NATIONAL SANITATION POLICY FOR JAMAICA

NATIONAL SANITATION POLICY FOR JAMAICA Ianthe Smith Environmental and Engineering Managers Ltd. September 2005

NATIONAL SANITATION POLICY Section Page 1.0 Introduction 3 2.0 Definitions 3 3.0 Situational Analysis 4 3.1 Institutional Setting 4 3.2 Existing Policies and Programmes Related to Sanitation 6 3.3 National Sanitation Situation 8 3.4 Rural Water Supplies 9 3.5 Sanitation in Public Schools 10 3.6 Public Sanitary Conveniences 12 3.7 Solid Waste Management 12 3.8 Poverty and Sanitation 16 3.9 Health Status 17 3.10 Informal/Unplanned Settlements and Sanitation 23 3.11 The Impacts of Natural Disasters on Sanitation 23 3.12 Investment in Sanitation 24 3.13 Jamaica s Progress within a Regional Setting 27 4.0 Vision Statement 30 5.0 Goals 30 6.0 Policy Objectives 30 7.0 Strategies 31 7.1 Health issues as key rationale 32 7.2 Institutional and Policy Framework 32 7.3 Waste minimisation, reuse and recycling 33 7.4 Promote Local Solutions 33 7.5 Encourage the Involvement of all Stakeholders 33 7.6 Regulation and Monitoring 34 7.7 Population targeting 34 7.8 Linkage between water supply and sanitation 34 7.9 Appropriate sanitation solutions for location 34 7.10 Recognition of dimensions of gender and poverty 35 7.11 Financial issues Funding for infrastructure and cost recovery 35 8.0 Principles 35 9.0 Applicable Policies, Legislation & Guidelines 37 9.1 New Legislation 38 10.0 Monitoring and Evaluation 38 11.0 Policy Review 39 References 40 TABLES Table 1 Roles and Responsibilities of Ministries & Agencies Related to Sanitation 4 1

Table 2 Source of Water Other than via Piped Water 1993 2003 (Percentages) 8 Table 3 - Sanitation Status in Public Schools by Parish 2003/4 10 Table 4 Condition of Toilets and Water Supply in Public Schools 11 Table 5 Status of Public Sanitary Conveniences Islandwide 12 Table 6 Solid Waste Generation and Collection 12 Table 7 Incidence of Gastroenteritis 2000 2004 19 Table 8 Policies Related to Sanitation 32 FIGURES Figure 1 - A gully filled with waste plastic bottles 13 Figure 2 - Waste plastic and other garbage polluting the sea 14 Figure 3 - Dumping of garbage around a No Dumping sign 14 Figure 4 - A skip overflowing with garbage 15 Figure 5 - Uncontained Commercial Solid Waste 15 Figure 6 - Poorly contained domestic garbage 15 Figure 7 Total Gastroenteritis Cases 2000-2005 20 Figure 8 Gastroenteritis Cases Under and Over 5 Years Old 20 Figure 9 Gastroenteritis Cases for the KMA Two Weeks Prior to & Post Hurricane Ivan 21 Figure 10 KMA Gastroenteritis Cases 2002 Mapped against Access to Water Piped into Yard per 10,000 Households 22 Figure 11 - Annual investment in urban water supply in Africa, Asia, and Latin America and the Caribbean, 1990 2000 24 Figure 12 - Annual investment in rural water supply in Africa, Asia, and Latin America and the Caribbean, 1990 2000 25 Figure 13 - Annual investment in urban sanitation in Africa, Asia, and Latin America and the Caribbean, 1990 2000 25 Figure 14 - Annual investment in rural sanitation in Africa, Asia, and Latin America and the Caribbean, 1990 2000 25 Figure 15 - Total annual national and external investment in water supply and sanitation in Africa, Asia, and Latin America and the Caribbean, 1990 2000 26 Figure 16 - Total annual investment in water supply compared to total annual investment in sanitation in Africa, Asia, and Latin America and the Caribbean, 1990 2000 27 Figure 17 - Median total investment in water supply and sanitation as a percentage of overall government investment, 1990 2000 28 Figure 18 - Coverage with improved drinking water sources in 2002 28 Figure 19 - Progress in drinking water coverage, 1990-2002 29 Figure 20 - Sanitation coverage in 2002 29 Figure 21 - Progress in sanitation, 1990 2002 29 APPENDICES Appendix 1 - Projects Being Implemented Under The National Poverty Eradication Programme Appendix 2 Millennium Development Goals 2

