i

ii

iii

Peter Harvey, Sohrab Baghri and Bob Reed

Water, Engineering and Development CentreLoughborough University UK

ASSESSMENT AND PROGRAMME DESIGN

iv

Water, Engineering and Development CentreLoughborough University

LeicestershireLE11 3TU UK

© WEDC, Loughborough University, 2002

Any part of this publication, including the illustrations (except items takenfrom other publications where the authors do not hold copyright) may be copied,reproduced or adapted to meet local needs, without permission from the author/s

or publisher, provided the parts reproduced are distributed free, or at cost andnot for commercial ends, and the source is fully acknowledged as given below.

Please send copies of any materials in which text or illustrations have been used toWEDC Publications at the address given above.

A reference copy of this publication is also available online at:http://www.lboro.ac.uk/wedc/publications/es.htm

Harvey, P.A., Baghri, S. and Reed, R.A. (2002)Emergency Sanitation: Assessment and programme design

WEDC, Loughborough University, UK.

ISBN Paperback 1 84380 005 5

This document is an output from a project funded by the UKDepartment for International Development (DFID)

for the benefit of low-income countries.The views expressed are not necessarily those of DFID.

Designed and produced at WEDC

v

About the authors

Peter Harvey is a Research Associate at the Water, Engineering and Develop-ment Centre (WEDC). He has worked as a public health engineer on emergencywater supply and sanitation (watsan) programmes in Africa, Asia and EasternEurope. He also has experience of rural water supply and sanitation projects inlow-income countries. His major interests include groundwater development andthe sustainability of water and sanitation projects.

Sohrab Baghri is a civil engineer with over fifteen years experience of watersupply and sanitation projects in Africa, Asia and the Middle East. He has workedon both emergency and long-term development programmes with a wide range ofinternational aid agencies. His interests include water treatment, environmentalsanitation and watsan facilities for children and disabled people. He is now Waterand Sanitation Adviser at Plan International’s headquarters.

Bob Reed is a Senior Programme Manager at WEDC. He specialises in watersupply and sanitation for rural areas, low-income urban communities and refu-gees. He has considerable experience of training, design and project implementa-tion in the Pacific, the Caribbean, Asia and Africa. In recent years he has focusedon the provision of improved and sustainable water supply and sanitation systemsfor displaced populations.

The authors would like to hear from anyone who uses this book in the field withcomments on its usefulness and areas which require improvement. Please for-ward comments or suggestions to Bob Reed at the address overleaf.

Sohrab Baghri Bob ReedPeter Harvey

vi

Water, Engineering and Development CentreLoughborough University

LeicestershireLE11 3TU UK

Phone: +44 1509 222885Fax: +44 1509 211079

Email: WEDC@lboro.ac.ukhttp://www.lboro.ac.uk/wedc/

About WEDC

The Water, Engineering and Development Centre (WEDC) is concerned witheducation, training, research and consultancy for improved planning provisionand management of physical infrastructure and services for development in low-and middle-income countries, focusing on the needs and demands of the poor.

WEDC is devoted to activities that improve the health and well-being of peopleliving in both rural areas and urban communities. We encourage the integration oftechnological, environmental, social, economic and management inputs for effec-tive and sustainable development.

vii

Collaborators

The ‘Assessment and Programme Design for Emergency Sanitation’ project(R6873) has been funded by the Department for International Development(DFID) of the British Government.

The following organisations have acted as peer reviewers for this research con-tract. They have reviewed draft documents, provided access to staff for interview,given advice on project design and implementation, provided information, andhave been involved in and provided support for field trials. This project would nothave been possible without their support and encouragement.

Opinions noted within these documents do not necessarily represent those ofDFID or the collaborators, but are solely those of the authors.

UNITED NATIONS HIGH COMMISSIONER FOR REFUGEES

DR!!!!!PDevelopment through Resource

Organisation and Planning

International Federationof Red Cross and Red Crescent SocietiesINTERNATIONAL COMMITTEE OF THE RED CROSS

viii

Acknowledgements

Thanks go to all individuals and organisations that have been involved in theproduction of the manual, guidelines and training modules. It is hoped that thewide range of organisations and individuals that have contributed to this projectwill facilitate the usefulness of this work to an even wider range of personnel andemergency situations.

