Wsp Tanzania Sanitation Review Draft Report Final Version[1][1]

WATER AND SANITATION PROGRAMME

WATER AND SANITATION PROGRAMME

African Conference on Sanitation and Hygiene AfricaSan +5Towards Meeting National and MDG Sanitation Targets:

A Review of Sanitation Status in Tanzania

Prepared by:

Deo Binamungu

ACHRID Limited

P.O. Box 72446,

Sam Nujoma Road,

Plot No. 698, Block A

Sinza Area (Opposite Mlimani City)

Dar Es Salaam

Tanzania

December 2007

TABLE OF CONTENTS 31INTRODUCTION

31.1Background

51.2Scope of Sanitation

61.3Review Objective

61.4Scope

71.5Expected Output

71.6Methodology and Report Structure

72TANZANIAS SANITATION STATUS AND TRENDS

82.1Prospects of Achieving MDG/National Targets

82.1.1Sanitation Coverage: Excreta Disposal

112.1.2Access to Sewerage Services

112.1.3 Solid Waste Management

132.1.4Garbage Disposal

132.1.5Hygiene Education and Promotion

152.1.6Inequities in Access to and Use of Quality Sanitation Services

12.1.7Main Critical Aspects for Achieving MDG Sanitation Targets

22.2Policies, Strategies, Institutional and Legal Frameworks

22.2.1Policies and Strategies

62.2.2Legal and Regulatory Framework

82.4Institutional Framework

82.4.1Excreta Disposal, Septic Sludge Management and Domestic Wastewater Treatment

102.4.2 Collection, treatment and sanitary disposal of solid waste

102.4.3Coordination Platforms

132.5Hygiene Promotion and Education

132.5.1 Hygiene promotion using PHAST approach

142.5.2Health Education

142.5.3 School WASH Programmes

152.6Financing

172.7Monitoring and Evaluation

172.7.1National Sanitation monitoring indicators

172.7.2Existing Information System for Sanitation

2.7.3 Sanitation linkage with improvements in health, mitigation of environmental 18pollution and poverty reduction

192.8Capacities

213SUCCESFUL EXPERIENCES, LESSONS LEARNED AND RECOMMENDATIONS

213.1Successful experience and lessons learned

213.1.1Latrinization Programme

213.1.2School Health Programmes

223.1.3PHAST Approach

223.1.4Health and Cleaniliness Competition

233.1.5 Healthy Villages Programme

243.1.6Emerging Coordination Mechanisms

243.2Recommended Actions


243.2.2Legal Framework

253.2.3Institutional Framework

253.3Financing

253.4Monitoring and Evaluation

263.5Capacities

27ACRONYMS

28REFERENCES

31ACKNOWLEDGEMENTS

LIST OF TABLES4Table 1: Linkages between Sanitation and All MDGs

8Table 2: Different Reported Sanitation Coverage in Tanzania

9Table 3: National Coverage of Excreta Disposal Facilities in Tanzania

13Table 4: Distribution of Households by Garbage Disposal, Tanzania mainland 2000/01

1Table 5: Sanitation Coverage and Health and Human Development Indicators

3Table 6: Policies and Strategies Adopted by Institutions Responsible for Sanitation in Tanzania

5Table 7: Focus of Sanitation Related Policies

7Table 8: Sanitation-related Legislations and Regulations in Tanzania

8Table 9: Division of Primary Functions in the Sanitation Sector

9Table 10: Division of Primary Functions among Institutions Involved in Sanitation

11Table 11: Objectives, Functions and Compositions

Table 12: Information Available on Investments for MDG/national Targets (Rounded off figures to

the nearest 100,000)16

LIST OF FIGURES

Fig. 1: Percentage Population Connected to Water Supply and Area Connected to Sewerage in

UWSAs in Tanzania mainland.11

12Fig. 2: Waste Generated and Amount Collected for Disposal in Cities and Municipalities in 2005

13Fig. 3: Common Methods in Use for Solid Waste Disposal in Tanzanian Urban Areas

14Fig.4: Tanzania Cholera Trends from 1998-2006

15Fig.5: Morbidity and Mortality due to Cholera, 1998-2006

1INTRODUCTION

1.1Background The review of the Tanzanian sanitation status is a reflection on how Tanzania is fairing to keep its promise in meeting the UN Millennium Development Goals (MDG) and its own national targets. On one hand, under Goal 7 (Environmental Sustainability), the MDG target calls upon each member country to reduce by half the proportion of people without sustainable access to safe water and basic sanitation by 2015. There are however, some relationships between sanitation and the rest of the MDGs as illustrated in Table 1. Table 1: Linkages between Sanitation and All MDGsGoalRelationship with Sanitation

Goal 1: Eradicate Poverty SaSan is Sanitation is critical for productive lives

Goal 2: Achieve Primary EducationSanitation is better for quality education, enrolment and retention (especially girls)

Goal 3: Empower Women and Gender Quality Sanitation enhances women dignity

Sanitation empowers women to seek better economic opportunities

Goal 4: Reduce Child Mortality Poor sanitation and hygiene claim the lives of 1.5 million children under five years per year