NATIONAL SANITATION POLICY 1.0 INTRODUCTION For many developing countries inadequate sanitation has presented and continues to present challenges based on its strong interrelationship with poverty. A vicious cycle exists as developing nations do not have the necessary infrastructure to provide adequate sanitation while it is recognised that appropriate levels of sanitation would place less stress on these fragile economies. In June 2005 WHO/UNICEF report is quoted as saying that People's access to sanitation must reach 138 million people every year if the minimum global water and sanitation target is to be met by 2015. Access to clean water and sanitation would save thousands of young lives every day and would boost economies Access to clean water and good sanitation is basic to life, and by extension significant to the protection of the fundamental right to life. Availability of water and sanitation is strongly related to other human rights such as health, education and work. Since sanitation is such a cross cutting issue related to housing, water supply, sewage disposal, solid waste management, maintenance of gullies and drains, healthcare, environmental management, poverty and education, its management poses challenges as no single Ministry or Agency has full responsibility. There are many players often not working in harmony towards common goals and objectives. There are currently a number of policies, guidelines and legislation that address different aspects of sanitation but their interrelationship is not well defined so there are gaps, overlaps and sometimes conflicts resulting in less than optimal utilisation of scarce resources and the long term beneficial impacts of some programmes are never realised. In order to improve the interrelationship among the players and utilize resources more efficiently this national policy will identify the stakeholders, define their roles and responsibilities and establish a common vision, goals and objectives. This is consistent with the recognition among policy and decision makers that joined up Government is the most effective way to address issues of poverty which has a direct relationship with sanitation. Broad strategies to achieve policy goals and objectives will be presented, however detailed strategies will have to be developed by stakeholder Ministries and Agencies. 2.0 DEFINITIONS Sanitation Sanitation is a term for the hygienic disposal or recycling of waste materials, particularly human excrement, domestic wastewater and solid waste. Sanitation is an important public health measure which is essential for the prevention of disease. 3

Hygiene 1 The science of preserving and promoting the health of both the individual and the community. It has many aspects: personal hygiene (proper living habits, cleanliness of body and clothing, healthful diet, a balanced regimen of rest and exercise); domestic hygiene (sanitary preparation of food, cleanliness, and ventilation of the home); public hygiene (supervision of water and food supply, containment of communicable disease, disposal of garbage and sewage, control of air and water pollution); industrial hygiene (measures that minimize occupational disease and accidents); and mental hygiene (recognition of mental and emotional factors in healthful living). Excrement The matter that is discharged from the bowel during defecation; faeces Reasonable access to water 2 This is defined as water supply in the home or within 15 minutes walking distance. Actually a proper definition should be adopted taking the local conditions into account; in urban areas, a distance of not more than 200 metres from a house to a public stand post may be considered reasonable access. In rural areas, reasonable access implies that anyone does not have to spend a disproportionate part of the day fetching water for the family's needs. Convenient distance 2 Convenient distance and access are distinct in a sense that there may be access to water but it is not necessarily convenient to fetch the water due to distance. The water should be within a reasonable distance from the home that is 200 metres. Public Health Field of medicine and hygiene dealing with the prevention of disease and the promotion of health by government agencies. The duties of carrying out the many services required to keep the population healthy and to prevent serious outbreaks of disease are divided among local and national government agencies. They provide health officers and nurses for schools and visiting nurses for homes. They oversee the water supply, the disposal of sewage, the production and distribution of milk, and the proper handling of food in restaurants. Public health agencies impose standards of public health on local communities when needed; they give financial and technical assistance to local communities in times of crisis, such as that caused by epidemics, hurricanes, and floods. Sanitation Facilities In this document sanitation facilities mean a source of potable water for drinking and hand washing as well as toilets for excreta disposal. 1 Columbia University Press 2 Definition from the UN CSD Methodology Sheet Indicators o f SD 4

3.0 SITUATIONAL ANALYSIS 3.1 Institutional Setting Table 1 outlines the responsibilities of various Ministries and Agencies related directly or indirectly to sanitation. Table 1 Roles and Responsibilities of Ministries & Agencies Related to Sanitation MINISTRY/AGENCY ROLES AND RESPONSIBILITIES Ministry of Land and Develop and implement Environmental Management Policies Environment Develop and implement Land Management Policies to address informal and unplanned settlements, particularly squatter management including prevention, eviction, relocation and regularization National Environment and Planning Agency (NEPA) Ministry of Water and Housing Ministry of Education, Youth & Culture Provide and manage shelters with acceptable sanitary facilities Establish planning requirements and develop and enforce environmental management standards Establish and enforce legal standards for effluent disposal Ensure through regulatory instruments or otherwise that housing developments are not sited in vulnerable areas Ensure that planning requirements for housing developments meet required standards for density and sanitation facilities (water supply and sewage disposal) Develop and implement policies for the management of water supplies, wastewater treatment/disposal systems and housing developments Implement programmes to provide potable water to all communities in Jamaica Implement programmes to provide for the safe collection, conveyance, treatment and disposal of sewage Ensure that all housing developments meet required standards for sanitation Develop and implement policies and programmes for hygiene and sanitation education in schools Ensure that all schools (public and private) provide acceptable sanitary facilities for students Ministry of Health Develop and implement health policies and legislation to promote appropriate sanitation practices Establish and monitor health indicators for sanitation Enforce Public Health laws Provide Public Education on sanitation and hygiene Hygiene promotion Ministry of Local Establish and implement policies to promote the provision of quality solid waste Government, Community management services (collection, treatment and disposal) Development & Sport (and Local Authorities) The Local Authorities Provide adequate number of properly maintained public sanitary conveniences (especially in urban centres) Prohibit/penalize urination and defecation in areas that are not designated for that purpose Work as partners with communities to establish acceptable water supply and excreta disposal systems National Solid Waste Management Authority Establish and enforce legal standards for solid waste storage, collection, transportation, treatment and disposal. Establish in collaboration with communities that do not receive curbside collection an acceptable means of solid waste treatment/disposal 5

