Factors influencing the implementation and adoption of water and sanitation interventions in urban slums in low- and middle-income countries Open Access

Pittluck, Rachel (Spring 2018)

Permanent URL: https://etd.library.emory.edu/concern/etds/jd472w50p?locale=en
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Abstract

Purpose: Global water and sanitation estimates mask significant disparities within countries. Much is made of the urban–rural divide, with rural populations lagging in access, but many city dwellers are themselves left behind. Inadequate water and sanitation are a defining feature of slums, which house a large proportion of the urban population in low- and middle-income countries (LMICs). Addressing the water and sanitation needs of slum residents will be essential for achieving the inclusive promise of the Sustainable Development Goals. It is, therefore, important to understand what drives poor water and sanitation conditions in these settings. The goal of this review was to understand factors that affect the implementation of water and sanitation strategies in LMIC slum settings and to consider how public health researchers might better leverage their work to support decision-making in these contexts.

Methods: The review draws on published and grey literature identified through keyword searches of PubMed, Scopus, the New York Academy of Medicine Grey Literature Report, websites of key stakeholders, and Google.com. Additional literature was identified through snowballing and checking reference lists. Documents included in the review were published in English between January 1, 2000 and April 1, 2018. They were reviewed for relevance to urban settings in LMICs.

Results: A range of economic, spatial, social, institutional, political, and informational factors complicate the provision of water and sanitation in slums. Their location and built environment, combined with high population density, make slums particularly vulnerable to the risks of inadequate water and sanitation. Political and institutional barriers, notably lack of tenure security, leave many slums underserved by the public sector. Typical on-site solutions such as pit latrines are a poor match for these settings, but there is limited research on what does work. Global indicators do not provide useful benchmarks to measure safe access in slums, and slum populations are often poorly represented in the data.

Conclusions: Public health researchers can contribute to improving water and sanitation in slums in three key areas: (1) identifying appropriate indicators; (2) ensuring representative data; and (3) studying which water and sanitation interventions work in urban slums, under which conditions.

Table of Contents

Introduction...........................................................................1

Global burden of unsafe water and sanitation.........1

Progress and remaining gaps...................................2

What is a slum?........................................................4

Water and sanitation in slums.................................6

Methods.................................................................................8

Results...................................................................................10

Economic factors......................................................10

Spatial factors...........................................................13

Social factors.............................................................15

Institutional factors..................................................18

Political factors.........................................................20

Informational factors................................................24

Discussion..............................................................................25

Limitations................................................................28

Conclusion and recommendations........................................30

References..............................................................................32

Tables and figures..................................................................37

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