Water, Sanitation and Hygiene in Nairobi County: identifying and resolving the problems

Water, Sanitation and Hygiene in Nairobi County: identifying and proposing policies to resolve problems. Course Unit: HCPP 3107: Public Policy Analysis and Applications Unit Lecturer: Dr. Lydia Ndirangu Students: Belinda Kaimuri HD337-040-0081/2014 Omari Loyce Vera HD337-040-0082/2014

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Table of Contents Abbreviations ............................................................................................................................................................................ 2

Abstract ....................................................................................................................................................................................... 2

Background ................................................................................................................................................................................ 3

Introduction ............................................................................................................................................................................... 5

Problem statement.................................................................................................................................................................. 6

Goals and objectives ............................................................................................................................................................... 7

Stakeholder Analysis .............................................................................................................................................................. 8

Evaluation criteria ................................................................................................................................................................... 9

WASH Policy Alternatives .................................................................................................................................................. 14

Status Quo – maintaining the current program ................................................................................................... 14

Restructuring the WASH infrastructure in the County ..................................................................................... 14

Public Private Partnerships (PPPs) for water and sewerage utilities ........................................................ 15

Training and deployment of additional primary health workers ................................................................. 16

Government subsidies and grants for rain harvesting equipment . Error! Bookmark not defined.

Promotion of grey water reuse ................................................................................................................................... 16

Steep penalties for vandalism of water infrastructures ................................................................................... 17

Inclusion of WASH education in primary curriculum ....................................................................................... 17

References ................................................................................................................................................................................ 25

Citations ..................................................................................................................................................................................... 26

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Abbreviations

ARI Acute respiratory infection

CLTS Community-led total sanitation

MDG Millennium Development Goal

NGO Non-governmental organisation

S&H Sanitation and Hygiene

WASH Water, sanitation and hygiene

WSP Water and sanitation programme

WSS Water supply and sanitation

Abstract Many people believe that simply providing a fresh, clean water supply will substantially reduce

water-borne illnesses. What most people do not know is that safe hygiene practices and access to

sanitation are crucial for combating the main health threats to children under five, in particular

diarrhea. Approximately 88 per cent of all diarrhea infections worldwide are attributed to unsafe

water supply, the lack of safe hygiene practices and basic sanitation infrastructure (Evans 2005).

And the scale of the problem is immense: today, nearly twice as many people lack access to

sanitation compared with water supply (UN 2005).

Access to safe water and proper sanitation and hygiene has been a challenge to both urban and

rural Kenya. According to the last national census carried out in 2009, only 30% of the population

(11.6M) access piped water while 57% (22M) have access to water which is inadequate in terms of

quality and quantity. These people rely on unsafe sources (contaminated ponds, streams and

reservoirs)1. Furthermore, 13.6% of the population (5.3M) use bushes to defecate while another

69.6% (26.9M) use basic pit latrines. Due to this harsh reality, women and school children

(especially girls) spend hours for water collection. School girls skip their classes during their

menstrual cycle. At the same time, the per capita freshwater availability continues to decline due to

escalating environmental degradation and population growth.2 Furthermore, poor sanitation costs

Kenya 27 billion Kenyan Shillings each year. This sum is the equivalent of US$8 per person in Kenya

per year or 0.9% of the national GDP. Open defecation costs Kenya US$88 million per year – yet

eliminating the practice would require less than 1.2 million latrines to be built and used.3

1 As per the Joint Monitoring Report 2010, 48% people use unsafe water. 2 SNV Netherlands Development Organisation report 2012. 3 According to a desk study carried out by the Water and Sanitation Program 2010.

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Background WASH in Nairobi

Nairobi is an urban agglomeration with a population of about 3.4 million people (Brinkhoff, 2010).

It is an inland city at 1500−1900 m above sea level and is traversed by the River Nairobi and

tributaries including Mathare and Ngong. A large proportion of the population lives in low-income

settlements, including very poor informal settlements (UNEP 2007). At present, water comes

mostly from surface resources, notably the Tana River basin (providing most of the formal supply)

and the heavily polluted Rivers Nairobi, Mathare and Ngong, on which informal peri-urban settlements are largely dependent. It is estimated that about 42 percent of households in Nairobi

have household piped water supply, while in informal settlements most people obtain water from

vendors (UNEP 2007). UN-Habitat (2003) reports that about 10 percent of the population is served

by sewers, while 20% have septic tanks and the remainder use latrines. In informal settlements,

about 60 percent of the population, about 24 percent of people are estimated to have a latrine

(improved or unimproved) or a flush toilet, while an estimated 68 percent use public toilets (mostly

over-crowded low-quality latrines), and an estimated 6 percent resort to open defecation or

defecation in plastic bags (“flying toilets”) (NCWSC/AWSB 2009).

Effective WASH programs in developing countries

By looking at developing countries that have effectively implemented WASH programs, Nairobi can

learn from these countries and adopt or tinker and adopt existing policies in these countries.

World Vision, an NGO, established water programs in Ghana, Mali, and Niger in 2009 and 2010.