All contributions are gratefully acknowledged. It should be noted, however, thatthe opinions in this document are solely those of the authors. The followingindividuals have contributed to the research either as peer reviewers, advisorypanel members, by testing the work in the field, or by providing information forspecific sections of the work.

Peer reviewersDFID Department for International Development, UKJohn Adams Bioforce/Trinome, FranceBen Fawcett IIDS, Southampton, UKJoy Morgan Independent Consultant, UKRutger Verkerk MSF, Amsterdem, Holland

Advisory panel membersAstier Almedom ex-LSHTM, London, UKAndy Bastable OXFAM, Oxford, UKMurray Biedler MSF, Brussels, BelgiumDixon Chanda ex-MSF, Amsterdam, HollandRiccardo Conti ICRC, Geneva, SwitzerlandUlrich Jaspers IFRC, Geneva, SwitzerlandAjeet Oak DROP, Pune, IndiaClaude Rakotomalala UNHCR, Geneva, SwitzerlandRutger Verkerk MSF, Amsterdam, Holland

ix

Editorial contributionsKimberley Clarke Independent Consultant, UK

Other contributorsRaissa Azzalini MSF, BurundiWilliam Corkill IFRC, Nairobi, KenyaJean-Michel Detre MSF, BurundiShemeles Gebeyehu MSF, Kala, ZambiaJulius Kibassa TRCS, Lugufu, TanzaniaPeter Maes MSF, Brussels, BelgiumRadjabu Mavlidi MSF, BurundiQumrun Nahar UNICEF, BangladeshJoseph Ng’ambi MSF, Kala, ZambiaDeo Ntahonsigaye MSF, BurundiGorik Ooms MSF, BurundiSamuel Phiri MSF, Kala, ZambiaVeronique Ridel MSF, BurundiHans Van Dillen MSF, Lusaka, ZambiaAlberto Villani MSF, Burundi

x

xi

Overview

Contents

1-14: Emergency sanitation manual

15-20: Guidelines for assessment and design

Case study

Bibliography

Index

xii

xiii

Contents

Abbreviations xviiiGlossary of terms xixList of figures xxList of tables xxii

MANUAL

Chapter 1. Introduction1

1.1 About this book 11.2 What is emergency sanitation? 21.3 Approach to sanitation programmes 31.4 People 5

Chapter 2. Is intervention necessary? 72.1 Criteria for intervention 72.2 Population and health 82.3 Assessing the need for intervention 11

Chapter 3. Principles of assessment 133.1 Assessment steps 133.2 Who should be involved in assessments? 153.3 Data collection 153.4 Equipment 163.5 Background information 163.6 Observation (visual assessment) 173.7 Mapping 173.8 Surveys 183.9 Interviewing 183.10 Group discussion (focus groups) 193.11 Measuring 193.12 Counting and calculating 193.13 Assessment reports 20

Chapter 4. Background information 214.1 General information 214.2 Demographic data 224.3 Physical features 244.4 Other organisations 29

xiv

Chapter 5. Recommended minimum objectives 315.1 Minimum objectives 315.2 Excreta disposal 325.3 Solid waste management 365.4 Waste management at medical centres 405.5 Disposal of dead bodies 445.6 Wastewater management 485.7 Hygiene promotion 52

Chapter 6. Excreta disposal 576.1 Associated risks 576.2 Selection criteria for excreta disposal 586.3 Communal or family latrines? 626.4 Immediate measures 636.5 Technology choice: Longer term intervention 686.6 Strategies for difficult conditions 786.7 Intervention levels 866.8 Design and construction 886.9 Emptying pits 101

Chapter 7. Solid waste management 1057.1 Associated risks 1057.2 Sources and types of solid waste 1067.3 Initial steps 1097.4 Key components of solid waste management 1107.5 On-site disposal options 1117.6 Transportation options 1147.7 Off-site disposal options 1167.8 Intervention levels 1187.9 Protective measures 119

