Report No.

32230-EG
Report No. 32230-EG

Arab Republic of Egypt

Operational Framework for Integrated
Rural Sanitation Service Delivery

March 31, 2005

Water, Environment, Social and Rural Development Department

The Middle East and North Africa Region

Arab Republic of Egypt

Operational Framework for Integrated Rural Sanitation Service Delivery

Document of the World Bank

 Arab Republic of Egypt

Operational Framework for Integrated Rural Sanitation Service Delivery

ACRONYMS

AHD Aswan High Dam

BCM Billion Cubic Meters
BCWE3 Branch Canal Water Board
BCWUA Branch Canal Water User Association
BVS Basic Village Services Project
CBO Community-Based Organizations
CEA Country Environmental Analysis
CDA Community Development Association
CPMB Continual Performance Monitoring and Benchmarking
DANIDA Danish International Development Assistance
DWB District Water Board
FC fecal coliform
GDP Gross Domestic Product
GOE Government of Egypt
GWSC Ghana Water and Sewerage Corporation
I&D irrigation and drainage
IIIMP Integrated Irrigation Improvement and Management Project
ISP Intensive Sanitation Project
IWRM Integrated Water Resources Management
LDII-P Local Development 11-Provincial Project
LE Egyptian Pound
LSDF Local Service and Development Fund
METAP Mediterranean Environmental Technical Assistance Program
MDG Millennium Development Goals
MCM Million Cubic Meters
MOF Ministry of Finance
MOHUC Ministry of Housing, Utilities and Urban Communities
MOHP Ministry of Health and Population
MOLD Ministry of Local Development
MWRI Ministry of Water Resources and Irrigation
NGO Non-Governmental Organization
NOPWASD National Organization for Potable Water and Sanitary Drainage
NWRP National Water Resources Plan
O&M operation and maintenance
ORDEV Organization for Reconstruction and Development of the Egyptian
Village
PER Public Expenditure Review
SFD Social Fund for Development
TDS Total Dissolved Solids
UK United Kingdom
UNICEF United Nations Children's Emergency Fund
USA United States of America
USAID United States Agency for International Development
WHO World Health Organization
WS&S Water Supply and Sanitation
WUA Water Users' Association
WUO Water Users' Organization

Country Director Emmanuel Mbi

Sector Director Inger Andersen
Sector Manager Vijay Jagamathan
Task Mana er A at Soliman
 Arab Republic of Egypt

Operational Framework for Integrated Rural Sanitation Service Delivery

Table of Contents

Page

Executive Summary 1

PART A: CURRENT SITUATION AND CHALLENGES

1. Introduction

2. Rural Water Supply

3 . Sanitation

4. Hygiene

5. Water Quality and Water Management

6. The Sanitation Problem

PART B: PROPOSED FRAMEWORK APPROACH FOR DELIVERY OF

INTEGRATED RURAL SANITATION SERVICE

7. Overview of Framework

8. Key Performance Determinants

9. Guiding Principles, Goals and Challenges

10. Building Blocks for Framework

11. Framework Tools

12. Operational Structure of Framework

13. Framework Implementation

14. Financing and Cost Recovery

15. Monitoring and Benchmarking

PART C: STRATEGIC DIRECTIONS FOR THE FUTURE

16. Piloting

17. Timetable and Budget

18. Strategy for World Bank Involvement in the Sector

19. Conclusions

ANNEX : Fresh Evidence on Diarrheal Risk Reduction

REFERENCES
TABLES

Table 1.1: Administrative Classification of Egyptian Villages

Table 1.2: Classification of Villages by Population Size
Table 1.3: Residential Building Types in Rural Areas
Table 2.1 : Primary Source of Access to Water Supply by Rural Households in Rural
Governorates, 1996
Table 2.2: Drinking Water Supply Sources in Rural Egypt, 2000
Table 3.1: Sanitation Coverage in Rural Egypt
Table 3.2: Wastewater Treatment Technologies in Rural Egypt
Table 3.3: Overview of On-Site Sanitation Options
Table 3.4: Cost Data for Simple Dry Pit Latrine, Not Intended for Emptying, 1997 Prices
Table 3.5 : Cost Data for Simple Dry Pit Latrine, Intended for Emptying, 1997 Prices
Table 4.1 : Water Sources, by Purpose
Table 5.1: Municipal Wastewater Flows, Treatment, and Discharges
Table 5.2: River Nile Water Quality, from Aswan to Delta Barrage
Table 5.3: Results of Field Analysis for Canals and Rayahs
Table 13.1: Selected Sanitation Technology Options for Framework Projects
Table 17.1: Implementation Cycles for CPMB

FIGURES

Figure 1.1: Trend of % Irrigation and WS&S Expenditures to GDP

Figure 5.1: Variation in FC Counts of Nile Water from Aswan to Delta Barrage
Figure 12.1: Downstream Movement of Improved Water and Environmental Quality
Figure 12.1: Operational Structure of Strategic Management Unit
Figure 15.1: CPMB Implementation Mechanism
 Acknowledgements

This sector study was prepared by a team consisting of Messrsl Mmes. Ayat Soliman (Team
Leader), Albert Wright (Senior Sanitation Consultant), Ahmed Gaber (Senior Water Supply and
Sanitation Consultant), Maher F. Abu-Taleb (Senior Water Resources Specialist), Hani El
Saadani (Water Resources Engineer), Shakeb Asfah (Consultant, Performance Monitoring and
Benchmarking), Chris Woltz (Communication Consultant), and Ahmed Shawki (Water
Resources and Irrigation Specialist). N. Vijay Jagannathan is the Sector Manager, and Inger
Andersen is the Sector Director.

The team would like to express its gratitude to H.E. Dr. Mahmoud Abou Zeid, Minister of Water
Resources and Irrigation; H.E. Dr. Mohamed Ibrahim Soliman, Minister of Housing and Urban
Communities; Dr. Abdel Rehim Shehata, Minister of Local Development; and their senior staff
and advisors for their support and cooperation during the preparation of this report. The team
would also like to thank representatives of local government, water user associations, and
community representatives during the local-level consultations conducted in the Delta and
Fayoum. In addition, the team wishes to thank representatives of international donors in Egypt
that provided valuable information.

Substantial contributions were provided by Ashok Subramanian (Sr. Water Institutions Specialist,
AFTNL), Eustache Ouayoro (Sector Manager, AFTU2), Safwat Abdel Dayem (Drainage
Advisor, ARD), and Jennifer J. Sara (Lead Infrastructure Specialist, LCSFP). Peter Kolsky
(Senior Water and Sanitation Specialist, ESDWS) and Alexander Bakalian (Senior Water Supply
Specialist, MNSIF) were the peer reviewers and provided useful comments and guidance.

Finally, the team would like to acknowledge the financial support provided by the Environment
Anchor to cover the work on performance monitoring and public disclosure under this study.
 Arab Republic of Egypt

Operational Framework for Integrated Rural Sanitation Service Delivery

Executive Summary

The Challenge

The Government of Egypt (GOE) has taken several measures to safeguard the quantity and
quality of water in Egypt. To this end, it has spent about LE 18 billion on wastewater
management projects over the past two decades. Operation and maintenance (O&M) costs for the
water supply and sanitation sector alone constitute 4% of GOE total recurrent budget. Yet water
quality in the country continues to degrade, impacting health and the quality of life. This
degradation also frustrates Government plans for downstream reuse of drainage water, a key
component in Egypt's water resources strategy. Damage costs from poor water quality are
estimated at 1.8% of national GDP. Moreover, previous Government programs on sanitation have
been planned and implemented in isolation, often leading to expensive, geographically
fragmented infrastructure projects with limited improvement to the ecosystem.

Much of the organic pollution load reaching the country's water bodies comes from rural areas,
where 57% of the people live. The present national system for water supply and sanitation has a
strong urban bias, while rural areas suffer from weak or non-existent institutional structures for
sustainable service delivery and operation, particularly sanitation. Recent improvements in
drinking water supplies to the rural areas did not include facilities to safely dispose of the
consequent increases in wastewater flows. Statistics on high levels of sanitation coverage mask
many inefficiencies and problems in the system. Existing household toilets cannot cope with the
increased wastewater flows. The result is spillage of wastewater into streets, irrigation drains, and
even into nearby canals. In addition, many areas in Egypt have high water tables, which render
many types of conventional low-cost, on-site sanitation technologies inappropriate.

Facing tightening water resource limitations and the economic costs from water resource
degradation, the GOE has recognized the need to address rural sanitation issues in a broader
institutional and planning context. This expanded view considers both the economic and
environmental aspects of rural sanitation, as well as health and hygiene factors. In support of this
GOE broadened perspective, the current World Bank sector work was initiated. Its goal was to
identify the root causes of the problems and propose a framework for addressing them,
considering recent developments in the water sector as well as global experiences. The work
included of a series of background and supporting studies, leading to the present report. The
effort also benefited from parallel ongoing sector work, including the Integrated Water Resources
Management (IWRM) Action Plan, the Public Expenditure Review (PER) for the water sector,
and the Country Environmental Analysis (CEA) for Egypt.

A New Integrative Approach

The Framework presented in this report links - for the first time in the Egyptian context - access
to investment in rural sanitation services to quantifiable water quality (and health) improvements
in a given hydrologic basin. The Framework provides an integrative, institutional structure of
relevant Government agencies and serviced communities that is built on IWRM principles:
treating water as a holistic resource, management at the lowest appropriate level, and
stakeholder participation.
Two decades of experience in establishing farmer management organizations within the water
resources sector proved valuable in proposing the local institutional setup for sanitation service
management. The Framework relies heavily on performance monitoring and benchmarking
systems to create incentives for ensuring the quality of provided services. While cost recovery is
needed to sustain services, the approach acknowledges that public benefits (and hence the public
goods component) most often exceed private benefits.

The Framework is specifically designed to serve the 27,000 small villages not presently included
in Government plans for delivery of sanitation services. It addresses identified problems through
a coupled top-down/bottom-up, demand-responsive process that takes place between two anchor
points: one at the national level, the other at the village level.

From the national level, a top-down demand is exerted on rural communities, calling for them to
achieve national goals for irrigation water quality, improved public health, and improved
household sanitation. Interested villages provide a bottom-up response by stepping forward to
participate in a national competition for funds under the Framework. The funds would be used to
improve village-level sanitation as a way to reduce water pollution sources from villages, while at
the same time improving public health and household sanitation. Villages provide information
that demonstrates their readiness to participate. In doing so, they simultaneously exert a bottom-
up demand for funds from the national level to finance locally initiated projects developed in
response to local needs and preferences. Successful villages receive a top-down response in the
form of funds for local-level activities to improve sanitation.

The Framework's specific objectives include:

100% coverage of all houses within each project village with access to improved sanitation
services
effective facilities for wastewater disposal
discontinuation of the practice of discharging untreated domestic wastewaters into irrigation
drains, canals, or storm drains
cost-effective measures for solid waste management.

The Framework uses the hydrologic basin as the basic geographical unit to manage the quality of
water in irrigation drains and canals. It also relies on competition as a means to prioritize villages
in the allocation of funds. The key local stakeholders in the Framework will be villages, water
users' associations, Branch Canal Water Boards, and local administrations. Stakeholders at the
national level are the Ministry of Water Resources and Irrigation (MWRI), Ministry of Housing,
Utilities and Urban Communities (MOHUC), Ministry of Local Development (MOLD) and
Ministry of State for Environment Affairs (MSEA), thus merging infrastructure provision with
ultimate ecosystem improvement goals.

The Framework envisages a Strategic Management Unit at the national level accountable to a
Framework Advisory Board. The Management Unit will define water quality and other national
goals for each hydrologic basin, in Branch Canal Water Board command areas, and within
villages. Actions taken at the village level to meet the national goals should, however, be locally
initiated and in accordance with local preferences.

Continual performance monitoring and benchmarking at village and Branch Canal Water Board
levels is a key element in creating both the incentives and public disclosure mechanisms for
achieving, monitoring, and sustaining water quality and health goals.
Piloting and Replication

In considering this Framework approach, it is important to be aware of recent developments in the

water supply and sanitation sector, including creation of the Holding Company for Water Supply
and Sanitation, which is an important step towards creating a financially viable structure over the
coming period. In addition, GOE is studying options to streamline and enhance subsidy targeting
in view of increasing fiscal burdens. This context further enhances the opportunity for the
Framework to become a viable option in addressing the vast challenge in phases.

The approach and elements of the Framework were discussed and endorsed at a high-level
Ministerial meeting among MWRT, MOHUC and MOLD in October 2004. It was agreed that an
integrative approach is the way forward to addressing compounded challenges in the water sector.
One of the key recommendations of the GOE representatives was to start by piloting the
methodology as a first step to replication and scaling up to the national level.

Piloting the proposed Framework approach in representative typologies can provide examples for
providing new service models in rural areas. These can then be integrated within a more
comprehensive, institutional market-oriented reform of the overall water supply and sanitation
sector. Many of the resulting lessons could also be applied to mother villages and urban areas.
First piloting options could include linking improved sanitation service with an improved
irrigation infrastructure through piloting the Framework approach in command areas of the new
Integrated Irrigation Improvement and Management Project (IIIMP).

Government, donors, and beneficiaries will be the principal sources of financing. In view of other
ongoing efforts in the water sector, the World Bank could provide added value to the piloting and
the subsequent implementation of the Framework. This would be done by leveraging funds and
integrative capacity across the water resources and water supply and sanitation sectors.
 PART A: CURRENT SITUATION AND CHALLENGES

1. INTRODUCTION

1.1 Purpose

The Government of Egypt (GOE) has taken several measures to safeguard the quantity and
quality of water in Egypt. Under its municipal water and wastewater program, the Government
has spent about LE 18 billion on wastewater management projects over the past two decades. At
present, there are more than 200 wastewater treatment plants in the country. Rural sanitation
coverage levels are high compared to those in other lower middle-income countries. Yet there is a
continuing degradation of water quality with direct impact on downstream availability, human
health, and the Nile River and northern lakes ecosystems.
Apart from agricultural wastes and salinity problems, the principal sources of organic pollution of
the country's water resources are domestic and industrial wastes. As a slight majority of the
population (57%) lives in rural areas, their contribution to pollution from organic wastes can be
significant. It is; therefore, appropriate for the Government to direct part of its water quality
improvement efforts toward rural sanitation.

Egypt ranks among the best lower middle-income countries in the world in providing rural
communities with improved drinking water supply and sanitation. Census data from 1996
indicate that 85% of buildings in rural Egypt had some type of sanitary facility, compared with
84% that have some type of in-house water supply (piped connection, yard tap, or hand pump).
The report of the Joint Monitoring Program for 2000 indicates that the access figures for water
supply and sanitation were 96% and 95%, respectively. Despite this, Egypt faces increasing
problems of public health and water quality deterioration from inadequate rural sanitation.
Organic pollution loadings to drains and canals are increasing. An important feature of Egypt's
dense and complex irrigation system is that drainage water often flows back into canals, where it
is reused for agriculture and may also serve as raw water sources for municipal water supplies.

The objective of this World Bank initiative is to identify the root causes of the problems and
propose a Framework for addressing them, taking into consideration related ongoing
developments and concerns in the country as well as experience from other countries. To provide
the background for the Framework, Part A of this report reviews the existing rural water supply,
sanitation, hygiene, and water management in rural Egypt within the general demographic,
physical, and institutional context.

1.2 The Rural Egyptian Context

The population of Egypt is 67.3 million, of which about 57% is rural. It is important to note that
the urbanlrural distinction - at least in the Nile Valley and Delta, which contain over 98% of
Egypt's population - is primarily an administrative distinction. An urban area is one
administered by a city council, and a rural area is one administered by a district council with
constituent village councils. Some villages are as populous, dense, and built-up as provincial
cities. There are 1,111 village council areas in Egypt, each consisting of a main (or "mother")
village, five or more satellite villages, and a number of smaller settlements, variously called
naga-s, or izba-s, or kuJirr-s. The small settlements are considered parts of one or another
satellite village, and the satellite villages are affiliated to one or another main village. There are
4,451 satellite villages. The number of settlements has never been officially enumerated, but is
estimated at 27,000 (hence, the typical rural settlement hierarchy is on the order of 1:4:5.). Of the
5,633 villages (main and satellite, with the small settlements included within the village
populations), 73% have populations less than 10,000; 25% have populations between 10,000 and
30,000; and 2% have populations exceeding 30,000. Table 1.1 shows the distribution of villages
in Egypt by administrative type.

Table 1.1 Administrative Classifications of Egyptian Villages

Source: Description of Egypt 2000, Cabinet Information Center, March 2002.

A key demographic feature of Egypt is population density in both urban and rural areas. The
average population density is 6 2 h 2 . It ranges from 2 persons/km2 in over 96% of the total area
to 1,492 persons/km2 in the Nile Valley and Delta areas, which account for about 4% of the land
area. About 98% of the present population lives on only about 4% of the available land. In rural
areas, the population density is about 1,500 p e r s o n s h 2 . Table 1.2 shows the size distribution of
Egyptian villages.
 Table 1.2 Classification of Villages by Population Size
No. of Villages of No. of Villages No. of Villages of
-
Population Less than of Population Population More
Governorate 10,000 Between than 30,000
10,000 and

Giza
30.000 --
Aswan -
-
lsmailia -
Red Sea -
-
-
Sharqiya -
Gharbiya -
-
-
-
Minya
I New Vallev
-
-
I Beni Suef -
South Sinai -
Damietta -
Sohag -
North Sinai -
Qena -
Kafr-El-Sheikh -
Luxor Cit 10 12 0
83 1 0
3,578 1,257 98
Source: Data of Ministry of ILC
scal Development, Based on Extrapolation of 1996 Census Data of the
Central Agencyfor Public ~obiliz&ionand Statistics (CAPMAS),2003.

Another demographic feature is the proximity of rural settlements to watercourses. With the
growth of population and settlements, irrigation canals and drains now pass through villages. This
feature has significant implications for sanitation and water quality in Egypt.

A high water table is found in much of the rural Delta, Fayoum, and Aswan, and to a lesser extent
in other locations. This poses formidable water supply and sanitation challenges. The basic
problem is that piped water consumption in these areas contributes quickly to further elevation of
the water table, leading to percolation and capillary action on house foundations and walls,
ponding in streets, and even ponding within homes. A high water table undermines the
performance of most on-site sanitation solutions. An elevated water table leads to the need for
very frequent - and costly - desludging, perhaps as often as once a week. Also, the high level of
village demand is such that households may have to wait days for the truck to show up.
Households may cope with these problems by self-limiting their piped water consumption to
levels below those recommended for health andlor by resorting to the use of unsafe sources
outside the home. Alternatively, the community will construct an informal gravity sewer system
that discharges untreated wastewater to a drain. Thus, water supply investments in high water
table areas are virtually without health benefit unless accompanied by concurrent sewerage
investments.
Residential buildings in rural areas are built of redbrick or mud brick (adobe). The
distribution of building types in rural areas of the rural governorates (in 1996) is given in
Table 1.3. The higher percentages of adobe construction in Upper Egypt Governorates are
obvious. Yard taps are more prevalent in adobe buildings than in redbrick buildings, where
house connections are more likely. A high water table will threaten the residents of different
building types in different ways: in adobe structures, residents will fear collapse of the
building from subsoil water percolation and capillary action, whereas in redbrick structures
(which are more likely to have house connections and to be multistory structures containing
several households), the main concern is how often the building's septic vault needs
evacuation.

Table 1.3 Residential Building Types in Rural Areas

Total Residential
Governorate Redbrick Adobe
Buildings
Number % Number %
Damietta 102,253 96,298 94% 5,955 6%
Daqahliya 522,970 312,484 60% 210,486 40%
Sharqiya 625,244 254,525 41% 370,719 59%
Qalyubiya 313,661 168,128 54% 145,533 46%
Kaft il-Sheikh 270,300 140,410 52% 129,890 48%
Gharbiya 411,223 222,202 54% 189,021 46%

ena 364,660 41,337 11% 1 323,323

Aswan 124,612 15,500 12% 109,112 88%
Luxor 74,783 16,003 21% 58,780 79%
1Source:TOTAL 5,986,476 1,987,786 33% 1 3,998,690 1 67% 1
Central Agency for Population Mobilization and Statistics (CAPMAS): Initial Results of the 1996
Census of ~&ulation,Housing, and Establishments

1.3 Institutional Framework of the Rural Water and Sanitation Sector

1.3.1 Local Administration

Local administration law assigns governorates the responsibility to "manage and operate utilities
of local character," which include waterlwastewater utilities. The waterlwastewater utility
management structure has been grafted onto the local administration structure. The highest level
of local administration is the governorate, which is divided into districts. Each district is centered
on a city or town, with a hinterland composed of a number of villages. The villages - classified
as main villages, satellite villages, and hamlets - are grouped into village council areas; the
village council is headquartered in the main village. At each level of local administration is a pair
of councils: an executive council composed of department heads, and an elected council, which is
a representative body. The village executive councils tend to be quite small; few villages have an
engineering department, so the village councils often seek the assistance of the district council in
technical matters, including water project planning, implementation, and operation.

The satellite village is the smallest unit that has any type of corporate identity under the Egyptian
local administration system, insofar as it is entitled to representation on the village popular
council. Community Development Associations (CDAs) are quasi-governmental organizations
that officially articulate the smaller settlements (nagas, azbahs, ku&rs).

Local council activity is primarily oriented to needs assessment and advising higher levels of
government on project needs. The governorates receive annual allocations from the state budget
for small-scale infrastructure projects. Supplementary funding comes from two other programs:

Shorouk is a national program for rural development established in the early 1990s to sustain
the participatory style of local council planning introduced to rural Egypt in the 1980s by the
USAID-funded Basic Village Services Project (BVS, 1981-1988) and the Local Development-I1
Provincial Project (LDII-P, 1988-1992). Each village council has a Shorouk Committee that
includes members of the village executive and popular councils and other community
representatives. Work projects require community cost sharing in capital costs, either in cash or in
kind, or both. Shorouk is managed by ORDEV (Organization for Reconstruction and
Development of the Egyptian Village), which is part of the Ministry of Local Development.

