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      Current state and trends of access to sanitation in Ethiopia and the need to revise indicators to monitor progress in the Post-2015 era

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          Abstract

          Background

          Investigating the current level and trends of access and identifying the underlying challenges to sanitation system development will be useful in determining directions developing countries are heading as they plan to promote sustainable development goals (post 2015 agenda). This research investigates the status and trends of access to improved sanitation coverage (ISC) in relation to the MDG target in Ethiopia with the aim of identifying prevailing constraints and suggesting the way forward in the post-MDG era.

          Method

          We examined data from a nationwide inventory conducted in accordance with the sanitation ladder at the national level and from a household survey in randomly selected urban slums in Addis Ababa. The inventory data were analyzed and interpreted using the conceptual model of the sanitation ladder. We used administrative reports and survey results to plot the time trend of the ISC.

          Results

          The data from the nationwide inventory of sanitation facilities, which are presented along the sanitation ladder reveal that more than half of the Ethiopian population (52.1%) still used unimproved sanitation facilities in 2014. The majority (35.6%) practiced open defecation, implying that the country is far from the MDG target for access to improved sanitation (56%). Most people in urban slums (88.6%) used unimproved sanitation facilities, indicating that the urban poor did not receive adequate sanitation services. Trend analysis shows that access to ISC has increased, but Central Statistical Authority (CSA) data reveal a decline. This discrepancy is due to differences in data collection methods and tools. Dry pit latrines are the most widely used toilet facilities in Ethiopia, accounting for about 97.5% of the ISC.

          Conclusion

          The sanitation coverage is far from the MDG target and the majority of the population, mainly the urban poor, are living in a polluted environment, exposed to water and sanitation-related diseases. The sanitation coverage estimates might be even lower if proper utilization, regular emptying, and fecal sludge management (FSM) of dry pit latrines were considered as indicators. In order to enhance sanitation services for all in the post-MDG era, urgent action is required that will establish proper monitoring and evaluation systems that can measure real access to ISC.

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          Most cited references21

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          Sanitation and Health

          As one article in a four-part PLoS Medicine series on water and sanitation, David Trouba and colleagues discuss the importance of improved sanitation to health and the role that the health sector can play in its advocacy.
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            Socio-economic aspects of improved sanitation in slums: a review.

            This socio-economic review provides an overview of the sanitation crisis in slum areas, and re-emphasizes the importance of sanitation. It highlights a lack of recognition of actual drivers for sanitation improvements, and the complexities in the provision of sanitation services in the context of urban slums with a mix of tenants and landlords. It elaborates how the drivers of demand for sanitation outlined in contemporary research are not universal but are rather context specific. The authors point out specific knowledge gaps for future research; for example, the need to establish a scientific basis for context-specific drivers of demand for sanitation improvements in slums, and a better understanding of associated complexities in order to set boundary conditions for achieving desired improvements. Copyright © 2011 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
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              Sanitation: a global estimate of sewerage connections without treatment and the resulting impact on MDG progress.

              Progress toward the sanitation component of Millennium Development Goal (MDG) Target 7c was reassessed to account for the need to protect communities and the wider population from exposure to human excreta. We classified connections to sewerage as "improved sanitation" only if the sewage was treated before discharge to the environment. Sewerage connection data was available for 167 countries in 2010; of these, 77 had published data on sewage treatment prevalence. We developed an empirical model to estimate sewage treatment prevalence for 47 additional countries. We estimate that in 2010, 40% of the global population (2.8 billion people) used improved sanitation, as opposed to the estimate of 62% (4.3 billion people) from the WHO/UNICEF Joint Monitoring Programme (JMP), and that 4.1 billion people lacked access to an improved sanitation facility. Redefining sewerage-without-treatment as "unimproved sanitation" in MDG monitoring would raise the 1990 baseline population using unimproved sanitation from 53% to 64% and the corresponding 2015 target from 27% to 32%. At the current rate of progress, we estimate a shortfall of 28 percentage points (1.9 billion people) in 2010 and a projected 27 percentage point shortfall in 2015.
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                Author and article information

                Contributors
                abebe.beyene@ju.edu.et
                tamenehd@yahoo.com
                kfaris@worldbank.org
                helmutk@comcast.net
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                2 May 2015
                2 May 2015
                2015
                : 15
                : 451
                Affiliations
                [ ]Department of Environmental Health Science and Technology, Jimma University, P. O. Box: 378, Jimma, Ethiopia
                [ ]Research and Development Directorate, Ministry of Water, Irrigation & Energy (MoWIE), P. O. Box: 5744, Addis Ababa, Ethiopia
                [ ]Water & Sanitation Program (WSP), the World Bank, Ethiopia Country Office, P. O. Box: 5515, Addis Ababa, Ethiopia
                [ ]Department of Epidemiology and Biostatistics, University of California, 185 Berry Street, Box 0560, San Francisco, CA 94143 – 0560 USA
                Article
                1804
                10.1186/s12889-015-1804-4
                4424569
                25933607
                c6b33468-8df4-4338-8642-e28282eaa962
                © Beyene et al.; licensee BioMed Central. 2015

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 18 August 2014
                : 27 April 2015
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2015

                Public health
                improved sanitation coverage,sanitation trend,sanitation ladder,millennium development goals,ethiopia

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