2nsa MONITORING NATIONAL SANITATION ACCESS T2 UNICEF-MLWB2012-01629-Nesbitt

 

 

National-level monitoring of sanitation access is a key topic to help track progress against national goals and supports decision making, advocacy as well as policy and programmes design.

In many countries, a definitive source of information of sanitation is the national census, but this is usually only carried out once a decade. This section reviews some key tools for monitoring national sanitation access:

  1. Joint Monitoring Programme (JMP).
  2. Multiple Indicator Cluster Surveys (MICS).
  3. Managing discrepancies in national sanitation access data.

 

Tool 1 JOINT MONITORING PROGRAMME (JMP)

The WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP) is the official United Nations mechanism tasked with monitoring progress towards the Millennium Development Goal (MDG) relating to drinking water and sanitation (MDG 7, Target 7c).

The issues presented in this discussion are:

  • What is the JMP?
  • What definitions does the JMP use?
  • What sources does the JMP use?
  • What method does the JMP use?
  • How do I get sanitation JMP data for a specific country?
  • Post-2015 monitoring.

 

Tool 2 MULTIPLE INDICATOR CLUSTER SURVEYS (MICS)

Multiple Indicator Cluster Surveys (MICS) are a UNICEF initiative, which assists countries in collecting and analysing data to fill data gaps for monitoring the situation of children and women. MICS has enabled many countries to produce statistically sound and internationally comparable estimates in health (including water, sanitation and hygiene), education, child protection and HIV/AIDS.

The issues presented in this discussion are:

  • What is Multiple Indicator Cluster Surveys (MICS) data?
  • What sanitation data does MICS collect?
  • How can MICS data be used in country sanitation programmes?

 

Tool 3 MANAGING DISCREPANCIES IN NATIONAL SANITATION ACCESS DATA

Many developing countries are faced with apparently contradictory data on levels of access to sanitation. This section discusses common discrepancies and how to resolve them.

Guidance information presented in this discussion includes:

  • steps to improve data convergence;
  • harmonizing National Sanitation Standards;
  • defining a pit latrine;
  • handling information on shared sanitation.

 

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Tool 1

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JOINT MONITORING PROGRAMME (JMP)
Level: Global and country

 

What is the JMP?

The WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP) is the official United Nations mechanism tasked with monitoring progress towards the Millennium Development Goal (MDG) relating to drinking water and sanitation (MDG 7, Target 7c), which is to: ‘Halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation’.

The core objective of the JMP is to compile, analyse and disseminate high quality, up-to-date, consistent and statistically sound global, regional and country estimates of progress towards internationally established drinking water and sanitation targets. The JMP plays a vital role in monitoring the impact of service development funded by national governments, bilateral and multilateral external support agencies, foundations and civil society organizations. The JMP draws on the mutually reinforcing strengths of both WHO and UNICEF and has grown into the single authoritative global source for objective drinking water supply and sanitation coverage estimates.

From its first report in 1993, the JMP has gained strength in resolution, consistency and accuracy of its outputs as well as in its global outreach. A key shift was from using administrative data to household surveys. There have also been significant improvements in the data presented by the JMP, particularly in the way that recent reports and a number of regional 'snapshots' have introduced the 'ladder approach' so that incremental steps towards use of improved water and sanitation facilities have been identified. The figure below (from the JMP Progress on Drinking Water and Sanitation 2014 Update) illustrates how the JMP shows data in a more nuanced way.

 

Figure: Sanitation coverage trends by developing regions and the world (1990–2011)

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Source: World Health Organization and UNICEF, ‘Progress on Sanitation and Drinking-Water - 2013 Update’, Switzerland and New York, 2013, p. 4

 

In 2006, the JMP established a set of core questions (see www.wssinfo.org/fileadmin/user_upload/resources/1268174016-JMP_Core_Questions.pdf), which sought to harmonize definitions of water and sanitation access across all statistical sources. Core questions were established on drinking water, sanitation and disposal of children’s faeces.