Overall, a report in 2011 illustrated a positive effect in terms of access to water and sanitation

services for the communities in targeted program areas that demonstrated a strong positive impact

of the WASH programs in Ghana, Mali, and Niger during 2009 and 2010. The study found that year

round access to protected water in these program areas increased from 72 percent to nearly 91

percent in Ghana, from 29 percent to more than 66 percent in Mali and from 35 percent to 76

percent in Niger. The report also indicated a very significant decrease in open air defecation

between 2008 and 2011 in the project areas in all three countries. These communities showed a

decrease in open defecation from nearly 97 percent to 45.8 percent in Ghana, from nearly 47

percent to 16 percent in Mali and from nearly 83 percent to 73.7 percent in Niger. A dramatic

increase in schools with hand-washing facilities in Ghana from 44 percent to nearly 87 percent and

Mali from 5 percent to 56 percent was noted and has helped encourage the practice of hand

washing in children. As a result of these and other successful WASH interventions, According to

researchers, there was a remarkable decrease of diarrheal diseases in the project areas and

households with at least one child younger than 3 who suffered from diarrhea during the two

weeks prior to the survey decreased from 28 percent to 11 percent in Ghana, from 42 percent to

26.7 percent in Mali and 46 percent to 34.6 percent in Niger. All three countries experienced a

significant reduction in the number of families with known incidence of trachoma. In relation to

Guinea worm, the report highlights, zero households having suffered from the disease in the project

areas in Ghana and Mali, showing a spectacular decrease since the 2008 situation.4

4 Information extracted from a report on Evaluation Results: World Vision’s Water, Sanitation, and Hygiene Programs, 2013

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Assessing Kenya’s neighboring countries, such as Ethiopia, access to WASH facilities significantly

increased in the project implementation areas during the project implementation period such as

more than 13,640 households gained access to clean water, and water supply coverage in the areas

visited averaged 75 percent, water consumption by each household increased an average of 70

percent, allowing families to access water not just for drinking, but also for cooking, bathing, and

hygiene, the time required to fetch water was reduced from four hours in some cases to a maximum

of approximately 30 minutes, access to sanitation increased due to the construction of pit latrines at

the household level after implementation of Community-Led Total Sanitation and Hygiene and in

about 67 percent of WASH projects visited, the beneficiaries contributed locally available building

materials such as sand, building stones, and fencing materials, thus contributing to community

ownership of the WASH infrastructure5.

5 Information extracted from a report on Evaluation Results: World Vision’s Water, Sanitation, and Hygiene Programs, 2013

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Introduction It seems unnecessary to restate the importance of WASH to human development and well-being. But yet, over half a century of the development project, over 10% of the world’s population do not have access to clean drinking water; a figure which doubles when applied only to rural areas. Over one third of the world’s inhabitants – and more than half of those that live in rural areas - do not have access to adequate sanitation facilities, more than 20 years after the end of the International Decade for Drinking Water Supply and Sanitation (JMP, 2012). In 2002, sanitation was included in the Millennium Development Goals (MDGs), and specifically within MDG 7, Target 10, which sets the aim of halving ‘by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation’. Yet, at national level in Kenya, hygiene and sanitation do not yet receive much attention, despite important health implications. The aim of this report is to explore the underlying reasons for this apparent paradox. The first thing that comes to mind when talking about sanitation is a latrine. The term ‘sanitation’, however, commonly covers a much broader area of activities. Table 1 lists the broad elements that most professionals would classify as sanitation, according to Evans (2005). Elements particularly studied in this paper are shown in italics. Table 1: Definitions

Sanitation

Safe collection, storage, treatment and disposal/re-use/recycling of human excreta (faeces and urine). Management/re-use/recycling of solid waste (rubbish). Collection and management of industrial waste products. Management of hazardous wastes (including hospital wastes, chemical/radioactive and other dangerous substances).

Hygiene Safe water storage. Safe hand-washing practices. Safe treatment of foodstuffs.

Water Management

Drainage and disposal/re-use/recycling of household waste water (also referred to as ‘grey water’). Drainage of storm water. Treatment and disposal/re-use/recycling of sewage effluents.

Source: Evans (2005) The range of activities in Table 1 is wide. The result is that a typical view of the ‘sanitation and hygiene sector’ extends from investment in large and costly items of infrastructure such as trunk sewers, via simple ‘on-site’ latrines for individual households, to provision of ‘soft’ items, e.g. support for women’s groups seeking to change defecation practices in their community. Improved hygiene is also a factor in reducing acute respiratory infections (ARIs). Studies tracing the routes of fecal-oral contamination in households suggest that hands are the microbe ‘superhighway’. They carry fecal germs from toilets or defecation sites to utensils, water and food. While washing hands at critical times is accepted as an effective intervention against diarrheal disease, evidence is also now growing for its effectiveness against respiratory infections (Cairncross 2003) such as tuberculosis (including transmission of germs from mouth to hand to mouth, e.g. via sneezing).

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Problem statement With a per capita water of less 1000 cubic meters, the global benchmark, Kenya is ranked among

water scarce countries. According to World Bank Country Brief (2009), as of the year 2008 the

renewable freshwater per capita stood at 534 cubic meters and is projected to reduce to 440 cubic

meters by the year 2015. This would definitely imply reduction in water sources for use and the

impacts would be more adverse for the majority poor residents of Nairobi who do not have

economical ability to plan for water shortages and have more pressing financial needs during water

shortages.

The sewerage system in the county use infrastructure that was set up in the 1960’s and has not

been upgrade to accommodate the surging population growth. While pit latrines are being used in

the informal settlements, open defecation is still quite common. In the informal settlements access

to improved sanitation is a constant challenge and due to the fact that there is no connection to the

current infrastructure of the sewerage system and the wide use of pay-pit latrines that fill up very

fast. Individuals who cannot afford to pay for use of a latrine has the option of open defecation in

the cover of darkness at night and due to insecurity in these settlements ‘flying toilets are used very

often.

Some of the impacts of lack of safe and accessible drinking water and proper sanitation include:

Longer hours in search of water for households especially by women and girls.

Young girls skipping school during their menses due to hygiene challenges.

Spread of sanitation and hygiene related illness like diarrhea, cholera and dysentery.

Increased child mortality of children under-fives years due to sanitation and hygiene related illnesses.

Poor management of water base resources as large sample population access few water

base resources leading to over utilisation of the water base resources.

Since water and sanitation is considered as a merit good, it is more convenient for the provision to

be provided by government for the general public. However, potential government failures are

expected; posturing of public officials on the WASH agenda with no solid intention of pushing for

resolution of WASH issues, distorting perception of costs required to upgrade and review the WASH

infrastructure and bureaucracy leading to inefficient use of public resources.