Sanitation reduces morbidity and mortality

Goal 5: Improve Maternal HealthSanitation reduces pre and post natal risks

Goal 6: Combat Diseases Malaria, diarrhoea, intestinal worms are manor diseases killing people Bladder and kidney infections are common among women

Sanitation prevents water related diseases

Goal 7: Ensure Environmental Sustainability Sanitation prevents environmental damage Sanitation improves urban dwellers lives

Goal 8: Develop Global Partnerships Sanitation calls for public-private partnership

On the other hand, Cluster 2 of the Tanzanian National Strategy for Growth and Reduction of Poverty (MKUKUTA), on Improvement of quality of life and social well being sets out to achieve by 2010 the following sanitation related targets:

Increased proportion

In principle the above targets are embedded in the Tanzanian Development Vision1 which emphasizes on improved human health as a critical ingredient for economic growth and elimination of poverty in Tanzania. The vision aims at achieving an absence of abject poverty by 2025. 1.2Scope of Sanitation

Sanitation has been considered differently among the stakeholders in the country. While others refer sanitation to safe disposal of human excreta others go beyond disposal of human feaces to even include wastewater as well as solid waste disposal. This has created ambiguity such that even the data given by different stakeholders concerning sanitation differ considerably in terms of coverage and scope. Ironically, there are divergences in the way the water and health sectors in Tanzania define sanitation. Whereas the former defines sanitation as the practice that separates people from excreta and protects transmission of faecal contaminant and is easily accessible in all seasons the latter sees it as the state of cleanliness of the environment which prevents the occurrence of diseases due to poor environment and hygiene. It is evident that the above definitions differ in scope as the water sector definition reflects only the options of human excreta disposal (in this case latrine) while that of the health sector is broader in scope as it includes latrines and liquid and solid waste management. All in all WHO defines the term sanitation as the provision of facilities and services for the safe disposal of human urine and faeces. The word Sanitation also refers to the maintenance of hygienic conditions, through services such as garbage collection and wastewater disposal. (WHO health topics, www.who.int/topics/sanitation/ent)

The Guidance Manual on Water and Sanitation by DFID explains sanitation as the safe management of human excreta which also includes both the hardware (e.g. latrine and sewers) and the software (regulations, hygiene promotion) needed to reduce faecal oral diseases transmission. It encompasses too the re-use and ultimate disposal of human excreta. The manual further explains that in developing countries sanitation includes drainage, solid waste management and the control of vector and vermin. By and large both the WHO and DFID definitions signify that sanitation is a very important aspect of public health of which its inadequacy has been a major cause of diseases world-wide, hence improvement of the same can have significant benefit on health both in households and across communities.

However, for the purpose of this report sanitation has been taken to encompass the following aspects:1) Hygiene, meaning, habits related to the safe management of human excreta.

2) Safe excreta disposal, which includes access to improved sanitation to avoid contact with excreta, which encompasses the following improved sanitation facilities and their proper use and maintenance:

a. Pit latrine with slabb. Ventilated improved pit (VIP) latrinec. Composting toiletd. Flush or pour-flush toi. pit latrineii. septic tank iii. piped sewer system3) Municipal wastewater treatment,

4) Septic sludge management (collection, treatment and sanitary disposal), including the emptying of septic tanks (and other similar facilities in place), transportation to designated treatment sites or final disposal, and technically, socially, financially and economically appropriate methods for the production of biosolids for reuse as fertilizers or soil improvers;

5) Municipal solid waste management collection, treatment and sanitary disposal. , through technically, socially, financially and economically appropriate methods to prevent health risks and environmental pollution.

The safe excreta disposal options listed under item 2 above concur with the acceptable MDG basic sanitation monitoring indicators. The rest of the aspects imply sanitation in its totality instead of a narrow perspective which considers sanitation only as ways of safe disposal of human excreta (latrines). 1.3Review Objective The second African Conference on Sanitation and Hygiene AFRICANSAN + 5, is scheduled to be held in Durban, South Africa from February 18 to 20, 2008. The overall objective of the conference is to promote sanitation and hygiene improvement programs in Africa and to assist key stakeholders identify actions to accelerate achievement of national targets and the Millennium Development Goals (MDGs) for sanitation.

At this conference participants will have an opportunity to review actions taken by different countries in their efforts to improve the state of sanitation and hygiene since the last AfricanSan + 5 conference of 2002.

On its part, Tanzania through WSP-AF and its partners have launched the preparatory phase of the conference which includes holding sector stakeholder meetings in order to pull together relevant information and also identify best practices and experiences within the country which can be shared during the conference. In that respect, WSP-AF has commissioned a private consultant Mr. Deo Binamungu to prepare a comprehensive report on the status of sanitation in the country as part of the Tanzanian specific input to the conference. The assignment will be undertaken in close partnership with the African Development Ban (AfDB), UNICEF and World Health Organisation (WHO).

