Safeguarding sanitation in high population density Kibera Slums settlements: A public health emergency


According to Water Aid (2006), approximately 1.1 billion people in the world do not have access to safe water, and another 2.6 billion do not have access to adequate sanitation. In developing countries an estimated 2.2 million people, most of who are children, die annually due to diarrhoea linked to a lack of access to safe drinking water, inadequate sanitation and poor hygiene (Water Aid 2006). The World Health Organisation estimates show that 88% of the burden attributable to unsafe water supply, sanitation and hygiene severely affects children in developing countries.

The poor are especially affected by inadequate and substandard sanitation services and these effects are not only limited to the health impact resulting from daily exposure to polluted habitats. Many of the poor, women and girls in particular, are forced to divert time and energy in search of a private place to relieve themselves. Often they can find such places only before dawn or after dusk which brings the risk of sexual assaults.

Women reduce their food and fluid intake during the day, which can result in kidney stones and urinal tract infections. Poor people are forced to pay in price for sanitation in terms of loss of time, dignity and health (Sijbesma, Diaz, Fonseca, & Pezon, 2008)

In many sector debates, no clear distinction is made between water and sanitation or between rural and urban areas. Often sanitation is assumed by default to be included with water as in the debates on privatisation(Allen, Adriana, & Hofmann, 2008). However, urban areas – irrespective of their size – are not simply very densely populated rural areas. Urban areas are distinctly different in a number of ways, such as: the large number of people living in rented accommodation, the relative proximity of government, the monetary character of the urban economy, the scarcity of land, the large fluctuating migrant populations, the cultural diversity, etc. All these contextual factors pose their specific challenges to delivery of urban sanitation services to the poor. Moreover, urban sanitation is not simply the flip side of urban water supply (Eales & Kathy, 2008).

In Africa, as many as 150 million urban residents representing up to 50 per cent of the urban population do not have adequate water supplies, while 180 million, or roughly 60 per cent of people in urban areas lack adequate sanitation. In urban Asia, 700million people, constituting half the population, do not have adequate water, while 800 million people or 60 per cent of the urban population is without adequate sanitation (UN-Habitat, 2008)

According to the Population Research Bureau, of the estimated 140 million people in

East Africa, the urban population comprises of at least 25%, 18%, 17%, 13%, and 11% in Tanzania, Kenya, Rwanda, Uganda, and Burundi respectively. An estimated 60 million people reside in East Africa’s informal settlements.

Statistics indicate by all measure that a third of the urban population is living in poverty. And therefore referring to World Bank/Cities Alliance figures indicated levels closer to a half, and also suggest that by 2020, urban poverty will represent almost half of the total poverty (Oxfam GB, 2009). It is approximated that over 60% of the urban population are poor and are living in deplorable informal settlements that are characterized with extreme deprivation of basic human needs especially service provision.

Urbanization has brought into play large array of negative impacts especially in the informal settlements ranging from the social issues to environmental ones. Just to mention but a few, some of these environmental issues include; high pollution levels {land, water and air}, poor solid waste management, poor drainage, poor housing, poor sanitation among others. The widespread sanitation and hygiene problems can be attributed to be as a result of poor political leadership, mismanagement of resources and poverty. The lack of basic services include; visible and open sewers, lack of pathways, the uncontrolled dumping of waste and polluted environments result to unhealthy living and hazardous living conditions. In addition, building of human settlements in unsuitable location for example near waste disposal sites are all issues to do with sanitation. Poor sanitation has led to increased diseases among the urban poor in the slums which are resulting to more deaths of children. These diseases are caused by the continued pollution of drinking water; entry of the bacteria into the food chains and this is mainly via fruits, vegetables, fish etc.; bathing, recreation and other contacts with contaminated water and also the polluted waters provide breeding grounds/sites for flies and insects which are responsible for spreading diseases.

With the already bulging population together with increasing levels of poverty, sanitation levels are growing from bad to worse. As evident , the local community in this areas are suffering and becoming more prone to infectious diseases leading to poor health standards which continues to be a growing nuisance especially to the most vulnerable who include the young ,women and the elderly and more so for people suffering from diseases that lower their resistance.

The global statistics on sanitation hide the dire situation in some developing regions. With an average coverage in developing regions of 50%, only one out of two people has access to some sort of improved sanitation facility. The regions presenting the lowest coverage are sub-Saharan Africa (37%), Southern Asia (38%) and Eastern Asia (45%). Western Asia (84%) has the highest coverage among developing regions. Out of every three persons two live in Southern Asia or Eastern Asia (WHO & UNICEF, 2006)

One of the major development challenges that the majority of African and Asian countries face is that of providing safe sanitation services in both urban and rural areas. While effort has been made by some governments to provide a basic level of these services to the population, the coverage levels have remained insufficient and only 61 per cent of the global population uses improved sanitation facilities. At least 2.6 billion people in the world are estimated not to have access to basic sanitation, of which 72 per cent live in Asia and 565 million are in Africa (WHO/UNICEF, 2010)

The sanitation coverage in Africa and Asia varies from country to country but the worst affected countries are in Southern Asia although there are also large numbers in Eastern Asia and Sub-Saharan Africa (WHO/UNICEF, 2010).

