The provision of sanitation facilities - a basic necessity for human health, well-being, dignity, and development - remains a mammoth challenge for developing countries where the vast majority of the 2.5 billion people without improved sanitation facilities reside. Sub-Saharan Africa (SSA) is one of the regions where decent, dignified, and functional toilet facilities remain largely inaccessible. Most of the countries in SSA will miss the Millennium Development Goal (MDG) for sanitation. There are sharp contradictions in the region between formal and informal sanitation institutions. There is also a disconnect between actors at the macro, meso, and micro governance levels. This paper shows how multi-level governance analysis, path dependency, and institutional inertia can be used to improve understanding of some challenges in the sanitation sector in SSA, and discusses approaches that can contribute to improving the sanitation situation in a sustainable way. In addition, the paper asserts that demand-driven strategies and private sector involvement in the sanitation sector is paramount for establishing new sanitation paradigms and sociotechnical regimes. We conclude that a good understanding of actors at all levels - their various roles, interactions, and the way they interpret and respond to policies - is key to accelerating progress in sustainable sanitation coverage in SSA.

In the last 20 years, in semi-arid Brazil, rural communities have begun to use water management technologies for households, in agriculture, livestock raising, and the environment, such as cisterns, subsurface dams, conservation methods of soil humidity, and aquifer recharge. These communities were also prepared to deal successfully with the severe drought from 2011 to 2013. To contribute to living with the challenge of droughts and climate change in the future, these experiences are multiplied all over semi-arid Brazil and included in an overall management programme with a sustainable comprehensive structure. The so-called principles of living with the semi-arid climate are summarized into different guidelines for sustainable livelihood and production: access to water and sufficient land area; rainwater harvesting to provide water security to households and communities; preservation, recovering, and management of drought-resistant vegetation; emphases on raising of small and medium-sized livestock and water and forage storage; appropriate crop selection and sustainable extraction, processing and marketing of crop products; and capacity building of the people. All these initiatives should contribute to bringing the discussion about the 'National Policy on Living with the Semi-arid Conditions' to the National Congress of Brazil.

Mainstreaming gender in an emergency water and sanitation (WatSan) response can be difficult as standard consultations and participation processes take too much time. To facilitate a rapid response that includes women's needs, a simple Gender and Sanitation Tool has been developed that can also be used by less experienced staff. The tool is a step-by-step guide on how to collect required data to define design parameters for sanitation facilities, based on ad hoc consultations with women who will be their users. In 2012 the tool was tested in South Sudan within the context of a Medecins Sans Frontieres (MSF) emergency intervention. Using the tool allowed for a quick and easy way to consult women about the design of facilities and consequently, after construction, an increased usage of facilities was observed in the intervention group compared with a control group where the tool was not used.

In this issue’s Crossfire, Rolf Luyendijk and Catarina Fonseca discuss funding priorities and who should be responsible for financing maintenance in order to make WASH services sustainable.

Access to appropriate facilities for menstrual hygiene and management (MHM) is recognized as a neglected need within the sanitation sector globally. However, little is known about the magnitude or trajectory of this need. Further, the particular services and facilities required to meet MHM needs depend on the practices and products employed by women and girls. We use nationally representative data from 58 low and lower-middle income countries to estimate that 800 million women in such countries menstruate regularly. Positive correlations between menstruation and nutritional status, as well as menstruation and household wealth, imply a growing need for menstrual management solutions as poverty declines, but both effects are dwarfed by the impact of declining fertility rates. Data on imports of disposable menstrual products reveal exponential growth in their use in low and especially lower-middle income countries. This trend is likely to continue as incomes grow and markets develop, making ever greater the need for provision of appropriate disposal facilities.

Point-of-use water treatment, especially chlorination, is an effective intervention to reduce diarrhoea, a leading cause of death for children under five. Yet success in chlorination uptake has been limited. One obstacle is objection to treated water's taste/odour. Protective chlorine residuals that are not offensive to users require accurate dosing - a challenge in practice. Further, taste sensitivity may be different for populations never exposed to chlorinated water. Here, household chlorination trials in Bangladesh similarly revealed dissatisfaction with treated water due to taste and odour, although attempts to quantify chlorine sensitivity disputed the dissatisfaction at lower residuals. A granular activated carbon (GAC) filter fitted to the spigot of a covered tank removed the remaining chlorine residual prior to drinking and increased user satisfaction. Such a filter removes taste as a barrier and allows over-dosing contaminated water to ensure disinfection, with implications for areas with high s...

This paper documents water carrying by children aged 9-18 years across Malawi in Southern Africa and evaluates impacts on health and school attendance. At 12 urban and rural field sites quantitative data were collected by questionnaire interviews with 1,504 children. Qualitative data collection preceded the survey. Overall 89 per cent of girls and 66 per cent of boys carried water, with 68 per cent of girls, but just 32 per cent of boys, carrying water daily. Water as the heaviest load routinely carried was reported by 57 per cent of children and 35 per cent reported pains and health problems from load carrying. Up to 10 per cent of girls and 6 per cent of boys responded that carrying water made them late or absent from school. Geography, age, and other factors influence these patterns. We conclude that girls in rural and remote rural communities have the heaviest burdens of daily water carrying detrimental to their health and school attendance. Improving water access and challenging gender stereotyping should reduce burdens on children, especially girls. © Practical Action Publishing, 2013.