The 2008 JMP report highlighted those countries making the most rapid progress, reflecting the efforts made by those countries that were starting from a low coverage rate in the baseline year of 1990. The new open defecation rates published during the International Year of Sanitation were used to great effect at the highest levels of government of some of the major developing countries to generate a renewed interest and greater emphasis on sanitation. The JMP has also collected some gender-disaggregated data through the major international household survey programmes. This has made possible a mapping of the distribution of the burden of collecting water that falls to women, men, boys and girls.

The 2010–2015 JMP strategy can be accessed at www.wssinfo.org/fileadmin/user_upload/resources/1268142297-JMP_strategy_2010_2015.pdf.

 

What definitions does the JMP use?

The JMP has developed a standard set of definitions that it uses to track sanitation access and use. Note that the JMP tracks and reports on the actual use of facilities, rather than only access, which need not necessarily imply use. (See the section below on discrepancies between JMP data and official government sanitation statistics.) The indicator measure use of improved sanitation is the proportion of the population using an improved sanitation facility.

Definitions of acceptable sanitation access and use can vary widely within and among countries and regions and, as JMP is mandated to report at global level and across time, it has created a set of categories for improved and unimproved facilities that are used to analyse the national data on which its trends and estimates are based. The table below indicates the types of sanitation included in each of these categorizations. The JMP has developed a sanitation ladder to help highlight the practice of open defecation and to provide a clearer picture of sanitation facility levels, rather than a simple pass/fail standard. The four-rung JMP sanitation ladder is presented below.

 

Figure: Four-rung JMP sanitation ladder

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Source: See www.wssinfo.org/definitions-methods/watsan-ladder

 

Table: Types and definitions of sanitation

Improved sanitation
Flush or pour-flush to:
• piped sewer system
• septic tank
• pit latrine
Ventilated improved pit (VIP) latrine
Pit latrine with slab
Composting toilet
Unimproved sanitation
• Flush or pour-flush to elsewhere (that is, not to piped sewer system, septic tank or pit latrine)
• pit latrine without slab/open pit
• bucket
• hanging toilet or hanging latrine
Shared facilities of any type
No facilities, bush or field

Source: www.wssinfo.org/definitions-methods/watsan-categories

 

Sanitation ladders

The four-rung sanitation ladder gives an understanding of the proportion of population globally with no sanitation facilities at all, of those reliant on technologies defined by the JMP as ‘unimproved’, of those sharing sanitation facilities of otherwise acceptable technology, and those using ‘improved’ sanitation facilities.

These refinements allow countries and the international community to form a clearer understanding of the situation of access to water and sanitation. As definitional differences are often the prime cause for discrepancies in the estimates between country figures and the JMP estimates, the ladder tries to show precisely where this discrepancy arises. This new way of analysing access has become an essential tool for data reconciliation at national level, between the different stakeholders and especially sector agencies and national statistics offices, as well as between the national level and the JMP.

 

What sources does the JMP use?

The country level estimates for sanitation use originate from data collected by national statistics offices, nationally representative household surveys, national censuses and, in some cases, administrative records. The JMP assembles, reviews and assesses this country data from a wide variety and increasing number of sources.

A few notable household survey sources for the JMP are given below.

  • Demographic and Health Surveys (DHS)
    DHS are nationally-representative household surveys funded by the US Agency for International Development (USAID) that provide data for a wide range of monitoring and impact-evaluation indicators in the areas of population, health, and nutrition.
  • Multiple Indicator Cluster Surveys (MICS)
    MICS are a UNICEF initiative that assist countries in collecting and analysing data to fill data gaps for monitoring the situation of children and women. MICS has enabled many countries to produce statistically sound and internationally comparable estimates in health (including water, sanitation and hygiene), education, child protection and HIV/AIDS (see section below).
  • World Health Surveys (WHS)
    The World Health Organization (WHO) compiles comprehensive baseline information on the health of populations and on the outcomes associated with the investment in health systems. It provides baseline evidence for the way health systems are currently functioning and is able to monitor inputs, functions, and outcomes. Also within the implemented Survey Programme, the WHO Evidence, Measurement and Analysis unit has developed the Study on global AGEing and adult health (SAGE) as part of an on-going programme of work to compile comprehensive longitudinal information on the health and well-being of adult populations and the ageing process.
  • Living Standards Measurement Surveys (LSMS)
    The LSMS are an on-going research initiative of the World Bank generating policy-relevant household-level data that provides an increasingly broad range of technical assistance as methods and technology continue to improve.