The Social Fund for Development (SFD) is a national-level program designed. to fund rural
public works and provide employment on public works programs. The program framework is
similar to Shorouk's. SFD often uses Non-Governmental Organizations (NGOs) and Community
Development Associations (CDAs) as social intermediaries and project implementers. Like
Shorouk, SFD seeks the participation of local popular councils in needs assessment and project
selection.

1.3.2 Water and Wastewater Authorities

An important consequence of the local administration arrangement is that Egypt's public water
systems are not managed under separate urban and rural authorities, as is the case in many Asian
and African countries. Rather, they are managed and budgeted as governorate-level utilities, with
most governorates containing both urban and rural settlements. Moreover, given Egypt's
population density and the centrality of the Nile water system as a drinking water source, many of
the physical water supply schemes are regional in scale. They cover one or two cities and a large
number of villages, thus tending to suppress the administrative distinction between urban and
rural systems. Engineering, maintenance, and quality testing resources (human, physical, and
financial) tend to be located in the district capitals, resulting in an "urban bias" in terms of
investment, operations management, and customer service.

Utility management is not as decentralized as the preceding paragraph might imply, for the
following reasons:

a) Most investments in water and wastewater treatment plants are handled by the National
Organization for Potable Water and Sanitary Drainage (NOPWASD), an arm of the Ministry
of Housing and Utilities (MHU).
b) Tariffs are set by the Cabinet. The tariff schedule is more or less uniform for all the rural
governorates and unrelated to their particular costs of service. Tariffs cover only a fraction of
operation and maintenance (O&M) costs (and none of the capital costs); hence, the utilities
depend on the Ministry of Finance (MOF) for most of their operating budgets.

Governorate utilities plan and implement the water distribution systems, with funding received
from the Ministry of Planning, the Shorouk program, or the Social Fund for Development. All of
these programs are general municipal infrastructure programs and fund road projects, etc., as well
as water and wastewater projects. Shorouk in particular - and SFD to a lesser extent - are
organized as block grant programs and seek village input into project identification and selection.
The networks generally suffer from poor selection of materials, poor design, and weak
supervision of pipelaying, leading to structural problems such as excessive leakage or breakage.
Secondly, the piecemeal manner in which networks are extended results in a steady degradation
of hydraulic efficiencies, characterized by low pressure in some zones and excessive pressure in
others. Low pressure leads to unreliable supply and contamination by subsurface water (where
water tables are high); high pressure increases the likelihood of pipe bursts, resulting in stretches
of time in which the zone receives no supply.

Operations management by the utilities is constrained by:

poor quality of completed works, leading to difficulties of operation and maintenance

inefficient methods of network problem identification and repair
deteriorating quality of raw water sources
limited incentives to bill and collect user charges
limited incentives to actively market water supply services to unserved areas or users
inadequate budgets for O&M
underskilled staff
chronic shortages of materials and supplies.

Steps toward local utility management reform and commercialization were taken in the early
1980s with the establishment of public sector water and wastewater companies in three rural
governorates (Beheira, Kafr il-Sheikh, and Damietta, all in the north). Further steps were taken in
1995 with the establishment of public economic authorities in seven governorates (Daqahliya,
Sharqiya, and Gharbiya in the Delta, and Fayoum, Beni Suef, Minya, and Aswan in Upper
Egypt). These reforms have consolidated facilities, personnel, and O&M budgets for
waterlwastewater utilities at the governorate level so that the water utility becomes a cost and
responsibility center distinct from other types of municipal services. The reforms also permit
revenue retention, unlike the local administration arrangement, in which the tariff revenue reverts
to MOF. They have definitely improved levels of responsiveness and cost recovery, but the
improvements have been only incremental, as the new utilities are still subject to the Cabinet
tariff schedule and to the full range of governmental personnel, procurement, budgeting, and
expenditure regulations. A recent presidential decree (135/2004) has made these 10 utilities (plus
the Cairo and Alexandria utilities) subsidiaries of a new National Holding Company for Potable
Water and Wastewater Projects under the Minister of Housing and Utilities.

1.3.3 On-Site Sanitation

No governmental agency regulates or provides technical or financial assistance in on-site

sanitation. UNICEF and SCF have been active in the Upper Egyptian governorates Asyut, Qena,
Sohag, and Aswan. Generally speaking, UNICEF and SCF assistance has been directed to small
communities situated along the escarpment of the Nile Valley, slightly beyond the irrigated area.
These communities have been neglected in public investment programs because they are small
and poorly represented in local councils.

There are surprisingly few detailed case studies of nongovernmental provision of rural sanitation
in Egypt. Virtually all published material on NGO activity in sanitation in Egypt is related to their
participation in donor-funded projects. Most often, the material represents the work of technical
assistance contractors or project evaluators rather than accounts written by the NGOs, much less
by Community Development Associations, who are the most common local implementation
agents.

From the limited information available, the following can be concluded:

The vast majority of reported NGO-based rural sanitation work is donor-funded. An

evaluation of a major USAID Egypt NGO capacity-building project found that 18 of 20
NGOs studied depended entirely on donor funding (Development Associates International,
2003). It is possible that this finding contains significant reporting errors; there may be
fully local initiatives that are not reported simply because the organizers are not obligated
to submit a report. Although no case of a fully community-based initiative was found in the
available documentation, it simply cannot be the case that rural Egypt has achieved 85%
sanitation coverage without significant locally originated initiatives, even if only in
constructing vaults1soakaways.

The typical NGO rural sanitation package includes funding for materials,
technicallengineering assistance, and organizational development. The NGO intervention
is often limited to building community support and mobilizing community resources for the
works. More recently, some of the donor programs have made capacity-building a project
objective. Such efforts may include support for community environmental action plan
preparation, training in project planning (Logical Framework Apprach, etc.), or training in
project financial management.

As far as cost sharing arrangements are concerned, labor is always provided by the
beneficiaries, though it is not clear in any instance whether this means physical labor by the
beneficiary or community hiring of manual laborers. There is greater variety in materials
cost-sharing arrangements, e.g.:

materials supplied by NGO

funds for materials provided by NGO, with purchase by CDA
materials costs shared in varying proportions by NGO at CDA
loan provided by NGO for some materials costs
part grant, part loan
NGO funds used to seed local revolving fund.

The revolving fund concept appears to be gaining popularity (see CARE, 2001 and
National Council of Negro Women, 1998). Revolving funds enable low-income
beneficiaries to spread their payments over years; in the Tansa village fund described later
in this report, a 10% interest change was applied to repayments to ensure fund solvency.

Whether on-site or off-site technologies are used, the local administration or local water
authority is invariably involved in O&M. In the case of off-site systems, the village sewers
 ultimately drain to a government-owned treatment facility, whether in the village or a
nearby town. In on-site systems, the household or communal facilities must be evacuated,
most commonly by sewerage vacuum trucks owned by the local council or the water
authority, though in some areas, a profession of sarabtiya (manual vault evacuators) can
still be found. Evacuation frequencies are determined by water consumption, water table,
and soil permeability levels; in some high water table areas, vaults need emptying so
frequently that households have lowered their water consumption below safe levels. The
governmental evacuation truck services are generally non-responsive and inefficient, and
disposal is usually to an agricultural drain.

e) No mechanisms for O&M cost recovery were described in any of the NGO-based rural
sanitation case studies.

Danish, Dutch, Finnish, KfW, UNDP, and USAID projects have also included on-site sanitation
components. However, based on a review of the size of these programs over the past two
decades, it is estimated that no more than 10% of household latrines in rural Egypt could have
been built with NGO or donor assistance. The overwhelming majority of on-site sanitation
systems in rural Egypt have been paid for directly by the householders, either by their own labor
or in the cost of house construction. The principal contribution of the NGOs and donors, apart
from the benefits to particular villages, has been to demonstrate innovative on-site technologies.
The impact of this contribution may be limited by the lack of an organizational "home" in which
the information can be stored and disseminated.

1.3.4 Irrigation and Drainage

The Ministry of Water Resources and Irrigation (MWRI) plans, constructs, operates, and
maintains the irrigation system from the Lake Nasser reservoir to the tertiary canal level and the
drainage system downstream of the tertiary canal user group. Irrigation and drainage departments
are organized in separate vertical hierarchies down to the district level. The boundaries of
irrigation and drainage districts are not coterminous. With the assistance of USAID and the
Netherlands, MWRI is promoting the development of participatory water user associations
( W A S ) at branch canal and district levels to plan water deliveries, resolve disputes among water
users, and maintain systems. There is partial capital cost recovery for tertiary canal and drainage
improvements, but no recovery of O&M costs, although pending legislation would allow the
W A S to charge and collect for agricultural water usage. Also and importantly, MWRI licenses
surface and groundwater abstractions and sets standards for municipal wastewater discharges to
drains.

The local canal system has three levels: (1) main canals, which draw from the large feeders that
take water directly from the Nile), (2) branch canals or distributaries, and (3) the tertiary level, the
mesqa, from which a group of farmers pump water to their farms. The mesqa watercourse is the
property of the farmers; all higher level watercourses are state property, constructed, managed,
and maintained by the Ministry of Water Resources and Irrigation.

Beginning in the late 1980s, the GOE initiated a program of mesqa improvement. It replaced the
formerly anarchic system of pumping based on individually owned mobile pump sets with a
system of single-point pumping to the mesqa, combined with physical improvements to the
mesqa ditches and a system of downstream control gates to allow continuous flow. A system of
partial capital cost recovery is attached to the mesqa improvements. The improvements have
given farmers greater water control, resulting in higher yields and enabling shifts to higher-value
crops. Legislation was developed to require the formation of mesqa-level water users'
associations ( W A S ) on improved lands, since some form of organization is needed to ensure
orderly distribution of water among the average 200 farmers in a mesqa under the single-point
pumping regime. There are presently some 5,700 W A S , covering about 10% of the irrigated
areas of the Valley and Delta.

Several donors, especially USAID and the Netherlands, have sought to expand the participatory
structures of the WUA to the public irrigation and drainage (I&D) system, starting with the
lowest level of that system, the branch canal. The different terms used in various technical
assistance projects - USAID prefers "branch canal water user association" (BCWUA), while the
Netherlands projects prefer "branch canal water board" (BCWB) - reflect differences in emphasis
within an overall agreement on the value of participatory, decentralized water management.
USAID views the BCWUAs as organizations for managing local I&D affairs. The Dutch-
conceived "water boards" include I&D management, but also are intended to address broader
water resource management issues, such as municipal pollution. (It should be noted that USAID
is not averse to BCWUA consultation or participation in the broader IWRM arena. Instead,
USAID is perhaps more "respectful" of current predictions, under which investments and O&M
of wastewater systems come under authorities other than MWRT, such as the governorates,
Ministry of Housing, Utilities, and Urban Communities ,etc.)

There is no legal basis for BCWUAs or water boards at present. This sets constraints on their
capacity to enforce decisions and especially on their capacity to raise funds for maintenance. The
Ministry of Water Resources and Irrigation (MWFU) has prepared draft amendments to the
Irrigation and Drainage Law (Law 1211984), which if approved, would allow the formation of
water users' organizations at any level of the public system and allow them to collect, retain, and
spend funds, all subject to MWRI regulation. (The draft amendments are currently at the earliest
stage of legislative review by the State Council. They will then be reviewed by the Cabinet, the
President, and the People's Assembly.)

There are now about 120 branch canal W A S and four district water boards, mostly established
under donor programs and with uncertain legal foundation.

1.4 Financing of'the Water Sector

Municipal water and wastewater services are currently heavily subsidized by the Government,
amounting to LE 25 billion/ year for drinking water and LE 2-3 billion1 year for irrigation water.
Public municipal water and wastewater agencies are caught in a vicious circle of low tariffs and
poor service. Although they were meant to be autonomous on O&M costs, economic authorities
are not legally allowed to adjust rates, which are generally set by local or governmental councils.
In Cairo, service fees comprise only 25% and 10% of the actual costs of water supply and
sanitation, respectively, as the major sources of finance are domestic loans and sovereign services
aid. The inherent subsidies to the O&M of the Water Supply and Sanitation (WS&S) subsector
amount to LE 3 billionlannum, or 2% of the total public recurrent expenditures1. Cost recovery in
secondary citiesltowns is better in water supply (with Alexandria being as high as 50%), but it is
as low as 10% in sanitation. Also, there is no reliable per-apartment metering, apart from
dwellings in new communities. Only recently, there has been an attempt to increase the tariffs for
Cairo, but this awaits approval by local councils and parliament. The debt overhang of the WS&S
subsector has reached LE 14 billion.

' World Bank, "Egypt Public Expenditure Review: Water Sector Policy Note," draft version, January 2005.
Source: Egypt Public Expenditure Review: Water Sector Policy Note, January 2005.

F i g u r e 1.1 T r e n d o f O
h lrrigation a n d
W S & S E x p e n d i t u r e s to G D P

I% T o t a l lrrigation
E x p . to G D P
I% Total W S&S Exp.
to G D P
2. RURAL WATER SUPPLY

Rural sanitation issues in Egypt must be situated in the context of rural water supply and usage
practices. This chapter presents a review of drinking water sources and uses, with emphasis on
public health aspects.

2.1 Water Supply Coverage

According to the Description of Egypt published by the Cabinet Information and Decision
Support Center in March 2002, the capacity of public water source/treatment works in rural Egypt
in 2000 ranged from a high of 702 litres per capita per day (LCD) (in Ismailia) to 70 LCD (in
Minya). These figures represent installed capacity divided by governorate population and hence
do not represent consumption levels, which are affected by plant operating efficiency, physical
losses, number of connections, use of alternative sources, etc. The high Ismailia figure is
unusual; without it, the range is 328 LCD to 70 LCD. The median Lower Egypt "installed LCD
capacity" is 120 LCD (Aswan); the median figure for Lower Egypt is 143 LCD (Sharqiya). Note
that these figures include urban areas.

There are few field studies that have measured actual household or LCD consumption by source,
and if there were, the reliability of the results would largely be limited to the particular district, as
indicated by the vast differences in installed LCD capacity noted above. Studies by Chemonics
International (2002) in Beheira indicate an average of 125 LCD provided to house connections in
FY 2001/02. Estimates are further complicated by the poor condition of most consumption
meters. Yard taps and standpipes are not metered at all.

For data on water supply coverage, this study has relied on the results of the most recent national
census of Egypt, carried out in November 1996. Although the results are now nearly eight years
old, they remain the most reliable and extensive source, as the census was conducted on a door-
to-door basis and covered all households.

The census tables present the data in terms of numbers of households by governorate. The main
distinction in the census is between households that rely on public supplies and those that rely on
private supplies. Public supply includes the following types of facility:

house connection
tap in the building (or compound)
public tap (standpipe)

Private sources include:

hand pumps
shallow wells
other (presumably supply by water trucks).

The data presented in these tables must be evaluated in the light of field observations, which
suggest that many rural households rely on multiple sources, including canal water (which the
census questionnaire did not offer as a response choice). Even households with house
connections may rely on standpipes or canal water for some uses, particularly washing of clothes
and utensils, for reasons to be discussed below. We can be sure that any household with a house
connection was counted in the census as having a house connection. But the tables do not
provide insight into the actual pattern of use in a multisource environment.

Table 2.1 shows type of access by rural households in the 18 rural governorates. The
governorates are sorted in descending order of number of households that do not rely on public
supplies.

The table indicates surprisingly low levels of house connection in rural households: only 40% of
rural households in rural governorates have house connections. Rates of house connection exceed
50% in only four rural governorates. Rates of house connection are 25% or less in six
governorates.

The table shows that 3 1% of households depend on building taps or public taps. Reliance on a
tap inside the building - the chief source for 17% of rural households - is very much a rural
phenomenon. The figure of 3 1% is likely to refer to yard taps within the central courtyard areas
of traditional Egyptian adobe residential compounds. The percentage of households relying on
building taps is generally higher in Upper Egypt (though Kafi il-Sheikh in the Delta also has a
high percentage). Most rural residential compounds will contain one or two elementary families;
a few may contain as many as four.

The main source of private supply is the hand pump, the primary source for 27% of rural
households; reliance on other types of private supply is minimal. Aquatero situations2 are known
to exist in some locations, but have not been documented. The high level of reliance on hand
pumps is potentially a problem, since these shallow sources (10-15 m) are susceptible to pollution
by wastewater seepage from vaults.

The Egypt Demographic and Health Survey 2000, relying on a sample of 16,957 households
throughout Egypt, suggests significant improvement in coverage since 1996, though it is possible
the survey includes a level of sampling error (e.g., under-representation of less accessible
households).

An aquatero is a small-scale private water supplier; the term comes from Latin America. The stock-
taking review did not find evidence of privately owned rural water schemes in Egypt. The primary
aquatero role in rural Egypt is in door-to-door water delivery by truck, which has been reported in
fringe areas of the Delta, specifically Beheira's western edge.
 Table 2.1 Primary Source of Access to Water Supply by Rural Households in Rural Governorates, 1996

Governorate Total Families Public Network Other Sources

(1996 Census)
Tap inside house . Tap inside building Standpipe Subtotal Pump Well Other Subtotal

Number % Number % Number % Number % Number % Number % N u m b e r % Number% Number %

Vlinya 548,755 100 73,302 13% 86,040 16% 85,580 16% 244,922 45% 292,397 53% 226 0% 11,210 2% 303,833 55%
--

Sohag 493,069 100 91,686 19% 147,595 30% 9,288 2% 248,569 50% 235,597 48% 2,637 1% 6,266 1% 244,500 50%
Sharqiya 690,006 100 293,015 42% 64,471 9% 148,952 22% 506,438 73% 159,790 23% 489 0% 23,289 3% 183,568 27%
Qena 369,691 100 84,812 23% 91,025 25% 12,375 3% 188,212 51% 166,891 45% 2,882 1% 11,706 3% 181,479 49%
Qalyubiya 415,566 100 182,576 44% 45,298 11% 10,445 3% 238,319 57% 172,356 41% 12 0% 4,879 1% 177,247 43%
Minufiya 453,890 100 194,69C 43% 62,850 14% 27,927 6% 285,467 63% 153,296 34% 616 0% 14,511 3% 168,423 37%
Asyut 378,435 100 78,162 21% 125,400 33% 21,854 6% 225,416 60% 146,663 39% 2,560 1% 3,796 1% 153,019 40%
Beheira 561,187 100 214,710 38% 53,864 10% 150,241 27% 418,815 75% 111,331 20% 1,482 0% 29,559 5% 142,372 25%
Gharbiya 473,565 100 270,252 57% 66,764 14% 31,634 7% 368,650 78% 103,381 22% 52 0% 1,482 0% 104,915 22%
Daqahliya 666,733 100 461,445 69% 67,420 10% 41,184 6% 570,049 85% 94,189 14% 2 0% 2,493 0% 96,684 15%
Giza 474,452 100 260,275 55% 96,811 20% 30,353 6% 387,439 82% 83,025 17% 2,916 1% 1,072 0% 87,013 18%
Beni Suef 267,116 100 40,674 15% 49,646 19% 91,898 34% 182,218 68% 82,641 31% 28 0% 2,229 1% 84,898 32%
Luxor 78,445 100 36,611 47% 12,028 15% 4,474 6% 53,113 68% 17,046 22% 781 1% 7,505 10% 25,332 32%
lsmailia 75,108 100 31,111 41% 4,745 6% 14,763 20% 50,619 67% 22,008 29% 137 0% 2,344 3% 24,489 33%
Aswan 115,214 100 58,081 50% 46,673 41% 3,37C 3% 108,124 94% 4,259 4% 61 0% 2,770 2% 7,09q 6%
-
'ayoum 300,298 100 62,417 21% 78,631 26% 154,816 52% 295,864 99% 2,684 1% 721 0% 1,029 0% 4,434 1%
<afr al-Sheikh 328,979 100 160,286 49% 55,996 17% 109,813 33% 326,095 99% 1,695 1% 1,189 0% 2,884 1%
3amietta 150,123 100 139,102 93% 3,862 3% 5,679 4% 148,644 99% 249 0% 1,231 1% 1,48q 1%
TOTALS 6,840,632 2,733,207 40% 1,159,119 17% 954,646 14% 4,846,974 71% 1,849,498 27% 15,602 0% 128,560 2% 1,993,66d 29%
Source: Central Agency for Population Mobilization and Statistics (CAPMAS): Initial Results of the 1996 Census of Population, Housing,
and Establishments
 Table 2.2 Drinking Water Supply Sources in Rural Egypt, 2000

Source Rural Lower Rural Upper Egypt

Egypt
House connections or yard tap 65.8% 64.0%
Standpipe 10.6% 11.6%
Private hand pump 19.2% 21.3%

Source: Egypt Demographic and Health Survey, 2000

2.2 Reliability and Continuity of Supply

The presence of a house connection provides little indication of the level of water service provided. The
problem of low levels of service, while never quantified at a national level, is widespread in rural Egypt.

Problems of quantity are manifested in low continuity or reliability of piped water supply. For instance, a
survey in five village council areas in Fayoum Governorate (IWACO/DHV/ECG, 1992) found that 46%
of households complained of low water pressure, 30% of frequent water cuts, and 22% of water not being
available during daytime. Problems of continuity or reliability dispose villagers to "conjunctive use" of
canal water for functions such as washing clothes and utensils, bathing, and even washing foodstuffs.