The existing institutional setting at the local and national levels is not structured to effectively address the most urgent problems associated with poor sanitation. Many of the rural areas and inner city communities that are most affected are still not getting the level of attention they need as there is often confusion among the local and national government institutions about roles and responsibilities pertaining to housing developments, gully and drain cleaning, solid waste management and town planning and development. Additionally there is still room for greater better collaboration among Non-Governmental Organisations (NGOs), Community Based Organisations (CBOs), community members, local and national government institutions to identify the root causes of sanitation problems and come up with long lasting and effective solutions that best suit the communities. Some of the problems that occur due to a failure of all stakeholders working together include: Siting low income housing with septic tanks and absorption pit systems in areas where the water table is high or that are prone to flooding Installing water supply systems in communities without any wastewater and excreta disposal solutions Siting housing developments in areas that will not be able to receive curbside garbage collection services due to hilly terrain and other factors without an appropriate solid waste management plan for the community Failure curb the growing problem of squatting While these are just a few examples, that create new and/or exacerbate existing sanitation problems which waste precious/scarce resources and ultimately require corrective action at additional cost which the country cannot afford. With a sanitation policy providing a vision, goals and objectives the stakeholders through a collaborative approach can make more coordinated interventions that can yield greater and long lasting benefits. 3.2 Existing Policies and Programmes Related to Sanitation Some existing policies that address some aspects of sanitation include the Water Sector Policy, the National Solid Waste Management Policy and the Poverty Eradication Policy. The Water Sector Policy The revised draft Water Sector Policy, Strategy and Action Plan, 2004 has as its main objective to ensure that all households have access to water by 2010. In order to assist in achieving this objective, Cabinet has approved the formation of the Rural Water Supply Limited to concentrate on increasing coverage in rural areas through building relationships with community groups. The policy also recognises the need to provide social water for those who are unable to pay the full cost of the service based on health, sanitation and environmental considerations, but plans to achieve some level of cost recovery using a community development approach. It also indicates that demand side management and reduction of unaccounted for water are some of the strategies to be used to improve the coverage and reliability of water supply. For wastewater systems the policy outlines the following objectives: 6

sewer all major towns sewered by 2020 rehabilitate existing non-compliant facilities to achieve compliance with national environmental standards The National Solid Waste Management Policy The National Solid Waste Management Policy, 2000 has established the framework for a standard setting and regulatory agency, the National Solid Waste Management Authority which facilitates the private sector as the principal service provider. It also indicates that cost recovery for provision of a sustainable service is key. The policy speaks to the establishment of sanitary landfills, setting standards for the proper containerization of waste, regular and reliable collection of garbage and safe and efficient transportation to the destination of treatment and/or final disposal. The policy also promotes waste minimisation, reuse and recycling as essential components of solid waste management. Poverty Eradication Policy Jamaica s Policy Towards Poverty Eradication is aimed at promoting integration and collaboration of government services/agencies; partnerships between government agencies, private sector, NGOs, CBOs, and donor/lending agencies; environmental sustainability and community empowerment. Two public sector agencies actively involved in implementing the policy objective are the Jamaica Social Investment Fund which provides communities with resources to improve physical, social and economic conditions and the Social Development Commission which implements the Integrated Community Development Programme focusing on building local institutions/groups capacity to develop and implement projects. The National Poverty Eradication Programme (NPEP) seeks to ensure the use of a community-based participatory approach to poverty eradication in which the community decides on its course of development. This is achieved through monitoring, coordinating and assessing the success of government's social programmes. The programme also develops and monitors strategic policies and programmes through an integrated approach involving relevant ministries, agencies, community groups and private entities. By the end of the 2004/2005 financial year, it is projected that approximately J$ 44.9 billion would have been spent on the NPEP programmes and projects since its inception in 1995. Of this amount approximately J$ 5.8 billion has been allocated for the 2004/2005 financial year. Some programmes directly related to sanitation that are being implemented under the National Poverty Eradication Programme are included at Appendix 1. Other policies that are still to be developed to address issues related to sanitation include: Health Policy Ministry of Health Squatter Management Policy - Ministry of Land and Environment Social Housing Policy - Ministry of Water and Housing 7

