List of Tables

I. Introduction
The sanitation chain may pose microbiological, chemical, or physical risks to people's health.
Health is defined as a condition of mental and social well-being as well as the absence of disease
or infirmity. As a result, it's critical to recognize the importance of safe sanitation systems in
addressing psychosocial dangers at the toilet and containment measures that affect acceptance
and use (i.e., features that affect well-being, such as toilet privacy).
Sanitation is defined as access to and use of facilities and services for the safe disposal of human
urine and faeces. From toilet capture and containment to emptying, transport, treatment (in-situ
or offsite), and final disposal or end use, a safe sanitation system is one that is designed and used
to keep human excreta away from human contact at all stages of the sanitation service chain.
Safe sanitation systems must meet these requirements while also addressing the co-disposal of
greywater, associated hygiene practices, and basic services required for the operation of
technologies in a way that is consistent with human rights.
At each point of the chain, a combination of technologies can be utilized, and when integrated
and managed appropriately, they can build a safe chain. The technology required is very context
specific, based on local technical, economic, and social considerations, and should be addressed
in the context of the entire sanitation service chain, as well as from a citywide viewpoint.
Climate change's impact on technology safety and sustainability, as well as technology's impact
on the national greenhouse gas emissions profile, should be considered.
From preventing illness to promoting and preserving mental and social well-being, proper
cleanliness is critical for good health. Diarrhoea is a major public health concern and a primary
cause of disease and mortality among children under the age of five in low- and middle-income
countries; poor sanitation also contributes to various neglected tropical diseases, as well as
broader negative consequences including undernutrition. Lack of access to adequate sanitation
facilities is another important source of danger and worry, particularly among women and girls.
Sanitation, which prevents disease while also ensuring privacy and dignity, has been recognized
as a core human right for all of these reasons.
National and local authorities responsible for the safety of sanitation systems and services,
including policymakers, planners, implementers, and those responsible for the formulation,
implementation, and monitoring of standards and regulations, are the primary target audience for
the recommendations. This comprises health authorities and, because sanitation is frequently
managed outside of the health sector, other sanitation-related agencies.
 I.1. The significance of sanitation for human health
Safe sanitation is essential for health, from preventing infection to improving and maintaining
mental and social well-being. The lack of safe sanitation systems leads to infection and disease,
including,
 Diarrhoea, a major public health concern and a leading cause of disease and death among
children under five years in low- and middle-income countries;
 Neglected tropical diseases such as soil-transmitted helminth infections, schistosomiasis
and trachoma that cause a significant burden globally; and
 Vector-borne diseases such as West Nile Virus, lymphatic filariasis and Japanese
Encephalitis, through poor sanitation facilitating the proliferation of Culex mosquitos.
Stunting affects over a quarter of children under the age of five around the world due to a variety
of factors including recurrent diarrhoea, helminth infections, and environmental enteric
dysfunction.
Antimicrobial resistance emerges and spreads as a result of a lack of proper sanitation systems,
which increases the incidence of infectious diseases and, as a result, the usage of antibiotics to
treat preventable infections. Inadequate faecal waste management from communities and health
care settings, which includes antibiotic residues, can also contribute to the evolution of
resistance.
Safe sanitation in health centers is a critical component of quality-of-care and infection-
prevention and-control strategies, particularly for preventing infection exposure of health-care
users and staff, and for protecting pregnant women and newborns from infections that can result
in negative pregnancy outcomes, sepsis, and mortality. Safe sanitation systems in homes,
schools, workplaces, health centers, public spaces, and other institutional settings (such as
prisons and refugee camps) are critical for overall wellbeing, for example, by decreasing the
hazards and anxieties associated with open defecation or shared sanitation.
Figure 1: Faeces flow diagram showing examples of hazardous events at each step of the sanitation service chain (adapted from
Peal et al., 2014)

I.2. Sanitation as a human development issue

Many places of the world have insufficient sanitation systems. Many individuals perform open
defecation around the world, and many more lack access to services that prevent faecal waste
from polluting the environment (WHO-UNICEF, 2017). Rural areas are underserved in many
low- and middle-income countries (LMICs), while cities struggle to meet the scale of sanitation
needs generated by rapid urbanization, and sanitation system maintenance is difficult and
expensive around the world. Climate change challenges necessitate ongoing adaptation to ensure
sanitation systems protect public health.
Sanitation has gained importance on the global development agenda, starting in 2008 with the
UN International Year of Sanitation, followed by the recognition of the human right to water and
sanitation in 2010 and the call for an end to open defecation by the UN Deputy Secretary
General in 2013. Safe management of sanitation, as well as treatment and reuse of wastewater,
was given a central place under the Sustainable Development Goals (SDGs).
Figure 2: The health impact of unsafe sanitation