The causes of continuitylreliability problems are hydraulic and structural. Hydraulic problems derive
from the design and layout of the water scheme, i.e., disequilibria between the capacities of the source,
treatment, transmission storage, and distribution components of the scheme or the hydraulic design of the
distribution system. Hydraulic deficiencies are the most common source of water supply continuity
problems and the most extensive in their impact. They stem from the piecemeal manner in which
Egyptian water schemes have been expanded. Most expansions are regional, developed by extending an
urban scheme to surrounding rural areas3. The urban schemes were expanded by transmission lines to
rural centers (e.g., main villages) and subsequently, by extension from main villages or main lines, to
smaller and smaller rural settlements. In the simplest case - extension without additional sourceltreatment
capacity - the result is that a fixed amount of supply must be spread over an increased demand. This
problem was addressed in two ways: either through expansion of the original sourceltreatment facility, or
by installation of small "package" water treatment plants (the so-called "compact units") at the extremities
of the network. The piecemeal nature of the extensions and capacity additions have led to an overall
degradation of scheme hydraulics, evidenced in zones of chronic low pressure (characterized by low levels
of supply) and zones of chronic high pressure (characterized by repeated pipe bursts leading to service
cuts).

Structural sources of continuitvlreliabilitv vroblems derive mainly from shortcomings in construction of

elevated storage and of distribution systems. Many elevated storage tanks in Egypt are no longer
operational, due to problems in construction/equipment and repair. Structural problems in the distribution
pipelines are of two types: (1) problems in material or pipelaying, which lead to breakage (often
--

Most parts of the Delta, Fayoum, and Aswan are covered by regional schemes now. The schemes vary greatly
in size, with the largest, such as the Shirbin scheme in Daqahliya, covering as many as a million people. Each
scheme takes its name from the largest water treatment plant in the system (always a conventional plant), but
may include many contributing compact units or groundwater stations as well. As networks become
increasingly interconnected, the schemes grow in size. The schemes are managed by the governorate utility.
In a few cases in which the scheme extends to another governorate, the water is sold in bulk to the
neighboring governorate, usually at the domestic tariff rate.
exacerbated by old age or by increased surface traffic weights on city streets), or (2) problems in
materials, pipelaying, or pipefitting, which lead to leakage. Naturally, hydraulic problems exacerbate
structural problems (pipe breakage in overpressurized zones), and structural problems exacerbate
hydraulic problems (physical leakage is estimated be 25% of water produced).

The local utility is responsible for maintaining public standpipes. Standpipe areas are poorly maintained
and often muddy and dirty. Several taps on the standpipe may no longer be operational.

2.3 Drinking Water Quality

Egypt relies on three types of water source/treatment technology:

a) large conventional surface water filtration plants, drawing from the Nile or canals
b) compact filtration plants, drawing from the Nile or canals
c) groundwater pumping stations, drawing from depths averaging 70 m4.

Many regional schemes combine supplies from different types of plants.

The quality of water discharged from large treatment plants is generally acceptable, although deteriorating
raw water quality in the Nile and main canals poses a growing threat.

The quality of water discharged by compact units is generally poor from a bacteriological standpoint. As
noted earlier, these units were installed mainly in the 1970s and 1980s to supplement supplies from large
surface water treatment plants (in areas lacking safe groundwater sources) as the urban schemes were
extended to the rural areas. The compact units present a set of problems:

a) Performance has suffered from lack of proper maintenance and problems of repair. Spare parts for
dosage regulators, etc., are difficult if not impossible to procure. Some experts now maintain that
the older compact units actually perform as pollution concentrators and injectors rather than as
water treatment facilities.

b) The majority of the units have aged well beyond their lifespans.

c) The compact units use canals as intake sources. Hence, they are subject t o levels of water pollution
in the canals, especially during "off' periods in the irrigation rotation. They are also subject to
source shortages at times of the year when canal levels are lowered to allow for maintenance.

NOPWASD plans to invest in additional compact units during the 2002-2007 five-year plan, presumably
to replace the ones that are no longer operating.

Groundwater-based works may suffer from quality problems related to chemical content and/or bacterial
pollution:

While each governorate has its own waterworks configuration, the example of Beheira water supply can be
used to illustrate the physical and management scales of the infrastructure involved. The Beheira utility
operates nine conventional water treatment plants, 28 compact units, and 92 groundwater-pumping stations.
Beheira is a large governorate, with 16 districts, but not significantly larger than other Delta governorates. It
is slightly atypical of Delta governorates insofar as the southern and western fringes have usable groundwater
sources.
 The water source may have high (TDS), leading to a salty taste andlor contain high levels of iron
(Fe) or manganese (Mn). Low-cost technologies for Fe/Mn removal have been tested in Egypt with
positive results, and NOPWASD has allocated significant 2002-2007 plan funding for supply and
installation of Fe/Mn removal units. Wells that produce water with TDS values above safe levels
are closed down.

Bacterial pollution has occurred in locations where residential settlements have intruded into the
wellhead precinct, leading to pollution of the wellhead by wastewater. The GOE response has been to
install chlorination units in the affected works. This strategy entails public health risks related to
carcinogenic properties of disinfection by-products. A sustainable strategy would involve proper
siting (or re-siting) of works, combined with wellhead protection and rigorous enforcement of
building controls.

The most general source of hazard to users of piped systems is contamination of supplies in the network
resulting from suction of subsurface water into underpressurized and structurally flawed pipes. To a large
extent, this problem is mitigated by high levels of post-chlorination that provide, in effect, for in-situ
treatment within the network.

Some distribution systems do not have washing and air valves, and few local utilities have mains flushing
programs.

2.4 Alternative Sources of Water

This chapter has focused on municipal water supply systems. But no discussion of rural water supply in
Egypt is complete without considering the use of alternative sources of water. The principal alternative
source is the canal. Though canal water is rarely used for drinking, it is commonly used for bathing (by
males), washing clothes and utensils (by women), and may occasionally be used to wash foodstuffs (an
instance of this way observed by the consultant).

There are basically three explanations for the use of canal water:

a) Sociologically inclined observers have suggested that doing chores at the canals provides women in
the conservative culture of rural Egypt with an acceptable social space for meeting with other
women of the village and for status display of clothes and utensils.

b) Households may need to use canal water for high-volume uses if they do not have a piped
connection or if the piped supply is unreliable, infrequent, or underpressurized.

c) Households in areas with high water tables may minimize the use of domestic sources (especially
piped connections) if they do not have a sewer connection. This is because under high-water-table
conditions the cesspit does not drain, and there are risks of house flooding and house collapse unless
the vault is evacuated very frequently, which is costly.

3. SANITATION

This chapter reviews sanitation coverage in rural Egypt, the types of technologies in use, and some of the
institutional forms of service provision and cost recovery.
3.1 Sanitation Coverage in Rural Egypt

Table 3.1 shows the percentage of buildings in the 18 rural governorates of Egypt with sanitary facilities.
The left-hand columns show sanitation coverage in the urban areas of these governorates, and the right-
hand columns show coverage in rural areas. The table indicates overall coverage of 85%; this percentage
is roughly equivalent to the percentage of buildings (in Table 2.1) that had in-house water supply sources
(40% house connections + 17% yard taps + 27% hand pump = 84%).

3.2 Sewerage in Rural Egypt

The table shows that 10% of buildings are sewered. This represents some 54 of the 1,111 village council
areas. NOPWASD has sewerage projects underway in another 74 village councils, and planning and
design work is underway for 256 more village councils. Shuruq has projects in various stages of
implementation in another 50 village councils. Most of these collection system projects use conventional
sewerage. Three small-bore sewerage networks have been implemented in rural Egypt; results have been
good, and another seven projects are underway. Many conventional sewerage systems have received
donor funding.

These figures do not include informal sewerage systems, i.e., systems installed by villages without
Government assistance and without notifying the Government (since they are in contravention of GOE
municipal wastewater discharge regulations). The number and extent of such systems is by definition
impossible to determine. The driving force for villagers to pay for such a system is typically a serious
high water table problem, since the problem puts their very homes in jeopardy. Such cases demonstrate
willingness to pay for sewerage under certain conditions.

3.3 Rural Wastewater Treatment

Both conventional and innovative wastewater treatment technologies have been applied in rural areas.
Table 3.2 lists the types of technology in use or under construction. GOE wastewater discharge regulations
notwithstanding, not all villages with official sewerage have wastewater treatment facilities, though the
understanding is that treatment will eventually be provided.

3.3.1 Activated Sludge

Conventional, activated sludge consists of primary treatment followed by aeration, sedimentation, and
chlorination prior to disposal in drains. This system is used primarily in the larger cities, and it achieves a
removal efficiency of 95%.
 Table 3.2 Wastewater Treatment Technologies in Rural Egypt

Date Funding Technolow Status

1986-1993 LD IINSAID Stabilization Pond
I I Aerated Lagoons I
Oxidation Ditch
operational
Extended Aeration
Fixed Film Reactor
Trickling Filter
Aerated Lagoons
operational
Stabilization Pond
Stabilization Pond
Oxidation Ditch I under construction
Extended Aeration
Stabilization Pond 3 operational
+ 3 under
construction
1995-present ShoroukIORDEV Stabilization Pond
under construction
Aerated Lagoons
1997-present Netherlands Upward anaerobic
under construction
sludge blanket (UASB)

Extended aeration was developed as a simpler form of conventional treatment that would be easier to
operate and maintain, and that would improve operating efficiency by up to 98%. It has been applied in
eight villages in Damietta, two in Sharqiya, and one in Gharbiya.

The oxidation ditch is a modified, extended-aeration system that is less costly to construct, but requires
25% more land than the normal extended-aeration system. There are 38 villages in Damietta, Menufiya,
Qalubiya, and Sharqiya using this technology.

3.3.2 Trickling Filter

Instead of an aeration tank, this technology relies on a trickling filter for biological action. Easier to
operate and maintain than an aeration tank, it is also less costly to construct. The drawback is that it
requires three times as much land. Currently, trickling filter technology is used in three villages, including
Sanhour in Fayoum Governorate.

3.3.3 Lagoons and Stabilization Ponds

Aerated lagoons consist of one or more lagoons that are aerated by diffused air or mechanical aerators to
achieve biological action. The technology has been applied in five villages in Damietta, Daqahliya and
Beheira. It has also been used for new communities built in the desert.

Stabilization ponds depend on one or more lagoons in a series that use algal activity to encourage
biological action. No equipment or power is needed; however, land requirements are 10 times greater
than for aerated lagoons and 25 times greater than for activated sludge. A good technology for areas with
plenty of surrounding land, this treatment has been used in about 35 villages, mostly in desert areas.
NOPWASD is now becoming interested in applying this technology wherever its land requirements can
be met.

3.3.4 Upflow Anaerobic Sludge Blanket Reactor

The newest addition to the array of rural wastewater technologies is the Upflow Anaerobic Sludge Blanket
(UASB) reactor. UASB's attractions are its relatively low land requirements and energy costs. In
addition, it produces both a highly stabilized sludge and biogas. Another attraction is that a UASB plant is
easily expanded in modular fashion. One drawback in the Law 48 context is that UASB effluent falls
somewhat short of secondarily treated effluent quality. In Brazil, this problem has been addressed by
adding ponds for polishing UASB effluent; the pond area requirement is half or less than the area required
by a conventional pond system.

A UABS reactor is currently under construction with Dutch assistance in Sanhour, a large village in
Fayoum Governorate, and a similar plant is planned or under construction in Kafr al-Sheikh Governorate
with Swedish assistance.
3.3.5 Assessment of Problems

In Egypt, all technologies suffer from a lack of trained, qualified staff for operations as well as from
insufficient maintenance funds. In addition, activated sludge plants have problems with treatment and
disposal of sludge, rehabilitation and maintenance of concrete aeration tanks, control, shortages of
chemicals for treatment, and the poor quality of construction materials. Trickling influent with high
organic load causes problems. Lagoons and stabilization ponds require large amounts of land, which is in
short supply, especially in the Delta.

3.3.6 Institutional Innovation in Rural Wastewater Management

The following subsections review two promising local initiatives in the governmental rural off-site sector.

3.3.6.1 Damietta Special O&M Fund Model

The USAID Basic Village Services and Local Development 11-Provincial projects constructed 17
integrated systems in villages of Damietta Governorate. Damietta suffers from high water table, and
several measures were taken to ensure the sustainability of the Damietta projects:

1. Beneficiaries were required to pay for house connections prior to project execution.
2. A Wastewater Section was established and staffed within each beneficiary village council to operate
and maintain the wastewater project. LDII-P prepared O&M manuals, and training was provided to
the village council operators and technicians.
3. A Wastewater Department was established and staffed at the governorate level to develop annual
O&M plans and budgets and provide technical supervision and assistance to the village councils. The
Department staff were trained in O&M planning and budgeting and supplied with reference materials,
including manufacturers' manuals and the LDII-P O&M manuals.
4. Each beneficiary household was required to pay LE 2 per month to supplement meager governorate
O&M budgets. These funds were retained in a special subaccount in the village council's Local
Services and Development Fund (LSDF) to ensure their dedication to O&M of the wastewater
project.

Local Service and Development Funds are the only governmental institution in Egypt that allows local
governments to impose, collect, and retain revenues to support local services. Under Law 4311979 on
Local Administration, LSDFs are established at each level of local government: local council (city or
village), district, and governorate. They are collected mainly by surcharges on a large number of
governmental revenue sources, e.g., crop taxes, cinema tickets, etc. (The Damietta wastewater surcharge
was imposed on the water bill.) The revenue collected from the source tax reverts to the central
government, but the surcharge revenue is retained in the LSDF. Law 43 sets out the percentage of the
collections that goes to the LSDF at each level of local government. While LSDF expenditure decisions
are in local council hands, the mechanism of the special subaccount makes it possible for some funds to be
earmarked for special purposes, as is the case in the Damietta special wastewater O&M accounts. It
should be noted that LSDF funds cannot be used to pay salaries, though they can be spent on service
contracts, an approach adopted in eight of the 17 villages.

The LSDF is a uniquely decentralized and flexible mechanism for cost recovery and locally managed
O&M expenditure in Egypt. The imposition of LSDF surcharges requires the approval of the local elected
("popular") council, and in some cases, considerable awareness-raising and consensus-building are needed
to ensure approval. It should be noted that a robust LSDF revenue stream depends on effective source
tadcharge collection by the concerned agency.

3.3.6.2 Daqahliya Matching Fund Model

In Daqahliya Governorate, the LSDF mechanism has been adapted to establish what is effectively a
revolving fund for local water and wastewater improvements. LE 0.50 is collected on each water bill and
deposited in a special subaccount at the governorate level. The governorate fund is then used to provide
matching contributions to separate community-based collections for extending the water or sewer
network.

Although the Daqahliya model is attractive in principle because of the incentive it provides for local
resource mobilization, an LDII-P study in 1991 found that though accumulated revenues in the fund were
substantial, expenditure was low. It is possible that the 1: 1 matching rate is insufficient to generate the
funds required for extension works without a massive level of contribution from the aspiring community.
(Note however that small-bore sewerage projects may pose less of a financial burden on the community.)
Furthermore, the matching fund mechanism as currently structured requires in effect that the community
pay 50% of project costs at a single point in time, even though the project will provide benefits for future
generations as well. Nevertheless, these shortcomings of the current fund mechanism could be overcome,
and the model is worth further consideration.

3.4 On-Site Sanitation

The common rural sanitation solution applied for years in most Egyptian villages was a vault (trunsh),
which may be described as an underground collection tank with unsealed brick walls and an unsealed
bottom. It varies in size, dimensions and depth, depending on the household and family size. The vault has
a concrete cover slab with one opening for evacuation. The users usually limit its use to black water
disposal while gray water finds its way to the street or the nearest water body in the village. People still
remember that in the old days they evacuated the vault every few years, sometimes not for 10 years. This
system is effective as long as the following two conditions are met:

a) the village does not have a potable water network and per capita water consumption is low, in
the order of 20 LCD
b) the water table is low, below 2 meters from the ground level, and soil conditions allow for the
percolation of the liquid part in the black water through the vault walls and bottom into the
ground.
These two conditions have changed drastically over the last decades, along with other major changes in
village characteristics:
a) basic infrastructure has improved, with most villages covered by electricity and water
networks
b) the majority of village houses have been rebuilt of brick and concrete instead of adobe brick
as in the old days
c) multistory houses replaced the traditional one-story building
d) the number of public buildings, e.g., schools and mosques, has increased over the years
e) population density is much higher
f) new economic activities exist, especially in the delta region
g) villages are much larger in area to match population increases.

The result is that the traditional vault or trunsh system has failed in most areas as a practical solution, and
other solutions have to be tried. The following sections review the on-site technologies used in rural
Egypt today:

Simple Dry Pit Latrine, not intended for emptying

0 Simple Dry Single-Pit Latrine, intended for emptying
0 Simple Dry Double-Pit Latrine, intended for emptying
Pour Flush Latrine with Holding Tank
0 Pour Flush Latrine with Bayara
Pour Flush Latrine with Septic Tank and Bayara.

Table 3.3 presents an overview of these sanitation options.

 Table 3.3 Overview of On-Site Sanitation Options

Sanitation Sewice Level Final Possible Water Plot Soll Required User
Option Disposal ADDli~ati~n
.. Reauirements Condition Involvement in Requirements
(Density I . I Requirements I 08M
Requirements) I I
Simple Dry Pit Latrine,
Not lntended for Emptying
None Not in hiah
density Geas
I Low10 I Stable. some I Some

soil
7 NonelPoor

Simple Dry Single-Pit

Latrine, lntended for
Emptying
Sludge
emptying off
site
Not in high
density areas

I
Low10 Stable, some
degree of
. permeable
Isoil
Some

-I NonelPoor

Simple Dry Double-Pit

Latrine, lntended for
Emptying

Pour Flush Latrine with

Holding Tank
Sludge
emptying off
site

Emptying of
Holding
Tank
Not in high
density areas

Not in high
density areas
I Low10
I
I Low
I
1 Stable, some

I None
I
I Some

I Some
I
7-- NonelPoor

Contents
off-site
Pour Flush Latrine with Sludge Not in high Low Permeable Some
Bayara emptying density areas soil
off-site
Pour Flush Latrine with Sludge Not in high LowIMedium Permeable Some
Septic Tank and Bayara emptying density areas soil
off-site

Source: Water Supply and Sanitary Drainage in Esna District, Pre-project study, Vol. 4: Rural Sanitation Programme, COW1 and Talaat Consultants,
October 1997.
3.4.1 Simple Dry Pit Latrine, Not Intended for Emptying

Description. This is the simplest type of pit latrine; a hole (the pit) is dug in the ground and
covered by a slab with a hole for defecation and urination. Only the water required for cleansing
after defecation is allowed to be discharged into any kind of pit latrine. It is not intended for
sullage. This latrine is without a lined or sealed pit, has a pit volume to last for 10 years before it
is filled, and has a concrete top slab with a prefabricated ceramic squatting pan. Based on typical
design criteria5 a pit for a household of six people, with an anticipated 10 years' lifetime, should
have a volume of at least 2.9 m3.

O&M This latrine does not require O&M, but when the pit is full, it has to be covered with a
concrete slab, a new pit has to be dug, and the original slab with the squatting pan has to be
shifted to the new pit. If a ceramic - and not a plastic - squatting pan is used, its lifespan is
expected to be about 15 years.

Costs. Construction costs and annual costs are summarized in Table 3.4. Two sets of costs are
shown: one applies to situations where the villagers participate as much as possible in the
construction and operationlreplacement; and the other applies where a local contractor is
responsible for all construction and operation/replacement.

Table 3.4 Cost Data for Simple Dry Pit Latrine, Not,Intended for Emptying, 1997 Prices

l Cost I
Villager's Participation
in Construction and Contractors
I
Operation
Capital Cost per Capita LE 29lcap LE 39lcap
Annual O&M Costs LE Olcaplyr LE Olcaplyr
Annual Replacement Costs LE 1.2/cap/yr LE 3.7Icaplyr
Total Annual Costs LE 1 .Ycap/yr LE 3.7lcaplyr
Source: Water Supply and Sanitary Drainage in Esna District, Pre-Project Study, October 1997.

Experience. Simple pit latrines are very common in rural Egypt because they are the cheapest of
all the options and easy to install using local labor and materials. But they have not proved to be
hygienically suitable in more densely populated areas, and they are not suitable for sullage
disposal. In such cases, the ventilated pit latrine is preferred, especially where odors from the
latrines and fly and mosquito breeding in the pits have proved to be a general problem.

Environment Health Engineering in the Tropics, Sandy Caincross and Richard Feachem,
1993

27
3.4.2 Simple Dry Single-Pit Latrine, Intended for Emptying

Description. The Simple Dry Single-Pit Latrine, intended for emptying, is similar to the Simple
Dry Pit Latrine described above, except that there is an opening in the squatting slab of at least
0.6 m for emptying. Because the pit is to be emptied, it may be designed with a smaller volume.
The minimum volume should allow for at least two years' use between each emptying.
Consequently, the minimum volume should be about 1 m3. This latrine is not intended for sullage
disposal.

O&M The excreta or septage removed from this type of pit latrine always contains relatively
fresh feces. The process of emptying, transporting, and disposal is usually unhygienic and
represents a health hazard. The excreta are difficult to remove and is accomplished either
manually or by a vacuum vehicle. Manual removal is difficult and unhygienic. If a vacuum
vehicle is used, the sludge should be stirred with high-pressure water so it can be sucked out more
easily. The use of vacuum and high-pressure equipment requires organized emptying services and
controlled disposal and, as such, is difficult to operate.

Experience. This system was once common in many rural areas in Egypt; however, after the
increase in water supply services and the difficulties of manual removal, it is rarely found today.
Moreover, the disposal of the desludged septage is always a problem.

3.4.3 Simple Dry Double-Pit Latrine, Intended for Emptying

Description. This version is constructed as a single-pit latrine, intended for emptying, but with
the pit divided into two chambers by a wall. The chambers have equal volumes, and each should
accommodate two years' use. This option is not intended for discharge of sullage. A top slab of
reinforced concrete covers both pits and has a hole for emptying above each chamber. The holes
are to be covered by reinforced concrete covers. One cover may be fitted with a ceramic
squatting pan, while the other may just have a plain surface and no hole for defecation. The
covers have to be shifted from one chamber to the other to ensure the operation described below.
The dividing wall may be made of double-layer burnt brick, limestone/cement mortar masonry, or
reinforced concrete. The choice of materials depends on available local materials and the type of
soil in which the wall is to be anchored.