3.3 National Sanitation Situation The 2001 Population Census indicated that out of a total of 748,326 households about 50% had piped water in their dwelling (public and private sources), 16% had access to piped public water in their yard, 22.3% can access water via public standpipe, public and private catchments and the remaining 11.7% get water from springs, rivers or other unidentified sources. These statistics clearly indicate that there is still a lot of work to be done to ensure that households have access to safe sources of water in order to facilitate proper sanitary practices and by extension decrease the risk of exposure to diseases. Of the 748,326 households 2.5 % had no access to any toilet facilities, 20% had shared access to either water closets or pit latrines (50-50 split) and 74% had dedicated access to water closets (352,041) or pit latrines (199,713). The statistics show that only about 50% of the households had exclusive use of flush toilets. This is further supported by data in the Jamaica Survey of Living Conditions 2002 which indicated that since 1993 the Housing Quality Index has shown a steady increase in the amount of houses with exclusive use of flush toilets from 40.2% in 1992 to 50.5 % in 2002. It is apparent that the use of pit latrines is still significant in Jamaica, especially in rural areas. Some of this usage is based on environmental factors such as inappropriate soil conditions or close proximity to water sources prohibiting the use of flush toilets with septic tanks and absorption pits or no access to sewerage systems. However there is no data readily available that indicates the number of pit latrines that are in use due to these reasons. The data presented in the Jamaica Survey of Living Conditions, 2002 is based on the analysis of 6,976 responses to surveys conducted across the island. The responses indicated that there has been a general increase in houses with indoor taps and exclusive use of flush toilets over the ten year period from 1993 to 2002. Houses with indoor taps showed a steady increase from 38.6% in 1993 to 45% in 2002 with a small decline between 2001 and 2002 from 46.6% to 45%. For the same period the number of households with access to piped water generally fluctuated between a low of 62.3% (1993) to a high of 70.9% (2001) with the average over the 10 years period being 65.7%. At the same time the number of households with access to standpipes declined from 20% in 1993 to 12.1 % in 2002. The use of other sources of water such as wells, rainwater tanks and rivers/ springs remained fairly constant. See Table 2 below: Table 2 Source of Water Other than via Piped Water 1993 2003 (Percentages) TYPE OF 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002* 2003 FACILITY Piped Water 62.3 63 63.4 66.8 66.1 65.7 67.6 66.6 70.9 64.5 Public Standpipe 20 20 16.5 14.9 15.1 14.2 15.3 13.2 13.1 12.1 Untreated (river, 3.1 2.1 2.9 2.3 3.8 4.4 3.2 3.2 3.1 3.3 spring, pond) Rainwater (tank) 11.4 11.4 13.2 12.9 11.4 13.1 10.5 11.7 11.6 15.3 Well/Other 3.1 3.2 4.1 3.1 3.5 2.6 3.5 5.4 1.3 3.0 * In 2002 an additional 1.9% of water was trucked to residents The survey indicates that all respondents to the survey in 2002 had access to some form of toilet facility including water closet, pit latrine or other. There were no responses for the 8

category none. It is possible that the survey did not gather information from persons living in informal settlements that do not have any access to toilets and therefore use undesirable means for excreta disposal such as throwing bags with excreta into gullies and drains. There is also a problem of access to water highlighted in the 2002 Jamaica Survey of Living Conditions. The statistics indicate that: Of 879 households surveyed in Jamaica, 89% were within 0-199 yards (182 m) of a public standpipe Of the 18 households in KMA surveyed 94.8% were within 0-199 yards of a public standpipe, Of the 121 households in Other Towns surveyed 89.3% were within 0-199 yards of a public standpipe, Of the 740 households in Rural Areas surveyed 88.6% were within 0-199 yards of a public standpipe. The statistics presented clearly highlight that in the Rural Areas and Other Towns approximately 11% of households (in each case) have to travel further than 199 yards to access water. 3.4 Rural Water Supplies Many rural communities in Jamaica obtain their water from minor water supply systems which consist of rainwater catchments, wayside tanks filled by water trucks and entombed springs. Most of the entombed springs and rainwater catchments are many decades old, with some reportedly built by the British Army when Jamaica was still a colony of Britain. Apart from minor repairs they have generally not been upgraded to meet the growing needs of the communities they serve. Most of these water supply systems do not have distribution pipes, so residents in the communities must fetch water from a standpipe. Rather than fetching water, some persons bathe, wash cars and clothes at the standpipe leaving the area polluted with garbage. Chlorination is the primary method of disinfecting the water supplies and it is often ad hoc, meaning that chlorination is irregular, the quantity of chlorine applied and the method of application vary significantly between facilities. Some entombed springs have been condemned by Parish Councils as the water quality does not meet the required health standards however, this has not stopped residents from using these water sources as they are closest to where the residents live. The Ministry of Local Government Community Development and Sport is implementing a programme to rehabilitate minor water supplies across Jamaica to improve the quality and accessibility of potable water for rural residents. While improvement in water supplies is necessary and important there is no complementary programme in place to address safe and appropriate wastewater and excreta disposal. 9

3.5 Sanitation in Public Schools Recognising that children spend a significant amount of time at school and that they learn many social skills within the school environment, the availability of adequate sanitation is very important to the well being of children. Data obtained from the Ministry of Education for 2003-4 for public schools from Infant to Secondary level is presented in Tables 3 and 4. The data indicates that pit latrines are still in use throughout the country in fairly significant numbers, especially in the rural areas. There is no data to indicate if environmental conditions contribute to the decision to use pit latrines. At the high end, St. Catherine is the parish with the largest number of schools (120) and the largest number of schools (43) with pit latrines. St. Elizabeth and Westmoreland have 50% and 54% of the schools respectively with pit latrines. At the low end, there are no schools in Kingston with pit latrines and only 8 schools in St. Andrew (7% of total within the parish) with pit latrines. Based on the data provided by the Ministry of Education, satisfactory water supply means that there is potable water running in the taps and satisfactory toilets means that the toilets are functional. An intermittent or non-existent water supply is regarded as unsatisfactory and unsatisfactory toilets mean they are not functional as a result of intermittent or nonexistent water supply or defective hardware. Table 3 - Sanitation Status in Public Schools by Parish 2003/4 3 of % of of % of schools schools schools schools of schools % of schools Number with flush with flush with pit with pit with periodic with periodic of Parish toilet toilet latrines latrines flush toilet flush toilet Schools Kingston 31 67 0 15 33 46 St. Andrew 73 68 8 7 26 24 107 St. Thomas 22 46 21 44 5 10 48 Portland 32 62 17 33 3 6 52 St. Mary 38 54 31 44 2 3 71 St. Ann 37 47 30 38 11 14 79 Trelawny 15 41 14 38 7 19 37 St. James 32 63 13 25 6 12 51 Hanover 17 44 15 38 7 18 39 Westmoreland 20 31 35 54 9 14 65 St. Elizabeth 34 40 43 50 9 10 86 Manchester 54 75 14 19 4 6 72 Clarendon 51 49 37 36 14 13 104 St. Catherine 55 46 43 36 18 15 120 TOTAL 511 321 136 977 3 Data obtained from the Ministry of Education Statistics Department 10