Therefore this analysis seeks to examine alternative solutions to poor access of improved sanitation

and safe drinking water for Nairobi County and recommend policy change to alleviate the problem.

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Goals and objectives This paper aims at identifying alternative policies that would best ensure access to improved

sanitation and safe drinking water by achieving goals and objectives outlined in the table below. To

reduce the risk of hygiene related diseases such as acute respiratory infections by 20%.

Table 2: Goals and objectives

Goal Objectives

Efficient distribution of water and sewerage infrastructure

a. To have regular piped water in Nairobi county. b. To install water points less than 500m of each community. c. To remap and upgrade the sewerage systems in Nairobi by end of 2017 to

support current and projected population size. d. To eliminate the option of open defecation through community led sanitation

programs by 80%.

Efficient WASH facilities and infrastructure

a. To have a national pupil to toilet ratio of 25:1 for girls and 30:1 for boys.

b. To reduce absenteeism in schools by girls by 50%.

c. To reduce the risk of hygiene related diseases such as acute respiratory infections by 80%.

Equitable deployment of public health workers

To adequately staff public health workers to the lowest unit of health according to population size by end of 2015.

Promote human dignity and quality of life

a. To reduce under five child mortality rate and infant mortality rate towards the MDG target of 33/1000 live births and 26/1000 live births by year 2015

b. To reduce number of children dying from WASH related illness such as diarrhea and dysentery by 50%.

c. To create awareness on importance of preservation of water catchment areas. Gender empowerment

a. To reduce number of hours women and girls spend searching for water b. To proactively involve women participation in existing programs that promotes

access to improved sanitation and drinking water.

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Stakeholder Analysis The issue of access to improved sanitation and safe drinking water is critically since it affects a

large proportion of the population and different stakeholders would be expected to have different

approaches in dealing with the problem. No competing interests are expected though. Below are

groups expected to have influence on the policy change recommendation;

General population

Generally every citizen in the county can identify with lack of access to safe drinking water and

improved sanitation. As the electorate it more or less expected that provision of water is solely the

role of government especially through the local authorities and parastatals.

Majority of the population is women and girls who are more adversely affected by WASH problems.

Moreover, it has been observed that women are more organized through women groups popularly

known as ‘chamas’ and are more eloquent in projecting social problems and spear heading for their

solutions.

Therefore gaining support and the influence of the general population may increase chance of

success of policy though marginally.

Central Government

It is the sole responsibility of government to provide goods and services that the market

mechanism cannot efficiently produce and price. As such, it is expected to provide citizens with

access to improved sanitation and safe drinking water. The government is expected to have more

influence to the policy change through financing, its role of policy formulation and implementation

and its laid down institutional framework.

Nairobi County Government

It is in the jurisdiction of Nairobi County Government where the policy change would be

implemented and is correctly assumed it would assume the role of a county government to

implement any program to promote access to improved sanitation and safe drinking water. It

would then be crucial to bring them on board early so as to guarantee their support, influence and

efforts in implementation of the recommended policy.

Donor community

Previously donor involvement has been witnessed in financing, implementation and monitoring of

WASH related programs to the lowest level of the community. Due to it is ability to organize itself in

various bodies and organizations and its culture of accountability, its role cannot be

underestimated in this particular policy change recommendation.

Private sector

There is a shift in Kenya’s private sector from sole concentration in profit generating activities to

social responsibility activities. The private sector has a great ability to supplement government

budget in provision of infrastructure and equipment through financing and participation through

designate departments and auxiliary organization that specifically deal with social responsibility to

communities.

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Evaluation criteria This paper will use the following criteria to gauge and identify the best policy alternatives for

improving WASH in Nairobi County. Each alternative is evaluated for effectiveness, sustainability,

administrative feasibility, political and public acceptability and scale. By evaluating each alternative

by these prescriptive criteria, the most feasible alternative can be pinpointed. Each criterion is

defined, measured for ability to meet goals and objectives for solving the problem, and assessed

according to a decision standard that provides for identifying the alternative that best fits

operational requirements.

Effectiveness: Each alternative is measured for its operative in improving access to clean water,

sanitation and hygiene services. Implicit within this is analysis of the metrics for improvement and

for whom access has been improved. These alternatives will be judged by the impact the will have

on alleviating problems, such as, water supply, excreta disposal and wastewater disposal.

Efficiency: Each alternative is measured in such a way that the economic benefits of policies exceed

their costs. For instance, in the case of the development of new water distribution infrastructure,

the value of the water produced should exceed the costs of production, to which should be added

environmental costs. For improvement of sanitation and hygiene, the reduction in WASH related

diseases is worthwhile so long as the unit value of the reduced diseases exceeds the cost of

providing it. Beyond that point, reduction in WASH related diseases has too high a cost in terms of

benefits foregone.

Sustainability: Each alternative will be assessed for the longevity of their impacts; whether the

effects of the programme continue beyond the period of implementation. ‘Sustainability’ is used

widely, pluralistically, and often incoherently in development. It is beyond the scope of this paper to

engage fully with the various definitional challenges of ‘sustainability’ but, as this paper is

concerned with performance in the post-implementation period, ‘sustainability’ should be taken to

mean a permanent change in the adaptive capacity of a given WASH system to cater for the needs of

its target beneficiaries in this regard.

Administrative feasibility: Each alternative will be assessed for its administrative capability of the

department or agency involved. For instance, metering supplies requires a certain level of

household visits and billing staff and deployment of public health workers would require the

available resource ready or train and deploy this resource. Furthermore, new policies will be

worthless unless their implementation is monitored and enforced.