Only one chamber is to be used at a time, while excreta in the other chamber are left to age for at
least two years in order to obtain a pathogen die-off. When the chamber in use has filled, it is left
full of excreta and closed for a period of at least two years. The other chamber is then emptied
and put into use. The emptied excreta contain feces that are considered safe for manual
emptying, village transport, and disposal on agricultural land. Based on typical design criteria, a
double-pit for a household of six people, with an anticipated two-year filling time, should have a
volume of at least 1.5 x 2 = 3.0 m3.

O&M. Removing excreta from a chamber with two or more years' use is difficult and dirty, but
not unhygienic. It is convenient, but not necessary for hygienic reasons, to use vacuum and high-
pressure equipment for emptying; manual emptying could also be considered appropriate. When
removing the excreta, it is necessary to shift the manholes from one chamber to the other. From a
health perspective, it not necessary to establish a defined disposal system with strict control
measures. Distribution on agricultural land is acceptable.

Costs. The construction costs and annual costs are summarized in Table 3.5.
 Table 3.5 Costs for Simple Dry Pit Latrine, Intended for Emptying, 1997 Prices

1 I Villager's Participation I 1
I Cost I in Construction and I Contractors I
Operation
Capital Cost LE 53 /cap LE 83 /cap
Annual O&M Costs LE 0 /caplyr LE 14 /cap/yr
Annual Redacement Costs I LE 6 /ca~/vr I LE 10 /cao/vr I

Conclusion. The simple double-pit latrine, intended for emptying, is considered to be a healthy,
acceptable solution when it comes to handling feces and urine. However, it cannot receive
sullage. It is an appropriate solution for certain villages with low water consumption, and
particularly in villages on dry land close to the desert or areas with low water tables.

3.4.4 Pour Flush Toilet with Holding Tank

Description. The pour flush toilet is based on an improved squatting pan or seat arrangement. A
water seal, which is a U-pipe filled with water, prevents passing of odors, mosquitoes and flies.
The squatting pan is placed, as an integrated part, in a concrete floor slab. The water requirement
is only 1-3 l/flush6, and flushing can be achieved by pouring from a can. This toilet is suitable in
Egypt because water is used for anal cleansing, and the discharge goes to a holding tank or a
soakage facility. The toilet is suited for in-house installation, and not necessarily on the ground
floor only. The pour flush toilet can be placed directly on top of a collection/soakage chamber. It
can also be connected to such a chamber by a pipe, in which case it is termed "offset pour flush
latrine." In the first case, excreta drop directly from the U-pipe into the chamber. In the second
case, the length of pipe to the chamber should not exceed about 8 meters.

Holding Tank: The pour flush toilet may be connected to one or two holding tanks, which may be
constructed of various materials. Usually sealed, the tanks vary in size and are designed to be
emptied by vacuum vehicles. Emptying intervals vary with tank sizes and the amounts of water
discharged to them. They are not intended for substantial amounts of sullage, and should
normally not be considered for discharge from showers. Double chambers provide sludge-
handling and disposal benefits similar to those described for the double-pit latrine.

O&M. The system requires an extremely well-organized emptying service and controlled
disposal of water and sludge. The water drawn from the tanks represents a serious health hazard.
If the emptying service does not come frequently enough, and if people do not have a good,
readily available alternative for defecation, the result is overflowing tanks or the use of
substandard defecation practices that result in serious health hazards and a deteriorating
environment.

Experience. Wastewater overflows from such tanks are common in the villages. The problem
may not be immediately evident. The village mosques may simply close their toilets when, or
just before, tanks overflow. Villagers may stop using their toilets, and/or start to carry small

Compared to 8-20 llflush for cistern-type flush toilets.

29
containers with blackwater from their tanks out of the village center. Defecation habits are
changed from the use of the toilet to the use of open-air or throw-to-the-street methods. The
results of overflowing holding tanks can thus cause serious risks of spreading of diseases and
degrading human environments.

The causes of overflows andlor changes to substandard defecation practices are too few and too
poor vacuum vehicles and too high costs involved when such vehicles are not available. It is not
envisaged that emptying services can be improved soon enough to avoid future overflows from
holding tanks.

The following projects have been identified:

- CAFE Project, 1995, where wastewater was collected from narrow streets and
poured into a large collection tank in villages in Sohag and Qena Governorates.
- CAP Project, from 2000 to 2004, in Fayoum (Tamiah Village: 50 tanks) and in
Aswan (Wady El-Saidah and El-Serag Villages: 80 tanks).
- A project funded by the Japanese Aid Authority implemented 50 tanks in Qay Village in
Beni Suef, in addition to some other villages.

Conclusion. Mainly because of the serious health hazards caused by overflowing, but also
because of the unhygienic emptying, transport and disposal practices, the use of pour flush toilets
with holding tanks should only be used with adequate and effective evacuation services and a
hygiene education program. The system is recommended in areas with a high water table.

3.4.5 Pour Flush Toilet with Bayara

Description. The bayara, as the term is used in this report, is a soakaway arrangement. The
bayara's soakaway capacity depends on the soil conditions of the site and the type and size of the
bayara. The bayara is intended for sullage as well, but the amount to be received has to be
estimated for each bayara that is to be built. There are many different bayara versions in use in
rural areas, but for future use the following typical types are proposed:

Three meters deep, with inside horizontal cross-sectional dimensions 2.0 x 2.5 m, with walls
of open limestone masonry with little or no cement mortar, and a reinforced concrete top slab
with D = $0.6 m with a concrete cover for easy maintenance
The same as above, but with brick walls (thickness: 37 cm) with holes for soakage
Five meters deep, with an inner diameter of $2 m, walls of open limestone masonry with little
or no cement mortar and a top slab of reinforced concrete, and a hole with D = $0.6 m with a
concrete cover for easy maintenance
The same as above, but with 37 cm-thick wall of burnt brick
Five meters deep, with an inner diameter of $2 m, with a 15 cm-thick wall of reinforced
concrete, and either perforated concrete or open-cement, mortar-strengthened, open limestone
masonry in the lowest 1.5 m of the walls.

The bayara does not have a constructed bottom (natural site-typical soil only). The availability of
brick and limestone as building materials varies from village to village.

O&M Bayaras operated without septic tanks tend to lose their soakaway capacity and cannot be
regarded as sustainable. Good routine desludging is an absolute requirement for keeping a bayara
in working order through a reasonably long lifetime. This again requires organized emptying
services with appropriate equipment.

Experience. Experience with the pour flush toilet is described above in Section 3.4.4. The bayara
is the only unit constructed to soakaway wastewater. It is well suited for low flat land. When
bayaras are used in higher areas on ground with some villages expansive soil, soakage from the
units can cause soil movement, leading to cracking and even collapsing houses. As long as water
consumption stays extraordinarily low and only an extremely small number of bayaras are built in
these areas, these problems may not occur. However, in some villages where just a little more
water than the normal is discharged through bayaras, the result may be bulging floors and
collapsing houses. Uses of the pour flush toilet with bayara include:

0 A UNICEF project, in cooperation with Shuruq, implemented various models in Upper Egypt
governorates
The Netherlands Fayoum Water and Sanitation Project implemented this model for
approximately 20 houses.

Conclusion. The pour flush toilet with a bayara is, from a health/technical point of view, an
acceptable solution in places where soakage capacities are relatively good and space and/or
available funds make it impossible to install a septic tank between the toilet and bayara. For this
solution, it is not advisable to connect more than one family to a bayara.

3.4.6 Pour Flush Toilet with Septic Tank and Bayara

Description. This solution is identical with the one just described, except for the addition of a
septic tank between toilet and bayara. The septic tank is considered a prerequisite to make a
bayara a long-term sustainable solution. A properly built septic tank with bayara is intended for
sullage discharge as well. The capacity to soakaway water will vary with location and typelsize
of the bayara, and the amount of sullage that can be received by a bayara will have to be
estimated for each one that is built. The long-term soakaway capacity increases with the use of a
septic tank. Different materials may be used. Where limestone is readily available and a sealed
tank is not necessary or appropriate, tanks can be made of open limestone masonry.

In extremely hot climates, it is not considered necessary to have large tanks. Two days' retention
time is sufficient. All tanks should be designed for 10 persons, despite a present average
household size of about six persons. Since it is extremely important to have as little solid
material as possible passing to the bayara, the tanks should have a minimum of two chambers.
Assuming a discharge of 70 LCD through the tanks, a tank size of 1.4 m3 water volume should be
sufficient. However, the tank dimensions have to be large enough for workers during
construction.

O&M. The system requires septic tanks be emptied of sludge regularly, every two years. The
bayaras should also be emptied for sludge.

Experience. Throughout the world septic tanks are commonly considered to be a prerequisite for
minimum treatment of wastewater in front of soakaway arrangements. They are quite common
for institutional sanitation such as at mosques and schools. Household septic tanks are also in
use, but their working principles are generally not well understood, and this is reflected in strange
designs and poor maintenance.

The following projects have been identified:

1. Save the Children Organization established a one-compartment septic tank system in Sohag
and Qena Governorates (924 one-compartment septic tanks in nine villages, covering 2,800
families)
2. CARE Egypt built multicompartment septic tanks in four villages in Aswan
3. CARE has tried a septic tank with an up-flow filter
4. CAFE project built 3,500 units in 35 villages
5. CARE project in Beni Suef is planning to serve 9,400 households with a septic tank model
equipped with a dual, up-flow trickling filter.

Conclusion. The pour flush toilet with septic tank and bayara is, from a healthltechnical point of
view, an ideal option for various types of soil.
4. HYGIENE

This chapter reviews the knowledge, attitudes, and practices relevant to the transmission of water-
and excreta-borne diseases in rural Egypt. It is important to understand hygiene practices and
integrate appropriate hygiene promotion within any sanitation framework to ensure that health
benefit goals are achieved. The primary source of information is Katsha (1989), an ethnographic
study of water use and hygiene in two villages of Minufiya Governorate in the southern Delta,
both with groundwater-based public sources and one suffering from high water table. This source
has been supplemented with insights from UNICEF, SCF, and other studies.

4.1 Selection of Water Sources

Many rural households rely on multiple water sources. In addition to the public network access
options of house connection, yard tap, and public standpipe, and the private provision options of
hand pumps or trucked supplies, extensive use is made of canals and mosques.

Drinking and Cooking. Most households understand that public supplies are safer for drinking
and cooking than canal water. However, rural Egyptians are averse to the taste of water with high
salts (TDS) content - even if TDS levels are within acceptable limits. Salty taste is characteristic
of public groundwater supply sources, and in these areas even households with a house
connection may use a hand pump as their main drinking water source, though it is likely to be
bacteriologically unsafe.

Table 4.1 Water Sources, by Purpose

- -

Purpose Source
Drinking and cooking Public network (house, yard,
standpipe)
Hand pump
Trucked supply
Personal washing House connection or yard tap
Mosque (men)
Washing clothes and utensils Canal
Standpipe

Personal Washing. Egyptians are extremely modest, so for personal washing they will select the
source that allows the greatest privacy, e.g., the house connection, yard tap, or hand pump. If
there is no source in the home, water may be carried into the house for bathing.

Washing Clothes and Utensils. The use of canal water for washing clothes, utensils, and even
foodstuffs is very common, particularly if the household faces one or another of the following
conditions:
a) Household has no piped source or pump
b) Household is in an area with a high water table
c) Public supply is salty and "hard.."

Washing clothes and utensils is a high-volume use; the canal provides copious amounts of
running water for this purpose. Where the water is "hard" (e.g., most groundwater supplies), it
does not raise suds easily. Moreover, many rural women believe that as long as the canal has a
steady water flow, the water is safe. Most importantly, where the water table is high, women
seek to minimize consumption in the household for fear of damage to the building or in order to
reduce flows to the vault or septic tank.

Washing clothes and utensils at standpipes has been observed, but it is less common. Due to the
poor condition of most standpipes, the queue is long; moreover, the area around the standpipe is
typically muddy and may serve as an informal garbage tip - not good conditions in which to try
to clean.

Many commentators have observed that use of canal water is not only a practical response to
water hardness, high water table, etc., but also serves social functions for women. The canal
washing points provide a "legitimate" public space for women to congregate outside of the home
in the conservative culture of rural Egypt, and an occasion for status display of the utensils and
clothes.

4.2 Water Use

Assessment of Source Safety. Most women believe that the piped public supply is the safest of the
available sources for drinking purposes, followed by hand pumps. Elderly informants however
still retain beliefs that reflect possibly very ancient views that the canal water is "sweet" and
imparts life-force.

Water Storage. Women take care to ensure minimum contamination when fetching water from
standpipes, even washing the container with soap before filling it; but if the queue is long, they
may dispense with this step. Contamination may occur in the home. Water for drinking is stored
in large clay jars, pots, or pans. The clay jars are kept covered, but household members with
unwashed hands may scoop the water out in cups. Pans are left on the ground and may be
contaminated by domestic animals, floor dust, etc. Fecal coliform counts of 685-2126/100 ml
were counted from clay jars after six hours storage; interestingly, the counts fell to 48-504 after
12 hours storage, presumably from sedimentation of suspended solids. The use of long-handled
scoops has been recommended as a means to reduce hand contact with the stored water.

Use of Canal Water. Canal water is used for washing clothes and utensils, and the consultant has
observed washing of beans with canal water in Beheira. Even villagers with safer alternatives
have cited several reasons for using canal water. Practical reasons include:
concern to minimize domestic usage in unsewered areas with high water tables
availability of copious, running flow
hardness of groundwater supplies makes it difficult to raise suds; more soap or detergent is
needed
house is kept cleaner by doing the washing outside.

Sociological explanations focus on the opportunities for socialization and status display that canal
washing offers to women in the relatively conservative culture of rural Egypt, which offers few
other opportunities for women to congregate in public. (Because of the queue, the public
standpipes don't offer the same opportunities.)

However, not all women use the canals, e.g., professional women or women whose husbands are
professionals; those who live at a distance from a canal; and schoolgirls who learn in school about
the danger of contracting schistosomiasis (bilharzia). It should also be noted that standard
practice is to boil clothes after washing, though some may skip this step if the canal water is
warm.

4.3 Latrines

The distinction between adobe (mudbrick) and redbrick construction is relevant to the discussion
of defecation practices and latrine upkeep. In adobe houses, the latrine tends to be cramped (150
cm x 150 cm), poorly lit, and unventilated. The opening is left uncovered. Water is used only
sparingly in the weekly cleaning in order to preserve the mud walls and prevent surcharges from
the latrine, and fleas and mosquitoes abound. The latrine in adobe houses is used mainly by
women: men go to the mosque, and children go in the street.

Latrines in redbrick homes tend to be better lit and ventilated, have a better disposal system, and
have a tap in the bathroom (if the household has a connection). Cleaning practices are little
different from those in adobe houses. "Only a few women use disinfectants, brushes, soap, or
kerosene in cleaning the latrines" (Katsha 1989, p. 63). Men and children are more likely to use
the latrine in redbrick homes.

4.4 Personal Hygiene

Handwashing. Handwashing in general is not frequent, and handwashing with soap is unusual.
A closely observed sample of 10 women in the surveyed area indicated that they did not wash
their hands with soap after changing babies' soiled clothes or before preparing food or
breastfeeding.

Bathing and Ritual Ablution. The cultural norm is to bathe once or twice a week, using soap.
People who pray perform ritual ablution, but this does not require the use of soap.

Barefootedness. Most people walk barefoot at home, and some women and many children walk
barefoot in the streets. If the foot has a cut, it may become infected from contact with animal or
children's feces or ponded sullage or subsurface water.
5. WATER QUALITY AND WATER MANAGEMENT

As noted earlier, some 98% of Egypt's population lives in the Nile Valley and Delta, a mere 4%
of Egypt's territory. The Egyptian Nile floodplain is arguably a single watershed. Under the
dense population conditions, watercourses crisscross human settlements, especially in rural areas,
and water uses are closely interdependent, given the presence of cross-connections between
agricultural and municipal water supplies. Hence, a consideration of water quality in the Nile,
canals, and drains and of some aspects of agricultural water management is relevant to the subject
of rural public health.

The first part of this chapter reviews data showing the extent of municipally originated pollution
in Egypt's surface water sources. The second part discusses the problem of cross-connections
between agricultural and municipal water supply brought about by drainage water reuse.

5.1 Pollution of Waterways

While MWRI regulations require that domestic wastewater be treated to strict standards set in
Law 48 prior to discharge into agricultural drains, in practice, this control can only be
maintained for well-operated wastewater treatment plants. Moreover, domestic wastewater
remains a major contributor to the pollution of agricultural drains through the uncontrolled
dumping of septage, sullage, and possibly mixed raw sewage on a daily basis at different
locations along the drain system, primarily from underserved rural villages.

Table 5.1 shows that the total wastewater flows generated by all governorates is estimated to be
5.1 BCMJyear. Approximately 1.6 BCMIyear of this flow receives treatment. By the year 2017,
an additional capacity of treatment plants equivalent to 1.7 BCM is targeted for construction
(National Water Resources Plan, 2002). Although this planned wastewater treatment capacity
increase is significant, it will not be sufficient.

Table 5.2 presents the basic water quality data reported in February 2001 at the standard Nile
River monitoring stations between Aswan and the Delta Barrage. Figure 5.1 presents the fecal
coliform data from Table 5.2 graphically.

Law 4811982 water quality standards are discharge standards, not ambient standards, so the law
does not specify a standard for fecal coliform levels in watercourses. Therefore, the value given
by the Food and Agriculture Organization of the United Nations (FAO) in 1989 as a guideline in
using water for unrestricted irrigation (1000JMPNml) has been used to evaluate water quality in
this report (as it is by the Ministry of Water Resources and Irrigation).

The results of a microbiological examination in the Nile River indicated great variation in the
spatial distribution of the fecal coliform counts. Counts greatly exceeding the F A 0 guideline for
unrestricted irrigation use were found around the catchment areas of Kom Ombo, El-Berba, Main
Ekleet, and Fatera drains. Fecal coliform counts in water samples taken from the specific bank
where the drain water enters were even higher, indicating the presence of untreated human wastes
in these drains.
 Table 5.1Municipal Wastewater Flows, Treatment, and Discharges

Number I Collected
of Installed Total Treated sewage
Governorate treat- capacity WW effluent discharge
ment m3/day discharge discharge to the
plants m3/day m3/day drain tanks m3/day

Red Sea 0 I 0
Sharqiya 1 3 8 1.OOO
Sohag 1 22.000
South Sinai 6 20.330
Suez 2 1 130.095
Total I 121 1 3,345.543

Source: NWRP-survey, Danvish 2000-2001 (note: negative discharge data still to be

verified)
 Table 5.2 River Nile Water Quality, from Aswan to the Delta Barrage

Source: Survey of Nile System Pollution Sources (IRG, USAIDIMWRI Water

Policy Reform Project, September 2002)
 The Damietta Branch of the Nile River begins at the Delta Barrage and ends 220
km downstream at Faraskour Dam near Damietta. The major sources of pollution to
the Damietta Branch are the Talkha fertilizer factory, the High Serw 1 Drain and the
High Senv Power station. An assessment of the results of a water quality
monitoring exercise carried out in the Darnietta Branch during February 2001
indicated the following:

Dissolved oxygen concentration ranged from 7.8 mg02/l at its southern part to
6.2 mg02/l at the northern part.
Nutrient concentrations (nitrogen and phosphorus) were within the permissible
limits.
The chemical oxygen demand (COD) exceeded the standard set by Law 4811982.
However, the concentrations were similar to those of the Nile water from Aswan
to the Delta Barrage.
(BOD) values comply with the consent standard, except at one location at the
downstream end of the branch.
TDS increased from 240 mg/l to 372 mg/l, but these values are still within the
permissible limits.
FC counts exceeded the FA0 guidelines at almost all sampling sites (Fig. 5.1) .
This is an indication of the discharge of human wastes into the Damietta Branch.

FQ. 116): Variation in FC oounts in Dsmitta branch.

The Rosetta Branch, starting from the Delta Barrage, receives relatively high concentrations of
organic compounds, nutrients, and oil and grease. Major sources of pollution are the Rahawy
Drain (which receives part of Greater Cairo's wastewater), Sabal Drain, El-Tahrrer Drain, Zawiet
El-Bahr Drain, and Tala Drain. At Kafr El-Zayat, the Rosetta Branch receives wastewater from
the Maleya and Salt and Soda companies. The ambient water quality status of the Rosetta
Branch, as measured in 200 1, indicated dissolved oxygen concentrations ranging from 5.1 mg02/l
at the southern part to 6.3 mg02/l at the northern part of this branch.
Nutrient concentrations were within the permissible limits. COD and BOD values exceeded the
standards, but were similar to those recorded for the Damietta Branch. TDS ranged from 240 at
the Delta Barrage up to 415 mg/l at the end of the Branch. High FC counts were detected at Kafr
El-Zayat, after which the water complied with F A 0 guidelines (1989) for unrestricted irrigation .

Water quality monitoring campaigns conducted to date have included irrigation canals only to a
very limited extent. In general, canals have similar water quality to that found at their point of
diversion from the Nile. The flow in the canals varies with irrigation demands. Many of these
canals are sources for drinking water treatmentplants as well. Table 5.3 presents the results of a
USAIDMWRI water quality monitoring survey conducted in 2001 for a representative sample of
canals and rayahs.