 

What method does the JMP use?

The JMP's method is to derive progress estimates based on linear regression. So data for each point in time are trend data not actual data points. For each country, survey and census data are plotted on a timescale from 1980 to the present. A linear trend line, based on the least-squares method, is drawn through these data points to provide estimates for all years between 1990 and 2012 (wherever possible). The total estimates are population-weighted averages of the urban and rural numbers. Sanitation trend analyses at country-level are made for sanitation facilities of an improved type and open defecation. The estimates for sanitation facilities of an improved type are then discounted by the proportion of the population that shares an improved type of sanitation facility. The ratio (proportion of the population that shares an improved sanitation facility between two or more households, including those used a public toilet) derived from the average of all available ratios from household surveys and censuses is subsequently subtracted from the trend estimates of total sanitation facilities of an improved type, and this gives the estimates for shared sanitation facilities.

 

How do I get sanitation JMP data for a specific country?

The JMP country data summary sheets are available for each country and can be found at www.wssinfo.org/documents-links/documents/?tx_displaycontroller[type]=country_files.

The JMP data provide a good overview of the progress a country has made over time. Moreover, because the data are differentiated by the use of different sanitation facilities/practices and coverage in both rural and urban areas, they provide a disaggregated view. Consequently, they can show general patterns and trends in sanitation practices. The JMP also provides maps, graphs and data that can be produced at country level and address specific data requirements. The JMP does not systematically present subnational estimates for different regions within a country, and therefore it is less useful as a tool to monitor the progress a subnational sanitation promotion programme has made. However, the JMP is extending its services and reaching out to assist countries to reconcile JMP and national data including (for example, as in Ethiopia) support to subnational estimates.

The JMP website (www.wssinfo.org) provides further information, including a detailed overview of definitions, FAQ about the calculation of JMP estimates and JMP country data summary sheets.

 

Post-2015 monitoring

The JMP facilitated a process of expert consultations on possible targets and indicators for water, sanitation and hygiene post-2015. This expert consultation involved over 200 international experts and 100 organizations over a period of two years culminating in an expert consensus aimed to feed into the deliberations of member states and other organizations. The aim of the consultation was to come up with a set of post-2015 WASH targets that are ambitious, achievable and measurable, addressing some of the shortcomings and unfinished business of the MDGs and guided by the concept of progressive realization of the Human Right to Water and Sanitation.

The consensus established four priority issues.

  1. Consistent with the United Nations (UN) Deputy Secretary-General’s Call to Action on Sanitation, there was broad consensus on the need to eliminate open defecation as a first priority and JMP would develop a specific focus on monitoring this post-2015.
  2. Targets should specifically include hygiene (handwashing with soap is top priority for improved health and access to menstrual hygiene management is crucial for women’s health, safety and dignity and to stopping girls from dropping out of school) and go beyond households, to include access to WASH in Schools and health facilities.
  3. Post-2015 targets should also introduce an additional higher benchmark called ‘safely-managed services’. For water, this means having access on premises to a reliable supply that is sufficient to meet domestic needs and does not represent a significant risk to health. For sanitation, this means having a system to safely store and transport excreta to a designated site for disposal or treatment.
  4. Post-2015 targets also need an explicit focus on reducing and eliminating inequalities in access between population sub-groups. Full details of the latest proposals are available in the factsheet produced by WSSCC at www.wssinfo.org/fileadmin/user_upload/resources/JMP-A5-English-2pp.pdf.

