Develop or update government-led multisectoral sanitation policies, planning processes and coordination (37).
Water/sanitation, health
National
Regulation
UEU.WJ.ZZ
Policy change concerning sewerage services, systems and policies
Sustain health sector engagement in sanitation through dedicated staffing and resourcing, and through action on sanitation in health services (37).
Health
National, community
Information, education and communication
UEU.VA.ZZ&UEP
Capacity building concerning sewerage services, systems and policies
Health services, systems and policies
Develop or update national guidelines, standards and regulations, to ensure sanitation systems and services protect public health (37), to include the following elements:
· safe management at each step of the sanitation chain, for example through minimum requirements for toilets and pit latrines or septic tanks, SOPs for safe emptying and transport of faecal waste, and health-based standards for faecal sludge and wastewater treatment and disposal or use in agriculture and aquaculture (38);
· risk management and management along the entire sanitation chain – see the sanitation safety planning guide (39);
· occupational health and safety for sanitation workers (35).
Water/sanitation, health
National
Regulation
UEU.WI.QD
Restrictions through enactment of laws or standards concerning sewerage services, systems and policies
Include sanitation in health policies where sanitation is needed for primary prevention, to enable coordination and integration into health programmes (37). For example, by including sanitation promotion in training curricula of health professionals, in job descriptions and local budgets.
Health, water/sanitation
National, community
Universal health coverage
Regulation
UEU.WJ.ZZ&UEP
Policy change concerning sewerage services, systems and policies
Health services, systems and policies
Conduct national risk assessment using health surveillance data to target sanitation services to settings with high disease burden, and to support outbreak prevention efforts. This process involves standardized data gathering and a stakeholder meeting, possibly as part of a joint sector review (37).
Health, water/sanitation
National
Assessment and surveillance
UEU.AA.ZZ
Assessment concerning sewerage services, systems and policies
UEU.VC.ZZ
Public health surveillance concerning sewerage services, systems and policies
Implement local risk assessment and management to prioritize improvements and manage system performance.
Sanitation safety planning involves an assessment of the sanitation system, identification of hazardous events and assessment of control measures, development of an incremental improvement plan, and monitoring and evaluation. The WHO manual Sanitation safety planning provides specific training and support (39).
Water/sanitation
National, community
Assessment and surveillance, other management and control
UEU.AA.ZZ
Assessment concerning sewerage services, systems
and policies
UEU.TB.ZZ
Planning concerning sewerage services, systems and policies
Address demand and supply of sanitation facilities and services concurrently by enabling marketing of sanitation services and developing sanitation services and business models (37)
Approaches to generate demand may include social marketing or incentives such as subsidies, etc.
Environment; industry; water/sanitation
Community; national
Taxes and subsidies
UEU.VR.QF
Economic measures concerning sewerage services, systems and policies
UEU.VR.ZZ
Non-economic incentives concerning sewerage services, systems and policies
Design, implement and monitor locally
appropriate and safe systems along the entire sanitation chain (37).
Examples include the following.
· Toilets should be made of durable material that can be easily cleaned, provide safety and privacy, with facilities for anal cleansing, hand washing and menstrual hygiene management.
· Ensure safe containment of faecal waste through adequate design, operation and maintenance.
· Use motorized emptying and transport over manual emptying and transport wherever possible, implement SOPs and health and safety measures for workers.
· Ensure adequate treatment of faecal waste before end use/disposal.
· Ensure multi-barrier approach is used along the entire service chain.
For more information, Annex 1 of WHO guidelines on sanitation and health contains sanitation system fact sheets which describe applicability of different sanitation systems to a given context, with consideration on design, operation and maintenance and mechanisms for protecting public health (37).
Water/sanitation, health, environment
National, community
Infrastructure, technology and built environment
UEU.TK.ZZ
Public facilities or infrastructure development targeting sewerage services systems and policies
Perform context-specific behaviour change programming based on understanding sanitation behaviours and their determinants (37).
Health, water/ sanitation
Community, national
Universal health coverage
Information, education and communication
UEU.PM.ZZ&VED
Education about sewerage services, systems and policies
Hygiene behaviours
Promote access to safe toilets in schools (25), health care facilities (26), workplaces and public places.