Table 5.3 Results of Field Analysis for Canals and Rayahs

Canal and Rayah DO COD BOD RDS TSS FC

Consent Standards 5 10 6 500 NA 1000*
Menoufi Rayah 5.97 16 3.02 225 29 10000
El-Beherri Rayah 7.58 14 1.74 220 6 1000-
El Nasey Rayah 6.71 12 3.96 220 16 10000
Astoun Canal 7.03 11 1.82 200 8 1600
Kelabia Canal 7.57 15 1.71 205 12 1500
East Naga Hamadi Canal 6.31 25 5.78 213 9 1750
West Naga Hamadi Canal 7.22 18 4.32 200 6 2500
Ibrahimia Canal (El-Minia) 8.12 23 3.08 200 17 650
Ibrahimia Canal (Beni-Suef) 7.38 21 2.01 230 12 1500
El-Lahoun 7.08 10 1.89 305 12 5000
Sako 6.98 10 2.68 280 40 1100

5.2 Drainage Water Reuse

The Upper Egyptian drainage system returns all drain water to the Nile. In the Delta, main drains
terminate in Egypt's northern lakes or in the Mediterranean. Provided that adequate drain water
quality is maintained, drainage water reuse (DWR) does not inevitably result in health hazards,
and - provided that salinity levels are properly considered - DWR is an appropriate strategy for
increasing water use efficiency. Indeed, DWR is part of Egypt's national water resources
strategy, with some 14% of Egypt's 2017 water requirements expected to come from
approximately 9.6 BCM of reused drainage water.

DWR is practiced both officially and unofficially. Official reuse is supported by the construction
of mixing stations at 29 locations, namely in the Delta, at which drainage water is returned to
canals. Another form of official reuse - intermediate reuse, whereby drainage water from minor
drains is returned to canals before it can become heavily polluted - was piloted under the USAID
Water Policy Reform Project. Unofficial reuse, the uncontrolled use of drainage water for
irrigation by farmers, is practiced mainly by farmers at the tail ends of the local irrigation and
system.

The health hazards posed by municipal pollution of drainage water are considerable and
extensive:
a) Mixed canal water may be used downstream as a municipal water source, e.g., for the small
package water filtration plants common in rural Egypt.
b) Mixed canal water may seep into groundwater, a source of domestic hand pump water
supplies.
c) As noted earlier, canal water is used for many domestic purposes by villagers without
reliable water supplies or by villagers in high-water-table areas who do not have sewerage.
d) Farm laborers may come into direct contact with polluted water.
e) Crops produced with polluted drainage water may pose health risks to consumers.
Official reuse (prior to 1999) amounted to some 5.19 BCM. It is estimated that about 0.65
BCWyear of drainage water is pumped to El-Ibrahimia and Bahr Yousef canals for further reuse.
Another 0.235 BCMIyear of drainage water is reused in Fayoum, while about 0.65 BCWyear of
Fayoum drainage is disposed of in Lake Qarun. In the Delta region, the amount of agricultural
drainage water reuse was estimated in 1995196 to be around 4.27 BCM in addition to about 0.3
BCM lifted to the Rosetta Branch of the Nile from West Delta drains. Unoficial reuse has been
estimated at 2.8 BCWyear.

The health hazards posed by municipal wastewater pollution now threaten to undermine the
GOE's drainage water reuse strategy. Since MWRI began systematic monitoring of drain water
quality in 1999, five of the 29 mixing stations have had to be closed down. The practice of
unofficial reuse is obviously harder to restrict, but participatory water management can help
relieve its root causes by reducing inequities in water distribution between canal heads and tails.
6. THE SANITATION PROBLEM

6.1 Summary of Findings

Approximately 57% of Egypt's population lives in the villages of the Nile Valley and Delta, an
estimated 38.4 million people as of the end of 2003. The average village has 8,003 inhabitants;
25% of villages have more than 10,000 inhabitants.

1996 census data, the most reliable source on water supply coverage, show that 71% of villagers
in Egypt's rural governorates rely on public supplies for their drinking water. About 40% have
house connections, another 17% have a yard tap, and the remainder (14%) use public standpipes.
The continuity and pressure of piped supply varies from locality to locality, as does the quality of
the water from the tap. An estimated 27% of rural households use a hand pump as their principal
domestic source. Most hand pumps draw from shallow sources likely to carry some level of fecal
contamination if the village has piped supplies as well.

Consumption and the quality of water consumed may slip below minimum requirements
whenever: a) public supply is inadequate or unreliable, or b) where the water table rises after
piped supply is extended to the locale. In either case, households - particularly those of adobe
construction - will find alternative sources (including canals) for some or all domestic uses.

The percentage of rural Egyptian households with some form of household sanitary facility is
85%, a percentage nearly identical to that of households with supply to or in the home (40%
house connections + 17% yard tap + 27% hand pump = 84%). It could be said that rural domestic
sanitation has kept pace with rural domestic water supply; however, these household systems
have failed to cope with the increased wastewater flows.

The conventional household vault system is the most common solution and provides adequate
household and community level sanitation where water tables are 2 m or deeper from the surface
and where soils have suitable permeability. However, there is continuous seepage to
groundwater, a potential health hazard where shallow wells are a drinking water source. Also, the
conventional vault requires occasional desludging, typically by vacuum truck or manual laborers
(sarabtiya). Desludged septage is generally disposed into an agricultural drain or possibly a canal.

Conventional vault performance is undermined by high water table conditions, which have grown
more prevalent as water consumption has increased. Subsoil water does not allow seepage and
may even lead to percolation upward, leading to damp floors and walls and occasionally the
collapse of the dwelling. To cope, owners must have the vaults drained frequently. In an
unknown number of cases, the community (or a section of the community) will seek to avoid the
costs of frequent evacuation by illegally/informally installing gravity sewers that drain to the
nearest surface water body. In either case (truck removal or illegal sewer), wastewater is
ultimately disposed to a water body. Alternatively, householders in affected areas may seek to
limit excessive vault evacuation expenses by sharply limiting their water consumption, even to
levels below WHO minima.

The septic tank solution, which has been tried at single-household and on-the-lot levels, provides
a reasonable degree of in-situ treatment: the effluent seeps to the ground through a percolation
vault and the desludged septage is disposed to agricultural drains. But because of its high
construction cost, the septic tank is uncommon in rural Egypt.
No more than 10% of rural wastewater discharges are treated. With increasing flows of
wastewater to watercourses (or groundwater), what was a household health hazard has become an
environmental and economic hazard in regions that suffer from a high water table. This is
especially true where drainage water is returned to canals for agricultural reuse, a key strategy of
GOE water resource managers. Canal water itself is already polluted in most Delta areas and
particular Valley areas. The populations at greatest risk are those whose water plant intakes are
located on a canal at points downstream of agricultural drain water discharge for purpose of
agricultural reuse. There are many such communities living in one or another of the Delta's
seven drainage basins. The responsibilities for wastewater system investment and for water
resources/irrigation are vested in separate ministries, and the respective subministerial local
branches have non-overlapping territories.

6.2 Adverse Impacts on Health and the Economy

The rural sanitation problem has adverse effects on health, environment, and the economy. The
causal linkages between water supply, sanitation, and health are well established. Globally,
diarrhea is one of the four leading causes of death. It accounts for 22 cases of death in the Middle
East and North Africa Region of the World Bank compared to 27 deaths per 100,000 globally7. In
Egypt, it is estimated that more than 17,000 children die (20% of all child deaths) every year from
diarrheal diseases caused by substandard water quality and inadequate quantity of water for
drinking; personal and domestic hygiene; inadequate sanitation facilities; and lack of healthy
personal, food, and domestic hygiene practices. The poor are the most affected by poor water
supply and unsanitary conditions.

Deterioration of water quality from poor rural sanitation results in increased costs of drinking
water treatment. It reduces water use efficiency as drainage flows become non-reusable for
irrigation, and it contributes to water scarcity, which jeopardizes Egypt's future agricultural and
urban development. The economic impact is already being felt. As a result of pollution, about five
reuse pumping stations have been shut down, and one project - the El Umoum Project - has not
been commissioned due to pollution problems. Total cost of environmental degradation has been
estimated at LE 14.5 billion, of which LE 2.9 billion/ year8 are estimated to be due solely to water
pollution and water resource degradation.

Health and economic risks fall disproportionately upon the poor. About 35% of the total labor
force in Egypt depends on the quantity and quality of water resources in agriculture. The rural
population density is about 1,200 per hectare of arable land, one of the highest in the world.
Thus, poor water quality (primarily salinity-related impacts and wastewater diffused into
irrigation water) and the foreseeable scarcity of water may have a substantial impact on small-
scale farm incomes (Abdel-Dayem and Abu Zeid, 1991; Engelman and LeRoy, 1993). And those
at greatest health risk from drain pollution are the farmers and farm laborers who are forced by
water shortage to use polluted drain water.

6.3 The Development Problem

The key challenges to addressing the rural sanitation problems include the following:

'World Bank Discussion Paper, 2004. "Environmental Health Review in the Middle East & North Africa
Region," Draft, June 2004.
World Bank Report 25 175-RGYArabRepublic of Egypt: Cost Assessment of Environmental
Degradation," June 2002.
 Enormity of scale of problem and cost of addressing it
Inadequacy of funds and capacity to start service provision in all villages at the same time,
thereby necessitating prioritization of target villages
Relative remoteness of sanitary drains from villages compared to irrigation drains and canals
that are much closer to villages, thereby making it tempting for people to dump wastes into
the irrigation drains
Sanitation tariff levels far too little for effective cost recovery, and the consequent effect on
revenues for sustainable operation and maintenance
Use of centrally directed, supply-driven approaches for providing sanitation service
infrastructure
High (and costly) treatment standards required of municipal wastewater treatment facilities.

The fundamental development problem is two-fold:

6.3.1 Lack of National Strategy for Rural Sanitation

The National Organization for Potable Water and Sanitary Drainage (NOPWASD) is the official
entity for making decisions on the distribution of investments for large-scale drinking water and
sanitary drainage projects in all governorates except Cairo and Alexandria. NOPWASD is
responsible for drawing up policies and laying down plans for drinking water and sanitary
drainage activities at the national level. It also carries out studies, makes designs, and supervises
large-scale national projects related to drinking water and sanitary drainage that are beyond the
capacity of local units serving more than one governorate. Their current program includes plans
for completing sewerage and sewage treatment plants for the 217 provincial cities and the larger
villages. The many smaller villages and settlements, such as the azbahs, are not included in the
organization's program of activities; in any case, NOPWASD is not responsible for on-site
sanitation.

6.3.2 Nonviable On-Site Technologies

The typical facility used for excreta disposal in rural areas in Egypt is the bayara. It is a
household vault or cesspit, which may or may not be lined. When lined, it has openings along the
lining to allow for percolation and seepage into the surrounding soil. In a few cases, the bayara is
used in conjunction with septic tanks. However, in many instances, it is the sole facility for the
collection and storage of domestic wastewater.

The household vault is effective in situations where soils are permeable and groundwater tables
are at least 2 m deep. Periodically, septage from the vault is evacuated for disposal, generally into
agricultural drains. Partial treatment occurs in the vaults through anaerobic decomposition of the
organic fraction of the wastes and through die-away of pathogens. The degree of such treatment
depends, in part, upon the interval between the emptying of the bayaras - the shorter the
emptying interval, the lower the degree,of treatment. Experience in Ghana and Tanzania has
shown that when left unused for one year, the night soil'in such pits becomes decomposed; in
addition, all bacteria disappear; but helminths remain. However, even the helminths disappear
when the pits are left fallow for two years, thereby making their decomposed contents safe to use
as compost. This has led to a design criterion that calls for the use of twin-pit systems (see
Section 3.4.3) in which one pit is used until it fills up, at which time it is allowed to rest for two
years while the second one is used. The application of this model calls for two types of
information, namely, the rate of accumulation of excrement in such pits, and the design
population that would be using the pit or bayara (in this case). The solids accumulation rate for
wet pits is slower than that for drier pits. In Egypt, the use of water for ablution would lead to wet
pits, and the solids accumulation rate would be about 0.02-0.04 m3/person/year.

In Egypt, a number of factors affect the effectiveness of these bayaras. They include the
increasing population growth and population densities, rising levels in the quantities of
wastewater resulting from increased water supply to the rural areas, and rising water tables. In
high water table areas, the bayara system becomes nonviable. With upward water pressure from
the water table, the bayara cannot be emptied often enough. Sewage swells up, ponding on lower
floors, flowing onto streets, etc. With the increased demand for vault evacuation, the evacuated
wastes are dumped into water bodies, such as nearby irrigation drains and possibly canals.
 PART B: PROPOSED FRAMEWORK APPROACH FOR DELIVERY OF
INTEGRATED RURAL SANITATION SERVICE

7. OVERVIEW OF FRAMEWORK
This part of the report describes a Framework approach that addresses rural sanitation as a
coupled bottom-up/ top-down service delivery system rather than the traditional top-down
infrastructure. ThiS Framework approach, for the first time in the Egyptian context, links access
to investment in rural sanitation services to quantifiable water quality (and health) improvements
in a given hydrologic basin.

An integrated, institutional structure of relevant government agencies and serviced communities

is proposed, built on the IWRM principles of treating water as a holistic resource, management
at the lowest appropriate level, and stakeholder participation. In this regard, two decades of
experience in establishing farmer management organizations within the water resources sector
have proved valuable in proposing the local institutional set-up for sanitation service
management. The proposed Framework relies heavily on performance monitoring and
benchmarking systems to create incentives for ensuring the quality of provided services. While
cost recovery is needed to sustain services, the approach acknowledges that public benefits (and
hence the public goods component) most often exceed private benefits.

The Framework is designed to support a coupled top-down/bottom-up demand-responsive

process that takes place between two anchor points, one at the national level and the other at the
village level. From the national level, a top-down demand is exerted on rural communities,
calling for actions aimed at achieving national goals.

Interested villages provide a bottom-up response by stepping forward to participate in a national

competition for funds under the Framework. This entails providing information that demonstrates
their readiness to participate in the competition. In so doing, the villages simultaneously exert a
bottom-up demand for funds from the national level to finance locally initiated projects
developed in response to local needs and preferences. Successful villages receive funds as a top-
down response to their demands, enabling them to undertake a series of activities for improved
village sanitation.

The Framework is driven by certain determinants and guiding principles. It has building blocks
and operational tools through which sustained delivery of equitable service can be provided at the
village level. These features of the Framework are described in the following chapters.

8. KEY FRAMEWORK DETERMINANTS

This Framework has been informed and influenced by many factors, including:

Government concerns about water pollution

Ongoing water-related work in the country
Special studies commissioned for the preparation of the framework
Lessons from national and global experience in rural sanitation.
8.1 Government Concerns about Water Pollution

Many of the concerns and pronouncements of Government about water stem from the growing
demand from the fixed supply available to the country. The dominant issues include:

The increasing pollution of waterways from domestic, industrial, and solid wastes
How best to control such pollution
0 How best to engage all members of the society in water-quality management
The best use of wastewater for optimum economic and environmental benefits.

Some of these concerns were reflected in 1997 in national policy themes and in the ongoing
National Water Resources Plan. Examples include:

Optimization of current available water resources

0 Protection of water resources and the mitigation of pollution.

The Framework has also been informed by some guiding principles included in a recent speech
by the Minister of Water Resources and Irrigation. Among the principles were:

There is a basic right of all people to have access to water of adequate quality and quantity
Managing water is a shared responsibility of all members of society
Water should be used in a sustainable way that does not compromise future use.

8.2 On-going Water-related Projects

The design of the Framework takes into account the need for compatibility with the principles
and details of some on-going projects. Examples are:

The IWRM principles that underpin the National Water Resources Plan under development
The evolving ideas behind various water board projects in the country that are funded by
different donors
The principles and institutional framework inherent in the World Bank-funded IIIMP.

8.3 Special Studies Commissioned for Developing the Framework

A number of special studies were commissioned to provide inputs for developing the Framework.
They include the following:

Stock-Taking of Existing Rural Sanitation Systems

A Socio-Economic Study for Improving Water Quality Management in Egypt, with Emphasis
on Sanitation
Putting IWRM to Practice in Egypt Using Continual Performance Monitoring and
Benchmarking Approach
Social Study for Wastewater in Rural Areas.

In addition, the current work benefited from a number of parallel, ongoing World Bank sector
studies including the IWRM Action plan elaboration, the Public Expenditure Review for the
water sector, and the Country Environmental Analysis (1992-2002).
8.4 National Experience

A vast amount of work has been done over the past years to address the problems of rural
sanitation in the country. This has been done not only by the GOE, but also with donor inputs
from countries such as the United States of America, Denmark, Germany, and The Netherlands,
among others. Numerous technologies have also been tried out. These include six different types
of on-site technologies, four different types of sewerage systems, and six different types of waste
treatment plants, all listed in Table 3.2.

In addition, a wide range of institutional and financial approaches have been tried out in different
parts of the country, using many organizations. These include central-level, national
governmental organizations like NOPWASD and the Social Fund for Development, as well as
international organizations like CARE. These have helped to train local-level organizations like
CDAs and the Shouruk. Furthermore, various implementation models have been tried out. These
include government units working in both participatory and non-participatory ways, use of
NGOs, and use of universities to work on research and development pilot projects.

8.5 Global Experience

The rural sanitation problems encountered in Egypt are not unique to Egypt. An early reported
case occurred in the United States of America in the mid-nineteenth century. At that time, the
technology of choice for sanitation was the cesspool. However, improved water supply was not
accompanied by changes in technology for wastewater disposal. In modem times, some villages
in Yemen also suffered the same experience when water supply improvements took place without
corresponding improvements in wastewater disposal. In both cases, the results were similar to the
experience in the rural areas in Egypt. Furthermore, there is implementation experience from
India, South Africa, and Ghana that might be relevant to what could be done in Egypt.

8.5.1 Experience in the United States of America:

In the United States of America's case, sewage overflowed from cesspools into residential streets
and commercial areas of towns. The consequent unsanitary environmental conditions were a
source of nuisance that started affecting commerce. It was also a public health concern; hence, an
alliance was formed between commercial interests, health officials, and the engineering
profession to address the problem. The result was development of what has come to be known as
conventional sewerage. A lot of today's design standards for conventional sewerage were set at
that time.

8.5.2 Experience in Yemen:

In the case of rural areas in Yemen, there were dedicated vaults for wastewater disposal. With the
improved water supply to the villages, these vaults failed, allowing wastewater to overflow into
lanes and streets in the villages. These villages had some of the first skyscrapers in the world.
Some were 13 stories high, built from thick sun-dried mud bricks. Apart from the aesthetic
nuisance from the wastewater in the lanes and streets, capillary action from the overland flow of
wastewater within the villages also led to the creeping of water up the walls of the multistory,
mud-brick buildings. This affected the stability of the buildings, leading to their voluntary
evacuation by residents. There has been a similar experience in some rural areas in Egypt, where
there has been dampness of walls due to capillary action on water overflowing local vaults. In
Yemen, villagers solved the problem on their own by constructing a network of sewers that
conveyed the wastewater to a communal septic tank for treatment and final disposal. A similar
solution has been adopted in a number of Indian villages, where pour flush latrines are used
exclusively for excreta; in these villages, simple, flat-gradient drains are used to collect
wastewater into nearby waste stabilization ponds for treatment.

8.5.3 Experience in India: Tapping the Strengths of Spiritual Organizations for

Community-Based Sanitation Projects - The Example of the Ramakrishna Mission
in India:

The Medinipur district rural sanitation project, also known as the Intensive Sanitation Project was
launched in India in 1990. It was a partnership between UNICEF, state- and district-level
governments, voluntary grassroots community level organizations, and a development-oriented
religious NGO known as the Ramakrishna Mission, which was established in 1897 with its
headquarters at the outskirts of Calcutta.

The aim of the project was to motivate people to move away from open-air defecation. The
project implementation strategy was to change mindsets and habits of people toward in-house
sanitation. A second objective was to promote a clean and hygienic living environment. Thus, the
goals of the project were similar to two Framework goals.

The key instruments used in the project were community mobilization and the involvement of the
local community at each stage of the program, especially in the delivery of sanitation messages.
Community mobilization was done through trained motivators selected from the target
communities. Their primary goal was to create awareness of the importance of health and
hygienic practices. This was done through home visits, motivational camps, exhibitions, and
special communication materials such as flash cards, calendars, motivational kits, and audio-
visual resources. Sanitation messages were conveyed through writings on walls, videos and slide
shows, and song squads. Training, especially the training of trainers, was given a high priority in
the project. All categories of workers were given appropriate training related to their work.

In 1990, barely anyone in the villages of West Bengal's Medinipur district had household latrines.
But just a decade later, roughly 80% of the families in Medinipur had latrines - reducing
exposure to communicable diseases of excretal origin and making Medinipur a role model for
other parts of India.

By 2002, approximately 1.2 million latrines had been delivered through the program throughout
West Bengal. The impact of widespread latrine development has been accompanied by a
remarkable reduction in cases and deaths associated with diarrheal diseases.

The Intensive Sanitation Project in Medinipur has proved to be a successful people's movement
and has helped develop a sense of pride and belonging among the villagers.

This project has demonstrated the inherent strengths and attributes of spiritual and religious
organizations, which are rarely tapped for rural sanitation. This could become relevant in the
project areas for the proposed Framework for rural sanitation.
8.5.4 Experience in South Africa: Turning the "Right to Water into a Reality" - The
South African ~ x ~ e r i e n c e ~ :

In 1994, 15.2 million of South Africa's population of 40 million lacked access to basic water
supply (i.e., 25 liters per person per day of water of acceptable quality within 200 meters from
home). Of these, 12 million lived in rural areas. In addition, 20.5 million lacked access to basic
sanitation (defined in South Africa as a ventilated, improved pit latrine or its equivalent). South
Africa has used a combination of instruments to turn things around. These include introduction of
policy reform with an accompanying legislative framework; devolution of responsibility for water
supply and sanitation from the national level to the local-government level; and using
community-based approaches. The efforts also include launching a capital works program, which
has provided infrastructure to meet the needs of over 7 million people, and the introduction of
free access to basic water supply through which water has been provided for some 27 million
people by July 1, 2002. As a result of all this, South Africa hopes that within seven years
everyone in South Africa will have access to basic water supply.