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Tool 2

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MULTIPLE INDICATOR CLUSTER SURVEYS (MICS)
Level: Country and subnational

 

 

What is Multiple Indicator Cluster Surveys (MICS) data?

UNICEF assists countries in collecting and analysing data to fill data gaps for monitoring the situation of children and women through its international household survey initiative, the Multiple Indicator Cluster Surveys (MICS). MICS are the world’s largest source of statistics on children and are essential for monitoring progress towards the Millenniums Development Goals (MDGs). Because all MICS are based on the same questions and methodologies, they are easily comparable. Videos explaining MICS and how to use them are available at www.childinfo.org/mics.html.

Governments usually carry out MICS with technical support from UNICEF and other UN agencies. Trained interviewers collect representative data through a series of face-to-face interviews. Since the mid-1990s, the MICS have enabled many countries to produce statistically sound and internationally comparable estimates of a range of indicators in the areas of WASH, health, education, child protection and HIV/AIDS. MICS findings have been used extensively as a basis for policy decisions and programme interventions and to influence public opinion on the situation of children and women around the world.

Results from MICS, including national reports and micro-level data sets, are widely disseminated after completion of the surveys and can be downloaded from the MICS pages at www.childinfo.org/mics.html. The latest version of MICS (MICS 5) is scheduled for 2012–2014.

 

What sanitation data does MICS collect?

The MICS are an important source for tracking progress over time and a key input to the JMP. The latest version of MICS (MICS 5) has four questions on sanitation in the household survey.

  1. What kind of toilet facility do members of your household usually use?
  2. Do you share this facility with others who are not members of your household?
  3. Do you share this facility only with members of other households that you know or is the facility open to the use of the general public?
  4. How many households in total use this toilet facility, including your own household?

The answers to the MICS questions are tabulated and discussed in the MICS country reports available at www.childinfo.org/mics.html

The MICS household survey also includes a question on the disposal of children’s faeces. For more information, see here.

 

How can MICS data be used in country sanitation programmes?

Because the MICS use a cluster-sampling approach, they are not well suited to monitoring country programmes. But MICS are a good method of measuring equity at the national level: they show disaggregated results, such as urban/rural, and they break down the results by the education level of the head of the household, religion, wealth quintiles and region. Because of this wealth of disaggregated data, MICS are useful tools for advocacy, benchmarking and targeting. MICS data can be especially useful in identifying exclusion and assisting governments in setting more realistic and specific long-term goals for disadvantaged groups.

Country-level MICS data can be found at www.childinfo.org/mics.html. MICS country reports are highly recommended as an essential tool for keeping track of the progress the sector makes over time.

 

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Tool 3

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MANAGING DISCREPANCIES IN NATIONAL SANITATION ACCESS DATA



Many developing countries are faced with apparently contradictory data on levels of access to sanitation. Common discrepancies between national and international coverage estimates are caused by:

  • different definitions of access between different data sources (for example, the inclusion or exclusion of people using shared improved toilets is a common discrepancy between different coverage estimates);
  • use of old estimates which do not reflect the latest findings from sample surveys or censuses;
  • use of the latest survey or census findings versus use of the JMP – JMP figures represent a trend based on linear regression;
  • different population estimates, including a different distribution of urban and rural populations; and
  • the use of JMP or household surveys (which represent outputs or the experience from a user perspective) versus statistics captured by a service provider on what services have been built or are being managed. Data from service providers (measuring latrines) may also rely on service coverage assumptions (e.g. a communal latrine or school latrine cubicle serving so many people) or not take into account facilities that are dysfunctional.

 

Steps to improve data convergence

There are a number of steps to develop more coherence and convergence in national level sanitation data.