1.4Scope

The main activities under this assignment are:

1. Preparing the review of the sector status in Tanzania;

2. Create a data base of main experiences and interventions in the sanitation and hygiene sector; and

3. Support the regional coordinator in the preparation of the consolidated synthesis

1.5Expected Output

The expected outputs of this undertaking include:

1. A documented knowledge of the status of the sanitation sector in Tanzania based on the guidelines provided by the Client; and

2. A detailed inventory of key documents and reports and the sources of information on sanitation and hygiene in the country.

1.6Methodology and Report Structure The Consultant has prepared this report by using the following methods outlined in the Terms of Reference (ToR) the task through:

1. Desk review of the sector including analysis of the available official data and information published by national and international agencies

2. Interviews with key stakeholders involved in the sanitation and hygiene sector

The structure of the report is based on the guidelines provided by WSP-AF. 2TANZANIAS SANITATION STATUS AND TRENDS This chapter examines the status and trends in Tanzania as it forges to achieve the MDG/national targets in as far as access to improved sanitation of its population is concerned. It highlights the status of infrastructure coverage of sanitation and hygiene education and promotion in the country and the critical aspects towards achievement of MDG and national targets. 2.1Prospects of Achieving MDG/National Targets

Tanzania reaffirmed its commitment to the MDGs when it formally subscribed to the Millennium Declaration at the United Nations (UN) General Assembly of 6-8 September 2000. Since then all subsequent national development strategies have focused on eradicating poverty. Access of improved water supply and sanitation services has been singled out in the NSGRP as well as in the Tanzanias Development Vision 2025 as one of the main development concerns in the country. As far as sanitation is concerned Tanzania has so far recorded a mixed progress in attaining MDGs and national targets. According to the MDG Progress Report the status of progress for sanitation is on track. The report cites increased budget allocation for water supply and sanitation since 2005/06/07 and increased water and sanitation projects in the urban areas as the main factors towards achieving MDG targets. Also, it confirms that the water sector has effective sanitation and water policies which are in line with the demands of the MDGs. Another key factor which might contribute towards achieving MDG and national targets is the supportive environment through the collaborative approach among the key stakeholders to develop a common understanding of the current sanitation situation in the country and identification of shortfalls and needs. Many of these stakeholders have of late been seeking to adopt and include in their planning systems the countrys sanitation and hygiene targets.

However, this encouraging trend as cited in this report pose some critical questions as analysed in the following sub-sections. 2.1.1Sanitation Coverage: Excreta Disposal

Information on sanitation coverage in Tanzania is provided by different field surveys as shown in Table 1. Whereas the HBS indicates that the overall sanitation level for Tanzania was 93% in 2000/01, the DHS puts it at 87% in 2004/05. Other field surveys include the National Census in 2002 (91.5%) and the Annual Health Statistical Abstract by the MoHSW 2006 (64.8%). Regardless of the timing for each survey, the overall percentage coverage gives an impression that sanitation coverage in Tanzania in terms of access to latrines at household level is relatively high. Table 2: Different Reported Sanitation Coverage in Tanzania

S/NSource of Information Sanitation Coverage Criteria Indicator

1Household Budget Survey (HBS) 2000/01Overall -93%

Rural 91.8%

Urban 97.7%Use of sanitation facilityThe proportion of people using sanitation facility

2Demographic Health Survey (DHS) 2004/05Overall 87%

Rural 83.3%

Urban 97.6%Use of sanitation facilityThe proportion of people using sanitation facility, urban and rural

3National Census 2002Overall 91.5%

Rural 89.0%

Urban 98.6%Use of sanitation facilityThe proportion of people using sanitation facility, urban and rural

4Sector Study MoHSW 2005Permanent toilets 47%

Temporary toilets 53%Use of permanent/temporary toiletThe proportion of people using permanent/temporary toilets

5Annual Health Statistical Abstract MoHSW 2006Overall coverage 64.8%Use of appropriate sanitary latrinesThe proportion of people using appropriate sanitary latrines

6WHO/UNICEF Joint Monitoring Program (JMP)Overall 47%

Rural 43%

Urban 53%Access to improved sanitation facilities in Urban and Rural Areas The proportion of population with access to improved sanitation, in urban and rural areas

Source: Annual Water Sector Status Report: 2006/2007

However, a study by WATERAID contends that the statistics employed in assessing progress towards the MDG target suffer from two basic limitations namely; The governments coverage figures tend to be exaggerated due to flawed data collection techniques; and

Most of these statistics give no impression of sanitation adequacy in terms of the accepted MDG definitions

It concludes that the coverage figures for basic sanitation tend to be over-stated and the scale of the sanitation challenge nationally has, until recently, been under-acknowledged by the government of Tanzania (GoT). The GoT has on many occasions used the figures in Table 2 to indicate progress towards achievement of both MGD and national targets in sanitation. But as seen in these statistics the term latrine is too broad since it covers both adequate and inadequate sanitation. Moreover, it is doubtful that these surveys made any physical check of the existence of the sanitation facilities in surveyed households. Hence, these data do not necessarily refer to latrine ownership but use even if the interviewed households share sanitation facilities or use public toilets. Based on the MDG definitions outlined in preceding chapter, the latest Joint Monitoring Programme (JMP) undertaken by WHO/UNICEF which is the official monitoring mechanism of