Political and public acceptability: Each alternative will be assessed for its easiness in having the

general public and political acceptance of the policy since it is desirable that policy changes should

be acceptable to the parties affected and should not encounter serious resistance in the political

process. There should normally be some proportionality between the effort that goes into

introducing a policy measure (the sacrifice of political goodwill, expenditure of political credit, the

resources involved in steering legislation through, overcoming public resistance and lobbying) and

the pay-off from that policy. A policy that achieves little, but at great political cost and arousing

much public antagonism, is clearly undesirable. Furthermore, a policy is more likely to be

acceptable if it is seen to be tackling a severe problem, if its costs and benefits are apparently

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equitably distributed, if there is a strong lead from prominent political and community figures, if it

is accompanied by adequate publicity, and if the population is well informed and public-spirited.

Scale: Each alternative will be assessed according to the extent of changes in the scale of WASH

problems. That is whether, through the activities designed to address WASH problems, their extent

has decreased. Where the first criteria, that is sustainability, examines quality of change, this

criteria examines quantity of change. Implicit within this is, to a limited extent, an analysis of the

returns to investment. Policies with greater benefit to investment ratios can provide more positive

lessons from which future policy designs can draw.

Equity and distributional effects: Each alternative will be assessed in its fairness in their

respective impact on the various socio-economic groups. Deserving groups, who may be mothers of

young children, children under the age of five, schools, girls or poor households, previously

receiving WASH facilities and infrastructure that were considered to be inadequate or obtained at

high personal or social cost, should benefit from policy reforms, and should certainly not find

themselves worse off. It is important that the consumption of such target groups should not be

reduced to below socially desirable levels.

Table 3: Evaluation Criteria

Criterion Definition Objective measure Decision Standard

Effectiveness

Alternative’s metric in improving water supply.

Number of target groups with accessible water supply.

20,000 – 50,000 Highest number.

Reduce cost of accessing water. 40% Highest percentage.

Distance between water points and households.

500m Shortest distance.

Install a distribution system for piped water in the county.

80% Highest percentage.

Alternative’s metric in improving sanitation.

Ratio of number of latrines/toilets in schools to girls and boys.

25:1 (girls) 30:1 (boys)

Highest ratio.

Number of facilities of disposable excreta and wastewater per 5000 population.

5 Highest number

Number of morbidity rates from WASH related illness.


Remap and upgrade sewerage system.

3 years Shortest period.

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Reduce the proportion of the population without access to improved sanitation.


Alternative’s metric in sanitation and hygiene education and water quality interventions.

Number of road shows per year to sensitize the issue.

1 per month Largest number of turnouts.

Number of school visits by public health workers.

Twice per month Material used by public health workers.

Number of sanitary towels distributed to poor schools.

500 per month Low stock levels at schools.

Reduced transmission of WASH related diseases via hand washing.

1/3 Highest fraction.

Regulatory impact.

Does the policy alternative require changes in the regulatory framework for WASH?

Yes/No No

Alternative’s metric in improving hygiene.

Reduction in absenteeism by girls at schools.


Reduction in the risk of hygiene related diseases.


Eliminate the option of open defecation


Efficiency

Improved water distribution infrastructure.

Easy access to water points. Distance between water points and households

Shortest distance

Upgrade sewerage system.

Improved sewer systems. Cost of

restructuring sewerage system

Lowest cost.

Construction and maintenance of latrines/toilets in schools and informal settlements.

Clean and well maintained facilities.

Cost of construction and

annual maintenance cost

Lowest cost

County resource requirements imposed by the alternative policy.

Does the alternative policy require significant county management and involvement?

Yes/No No.

Sustainability Cost of alternative over benefits gained.

Does the cost of the alternative outweigh the benefits it may deliver?

Yes/No No

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Alternative prevention of children under five and infant mortality.

Ratio of input costs to increase in Disability Adjusted Life Years6 (DALY’s) - feco-oral diseases account for 85% of preventable DALYs.

1:30 (Cost to DALY’s)

Highest Ratio.

Alternative’s consistency in delivery of water to water points.

Percentage of consistent distribution of water and water systems.


Alternative’s adequacy in water and sanitation infrastructure and hygiene campaigns and promotions.

Percentage of attention rate from successful hygiene campaigns and promotions.


Percentage of complete and adequate water and sanitation infrastructure


Alternative’s promotion of innovative techniques and facilities for water and sanitation infrastructure.

Number of successful innovative water and sanitation facilities.

5 per year. Highest number.

Percentage of remunerated and employed innovation technology.


Alternative’s awareness on importance of preservation of water catchment areas.

Percentage of attention rate from successful sensitization and awareness campaigns.


Administrative feasibility

Human Resource capacity.

Public health worker levels required per metro area7.

2:1000 Lowest number.

Political and Public Acceptability

Support for policy across stakeholder groups.

Level of support for policy alternative assessed by PRINCE Analysis.

PRINCE Analysis score.

Highest score.

Alternative’s requirement of behavioral change.

Does the policy require behavioral change to conserve water catchment areas by political officers and general public?

Yes/No Yes.

6 The prevention of a child’s death should only be measured as having a full impact on DALYs if there is no chance of this change being reversed over time such that eliminating childhood mortality from diarrheal disease amongst the villages 100 children then it is common to assume that this has resulted in an additional 3000 DALYs. 7 Nairobi has four metro areas; Core Nairobi, Southern Metro, Northern Metro and Eastern Metro.

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Scale

Alternative’s impact to socio-economic groups targeted.

Percentage of people that have received the intended ‘effect’ per 1 million of the population (as identified by the effectiveness criteria).


Does the policy impact continue beyond the period of donor/government/community input?

Yes/No Yes.

Degree to which targeted socio-economic groups can claim that the policy continues to be implemented due to initial activities.

4 Highest scale8.

Number of people using the installed latrines/toilets in a village/slum/urban center.

50 per 5 million population per

day Highest number.

Equity and distributional effects

Alternative’s priority in the provision of water and sanitation infrastructure.