Health, water/sanitation, environment
Community: schools/ child- care settings, health care, workplace
Universal health coverage
Information, education and communication
UEU.VB.ZZ&UAK
Awareness raising concerning sewerage services, systems and policies
Design, construction and building products and technology of buildings for public use
UEU.TA.ZZ&UAK
Advocacy for sewerage services, systems and policies
Design, construction and building products and technology of buildings for public use
Promote shared and public toilet facilities that safely contain excreta as an incremental step when individual household facilities are not feasible (37).
Health, water/sanitation, environment
Community
Universal health coverage
Information, education and communication
UEU.VB.ZZ&UAK
Awareness raising concerning sewerage services, systems and policies
Design, construction and building products and technology of buildings for public use
UEU.TA.ZZ&UAK
Advocacy concerning sewerage services, systems and policies
Design, construction and building products and technology of buildings for public use
Provide training and technical support to community health workers/environmental health officers for inspection of sanitary facilities and supporting households in improving their sanitation facilities (37). See SI forms and sanitation system fact sheets (40, 41).
Water/sanitation, environment, health
Community, national
Universal health coverage
Information, education and communication
UEU.PH.ZZ
Training about sewerage services, systems and policies
Raise awareness about climate adaptation options for sanitation systems, such as selecting sites less prone to floods, taking measures during/after extreme weather events, constructing simplified sewer networks to withstand flooding and flotation, etc. (37) (42). Also see “Sanitation safety: Adaptation and increased resilience” section in chapter 7. Climate change.
Water/sanitation, environment, health
Community, national
Universal health coverage
Information, education and communication
UEU.VB.ZZ&UBS
Awareness raising about sewerage services, systems and policies
Climate change
Involve children at home and in school in promotion of safe sanitation (43).
Education, water/sanitation, environment, health
Community, schools/child- care settings
Universal health coverage
Information, education and communication
VED.PM.ZZ
Education to influence hygiene behaviours
Involve and support all community members in the design, construction and use of sanitation facilities (43).
Water/sanitation, environment, health
Community
Universal health coverage
Information, education and communication
VED.VB.ZZ&XBO8.6
Awareness raising to influence hygiene behaviours
Community
Promote avoiding open defecation and adopting safe sanitation facilities (37).
Health, environment
Community, national
Universal health coverage
Information, education and communication
SMD.PN.ZZ&UEU
Advising about toileting
Sewerage services, systems and policies
Promote safe disposal of child faeces, that is, into latrines (37).
Health, environment
Community, national
Universal health coverage
Information, education and communication
UEU.VB.ZZ
Awareness raising concerning sewerage services, systems and policies
UEU.TA.ZZ
Advocacy concerning sewerage services, systems and policies
Promote washing hands with soap at critical times, such as after defecation, after child cleaning and before preparing food (37).
Health, environment
Community, national
Universal health coverage
Information, education and communication
VED.PM.ZZ
Education to influence hygiene behaviours
Promote maintaining functional and clean toilets (37).
Health, environment
Community, national
Universal health coverage
Information, education and communication
VED.VB.ZZ&UEU
Awareness raising to influence hygiene behaviours
Sewerage services, systems and policies
Promote safe management of domestic animals and their excreta (37).
Health, environment
Community: national
Universal health coverage
Information, education and communication
VEB.VB.ZZ&UGR
Awareness raising about hygiene behaviours
Agriculture
VEB.TA.ZZ&UGR
Advocacy about hygiene behaviours
Agriculture
· WHO 2018: Sanitation system fact sheets: Annex 1 of the Guidelines for sanitation and health (37)
· WHO 2006: Guidelines for the safe use of wastewater, excreta and greywater in agriculture and aquaculture; volumes 1–4 (38)
· WHO 2020: Sanitary inspection forms for sanitary systems, sanitation system fact sheets (40, 41)
· WHO/Neglected Tropical Disease NGO Network 2020: WASH and health working together: a ‘how to’ guide for NTD programmes (29)
This is a toolkit to address WASH and neglected tropical diseases.