  • Provide a clear explanation of the definitions, nature and methods of collection of JMP data.
  • Clarify the definitions, standards and norms in the collection of national data.
  • Check that national service coverage statistics are realistic and that they take into account facilities that are no longer functioning or not used.
  • Promote improvements in the transparency of national data collection.
  • Promote research into national monitoring. Encourage multi-stakeholder dialogue to reconcile different data sources and build consensus on what numbers best reflect the national situation.

 

Reconciling data in Ethiopia

Two key national data sets, the Ministry of Water and Energy (MoWE) provider data and JMP data, showed rural water coverage figures that differed up to 30% in 2010. From 2012, Ethiopia undertook a National WASH Inventory (NWI) that collected provider and user data applying service standard norms. A concerted national dialogue between stakeholders in Ethiopia resulted in improvements in the household survey data and, as a result, the latest JMP result recorded a higher figure (39% for 2011), while the NWI lead to a downward revision of MoWE results (to 49%), leaving just a 10% access figure difference (see the figure below). The convergence of these figures and a better understanding of what each figure is measuring have given policy makers and Ethiopia’s leadership clarity on the scale of the challenge it faces to achieve the national target of universal access.

Figure: JMP and MoWE data for rural water coverage in Ethiopia (1990–2013)  

9 toolkit figureSource: Butterworth, John, ‘Why different methods generate different numbers: Case study from Ethiopia’, presentation, Monitoring Sustainable WASH Services Delivery Symposium, IRC, 2013

 

Harmonizing national sanitation standards

When JMP definitions deviate from national definitions, figures on the percentage of people who use improved sanitation facilities may vary. Harmonization is always desirable, but not always feasible or critical. This can have a minimal effect, for instance, if a country accepts shared sanitation facilities as improved, but only 6 per cent of the population shares (as in Pakistan, JMP, 2014). But there are cases where the difference can be sizeable. In Ghana, for instance, it is common to share latrines, a normal practice for 59 per cent of the population (JMP, Ghana, 2014). Classifying these latrines as ‘unimproved’ has a significant impact on Ghana’s national sanitation coverage status according to the JMP (see discussion on shared latrines below).

The latest version of MICS (MICS 5) included three questions on this topic:

  • Do you share this facility with others who are not members of your household?
  • Do you share this facility only with members of other households that you know, or is the facility open to the use of the general public?
  • How many households in total use this toilet facility, including your own household?

These questions aim to differentiate the use of facilities that anyone can use, which are expected to be largely public sanitation facilities, from the use of facilities only by a known group of people, which are expected to be largely shared private facilities. For further information on shared sanitation click here.

Perceptions on the benefits of prescribing and standardizing high-cost sanitation technologies have changed a lot in recent years. Back in 1986 in India, UNICEF recommended one standard design for rural and urban on-site sanitation: the double vault pour flush latrine (source: IRC 2003. Sanitation Policies. Thematic Overview Paper. Author: Myles F. Elledge). Such standards still exist in several countries. In Zimbabwe, where 40 per cent of the rural population practices open defecation (JMP, 2014), the VIP-latrine remains the standards set by the government. This is one of those cases where harmonization is likely to be challenging, and which requires an in-depth understanding of national sanitation practices, the local sanitation market and the underlying reasons for the high standard.

In most countries demand-led low-cost total-sanitation approaches are challenging the idea of imposing (unachievable) standards on the rural and urban poor. One of the CATS principles underlines this (i.e. that sanitation policy does not impose standards for households for choice of sanitation infrastructure).

 

Defining a pit latrine

Discrepancies in sanitation definitions may exist between what is considered, for example, ‘adequate’ by a community, ‘hygienic’ by a government and ‘improved’ by the JMP. Harmonizing standards helps to make country monitoring more coherent, enables clear targets to be established and means that national and international reports are better able to reflect the reality on the ground.

The degree to which newly built latrines meet the national and/or JMP sanitation standard is a common concern for governments, development agencies and donors. This is a dilemma particularly when popular sanitation promotion approaches, such as UNICEF’s Community Approaches to Total Sanitation (CATS) have demonstrated that uptake can be accelerated when communities are allowed to determine their own standards.