Table 3: National Coverage of Excreta Disposal Facilities in Tanzania

Type of facilityNational Coverage (%)

UrbanRuralTotal

Pit-Latrines92.682.384.6

Traditional Pit-latrines89.381.983.5

Ventilated Improved Pit-Latrine (VIP)3.30.41.1

Septic Tanks and Soakage pits3.60.51.2

Sewerage1.40.30.5

Others (type not indicated)0.70.90.8

Without access to any excreta disposal facility1.71612.8

Source: DHS 2004

the MDG commitments, has revealed a declining trend in sanitation coverage in the rural areas from 45 per cent in 1990 to 43% in 2002. The report shows a slight increase of sanitation coverage in the urban areas from 52% in 1990 to 53%. Overall, the average access level to basic sanitation is about 47%. Though these figures may seem to depict a favourable situation relative to other developing countries and specifically so in Sub-Saharan Africa, it remains a fact that Tanzania still lags behind in sanitation coverage and the situation is hardly changing.

There are also notable geographical variations in terms of sanitation coverage. In nomadic communities the coverage is as low as 12%. The PHDR (2005) indicates that in some rural districts more than 50 per cent of households were found to have no toilet facilities. For example, the report found out that 57 per cent of the households in Ngorongoro district had no toilet facilities whereas in Kiteto and Simanjiro districts the figure was slightly higher at 58 and 61 per cent respectively. The situation in Monduli district was worse with 79 per cent of the households without toilet facilities. In all these districts majority of inhabitants are pastoralists.

The MDG Progress Report (2005) by GoT notes also another shortfall regarding these data that they do not reflect the actual use of the facilities or other hygienic practices that would help reduce prevalence of water and sanitation related diseases. The data regarding school sanitation is on the other hand, difficult to obtain from the National Census and demographic surveys. Therefore, the status of coverage indicator in schools relies on data provided by MoEVT. According to MoEVT statistics out of 333,899 permanent toilets required for government and non-government primary schools only 129,944 are available reflecting a shortage of 203,955. Hence, the coverage is about 39 per cent. However, it is important to note that, this data does not describe the adequacy of facilities as it is common to find schools with a high concentration of boys and girls using only one or two stances.

This trend of ambiguity in definitions and inadequate data and information makes it difficult to precisely figure out the magnitude of the adverse effects of poor sanitation and hygiene in Tanzania. However, few available data indicate that there still a long way to go to achieve the so called Improved Sanitation. The direct result of stagnant changes in sanitation coverage is the ever unabated incidences in sanitation related diseases such as diarrhoea, especially among the under 5, dysentery and cholera. Figures 4 and 5 show the trends in cholera prevalence as well as morbidly and mortality rates related to cholera between 1998 and 2006 in Tanzania. 2.1.2Access to Sewerage Services Very few urban areas in Tanzania are provided with sewerage systems. For instance, out of 18 cities/municipalities/towns only ten have sewerage systems. Urban authorities with sewerage systems include Dar es Salaam, Tanga, Morogoro, Dodoma, Arusha, Mwanza, Mbeya, Tabora, Iringa and Moshi. According to UWSSAs Report (2005/2006), the total number of sewerage connections is 13,055 indicating coverage of 10 per cent in terms of area and 14 per cent in terms of population. The NWSDS however, indicates that sewerage coverage is 17%. These figures indeed show that aggregately access to sewerage services in Tanzanian cities or municipalities is limited. In most municipalities, the collected sewage is treated in waste stabilization ponds (WSP) before being discharged into water courses such rivers, lakes or ocean. However, most of the ponds are not working properly which creates a risk of discharging partially treated waste water to the surface and groundwater resources. For example, about 15% of Dar es Salaam residents are connected to the city sewer network that was built in the late 1950s. The city has eight waste stabilisation ponds, of which only four are in operation. Fig. 1: Percentage Population Connected to Water Supply and Area Connected to Sewerage in UWSAs in Tanzania mainland.

Source: (Modified from Ministry of Water Annual Reports for Urban Water Supply and Sewerage Authorities for Financial year 2004/2005 and DAWASCO in October, 2006.)

2.1.3 Solid Waste Management

Availability of solid waste services in many urban areas of Tanzania is also still poor. It is estimated that only 25% of generated solid waste is being collected. About 5-10% of the urban population receives regular solid waste collection services in most cases confined to few areas, usually the urban centers and high-income neighbourhoods. Poor people in unplanned urban areas and those who live in rural areas have no access to solid waste collection.

Fig. 2: Waste Generated and Amount Collected for Disposal in Cities and Municipalities in 2005

Source: Blinker et al., 2006

The disposal options are limited to open crude dumping, semi controlled and land filling. In recent years, the Ilala municipality in Dar es Salaam has designed a sanitary disposal system where solid waste is land filled properly. In addition there is no ground water contamination because leachate is not allowed to escape to the environment. The sanitary disposal system forms 5 percent of all the disposal systems employed in cities and municipalities in Tanzania.