Does the policy give priority to poor groups in provision of water and sanitation infrastructure?

Yes/No Yes.

Does the policy offer cheaper tariffs to poor urban centers?

Yes/No Yes.

Alternative’s priority in administering public health.

Does the policy offer public health subsidies to poor socio-economic groups?

Yes/No Yes.

8 Degree scale: 1 being lowest and 5 being highest.

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WASH Policy Alternatives A successful WASH program will improve the social welfare of the people while at the same time

teach and encourage people on safe hygiene practices and the benefits of having accessible and

dependable sanitation facilities. The following is an analysis of affordable WASH policies that have

been adopted in other counties and countries. These policies are evaluated in terms of their

potential applicability and adaptability to Nairobi County. The alternatives are:

1. Maintaining the current program with, the status quo alternative;

2. Restructuring the WASH infrastructure in the County;

3. Public Private Partnerships (PPPs) for water utilities; 4. Training and deployment of additional primary health workers to all administrative units;

5. Government subsidies and grants for rain harvesting equipment;

6. Promotion of grey water reuse;

7. Steep penalties for vandalism of water infrastructures;

8. Inclusion of WASH education in primary curriculum.

Each alternative is evaluated by the six criteria listed above – effectiveness, sustainability,

administrative feasibility, political and public acceptability and scale.

Status Quo – maintaining the current program Nairobi County has no specific policy guideline relating to provision of safe drinking water and

improved sanitation. However in 2009 the Nairobi City Water and Sewerage Company (NCWSC)

and Athi Water Service Board (AWSB) in partnership with Water Sanitation Program-Africa

developed a document to offer guidelines in the provision of safe water and improved sanitation

particularly in the informal settlements. It documents actions to be implemented and recommend

steps to be followed in the implementation. Since 2009 the WASH situation in those informal

settlements are largely still the same, this cast doubt as to whether implementation of these

strategic guidelines took place.

There is a national policy relating to the WASH agendas documented in the National Environmental

Sanitation and Hygiene Policy,2007 where the main goals of this policy being to educate all

households on the importance of improved WASH practices; to ensure all public areas like markets

and institutions have access to hygienic, affordable, functional and sustainable toilets and hand

washing facilities; to ensure premises everywhere are clean free from waste and unpleasant odour

with proper drainage; and to reduce WASH related diseases. This policy is to accelerate the

achievement of WASH related objectives in the MDGs by 2015.

These goals are primarily to be achieved through actively disseminating information and encourage

a participatory approach by households, communities, donor, private sector and government

sectors towards promoting use of safe water and improved sanitation. By providing information

through hygiene and sanitation promotional activities the public is expected to make informed

choices regarding safe drinking water and improved sanitation while at the same time setting aside

resources to investing in WASH.

Restructuring the WASH infrastructure in the County The current water and sewer infrastructure was laid during the post-colonial times and ever since,

it has not matched the growth of the county. Rapid population growth in the county and urban

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migration has led to more people living in the county which also serves as the capital city. Therefore

the current water infrastructure is stretched. In formal settlement areas, water dry taps are a

normal experience while those who are economically advantaged and own homes are able to sink

boreholes to get water. The informal settlements in which majority of the county population and

the poor live cannot access piped water and depend on water kiosks or vendors who exploit the

residents by charging exorbitant prices.

Currently there are two sewage treatment plants in Dandora and Kariobangi which normally have

overloaded pipes and blockages and sewer burst have become a norm. While the formal

settlements have toilets, irregular water supply does not guarantee their hygiene and sanitation. In

the informal settlement in the informal settlement there is use of communal pay toilets and latrines

and open defecation.

Restructuring of the infrastructure would involve: intensification of formal water and sewerage

networks particularly in the slums, upgrade of technology used i.e. use of galvanized pipes to

reduce bursting and water contamination; increase in number of piped communal water points and

metered pressured water connections in households across the county; addition of at least one

sewerage treatment plant and upgrade of the existing ones; construction of simple systems for

waste discharge and provision of pit latrine emptying services to slum areas; and development of

communal ablution blocks that have flush toilets and water supply in public areas including public schools.

Public Private Partnerships (PPPs) for water and sewerage utilities Water PPP projects in developing countries are a growing trend with South Africa being the first

African country to veer into this direction. The appropriate main rationale for introducing private

operators in support of utilities reform it the need for more realism, proper regulation and due

consideration of social issues.

Nairobi County can benefit from PPPs considering the lack of enough fiscal resources to cover the

financial losses of public utilities and to invest in infrastructure rehabilitation and expansion9, PPP

for water utilities seems to be an attractive solution. Concerns have been raised in contracting of

the provision of such essential services as inherently fraught with conflicts, given the monopolistic

nature of these services. However, PPP arrangements can work well in the diverse settings such as

that the county faces pointing to weak institutional capacities, poor governance and gaps in the rule

of law and enforcement of contracts10.

PPP projects include those in the provision of water and sanitation services delegated by contract

to a private operator, which usually takes over the management of an existing utility. This may

include divestitures (in which infrastructure assets are sold to private investors); concessions

(whereby a private operator becomes responsible for both operation and investment); leases-

affermages (whereby a newly established private utility operates a publicly owned system and

collects revenues that it then shares with the public owner, who remains in charge of investment);

9 This is an assumption; lack of financial resources may arise from various factors such as misuse of these financial resources. 10 Will require enforcement of property rights – Coase Theorem.

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management contracts (in which the services are provided by a publicly owned utility that is

managed by a private operator); and mixed-ownership companies (in which a private investor

takes a minority share in a water company and operates it on behalf of the local authorities, sharing

the financial gains with the public partner).