Table 4 Condition of Toilets and Water Supply in Public Schools Parish of schools with toilets not OK % schools with toilets not OK of schools with water supply not OK Kingston 11 24 5 11 St. Andrew 33 31 29 27 St. Thomas 23 48 12 25 Portland 22 42 30 58 St. Mary 31 44 34 48 St. Ann 44 56 37 47 Trelawny 13 35 13 35 St. James 16 31 13 25 Hanover 12 31 18 46 Westmoreland 30 46 23 35 St. Elizabeth 35 41 32 37 Manchester 33 46 38 53 Clarendon 36 35 63 61 St. Catherine 47 39 51 43 % of schools with water supply not OK While many schools are equipped with toilets and piped water, the infrastructure is often not in satisfactory condition. The data shows that in most parishes about 40% of the public schools do not have satisfactory toilet facilities and 40% do not have adequate or reliable water supply. 56% of the public schools in St. Ann had unsatisfactory toilets, while 48% of the public schools in Portland had unsatisfactory piped water. The range of problems plaguing the water supply includes: Irregular supply Missing taps Leaking pipes No supply The lack of functional sanitation infrastructure in schools is a combination of a number of factors: (a) The budget for maintaining schools is less than adequate (b) Schools are vandalized often by persons living in the same communities as schools, toilets and taps are stolen for domestic use (c) Children are not appropriately trained in how to use toilet facilities and how to take care of them so they sometimes destroy/vandalise the facilities Although no data is available for private schools, the data could be very similar. The overall conclusion is that sanitation in schools needs urgent attention. 11

3.6 Public Sanitary Conveniences Data on the status of pubic sanitary conveniences in some parishes is presented below in Table 5. Information gathered indicates that the existing public sanitary conveniences in most parishes need upgrading and repair and the parishes also require additional facilities. Some Parish Councils have indicated that there are Corporate entities within their parish willing to assist with establishing new public sanitary conveniences in town centres but the constraint has been the availability of suitable locations. Table 5 Status of Public Sanitary Conveniences Islandwide PARISH SANITARY CONVENIENCES REMARKS St. Ann St Ann s Bay 1 No. Brown s Town 1 No. Ocho Rios 1No. Claremont No. The Ocho Rios facility is not in use at this time due to the closure of the Courthouse where it was located Clarendon May Pen - 2 No. More sanitary conveniences required; Juici Patties offered to build one but no land available Hanover Lucea 1No. The sanitary convenience needs to be upgraded Portland Port Antonio 1No. Hope Bay 1No. Buff Bay 1No. St. Mary Port Maria 2 No. Freetown 1No. Highgate 1No. Richmond 1No. Retreat 1No. Oracabessa 1No. Gayle 1No. St. Elizabeth St. James Montego Bay 2No. Cambridge 1No. 3.7 Solid Waste Management All facilities are in need of repair All facilities are in need of repair All facilities are in need of repair All facilities are in need of repair It is estimated that approximately 2500 tonnes/day of waste is generated across the island. Of this amount about 72% is collected, that is, approximately 1800 tonnes/day. The estimated generation and collection rates in the wastesheds are indicated in Table 6. Table 6 Solid Waste Generation and Collection WASTESHED ESTIMATED GENERATION ESTIMATED COLLECTION (tonnes/yr) Percentage (%) Tonnes/yr Riverton (St. Thomas, St 526,403 72 381,106 Catherine, Kingston & St. Andrew) Retirement (St. James, Trelawny, Hanover, Westmoreland) 166,951 69 115,815 Southern (Manchester, St. 122,202 48 59,736 Elizabeth, Clarendon) Northeastern (St. Ann, St. Mary, Portland) 129,940 56 73,535 12

The collection service that currently exists is a hybrid system in which public and private service providers share in the collection of waste islandwide. Within some wastesheds the state is the sole provider of solid waste management services. The rural parishes, especially those in the Southern and Northeastern wastesheds have low collection coverage and this means that solid waste in inappropriately disposed of. The Riverton and Retirement wastesheds while having higher collection coverage have areas that receive irregular or no collection resulting in the same problem. Some of the main solid waste management problems which exist include: Limited solid waste management programmes in areas which cannot receive curbside collection by a garbage truck. This causes persons to dispose of waste inappropriately in gullies, rivers or to burn waste. Poor containerization of residential waste which causes waste to be vandalized and scattered which contributes to the proliferation of disease carrying vectors and rodents. Failure of many commercial entities to properly containerize their waste and to make private arrangements for the regular collection of their waste. Many commercial entities are not willing to pay the cost for this service and this leads to the pile up of garbage and the proliferation of disease carrying rodents and vectors. Lack of garbage receptacles in public places Inadequate and inconsistent curbside garbage collection services due to inadequate garbage collection trucks A proliferation of plastic waste which is improperly disposed of or burned. Improper disposal causes problems such as mosquito breeding and blocked gullies and drains which leads to flooding. Burning causes the release of toxic fumes which are harmful to health. There are no policies or programmes in place to minimise the use of plastics or to encourage recycling Failure to enforce laws prohibiting dumping and littering Figure 1 - A gully filled with waste plastic bottles 13