Fig. 3: Common Methods in Use for Solid Waste Disposal in Tanzanian Urban Areas

Source: Cleanliness Competition Draft Report, MOHSW, 2007

2.1.4Garbage Disposal

Another common solid waste management method is through garbage collection. Hence, disposal of household garbage is one of environmental health indicator especially in urban areas where most land is occupied for dwelling and commercial activities. Table 3 represents the data collected by HBS. The table depicts the distribution of households by means of garbage disposal as reported by National Bureau of Statistics (NBS).

Table 4: Distribution of Households by Garbage Disposal, Tanzania mainland 2000/01

Type garbage disposedMainland Tanzania (%)Rural

(%)Other Urban

(%)Dar es salaam

(%)

Rubbish pit in compound23.123.524.714.6

Rubbish pit outside compound30.527.144.938.4

Rubbish bin3.10.58.820.3

Thrown inside the compound19.322.88.91.2

Thrown outside the compound22.024.511.816.2

Others2.01.60.99.3

Number of HH6,453,7555,046,213981,563425,979

Source: NBS, 2005, Environmental Statistics, Tanzania Mainland2.1.5Hygiene Education and Promotion

The sanitation situation on the ground validates that hygiene practices are also very low. For instance, MoHSW study revealed that only 31.3 per cent of latrines had hand washing facilities, while 50% of families wash hands in shared containers and 15.1% of the households had children feaces around their compounds. The horror is justified by recurrences of cholera outbreaks in almost all regions including Dar es Salaam which hosted the disease for the whole year of 2006. Epidemiological data for 2004-2005 indicate that, there were 12,923 reported cases of cholera with 350 deaths, 154,551 cases of dysentery with 170 deaths and 863,488 cases of typhoid with 1,167 deaths. The situation worsened in 2006 where a total of 14,297 cases and 254 deaths occurred due to cholera alone. Figs 4 and 5 below indicate the trend of cholera disease in the country between 1998 and 2006.

In conclusion the MDG Progress Report by GoT notes that demand for improved personal hygiene was not well linked with sanitation and availability of water in the MDG 7 as there is no monitoring indicator for hygiene practices in the MDG target. However, NSGPR/MKUKUTA has identified cholera outbreak within a given period as a monitoring indicator for improved hygienic practices.

Fig.4: Tanzania Cholera Trends from 1998-2006

Furthermore, sanitation is usually promoted on the basis of health benefits only and reasons which could help change the peoples behaviours such as convenience, privacy and status are neglected.

Fig.5: Morbidity and Mortality due to Cholera, 1998-2006

Despite the high burden of water related or water borne diseases, recently there have been some notable social and economical improvements in the country. The education and health sectors are doing relatively well, as is the countrys economic performance. One result has been a decline in child mortality from 1999 to 2005, infant mortality fell from 99 deaths per 1000 live births to 68 per 1000 live births, while U5 mortality rate from 147 per 1000 live births to 112 per 1000 live births. However; one cannot plainly link this improvement in health indicators with sectoral progress on sanitation and hygiene due to existence of other programmes like immunization and nutrition which to some extent do much better than sanitation. This requires a more scientific approach to quantify the impact of improved sanitation and hygiene practices to health and wellbeing. The best way is perhaps to conduct an impact evaluation to quantitatively show how much sanitation and hygiene contribute to these achievements.

2.1.6Inequities in Access to and Use of Quality Sanitation Services

The National Health Policy 1990 (now under review) aims at implementing both national and international commitments. The vision is to have a healthy community that can contribute effectively to individual development and the country as a whole. Hence, the ministrys mission is to facilitate the provision of basic health services which are proportional, equitable, of high quality, affordable, sustainable and gender sensitive. Though the policy stresses on equity and quality delivery of services, in reality the implementation of sanitation and hygiene have not received sufficient attention. Urban areas are more advantaged compared to rural areas. For instance, the sewerage services in urban areas are exclusively a government responsibility except that the users pay little tariffs. On the other hand, on-site sanitation which is very common in rural areas is the responsibility of the household. Thus, sewerage is highly subsidized by the government as opposed to on-site sanitation which is used by majority of the urban and rural poor. Furthermore, planning of sanitation services especially in urban areas favours sections of the communities that are easiest to reach and ignore households living in slums or the unplanned urban areas. This is especially so when the charges associated with these services are too high. Hence, access to adequate basic sanitation such as sewerage networks are connected only to areas where affluent sections of the population reside. The sanitation and hygiene component is as important for health as water supply. Adequate sanitation and improved hygiene practices can only be easily attained when go hand in hand with access to clean and safe water supply. However, currently access to clean and safe water is unevenly distributed in favour of the urban areas to rural areas. Similarly, the urban water supply networks do not reach the unplanned areas. In so doing most of population lacks clean and safe water supply to facilitate hygiene practices within their communities.

Household sanitation is also faced with the non-active participation of women in the decision making process. Women who have the most to gain from sanitation and generally more receptive to its benefits than men has not been adequately addressed by agencies promoting sanitation. For example, there is a general dependency of majority of women on men to finance latrines and dig pit latrines.