I.3. Hygiene and Sanitation Current status in Ethiopia

Although solid data is lacking, some studies show a low commitment to latrine construction and
use in Ethiopia, despite the country's lack of upgraded latrines. There are a variety of reasons for
this, including Ethiopian latrines' poor reputation (perceived lack of stability, privacy, and
safety), a scarcity of affordable, durable building materials, and men's reported reluctance to
'build a house for feces.' There does not appear to be a significant tradition of handwashing with
soap (or a substitute) after defecation or contact with children's feces, despite the fact that there
are a range of cleansing rites. Chronic water shortages and a lack of funds to purchase soap are
cited as reasons.
There are regional differences, however it is estimated that access to a latrine range from 9% in
rural areas to 72 percent in urban areas. This results in a national average of 18 percent, with
traditional latrines manufactured from locally accessible materials accounting for the majority.
Some traditional latrines fail to meet issues about odor, rising gas, structural collapse, fear of
falling in, flies, seclusion, and weather protection. Using a variety of concrete slabs to improve
traditional latrines has primarily been a donor and NGO endeavour. The plan was carried out
without a unified subsidy scheme, resulting in unsustainable construction and distribution.
The dedication to knowing the varying quality or safety of water sources is required for a safe
drinking water chain. It also addresses the importance of protecting drinking water at the source,
as well as during extraction, collection, transportation, storage, and eventually delivery for
consumption. The safe drinking water chain is broken at the source because of limited access.
Liquid waste disposal is a burgeoning urban problem that has yet to be overcome. Because the
sewerage network (which is limited to Addis Ababa) only serves a tiny percentage of the more
affluent households, septic tanks and pit latrines are frequently used for planned building. This
necessitates a significant expenditure in 'evacuation.'

Table 1: defecation practice – Ethiopia, 2000

II. Policies, regulations and guidelines, introduction

Sanitation systems that are safe involve input from a variety of stakeholders, but national and
local governments are critical to their effective development, delivery, maintenance, regulation,
and monitoring.
Sanitation services must be available to people where they live, with components ranging from
support for self-provisioning of modest toilets to the building and operation of major sewage
systems with technologically advanced treatment facilities. Local government is normally in
charge of ensuring appropriate sanitation, but even if it isn't, local control and coordination are
necessary to guarantee that all of the service chain's complimentary components work together
successfully.
The services can be broadly divided into three categories, according to how they are delivered:
- Customer services, such as toilet construction, hardware supplies, removal of faecal
sludge or containers, and provision of public toilets.
- Public services, which include operation and maintenance of sewerage and drainage
systems and faecal sludge treatment.
- Infrastructure development, comprising the design and construction of sewerage,
drainage, faecal sludge transfer stations and faecal sludge and wastewater treatment
plants, primary water supply systems or slum upgrading.
Figure 3: Categorization of sanitation services

