415657839">one of the best in the world</a>.</p>
<p>The absence of enlightened political leadership in nearly all countries of the world, both developed and developing, will exacerbate the problem in the coming decades because of increasing uncertainties due to both expected events like climate change and unexpected ones like COVID-19. </p>
<p>Water affects all aspects of life, economic activity and ecosystems. As the British-American poet, W.H. Auden wrote: “Thousands have lived without love but none without water.”</p><img src="https://counter.theconversation.com/content/140167/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Para penulis tidak bekerja, menjadi konsultan, memiliki saham atau menerima dana dari perusahaan atau organisasi mana pun yang akan mengambil untung dari artikel ini, dan telah mengungkapkan bahwa ia tidak memiliki afiliasi di luar afiliasi akademis yang telah disebut di atas.</span></em></p>During normal times, and even more during the present pandemic, access to clean water and proper sanitation is essential.Cecilia Tortajada, Senior Research Fellow, Institute of Water Policy, Lee Kuan Yew School of Public Policy, National University of SingaporeAsit K. Biswas, Distinguished visiting professor, University of GlasgowLicensed as Creative Commons – attribution, no derivatives.