As discussed earlier, sanitation in schools is in the worst shape of all, only 36.7% school with adequate sanitary accommodation (Poverty and Human Development Report 2005).Toilets are smelly and dark; children naturally do not want to use them. In addition lack of washing facilities, privacy especially during menstrual period contributes to drop out of school girls altogether.

Finally, it is important to note that the MoW which under the WSDP has invested a significant amount in sanitation has not been able to establish any equity monitoring indicators to ensure that even the poorest and most vulnerable groups access basic water supply and sanitation services. Table 5: Sanitation Coverage and Health and Human Development Indicators

PopulationExcreta disposalDomestic wastewatertreatmentSolid wasteHealth indicatorsPoverty indicators

CollectionSanitary disposal(*)ADD(1)Chronicmalnutrition(2)Childmortality(3)HDI(4)Extremepoverty(5)

200712015120072MDG / N.G.2007N.G.2007N.G.2007N.G.YearYear(2004-5)**2004**Year2003***

Urban97.6%26%

Rural83.3%41%

Total39,446,06149,861,76887%95%38%112/100030%

N.G. National goal

(1) Incidence of acute diarrhoeal diseases in children under 5 (2) In terms of stunted growth in children under 5 (3) among children under 5(4) Human Development Index (5) According to national criteria

(*) Specify final disposal method

Sources and comments: 1NBS and ORC Macro-2005; 2 Tanzania Demographic Health Survey Report 2004/5; Tanzania Poverty and Human Development Report 2005;

2.1.7Main Critical Aspects for Achieving MDG Sanitation Targets

(a)Reforms Different sectors involved in sanitation in Tanzania have since the 1990s adopted a number of policies and strategies to embrace the public sector and local government reforms. Both the Local Government Reform Policy and the Local Government Act (1982) amended in 2000, devolves the responsibilities of provision and facilitation of water and sanitation services to the LGAs. The policy and legal reforms provide a good opportunity for central government to support LGAs to generate more revenues, reduce costs, and operate water and sanitation services more effectively. In other words, they empower the communities through their LGAs to prioritise areas of interventions, plan and implement their sanitation and hygiene promotion activities. However, in reality this devolution of responsibility and authority ahs been progressing at a low pace as there have been some perceived resistance from the central government ministries that were used to providing such services directly to the communities. Although the roles and responsibilities of government institutions for the implementation of development projects/activities are diagrammed on paper, LGAs, wards, communities have yet to sufficiently assume their assigned roles. Thus, it is common to observe disconnects in community and ward level planning, absence of monitoring, absence of general district support to communities, lack of district initiative to address local issues (b) Financing Another critical aspect is the financing of sanitation and hygiene promotion activities. Traditionally, the national financing for sanitation and hygiene promotion activities both from the Government of Tanzania and the donors has been all along meagre relative to sector investments in water supply. Neither the MoHSW nor MoW has indicated a clear priority to invest in this sub-sector. Despite the fact that the former has the legal mandate to nationally drive the sanitation and hygiene agenda, it does not have a viable strategy to solicit adequate funding to invest in the sub-sector.

For over two decades sanitation and hygiene have been combined with water supply in the manner which has worked to the sidelining of the former thus, leaving a bulk of resources and attention with the latter. More often than not, sanitation development has been planned to move at the same pace as water supply with a specific time frame regardless that the promotion of the former requires more time to enable people change their hygiene behaviour and sanitation practices. Where resources have been available a greater proportion is usually spent on constructing water infrastructure and not enough on promotion, planning and support of sanitation initiatives.

In addition, technocrats do not have capacity to convince policy makers and or politicians to take action on ensuring that there is enough funding for sanitation. The capacity required here is to convince the decision makers at all levels to value the relationship between water supply and sanitation. Most of the decision makers in the MoHSW are medical professionals who by nature of their professional inclination focus more on curative related financing than prevention. And when preventative issues are discussed for financing there is a tendency to dwell more on immunization, HIV/AIDS, Trachoma, Malaria, and the like than on improved environmental sanitation. Most of these interventions are donor driven investments. This is in spite of the emphasis in the NHP, that prevention is better than cure. Moreover, the existing policies do not allow any subsidy to household sanitation, and that the commonly promoted improved sanitation technologies for households are too costly for the majority of the people especially the poorest. (c) Capacities

Sanitation requires capacity in terms of technical, human resources and working tools. Technical capacity refers to assisting communities to adopt sanitation options or systems that are affordable. In most areas especially in rural areas communities have been exposed to costly technologies and often a single technology. Likewise the health sector at LGA level and especially at ward or community level is faced with acute shortage of personnel. While in urban areas one ward is allocated at least with about two health assistants or inspectors, the situation in rural Tanzania where a ward may consist between three and five villages, only one health person is allocated. Moreover, rural sanitation personnel are hardly equipped with working tools such as transport. At district level training is usually adversely affected by limited financial resources. Hence, LGAs have limited skills and experience in delivering sanitation and hygiene services. In addition there is no proper guidance provided by MoHSW and/or MoW on how LGAs should plan and implement sanitation and hygiene activities. 2.2Policies, Strategies, Institutional and Legal Frameworks


