NEWS

Improving sanitation services a top priority, according to study of under-served urban residents

Themes: Sanitation
Countries: Ghana Kenya

As we mark World Cities Day 2020 on Saturday, new research from WSUP shines light on the complex needs of marginalised communities in cities.

The analysis rated 17 differing services in Accra, Ghana, and Nairobi, Kenya and found that, consistently, residents placed sanitation services close to the top.

Surprisingly, there have been few dedicated studies into needs from the perspectives of the residents themselves. But, as WSUP seeks to promote water and sanitation services that are more integrated within wider developments, increasing this understanding is vital.

In Accra, residents placed flood control as the most important, with sanitation coming fourth top out of 17 different services. In Nairobi, sanitation was ranked top, above other issues such as street paving and water supply. Water supply was seen as less important in Accra, potentially because residents were already relatively satisfied with their service compared to other needs.

Read more on the research project from Guy Norman:

What do slumdwellers want?

Service improvement priorities of slumdwellers in Ghana & Kenya

Guy Norman PhD

Guy Norman was previously WSUP’s Director of Research, and is currently MD and Lead Consultant of Urban Research Ltd.

WSUP is about water and sanitation. But slums have other big problems that need fixing, not just water and sanitation. Often, these problems inter-relate: for example, it may be difficult and costly to lay a water pipe network in a slum because streets are irregular and narrow, and because land ownership is not clearly documented. Similarly, safe sanitation may be made more difficult when domestic garbage collection services are poor: garbage gets thrown into latrines and toilets, and it blocks up street drains, making seasonal flooding worse.

Things also inter-relate in more technical ways. The recent MapSan evaluation of the health impact of a WSUP sanitation intervention in Maputo (Mozambique) is the most rigorous study to date of the health impacts of urban sanitation. This study found that WSUP’s intervention had no direct impact on child health, though an encouraging effect was observed on the prevalence of some faecal pathogens in children born during the study period.

It’s certainly not that the intervention was bad: the researchers evaluated intervention delivery as excellent. But this study strongly suggests that sanitation improvements on their own are not going to be sufficient to break faecal-oral disease transmission pathways in slums: in other words, it seems likely that sanitation improvements in slums are necessary but not sufficient for achieving substantial health gains.

It seems very likely that impacting on faecal-oral disease burdens requires other parallel interventions: for example, better drinking water quality, better food hygiene, perhaps street and compound paving. Honestly, at this stage we don’t really know what! But water and sanitation interventions certainly need to tie more closely to wider slum improvements.

Against this backdrop, what do slumdwellers themselves want? What basic services do they consider most important? Surprisingly little is known about this: there have been few systematic studies in this area.

So under the 2016-2020 Urban Sanitation Research Initiative (USRI), WSUP delivered a study of slumdweller prioritisations of basic services in Nairobi (Kenya) and Accra (Ghana). It was an exciting project for us: it was the first significant piece of research delivered internally within WSUP (all other research projects under USRI were commissioned to external research teams).

Specifically, we aimed to assess what types of basic service improvement are prioritised by slumdwellers; to understand the extent to which prioritisations vary among cities and communities; and to explore whether prioritisations are associated with possible predictors (including current service level, gender and tenure status). We stress that we did NOT set out to “demonstrate” the importance of water and/or sanitation, and we took multiple measures to avoid bias.

Kaptagat Chairman who helped with community mobilization of landlords buy in the project

How did we design the study?

To start with, we developed a list of basic urban services, then refined this through focus group discussions in Nairobi and Accra, and interviews with expert informants (like municipal planners). We ended up with the following list of 17 services:

  • Administrative support with tenure rights
  • Air pollution control
  • Education (primary, secondary)
  • Electricity supply
  • Environment: clean rivers, public spaces
  • Fire-fighting services
  • Flood control & storm drains
  • Garbage removal, street cleaning, pest control
  • Healthcare (clinics, health visitors) Housing build quality
  • Street paving
  • Policing & crime prevention
  • Roads and transport outside community
  • Sanitation: toilets, pit-emptying, sewers
  • Social care (elderly, disabled…)
  • Street lighting within community
  • Water supply

Having developed this comprehensive list, we then designed large-scale household surveys in Nairobi and Accra, aiming to understand prioritisations. We interviewed about 3,000 respondents in each city: this very large sample size allowed us to generate whole-city data, but also statistically reliable data for 8 sub-areas within each city. The surveys covered pretty much all low-income settlements in each city, ranging from “extreme” slums to less extreme moderate-low-income areas. We used a sampling approach called systematic spatial sampling.

