Health, hygiene and appropriate sanitation: experiences and perceptions of the urban poor

Don't teach us what is sanitation and hygiene. This quote from Maqbul, a middle-aged male resident in Modher Bosti, a slum in Dhaka city, summed up the frustration of many people living in urban poverty to ongoing sanitation and hygiene programmes. In the light of their experiences, such programmes provide inappropriate sanitation, or demand personal investments in situations of highly insecure tenure, and/or teach hygiene practices that relate neither to local beliefs nor to the ground realities of a complex urban poverty. A three-year ethnographic study in Chittagong, Dhaka, Nairobi and Hyderabad illustrated that excreta disposal systems, packaged and delivered as low-cost safe sanitation, do not match the sanitation needs of a very diverse group of urban men, women and children. It is of little surprise that the delivered systems are neither appropriate nor used, and are not sustained beyond the life of the projects. This mismatch, far more than an assumed lack of user demand for sanitation, contributes to the elusiveness of the goal of sanitation and health for all. The analysis indicates that unless and until the technical, financial and ethical discrepancies relating to sanitation for the urban poor are resolved, there is little reason to celebrate the recent global declaration on the human right to water and sanitation and health for all.