The Problem of Sanitation in Urban Kenya
Kenya is experiencing rapid urbanization. This has been a boon for those fortunate enough to be counted in the ranks of the country’s wealthy elite. Among other benefits of wealth, they enjoy all of the sanitation luxuries that one can imagine: they drink water from the tap that is supplied by pipes; they use toilets that flush in the comfort of their own homes.
The same cannot be said of many of the country’s poorest residents. In Garissa County for example, a cholera outbreak tore through a number of refugee camps: 1,216 cholera cases were reported and 14 lives were lost. In May of 2018, a series of floods collapsed pit latrines and flooded toilets in schools throughout almost a dozen regions of Kenya — including Nairobi. Classrooms and hallways filled with effluent and sewage led to the temporary closure of 200 schools, forcing students to remain at home.
In Nairobi, 60% of the city’s 4.3 million residents live in informal settlements. These settlements are characterized by a lack of basic infrastructure. Residents often lack access to improved water sources and have inconsistent access to improved sanitation. For example, women may feel comfortable using public toilets during the day — when there is ample lighting — but unsafe using them at night. Indeed, the density of the population is a factor which is working against the installation of adequate sanitation services in these communities. Many settlements have little unoccupied land to spare.
Why does this all matter? First, and foremost, access to water and sanitation is a fundamental human right; it is one of the few things that we cannot live without. Yet, even if one sets aside this broader humanitarian concern, solving Kenya’s sanitation issues represents a step toward ameliorating an equally pressing global health crisis: eradicating diarrhea.
Globally, diarrhea is the second leading cause of death of children under the age of five.
Impacts of Diarrhea
Ask those of us who come from high income countries what the most pressing health concerns of the day are and the response is likely to be cancer, heart disease, or Alzheimer’s disease. As someone situated firmly outside of medicine these would have been my responses as well. But, through my work at Archimedes Project, I have discovered how narrowed we allow our vision to become by the problems that appear before us. It is true that the diseases I have mentioned kill millions each year. Still, those afflicted by these conditions are generally adults, and usually elderly. Meanwhile, on the World Health Organization’s (WHO) list of the top 10 global causes of death are diarrheal diseases. Though ranked 9th among the most deadly diseases globally, if one looks at the data by age one finds that diarrhea is the 2nd leading cause of death of children under the age of 5. What, in developed countries, constitutes an unpleasant day of messy diaper changing is a serious health threat in much of the rest of the world.
Diarrhea is caused by a number of infectious diseases: cholera, rotavirus, and dysentery among them. Most diarrhea is caused by food or water contaminated by feces, making its way into the bodies of patients by what is called the fecal-oral route.
Diarrheal disease can occur anywhere in the world. Nevertheless, the problem is far more acute in developing nations where poor infrastructure is much more likely to be present and thus the disease burden much higher. Globally, 1.8 million people drink water contaminated with fecal matter; the majority of these people live in sub-Saharan Africa, Southern Asia, and East Asia.
Fortunately, diarrhea does not have to continue to be a problem. We know that improvements in water and sanitation greatly serve to reduce death and disease from diarrhea. While humanity may not yet be able to consistently prevent a tumor from metastasizing, or guard a person against heart disease, we do have the ability and technology to prevent diarrhea.
Challenges in Kenya
Kenya’s sanitation problem has not gone unnoticed. There are numerous organizations and companies working to ameliorate the sanitation issues facing the country. There is no shortage of well-intentioned, well-funded, and well-staffed organizations operating in Kenya with the goal of increasing water and sanitation accessibility. Yet the problem still persists, and is estimated to take 200 additional years to resolve given the current rate of change. Archimedes Project Fellow, phyllis gichuhi, dedicated some of her time during her Fellowship to researching why this issue is so difficult to solve. Her research identified a number of challenges that any organization or enterprise seeking to alleviate sanitation inadequacy should take into account before diving headlong into Nairobi.
Land tenure
First, land tenure in Kenya’s slums is ill-defined. The risk of relocation leaves residents of informal communities unwilling to invest in private toilets. The rationale being that such an investment is totally wasted if one is later forced out of one’s home, or the community that can access the toilet. Even when residents are living under the purview of a well established landlord, there is a reluctance to invest in sanitation. Residents are savvy. They know that investing could lead to rent increases — increases that they may not be able to afford. Residents are content to live with inferior sanitation when the alternative is the risk of making an investment in sanitation, but being unable to use it because they can no longer afford to live in their home.
Distrust
Community attitudes must also be accounted for in planning. Distrust is pervasive in the slums of Nairobi. The promises of Kenya’s government are young and therefore the sting of their vacuousness is fresh. Many residents are long standing community members and have seen NGOs come and go, having accomplished little. Citizens have come to expect services acquired from organizations to be provided free of charge. A history of interactions with NGOs has left an imprint upon these communities; they are given to see all outside organizations as providing charity. An enterprise must carefully stick to its purpose of providing a product — as opposed to a service — to be seen as a business fulfilling one of the community’s demands, and not as another non-profit.
Gatekeepers
Furthermore, even those enterprises that succeed in establishing themselves as businesses must contend with powerful community influencers. Gatekeepers have emerged in informal settlements; they can either be a great help or an obstruction to organizations attempting to integrate themselves into the neighborhood. Having the buy-in of these leaders is crucial for an enterprise’s success in any of the informal settlements in Nairobi.
