Sustainable systems to collect and treat sewage are practically non-existent throughout Haiti, according to the World Bank. Limited access to clean water and improved sanitation makes it easier for cholera and other diseases to spread. One alternative, a waterless toilet and waste collection service, may provide a significant health benefit in dense urban settings. But uptake of this new technology requires behavior change and a willingness to pay for the service.

Both requirements were largely met in a study led by researchers with the Stanford Woods Institute's Water, Health & Development program.

Published in the journal Environment & Urbanization, the study reports urban Haitians who participated in a trial of a new toilet technology and service gave the system high ratings for safety, convenience and modernity. Almost three out of four users who participated in the study chose to pay to continue the service.

“The flush toilet in Haiti is an image of modernity. This dry toilet harkened to that aspirational product, and ‘showed itself off’ to neighbors through the twice-weekly collection service,” says Stanford environmental engineering graduate student Kory Russel, the study's lead author. “People had an increase in feelings of pride.” Russell and study co-author Sebastien Tilmans are co-founders of re.source, an interdisciplinary, multi-national team working on water and sanitation challenges in Peru, Mozambique and Haiti.

Container-Based Sanitation

Earlier this year, Russel and Tilmans found a 3.5-fold reduction in open defecation among households that used the waterless toilet and collection service called Container-Based Sanitation (CBS). But until now, little was known about users’ perceptions and willingness to pay for the system, says Russel. Both of whom have participated in the Woods' Rising Environmental Leaders Program,

Prior research has demonstrated low demand—willingness and ability to pay—for improved household toilets. Some explanations for this low demand include the fact that toilets are often marketed on the basis of health improvements, whereas households care more about privacy, convenience, and status. In addition, improving a toilet typically requires a large up-front investment, which can pose a hardship for a low-income household. Finally, many urban householders lacking high quality sanitation services are renters. They are understandably reluctant to make major capital investments in homes they do not own.

Options are limited for low-income urban households, particularly in the research site, Shada, the largest slum in Cap Haitien, Haiti. Public facilities typically close at night. Pit latrines can require manual cleaning, which exposes workers and community members to pathogens. And flooding of latrines can wash sewage into streets and homes. Open defecation leaves women and children vulnerable to assault. 

The container-based sanitation system offers users an attractive alternative to the shortcomings of those other options. CBS toilets are available 24/7.  Contrasting with public toilets, they are viewed as a high-quality sanitation solution. Users don't have to worry about emptying them, as they do with traditional pit latrines. Positioned above ground, they do not flood. And they can be used within the safe confines of home.

The toilets had been distributed at no cost to users during a pilot study in tandem with the Haitian/American nongovernmental organization Sustainable Organic Integrated Livelihoods (SOIL).  Led by Sasha Kramer (Stanford ’06), SOIL worked with re.source to develop and deploy the CBS toilet service in Haiti.

In addition to health benefits and user satisfaction, container based sanitation offers another public advantage. The collection service creates jobs. “Unemployment is incredibly high,” says Russel. “Trained, uniformed, professional collectors can serve subscribers who choose to pay for a valued service.”

Moving Forward

The research team has been awarded a Stanford SEED grant to adapt this solution to urban Bangladesh. In addition, the Stanford Global Development and Poverty Initiative will support the team in adapting the container-based sanitation model to the technical, financial, socio-cultural, and institutional challenges of the South Asian region. The region is home to more than 40 percent of those worldwide without access to improved sanitation services.

Over the summer, Jenna Davis, associate professor of civil and environmental engineering and Higgins-Magid Senior Fellow at Woods, and students Laura Kwong, Shreyan Sen and Phil Salazar deployed two prototype CBS toilets in the city of Khulna, Bangladesh. They obtained feedback from test households. The team also established a partnership with the International Center for Diarrheal Disease Research, Bangladesh, and the nongovernmental organization Water and Sanitation for the Urban Poor, supported in part by HSBC Bank. Through this multi-year collaboration, the partners will install improved sanitation facilities in low-income urban communities of Bangladesh. They will research CBS service delivery, sustainability of shared sanitation facilities, and fecal sludge management.

Support for this research has come from Woods, the Stanford Institute for Innovation in Developing Economies, the Bill and Melinda Gates Foundation, and the U.S. Environmental Protection Agency. The sanitation service was developed in collaboration with the nongovernmental organization Sustainable Organic Integrated Livelihoods (SOIL), which continues to operate and expand the service. SOIL serves more than 500 families in Haiti.

Read more in this Research Brief.