For leases-affermages and management contracts, incentives for efficiency are usually spelled out

in more detail in the contracts. Progress is, therefore, directly related to the specific design of the

remuneration and incentive scheme. In leases-affermages, the operator is typically enumerated by a

fixed volumetric fee, in exchange for being responsible for all operational costs. This creates a direct

incentive for making efficiency savings, because these translate directly into profits. In management

contracts, the remuneration typically comprises a fixed component plus a variable bonus for

meeting contractual targets. Key elements include the choice of the indicators for measuring

progress, the reliability of the baseline, and the mechanism for verifying compliance with the

agreed-upon targets.

Training and deployment of additional primary health workers The main focus of this alternative is in the provision of equitable health service to the county to

both promote and sensitize on sanitation and hygiene issues as well as upping the level of service at

the counties health centers for WASH related illnesses.

As at the 2009 population census, Nairobi County has an approximate population of 6.5 million

people; a 2008 report indicates that the Ministry of Health had an overall vacancy level of 29% with

1.5 health care workers per 1,000 population in Kenya, which falls below the figure of 2.3 per 1,000

population reported in analyses by the World Health Organization (WHO) on the minimum staffing

threshold to achieve minimum coverage. Therefore, there is a need to recruit, train and deploy

healthcare workers in the county to offer WASH sensitization programs and treat WASH related

diseases.

County promotion of grey water reuse Grey water is household wastewater effluent originating from baths, showers, kitchen and hand

wash basins and laundry and constitutes 50-80% of indoor household water use. It represents

water that can potentially be intercepted at the household level for reuse. Grey water is mostly

practiced on an informal basis to supplement irrigation water, either in urban gardens in middle to

upper income suburbs or in food gardens in lower income informal, peri-urban and rural areas.

A clear understanding of the potential health risks, operational problems and environmental

impacts that can be caused by improperly designed grey water treatment and land application

systems is necessary to ensure only suitably designed grey water treatment and land application

systems are permitted. There will be a cost to design, install and maintain such grey water reuse

systems if they are to protect public health and be environmentally sustainable. Moreover, grey

water systems must be designed for long term use as some past experiences in various countries

have shown that some poorly developed grey water systems will result in clogging of the soil,

odour, blockages and become a burden (financial and time) due to constant maintenance

requirements.

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The county can also offer exemptions from taxation part or all of the assessed value of property on

which grey water reuse initiatives are made, exemptions on grey water reuse equipment and

supplies from Value Added Tax (VAT) can be offered to individuals and entities and rebates and

financial incentives can be offered to promote grey water reuse.

Steep penalties for vandalism of water infrastructures So far, steps are currently being undertaken to achieve this alternative such as the current

Vandalism Bill that will include a law on vandalism of water infrastructure. Other ways that the

county can prevent vandalism include improving customer and utility relations, increasing the community’s sense of ownership and strengthening law enforcement. Furthermore, the county

needs to develop a monitoring and reporting tool to capture all vandalism events to gain an

understanding of each incident of vandalism so that strategies can be put in place to reduce the

likelihood of such events, identify trouble spots, observe trends over time, understand the

effectiveness of intervention strategies and highlight where improvements are needed.

Also, the steep penalty on all individuals and/or entities caught with vandalized water and

sewerage infrastructure should be implemented, not only at the country level but also at the county

level via by laws.

Inclusion of WASH education in primary curriculum This agenda has been largely driven by NGO’s in collaboration with government agencies such as

The Ministry of Education in collaboration with the Ministry of Public Health and Sanitation and

other partners developing a National School Health Policy and National School Health Guidelines in

2009 that promotes sustainable WASH infrastructures, functional sanitation facilities and hygiene

sensitization in schools.

However, sustained curriculum on WASH is required to develop adequate knowledge, attitudes and

skills on hygiene through life skills-based hygiene education and child participation. Therefore, life

skills-based education seeks to instil hygiene practices into the realities of children’s daily lives,

helping them acquire the knowledge of appropriate hygiene behaviors and the skills to use them.

This approach considers the learning differences of various stages of child development and

addresses them in the programme design, allowing children to effectively transform knowledge

into practice.

Analysis

Impacts of alternatives on Nairobi County The solution analysis used in this paper will be a multi goal analysis since there are other goals

other than efficiency that are being considered, that is, equity, social benefit and empowerment

considering that social benefit cannot be quantified.

a. Feasibility of current WASH program

The current WASH program has only been successful in increasing awareness on sanitation but has

not increased sanitation coverage to the intended 66% since as per Progress on Drinking Water and

Sanitation – 2014 update prepared by WHO and UNICEF shows that sanitation coverage for the

country is at 30% and for the urban area is at 31% as 2012.

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This policy has not increased access to safe drinking water in the county neither has it reduced cost

of accessing water. Open defecation has not been eliminated. The same report show the percentage

that uses open defecation to be at 13% and 18% for the country and urban areas respectively. The

policy has not put any structural improvement to water and sewerage systems. While no

challenges have been noted as regards to administration and political acceptability of the policy

neither can it be said it is active implementation is on course. Therefore this alternative does not

score highly against the evaluation criteria.

b. Feasibility of restructuring the WASH infrastructure in the County

This will see the network of water pipes and sewerage pipes remapped and more pipes laid down

to accommodate the swelling population of the county. This would cost about KES 1.2 billion, of

which will be partly from the county funds and grants which will be sought. This aims at ensuring

piped water is available to every house and communal water points at informal settlements under

the NSWC to ensure cheap and near available water for all residents. The availability of water will

facilitate clean ablution blocks and more will be constructed in informal settlement, schools and

other public area under this program.

Expansion of the sewerage system will solve the current problem of busting pipes and purchase of

five exhausters will ease and legitimize the work of pit latrines emptier who work in slum areas

under very unhygienic prone-to-diseases conditions.