Sanitation is embedded in a number of policies and strategies as shown in Table 5. This indicates the cross cutting and multidisciplinary nature of the sector and the importance it commands in contributing to the well being of the population. However, there is no single policy on sanitation to spearhead a common vision and guidance to all the sectors involved in sanitation. The main sectors are health, water, education and environment. Hence, each sector has developed its own policy and strategies to address its immediate and long term needs. At present MoHSW is preparing a consultative process to develop a National Sanitation Policy so as to rectify this situation. Table 6: Policies and Strategies Adopted by Institutions Responsible for Sanitation in Tanzania

S/NInstitution/AgencyPolicy/StrategiesAreas of Emphasis

1

MoHSWNational Health Policy (1990) under review

Need for adequate water supply and basic sanitation to minimise water borne and water related diseases which are the major problems in the country;

Recognition of health of individuals, households and community at large as dependent on the availability of safe water supply, basic sanitation and improved hygiene practices

National Environmental Health and Sanitation Policy Guidelines (2004) Raising public awareness and demand for improved environmental health and sanitation services for good quality of life

Draft National Environmental Health, Hygiene and Sanitation Strategy (2006-2015) - NEHHASS

Setting out how MoHSW and stakeholders will implement the National Health Policy to achieve NDV (2025), MDGs (2015) and NSGRP (2010) targets

Draft Sanitation Options Manual (2006)

Provision of basic designs for sanitation hardware and facilities

2MoWNational water Policy (2002) - NAWAPO

Integration of water supply and sanitation and hygiene education

Urban sewerage services

National Water Sector Development Strategy (Draft) Setting out the strategy for NAWAPO implementation and a guiding document for implementation of WSDP. Guidelines to support realignment of the water related aspects of other key sectoral policies with the NAWAPO

Clarifies institutional arrangement that defines roles and responsibilities of various actors

WSDPAddresses the need to include sanitation as part of water supply interventions

3PMO-RALG/LGAs Local Government Reform Policy Improvement of service delivery by making local authorities more democratic and autonomous within the framework established by the central government

Provision and facilitation of water and sanitation services as an important responsibility of local government authorities

4VPO-Division of Environment National Environment Policy (1997) Promotion of technology for efficient and safe water use, particularly for water and waste water treatment, and recycling Provision of community needs for environmental infrastructure, such as safe and efficient water supplies, treatment and waste disposal services

Promotion of other health related programmes such as food hygiene, separation of toxic/hazardous waste and pollution control at the household level Development of environmentally sound waste management systems especially for urban areas A review of laws, rules and regulations governing hazardous wastes and other wastes

5Ministry of Lands and Human Settlements National Land Policy (1995)

Provides a framework for enforcement of sanitation and housing standards in the country.

National Human Settlements development Policy (2002)

Recognizes the existence of unplanned settlements in most urban areas in Tanzania, which call for social services infrastructure upgrading such as roads, water supply and sanitation.

6MoEVTEducation and Training Policy (1995) Statements on provision of adequate sanitation facilities and hygiene education in all education sector institutions.

The policy recognizes the need for inclusion of Environmental Health, Hygiene and Sanitation in education curricula and programmes.

Setting standards for school sanitation

7MCDGCGender Policy Provides framework for participation of women and men in development including matters related to water, environmental health, and hygiene and sanitation activities.

Stresses on the interests of women in proper storage of water at home, privacy, and specific gender needs of toilets.

The above policies and strategies indicate how important the country gives to the development of the sanitation sector. As the shown in Table above the existing sector policies and strategies relate to the following key issues on sanitation and hygiene promotion:

Hygiene promotion and health education

yes

Excreta disposal

yes Collection, treatment and sanitary disposal of septic sludge yes Wastewater treatment

yes Collection, treatment and sanitary disposal of solid waste yesEach of the sector policies has a special focus on poverty reduction, environment protection or economic development as illustrated in Table 7 below:Table 7: Focus of Sanitation Related Policies

SNFocus Sector Policies

1Policies which form part of poverty reduction strategies National Health Policy

National Water Policy

National Education Policy

National Community Development Policy

National Land Policy and National Human Settlements Development Policy

Rural Development Policy and Strategy

2Environmental protection policies National Environment Policy

National water policy

National Land policy National Human Settlement Development Policy

Industrial policy

3Economic Development Policies

Industrial policy

National Water Policy

National Environment Policy

Legal Framework 2.2.2Legal and Regulatory FrameworkThere are several sector- specific legislations which guide implementation of various aspects of environmental health in Tanzania including that for sanitation, hygiene, drainage, infectious diseases control, occupational safety and health and industrial and chemical exposure. Table provides references of such laws and regulations related to specific sanitation issues. Overall, the provision of water supply and sanitation services in Tanzania resides primarily in Cap. 281 of the Laws of Tanganyika 1947-1950 and subsequent amendments, regulations and ordinances. Hence, existing legislations have been developed over time through various amendments to this original primary law. This fact has led to a number of flaws in the current legislative provisions as highlighted in the textbox below. Table 8: Sanitation-related Legislations and Regulations in TanzaniaS/NSANITATION ISSUESYES/NOREFERENCE

1Hygiene promotion and health educationYES Cap. 281 of the Laws of Tanganyika 1947-1950 and subsequent amendments, regulations and ordinances

2Excreta disposal

YES Environmental Management Act, 2004;

The Local Government( District Authorities) Act, 1982 as amended to 30th June 2000;

The Local Authorities (Urban authorities) Act, 1982 as amended to 30th December, 2000.

