Economic evidence on sanitation supports decisions on resource allocation and selection of efficient and affordable sanitation interventions. This study presents the economic efficiency (costs versus benefits) of sanitation interventions to better manage human excreta, from 47 field sites, covering six countries of Southeast Asia (Cambodia, China, Indonesia, Lao PDR, the Philippines and Vietnam). Costs were estimated in each location, while benefits (improved health, avoided water pollution, reduced sanitation access time, resource recovery) were estimated using evidence from published studies and field sites. The economic return per currency unit invested, known as the benefit-cost ratio (BCR), and the cost per disability-adjusted life-year (DALY) averted were estimated. Across 25 rural field sites, pit latrines had a BCR of at least 5 in all countries, except Cambodia where the BCR was 2. In 22 urban field sites, septic tanks with wastewater management had a BCR of at least 2. Costs per DALY averted were found to be ‘cost-effective’ for most sanitation interventions in all countries. Economic performance declined significantly when considering non-use of facilities by households or unused infrastructural capacity. However, the economic net returns were positive under all pessimistic scenarios examined in one-way sensitivity analysis. This study demonstrates that sanitation is a highly profitable social and economic investment in six Asian countries.

There is an urgent need to improve the delivery of water and environmental sanitation services to the urban poor in low and middle-income countries to protect health and to promote sustainable livelihoods. Conventional support to public providers through loans for capital investment linked to capacity building has not achieved the desired results. There is a growing awareness of the need for institutional reform to overcome the all too common failures if service to the poor is to reach an acceptable level. The urban poor in Asia typically represent one quarter to one half of a fast growing urban area's population often dwelling in unplanned areas without any security of tenure. A study was undertaken in ten Asian countries to investigate the roles of and interaction between the public sector, private entities and civil society in serving the urban poor with water supply, sanitation and solid waste management. Case studies, including focus group discussions with low-income slum residents, were undertaken by country-based researchers distributed over a spectrum of service type, country population, city size and institutional|contract type to investigate the benefits of infrastructure partnerships. Analysis of the 20 studies confirmed the limited ability of existing public entities to reach the poor. The essential need for some level of service provision was being met by a mixture of poor quality self-provision, by informal private entities often at high, unregulated prices, or by innovative civil society involvement experiencing difficulties in scaling-up. A number of the new public private approaches were found to be successfully reforming the direct public providers; however these were usually serving poor people only by default through the general improvement in performance. A very limited number of public private community partnerships with international operators were found to be dramatically improving service to some of the poor, with better quality at lower price, but often with long-term uncertainty over contractual stability. Copyright © 2003 John Wiley & Sons, Ltd.

Across Southeast Asia many of the poorest communities live on marginal land or over water. Owing to adverse geographic and climatic conditions in these areas, neither conventional nor most well known 'alternative' sanitation options are feasible at affordable prices for poor communities or poor governments. A recent study in the region has started to develop a typology of challenging environments for sanitation as a means to: assess the scale of the challenges; understand the specifi c issues involved in improving sanitation; identify, develop or improve sanitation technologies to cope with different environments; and to disseminate the results in the study countries, regionally and beyond.

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Across East Asia many of the poorest communities live on marginal land or over water. Owing to adverse topological, geographic and climatic conditions, neither conventional nor most of the well known ‘alternative’ low cost sanitation options are feasible at affordable prices for poor communities or governments. A recent study in Indonesia has started to develop a typology of challenging environments for sanitation as a means to: assess the scale of the challenges; understand the specific issues involved in improving sanitation; identify, develop, improve or adapt sanitation technologies to cope with different environments; and to disseminate the results in the study countries, regionallyand beyond. Four main challenging environment types were identified: coastal & estuaries: rivers and riverbanks, swamps and high water tables, and flood prone areas. Generally, challenging areas in addition to the limitation on conventional and low cost sanitation technologies were found to have the following characteristics:Open defecation into water is a common practiceCommunities use polluted surface and groundwater sources for domestic activities: bathing, washing, children playing, defecating (directly or indirectly), and even sometimes for cookingHouse patterns are unplanned and the areas may be densely populated by poor householdsOccupation is illegal or semi-legalThere is a lack of adequate access for de-sludging vehicles, due to narrow paths made of wooden planks, andHousehold access to clean water is a limited an therefore a high priority than sanitation The review of both technical and non-technical aspects of sanitation in these challenging environments confirmed the difficulties in implementing affordable sanitation options. Decentralized wastewater treatment systems from in-house or communal toilet facilities, are however options which have considerable potential in these areas, especially for overhanging houses, houses built on stilts and in-land houses.