This paper outlines the findings of a fecal sludge management (FSM) initial scoping study in twelve cities. This short, desk-based study used innovative tools to assess the institutional context and the outcome in terms of the amount of fecal sludge safely managed. A range of cities was included in the review, all in low-and middle-income countries.None of the cities studied managed fecal sludge effectively, although performance varied. Where cities are seeking to address fecal sludge challenges the solutions are, at best, only partial, with a focus on sewerage which serves a small minority in most cases. FSM requires strong city-level oversight and an enabling environment that drives coordinated actions along the sanitation service chain; this was largely absent in the cities studied.Based on the findings of the review a typology of cities was developed to aid the identification of key interventions to improve FSM service delivery. Additional work is recommended to further improve the tools used in this study in order to enable better understanding of the FSM challenges and identify appropriate operational solutions.

This paper describes the results of a research study which aimed in part to develop a method for rapidly assessing fecal sludge management (FSM) in low-and middle-income cities. The method uses innovative tools to assess both the institutional context and the outcome in terms of the amount of fecal sludge safely managed.To assess FSM outcomes, a fecal sludge matrix and accompanying flow diagram was developed to illustrate the different pathways fecal sludge takes from containment in water closets, pits and tanks, through to treatment and reuse/disposal. This was supplemented by an FSM service delivery assessment (SDA) tool which measures the quality of the enabling environment, the level of service development and the level of commitment to service sustainability. The tools were developed through an iterative process of literature review, consultation and case studies. This paper considers previous work done on FSM, suggest reasons why it is often neglected in favour of sewerage, and highlights the importance of supporting the increasing focus on solving the FSM challenge.The tools are presented here as useful initial scoping instruments for use in advocacy around the need for a change in policy, funding or indeed a cityÕs overall approach to urban sanitation.

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.

The urban population will rise to 6.7 billion by 2050. The United Nations has committed to provide everyone with safely managed sanitation, but there is limited understanding of the scale of the challenge. This paper describes a methodology for rapid assessment of sanitation in cities including a graphical representation (a shit-flow diagram or SFD) and reports on findings from implementation in 39 cities. The SFD provides high level information for planning purposes covering the entire sanitation system in a city. More than half of the human excreta produced in these cities is not safely managed. The most significant portions of the unsafely managed excreta are: (i) contents of pits and tanks which are not emptied and are overflowing, leaking, or discharging to the surrounding environment (14%); (ii) contents of pits and tanks which are emptied but not delivered to treatment (18%); (iii) fecal sludge and supernatant delivered to treatment but not treated (3%); (iv) wastewater in sewers not delivered to treatment (14%); and (v) wastewater delivered to treatment but not treated (6%). Many cities currently relying on onsite sanitation for safe storage, particularly in Africa, will need new strategies as populations grow. Containment systems that discharge to open drains are common in some Asian cities; these pose a public health risk. Dumping of excreta is widespread and there is a lack of realistic performance data on which estimates of the extent and effectiveness of treatment can be made. The SFD production process can be challenging due to a lack of data and low technical capacity in cities. There is often uncertainty over terminology and over the status of infrastructure. Formalizing definitions for the SFD preparation process was found to be useful in overcoming capacity constraints in cities. The SFD produces a credible snapshot of the sanitation situation in a city. The paper provides evidence of the urgent need for improved management and monitoring of urban sanitation in cities around the world and highlights the role of the SFD as a planning tool.