Sanitation services should fit together to ensure coherent sanitation service chains (as illustrated
in Figure 3) that safely manage excreta from generation to treatment and safe disposal or use.
This demands technical alignment (e.g. the design of pits and emptying equipment so that they
work together to enable the hygienic removal of faecal sludge) and coordinated planning, so that
all components of the service chain are in place (e.g. faecal sludge treatment plants are present
and functioning to deal with collected sludge).
The responsibility of the national government includes establishing standards and targets, as well
as empowering local governments and other organizations to deliver and manage sanitation
services. Local governments are guided and supported by national authorities, who may also
assist in the creation of important infrastructure.
Local governments are in charge of (or monitor) service delivery and are accountable to both the
national government and local populations. It has direct responsibility over public service
providers while also regulating and maintaining communication with customer service providers,
whose primary relationship is with users. It also works with user communities to strike a balance
between community needs and their desire and ability to pay for services, as well as to encourage
communities to take an active role in attaining successful sanitation.
 II.1. Policy and planning
II.1.1. Policy
Governments must implement laws to guarantee that the whole population of their jurisdiction
has access to safe sanitation services, which can be accomplished by setting incremental goals or
milestones. Existing policies, regulations, and legislation should be reviewed on a regular basis
to ensure that they do not contain provisions that obstruct sanitation improvements, such as
prohibitions on providing services in informal settlements, the outlawing of pit latrines where no
viable alternative exists in the medium term, or legal/regulatory barriers to the safe use of treated
wastewater, excreta, and greywater in other sectors' policies, regulations, and legislation (e.g.
agriculture, food safety).
Providing sanitation for everybody is difficult, and the measures taken must be customized to the
conditions present in each setting. This necessitates the use of a variety of sanitation systems and
services at the same time, as well as being practical and feasible, preferably based on what has
been found to work in practice in a given context rather than an ideal vision or imported
approaches from a different physical, economic, and social environment.
A useful strategy is to build national policy by referencing existing programs that are performing
successfully in tandem with local-level innovation in sanitation, so that each can inform the
other. A wide-ranging and comprehensive stakeholder conversation should be included in the
policy design or modification process to build consensus among the numerous actors involved in
sanitation and to allow for ongoing evaluation of behavior change techniques. Policies must be
implemented, as well as course corrections as necessary.
The key policies which include sanitation are:
- The Health Policy
- The Ethiopian Water Resources Management Policy
- The Draft Environmental Health Policy.
II.1.2. Planning sanitation systems
It is critical to understand the current mix of sanitation systems in use in order to formulate
inclusive, equitable, and practical solutions, as well as to plan how that mix should change over
time as progress is made toward the sanitation and hygiene targets established in local and
national policies. Distinct types of communities (e.g., urban and rural populations) have different
mixes and targets, and intermediate and final goals should be determined for each. Figure 4
shows how technological targets might be visualized, with unsafe sanitation systems being
phased out in order to attain universal access to safe sanitation systems over time.
As a result of this strategy, sanitation has gradually improved in different regions and at different
times. Interventions can be targeted and sequenced to maximize their favorable public health and
well-being effects. This technique can offer far more benefits in the short to medium term than
master planning, which establishes long-term goals but often overlooks intermediate measures.
Sanitation targets are often accomplished in much longer time frames than electoral cycles or
externally sponsored programs (i.e. 3–5 years). As a result, sanitation planning should be
formalized and incorporated into government planning, budgeting, and finance systems. At the
federal and local government levels, distinct budget lines, financing windows, and expenditure
regulations for sanitation can help achieve this. An adaptive planning approach can be used,
which includes long-term policy and strategy formulation, continuous links between planning
and implementation, regular monitoring, evaluation, and ongoing learning from both successes
and failures, and ongoing dialogue with intended beneficiaries to tailor activities to their needs.

Figure 4: Example of phasing out unsafe sanitation over time

II.2. Legislation, regulations, standards and guidelines

To make the best use of public funds, accomplish standards, and attract new service providers,
the legislative framework for sanitation should cover the entire service chain, including both
sewered and non-sewered sanitation.
It is the responsibility of the government to ensure that sanitary standards are met. Standards and
regulations should avoid recommending specific technologies or systems for specific scenarios
because their applicability is influenced by a variety of factors. Furthermore, because policy
evolves more slowly than technology, it might stifle innovation. Instead, norms and regulations
should specify the degree of performance required to ensure a safe sanitation service chain while
also allowing for flexibility in how it is delivered.
The public and private sectors can both provide sanitation services; while all service providers
should adhere to the same standards, different regulating systems may be required for different
service delivery models. Sanitation standards can be included in local legislation and bylaws, as
well as national legislation. The most appropriate technique is determined by country-specific
criteria.
Minimum requirements for toilets, septic tanks, service standards for container and mobile
toilets, and factors linked to occupational health and safety should all be included in the legal and
regulatory framework. It should also identify duties and responsibilities, as well as reduce the
number of mandates that overlap.
In addition, developing national guidelines on sanitation systems that covers the entire service
chain as well as criteria for their selection could be beneficial. Because each country's demands
are different, what is eventually included should be defined by a policy debate that recognizes
that everyone has the right to sanitation services that are accessible, safe to use, and health-
protective, as well as inexpensive and acceptable.
These and any other sanitary features should be governed largely by public health considerations.
They do, however, have repercussions for the environment and public amenity, as well as the
cost, accessibility, and affordability of sanitation services. The weighting of these criteria is
determined by the conditions of each country (or local government jurisdiction exercising
legislative or regulatory responsibilities).
Fees and tariffs for services given by utilities, governmental institutions, or companies under
their control are a major area for regulation that applies across the entire service chain (e.g.
treatment plants under lease or concession arrangements). Sewer connection fees, fees for using
public or shared toilets, sewerage tariffs, prices for pit emptying by utilities or public institutions,
faecal sludge tipping fees, and other taxes are examples. They should be controlled at prices that
ensure sanitation services are affordable to all, including low-income households, while also
staying financially feasible for privately or commercially managed sanitation providers.

