TECHNICAL PAPER # 56
 
                          UNDERSTANDING SANITATION
                           AT THE COMMUNITY LEVEL
 
 
 
 
                                    By
                              Bruce P. Davis
 
                            Technical Reviewers
                              Ira J. Somerset
                             Dr. Romero Cartier
 
 
                               Published By
 
 
                                   VITA
                     1600 Wilson Boulevard, Suite 500
                       Arlington, Virginia 22209 USA
                   Tel:  703/276-1800 * Fax:   703/243-1865
                         Internet:  pr-info@vita.org
 
 
 
               Understanding Sanitation at the Community Level
                           ISBN:  0-86619-273-5
                [C] 1986, Volunteers in Technical Assistance
 
 
                             PREFACE
    
This paper is one of a series published by Volunteers in Technical
Assistance to provide an introduction to specific state-of-the-art
technologies of interest to people in developing countries.
The papers are intended to be used as guidelines to help
people choose technologies that are suitable to their situations.
They are not intended to provide construction or implementation
details.  People are urged to contact VITA or a similar organization
for further information and technical assistance if they
find that a particular technology seems to meet their needs.
 
The papers in the series were written, reviewed, and illustrated
almost entirely by VITA Volunteer technical experts on a purely
voluntary basis.  Some 500 volunteers were involved in the production
of the first 100 titles issued, contributing approximately
5,000 hours of their time.  VITA staff included Steve Oppenheimer
as editor, Suzanne Brooks handling typesetting and layout, and
Margaret Crouch as project manager.
 
The author of this paper, VITA Volunteer Bruce P. Davis, is a
public health engineer in the Wayne County, Michigan Health
Department, and has 20 years of experience in environmental and
public health.  The technical reviewers are also VITA Volunteers.
Ira Somerset is with the U.S. Food and Drug Administration, and
specializes in sanitation engineering and food inspection.  Dr.
Romero Cartier is a registered civil engineer, land surveyor, and
sanitary engineer with wide experience for the World Health
Organization and other agencies.
 
VITA is a private, nonprofit organization that supports people
working on technical problems in developing countries.   VITA offers
information and assistance aimed at helping individuals and
groups to select and implement technologies appropriate to their
situations.  VITA maintains an international Inquiry Service, a
specialized documentation center, and a computerized roster of
volunteer technical consultants; manages long-term field projects;
and publishes a variety of technical manuals and papers.
 
 
             UNDERSTANDING SANITATION AT THE COMMUNITY LEVEL
 
                   by VITA Volunteer Bruce P. Davis
 
 
I.  INTRODUCTION
 
Sanitation at the community level is not significantly different
from sanitation at the individual level.   Sanitation means healthful
living conditions and clean practices for the handling of
water and food and the disposal of personal wastes.   Sanitation,
in other words, means good hygiene.   At the community level, this
means provisions for a safe water supply, safe liquid and solid
waste disposal, and a sanitary food supply.
 
Understandably, most people are concerned first and foremost with
themselves.  Individuals must obtain food and water and prepare
them for use, relieve themselves, and find shelter.   Unfortunately,
the simplest and most convenient ways for individuals to meet
these personal needs are sometimes not in the best interests of
the community as a whole.  It is essential, therefore, that the
meeting of these basic sanitary needs is viewed as a community
concern.
 
Because poor community sanitation leads readily to conditions of
disease, the quality of community sanitation affects many different
facets of community life.  Life expectancy of adults and
children, the physical condition of newborns, the availability of
a healthy and productive work force, and the general well-being
of the populace are all affected by the quality of the sanitation
systems.
 
Most of this paper deals with the broad conceptual issues involved
in choosing and implementing sanitary systems.   The four
major areas covered are:
 
               o     sanitary water supplies;
 
               o    the disposal of liquid and solid wastes;
 
               o     food supplies; and
 
               o     the safe use of insecticides.
 
Within these broad areas, a discussion of sanitation at the
community level inv olves addressing several factors:   contaminated
water courses or ground supplies; exposed excreta or decaying
organic matter; exposed garbage and trash; collection and
delivery of water and wastes; control of flies, pests, and
rodents; food protection; and insecticide use.
 