Chapter 8. Waste management at medical centres 1218.1 Types and sources of medical waste 1218.2 Associated risks 1228.3 Minimising risks 1248.4 Segregation, storage and transportation 1258.5 Disposal technology choices 1278.6 Intervention levels 1318.7 Education and training 1328.8 Key recommendations for waste management 133

xv

Chapter 9. Disposal of dead bodies 1359.1 Associated risks: myths and realities 1359.2 Medical epidemics 1369.3 Cultural practices and needs 1389.4 Mortuary service and handling of the dead 1389.5 Burial 1399.6 Cremation 1409.7 Key recommendations for the disposal of the dead 140

Chapter 10. Wastewater management 14310.1 Associated risks 14310.2 Sources and types of wastewater 14410.3 Selection criteria 14410.4 Technology choice 14610.5 Wastewater treatment 15510.6 Cholera treatment centres 16110.7 Rainfall runoff 161

Chapter 11. Hygiene promotion 16311.1 Hygiene and health 16311.2 Definition of hygiene promotion 16411.3 Focus of hygiene promotion in emergencies 16411.4 Key principles of hygiene behaviour 16511.5 Staff 16711.6 Women, men and children 16811.7 Hygiene promotion actions 16911.8 Intervention levels 17211.9 Key indicators for hygiene practice 17311.10 Key indicators for programme implementation 17411.11 Relationship with other aspects of sanitation 174

Chapter 12. Community participation 17712.1 What is meant by community participation? 17712.2 Stakeholder analysis 17912.3 Gender and vulnerable groups 18112.4 Participation matrix 18112.5 Community mobilisation 18212.6 Participatory appraisal techniques 18312.7 Problem-tree analysis 18512.8 Finance 187

xvi

Chapter 13. Programme design 18913.1 Programme summary 18913.2 The Logical Framework 19013.3 Activity plan 19213.4 Programme Gantt chart 19313.5 Personnel 19413.6 Implementation plan 19513.7 Costs and budget 19513.8 Proposal writing 198

Chapter 14. Implementation 19914.1 Implementation framework 19914.2 Staff 19914.3 Materials and equipment 20014.4 Finances 20114.5 Time 20214.6 Outputs 20214.7 Community 20314.8 Information 20314.9 Programme management 20414.10 Monitoring and evaluation 20614.11 Monitoring methods 20714.12 Evaluation 21114.13 Report writing 213

GUIDELINES

Chapter 15. Instructions for use 21715.1 About these Guidelines 21715.2 Approach 21815.3 Guideline user group 21915.4 Relationship between emergency sanitation and other

activities 22015.5 Time targets 22015.6 Instructions for use 220

Chapter 16. Rapid assessment and priority setting 22316.1 Is intervention appropriate? 22316.2 Assessment process 22316.3 Getting started 22516.4 Data collection 22516.5 Data analysis 23416.6 Interpretation of results 250

xvii

Chapter 17. Outline programme design 25717.1 Design process 25717.2 Problems, constraints and points of interest 25917.3 Solution selection 25917.4 Comparison with current practice 25917.5 Outline programme proposal 26017.6 Approval of programme and budget 260

Chapter 18. Immediate action 26318.1 Objective of immediate action 26318.2 Action selection process 26318.3 Relationship with longer-term activities 265

Chapter 19. Detailed programme design 26719.1 Design process 26719.2 Stakeholder analysis 26819.3 Gender and vulnerable groups 26919.4 Community participation 26919.5 Baseline survey 27019.6 Necessary action selection 27219.7 Selection checklist 27619.8 Developing the logical framework 27719.9 Developing the programme activity plan 27719.10 Developing the time frame for the activity plan 27719.11 Determining responsibilities 27819.12 Determining resources 27919.13 Preparing the budget 28019.14 Feedback and refinement of plan of action 28019.15 Final programme proposal and approval 281

Chapter 20. Implementation 28320.1 What is implementation? 28320.2 Implementation planning 28420.3 Implementation framework 28620.4 Implementation management 28820.5 Monitoring 28920.6 Evaluation 290