Figure 2 - Waste plastic and other garbage polluting the sea Figure 3 - Dumping of garbage around a No Dumping sign 14

Figure 4 - A skip overflowing with garbage Figure 5 - Uncontained Commercial Solid Waste Figure 6 - Poorly contained domestic garbage 15

3.8 Poverty and Sanitation Research has indicated that poverty is caused by the complex interplay of a myriad of socioeconomic factors each of which in turn is the product of several other factors. Among the causes or correlates of poverty which have been put forward at one time or another are the absence of economic growth, poor social and physical infrastructure, culture, the absence of natural resources to exploit, lack of education, increases in inflation rates and unemployment. In addition it has been found that poverty is not equally distributed among societies but tend to have its greatest impact on the aged and infirmed, and specifically, women and children. Poverty is described in the Jamaica Human Development Report, 2000 by PIOJ and UNDP, as a state of: dilapidated housing no sanitary conveniences inability to care for children hunger, inability to buy shoes no job or steady income The effect that poverty has on sanitation is far reaching. Some of the ways that poverty affects sanitation are as follows: Many poor people are illiterate or semi-literate so they are not able to obtain and/or utilize information which can assist them in improving their situation Poverty implies that income is low or non-existent which means that housing is poor; there may be no electricity or water Nutrition is poor and therefore they are not as healthy making them more susceptible to contracting diseases The incidence of poverty in Jamaica based on statistics from the Jamaica Survey of Living Conditions 2003, published by the Planning Institute of Jamaica (PIOJ) declined slightly from 19.7 % in 2002 to 19.1% in 2003. The overall incidence of poverty in Jamaica has declined between 1993 and 2004 by about 5%. The highest level of poverty is reported to be in Rural Areas at 24.2 % while Other Towns had the second highest level of poverty at 15.8% followed by the KMA 4 with 9.5%. The data on the incidence of poverty by region presented above must be interpreted with great caution. The significance of poverty in the urban areas of Jamaica must not be minimised because upon examination of the absolute numbers and density of concentration, it is apparent that urban poverty is a very serious problem. Using standards established by the Planning Institute of Jamaica (PIOJ) and the Statistical Institute of Jamaica (STATIN), poverty is gauged by a person's position relative to the national poverty line, which is based on annual consumption. Consumption is used as a proxy for income, because of the difficulties associated with obtaining reliable income data. The poverty line is computed for a reference family of five, which includes one adult male, 4 KMA Kingston Metropolitan Area 16

one adult female, an infant, a teenager and a pre-teen child. Using nutritional requirements established by the World Health Organization (WHO), Pan American Health Organization (PAHO) and the Ministry of Health, a low-cost food basket is designed for this reference family. To account for non-food needs, the reciprocal of the average food share for the lowest income quintile is multiplied by the cost of the minimum food basket; the result is the estimate of the poverty line for the family of five. The poverty line for an individual in 2003 was $53,725.70 per annum and for a reference family of five it was $203,054.22. One must note the disparity in the statistics for those persons described as being poor at 19% and those persons not having access to satisfactory sanitation (access to piped water and flush toilets in their homes) at about 50%. If inadequate sanitation was a consideration in establishing the level of poverty in Jamaica, the incidence of poverty would be greater than 19%. Poverty, Sanitation and Gender Gender is recognized globally as an extremely important aspect of poverty. Globally, women face an array of social, economic, cultural and religious discrimination which limit their access to economic resources and political participation. In Jamaica, as in most cultures, women have the primary responsibility for water, sanitation and hygiene at the household level and they play a crucial role in influencing the hygiene behaviours of young children. Lack of access to environmental sanitation and hygiene tends to affect women in poor households to a greater extent as they must spend a major part of the day fetching water for the numerous household activities. The time spent having to fetch water also prevents them from securing steady employment which could bring in additional income to support the family. There are privacy issues for women where no bathrooms are available. This often places them at risk for abuse and violence. Where there is limited or no access to sanitation facilities, mothers and their young children face a higher risk of contracting diseases related to poor sanitation placing undue strain on the immediate family and by extension the country. There is no empirical data for Jamaica that correlates poverty according to gender with access to water supply and sanitation. 3.9 Health Status A common health indicator for sanitation and access to healthcare services is the number of gastroenteritis cases. Data obtained from the Ministry of Health aggregated in Table 7 provides a breakdown of the gastroenteritis cases by parish for the period 2000 to 2004. The significant increase in cases in 2004 is partially attributable to the effects of Hurricane Ivan which disrupted water supply and garbage collection services. Figures 7 and 8 provide a graphical representation of the data. The data suggests an overall increase in the incidence of gastroenteritis over the 17