There is more to effective sanitation than just technology.
Often, some highly unhealthy practices are part of the accepted
and habitual lifestyle of the populace.   To implement new methods
of dealing with food, water, and wastes, the members of the
community must be persuaded that change is necessary.   For community
education to have any impact, and for the needed resources
to be committed, the community's political and spiritual leaders
must be supportive of efforts to promote sanitation.
 
II.  COMPONENTS OF SANITATION
 
WATER SUPPLY
 
A first step in the sanitary treatment of water is to determine
whether any biological or chemical contaminants are present in
the existing supply.  If contaminants are found, their source
must be determined.  For example, there may be industrial wastes
or agricultural runoffs that are polluting the water supply.  If
the water supply is from wells or other underground sources, it
must be determined if the wells are protected from animal and
agricultural wastes.  (Step wells are so prone to contamination
that they should be avoided.)
 
Some sources of pollution may not be immediately evident.  For
example, contaminants may enter the water far upstream.   A variety
of standard procedures exists to test for contaminants, and
to conduct a sanitary survey of the entire water supply.  Field
test kits are available that will determine if certain bacteria
(known as the "fecal coliform" group) are present from human
wastes.  For other kinds of pollutants, such as agricultural
chemicals and industrial wastes, most testing must be done in a
laboratory.  Usually water samples are collected from several
sites and then sent to the laboratory.
 
In many cases, it is possible to eliminate the sources of contamination.
Where this cannot be achieved, the water supply must be
disinfected and is sometimes cleaned by simple filtration.  Plants
can be built for the treatment of polluted streams.   These plants
usually use clean sand as a filter and add chlorine or other
disinfectant to the water to kill harmful bacteria.   Polluted
wells can also be treated with chlorine.   However, these kinds of
treatments will do nothing to remove many pesticides or other
chemicals; the only way to deal with chemical pollutants is to
stop them from entering the water supply.   If the contaminants
cannot be eliminated or cleansed, then the water supply must be
considered unacceptable.
 
The same considerations that apply to the source of the water
also apply to its transport.   Are the transport containers or
pipes that carry the water protected from contamination?  Are the
transport devices clean and safe?
 
In addition to water quality, there are several other factors to
consider when managing water resources.   While we cannot discuss
them here in detail, they must at least be mentioned:   Is the
present quantity of water being supplied adequate for present and
future needs?  What effect does the removal of water at one site
have on the supply of water at other locations--downstream or at
neighboring wells, for example?
 
Special care must be taken to ensure the cleanliness of water at
the point where it is delivered to homes or to other distribuion
points within the community.   For example, if the water is transferred
into storage containers, it is important that the containers
be cleaned often.  It is also important that the people
who do the cleaning are themselves careful in their personal
hygiene.
 
Dip storage containers--that is, water containers into which each
family dips its own smaller water containers--should not be used.
This is because each family, by dipping into the water supply,
distributes its dirt and disease carriers into the water and
spreads them to the rest of the community.   In general, the
stored water supply should not come in contact with individual
persons or household containers; rather, the stored water should
be transferred into private containers through a pipe or spigot.
Water containers should always be covered.
 
 
WASTES--LIQUID AND SOLID
 
If not properly handled, waste products serve as a breeding
ground for disease-carrying insects, mice, rats, and other pests.
Moreover, poorly handled waste products can find their way directly
into the water supply or the food chain.   Adequate transport,
treatment, and storage of wastes is therefore essential for
good sanitation.
 
Liquid Wastes
 
The term "liquid wastes" refers to human and animal excrement and
urine.  Before deciding what changes, if any, should be made in
the existing disposal systems, it is helpful to make a survey of
the existing systems to answer the following questions:
 
     1.   Are the existing liquid waste disposal systems adequate
         for the number of people presently being served, and
         for the number of people anticipated in the future?
 
     2.   Is the current system sufficiently isolated from surface
         and ground water drinking and bathing sources?  If
         not, does the system need to be moved to a different
         location, or can it simply be repaired to prevent
         leakages?  Would it be possible/practical to move the
         water source?
 