Access to adequate sanitation is generally a problem in most urban poor communities in Africa and Asia due to poor service provision by sanitation agencies, high population densities and limited availability of land to build new latrines once the old ones fill up (Wegelin-Schuringa, 1997)

According to the 2006 Human Development Report, two in three people in urban areas identify the “flying toilet‟ as the primary mode of excreta disposal available to them. With neither public nor private latrines available, many residents resort to defecating in plastic bags which they dump in ditches or throw on the wayside.

Factors leading to poor sanitation

  1. Urbanization

Globally, more people now live in urban centres than in rural areas and this trend is expected to continue. Within the next 30 years, developing countries are predicted to triple their population size and account for 80% of the world’s urban population. In Asia the rural population is expected to decrease in the next 25 years. Projections for this urbanisation look bleak, with slums to see 60%of all urban population growth and increased poverty. Without a fundamental change, our urbanising world will, in reality, become vast sprawl of inhuman slums and informal settlements.

The world population is becoming predominantly urban. While the population of industrialized countries is already largely urban, urbanization processes are still acute in developing countries. Today, 40 per cent of the population in developing countries already lives in cities. By the year 2020, that figure will have risen to 52 per cent. Latin America and the Caribbean already have 75 per cent city dwellers, while in contrast, only one-third of the population of Africa and Asia live in urban areas. The greatest challenge will present itself in Africa and Asia, where explosive demographics is expected in the next quarter century. By 2015,153 of the world’s 358 cities with more than one million inhabitants will be in Asia (UNCHS,Habitat, 2001)

Rapid urbanization, one of the greatest socio-economic changes during the last five decades or so, has caused the burgeoning of new kinds of slums, the growth of squatter and informal housing all around the rapidly expanding cities of the developing world. Urban populations have increased explosively in the past 50 years, and will continue to do so for at least the next 30 years as the number of people born in cities increase and as people continue to be displaced from rural areas that are almost at capacity. The rate of creation of formal sector urban jobs is well below the expected growth rate of the urban labour force, so in all probability the majority of these new residents will eke out an informal living and will live in slums.

The developing world has been predominantly rural but is quickly becoming urban. In 1950 only 18 per cent of people in developing countries lived in cities. In 2000 the proportion was 40 per cent, and by 2030 the developing world is predicted to be 56 per cent urban. Future urban growth in developing countries will be absorbed by urban centres, which have a high average annual urban population growth rate of 2.3 per cent, in contrast to the developed world’s rate of 0.4 per cent (UNHSP,Habitat, 2003)

According to the Population Research Bureau of the estimated 140 million people in

East Africa, the urban population comprises of at least 25%, 18%, 17%, 13%, and 11% in Tanzania, Kenya, Rwanda, Uganda, and Burundi respectively. An estimated 60 million people reside in East Africa’s informal settlements. As Table 1 shows, a relatively small proportion of East Africa’s population is classified as urban; this proportion is going to dramatically increase in the next 15 – 20 years (Lubaale & Musyoki, 2011)

Table 1: Urbanization Trends in East Africa

Country 2000 2010 2020 2030
Kenya 19.7 22.2 26.6 33.0
Uganda 12.1 13.3 15.9 20.6
Tanzania 22.3 26.4 31.8 38.7
Rwanda 13.8 18.9 22.6 28.3
Burundi 8.3 11.0 14.8 19.8
East Africa 20.7 23.7 20.20 33.7

2. Poverty

Poverty in East Africa remains one of the greatest challenges facing the people and their governments. In Uganda, poverty trends show a mixed picture. In 1992, 56% of the population was poor. This declined to 44% and 34% in 1997 and 2000respectively. Recent estimates show that urban poverty constitutes 18% compared to45% for the rural. Urban poverty increased from 9.6% in 2000 to 12.2% in 2002/03. The population in Uganda is predominantly rural and agricultural based. There are significant regional disparities in poverty levels, with the highest incidence in the north of the country. In these regions, long affected by conflict, all the MDG indicators fare very poorly.

For Rwanda, poverty fell from 60% in 2001 to 57% in 2005/06. There were important regional dimensions to this: the poverty headcount fell substantially in Eastern Province, fell by smaller amounts in Northern Province and the City of Kigali, and actually rose slightly in Southern Province. The level of inequality was already high in2000/01, with a Gini coefficient of 0.47, and this rose to 0.51 in 2005/06. The high initial level of inequality, and the fact that inequality worsened over this period, were important factors making the consumption growth less effective in terms of poverty reduction – in more technical terms, lowering the growth elasticity of poverty reduction. Inequalities rose in Southern and Western provinces in particular. Even though the consumption growth rate was positive in Southern Province, poverty also rose. The population of Rwanda is young, with a mean age of 21 years and children under 15 years comprising 43% of the population.