The questionnaire comprised various sections, but let’s here focus on the questions around basic services. We didn’t want to present respondents with a long and tedious list of 17 services, so instead we designed and printed cards, one representing each service (the photo shows only 10 cards, but respondents were given all 17).

Cards representing basic services

We asked respondents “Please put the cards into four groups, depending on whether you consider the current service level to be non-existent or poor or adequate or good”.

We then asked: “If the authorities were to invest money in this community, which 5 services do you think should be prioritised?”

So which services were most highly prioritised?

The 5 most frequently prioritised services in Accra were:

  1. Flood control (50% of respondents)
  2. Garbage removal (48%)
  3. Housing quality (48%)
  4. Sanitation (41%)
  5. Social care (39%)

The 5 most frequently prioritised services in Nairobi were:

  1. Sanitation (49% of respondents)
  2. Street paving (47%)
  3. Water supply (46%)
  4. Environment (44%)
  5. Garbage removal (43%)

So we can see that Sanitation and Garbage removal were considered top priorities in both Accra and Nairobi. But Water supply was considered a top priority only in Nairobi.

What about variation WITHIN cities? We don’t have space to go into that here but briefly: there was variation in prioritisations among sub-areas within each city, but in general the same broad patterns were seen across the whole city.

Analysis of association between prioritisation and other variables

The graph below shows a plot for Nairobi of average service prioritisation score (blue) against average respondent perception of current service level (orange):

Graph showing average service prioritisation in Nairobi

From the plot, we can see some indication of a negative association. In order to explore this in a more rigorous statistical way, we used logistic regression to assess whether there were statistical associations between service prioritisation and other respondent/household characteristics (including respondent’s perception of current service level, poverty level, and gender). No space here to explain the analysis in detail: full details in our forthcoming research article.

As expected, there was often an ordered pattern of association between prioritisation of a service and respondent’s perception of the current level of that service. Considering for example Street paving in Accra: by comparison with respondents who rated the current situation as “excellent”:

  • respondents rating Street paving as “adequate” were about 5 times more likely to prioritise this service
  • respondents rating Street paving as “poor” were about 46 times more likely to prioritise it
  • respondents rating Street paving as “non-existent” were about 51 times more likely to prioritise it

These are big effects, indicating very clear association.

But it wasn’t always so simple: for many services, counter-intuitively, people who rated current level of Service X as “poor” prioritised that service more highly than people who rated current level of that service as “non-existent”… perhaps because they didn’t expect that service?

The full association findings are too complex to describe here. But we briefly note an interesting finding, which is that respondent gender showed few strong associations: for example, no association between gender and prioritisation of healthcare.

Clothes hanging to dry_ Githima

Conclusions: simply stated

  • Sanitation and garbage removal were among the 5 most frequently prioritised services in both Accra and Nairobi
  • Water supply was among the 5 most frequently prioritised services in Nairobi, but not in Accra
  • Other highly prioritised services included flood control, housing quality and social care in Accra, and street paving and environment in Nairobi
  • But this certainly does NOT mean that lower-prioritised services are unimportant!

What does this mean?

  • Systematic studies of this type can be of value for informing urban planning at the city level: community prioritisation should probably not be the only factor in investment decision-making, but it’s an important factor.
  • If systematic studies of this type were extended across a wider sample of cities, it seems likely that more generalisable conclusions might emerge, of potential value to wider thinking about urban development.
  • And finally: a multi-services perspective of this type ties to the view that urban water and sanitation shouldn’t be expected to impact on health and wellbeing in isolation: they need to tie to wider improvements in basic services and quality of the urban environment.

Learn more about WSUP's approach to creating sustainable cities