Overlapping Systems
Another challenge to grapple with is Nairobi’s fractured sanitation regime. Research has characterized informal settlements as having as many as five coexisting paradigms for household sanitation practices. It is imperative to acknowledge that almost all of these paradigms are firmly embedded within the community. Whether a person uses private toilets or is practicing open defecation (i.e. defecating outside, without a toilet, into bags or containers), they do so for a reason: given their economic, social, and housing situation they are choosing the best solution available to them. New technology or complex systems are not necessarily needed in Nairobi’s informal settlements. Enterprises are likely to find that improvements to existing systems are more well received.
Empowering Women
Finally, there is evidence that “the effectiveness of projects involving women is up to seven times higher than” (Winter et.al) those that do not (Archimedes Project’s dedication to centering women and female leadership is well supported). The challenge is that gendered improvements may be seen as a threat to men. The fact that women often lack political and economic independence and, therefore, their efficacy in effecting change is limited, is inextricable from men’s reluctance to cede any power (or, in this case, perceive their power as diminished). This, in spite of women’s role as the primary providers of sanitation and water for households. Any organization seeking — rightly, one might argue — to place women at the forefront of their water and sanitation improvements must think carefully about how they will circumvent the power disparity: how will they make women feel safe, equal, and important, without making men feel that some of their power has been stripped away?
The World Health Organization reports that diarrhea kills 525,000 children under the age of five annually. This statistic, taken with the fact that diarrhea is most prevalent in low-income countries, makes clear that the problem is affecting our most vulnerable and disadvantaged citizens. We mustn’t stand by and allow this preventable disease to continue to ravage communities across the world. As Earth becomes increasingly interconnected, so too must we begin to see our fates and well-beings as inextricable from those of humans thousands of miles away. Now is the time to end death by diarrheal disease.
Kenya’s sanitation situation is dire. But Kenya is also ripe with opportunity for improvement. Kenyans are well aware of the limitations and inadequacies of their systems, but they are making the best of the financial and housing situations they have been presented with. Archimedes Project is seeking to create an innovative social enterprise; one that accounts for the challenges before beginning operation in Kenya’s slums. By thoughtfully crafting a business model before entering the community we hope to circumvent many of the challenges that our peer organizations have confronted. If you are a sanitation expert looking to broaden your impact — or, perhaps, a sanitation novice inspired, and galvanized by what you have learned from reading this article — we invite you to get involved as we look for novel ways to solve this problem.
About the Author
Reggie Gilliard was born and raised in New Jersey. In 2017, he graduated from the University of Pennsylvania, and began a career in education. He currently teaches at Collegiate School in New York City. Reggie has had a lifelong commitment to service, working with various youth organizations, but Archimedes Project represents his first foray into water and sanitation. Currently, he supports the organization’s communications work.
Bibliography
Samantha Winter, Francis Barchi & Millicent Ningoma Dzombo (2019) Not just any toilet — women’s solutions to sanitation in informal settlements in Nairobi, Development in Practice, 29:1, 15–25, DOI: 10.1080/09614524.2018.1519013
“Cholera — Kenya.” World Health Organization, World Health Organization, 11 Dec. 2017, www.who.int/csr/don/21-july-2017-cholera-kenya/en/.
Mozaffarian, D. “Prevalence of Coronary Heart Disease by Age and Sex.” American Heart Association, 27 Jan. 2015, www.heart.org/idc/groups/heart-public/@wcm/@sop/@smd/documents/downloadable/ucm_449846.pdf.
“The Top 10 Causes of Death.” World Health Organization, World Health Organization, 24 May 2018, www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death.
“Causes of Child Mortality.” World Health Organization, World Health Organization, 6 Dec. 2018, www.who.int/gho/child_health/mortality/causes/en/.
Diarrhea. Jan. 2018, https://www.dhhs.nh.gov/dphs/cdcs/documents/diarrhea.pdf.
Global WASH Fast Facts. 11 Apr. 2016, https://www.cdc.gov/healthywater/global/wash_statistics.html.
Prüss-Üstün A, Bos R, Gore F, Bartram J. Safer water, better health: costs, benefits and sustainability of interventions to protect and promote health. World Health Organization, Geneva, 2008
“Governance and Advocacy.” Umande Trust, umande.org/governance-and-advocacy/
“Overview.” Kenya Water for Health Organization, Kenya Water for Health Organzation, http://kwaho.org/overview/
Water & Sanitation for the Urban Poor, https://www.wsup.com/approach/programmes/
“KWTA Background Info.” Kenya Water Towers Agency, Kenya Water Towers Agency, http://www.kwta.go.ke/background/
“200 Years is a Long Time to Wait.” The Fulcrum, Medium, https://blog.archimedesproject.com/why-another-sanitation-enterprise-in-kenya-4fc3b3cff57a
“Drinking-Water.” World Health Organization, World Health Organization, https://www.who.int/news-room/fact-sheets/detail/drinking-water
Welie, Mara J. Van, et al. “Analysing Transition Pathways in Developing Cities: The Case of Nairobis Splintered Sanitation Regime.” Technological Forecasting and Social Change, vol. 137, 10 Aug. 2018, pp. 259–271., doi:10.1016/j.techfore.2018.07.059.
“Diarrhoeal Disease.” World Health Organization, World Health Organization, www.who.int/en/news-room/fact-sheets/detail/diarrhoeal-disease.