II.2.1. Guidelines and Minimum standards

i. Household
The village leadership will ensure that all households meet the minimum standard (access to a
sealed, used, cleaned, and maintained latrine with an operational handwashing facility – supplied
daily with water + soap/ash or substitute, and a compost pit for all other organic wastes,
including animal feces) with the help of HEW. “Sealed” means that there are covers for the hole
in the platform/slab and that any ventilation pipe is screened.
The woreda health office will be encouraged to fund the construction of two demonstration
household latrines per 100 households in each kebelle (one improved traditional pit latrine with
wood and mud slab, cover, and handwashing facility; and one improved traditional pit latrine
with 60cm x 60cm reinforced concrete slab, cover, and handwashing facility). As part of local
artisan training, demonstration units will be built in appropriate locations (for the vulnerable or
as incentives for CHPs) to demonstrate people some alternatives in practice.

ii. Institutions
There shall be no institutional/public or community latrines built without a 'guaranteed' provision
for ‘emptying’, which entails a manual option (As a standard, twin vault, dry - urine diversion -
units could be used.). The woreda health office will make ‘emptying’ the key feature of all
institutional latrine construction.
The woreda health office will also ensure that all schools have separate latrines for girls and boys
(with urinals) with hand-washing facilities (with soap and water) in the following stance to pupil
ratio:
o Girls to latrine stance ratio < 100:1
o Boys to latrine stance ratio < 150:1
o Boys to urinals ratio < 150:1
o All have simple handwashing facilities-supplied daily with water, soap/ash
o All classrooms have safe drinking water from a ‘safe chain’.
o All schools have refuse pits
Religious leaders will be encouraged to provide facilities at their congregations. Biogas units
have proven to be particularly successful for high concentrations of individuals, thus prison
officials will be pushed to provide minimum standard facilities.

iii. Public
Urban woreda and municipal authorities will be responsible for ensuring that appropriate public
latrines are available in public areas such as markets and bus stops. Public latrines must be
engineered to withstand continuous, heavy use while also being simple to clean and empty on a
regular basis. Public latrines should ideally be developed with a mix of public/donor -
NGO/private sector investment and privately managed (on a long term cost recovery basis).
It will be required for city governments to spend in persuading users that paying for a greater
quality of service is necessary. The viability of such arrangements will have to be thoroughly
assessed and monitored on a regular basis. People in cities are often willing to pay for clean
public restrooms with running water (soap) for handwashing.

iv. Communal
House owners (renters) will be required to comply with IHS standards by the urban woreda,
municipality, or urban local government authority. ‘Easy to empty latrines’ with handwashing
facilities will be provided on a family to stance ratio <10:1: with each family group having a key
for the locked door sharing responsibility for cleaning and emptying.
A management committee will be responsible for ensuring proper sanitation and timely
emptying. A manager or cleaner can be hired and paid through user donations. The urine
diversion units with twin vaults could be adopted as a standard. Biogas units have also been
successfully implemented in Addis Ababa, Ethiopia's capital. Integral handwashing facilities
with water (enough for multiple uses) and soap should be provided in both public and communal
toilets.
II.2.2. Proclamations and regulations
A number of proclamations have been issued to assist regions, zones, and woredas in developing
a regulatory framework to support the various promotional tactics.
The proclamations include the following:
- Public Health Proclamation - the proclamation states that no person shall dispose of solid,
liquid or any other waste in a manner which contaminates the environment or affects the
health of the society. Art. 12 No. 2 (no enabling bylaws).
- Ethiopian Water Resources Management Proclamation
- Environmental Protection Authority Establishment Proclamation.

i. Containment
The fundamental premise in this stage is that the toilet waste is held within the containment
technology and/or discharged into the local environment in a way that does not expose anyone to
the hazard. For example, feces sludge should be trapped in either an impermeable (such as a
septic tank) or permeable (such as a wet-pit) technology that leaches directly into the subsoil. In
either situation, sludge should not be released into the environment since it could expose users
and the surrounding community to faecal germs. Liquid effluent from an impermeable container
should either be totally contained and discharged to a sewer or subsoil structures via a soak pit or
leach field, or it should be discharged to a sewer or subsoil structures via a soak pit or leach field.
It should not be dumped to an open drain or water body where it could expose the local
community and/or wider community to faecal pathogens through contact or eating.

