When is shared sanitation acceptable in low-income urban settlements? A user perspective on shared sanitation quality in kumasi, kisumu and dhaka

Shared sanitation facilities (SSFs) have contributed considerably to sanitation access in many low-income settlements. While many SSFs are of unacceptable quality, others have been found to be a hygienically safe and a socially and economically viable sanitation option. Within its framework, the WHO/UNICEF Joint Monitoring Programme (JMP), evaluating progress on the Sustainable Development Goals, considers shared sanitation as ‘limited sanitation’. Overall, there is uncertainty about the criteria to distinguish between unacceptable and acceptable quality of SSF. In our study, we used a user-centred qualitative approach in low-income urban settlements in Kumasi (Ghana), Kisumu (Kenya) and Dhaka (Bangladesh) and conducted 17 focus group discussions to evaluate how SSF users define the quality of an SSF and which aspects they consider as essential priorities for good-quality SSF. In descending order, the user priorities identified are: immediate water access, cleanliness, gender-separated toilets, flush toilets, lighting for use at night, lockable/functional doors, tiling, handwashing stations and privacy. This list can serve as input to the sanitation guidelines, local building codes and the establishment of minimum national sanitation standards. SSFs that meet these minimal criteria can then be promoted as an incremental step when individual household facilities are not feasible.