This alternative will cost the county approximately Kes 1.2billion in laying the infrastructure and

hiring additional staff. It will increase access to piped water to a mean distance of 100 metres from

households and public institutions and reduce cost of water by 50%. The NSWC will have oversight

of implementation and maintenance.

c. Feasibility of Public Private Partnerships (PPPs) for water utilities

The policy is partly in practice as private investors partnered with the county government

formerly the county council of Nairobi to increase number of public toilets. The public toilets come

with water supply and bathing areas. These are within the CBD and the same has been extended to

informal sector by the donor community.

This alternative will completely solve the problem of open defecation and 'flying toilets' in slum

areas. Initial outlay is nil since the private investors would competitively bid to provide these

services and would pay fees to facilitate the bidding process. This would increase the number of

toilets to ensure a maximum of 5 households share a toilet block that is multipurpose with water

facilities. The private investors will be required to deliver piped water to all households in

partnership with Athi Water Services. Also, sewerage services will be provided to through the same

mechanism.

The fees charged by household will be regulated by the NSWC Company to ensure that there is no

exploitation and the mean distance to water points would be reduced to between 0 and 50 metres

while the cost of accessing water should reduce by about 60. All households, schools and

community areas would have access to water and improved sanitation facilities.

d. Feasibility of Training and deployment of additional primary health workers to all

administrative units

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The deployment of health workers will require hiring at least 2200 more trained personnel. The

primary health workers are to offer households, schools and the community at large sensitization of

preventive health care. This alternative will ensure every metro area will have public health

workers in the ratio of 2:800. The alternative however does not provide means of increasing access

to safe water nor improved sanitation to households, schools and common community areas.

e. Feasibility of County promotion of grey water reuse

The alternative will reduce cost of water by 20% and will not necessarily increase access to safe

water. It will mainly conserve water and save the trip to water points. Grey water will also improve

sanitation as it will be used in the toilets for cleaning. The county will not incur any cost while the

households and schools will incur the cost of installing a grey water system which can be as cheap

as the cost of a pipe (KES 200 per metre) to redirect grey water. The county will incur sensitization

cost which will require hiring expert personnel and five public health workers per metro area.

f. Feasibility of Steep penalties for vandalism of water infrastructures

The alternative will require passing of a Vandalism Bill by the County Assembly and require

creation of a monitoring and policing unit to deal with suspects of vandalism which cost

approximately Ksh. 1.5 million to set up the unit and Ksh. 1.2 million annually in subsequent years.

The alternative will reduce cost of accessing water by 15% and increase access to water by 20%.

The alternative will not increase sanitation facilities in the county. There is no significant opposition to this alternative.

g. Feasibility of Inclusion of WASH education in primary curriculum

The alternative will not increase access to safe water nor reduce cost of access to safe water and

improved sanitation. This alternative will instead in calculate good hygiene and sanitation habits

among school children who will be agents of good hygiene and sanitation for their respective

household. In this way the number of admission to hospital for WASH related illnesses will reduce

by 50%. Infant and child mortality is expected to reduce to 30 per 1000s live births and 50 per

1000 live births in five years of implementation of the policy.

Curriculum changes are mandated by the Ministry of Education at national level and therefore the

County will have to depend on the Ministry to adopt and implement the policy making immediate

implementation infeasible.

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Prince Analysis Stakeholders are critical to the success of any project and should be included in every major

assessment and decision. Stakeholders are defined as the ones who are positively or negatively

affected by the course of the project and any resulting solutions or conclusions. The Prince Analysis

is intended to provide insight into stakeholder views on a given issue. The prince analysis is a form

of Stakeholder Analysis that facilitates institutional and policy reform processes by accounting for

and often incorporating the needs of those who have a ‘stake’ or an interest in the reforms under

consideration, their interests, and their capacity to oppose reform, reform advocates can choose

how to best accommodate them, thus assuring policies adopted are politically realistic and sustainable and thus revealing a support for or opposition to the eight WASH policy alternatives

proposed above.

Four stakeholder groups were identified for purposes of the Prince Analysis as those groups which

have an interest in and authority in influencing and making sustainable WASH policy. The

stakeholder groups are:

1. General Population;

2. Nairobi County Government;

3. Donor Community;

4. Private Sector.

The eight policy alternatives are rated against each stakeholder group’s position on the issue, the

political power and influence of each stakeholder group and priority of the issue to each

stakeholder group;

a. Issue Position – Stakeholders will be ranked on a scale of minus two to three in the

following manner:

-2: Strongly Opposed -1: Fairly Opposed

0: Neutral +1: Fairly in Favour

+2: Strongly in Favour

b. Power – Stakeholders will be ranked according to their ability to influence a decision or

outcome. The rationale for this is to understand which interest group might hold more

influence on a given issue over another interest group. This will be ranked in the following

manner:

0: Low

1: Medium

2: High

The ranking “high” indicates the groups with the power of veto in both an informal and

formal setting. This ranking would include the Nairobi County and Donor Community since

they have significant connections in the political realm, are organised, have financial

backing and can lobby for a policy effectively. The general population will have a “low”

ranking even though they are large in number because they are loosely organized and

would tend to voice concern individually rather than as a group. Despite the general

population having a final say at a voting of either policies, they do not have direct individual

influence on a day-to-day basis. Therefore, the general population will have a “low” ranking.

Private sector would receive a “medium” ranking despite them having a significant number

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that would change an agenda, they do not have the backing that the donor community and

county may have. The “medium” ranking is maintained because they may have effective

lobbying effort.

c. Lastly, stakeholders are ranked according to the priority they hold for a specific alternative,

priority that the stakeholder groups hold are as follows:

0: Fairly important

1: Neutral

2: Highly important

In ranking each stakeholder group’s priority for this issue, the general population and donor

community would be given a “highly important” rating.