ii. Conveyance
The key principle for safe conveyance is to limit the exposure of workers performing operations
and maintenance, the community living and working in the vicinity of the work, and the wider
community, all of whom could be exposed to pathogens through ingestion and inhalation of
faecal pathogens while at home or at work, in recreational and drinking-water supply and food
supply chains.
Sewers are an effective means of transferring wastewater that require relatively little
maintenance if they are adequately designed, constructed, operated, and maintained. All sewer
pipes, however, can get blocked with solid waste and other substances, requiring rodding,
flushing, jetting, or bailing to clear. Pumps, interceptor tanks, and access chambers must all be
maintained if they are used. Workers may be exposed to dangerous wastewater and/or poisonous
gases when performing sewer maintenance. Sewer leakage can lead to wastewater exfiltration
and groundwater infiltration. Exfiltration of faecal pathogens into groundwater and water
supplies could expose the local and larger communities to faecal pathogens through ingestion.
Risk assessment should be used when there is a worry that the quality of groundwater or piped
water is being harmed.

iii. Treatment
To protect public health, the facility must be designed and operated with a defined end
use/disposal goal in mind. At the therapeutic stage, this is the most important principle. For
example, if effluents are to be utilized for irrigation or released into drinking or recreational
water bodies, or if sludge is to be used as a soil conditioner for agricultural development, the
treatment process should be planned with pathogen removal, reduction, or inactivation in mind.
The risk to the larger community exposed to the hazard is likewise decreased when the hazard is
eliminated or lowered to a tolerable level. The amount of risk is determined by the likelihood of
human exposure to pathogens in the effluent or sludge (i.e., consumer use).
In general, a treatment plant that performs well in pathogen removal will also perform well in
physical and chemical removal, but this is not always the case. During the design of the
treatment procedure, an emphasis on pathogen removal (reduction or inactivation) is
recommended. However, in addition to understanding the required treatment efficacy and
downstream effluent or sludge use, there are a number of factors to consider when choosing a
treatment procedure.
iv. Disposal or end use
The essential principle during the end-of-life/disposal process is to reduce the risks to sanitation
personnel and the general public from lingering pathogen threats, such as farmers who may be
exposed through ingesting after direct contact with pathogen-containing compost used for soil
improvement. Where effluent is discharged into surface waters or groundwater, the general
public may be exposed to pathogens by ingestion of contaminated drinking water or through the
food chain if contaminated water is utilized for irrigation.

II.3. Effluent standards

Standards for effluent disposal have a significant role in controlling of pollution discharges in
developed countries. A strict regulations for wastewater discharge is very important, and results
for only convectional water pollution. However, different countries would have different
wastewater /effluent discharge standards, and the standards are not technology based or a
minimum pollution standards particularly for developing countries. A quality based-limits or
standards are water/wastewater quality standards applicable to the receiving water to protect the
water bodies designated uses like, contact recreation and aquatic life.

III. References
EPA effluent standards. (2014). General Standards for Discharge of Effluents. EPA, 654798, 1–16.
http://extwprlegs1.fao.org/docs/pdf/tw164144.pdf
Jining, C., & Junying, C. (2016). MUNICIPAL EFFLUENT DISPOSAL STANDARDS. In POINT SOURCES OF
POLLUTION: LOCAL EFFECTS AND IT’S CONTROL: Vol. I. Encyclopedia of Life Support Systems
(EOLSS).
Ministry of Health, (2006), National Hygiene and “On-Site” Sanitation Protocol, Water and Sanitation
Program
Ministry of Health, (2005), National Hygiene and Sanitation Strategy, Water and Sanitation Program
MINISTRY OF WATER RESOURCES, Ethiopian Water Resources Management Policy,
Salvato, J. A., Nemerow, N. L., Agardy, F. J., & Salvato, J. A. (2003). Environmental engineering (FIFTH
EDITION). John Wiley & Sons Inc.
World Health Organization. (2018). GUIDELINES ON SANITATION AND HEALTH. World Health
Organization. ISBN 978-92-4-151470-5
World Health Organization. (2011). Guidelines for drinking-water quality. (Fourth Edition). World Health
Organization.
Lecture notes including wastewater treatment, sewerage and urban drainage, and Water and Wastewater
Quality Analysis