CASE STUDYCase study: Kala Camp, Luapula, Zambia 293

Bibliography 349Index 353

xviii

Abbreviations

CDC Centres for Disease ControlDFID Department for International Development (UK)DROP Development for Resource Organisation and PlanningICRC International Committee of the Red CrossIFRC International Federation of Red Cross and Red Crescent SocietiesLSHTM London School of Hygiene and Tropical MedicineM&E Monitoring and evaluationMSF Médecins Sans FrontièresNGO Non-governmental organisationO&M Operation and maintenancePAHO Pan American Health OrganisationPHAST Participatory Hygiene and Sanitation TransformationPRA Participatory rural appraisalRRA Rapid rural appraisalSWOT Strengths, weaknesses, opportunities, threatsTRCS Tanzania Red Cross SocietyTSS Total suspended solidsUNCHS United Nations Centre for Human Settlements (Habitat)UNHCR United Nations High Commissioner for RefugeesUNICEF United Nations Children’s FunduPVC unplasticised polyvinyl chlorideVIP Ventilated improved pit (latrine)WEDC Water, Engineering and Development CentreWHO World Health Organisation

xix

Glossary of terms

Desludge: to empty the contents of a latrine pit or septic tankClosed setting: affected site has clear boundaries and population figures

are known (e.g. refugee camp)Epidemic: the appearance of a particular disease in a large number of

people in the same period of timeFaecal–oral: disease transmission from faeces to the human digestive

system via the mouthGender: the physical and/or social condition of being male or

femaleInfiltration: the absorption of liquid by material, for example when

water is absorbed by the groundLandfilling: the disposal of solid waste by excavating a hole in the

ground, filling this with waste and then covering with soilto fill the hole

Latrine: a toilet, especially a simple one such as a hole in theground

Logistics: the careful organisation of procurement, transportation,storage and distribution of materials and equipment

Morbidity: the number of cases of a particular disease reported withina particular society and within a particular period of time

Mortality: the number of deaths within a particular society and withina particular period of time

Open defecation: to defecate outside a latrine, normally in a naturalenvironment

Open setting: affected site has no clear boundaries such as a normalurban or rural area

Sludge the build up in volume of excreta, normally within aaccumulation: latrine pit or septic tankSocio-cultural: relating to the social and cultural practices, beliefs and

traditions within a particular societyStakeholder: a person or group of people who have a share or a personal

or financial involvement in a programmeSuperstructure: the part of a building which is above the groundSustainability: the ability of something (e.g. activity, facility or system)

to keep operating effectively without negative impactVector: an insect or animal which carries a disease from one animal

or plant to another (particularly humans)Wastewater: ‘dirty’ water arising from laundry areas, kitchens,

bathrooms, etc.

xx

List of figures

1.1: Approach to emergency sanitation programmes 4

2.1: Causes and transmission routes of environmental-related diseases 9

3.1: Assessment steps 14

4.1: Sketch map of the affected area 254.2: Sketch map of dwelling area 26

6.1: Transmission of disease from faeces 586.2: Open defecation field 646.3: Trench defecation field 656.4: Shallow family latrine 666.5: A simple pit latrine 686.6: Deep trench latrines 696.7: Ventilated improved pit latrine 716.8: Cross-section of a typical water-seal pan 726.9: Pour-flush latrines 726.10: Overhung latrine 736.11: Borehole latrine 756.12: Temporary toilet block over existing sewer 776.13: Pollution from a pit latrine above the water table 786.14: Raised twin-pit ventilated latrine 806.15: Sand-enveloped pit 806.16: Double vault composting latrine 826.17: Wastewater treatment using a septic tank 836.18: Aqua privy 856.19: Cross-section of latrine slab with footrests 906.20: Reinforced latrine slab 916.21: Domed pit slab 926.22: Wood and mud latrine slab 926.23: Squat-hole cover 946.24: Stress concentrations on rectangular and circular pits 956.25: Shallow pit with lining 976.26: Vacuum tanker emptying latrine pit 1016.27: Vacuum tanker with remote pumping unit 102

xxi

7.1: Initial steps in solid waste management 1097.2: Communal solid waste pit 1127.3: Communal bin made from an old oil drum 1137.4: Refuse collection containers and vehicles 1157.5: Emptying a cart at a transfer station 1167.6: Simple landfilling 117