This remarkable success in increasing access to basic water supply has been underpinned by a
strong political leadership and support from the national government, which made it possible to
devote so much financial support for the capital works program and the free basic water policy.
An important contributory factor has been the existence of a very substantial institutional and
technical capacity that was already in place before 1994. The existence of an appropriate
institutional framework facilitated the introduction of legislation needed for the program. The
level of economic development in South Africa made the policy of free access to basic water
possible. This is not necessarily applicable to less-developed countries unless they benefit from
new and creative concessional funding from external sources.

This case illustrates the importance of political will in introducing a radical policy in sector
reform.

8.5.5 Experience from Ghana -From a Central to a Local Government and Community -
Based Approach to Rural Water Supply and Sanitation:

This case study involved a shift from a supply-driven, central government approach to a demand-
driven approach to rural water supply and sanitation. It also involved a shift in the role of central
government: from that of an implementer to that of a facilitator, with greater involvement of the
private sector, thereby introducing competition with consequent improvement in performance and
reduction in the cost of service provision.

Up to 1990, one national public authority, the Ghana Water and Sewerage Corporation (GWSC),
was responsible for water and sewerage services for both urban and rural areas throughout Ghana.
During that period, boreholes equipped with hand pumps served most rural communities. The
boreholes were drilled and maintained by the GWSC, donors, or NGOs. With only one private
drilling company, the drilling market was characterized by lack of competition. As a result, the
average cost of boreholes in Ghana was $9,000, compared to $3,000 in the UK or the USA.
Mobile crews were responsible for their maintenance. In these circumstances, only about 40% of

9
Drawn from the "Blue Gold series on African experience in water and sanitation, World Bank Water and
Sanitation Program, 2002.
hand pumps worked at any time, and there was no sense of ownership by the communities that
were served by hand pumps. When hand pumps broke down, communities simply waited for
them to be repaired when the mobile repair crew appeared. The situation was no better for piped
systems that suffered long periods of supply interruptions due to breakdowns and maintenance
neglect.

Beginning in the late 1980s, a number of institutional and policy reforms were introduced. New
legislation was passed under which the GWSC was replaced by Ghana Water Company Limited
(responsible for urban water supply) and the Community Water and Sanitation Agency
(responsible for rural water and sanitation services). A new national water and sanitation policy
was also introduced to shift service provision from a supply-driven to a demand-responsive
approach.

Under the new national policy, ownership of water supply and certain core functions were
transferred from central government to the local government and the communities. The private
sector became increasingly involved in various aspects of service provision. In one $20 million,
World Bank-financed community water and sanitation project implemented in 26 of the 110
districts in the country, district assemblies constructed 1,200 water points and 29 piped systems.
There was also a lot of private sector and NGO involvement in the project, including four drilling
companies, 32 NGOs, and community-based organizations (CBOs). Several national and
international NGOs were commissioned to train and build the capacities of the district-level
NGOs and CBOs. The success of this project has led to a follow-up $80 million, nine-year World
Bank-supported project. One of the aims of the new project is to shift from individual donor-
supported water supply projects to a sector-wide approach under which all external support
agencies would be encouraged to pull their resources into a single national water sector program.

Several factors have helped to make this reform process successful. A key factor was the speed of
implementing the reform process. It was not rushed. Instead, a gradual approach was followed in
transferring responsibility from the central level to the local government and community level.
The transfer rate was matched to support from the central level and the rate of building technical
capacity in areas where local capacity was deficient. Secondly, the involvement of the private
sector was accompanied by an incentive structure under which contractors were paid for their
outputs rather than their inputs. Finally, the decentralization of service provision was aided by the
general process of decentralization taking place within the country at the time.

8.5.6 Research Experience with Leaching Vaults and Trenches:

During the late 1950s and 1960s, there was a tendency for leaching pits, vaults, and trenches to
fail after years of good performance. Field studies revealed that soil microorganisms caused these
failures by sealing the percolation face of soils. Such organisms use the wastewater as their
source of food and multiply in population, choking the pores through which wastewater infiltrates
into the soil. Secondly, they deposit their metabolic waste products on the leaching faces of the
walls of the pits, vaults, and trenches. This results in progressive sealing up of the walls; it also
reduces the rate of infiltration of wastewater into the soil. Eventually, the system fails, and any
more wastewater introduced into the vaults simply builds up and overflows into the surrounding
environment.

Studies at the University of California at Berkeley and in Israel showed that if you stop feeding
wastewater to the failed pits, the clogged soil surfaces open up due to a process known as
endogenous respiration. After a period of about six months, the pores in the face of the leaching
walls become completely unclogged.
What this means in practice is that if a vault or pit in service becomes clogged and fails to
function properly, it can recover its leaching properties if it is allowed to lie fallow for at least six
months. Consequently, septic tank leaching fields are now constructed such that there are two of
them in parallel. One set is used for one year. Then the flow of waste effluent from the septic tank
is switched to the other. After another year, the flow is switched back to the first. This is the basis
for a recommendation to use two parallel sets of vaults for wastewater in Egypt.

8.5.7 Lessons from Global Experience:

The following are the lessons learned from global experience:

1. Improvements in community drinking water supplies invariably result in increased

wastewater flows. Appropriate wastewater disposal facilities should be installed to cope with
this. These should be on-site or off-site facilities, depending on the magnitude of the
wastewater flows, soil and groundwater conditions, and housing and population densities.
Failure to install facilities results in environmental degradation, public health risks, and
pollution of groundwater or surface water resources.

The strategic inference for Egypt is that wastewater management should be treated as an
indispensable component of improvements in rural water supplies and basic sanitation.
This is because in rural Egypt there are reciprocal impacts and interconnections between rural
water supply, basic sanitation, wastewater disposal, and irrigation water quality.
consideration of water quality and of environmental quality also raises the question of solid
waste disposal. Therefore, in addressing problems in any one of these areas, it is counter-
productive to follow a fragmented approach. A more comprehensive and integrated approach
is what is required, and Integrated Water Resources Management is the appropriate
instrument to use.

2. Where on-site disposal of wastewater is technically feasible, it is helpful to use two parallel
sets of bayaras. Where such bayaras are used solely for wastewater disposal, users should be
instructed to switch from one to the other once a year.

The risk of pollution from wastewater flows in rural areas would be reduced significantly if
the wastewater were separated from excreta for separate disposal. This is because in Egypt, as
is the case in other countries, the amount of excreta produced per person (in terms of weight
per person per day) do not change significantly with improvements in drinking water supply.
What changes is the quantity of wastewater per person. Existing sanitation systems appear to
work well before an increase in wastewater flows. This suggests that it would be good to
separate excreta disposal facilities from wastewater disposal facilities. This practice is
followed in many countries. For example, in many British colonies, septic tanks are designed
to accept and treat only water closet wastes. Sullage (or wastewater from bathrooms,
kitchens, and laundry) is discharged to separate soakaway pits that are basically bayaras
designed to handle sullage exclusively. In rural areas where pour flush latrines are used,
excessive wastewater flows resulting from improved potable water supplies have been
successfully handled by installing low-cost, flat gradient, small-diameter sewers to convey
the wastewater to communal ponds or to other treatment systems. The key advantage of
separating wastewater from excreta is that the organic pollution load in sullage or wastewater
is very much lower than would be if the off-site systems also included excreta. Thus, with
minimal treatment - such as primary treatment - pollution from wastewater can be lowered.
4. It is important to tap the inherent strengths of spiritual and religious organizations. In a
village in Egypt where village members made voluntary contributions toward construction of
a wastewater drainage system, the idea was hatched at the local mosque after worship.

5. Strong political will, backed by adequate technical support, is important in introducing a

radical policy in sector reform aimed at transferring service delivery functions from the center
to the local level.

9. GUIDING PRINCIPLES, GOALS AND CHALLENGES

9.1 Guiding Principles

Based upon the lessons from national and global experiences - and from various concerns and
studies - the following guiding principles have been chosen as the drivers for the Framework for
Rural Sanitation in Egypt:

Treat wastewater management as an indispensable component of improvements in rural

sanitation and rural water supplies
Pursue public health and water quality goals simultaneously
Recognize hygiene education and promotion as a central mechanism for achieving health
benefits from improved sanitation
Recognize the centrality of irrigation water quality in government economic policies and
water resources management
Adhere to the principle of fiscal equivalence in cost recovery (with special reference to
polluter pays, user pays and beneficiary pays principles)
Realize that public benefits (economic and health) from improved rural sanitation far exceed
private benefits
Accept the need for Government to assume responsibility for the public components of water
and sanitation infrastructure
Focus on service delivery rather than infrastructure delivery
Stress the need for reliable flow of adequate revenues and credible operational arrangements
as a prerequisite for reliable and sustainable service delivery
Treat access to a clean, healthful living environment as a basic right and a shared
responsibility of all people
Consider using two parallel vaults, and switching from one to the other every year, for on-site
disposal

9.2. Goals

The proposed Framework is designed to complement and capture more fully GOE improvements
in rural drinking water supplies. Given Government concerns about water quality, the proposed
Framework is driven not only by concern for hygienic latrines and improved public health, but
also the need to protect rural irrigation drains and canals from pollution from domestic wastes.
Thus, assuming the availability of adequate and sustainable drinking water supplies, the goals of
the Framework are as follows:

Private household goals: improved access to hygienic and convenient latrines that provide
privacy and safety at household levels in rural areas
Public health goals: access to a clean and healthful living environment, together with
healthful behavioral changes
 Water quality goals: improved quality of water in irrigation drains and in irrigation canals.

9.2.1 Specific Objectives

To achieve private and public health goals, the Framework needs to provide:

Improved access to sanitation services for all houses within each project village
Effective facilities for wastewater disposal, either on-site at the household level or through a
community-level sewerage system, whichever is appropriate for the local conditions
Cost-effective measures for solid waste management
An awareness campaign to promote improved personal hygiene and public health
Hygienic toilets in schools, clinics, and mosques.

To achieve water aualitv goals in irrigation drains and canals, the Framework needs to aim at:

Discontinuing the practice of discharging untreated domestic wastewaters into irrigation

drains, canals, or storm drains.
Providing, on an interim basis, a minimum of primary treatment (or its equivalent) for all
wastewater generated from any village funded through this Framework, before such
wastewater is discharged into irrigation drains". (No such primary treated wastewater
effluent should be discharged into irrigation canals.) Where primary treatment leads to the
production of sludge, it should receive treatment such as anaerobic digestion or aerobic co-
composting with solid wastes so that it can be used as a soil conditioner or safely disposed of.
Assuring adequate coverage of villages within the boundaries of Branch Canal Water Boards
with improved household- and community-level sanitation.
Providing eventual total coverage of all subdrainage basins and Branch Canal Water Board
command areas within each of the approximately 50 major drainage basins in the country.

9.3. CHALLENGES

In pursuing these objectives, the proposed Framework is designed to address the following
challenges:
The scale of the problem, and expected high cost of addressing it
The inadequacy of funds for financing projects, and the limited capacity to support all
villages at the same time
The need to stretch available financial resources to as many villages as possible
0 The need to derive early returns from both public and private investments in rural sanitation
in terms of improved irrigation water quality and improved public health
The need to prioritize target villages in a transparent and equitable way, and to support those
villages that are ready or well placed to make the best use of the limited resources
The need for self-selection by villages rather than preselection by central agencies.

lo This is to be done in conformity with Law No. 48, 1982, Item 2, which states that "it is interdicted to
dispose of wastes from sanitary drainage operations .... into water courses ... except by permission from
the MWRI."
10. BUILDING BLOCKS FOR FRAMEWORK

Based on the above, the proposed Framework will be supported by two key building blocks:

0 The hydrologic basin as the basic geographical unit for managing the quality canal and
drainage water
0 Branch Canal Water Boards as the framework for clustering villages for competition and
implementation within hydrologic basins.

10.1 Hydrologic Basin as the Basic Unit for Water Quality Management

Managing sanitation in 27,000 villages can be unwieldy and cumbersome. To simplify the
process, it is helpful to subdivide the country into smaller, independent zones. Given the
Framework goal to improve water quality in irrigation drains and canals, it is logical to choose
the hydrologic basin (e.g., drainage basin) as the natural geographical unit for strategic
management of irrigation1 drainage water quality. The Framework therefore uses the hydrologic
basin for setting water quality goals, for performance monitoring and benchmarking, and for
organizing competition to prioritize villages for access to funds. This implies that existing
drainage basins in the country (about 50 of them) need to be prioritized, using water quality,
health, and other appropriate criteria.

10.2 Branch Canal Water Boards

Since the Framework's initial focus is on the estimated 27,000 smaller villages, it would be
impracticable for each village within each drainage basin to compete as a separate entity for
project funds. A practical alternative would be for villages to compete as aggregated clusters. A
suitable platform for such clusters would be the command area or boundaries of Branch Canal
Water Boards (BCWBs).

Mesqa-level Water Users' Associations are closer to the villages. However, they tend to be pre-
occupied with daily, routine pumping operations, with no activities outside their normal irrigation
duties. On the other hand, there are village representatives (usually women) on the executive
boards of BCWBs who speak about village-level issues such as water supply and sanitation.
Thus, the BCWBs should be well placed to serve as a springboard for mobilizing villages within
their boundaries and for helping them to compete collectively for high placement on the
Framework priority list.

In its role, the Branch Canal Water Board would:

0 Establish a subcommittee for rural sanitation within their command area to work with
appropriate entities to execute projects under the Framework at the village and command area
levels
0 Arrange for dissemination and awareness-raising about the Framework in villages within
their command areas. The board would use social intermediaries or their equivalent to help
their villages qualify to participate in the competition, and to compete as a cluster of villages
within the command area
Promote Framework projects to ensure that all villages within the command area boundaries
agree to take part in the Framework program and work to gain a high priority
0 Assist the cluster of villages within its command area to implement projects once it secures
funding for them
0 Assist in monitoring progress by establishing and operating a continual performance
monitoring and benchmarking program within their command areas while, at the same time,
cooperating with the national-level anchor point in benchmarking the performance of the
BCWBs.

The assumption of such a role would be a win-win effort because improved water quality is one
of the goals of BCWBs. Hence, in helping villages within their command areas to win support for
village-level improved sanitation under the proposed Framework, BCWBs would be helping their
own cause.

With this use of BCWBs, improvement in irrigation drainage water quality would start from the
upstream level. It would begin with action at the household level, leading to 100% coverage of
project villages with improved household latrines. This should be followed by providing
improved wastewater disposal systems for 100% of the villages within the Branch Canal Water
Board's boundaries. The result would be improved water quality in irrigation canals in each of the
command areas of the project BCWBs. Eventually, the command areas of all the Branch Canal
Water Boards within each drainage basin would be covered with improved wastewater disposal
systems, with consequent improved drainage water quality. The net result would be progressive
and cascading improvement of irrigation drainage water quality in one drainage basin after
another. In effect, there would be a downstream frontal [tneed this word?] movement of
improved irrigation drainage water quality from the mesqa level, through the command areas of
Branch Canals, down to each of the drainage basins, and, eventually, to the entire basin of the
Nile, as shown in Figure 12.1. However, without a complementary process for managing wastes
from mother villages, urban areas, and industries, only limited improvements will be achieved in
the quality of irrigation water quality in the country as a whole. It is therefore imperative that -
following successful piloting and refinement of the Framework methodology - parallel processes
be initiated for mother villages, urban areas, and industrial wastes.
Figure 10.1 Downstream Movement of Improved Water and Environmental Quality

I Household Level I
I

Village Level
I

Board Level

Resources
11. FRAMEWORK TOOLS

The key Framework tools are:

Empowerment of local people

Competition as basis for prioritizing villages for access to limited grants for rural sanitation
service
A readiness scale for prioritizing clusters of villages within BCWBs
Principles of Integrated Water Resources Management
Incentives and demand orientation
Management at the lowest appropriate level
Rights and responsibilities of individuals and communities.

11.1 Empowerment

Empowering local people is a cornerstone of the Framework's approach. This entails local and/or
external use of community efforts to analyze environmental conditions and the risks posed by
them. The work will help communities understand the extent to which they are contributing to the
situation. The objective is to motivate them to do what they can to improve sanitation conditions
both at the domestic and community levels. This provides the springboard for developing
community-led, participatory interventions to improve household- and community-level
sanitation. It should help to promote ownership of local projects and at the same time tap the
creative genius of communities.

11.2 Competition

Competition is a critical tool for the Framework. For operational and practical reasons, it is not
possible to start projects everywhere at the same time. Thus, there should be a system for
prioritizing villages for gaining access to project funds.

One option would be to adopt the principle of preselection, in which a centralized agency uses a
set of criteria to assign priorities to target villages.

Another option would be to use the principle of self-selection, in which villages would be given
an incentive to compete to place high on a priority list for project implementation on the basis of
published criteria. The selection criteria could take the form of a "readiness scale." The higher the
level of a village on the readiness scale, the higher it would be on the priority list. In view of the
incentive for self-improvement inherent in the self-selection option, it is chosen for the
Framework.

11.3 Readiness Scale

Another crucial tool of the proposed Framework is the readiness scale. It serves two purposes: (1)
to provide a transparent basis for determining qualification for inclusion in the competition for
Framework projects; and (2) to serve as an instrument for assigning priority for funding villages
or clusters of villages that wish to participate early in the proposed rural sanitation service
delivery.

Thus, there may be two categories of criteria on the scale: one to serve as a screen for
determining which villages can participate in the competition, and the other for determining
where villages should be placed on the priority list. As discussed earlier, it would be more
practicable for villages to compete in clusters defined by the boundaries of BCWB command
areas rather than as individual villages.

Since there may be limited funds for the 27,000 villages to be served, the amount of funds
required by a cluster of villages would be a key in determining priorities. To be able to stretch
available funds as far as possible to as many beneficiaries as possible, the Framework would
operate on the principle that, other things being equal, the lower the funding assistance requested,
the higher the priority assigned to the village concerned.

Examples of factors that may be quantified for inclusion in the readiness scale are given below.

Category I: Qualification to participate in competition: The factors to be taken into account in

qualifying clusters of villages for participation in the competition for funds may include:

Access to improved drinking water supply already in place

Level of coverage with hygienic latrines at household level; the higher the coverage, the
higher the score on the scale
Fraction of village community covered with working infrastructure for wastewater collection
and disposal; the higher the fraction, the higher the score
Having in place a credible arrangement for achieving 100% coverage with hygienic
household latrines
Having in place village-level organizations to lead the process of improving sanitation
Having in place a reliable system for solid waste collection and disposal without creation of
public nuisance or disposal into drains.
Awareness of the health and environmental consequences of improved sanitation as
evidenced by healthful behavioral changes, and demonstrated by the results of participatory
rural appraisal or its equivalent
Evidence that all villages within the command area of BCWB are willing to participate in the
program and have met the minimum criteria to participate
Agreement to participate in a continual performance monitoring and benchmarking program
based at the level of the BCWB command area.

Category 11: Priority-determining scale: The factors for determining the level at which clusters
of villages or BCWBs would be placed on the priority list may include the following:

Size of funding assistance required; the lower the size, the higher the score on the scale
Completion of design and costing of acceptable facilities for wastewater collection and
disposal either on-site or off-site
Soundness of plans for completing project, once requested grant funds are provided
Evidence of availability of trained or trainable local people to implement the project
Evidence of credible arrangements for sustainable flow of revenues to cover operation and
maintenance of installed facilities
Having in place a participatory system of community organization underpinned by incentives
that are driven by the 4Rs (i.e., agreed Rules of behavior within the community such as
adherence to the rights and responsibilities approach; a Referee system to check compliance
with the agreed rules; a Reward and sanctions system to reward compliance and punish
abuse; and a system for Resolution of conflicts)
 Evidence that community rules reflect acceptance of rights and responsibilities approach
Scale of the opportunity cost the village is willing to incur if selected for the project, as
evidenced by the amount of cash and in-kind contributions the community promises to make
toward project implementation in relation to total project cost.

It is apparent that villages and BCWBs might be expected to incur costs to score high on the
readiness scale. The reward for incurring such costs would be the opportunity for early access to
funding under the Framework.

11.4 IWRM Principles

The Framework has private, public health, and water quality goals. All three are interrelated. The
application of Integrated Water Resources Management principles in pursuing these goals implies
recognition of these interrelationships and that, in addressing anyone of them, we should make
sure that we do not undermine any of the other goals. Failure to do this when access to water
supplies was improved was the probable reason why most of the current rural sanitation problems
arose.

Thus, IWRM principles are an indispensable Framework tool. Their use in the Framework is
consistent with government acceptance and use of IWRM in formulating the National Water
Resources Plan. Besides, the goals of IWRM: Treating water as a holistic resource - cross-
sectoral planning and management; managing water at the lowest appropriate level -
decentralized management; ensuring stakeholder participation - NGOs, think tanks, and
women 's groups; and ensuringJinancia1sustainability - are consistent with Framework goals.

11.5 Incentives and Demand Responsiveness

Incentives are central to the Framework, which recognizes that performance is driven by the
behavior of actors, and that behavior is driven by the incentives that face the actors. Hence, it is
incentives that drive performance. The continual performance monitoring and benchmarking
process, described later, is one of the instruments that will be used to create additional incentives
for participation in the Framework. The publication of the benchmarking results will give public
recognition to good performers and provide an incentive for sustaining such good performance. In
addition, consideration may be given to making clusters of villages compete for differential
certificates indicating that their agricultural produce comes from areas with improved irrigation
water quality.

Demand is also central to the Framework. It reflects what people want and are willing to pay for.
Its use by the Framework is based on the premise that people are willing to pay for things that
matter to them. This, in turn, calls for awareness-raising so that villages would perceive their own
contribution to prevailing conditions in their villages as well as their possible harmfid impact on
these conditions.