The Kenya statistics tell a slightly different story. At least a third of Kenya‟s urban population is living in poverty by any measure. Recent World Bank/Cities Alliance figures indicated levels closer to a half, and also suggest that by 2020, urban poverty will represent almost half of the total poverty in the country (Oxfam GB, 2009). It is approximated that over 60% of the urban population in Nairobi are poor and are living in deplorable informal settlements that are characterized with extreme deprivation of basic human needs especially service provision. The 2005/06 Kenya Integrated Household Budget Survey (KIHBS) showed worsening poverty both in rural and urban areas. But an analysis of recent poverty data shows an increase in urban poverty of close to 50% of the population (Lubaale, 2011).

3. Inadequate water provision

Historically, the informal settlements of Nairobi have lacked environmental services. For almost 20 years after independence in 1963; the government policy was to demolish informal settlements. In pursuance of this policy, the Nairobi City Council Water and Sewerage Department was unwilling to provide basic services to informal settlements for fear of legitimising them.

Such discriminatory policy practices have led to a situation whereby a large population is deprived and not served by the major city water networks, resulting in insufficient distribution outlets and acute shortages. This in turn has encouraged the proliferation of unofficial ways of accessing water services. Technically as well as institutionally these systems are inadequate, even if they are far better than no systems at all. Providing adequate systems would go a long way in ensuring the provision of sufficient water to Kibera. The position taken by the project was that the new pipe network would solve the technical insufficiency.

At the start of the project, water supply was distributed through small diameter pipes of 1.5 to 2.0 inches serving multiple users. These are individually owned parallel pipes drawn (illegally) from small diameter mains serving neighbouring residential areas. At the same time, there exists a limited distribution network provided by the Council in some villages. However, the suppliers/operators are not technically co-ordinated within the distribution network managed by the Council, are generally not officially recognised, and do not pay the regular dues. (Munguti & McGranahan, 2002)

4. Inadequate Planning

Urban settlements and cities in Africa continue to become more chaotic as increasing population put more pressure on capacity of urban cities to provide services to their residents. The cost of urban infrastructure and services (Housing, Water, Transport, Healthcare, and sanitation among others) has become unaffordable to majority of urban dwellers due to widespread poverty, and low-income levels. This has resulted to the growth of slums and informal settlements, which are unplanned, lack basic infrastructure and services such as water, electricity, roads, lighting and sanitation among others. It therefore emerges that Housing planning and development policies and concepts applied have failed to meet the demand for housing, infrastructure and services (Akatch & Kasuku, 2002)

The unplanned, crowded housing and lack of infrastructure have led to acute drainage and sanitation problems. In Kibera, water does not easily flow out of the compounds.  Blocked drainage channels, overflowing pit latrines (especially during rainy season), stagnant pools of dirty water and heaps of uncollected garbage are all too evident. The poor drainage and sanitation system has contributed to the emergence of breeding sites for mosquitoes and flies. Where the flow allows, the waste enters directly into the Mbagathi River, thus further polluting an important source of water for washing, bathing and, at times of extreme stress, for drinking (Munguti & McGranahan, 2002)

5. Poor Governance

Local Government should have a key role in all aspects of urban developments but in most developing countries, they are still weak. Strengthening the democratic self-governance at this level is very crucial. The slow decentralization of responsibility and authority need to be hastened up through the support of developing fiscal reforms and coming up with other means of increasing financial resources. The devolution of power to local authorities however must be accompanied by governance reforms and strengthening of institutional capacity. One of the most critical issues for the poor is lack of affordable land and basic services for housing and therefore more effective land and housing markets need to be promoted through regulatory reforms but local authorities got to handle land issues in a proactive manner. Legislation of informal settlements, provision of tenure security and improved basic services are urgent measures (Tannerfeldt & Ljung, 2006).

State of environmental conditions and their health implication to urban residents

  1. Dumping of Solid waste

There is no regular solid waste collection within the settlement. Most residents dispose off their solid waste by dumping it in open drains, along the railway line and in pit latrines. The closest collection point is on the main road outside the settlement (TRUST, 2009). The growth in MSW generation has been rapid, while the capacity to collect and safely dispose of the material has been on a general decline. Nairobi, gives a typical situation in most local authorities in Kenya over the years. The suburban areas, which are mainly occupied by the urban poor rural migrants and the jobless, are characterized by high population densities and unplanned poor residential structures which are hardly accessible (Henry, Yongsheng, & Jun, 2006).

2. Water Supply

According to Birongo and Le (2005), Kibera perhaps suffers the greatest water shortage in Kenya. In terms of water sources, Kibera relies on hawked water drawn from piped water, boreholes and the polluted Nairobi River to meet its water needs. Drinking water is pumped through plastic pipes alongside sewage trenches.

Most slums dwellers have three main concerns with water: access, cost and quality. They

complain about the limited access to water points, which are often located far from their houses, some landlords ration water such that it is only available on specific days of the week and at specific times. For many years, Kibera slum has not had clean water points as most collected water comes from Nairobi dam. The Kenyan government in 2007 admitted that sustainable access to water dropped to as low as 20 per cent in the settlements of the urban poor where half of the urban population lives. This is a tragic situation given that Kenya falls far below the estimated defined minimum water per capita requirement (Water Sanitation Programme, 2008).