3Collection, treatment and sanitary disposal of septic sludge

YES Public Health (Sewerage and Drainage) Act, 2002 R.E

The Local Government (District Authorities) Act, 1982 as amended to 30th June 2000;


4Wastewater treatment

.

YES Public Health (Sewerage and Drainage) Act, 2002 R.E

Environmental Management Act, 2004; The Local Government( District Authorities) Act, 1982 as amended to 30th June 2000;


Collection, treatment and sanitary disposal of solid waste Environmental Management Act, 2004; The Local Government( District Authorities) Act, 1982 as amended to 30th June 2000; The Local Authorities (Urban authorities) Act, 1982 as amended to 30th December, 2000

5Control of pollution in hydro-graphic basins

YESEnvironmental Management Act, 2004

6Reuse of human excreta


Reuse of Septic sludge


Reuse of Municipal wastewater

YES Public Health (Sewerage and Drainage) Act, 2002 R.E Environmental Management Act, 2004;


Reuse of solid waste

YES Environmental Management Act, 2004;

Public Health (Drainage and Sewerage) Act, 2002 R.E;

The Local Government( District Authorities) Act, 1982 as amended to 30th June 2000;


2.4Institutional Framework The MoHSW is legally mandated as a lead ministry for coordination and setting of standards for sanitation in the country as well as supporting LGAs to deliver sanitation and hygiene services. Other agencies which claim to be key sub-sector stakeholders are the Ministry of Education and Vocational Training (MoEVT), which is involved in school sanitation, the Ministry of Water (MoW), which in addition to sanitation in rural areas is responsible for sewerage services in the urban areas. The Prime Ministers Office Regional Administration and Local Government (PMO-RALG), which is directly responsible for the LGAs has to ensure that the latter implement their statutory duties which include promotion of sanitation and hygiene. The environment sector, on the other hand has the responsibility of providing legal and institutional framework for sustainable management of the environment and natural resources as prescribed in the national Environmental Policy.2.4.1Excreta Disposal, Septic Sludge Management and Domestic Wastewater Treatment

In general the institutional framework with regard to excreta disposal, septic sludge and domestic waste water treatment in the country is as described in TableTable 9: Division of Primary Functions in the Sanitation Sector

SNInstitution/AgencyKey Responsibilities

1MoHSW Formulation of policy guidelines and strategies

Prepare Acts and Regulations

Protecting public health (setting standards, regulating processes)

Provide technical assistance to LGAs

Supervision and Monitoring the performance of LGAs, service providers for compliance

2MoW Formulation and coordination of NAWAPO, WSDP

Setting standards

Quality monitoring, evaluation and assurance

Coordination of water sector development activities

Urban sewerage

3PMO-RALG Coordinate planning of Water Supply and Sanitation projects from LGAs

Coordinate LGA budgets

Coordinate capacity building for LGAs

4MoEVT Formulate standards for school sanitation Oversee implementation of school sanitation

5LGAs Coordination of physical planning of sewerage/ sanitation

Provide sanitation services to the population in their areas

Formulate by-laws concerning sanitation

Primary school latrine provision

6UWSSAs Own, manage and develop water supply and sewerage assets

Prepare business plans to provide water supply and sewerage services, including capital investment plans

Secure finance for capital investment and relevant subsdies

Contract and manage service providers

Formulate by-laws for srvice provision

Table 10: Division of Primary Functions among Institutions Involved in Sanitation National GovernmentRegional LevelLGAsPrivate sectorNGOsUser committeesUsers

MOHSWMOWMoEVTNEMCUWSSAsInstitution 2

Development of

policies and strategies

Regulation

Implementation

of projects

O&M management

Oversight

Responsible Involved

Not involved

2.4.2 Collection, treatment and sanitary disposal of solid waste

The management of solid waste in Tanzanias urban and rural areas has become an ever increasing problem. In urban centres, the problem is much greater because of the many sources of waste generation, which include households, industries, commercial entities, institutions, agriculture and hospitals. A large part of the waste especially solid waste are buried or burnt on-site, disposed haphazardly by road sides, on open spaces, or in valleys and storm water drains. In addition, the municipal solid waste management units are involved in crude dumping, normally in natural depressions, on open land and in abandoned quarry sites. Wastes containing hazardous components and hospital waste are also disposed of in the same dumpsites.

Plastic waste on the other hand have been a major threat to the environment though the government has taken some initiatives to prohibit industrial manufacturing of fine polythrene bags measuring

Documents

Wsp Tanzania Sanitation Review Draft Report Final Version[1][1]