Demand is best expressed in terms of opportunity cost or by how much cash, time, or other forms
of resources people are willing to forgo in order to get what they want. The use of a demand-
responsive approach is advocated in place of a supply-driven approach because the former
induces commitment and better care of facilities that are provided. This, in turn, induces
willingness to commit resources to keep facilities in working order, thereby enhancing the
prospects of their sustainability. The use of this approach requires that beneficiaries make not
only in-kind contributions, but also some minimum cash contributions to the cost of facilities as a
means of reflecting the value they attach to them.

11.6 Management at the Lowest Appropriate Level

Also known as the subsidiarity rule, management at the lowest appropriate level is one of the
Dublin Principles that form the basis of Integrated Water Resources Management. It is designed
to prevent the perverse incentives that are created through principal-agent problems. The term
"principal" refers to top management, supervisor, or owner of an enterprise. In the Framework, it
refers to the national-level unit responsible for managing the Framework. The term "agent" refers
to those responsible for carrying out the instructions of management at the local level. It has been
observed that when agents are far from their supervisors, they are able to hide activities they do
not want the supervisors to see. As a result, agents are able to get away with many things they
could not possibly get away with if their supervisors were closer. A number of institutional
studies have shown clearly that when management is far from what it is managing, performance
suffers as a consequence of principal-agent problems. To avoid such problems, the Framework
advocates placing management as close as possible to what is being managed. The use of BCWB
is part of the attempt to implement the subsidiarity principle. It is also anticipated that a
combination of NGOs and CDAs would be used to provide village-level support and supervision
to ensure management at the lowest appropriate level.

11.7 Rights-Based and Responsibilities-Based Approaches

This tool derives from two of the principles enunciated by the Minister of Water Resources and
Irrigation. These are that:

0 There is a basic right of all people to have access to water of adequate quality and quantity
0 Managing water is a shared responsibility of all members of society.

Combining these two, we arrive at the maxim that:

All the people within a village community have a right to have access to water of adequate
quality and quantity, and they have a shared responsibility to ensure that this is the case.

A corollary of this is that:

0 All people in a village community have the right to a clean and healthful living environment
as well as a shared responsibility to avoid disposing of their wastes in ways that would
adversely affect the cleanliness and healthfulness of their living environment.

It is important that community members agree to live by these maxims and ensure that they have
rules that create incentives (like the 4 ~ s " )that induce their members to comply with the rules. In
view of the importance attached to this tool, it is one of the factors for gaining points on the
readiness scale.

l 1 Experience shows that successful groups and entities tend to be governed by the 4Rs. These are: an
agreed set of Rules that govern behavior within the group; a Referee system for checking compliance with
the agreed rules; a Reward and sanctioning system to reward those that comply with the rules and to punish
those who break the rules; and a system for the Resolution of conflicts. Together, they serve as an incentive
system to avoid such issues like free-rider problems.
12. OPERATIONAL STRUCTURE OF FRAMEWORK

A central feature of the Framework is a coupled top-downhottom-up, demand-responsive process

that takes place between two anchor points, one at the national level, and the other at the village
level. One of the two anchor points is a possible Strategic Management Unit located at the
national level from which the top-down processes take place; the other anchor is a set of Village
Level Units from which the bottom-up processes take place.

In addition to the two extreme anchor points, there are two important intermediate levels between
these two anchor points that have been described earlier. These are the Hydrologic Basin Level
and the Branch Canal Water Board Level. Figure 14.1 depicts the operational structure
envisioned for the Framework. The figure also shows three other entities: an advisory board for
the Strategic Management Unit, Village Cluster Level Units, and a unit for Performance
Monitoring and Benchmarking.

12.1 The Strategic Management Unit

The Strategic Management Unit is the equivalent of a Project Implementation Unit. It is

envisaged, however, that it would be accountable to an Advisory Board, as shown in Figure 14.1.
Its functions may include:

Preparing national goals, guidelines, and incentives

Prioritizing the drainage basins in the country on the basis of agreed criteria such as public
health risks due to pollution, areas where drainage reuse is seriously affected by pollution,
number of drainage water reuse projects, and population density
Defining desirable water quality goals and targets for each drainage basin and for drains
within the command area of each BCWB
Aggregating villages according to the BCWB within whose boundaries they occur
Developing a readiness scale for use in competition for Framework funds
Defining and publicizing rules for competing for Framework funds
Raising dedicated funds for implementing Framework projects
Organizing workshops for sharing and learning from experience
Refining operational processes in the light of experience
Extending the program eventually to mother villages, urban areas, and to industrial wastes.
 Figure 12.1 Operational Structure of Strategic Management Unit

7 1 Strategic Management Unit I-

Advisory

9 Drainage Basin Level Unit D

A1
1 I
Monitoring and
D Village Level Units 4
Bench Marking
Unit
The Strategic Management Unit will be responsible for setting the overall direction of the
Framework: its goals and policies, rules, and operational boundaries - including rules of
engagement, such as definition of what needs to be done to be high on the priority list. It is within
these operational boundaries defined at the top that projects will be planned and implemented at
the village or bottom level.

Specific technological options and standards to be used at the village level are not to be mandated
from the top. It is only the end results and special requirements and prohibitions - such as
providing an agreed level of treatment for wastewater before discharging it into irrigation drains -
that are to be specified at the top. This does not preclude offering guidelines or suggestions on
possible technological options that could be used to meet goals. However, use of such options is
optional, not mandatory.

12.2 Village Level Units

The village unit is where projects are initiated and implemented, using participatory approaches
that consider gender concerns and social equity. Villages respond to demands from the national
level for bids to compete for Framework funds. It is anticipated that BCWBs in which the villages
are located will be responsible for ensuring that they have access to technical assistance for
preparing projects and bids for funding. Once funds are available, villages will be responsible for
implementing projects. Since the goal is to provide sustainable service, village bids will be
expected to include credible and reliable arrangements for operation and maintenance of installed
infrastructure. Village plans may therefore include:

Mobilizing the community for participation in all phases of projects - from preparation to
operation and maintenance
Arranging for community and household contributions towards financing and cost recovery
of projects, including both capital works and operation and maintenance.

12.3 Village Cluster Level Units

Villages may be aggregated into two different forms of clusters. One would be formed within the
boundaries of BCWBs, as described earlier. The other would be formed, where necessary, to
provide secondary treatment of wastewater from the cluster of villages. The idea would be to
install interceptor sewers to collect the effluent from primary treatment plants from a cluster of
villages for treatment at a central point to achieve economies of scale in treatment plants. It is
anticipated that secondary treatment would be the responsibility of Government, and that the cost
would be financed from Framework funds separately from those awarded to villages through
competition.

12.4 Framework Advisory Board

A Framework Advisory Board would oversee the Framework Management Unit. The board
would be responsible for overall policy direction, national-level appointments, and fundraising.
Its membership would include representatives from core ministries, donors, and other entities
involved in financing the Framework. To improve its effectiveness, the board could form working
groups or task forces for different aspects of the Framework.

Government membership on the advisory board may include the following:

Ministry of Housing, Utilities and Urban Communities

 Ministry of Water Resources and Irrigation
0 Ministry of Health and Population
Ministry of State for Environment Affairs
0 Ministry of Local Development
National Network for Monitoring Nile Pollutants
Organization for the Reconstruction and Development of the Egyptian Village
Social Fund for Development.

Donor membership may include representatives who make financial contributions to the
Framework.

NGOs that may be considered for inclusion include:

0 Egyptian Water Partnership

Water Resources Protection Society.
13. FRAMEWORK IMPLEMENTATION

Implementation of the Framework includes the following issues:

Implementation Cycle
Stages of Implementation
Institutional Arrangements
0 Legal Considerations
Technology Choices
Financing and Cost Recovery
Performance Evaluation

13.1 Implementation Cycle

A three-stage implementation cycle is envisaged, including:

1. Preparatory phase
2. Project Implementation phase
3. Post-construction phase

13.1.1 Preparatory Phase

During the Preparatory phase, villages prepare individually and collectively within BCWB-based
clusters to compete for Framework funds. They expect to be successful in their bids and gain
access to Framework funds for sanitation projects within their villages. The experience of
working with other villages should help promote good relations among members of a cluster. It is
anticipated that Preparatory phase activities would be coordinated at the Brach Canal Water
Board level, and that villages will benefit from technical support from NGOs and from entities
such as CDAs and the SFD activities during this phase may include:

Awareness-raising
Mobilizing communities to organize themselves to meet requirements for bidding for funds
under the Framework
Organizing villages in clusters according to the Branch Canal Water Basins within whose
boundaries they are located
0 Securing resources for preparing bids for Framework funds
Undertaking participatory rural appraisals
Undertaking such other activities as may be needed to have winning bids.

One of the issues to be resolved is how villages will finance these pre-implementation activities.

13.1.2 Project Implementation Phase

The Project Implementation phase would start once vllages have been successful in their bids for
Framework funds. Anticipated activities include:

Collecting and banking of community and Framework funds

Securing technical support for participatory design and implementation of physical works
Mobilizing community members for effective participation in the detailed design and
implementation of needed physical works
 Providing education for hygiene and behavioral change, targeting schools and the general
public
Ensuring 100% coverage of houses with improved and hygienic toilets
Ensuring provision of adequate sanitation in village-level schools, clinics and mosques
Installing appropriate on-site or off-site facilities, as appropriate, for wastewater management
Arranging for operation and maintenance of installed physical facilities for sanitation
Establishing reliable arrangements for user contribution to capital and operational costs.

13.1.3 Post-construction Phase:

An important responsibility during the Post-construction stage is to establish a stable institution

for the reliable operation and maintenance of the installed physical facilities. Possible options
include:

0 Reliance on similar institutions within mother villages if they are near enough to the villages
0 Using local private service contractors
0 Using local or indigenous NGOs trained by national or external NGOs.

Other activities may include:

Ensuring that there is a reliable flow of user contributions to cover the cost of repairs and the
operation and maintenance of installed infrastructure
Monitoring performance
Feeding back results of monitoring and evaluation to the national level for use in refining the
project cycle and the entire operation of the Framework.

13.2 Stages of Implementation

Law No. 48 of 1982 prohibits disposing wastes from sanitary operations into watercourses; but it
allows it if permission is obtained from the Ministry of Water Resources and Irrigation. At
present, wastewater from a number of villages flows informally into irrigation drains and
irrigation canals. Strictly speaking, this is illegal. But given the way such wastes flow from public
places into these water bodies, it is difficult to prosecute anybody. Hence, the pollution of water
in irrigation drains and canals continues unabated.

Two possible options may be considered in addressing this issue. One is to continue with
business as usual, under which communities would continue to pollute water in irrigation drains
and canals by adhering to current practice. The other option is to adopt, with permission from the
MWRI, a two-stage approach in which partial treatment would be given to the wastewater on an
interim basis, to be followed later by full treatment in compliance with Law No. 48. The
Framework recommends this second alternative because it is deemed to be the one that would
lead eventually to improved water quality. Accordingly, the proposed two-stage approach is
described in this section.

13.2.1 First Stage

The first stage of implementation will aim at complete achievement of both private- and village-
level public health goals, as well as partial achievement of the water quality goal.
To these ends, villages would be free to choose the technological solutions they prefer. Basically,
there would be two options to choose from: an on-site solution, and an off-site solution. The
choice would depend upon the quantities of wastewater being generated and the prevailing soil
conditions.

The on-site solution would apply where wastewater generation is low, permeability of the soil is
good, and housing and population densities are low. Even under these conditions, possible future
improvements in drinking water supplies should be anticipated. Hence, it would be advisable
always to have separate vaults for wastewater disposal and for excreta disposal. Also, two sets of
parallel vaults are recommended for each application so that once-a-year users can switch from
the one to the other, as described earlier. The on-site solution, where feasible, should attain water
quality goals as well.

The off-site solution is indicated for conditions of high wastewater flows, high ground water
levels, and high population and housing densities. In such cases, a collection system would be
necessary. As required by Framework guidelines, it would be against rules to discharge raw
wastewater directly into any irrigation drain or canal. Such wastewater should first be given
primary treatment before being discharged into irrigation drains.

Subject to land availability, the Imhoff Tank system is recommended for the primary treatment. It
provides both primary sedimentation and sludge digestion in a single, two-story unit in which the
digester is located below the sedimentation compartment. This approach should remove at least a
30% of organic pollution in the inflow wastewater. Other possible technological options that may
be considered - subject to availability of land and other imperatives - include the oxidation ditch
and waste stabilization ponds.

13.2.2 Second Stage

The second implementation stage applies only to villages that choose the off-site solution. In this
stage, an interceptor sewer would be installed to divert effluent from the Imhoff tanks into a
secondary treatment plant that would serve a cluster of villages. Branch Canal Water Boards may
facilitate aggregation of villages for this purpose. However, it should not be a requirement that all
the villages within the boundaries of the BCWB command area should be connected to one waste
treatment plant. There may be cases where it would be more cost-effective for a village to have its
own secondary treatment facility, an option that should not be discouraged.

The number and location of secondary sewage treatment plants in each command area should be
driven by technical considerations and consultations with the local civil society and relevant
institutions at the mother-village level. In view of the economies of scale inherent in sewage
treatment plants, cooperation between two or more BCWBs during the second stage should be
encouraged.

13.3 Institutional Arrangements

The details of the institutional arrangement need to be worked out with a number of institutions in
the country. In doing so, several factors should be considered, especially the fact that:
Mother villages have institutional responsibility for the small villages that are essentially
satellite villages to them
Eventually, Framework implementation will be extended to cover mother villages, urban
areas, and industrial wastes
 NOPWASD is the government entity responsible for the design, construction, and initial
operation and maintenance of sewerage and sewage treatment plants in cities and mother
villages. After an initial period of about two years, the operation and maintenance of the
systems they build will be transferred to the local authority.

For these reasons, institutional arrangements should anticipate possible future involvement of
NOPWASD in the Framework as it is eventually extended to mother villages, urban areas,
and industrial wastes.

Other organizations that have been involved in providing rural sanitation services include the
Shorouk program and the Social Fund for Development. However, SFD's role has been
mainly to implement projects funded by donors such as KfW or by international financial
institutions such as the International Development Agency of the World Bank Group. Thus,
the institutional design should take into consideration possible roles that the Shorouk
program, SFD, and the CDA can play in the implementation.

Based on the foregoing and other considerations, the design of the institutional arrangement
will take into consideration the following:

0 The various activities that need to be undertaken at the various points in the
implementation cycle
0 The institutional levels at which the various activities would take place, such as the
following:
0

o The national level: involving the Strategic Management Unit and the Advisory
Board
o Branch Canal Water Board levels for intermediation and coordination of
activities of clusters of villages within their boundaries
o Villages where projects would be designed, implemented, run, and used.

0 The key actors or centers of activity located at each of the three institutional levels listed
above, including:

Village-level actors, including community-based groups

Actors and institutions at mother villages, such as popular councils, executive
councils, and CDAs
Water user associations
NGOs - international, national, local, and quasi-Government such as the Shuruq
Branch Canal Water Boards
Governorates
The Social Fund for Development
Ministries and Ministers of State
Private sector contractors.

13.4 Legal Considerations

As stated earlier, it would be against Law No. 48 for primary treated wastewater effluents to be
discharged into irrigation canals. The responsibility for secondary treatment - by inference from
current practice in urban areas - falls on the Government; however, lack of funds may not allow
Government to fulfill this obligation. It is therefore recommended that MWRl permission be
secured to permit disposing primary treated wastewater effluents in irrigation canals on a
temporary basis, pending construction of secondary treatment plants by Government.

13.5 Technology Choices

Numerous technologies have been tried for rural sanitation in Egypt. However, most of the trials
have taken place in mother villages and not in the smaller or satellite villages that are the
immediate focus of this Framework. A summary review of these trials is included in Part A of
this report, and a full review is included in a stocktaking exercise of existing rural sanitation
systems in Egypt that was undertaken to provide data for the proposed Framework (Gaber, 2004).

As a general principle - given the demand orientation adopted for the Framework - it would not
be appropriate to impose technological options on any village. It is important, however, that
village community-initiated technological choices be technically feasible and appropriate for the
local conditions. To this end, villages should have access to information on a range of
technological options that are feasible for their situation. They may choose from this range if they
wish; alternatively, they may choose other options, provided they are technically feasible. A short
list of sanitation technological options is given in Table 15.1. The options are based on
experience from various sanitation technologies tried in Egypt, conclusions from the Stocktaking
study, and experience from other parts of the world.

Table 13.1 Selected Sanitation Technology Options for Framework Projects

Type of Purpose Technological Options Conditions Suited for

System Use
Simple Dry Double-Pit, Low water usage;
intended for emptying Poor soil
permeability;
Low water table;
Low-medium
Excreta disposal housing density
On-site Pour-Flush Toilet with twin Medium water use;
Sanitation pit soakaway or bayara, Good soil
intended for emptying pernieability ;
Low water table;
Low-medium
housing density
Pour-Flush plus Septic tank High water usage;
with twin-pit soakaway or Poor soil
bayara, intended for permeability;
emptying High density
housing;
High water table
Wastewater Disposal Separate twin-pit soakaway Where on-site
system for sullage disposal sanitation is used for
excreta disposal
 I Simplified Sewerage with High water usage;
Wastewater conveyance small-diameter, shallow- Poor soil
depth, and flat-gradient permeability;
sewers High density
housing;
Off-Site
I High water table
Sanitation
I Primary Treatment Imhoff Tank with sludge As interim solution
drying beds to pollution of water
in irrigation drains
and canals
Long-term solution
Sludge Digesters o r co- to wastewater
composting of sludge with disposal in rural
garbage areas

Alternative Treatment Constructed Wetlands Remote areas like the

Options In-stream Wetlands fringes of the Delta
m
I Waste Stabilization Ponds
14. FINANCING AND COST RECOVERY

Most Egyptian rural sanitation projects have been for mother villages. However, financing these
projects should provide a guide for how projects under the proposed ~rameworkmay be financed.

The principal sources of financing for the past rural sanitation projects have been:
Government
Donors
NGOs
Households and Beneficiaries.

14.1 Government Financing

Government financing of rural sanitation is provided through several agencies, but principally
through three agencies: namely, NOPWASD, the Social Fund for Development, and the Shorouk
program.

Through NOPWASD, Government has financed the planning, design and implementation of
capital works for sanitation projects. Government has also funded the initial operation and
maintenance - usually lasting up to two years - before handing projects over to local authorities.

Government funds provided through SFD and the Shuruq program are usually in the form of
block grants that call for matching contributions from the beneficiary communities. Such
contributions reach as much as 25% of the infrastructure costs.

14.2 Donor Financing

A number of donor governments help finance rural sanitation projects in Egypt. These include the
governments of Canada, Denmark, Finland, Germany, The Netherlands, Switzerland, United
Kingdom, and the United States of America. Donors have usually worked with NGOs, principally
the CDAs, which have consequently gained substantial project experience in different parts of the
country.

Donors, including UNICEF, normally provide funds for designing and constructing sanitation
infrastructure, usually with beneficiary participation in the form of labor and cash contributions
that represent matching funds, usually set at 25%. [can we delete this sentence'?+] In this project,
they also asked for 25% contribution from the beneficiaries. Most NGOs become involved as
facilitators working on donor-funded projects. A typical example of this is CARE.

14.3 Household and Beneficiary Financing

Not much is written about self-provision of sanitation services in Egypt. However, it is apparent
that beneficiaries contribute up to 25% of infrastructure costs. Thus, households contribute to
capital costs of projects and also make direct contributions to monthly costs of operation and
maintenance. Furthermore, in some projects, they contribute indirectly through surcharges
imposed through the Local Services and Development Fund (LSDF).
14.3.1 Local Services and Development Fund

LSDF is the only fund in Egypt under which local governments are allowed to impose, collect,
and retain revenues to support local services. Established under Law No. 43 of 1979, it allows
administrations at each level of local government (village, district, and governorate) to levy
surcharges on such revenue sources as crop taxes, cinema ticket sales, and water bills.

The law sets out the percentage of the surcharge that can go to each level of local government. It
also allows some funds to be ring-fenced and earmarked for special purposes such as financing
aspects of the proposed Framework on rural sanitation. This was the case in a special wastewater
operation and maintenance account that was established for Damietta. Although LSDF proceeds
cannot be spent on salaries, they can be spent on service contracts; this was an approach adopted
by 17 villages in the Damietta Sanitation Project.

LSDF is worth considering as a potential funding source for householdfbeneficiary financing

under the proposed Framework. However, administrators should note that imposition of an LSDF
surcharge requires prior approval of the local elected council at the mother-village level, and that
a considerable amount of ,awareness-raising and consensus-building is needed to ensure the
required approval.

14.4 Proposed Financing and Cost Recovery Arrangements

Based upon past practices, sources of financing for the proposed Framework can come from the
following sources:

Government financing
Beneficiary financing
Donor financing, including funds from the World Bank.

14.4.1 Government Financing

For off-site sanitation systems, it is recommended that the Government assume responsibility -
not for all sanitation infrastructure, as is the case in urban areas - but only for trunk infrastructure
and treatment plants, both primary and secondary. In this context, trunk infrastructure refers to
sewerage systems whose diameters exceed 100 mm or 4 inches, together with their appurtenances
such as manholes and pumping stations.

14.4.2 Beneficiary Financing

It is recommended that for off-site sanitation systems, beneficiaries assume responsibility for
matching funds toward feeder sanitation infrastructure: the public component of sanitation
infrastructure between trunk infrastructure and household-level sanitation facilities that feed into
the feeder12infrastructure.

For on-site sanitation systems, it is recommended that beneficiaries assume full responsibility for
in-house facilities, but be required to make matching contributions of about 50% of the cost of
disposal systems such as soakaway pits for pour flush toilets and soakaway systems for sullage

l2 In this context, feeder sewers are defined as those whose diameters are equal to, or less than, 100 mm or
4 inches.
disposal. Communities may be encouraged to work out how best to provide for the indigent
among them.