3. Pollution

Given that these slum settlements are illegal in Kenya, slum dwellers are not provided any services, which would include; latrines, water, maintenance and repairs, infrastructure etc. which results in higher rates of defecation in public areas where there no clearly defined boundaries for waste disposal. Although the proportion of urban dwellers defecating publicly has declined by 33% per (from 3% in 1990 to 2%in 2008), this has not been the case in rural areas where proportion has increased from 17% in 1990 to 18% in 2008. In fact, more than 600,000 residents of Kibera have developed a common practice known as the “flying toilet”, which refers to the practice of defecating into a plastic bag that is then tossed away. This custom poses serious environmental problems and health risks for the people in the area and greatly contributes to water pollution (K’akumu & Olima, 2007).

There are trenches that carry refuse and human wastes to the river at the base of the valley. The river then runs into Nairobi Dam. Both the river and the dam are used for recreation (e.g. swimming) and resource (e.g. bathing; clothes washing). The plastic pipes are brittle and exposed, often breaking, to be repaired without care for sanitation. The pipes are jammed or taped back together often without being cleaned, creating suitable habitat for waterborne diseases like cholera and typhoid (Birongo & Le, 2005)

4. Sanitation and health

The United Nation Habitat (2008) have described sanitation and hygiene challenges in slums in terms of poor basic services results in lack of access to sanitation facilities or safe water sources. This is due to the lack of waste collection services, a poor rain water drainage system, poor infrastructure and absence the of an electricity supply. Diseases related to contaminated drinking-water, unsanitary food preparation, unimproved excreta disposal and unclean household environments constitute a major burden on the health of peoples in the developing world and are among the leading causes of ill-health.

Results from a study undertaken by studies show that around 4 billion cases of diarrhoea are experienced annually, resulting in 2.2 million deaths of children under the age of five. Research on health benefits has shown that the greatest impact on diarrhoeal disease comes from a wide adoption of three key practices: clean sanitary toilets used by all, hand washing by all with soap or soap alternatives, and safe storage and drawing of clean water (Sijbesma, 2008). Although the sanitation coverage is much lower in the rural areas compared to the urban areas, those living in urban areas face a greater risk to health. This is due to the much higher population densities in the informal settlements where the worst environmental health conditions prevail, resulting in illness and death (Mulenga et al., 2004).

The situation in Uganda is not significantly different from that in Kenya. The traditional approach has focused mainly on improving water supplies. Notwithstanding the emphasis on improving water supply, 80% of incidences of diseases in Uganda are linked to poor sanitation (Water Aid, 2006). These diseases are the top killer in the country with a lack of clean water accounting for nearly 50% of the diseases. In 1996 diarrhoea, worm infestations, eye infections and skin diseases (all either water borne or water related diseases) accounted for 23.5% of illnesses in all health units across Uganda. In Uganda, cholera epidemic in 1998 recorded 46,000 cases and 1,900 deaths in 37 districts. Some of the impacts are such that3.5% of all work time is lost due to sanitation related diseases culminating in 40 million working days per year lost due to sanitation related diseases.

In Kenya approximately 80% of hospital attendance is due to preventable diseases out of which 50% are water, sanitation and hygiene related. For example, about 2,500 Kenyans died from diarrhoea and gastroenteritis diseases in 1999. At about the same time, diarrhoea and gastroenteritis diseases were the highest causes of infant hospitalization. Thousands of children suffer nutritional, educational and economic loss as a result of diarrhoea and worm infections. In all these cases, informal urban settlements are the worst hit due to extreme congestion and general hygienic negligence. A rapid applied research pilot study to determine the level of hygiene awareness conducted in Korogocho slums of Nairobi in Kenya by NETWAS Kenya and the Water Supply and Sanitation Collaborative Council in 2003 indicated that knowledge on the key hygiene behaviours and practices by the slum residents was very low and only 29% of the respondents had ever attended any form of hygiene training (Ghosh, Karanja, & WSSCC, 2003).

Environmental improvements are very important in making the health status of individuals better. Prevalence of water-borne diseases, suggest that improvement in provision of drinking water, better waste management, improved toilet facilities in slums will lead to a more sustainable and significant improvement in health status than just simple treatment. From our point of view, investment in education, environmental infrastructure and sanitation are much more important than inverting in medical treatment or care (Mulumba, Juma, & Kakosova, 2004).

As a generalization, demand for sanitation in slums is high and the constraints relate to space, 279 affordability, limited design choice, lack of a permanent solution (linked to lack of pit 280 emptying services), land tenure and landlords not meeting their responsibilities.