8.1: Categories of waste from medical centres 1228.2: Sharps container 1268.3: Temporary drum incinerator 1288.4: Permanent incinerator 1298.5: Sharps pit 130

10.1: Wastewater treatment by soil 14710.2: Unlined soakpit 14810.3: Soakpit lined 14910.4: Section through an infiltration trench 15110.5: Evaporation pan 15310.6: Evapotranspiration bed 15410.7: Grease trap 15610.8: Settlement tank 15710.9: Tank inlet and outlet pipe 15810.10: Horizontal reed bed 15910.11: Vertical reed bed 160

12.1: Problem-tree analysis example 18612.2: Objectives-tree analysis example 187

15.1: Stages in emergency sanitation programme design 218

16.1: Assessment process 22416.2: Priority-setting flow chart 253

17.1: Outline design process 258

18.1: Immediate action process 264

19.1: Detailed design process 268

20.1: Implementation planning process 284

xxii

List of tables

2.1: Sanitation-related diseases, causes and transmission routes 82.2: Approximate threshold levels for mortality 11

3.1: Assessment equipment 16

4.1: Assessment cover page 224.2: Demographic profile 234.3: Soil infiltration rates 27

5.1: Recommended minimum objectives for safe excreta disposal 325.2: Recommended minimum objectives for solid waste management 365.3: Recommended minimum objectives for waste management

at medical centres 405.4: Recommended minimum objectives for the disposal of dead bodies 445.5: Recommended minimum objectives for wastewater management 485.6: Recommended minimum objectives for hygiene promotion 52

6.1: Advantages and disadvantages of communal and family latrines 626.2: Recommended interventions for space of more than 30m2 per person 866.3: Recommended interventions for space of 20-30m2 per person 876.4: Recommended interventions for space of less than 20m2 per person 876.5: Spacing for steel reinforcing bars in pit latrine slabs 916.6: Lining requirements for different soil types 966.7: Suggested maximum sludge accumulation rates 986.8: Recommended septic tank retention times 996.9: Value of sludge digestion factor ‘F’ 100

7.1: Recommended interventions for different scenarios 119

8.1: Risks, pathways and hazards of medical waste 1238.2: Segregation categories 1258.3: Recommended interventions for different scenarios 132

10.1: Sizes of settlement tanks 143

11.1: The effects of hygiene practice on diarrhoeal disease 16411.2: Focus group discussion agenda 17011.3: Recommended interventions for different scenarios 172

xxiii

12.1: Example stakeholder analysis 18012.2: Example participation matrix 18212.3: Example ranking exercise 18412.4: Example seasonal chart for health and hygiene 185

13.1: Generalised logical framework 19013.2: Example activity plan 19213.3: Example Gantt chart 19313.4: Example human resource plan 19413.5: Example implementation plan 19513.6: Example sanitation budget 196

14.1: Implementation by milestones 20514.2: Monitoring framework 20814.3: Log-frame analysis example 20914.4: Checklist analysis table 21114.5: Evaluation framework 21214.6: Situation report example 21414.7: Evaluation report outline 215

16.1: Base score definitions 23516.2: Sector analysis results 25116.3: Assessment summary 25216.4: Intervention levels 25216.5: Recommended intervention levels and scenarios 254

17.1: Structure of outline programme proposal 260

19.1: Stakeholder analysis 26919.2: Excreta disposal options 27319.3: Solid waste management options 27319.4: Waste management options at medical centres 27419.5: Disposal options for dead bodies 27419.6: Wastewater management options 27519.7: Hygiene promotion options 27519.8: Selection checklist 27619.9: Logical framework 27719.10: Example Gantt chart 27819.11: Implementation plan 279

20.1: Implementation framework 28720.2: Implementation by milestones 288

xxiv