5 year period which could be attributable to a combination of more cases being reported as well as an increasing problem with sanitation. Figure 9 is based on GIS data from the Ministry of Health for the KMA and it provides a pictorial representation of gastroenteritis cases two weeks prior to and two weeks after Hurricane Ivan. Of significance is that most of the gastroenteritis cases in the KMA occur in the inner city or poor communities in the southern part of Kingston. This supports the interrelationship between poverty, poor housing, poor sanitation and poor health. Figure 10 is based on GIS data from the Ministry of Health for the KMA and it provides a pictorial representation of gastroenteritis cases based on access to piped water. The data indicates that more cases of gastroenteritis occur where more households rely on water in the yard or from standpipes rather than within the household. 18

Table 7 Incidence of Gastroenteritis 2000-2004 Parish 2000 2001 2002 2003 2004 <5 yrs old >5 yrs old <5 yrs old >5 yrs old <5 yrs old >5 yrs old <5 yrs old >5 yrs old <5 yrs old >5 yrs old KSA 5538 1112 4989 1016 5515 1679 6387 7047 8682 1957 St. Thomas 228 182 180 151 169 177 236 184 208 148 Portland 550 274 341 337 455 499 539 494 861 796 St. Mary 679 400 387 365 725 708 1079 1026 1865 1579 St. Ann 1970 1772 620 870 954 982 1785 1916 1904 2121 Trelawny 556 385 381 298 414 329 421 289 389 247 St. James 1666 951 961 787 1361 1056 1513 1289 2540 1465 Hanover 567 192 266 105 342 131 296 141 608 357 Westmoreland 976 520 583 504 544 577 766 714 1745 1388 St. Elizabeth 248 131 424 220 608 388 894 625 1329 701 Manchester 2320 1315 1501 936 1467 1255 2282 1707 2556 1633 Clarendon 661 412 429 351 421 342 711 601 1097 812 St. Catherine 1241 1102 458 735 404 728 523 601 1498 978 17200 8748 11520 6675 13379 8851 17432 16634 25282 14182 TOTAL (all ages) 25948 18195 22230 34066 39464 19

Figure 7 Total Gastroenteritis Cases 2000-2005 Number of cases 45000 40000 35000 30000 25000 20000 15000 10000 5000 0 2000 2001 2002 2003 2004 Year Figure 8 Gastroenteritis Cases under and over 5 years old Number of Cases 30000 25000 20000 15000 10000 5000 0 2000 2001 2002 2003 2004 Year <5 yrs old > or = 5 yrs old 20

Figure 9 21

22 Figure 10 2 0 2 4 6 K ilo m e te rs Access to W ater Piped into Yard per 10,000 hou seh olds 0-64 6.2 64 6.2-16 3 1.46 1631.46-2984.05 2984.05-4929.9 4929.9-8046.88 Gastroenteritis C ases 2002 HealthG IS, Health Promotion & Protection Division, M in is try o f H ea lth, Ja m a ica. LE G E N D KMA GASTROENTERITIS CASES 2002 MAPPED AG AINST ACCESS TO W ATER PIPED INTO YARD PER 10,OOO HOUSEHOLD N E W S 1

3.10 Informal/Unplanned Settlements and Sanitation Unplanned settlements generally occur on marginal lands, near to gullies and rivers and sometimes near to waste disposal facilities. Informal settlements use nearby open lots, rivers and gullies for solid waste, wastewater and excreta disposal creating an unhealthy and unsanitary environment. Persons without sanitary facilities use the river as both as source of water for domestic purposes (drinking, cooking, bathing and washing) and as a sink for wastes. Industries also discharge wastes into rivers, therefore persons relying on rivers as a source of domestic water are at high risk of contracting waterborne diseases. Unplanned settlements due to their dense configuration and lack of proper roads, do not receive curbside garbage collection services. Waste is indiscriminately disposed of leading to the breeding of flies, mosquitoes, rats and cockroaches. It is very difficult for the Government to upgrade many of the informal and unplanned settlements as they are situated in vulnerable areas or the layout does not facilitate upgrading. The lack of affordable housing, unemployment and crime are some of the key issues that drive persons to squat or inhabit lands not suited or designated for housing or to capture lands owned by other persons. Also the Government has failed to adequately enforce laws against squatting or capturing of lands. To date the Ministry of Land and Environment has identified 595 squatter settlements throughout Jamaica but further studies are to be conducted to ascertain the number of households and occupants in each household within these settlements. Crude estimates indicate that approximately 10% of the population live in squatter settlements and that the number is growing. The Ministry of Land and Environment with assistance from the World Bank plans to conduct a sample survey of squatter settlements in the near future to obtain further details on the extent of the situation in Jamaica. 3.11 The Impacts of Natural Disasters on Sanitation Jamaica is vulnerable to natural disasters such as drought, floods, hurricanes and earthquakes. Natural disasters threaten advances made in the coverage and quality of water supply and sanitation services. The services most severely affected by natural phenomena are water supply, drainage and sewerage systems. Despite progress in natural disaster prevention, mitigation and response, there is still a long way to go. The climate trends indicate an increase in the number and severity of hurricanes in years to come. This means that there will be increased sanitation problems in the aftermath of these events. After a hurricane, regular water supply is disrupted, houses are flooded, rivers carry higher levels of coliform bacteria and electricity supply is disrupted so food cannot be safely stored. Figure 9 which provides detailed data on gastroenteritis cases with in the KMA indicates that the areas most severely affected under normal conditions are the inner city areas many of which are located in the southern section of Kingston. After Hurricane Ivan the same areas experienced a significant increase in the incidence of gastroenteritis cases. 23