For both on-site and off-site systems, it is recommended that beneficiaries be responsible for
recovery of operation and maintenance costs. The actual ability to recover O&M costs may vary
from one basin to the other, and can be assessed during implementation. Arrangements may be
made to secure LSDF surcharges to cover part of O&M costs for sewerage and sewage treatment
costs, with the balance coming from direct contributions from beneficiaries.

14.4.3 Donor Financing

It is recommended that donor contributions go to finance sofhvare costs as well as the difference
between total costs and the fraction paid by Government and beneficiaries. It is considered
important that donors involved in the Framework adhere to common approaches in financing. A
recommended approach would be placing all funds into a common basket managed by the
Strategic Management Unit of the Framework, with donor involvement through the Framework
Advisory Board.
15. PERFORMANCE MONITORING AND BENCHMARKING

The Framework intends to measure performance in each of the three key goals:

Private goals: improved access to hygienic latrines at household levels in rural areas
Public health goals: access to a clean and healthful living environment
Water quality goals: improved quality of water in irrigation drains and canals.

Given the fact that incentives drive performance, the continual performance monitoring and
benchmarking (CPMB) tool will be used to evaluate performance. This tool was chosen because
of the following features:

It is an instrument that stimulates the achievement of Framework goals

Its focus is on results, not just on the means of getting results
It recognizes that an assessment and discussion process involving various stakeholders is
essential for transforming measurement of results into actions for continual improvement
In addition to measuring results, it embeds information from performance evaluation into
critical decision-making processes of the management
Performance is measured continually to ensure that a performance-driven culture is
institutionalized
It stimulates collaboration and friendly contests between communities.

The CPMB will provide appropriate incentives to motivate all stakeholders - communities and
the key players at both anchor points - to participate and contribute effectively towards all three
goals of the Framework. The incentives program includes five cyclical steps:

Develop a methodology to assess performance for each of the goals

Communicate the results to stakeholders
Identify and develop strategies and subprojects to help reach the performance goals
Compete for project funds that require technical assistance that is not available locally
Implement corrective actions to meet established performance targets.

After completing a cycle of performance evaluation, shown in Figure 15.1, the process restarts
with a fresh focus on monitoring and measuring whether or not corrective actions have produced
the desired results.
 Figure 15.1: CPMB Implementation Mechanism
SkIL"
1. Performance
Assess performance using agreed
Monitoring indicators and targets, conduct root
analysis and identify actions for
2. Communicate
5. Implement
Projects Performance Inform stakeholders about performance
strategy for
I w
Identify projects that can be
local resources; prepare projects that
4. Secure 3. Identify external
Funding
-4
Seek funding for projects; these must be
A System of Continual building and investment
- - MeasuremMey to w
Implement projects in accordance with g(
Accountability
-
and
targets; Go back to Step

It is anticipated that CPMB can be put into operation within six months. The main
implementation steps would include:

Identifying and selecting a water board where the first CPMB initiative will be launched. This
will be chosen from the first set of Branch Canal Water Boards that win funding under the
Framework competition.
Creating a CPMB team and placing it in the overall management structure of the water board.
Assessing baseline data, including assessment of participation in villages within the
command area of the selected water board, and an assessment of water quality in the area
within the jurisdiction of the water board. These activities will involve the following
substeps:

o Selecting performance indicators.

o Developing performance evaluation methodology. This process can become
complex, but experts with a strong experience in developing performance evaluation
methodologies can manage the process successfully. To remain simple and
transparent, the methodology should use quantitative, qualitative, and visual
information and seek inputs of experts in the review process.
o Evaluating data needs and format.
o Identifying critical monitoring points and sites for data collection. These points will
cover villages, drains and canals, and other points considered necessary by the water
board.
o Developing the data collection system. The first round of data collection will require
creating and training data collection teams. It is strongly suggested that local staff
 and skills should be used. Where necessary, technical support from governorate- and
national-level resources should be sought.
o Analyzing performance using the data collected from various sources and applying
the methodology agreed upon.
o Discussing and reviewing results.
o Communicating results to various stakeholders.

The CPMB initiative will produce strategic benefits by:

Generating a baseline water quality management report for each village and for each Branch
Canal Water Board; this will serve as the reference point for measuring progress over time.
Generating a baseline management report on rural sanitation service delivery, solid waste
disposal processes, and the cleanliness of village public places.
Setting up a system of continual performance measurement, enabling project proponents and
water boards to measure progress continually and assess the results of their actions and
investments.
Enabling villages and water boards to share information and promote cross-learning.
Creating transparent management mechanisms for water quality and village environmental
quality at the level of water boards.
Motivating donors and Government to create a common fund for rural sanitation and
irrigation drain water quality management based on the principles of "show results and get
funds."

Communications Tools

Detailed research by other donors13 indicates that the poor quality of surface water in irrigation
canals and drains is a known concern of farmers and village-level residents in Egypt. In general,
residents are aware of the problems of poor water quality - that there are adverse health
consequences from exposure to unhygienic water in terms of acute and chronic health problems,
along with impacts on agricultural productivity.

Despite that knowledge, some local-level practices that degrade water quality continue - such as
direct (or indirect) dumping of household sewerage into canals, improper management of
livestock waste, dumping of solid waste along canals, and use of contaminated canal water for
washing. These practices persist for a variety of reasons - reasons that this project will seek to
understand and mitigate. They may include the high cost to change practices, lack of viable
alternatives for sewerage disposal because of high water tables and the high cost of land, and lack
of viable alternatives for solid waste collection and disposal.

Communications strategy will be a key factor in performance monitoring - providing local-level

stakeholders with information and understanding to inspire local-level changes in practice. A
successful strategy will enable them to evaluate and prioritize initiatives to improve the quality
of water, and give them the tools they need to work with donors and governorate-level officials to
plan new initiatives. Overall, the communications component of the Framework will help
improve water quality and sanitation by helping to convey to local, district and national level
players:

l3 Egypt Water Quality: Management Action Plan: Phase 11, Robert A. Kelly and James Welsh, July 1992,
submitted by PRIDE to USAID, USAID Contract Number ANE-0 178-Q-00-1047-00.
 What is the status of local-level water quality and sanitation - what do data show about how
severe the problem is and where?

What are the options and solutions for addressing problems with water quality - what can be
done to address the problem through changes in local practices, through local-level
initiatives, and through outside investments?

What are local-level priorities for addressing water quality problems - what are the key
solutions that the local-level stakeholders, through the water boards, identify as their top
priorities?

What progress is being achieved - showing the changes in water quality?

Communications tools can cover the following approaches:

Baseline context (one time): use local civic leaders, printed materials for local distribution,
and volunteers to spread messages about the program's approach, possibilities for local
actions, and outside investments. These efforts may require integration with hygiene
education messages from sanitatiodeducation partner organizations, as available, using
radio/TV and other media as available.

Baseline data and situation (one time): use local civic leaders, printed materials for local
distribution, and volunteers to spread messages about water quality baseline data, priorities
for local-level changes in practices and local-level actions, as well as a planned approach for
outside investments. E-mail and the Web will be used to reach governorate- and national-
level stakeholders, conveying messages about the general project approach.

Water quality progress (monthly or quarterly): the results of initial local-level actions will
be the basis for awarding targeted funding, which is a good opportunity for local-level civic
leader communication, public events, TV/radio coverage, etc. Progress will also be reported
to governorate- and national-level stakeholders by e-mail and the Web.

Water quality updates (quarterly): Governorate- and national-level audiences of

Government, NGO, and donor staff will receive periodic (quarterly) updates.

Communications about program actions and accomplishments. This outreach effort will
heighten awareness of the CPBM; direct attention to locally identified efforts that may
require outside funding and support; and focus on accountability where responsibilities are
already clearly defined.
 PART C: STRATEGIC DIRECTIONS FOR THE FUTURE

16. PILOTING

The Framework will be implemented in three phases. The first phase will be a pilot phase, the
second will be a full-scale implementation, and the third could potentially be expansion to cover
urban and industrial wastes.

16.1 Objectives of the Pilot Phase

The main objective of the pilot stage is to test aspects of the Framework for which there are
technical andlor operational uncertainties. Possible issues that might be investigated include:
Using different organizations to help villages prepare to compete for priority ranking for
financial support
Using different organizations to provide technical support to villages at different stages of
service provision, including awareness-raising, participatory rural appraisal, planning,
implementation, and operation and maintenance of installed facilities
Feasibility and sufficiency of ranking criteria for drainage basins and for clusters of villages
within water board command areas
Developing village-level support mechanisms and assessing existing local capacities and
required support
Assessing support from various organizations - Government, donor community, NGOs, etc.
Testing how best to scale-up the pilot project to cover the rest of the country and, eventually,
to urban areas and industrial wastes.

16.2 Champions for the Pilot Phase

There are numerous possible champions for the proposed Framework approach. At the national
level, they include the Ministry of Water Resources and Irrigation (MWRI) and the Ministry of
Housing and Urban Communities (MOI-IUC). In addition, partner agencies can include the
Ministry of Health and Population (MOHP); the Social Fund for Development (SFD); the
Ministry of Local Development (MOLD); and the Egyptian Water Partnership.

At the governorate level, champions may include two or three governorates where the IIIMP is
being implemented; and at the local level, they may include Water Users Associations ( W A S ) ;
Community Development Associations (CDAs); ShorouWORDEV (Organization for
Reconstruction and Development of Egyptian Villages); and Branch Canal Water Boards. The
Framework will also be shared with donors and international NGOs who express interest in
serving as champions. The initial candidate donors would include those that had been involved in
the sector in the past: Denmark, Germany, The Netherlands, and the United States of America.

16.3 Choice of Pilot Area

The pilot area will be chosen on the basis of the following criteria:

Where the goals of the piloting phase would be easiest to achieve

Where there are projects under way with objectives that are similar to those of the pilot phase
Where there can be synergies and cost-sharing of common facilities and operational
institutions.
During a high-level, ministerial meeting held by MWRI with MOHUC and MOLD in October
2004, elements of the proposed Framework were discussed and endorsed. A prospective area for
the pilot work has been suggested in command areas chosen for the Integrated Irrigation
Improvement and Management Project (IIIMP) funded by GOE and the World Bank. The
objective of the IIIMP is integrated planning, management, and execution of all interventions
needed in Project command areas. Since it will be using the same institutions envisaged for use
under the Framework - namely, Water Users Associations and Branch Canal Water Boards - it
might be expedient to establish a relationship between the Framework and IIIMP.

Further conclusions/recommendations for piloting the Framework approach included:

The concept of the hydrologic basin is in accordance with the vision of the Holding Company
for Water Supply and Sanitation as a responsible national authority
Engineering designs can be part of the integrated design packages, with WUA participation
During implementation, each sector will be responsible for work under their jurisdiction
A public awareness campaign is needed to introduce the concept to beneficiaries and to
maintain a high profile of the proposed approach for potential scaling up.

17. TIMETABLE AND BUDGET

It is anticipated that the Framework's timetable and budget would be established by:

Defining outcome targets at different levels of operation by selected target dates

Identifying the inputs needed to achieve the outcome targets
0 Identifying the infrastructure as well as the human and financial requirements needed to
produce the required inputs
Translating financial requirements into budget lines, and estimating financial cost per year
Differentiating between capital and operation and maintenance costs on the basis of best
practices
Differentiating between hardware and software interventions.

The budget and implementation timetable would be defined on the basis of this information.
Since a demand-responsive approach is to be followed, some of the information identified above
cannot be determined before the program of activities begins. However, it should be possible to
make some estimates based on aggregate cost figures applicable to Egyptian practices.

The interventions needed to produce the desired inputs for the Framework program of activities
would include:

Identifying partners
Establishing the Advisory Board, the Strategic Management Unit, and the team for the
continual performance monitoring and benchmarking program
Producing operational guidelines for donor coordination, competition for Framework
funding, and participating Branch Canal Water Boards
Securing Government commitment and leadership
Prioritizing drainage basins in the country
Preparing national goals for:

o Water quality
o Village environmental conditions
 o Household toilets
o Minimum treatment prior to discharge into irrigation drains
o Minimum water quality standards for agricultural use of treated wastewater effluents
Selecting pilot areas
Producing a readiness scale
Selecting and training operational and technical support staff.

The basic information needed to carry out the activities listed above is not yet available. It is
recommended that this information be collected for use in defining the required timetable and
budget in the next phase of preparing the Framework. This should be done in coordination with
the team responsible for the IIIMP.

Performance monitoring and benchmarking is a key element of the Framework, and can be
initiated as part of the IIIMP program or as a parallel mechanism to support rural sanitation
service delivery. The 1-year, 5-year, and 10-year implementation cycles for the CPMB are
shown in Table 19.1.
 -
e n t a t i o n 2 l e s for CPMB
l-YearPlan . e e 4 R I -
1. Work with one water board and establish the benchmarking program by end of Year 1. Key Milestones for this
initiative will include:
Baseline report on water quality for the selected water board
Identification and agreement on performance indicators and methodology
Identify key stakeholders, their roles and needs, and communications tactics
Training local teams on data collection, monitoring and analysis
Establish a performance management system at the water board (train staff, establish procedures and
transfer computer tools)
Develop communications infrastructure to leverage data collection for dissemination to local,
governorate, and national levels
Develop and implement initial baseline water quality communications messages
Institute a high-visibility event for public recognition and reward for best performing village, with
corresponding regional- and national-level communications tactics
1. Based on data compiled, analyze and understand capacity building and investment needs to achieve water
quality goals
2. Establish annual, medium, and long-term targets
3. Develop expansion plan.

5-Year Plan
1. Establish benchmarking system in 50 water boards
2. Create investment and capacity building support fund tied to performance and benchmarking ranking
3. Institute a system of annual benchmarking report for water boards
4. Create an Egyptian team and appropriate organization for disseminating the performance-based management
system to other water boards
5. Selectively introduce a system of user fees to strengthen local revenue generating capacity
6. Create water board clusters to support integrated water resource management

10-Year Plan
- - -

I. Expand the coverage of performance based and benchmarking program to 90% of the villages in Egypt by 2015.
18. STRATEGY FOR WORLD BANK INVOLVEMENT IN THE SECTOR

18.1 Current World Bank Involvement

The World Bank is involved in a number of water-related projects and sector work, including:
Development of an IWRM Action Plan
0 Integrated Irrigation Improvement and Management Project (IIIMP)
The West Delta Infrastructure Project.

All three are in support of the Ministry of Water Resources and Irrigation. The second project,
IIIMP, is aimed at integrated planning, management, and execution of all projects needed in the
project command areas - an area of about 500,000 Feddans. The key stakeholders involved in
this project -- the Water Users Associations, Branch Canal Water Boards, and District Water
Boards - are the same as those that will be involved in the proposed Framework for Rural
Sanitation in Egypt.

Thus the World Bank has a comparative advantage in being involved in the planning and
implementation of the proposed Framework. Its involvement will pave the way for productive
synergies between the two projects, especially if common areas are chosen for the initial
implementation of the two projects. The Framework can take advantage of the various types of
integration envisaged in the IIIMP, which include management, physical, and policyllegal
integration.

18.2 Assistance in Sector Reform to Improve Accountability

The design of the Framework, together with its Continual Performance Monitoring and
Benchmarking program (CPMB), implies holding villages individually accountable for the
standards of sanitation service provided within their boundaries. It also holds them - along with
other villages and their Branch Canal Water Boards (BCWB) -jointly accountable for water
quality in the irrigation drains and canals associated with the BCWB. This is in contrast to the
system of accountability implied in the current assignment of responsibility for sanitation
services. The present system empowers NOPWASD - and not local authorities - to plan, design,
and build sanitation infrastructure for local authorities. This implies absolving local authorities
from their legal responsibility not only for meeting the sanitation needs of their residents, but also
for desisting from practices that pollute water resources.

Also, tariff levels are currently set at the central level, and not at the local level. This practice
does not ensure a sustainable flow of revenues for proper operation and maintenance of installed
systems.

Thus, the present system inadvertently creates a conflict of interest because the Government
cannot hold itself accountable for what it fails to do correctly. There is a need for sector reform to
relieve Government of the responsibility for providing adequate service and shift it to local
authorities, which should assume the responsibility for preventing pollution of water resources.
This action will help to change the role of Government to that of a facilitator.

The World Bank can help GOE undertake the necessary sector reform to address the issues of
accountability and tarlflsetting.
18.3 Service Provision and Service Delivery

The sector reform called for above would shift the responsibility for service provision from the
central to the local-authority level. In many parts of the world, local authorities interpret this as
meaning that they should create departments to supply the service. This is a misunderstanding.
What it implies is that the local authorities should ensure that cost-effective services are provided
by an entity that the local authority can hold accountable. This could be a private sector entity or
an independent public entity that has a competitive advantage for delivering the service in a cost-
effective and accountable way.

The Bank can help address this issue as part of the proposed sector reform.

18.4 Filling a Gap in Sanitation Service Delivery

The proposed Framework is potentially a groundbreaking approach to rural sanitation. It is the

first time that a rural sanitation program is being driven not only by considerations of public
health and private convenience, but also by strong consideration of the need to,safeguard water
quality. These concerns have made the proposed rural sanitation program a central feature in the
IWRM program of the Ministry of Water Resources and Irrigation.

In addition, the current centralized supply-driven approach to sanitation service delivery does not
include plans by NOPWASD for the 27,000 small satellite villages that are the immediate focus
of the proposed Framework. Thus, there is a gap in service delivery to meet the needs of people in
these 27,000 villages.

By pursuing this Framework, the World Bank would be contributing to developing this
groundbreaking approach while, at the same time,fdling the gap in service provision.

18.5 Achieving Government Goal of Improving Irrigation Water Quality

Success in the proposed Framework for rural sanitation will not be enough to achieve the
Government goal of improving irrigation water quality. Attaining this goal will require
participation of mother villages, urban areas, and industries in the Continual Performance
Monitoring and Benchmarking program.

The proposed sector reform is a prerequisite for extending the CPMB program to other areas.
World Bank experience in the proposed Framework will place the Bank in a position to help the
Government of Egypt pursue the proposed sector reform, thereby helping the Government
achieve its goal of irrigation water quality improvement.

In sum, World Bank involvement in the rural sanitation sector is advantageous in the following
ways:

1. Assisting Government undertake the necessary sector reform to address issues of

accountability and tariff-setting in the sanitation sector
2. As part of the proposed sector reform, helping Government address conflict-of-interest issues
in service provision and delivery at local-government levels
3. Using the Framework to contribute to developing a groundbreaking approach to sanitation
programs while, at the same time, filling the gap in providing sanitation service to the 27,000
small villages in Egypt
4. Using the experience in the proposed Framework approach to help Government to achieve its
goal of irrigation water quality improvement in the country.

19. CONCLUSIONS

One object of this report is to identify the root causes of the increasing organic pollution load
causing deterioration of irrigation drainage water in rural Egypt. Such deterioration a major
factor undermining Government plans to reuse irrigation drainage water, and it adds to the
increasing health and economic costs related to the degradation of fresh-water bodies. A second
object of this report is to describe a proposed approach - the Framework - for addressing these
problems.

The principal conclusions of this report are:

Much of the water pollution problem is caused by the failure to provide facilities to handle
the increased wastewater flows that have resulted from improved rural water supplies in the
recent past
The rural sanitation problem has a significant impact on health and the economy of the
country
Current government plans to address sanitation problems are limited to urban areas and
mother villages; there are no plans for improving sanitation for the 27,000 small villages that
are satellites to the mother villages
A program of action is needed to arrest the continuing deterioration of irrigation drainage
water quality, focusing initially on the 27,000 smaller villages in order to refine the
methodology for intervention. Following this, the program of intervention should be extended
to mother villages, urban areas, and industrial wastes
The Framework described in this report provides a program of intervention
The Framework's approach, for the first time, links access to investment in rural sanitation
services to quantifiable water quality (and health) improvements in a given hydrologic basin
Performance monitoring and benchmarking is a key Framework tool in ensuring that agreed
water quality improvement targets are achieved
The Framework approach and methodology are based on extensive consultations with all
relevant stakeholders at the national and local levels
The World Bank has a comparative advantage in playing a lead role in implementing the
proposed Framework so that synergies can be produced between the Framework and other
World Bank projects in Egypt, such as the IIIMP
A high-level ministerial meeting organized by the Ministry of Water Resources and Irrigation
- together with the ministries of Housing and Urban Communities and Local Development -
to discuss a draft of this report has endorsed the proposed Framework approach and
supported piloting the first stage of implementation.
 ANNEX
Fresh Evidence on Diarrheal Risk Reduction
Diarrheal Risk Reduction by Single or Multiple Interventions
Citation Water Water Quality Sanitation Hygiene Multiple Nutrition Mother
Supply (Bacteriological) Hand washing Education
(Each 10%
of Years of
Education
Attended)
1. Esrey et al. 19% 15% 36% 33% 30%
(1990) (Source)
2. WHO (1998) 70%
3. Varley et al. 10% 30%
(1998)
4.a Semenza et 85%
a1. (1999) (Standpost and
manual
chlorination)
4.b Semenza et 62%
al. (1999) (piped and
manual
chlorination)
5. Wang (200 1)
6. Wolff et al.
(2002)
7. Curtis et al.
(2002)
8. Fewtrell et al. 6% 44% 24% 45% 33%
(2004) (Stand- (Standpost and
post) manual
chlorination)
Note: Studies 1, 2, 3, 5, 7 and 8 are meta-analyses whereas 4 and 6 are single analyses.
Most of the studies are in rural areas. Some risk reduction rates, which reflect speci$c
endogenous and exogenous multivariate factors, could benejtpom additional analysis to
make the results more robust, i.e., multiple interventions. In Fewtrell et al. there are not
enough good studies to calculate a better risk reductionfor sanitation interventions.
Recent evidence shows a reduction of acute respiratory infection through better hygiene.
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