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Regulation of sanitary services as a public good

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Yvonne Magawa (ESAWAS), Baturu Battery (WHO), Bisi Agberemi (UNICEF), Jan-Willem Rosenboom

& Alyse Schrecongost (BMGF)

Faecal sludge transport workers in Kenya – UNICEF / UN0348903 / Modola

This blog is part of a series for World Toilet Day that highlights issues within WHO-UNICEF country of the worlds Sanitation report. The topic of sanitary regulation is also addressed in ‘Catalyzing the city sewer for all through the regulatory service Service providers‘from IWA Regulation on the Urban Inclusive Sanitation Initiative members of the Advisory and Working Group – Yvonne Magawa (ESAWAS), Diego Polania (CRA) and Gustavo Saltiel (World Bank).

Too long sanitation, especially on-site sewer systems such as septic tanks and toilets, remain the responsibility of the household.

The scarce investment available for urban sanitation gravitates towards expansive infrastructure, reaching small parts of large urban areas, primarily the affluent population. Urban population continues to grow rapidly, often in densely populated areas with limited basic public services or infrastructure. Especially due to sanitary conditions, households are forced to make do, covering the cost of basic access for themselves. However, the very nature of safe sanitation means that the decisions and priorities of individuals are largely separate from what would be needed to protect public health, the environment and reach the poorest. Safe retention, discharge, transport and treatment of human waste and prevention of pits and septic tanks from polluting groundwater and open drains are needed, but without investment regulations they will not prioritize public health outcomes.

This situation is unfair to households and ineffective in achieving the primary purpose of sanitation: public health protection. Sanitation is basically a public good. The decisions of individuals maximize their own best interests – they do not necessarily serve the best interests of society as a whole.

Sanitation investments need to be planned, regulated and financed in order to align the priorities of individual households with the priorities of service providers. This alignment is needed to address the broader societal goals of protecting public health, a cleaner environment and stronger economies. Among countries that have generated extraordinary gains, a common factor has been strong political leadership that has clarified public goals, given clear mandates responsible authorities to achieve these objectives, regulated service providers and mobilize the appropriate necessary investments.

Where utilities manage sewerage, in general these utilities have a defined mandate oriented towards public services, accountability and funding strategies. Over two-thirds of countries have environmental standards for wastewater treatment.

With the exception of sewage areas, urban sanitation remains a public good, but is mostly provided by unorganized and unregulated private or informal actors. Several countries have standards for the treatment of faecal sludge or the safe reuse of wastewater or sludge. Individual discharge and transport service providers may or may not be subject to a few regulatory regulations or standards on paper. Where standards exist, they are almost universally separated from efforts to monitor, encourage, or enforce compliance. As a result, less than a third of authorized supervisory agencies are able to perform basic oversight and enforcement functions.

Robust regulatory systems can address the market failures of urban sanitation to protect public health and encourage the provision of safe, inclusive and sustainable services. We highlight three issues key to achieving this outcome that deserve case studies, discussion, and sectoral learning and evolution.

First, regulations can help better link health services to public health. A simple statement, but not a simple task. Sanitary services regulations have long lagged behind water services: only 1 in 5 countries has any indicators of the quality of sanitary services. If sanitary services want to protect public health, then guidelines and supervision harmonized with public health must become the expected norm in all countries, both for canalized and canalized sewer systems. Health outcomes must be shaped into simple, transparent and effective bylaws, codes and standards; measurable and funded monitoring and enforcement systems are needed to make these standards meaningful. To achieve this, systems must be designed in collaboration with public health authorities. Public health risk assessment and risk management priorities must underpin product and service standards throughout the health care chain. This includes measures to address the specific health risks, stigma and marginalization faced by health workers in unregulated conditions.

Other, as with health regulations, the focus of economic and regulation of sanitation services must be on safe, inclusive services, regardless of the infrastructure used. The failure to focus mandates and regulatory frameworks on service outcomes instead of infrastructure inputs exacerbates systemic injustice and exclusion. In most cases, providers of products and services that are not for sale remain disordered and unorganized actors in retail. They provide services of wide variability in price and quality, with little responsibility for the quality of their services to households or for public health. Market structuring – especially economic and service performance regulation – is needed if public or private service providers are encouraged to protect public health, reach low-income communities and mobilize investment and innovation. Economic regulatory tools can help align customer engagement and accessibility goals with the financial interests of service providers.

Finally, if the public sector is well structured and regulated, it can increase business opportunities, available financial resources, and encourage investment in innovation to achieve health and inclusive goals. Recognizing sanitary conditions as a public good does not mean that the public sector is solely responsible for providing public services. In fact, without structuring sanitation services as a public service, opportunities for private sector engagement are more limited, higher risk, less efficient, less profitable, and less aligned with the public good. Tools and business models that reconcile the interests of the public, customers and service providers have not always been clear, but promising innovations are emerging in urban markets in Kenya, Malaysia, Zambia and other countries. In these areas, regulators insist on improving performance in the sector. They also support utilities and the private sector to learn and grow as the sector transforms, and more is expected of all.

Significant challenges remain. In many countries, sanitation is entirely managed by municipalities. Municipal service systems are subject to the short-term political interests of individuals, lack accountability mechanisms, and have limited flexibility to generate revenue effectively. Compliance with treatment or the relationship between customer-based revenue mechanisms and service quality may be opaque.

We have good reason to believe that well-designed regulatory systems can accelerate global progress toward SDG 6.2 and 6.3 and improve public health. The WHO guidelines on sanitation and health provide a useful starting point in addressing public health criteria in sanitary regulations and articulating the role of the health sector in providing sanitary authority services.

In addition, the new publication – WHO-UNICEF country of the worlds Sanitation – Today’s launch draws attention to the role of regulators in resolving the sanitary crisis. The report brings together lessons from countries with high success and presents a vision of what is needed to provide universal access to safe sanitation. It calls for urgent action around five areas: governance; financing; capacity development; data; and innovation and highlights leadership, effective coordination and regulation as effective ways to achieve safe sanitation for all. Building on the guidelines set out in the report, WHO and other partners working with regulatory networks such as East and South Africa, Water and Sewerage (ESAWAS) Association of Regulators and International Network of Regulators for Drinking Water and Sanitation WHO (RegNet), will work on creating concrete and contextualized changes in the regulation of sanitary services that can inform future updates of the report.

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