Evaluating past initiatives to redress poor state of sanitation

Kibera Integrated Water, Sanitation and Waste Management (WATSAN) project

Another component of KENSUP is the Kibera Integrated Water, Sanitation and Waste Management Project (WATSAN), an initiative of UN-HABITAT‟s Water for African Cities program, led by UN-HABITAT and implemented by a local non-governmental organization, Maji na Ufanisi. A central goal of WATSAN is to address community inclusion, education, and economic development in Soweto East. Consequently, the program supports “small-scale community based initiatives in water, sanitation and waste management.” This program recognizes the fact that past attempts to improve water and sanitation in Kibera have failed because they did not integrate water, solid waste, sanitation, and drainage, which “need to be addressed simultaneously in settlements like Kibera if there is to be a perceivable improvement in the living environment.

Site identification and design for all infrastructures is complete, and construction of water and sanitation facilities has begun. Currently, deteriorating water standpipes and 110 toilets and 50 bathrooms serve the entire 70,000 residents of Soweto Village. The WATSAN initiative is facilitating the construction of ablution blocks, which are communal water and sanitation facilities. These sanitation facilities are “all-in-one complexes with VIP [ventilated improved pit] latrines, shower cubicles and water booths.” Community members are building the structures, which are strategically placed to provide access to all residents. Upon completion, residents will also be in charge of maintenance of these structures. There is no mention about how residents will pay for these new services (Marie Huchzermeyer, 2006)

Roles of Stakeholders in Sanitation


The Ministry of Local Government is in charge of formulation and administration of the Local Authorities Policy, the oversight and management of other local authority bodies through formulation of by-laws and also administration of the Local Authority Transfer Fund in order to oversee the general development of the local authorities in Kenya. Specifically the Ministry of Local Government and the Ministry of Water and Irrigation have common mandates with respect to the performance and good corporate governance of public water and sanitation utilities, as well as environmental sanitation related to disposal of excreta.

The Ministry of Health and Sanitation is the lead agency with respect to environmental sanitation with shared interest in the development of basic sanitation infrastructure and promotion of hygiene through continuous supply of sufficient clean water. The Ministry of Health and Sanitation, Division of Environmental Health, has the overall mandate for hygiene education and basic sanitation where facilities do not rely on sewerage systems, such as pit latrines which are predominant within the informal settlements and in rural areas. As stipulated under the National Health Sector Strategic Plan of Kenya and the National Environmental Sanitation and Hygiene Policy, the Ministry of Health is expected to undertake national hygiene campaigns in fulfilling its mandate to provide basic sanitation and hygiene education.

The Nairobi City Water and Sewerage Company (NCWSC) is the Water Service Provider in charge of water services in Nairobi area. The NCWSC was formed to take over provision of water and sewerage services from the former Department of Water and Sewerage in the City Council of Nairobi. The institutional responsibility for installation of water and sanitation infrastructure was handed over to the NCWSC for maintenance, while the Athi Water Services Board remained responsible for laying large scale infrastructure such as trunk mains.

The Nairobi City Water and Sewerage Company (NCWSC) has in place the Informal Settlements Department that will deal with water and sanitation supply in informal settlements. In coordination with the Athi Water Services Board, the NCWSC is targeting specific informal settlements to extend water and sanitation services through constructing water kiosks and ablution blocks (toilet and bathroom services) (Hakijamii Trust & COHRE, 2008).

Non-Governmental Organisations

NGOs play an important role in advancing the right to water and sanitation and are necessary stakeholders in the water sector. There are a number of Non-Governmental Organisations that deal with the various aspects on the right to water and sanitation in Nairobi. It is important to note that while some NGOs will assist CBOs with infrastructure development, others work purely on advocating for the human right to water and sanitation (Hakijamii Trust & COHRE, 2008).

The various roles played by NGOs in the sanitation sector can be broadly grouped into six categories:

  1. Facilitation of service delivery including direct service provision (particularly in emergency and humanitarian relief contexts or in areas characterised by extreme poverty or geographical remoteness) or playing an intermediary or broker role between communities and service providers.
  1. Community education, awareness-raising, sanitation and hygiene promotion and marketing including stimulating demand, gender sensitive approaches, supply chain strengthening and implementing behaviour change programs.
  1. Building partnerships and promoting networking between different sector actors including representing community views to governments and service providers and translating and communicating national policies and regulations to the local level.
  1. Capacity building for local governments, service providers, in-country civil society groups and end users (households and communities).
  1. Research and innovation including demonstration and piloting of innovative and locally adapted approaches and technologies.
  1. Engaging in policy dialogue including promoting proven approaches and technologies, communicating lessons learnt, communicating community needs, advocating gender equity and monitoring the effectiveness of programs and government initiatives.