     3.   Are there sufficient numbers of comfort stations, bathrooms,
         or waste holding and collection facilities in
         the community?
 
Ideally, every possible step will be taken to control and contain
liquid wastes within the disposal system.   If possible, a planned
layout of the housing locations and the latrines (if these are
outside the homes) should be carefully designed to minimize
containment problems.  Places of deposit of exposed excreta (such
as latrines and public comfort stations) must be screened or
otherwise protected from access by flies and other disease carriers,
such as rodents and mosquitoes.   Domestic animal manure
must be treated similarly.
 
A crucial aspect of liquid waste management is the selection,
monitoring, and maintenance of a discharge location.   There are
three main types of waste disposal facilities (there are advantages
and disadvantages with each kind of disposal):
 
     1.   surface water discharge (into a stream or river);
 
     2.   ground surface deposit (onto or under the ground); and
 
     3.   pipe system to a treatment or disposal facility.
 
Surface Water Discharge (into a Stream or River).   If a surface
water discharge system is already in place, it must be determined
if the discharge location is sufficiently distant and isolated
from wells or other water sources.   Again, this determination
should be based in part upon the sanitary survey of the local
facilities.  If pollutants found in a water supply are the same
as those in a nearby discharge location, then the discharge
location and the water supply are probably too close together.
Generally, discharge locations should be at least 45 meters from
an underground water supply and as much as several kilometers for
surface supplies, especially in the tropics.   The minimum separation
distance may vary depending on a number of factors.   Equally
important, a survey of the downstream waters is needed to find
out if contaminants from the liquid wastes pose a danger to
downstream water users.
 
In general, naturally occurring biological processes tend to
cleanse the water.  The larger the volume of the surface water,
and the faster it moves, the quicker and more effective this
cleansing action will be.  Slow moving or small volumes of water
result in a longer time for the biological action to cleanse the
water.  During this waiting period, disease organisms are alive
within the water, and unpleasant odors may develop.   Also, if
some of the solid waste materials become lodged in debris or in
the bends and turns of the surface water course, disease carrying
fly populations may develop.   Bathers and people using the water
to wash clothes may also be affected.
 
If the downstream water quality is not safe, it may be necessary
to prohibit its use.  Alternatively, it may be necessary to
discontinue the surface water discharge and find an alternative
means of disposal.  Trained health workers should evaluate the
water quality, and contribute to discussions of the various
alternative courses of action in the event the water quality is
not safe.
 
Ground Surface Deposit.  If liquid wastes are being deposited in
or on the ground, it is necessary to determine where the populace
is depositing the wastes.  Some of the possible sites include
latrines, pit privys, roadways, drainage ditches, and backyards.
 
There are several possible problems with the surface discharges
of liquid wastes, particularly if the wastes are not properly
stored and isolated.  Liquid waste depositories can be breeding
grounds for disease-carrying flies and a source of parasitic
worms.  As a result, there is a high potential for the transmission
of internal diseases, especially to children who may have
direct contact with the polluted waters while playing.   In addition
to the risks of disease, there is a strong nuisance odor
associated with these deposits.
 
These problems may be alleviated in a number of ways.   First,
area comfort stations should be provided in sufficient numbers
for the population.  If the wastes are not to be transported to a
separate location (via sewers or other transport), an underground
septic tank should be used and the effluent disposed of in soakways
or oxidation ponds.  An oxidation pond is a shallow pool or
pond in which the wastes are decomposed by the action of bacteria
over a specified period of time.   Air must be available to the
oxidation pond, and is sometimes even forced into the pond, to
help the bacteria do their work.   Once the waste has been reduced
by the bacteria, it is relatively clean and can be discharged
into a stream.  A soakway is a kind of oxidation pond lined with
pebbles; the pebbles hold onto the human fecal matter and other
organic material, while allowing the purely liquid part of the
human waste to drain into the ground.
 
Oxidation ponds and soakways are always covered with some water,
both because the bacteria require some moisture to work, and
because the water helps to control odors.
 