One of the key categories of improved sanitation facilities is the pit latrine with slab. This form of dry latrine often represents the lowest rung on the sanitation ladder that is recognized as an improved sanitation facility, particularly in rural areas. These latrines play a critical role in ensuring the transition from unimproved to improved sanitation facilities – and thus ensuring progress towards meeting the MDG target for sanitation.

Definition of a basic pit latrine

The definition of what constitutes a basic or simple pit latrine can be contentious because of multiple adaptions (different types of slabs, different superstructures, etc.). Under the MDGs, basic sanitation is defined as:
 
the lowest-cost option for securing sustainable access to safe, hygienic and convenient facilities and services for excreta and sullage disposal that provide privacy and dignity, while at the same time ensuring a clean and healthful living environment, both at home and in the neighbourhood of users.
 
The more specific JMP definition of a pit latrine with slab is:
 
a dry pit latrine that uses a hole in the ground to collect the excreta and a squatting slab or platform that is firmly supported on all sides, easy to clean and raised above the surrounding ground level to prevent surface water from entering the pit. The platform has a squatting hole, or is fitted with a seat.

 

The above JPM definition is highly compatible with the CATS approach in that it neither prescribes a concrete slab (reference: The French translation of the JMP definitions has created some confusion. The French translation of slab (dalle) connotes a solid, usually concrete slab rather than the more general term intended by the definition. As a result, many stakeholders remain uncertain whether pit latrines with non-concrete slabs, particularly those with mud or earth covered floors, qualify as an improved sanitation facility. Nevertheless, the use of a concrete slab/platform/‘dale’ is not a criterion), nor specifies any particular building material for the superstructure (as long as it provides privacy). It does not say, for example, that a latrine needs a roof or that the squatting hole needs to be covered.

In conclusion, the JMP definition of a pit latrine with slab will render the majority of simple pit latrines constructed under promotion programmes that trigger communities to design and construct their own latrines as ‘improved’, as long as they follow the basic criteria in the above definition.

 

Handling information on shared sanitation

In current JMP definitions, shared sanitation facilities are categorized as ‘unimproved’ facilities. Yet there are many societies, such as Ghana, which have a high number of shared facilities and the national policy accepts shared facilities as improved. In other situations, separate households within in the same kin group share latrines and the argument has been made that this is similar to having a household latrine and so latrine access should be regarded as improved.

With the assumption that sharing constitutes a greater public health risk, there has been a proposal that, in the post-2015 JMP definitions, facilities shared with fewer than five households might be regarded as ‘improved’ and above this amount as ‘unimproved’. Kelly Baker of Emory University is currently studying the impact of sharing latrines on sanitary conditions in the Global Enteric Multicenter Study (GEMS) – the largest, most comprehensive study of childhood diarrhoeal diseases ever conducted in developing country settings (see http://medschool.umaryland.edu/GEMS). Initial findings seem to suggest that the prevalence of faecal contamination does increase in shared facilities and that sharing a facility (with a low threshold of just 1 to 3 other households) is commonly associated with moderate to severe diarrhoea in young children.

An April 2014 article (source: Heijnen, Marieke; Cumming, Oliver; Peletz, Rachel; Chan, Gabrielle Ka-Seen; Brown, Joe; Baker, Kelly; and Clasen, Thomas, ‘Shared Sanitation versus Individual Household Latrines: A Systematic Review of Health Outcomes’, PLoS ONE, vol. 9, no. 4, 17 April 2014: e93300, available here.)concludes that the evidence to date does not support a change of existing policy of excluding shared sanitation from the definition of improved sanitation used in international monitoring and targets. However, such evidence is limited, does not adequately address likely confounding, and does not identify potentially important distinctions among types of shared facilities.

Research on the public health significance of shared sanitation is continuing. For the time being, sharing a latrine is still regarded as unimproved access.