Community roles

Full involvement of communities in all stages of programme implementation and management is the correct pragmatic approach for the present. However, this approach does not divest Governments and NGOs of their responsibility for continuing and evolving support of the programmes which they promote. As communities change, and the needs of their water and sanitation systems change, the appropriate type of support -education, training, financial subsidy, technical assistance, maintenance, even rehabilitation – should evolve. Without support, however, few community-based water and sanitation systems will achieve anything approaching permanence

Gap Identification

Most organisations seeking to solve or provide solution to the issue of poor sanitation in informal settlements have been inclined to believe that the way to go is by coming up with projects after projects. In a snapshot, many projects have been implemented at the community level with the aim of promoting better sanitation levels but all have fell short of the their initial expectations. They have partly tried to solve the existing problems but the overall effect of the implemented projects amount in less significant impact on the ground. With the multitude of programmes implemented in Kibera informal settlements to help in reducing the monster of poor sanitation; there is still a lot lacking to fully acknowledge that the levels attained are measureable and this can be mostly said to be because of being too reliable to the conventional project approach which has not being producing the expected output. Its planning approach is usually aimed at a given segment of the population thus does not look into sanitation chains(latrines not emptied, treatment systems not present); in terms of resources and efficiency; overlap is very common and as a result synergy is rarely achieved therefore sustainability is usually a recurrent and well-documented problem. For sanitation to be solved comprehensively, a service delivery approach need to be adopted whose planning focuses on entire population needs, factor all elements of sanitation chain and which aims to optimise resource and achieving high levels of sustainability and reliability and whose outcomes are achievable unlike the project approach which are not consistently achievable.

Theoretical Framework

Malthus population theory

According to Malthusian theory of population, population increases in a geometrical ratio, whereas food supply increases in an arithmetic ratio. This disharmony would lead to widespread poverty and starvation, which would only be checked by natural occurrences such as disease, high infant mortality, famine, war or moral restraint. His main contribution is in the agricultural sector. According to this theory there are two steps to control the population: preventative and positive checks. Preventative means control in birth rate, and uses of different methods to control birth; and positive checks means natural calamities, war, etc. His theory was wrong because Malthus only considered two factors when he established his basic graph: food supply and population growth. Other factors such as improvements in technology proved him wrong. He was right at his time but development made him wrong. If it wasn’t for outside influences on population growth and food supply, his mathematical reasoning which proved his theory and was right (Seidl, I & Tisdell, C. A., 1999) This theory touches on population growth which has often lead to urbanization which is a major contributor to poor sanitation in informal settlements but I found the theory insufficient regarding other aspects of sanitation.

Sanitation and Hygiene Service Delivery Model

This service delivery model was developed by Joep Verhagen and Peter Ryan in the year 2008. The model suggests that appropriate and sustainable service for the urban poor would be safe and easy to use and would not lead to further deterioration in the urban environment. As with most complex problems, the failure to provide such services has many tangled roots. To provide sustainable and affordable sanitation services to the urban poor a number of factors have to be in place and working together, irrespective of the technology:

  • Policy and political factors to create the environment to move forward
  • Knowledge factors to enable appropriate questions to be asked and decisions to be made
  • “Soft” factors such as skills, hygienic behaviour, norms and practices
  • “Hard” factors such as suitable technologies
  • Financial factors such as availability of finance for capital expenditure, ability/willingness of users to pay for services

For a service to work all of the above have to be in place. Where one or more are missing, the service is impaired or fails completely. With few honourable exceptions, there appears never to have been a comprehensive approach to planning and maintaining urban sanitation systems that has looked at these factors in combination.

In any event, in informal settlements, when it comes to sanitation, residents have by and large been left to fend for themselves. An individual household will take a decision to construct a toilet for its own use (perhaps shared with neighbours). What happens downstream in terms of impact on water supply, or in terms of when the pit is filled, is not a central consideration, at least not to start with.

A service delivery approach focuses on the service itself, understood in terms of quantity, quality, reliability and accessibility as the main objective of sanitation (and hygiene) interventions. This contrasts with a project-based approach, which typically looks at sanitation delivery systems. Two key aspects of the service delivery approach are scale and sustainability.

Services are provided by delivery systems. These contain both hardware and software. For sanitation, the hardware includes VIP latrines, Vacutugs and treatment plants, while the software includes hygiene education and the skills of the environmental health technicians. In some situations the system and the service may seem to be almost the same thing: certain types of ECOSAN may be a case in point (Verhagen & Ryan, 2008).

Conceptual framework

Service delivery approach is the best way to solve the ever resting problem of sanitation in our urban informal Settlements. As identified earlier, there are several causes of poor sanitation which could be as a result of poor governance in the area which lead to minor or at other times no planning at all for basic infrastructure like water systems, sewerage lines, roads, solid waste collection points among others. The situation is worsened by the inability of the existing population to afford the building of a sanitation block where they can dispose their faecal matter and that is why the issue of open defecation has been rampant in the informal settlements. Therefore the main pointer to the existing situation can be identified to be the prevailing poverty. The poverty is well demonstrated through the high levels of unemployment and the few with employment tend to earn very low income which cannot match up the needs to be catered for per given household. For us to solve the issue of sanitation informal settlements we need to switch from the idea of depending on NGO‟s to come up with projects to build sanitation blocks but the government should partner with these organisation to come up with an a long-term solution hence service delivery model which calls for strategic planning will concentrate on installation of sewer lines which can be diversely connected to the neighbouring affluent estates which are well provided with sewer infrastructure. Since the process of installing sewer line is very capital intensive, the government together with all other relevant stakeholders can join forces to ensure that sanitation sanity is promoted in Kibera slums through joint financing programme which will help see the problem brought to an end. Planning can be done with serious involvement of the community from the inception stage of the process. Once planning is done and the community is educated on the importance of better sanitation, then demarcation should be done where the perceived sewer line and water systems should pass and the existing households can be relocated tentatively or can be resettled in the Kibera flats which are as a result of Kenya Slum Upgrading Programme. Through these, the sewer infrastructure can commence with the local community providing the required unskilled labour which can be a source of income to them and therefore some economic empowerment in the process.