Table 4: Prince Analysis

Stakeholder Group Issue Position

(A) Power (B)

Issue Priority

( C)

Rating:

(A*B*C)

Status quo General Population 2 0 2 0

Nairobi County

Government 2 2 1 4

Donor Community 2 2 0 0

Private Sector 1 1 1 1

Total 5

Restructuring the

WASH

infrastructure in

the County

General Population 2 0 2 0

Nairobi County

Government 1 2 2 4



Total 12

Public Private

Partnerships

(PPPs) for water

and sewerage

utilities


Nairobi County

Government 2 2 1 4



Total 13

Training and

deployment of

additional

primary health

workers


Nairobi County

Government 1 2 1 2



Total 2

County promotion General Population 1 0 1 0

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of grey water

reuse

Nairobi County

Government 2 2 0 0



Total 9

Steep penalties for

vandalism of

water

infrastructures


Nairobi County

Government 1 2 2 4



Total 9

Inclusion of WASH

education in

primary

curriculum


Nairobi County

Government 1 2 2 4



Total 8

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Evaluation alternatives against Criteria The table below gives the scores of each alternative based on the evaluation criteria 0 being the

highest score and 5 the highest score. (Note that scoring on county resources to be used to put in

place the policy is negative showing the extent of resources to be applied).

Table 5: Evaluation alternatives against Criteria

Criterion Status quo-

current policy

Restructuring WASH

infrastructure

Introduce PPPs

Deployment of health

workers

Promotion of

reuse of grey

water

Penalties for

Vandalism

Inclusion of WASH educatio

n in primary

curriculum

Effectiveness

Alternative’s metric in improving water supply.

0 4 4 0 1 2 0

Alternative’s metric in improving sanitation.

2 3 4 3 3 2 3

Alternative’s metric in sanitation and hygiene education and water quality interventions.

3 3 3 4 1 1 4

Regulatory impact.

0 3 2 3 4 1 1

Alternative’s metric in improving hygiene.

4 3 4 2 2 1 2

Efficiency

Improved water distribution infrastructure.

1 4 4 0 0 1 0

Upgrade sewerage system.

1 4 4 0 0 0 0

Construction and maintenance of latrines/toilets in schools and informal settlements.

1 4 4 1 0 1 0

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County resource requirements imposed by the alternative policy.

-3 -4 0 -4 0 -4 -3

Sustainability

Cost of alternative over benefits gained.

3 4 4 2 3 1 1

Alternative prevention of children under five and infant mortality.

2 3 3 2 1 0 1

Alternative’s consistency in delivery of water to water points.

1 3 4 0 0 4 0

Alternative’s adequacy in water and sanitation infrastructure and hygiene campaigns and promotions.

3 3 4 2 1 1 1

Alternative’s promotion of innovative techniques and facilities for water and sanitation infrastructure.

0 1 3 0 1 0 0

Alternative’s awareness on importance of preservation of water catchment areas.

0 0 0 1 1 0 2

Administrative feasibility

Human Resource capacity.

1 1 3 1 4 1 1

Political and Public Acceptability

Support for policy across stakeholder groups.(Prince Analysis Aggregates)

5 12 13 2 9 5 8

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Alternative’s requirement of behavioral change.

3 3 3 4 3 2 3

Scale

Alternative’s impact to socio-economic groups targeted.

2 3 4 3 2 3 3

Equity and distributional effects

Alternative’s priority in the provision of water and sanitation infrastructure.

1 3 3 1 1 1 0

Alternative’s priority in administering public health.

3 3 3 4 4 2 4

Total Score 33 63 76 31 41 25 31

Recommendation Following the analysis, it is recommended that the county implements the alternative of Public

Private Partnership (PPPs) for water and sewerage facilities. Besides the fact that this alternative is

getting positive results in South Africa, it also rate highly against the evaluation criteria applied for

this particular policy problem.

The county should package the alternative in such way that would attract a large pool of investors

and develop a comprehensive metric to measure the investors for qualification and capacity to

deliver.

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References Evans, Barbara. 2005 “Securing Sanitation: the compelling case to address the crisis”. Report produced by the Stockholm International Water Institute (SIWI), in collaboration by the World Health Organisation (WHO) and commissioned by the Government of Norway as input to the Commission on Sustainable Development. Joint Monitoring Programme. 2014. “Progress on sanitation and drinking-water - 2014 update”. Report of a World Health Organisation/United Nations Children's Fund Joint Monitoring Programme for Water Supply and Sanitation. Ministry of Health, Government of Kenya. 2007. “National Environmental Sanitation and Hygiene Policy”. Drafted under the guidance of Environmental Sanitation and Hygiene Working Group (ESHWG) of the Ministry of Health and support from Water and Sanitation Program–Africa Region (WSP-AF), the World Health Organization (WHO), and the United Nations Children’s Fund (UNICEF). Newborne, P and Caplan, K. 2006. “Creating Space for Innovation: understanding enablers for multi-sectorial partnerships in the water and sanitation sector, Building Partnerships for Development”. Tear Fund. 2007. “Sanitation and hygiene in developing countries: A case study from Madagascar, identifying and responding to barriers”. Report of a collaborative project with the Overseas Development Institute. Water Supply and Sanitation Collaborative Council. (Undated). “Listening – to those working with countries in Africa, Asia and Latin America to achieve the UN goals for water and sanitation”. A WASH publication, Water Supply and Sanitation Collaborative Council.

Citations Brinkhoff, T. 2010. City Population. http://www.citypopulation.de UNEP. 2007. City of Nairobi Environmental Outlook. Accessed at http://www.unep.org/dewa/africa/docs/en/NCEO_Report_FF_New_Text.pdf USAID. 2010. Water Sanitation Profile, Kenya. Accessed at http://www.washplus.org/sites/default/files/kenya2010.pdf

http://www.citypopulation.de/

http://www.unep.org/dewa/africa/docs/en/NCEO_Report_FF_New_Text.pdf

http://www.washplus.org/sites/default/files/kenya2010.pdf

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