While the same information was not available for rural areas, it is expected that a similar trend occurs. It is also clear from this information as well as past experience that natural disasters exacerbate and generally increase sanitation problems. Shelters for those persons dislocated as a result of natural disasters can also be the source of sanitation problems if they are not equipped with the necessary facilities. Schools and community centres are usually used as shelters. They are often overcrowded and may not have sufficient piped water, toilets and facilities for the preparation and storage of food and garbage. Usually the very young and very old occupy shelters and due to their age they are at a higher risk of contracting illnesses due to poor sanitation under these conditions. 3.12 Investment in Sanitation Information obtained from the WHO Global Water Supply and Sanitation Assessment 2000 Report, Investment in Africa, Asia, and Latin America and the Caribbean indicates that over the ten year period, 1990 to 2000 significant investments have been made in water supply and sanitation for Africa, Asia and Latin America. Figures 11 14 provide data on the source and amount of these investments. Two sources of investment are shown: investment from government agencies (national) and investment from external support agencies. Investments were averaged over the years 1990 2000 for each country that provided information. A total investment was then determined for all the countries that provided data and extrapolated for the whole region. Investments made directly by householders that were independent of government aid (for example, for the construction of a private latrine), are unlikely to have been included in the country figures reported. It is also possible that the national investment figures provided by some of the countries might have included loans from international development banks. Figure 11 - Annual investment in urban water supply in Africa, Asia, and Latin America and the Caribbean, 1990 2000 24

Figure 12 - Annual investment in rural water supply in Africa, Asia, and Latin America and the Caribbean, 1990 2000 Figure 13 - Annual investment in urban sanitation in Africa, Asia, and Latin America and the Caribbean, 1990 2000 Figure 14 - Annual investment in rural sanitation in Africa, Asia, and Latin America and the Caribbean, 1990 2000 25

Figure 11 provides information on investment in urban water supply. The corresponding investment in rural water supply is shown in Figure 12. It is clear that the level of investment in rural water supply in Latin America and the Caribbean is far lower than the corresponding investments in Asia and Africa. This can be explained by the fact that the rural population of Latin America and the Caribbean is much smaller than the rural populations of Africa and Asia. Furthermore, the investment in rural water supply is less than that in urban water supply for every region, despite the huge gaps in rural coverage; and the total investment in rural water supply is roughly half that in urban water supply, whether from local or external sources. Investment in urban sanitation is shown in Figure 13. In all of the regions shown, the figures indicate investment in sanitation is less than it is for urban or rural water supply. Latin America and the Caribbean have a substantially higher level of local investment in sanitation when compared to external support and the region also successfully attracted more external contributions than other regions. With regard to rural sanitation, Figure 14 shows that investment is very small when compared with levels of investment in rural water supply or urban sanitation. Again, the level of investment in Latin America and the Caribbean compares favourably with practically all other regions, bearing in mind the small rural population. Figure 15 - Total annual national and external investment in water supply and sanitation in Africa, Asia, and Latin America and the Caribbean, 1990 2000 26

Figure 16 - Total annual investment in water supply compared to total annual investment in sanitation in Africa, Asia, and Latin America and the Caribbean, 1990 2000 Figure 15 shows the total annual national and external investment in water supply and sanitation. In terms of total investment, Africa received the most external investment for the water supply and sanitation sector, but also invested fewer local resources than any other region. Sanitation is not normally considered a priority in development projects and a comparison of the total investment in water supply with the total investment in sanitation makes the relative neglect of sanitation abundantly clear (Figure 16). The current low level of sanitation coverage (only 60% of the global population has access to any sort of improved sanitation) appears to be explained in part by the low level of investment in sanitation when compared with the investment in water supply. Of the total annual investment in the sector, approximately US$ 16 billion, only one-fifth seems to be directed to sanitation. Despite that relatively low level of investment the progress over the decade, measured in terms of additional people served with sanitation facilities, has been huge. The reason for this progress might be that investment has been made not only by governments and external support agencies, but also directly by householders through low-cost technologies. Such investment, however, is not likely to appear in the statistics. Figure 17 shows governmental investment in water supply and sanitation as a proportion of overall governmental investment. Among the three regions, the proportion invested in water supply and sanitation is highest in Latin America and the Caribbean, and is more than double that invested in Asia. 27

Figure 17 - Median total investment in water supply and sanitation as a percentage of overall government investment, 1990 2000 3.13 Jamaica s Progress within a Regional Setting Based on data from WHO, Figure 18 indicates that the percentage of the population using improved drinking water in Jamaica in 2002 was greater than 91% and the percentage of the population using improved sanitation in 2002 was between 76% and 90%. Figures 19 and 21 show that Jamaica is on track with its water supply and sanitation programmes to meet the Millennium Development Goal (MDG) targets for 2015. Refer to Appendix 2 for the Millennium Development Goals. Figure 18 - Coverage with improved drinking water sources in 2002 28

Figure 19 - Progress in drinking water coverage, 1990-2002 Figure 20 - Sanitation coverage in 2002 Figure 21 - Progress in sanitation, 1990-2002 http://www.who.int/water_sanitation_health/monitoring/jmp04_3.pdf 29