Also since a sewer line is a system that starts from collection to transportation and finally to treatment then disposal hence where the system ends needs to be improved to cater for the increased waste. Therefore the management of the treatment plant is required to be efficient and competent meeting in the required standards for their effluent of treated liquid waste. A good local administration in place can help identify specific points where sanitation blocks can be established to serve a given number of household and assist in their establishment.

In a nutshell for sanitation to be achieved in Kibera informal settlements, good governance should be in place, which is ready to work in association with the community and also willing to partner with various stakeholders to make this dream a reality and finally the governance in place should have strategies for economic empowerment of the population in the informal settlements thus to reduce poverty index and therefore improve the living standards. This will be promoted with continuous community education on the importance of proper sanitation thus environmental awareness can be highly inculcated in the lifestyle of these economically empowered citizens. When sufficiently and comprehensively done it will be a road map towards a successful capacity building achievement. The overall determinant of success or failure of this step of change will solely depend on the prevailing environment in terms of whether there are supporting policies and legislations which create conducive atmosphere for the implementation.


For proper levels of sanitation to be promoted in Kibera, then a something must be done to address this thorny issue. We appreciate that right a reasonable standard of sanitation is a right of every citizen of Kenya and thus all relevant stakeholders with diverse interests in Kibera need to come together and see how this „right‟ can be transformed from a mere desire in paper to become a reality. Since promotion of sanitation is a collective effort then community involvement should be instituted at every level of project development. Better governance from the local leaders and project developers and all stakeholders will help yield sustainable results. Perhaps, for the service delivery of amenities and infrastructure to materialise, it is high time for the government to do a formal planning for this settlement and issue title deeds that will ensure permanent houses can be availed to this noble Kenyans. Therefore since project-based sanitation promotion has not yet given the community the ripe fruits that it first promised, let’s turn to service delivery approach and turn around this nightmare of sanitation that has held back this fundamental right from these precious Kenyans.


  • The private sector and NGO‟s need to empower the local residents through organisation of workshops, seminars as well as trainings which will help teach this population on the importance of achieving sustainability when it comes to promoting environmental cleanliness.
  • The council need to establish a better solid waste management systems by establishing even if its large containers that will be used as disposal points to promote a clean environment.
  • The government should introduce community health workers to be visiting the homes in the informal settlement to ensure that the children health is upheld even in this dilapidated environment.
  • Environmental education needs to be extended to the community so that residents can be involved in reducing household waste by re-using the recyclables and disposing the other waste appropriately without disposing it on the drainages and on the river at night. Even the ones using flying toilets will benefit from this education.
  • The existing drainages need to be enclosed so as to avoid these exposed breeding sites that are increasing the potential of vulnerability to small children as well as various contamination that may result due to this exposure.
  • The county government should institute a frequent say monthly environmental clean-ups project campaigns to help upgrade the environmental outlook in the informal settlement.
  • Community participation should be made a priority in any development or project being established in Kibera so as reduce level of resistance and thus increase the chances of acceptability and success of the undertaking.
  • More CBO‟s need to be formed in order to supplement the works of NGO‟s and private sector in the area .e.g. to help in sensitization and educating the community on hygiene promotions and WASH activities
  • The government need to address the issue of title deeds and thereafter provide incentives to the landlords as they encourage them to build better houses which will give the government an opportunity to lay down the required service infrastructure. Title deeds will effectively be done once mapping for the informal settlement is appropriately done and thereafter subdivision of plots to be effected.
  • The county government together with the NGO‟s should collaborate in organising pro-environment campaigns that will encourage responsible water usages since it has been established to be a scarce resource. These campaigns should focus on re-use; reduce consumption and recycling to avoid unnecessary shortages.
  • Better Governance should be adopted by all local leaders and representatives of the area so that they have one mind towards the destiny of solving the sanitation problem once and for all without politicizing the process so as to achieve as sustainable development.
  • Since inadequate planning is coming out as a strong factor leading to poor sanitation levels, the national government should adopt the service delivery approach rather than concentrate on the over-relied project based approach which is not yielding sustainable solutions. Therefore planning for infrastructure and utilities need to be focussed. This will be achievable once a master plan for the large informal settlement is developed.
  • Government should construct a hospital in Kibera to help promote health education to the residents and treat the unending health-related diseases brought about by the poor sanitation levels e.g. malaria, diarrhoea, typhoid, eye and skin infections, cholera among others.

An Integrated Action Plan to Solve Sanitation Problem

Issue Proposed Interventions Actors Time Frame
Inadequate Planning Formalize the settlement through;

·         Submission &Issuance of title deeds

·         Doing a plan for the informal settlements


County government, Ministry of Lands 3 years
Poor Governance Promote institutional capacity through;

·         Proper legislations

·         Accountability sessions


County Government, NGOs, Local administration, community 1 year
Poor infrastructure Improve service delivery systems through;

·         Road construction

·         Sewerage connections

·         Water supply connections

·         Free Sanitation blocks to be constructed

·         Permanent housing to promoted through incentives

National government, international Financial institutions e.g. World Bank 5 Years
Poor Health standards Promoting better health standards through;

·         Building a hospital within Kibera

·         Government employing community health workers.


County Government, Ministry of Health, Private Sector 3 years
Low environmental Awareness Sensitization through;

Trainings, campaigns workshops, conferences etc.

NGOs, CBOs, Private Sector Continuous


Akatch, S. O., & Kasuku, S. O. (2002). Informal Settlements and the Role of Infrastructure: The case of Kibera, Kenya. Discovery and Innovation, 14(1), 32–37. doi:10.4314/dai.v14i1.15421

Allen, Adriana, & Hofmann, P. (2008). Moving down the ladder: Governance and sanitation that works for the urban poor. In Essay for the IRC Symposium on Urban Sanitation. IRC International Water and Sanitation Centre. Delft, The Netherlands.

Birongo, J. M., & Le, N. Q. (2005). An Analysis of Water Governance in Kibera, Kenya. Retrieved from

Eales, & Kathy. (2008). Partnerships for sanitation for the urban poor: Is it time to shift paradigm? In Essay for Symposium on Urban Sanitation. IRC International Water and Sanitation Centre. Delft, The Netherlands.

Ghosh, G., Karanja, B., & WSSCC. (2003). Water, Sanitation and Hygiene for All, The WASH Campaign in Kenya. NETWAS. Retrieved from

Hakijamii Trust, & COHRE. (2008). Summary Description of Water Sector Institutions in Nairobi, Kenya and their Roles.

Henry, R. K., Yongsheng, Z., & Jun, D. (2006). Municipal solid waste management challenges in developing countries–Kenyan case study. Waste Management, 26(1), 92–100.

K’akumu, O. A., & Olima, W. H. A. (2007). The dynamics and implications of residential segregation in Nairobi. Habitat International, 31(1), 87–99.

Lubaale, G. N. . (2011). The Challenges of Urban Planning for Poverty Reduction: Nairobi’s LASDAP (Draft PhD Thesis). University of Witwatersrand, Johannesburg.

Marie Huchzermeyer. (2006). “Slum Upgrading Initiatives in Kenya within the Basic Services and Wider Housing Market: a Housing Rights Concern,.” COHRE Africa Program.

Mulumba, J. A. ., Juma, O., & Kakosova, B. (2004). Health status of people of slums in Nairobi,Kenya.

Munguti, K.-K., & McGranahan, G. (2002). Public private partnerships and the poor: case study-Kibera. Small enterprises and water provision in Kibera, Nairobi. \copyright WEDC, Loughborough University. Retrieved from

Oxfam GB. (2009). Urban Poverty and Vulnerability In Kenya. Oxfam GB Kenya Programme.

Seidl, I, & Tisdell, C. A. (1999). Carrying capacity reconsidered: from Malthus‟ population theory to cultural carrying capacity. Ecological Economics.

Sijbesma, C., Diaz, C., Fonseca, C., & Pezon, C. (2008). Financing Sanitation in Poor Urban Areas. Essay for IRC 40 Symposium.

Tannerfeldt, G., & Ljung, P. (2006). More urban less poor: an introduction to urban development and management. Routledge. Retrieved from


UNCHS,Habitat. (2001). Cities in a Globalizing World: Global Report On Human Settlements. Gutenberg Press. Retrieved from

UN-Habitat. (2008). The State of African Cities. UN-Habitat,Nairobi. Retrieved from

UNHSP,Habitat. (2003). The Challenge of Slums Global Report on Human Settlements. Earthscan Publications Ltd,London and Sterling, VA. Retrieved from

Verhagen, J., & Ryan, P. (2008). Sanitation Services for the Urban Poor: Symposium Background Paper. Presented at the IRC Symposium: Sanitation for the Urban Poor Partnerships and Governance., The Netherlands: Delft, The Netherlands.

Water Aid (2006). Bridging the Gap: Citizens’ Action for Accountability in Water and Sanitation. Water Aid.

Water Sanitation Programme. (2008). Improving Water utility Services through Delegated Management. World Bank Water and Sanitation Programme.

Wegelin-Schuringa, M. (1997). Sanitation and communication situation analysis for peri-urban and rural areas in Zambia. IRC Delft, The Netherlands.

WHO, & UNICEF. (2006). Meeting the MDG drinking water and sanitation target : The Urban and Rural Challenge of the Decade. World Health Organization,Geneva.

WHO/UNICEF. (2010, update). Progress on Sanitation and Drinking-Water. WHO Press.

0 0 votes
Article Rating
Notify of

Inline Feedbacks
View all comments
Would love your thoughts, please comment.x