In rare cases, liquid wastes can simply be deposited on the
ground and covered with soil.   An estimate must be made of the
amount of area needed, given the number of years of expected use.
The waste deposit area must not be in close proximity to ground
or surface water sources, wells, or bathing or play areas.  Most
important, it must be determined if adequate quantities of soil
will be available to cover the wastes.
 
Alternatively, liquid wastes may be composted for use as fertilizer
for vegetables (but not green leaf vegetables).   Human
wastes should be treated with disinfectant before composting.
 
If liquid wastes are not to be stored at the location of the
comfort stations, or transported through sewers, then provisions
must be made for the pickup of the wastes and delivery to the
storage site.  In the design of a transport system, a number of
considerations arise.  The people designated to pick up the wastes
must be trained by health workers on the proper handling of
wastes.  A variety of containers and transport vehicles may be
used, including tank trucks or wagons, buckets, and lined and
covered ditches.
 
Whatever ground surface deposit method is used, it is essential
to avoid stagnation (or ponding) of the wastes.   Stagnant pools
of wastes are breeding grounds for insects and other carriers of
infection and disease, especially in crowded or congested areas.
 
 
Pipe System.  The movement of liquid wastes by a pipe system
eliminates many sewage collection and delivery problems, including
those associated with fly breeding and disease, and
odors.  However, pipes are costly and difficult to install,
especially in areas with winding streets or unstable population
locations.  Moreover, pipes require routine maintenance and
checking and water to carry the waste.
 
Because sewer pipes significantly reduce the risks of disease and
water supply contamination, their installation should be considered.
One way to reduce the total costs and construction involved
is to utilize the pipes in conjunction with community
comfort stations.  Provided a sufficient number of latrines are
available to handle the needs of the population, this can prove
to be an effective approach to waste and disease control.
 
When sewer pipes are used, discharge is usually into a waterway,
an oxidation pond, or other treatment/disposal facility.  The
location of the oxidation pond must be decided based on a number
of partly conflicting factors.   On the one hand, it should be
located as far from the living areas as possible, in order to
minimize odor and disease problems.   On the other hand, to conserve
sewage pipe, the pond should be located as centrally as
possible.  Finally, the pond should be located so that all the
pipes run downhill to reach it--since gravity is what brings the
wastes to the pond--to avoid costly pumping.   The final choice of
location will reflect a balance or compromise among these considerations.
For an oxidation pond to be functional, some water may
have to be added; in a dry climate, this approach may not be
feasible.
 
Solid Wastes
 
"Solid wastes" refers to ordinary household garbage and trash;
refuse from eating houses, markets, and hospitals; and any other
items disposed of by people or businesses.   These wastes may
include everything from animal carcasses and manure to paper,
metal, and food scraps.  Sometimes excreta collected from roadside
deposits is included.  Because of the variety of materials
in solid wastes, they can pose an unpredictable degree of health
hazard.
 
To avoid the breeding of flies and vermin, the best approach is
to collect, transport, and dispose of this material in a landfill
that is covered daily by at least 15cm of earth.   By following a
few simple guidelines, it is possible to create a remarkably
effective and sanitary solid waste disposal system.
 
Ideally, covered individual or commercial collection containers
should be placed on the streets, making sure that enough are
available to handle the refuse created by the populace.   In
practice, however, refuse containers in poor, densely populated
neighborhoods are apt to find other uses--for storage or even for
shelter.  Replacement costs could be substantial, so communities
should address the need for surveillance.
 
If used, bins should be disinfected and sprayed with insecticides
on a frequent basis.  Collection bins should be kept covered, and
sprayed with insecticides once a day.   Spillage from these bins
must be cleaned up promptly (otherwise it becomes a breeding
ground for insects).  All collection containers must be designed
for ease of use, both in terms of putting material in and in
terms of unloading it.
 
The astute reader will have noticed that there has been no mention
of rats or cockroaches, despite the obvious sanitation
problems these pests represent.   In fact, the only way to control
them, as well as flies, mosquitoes, and other rodents, is through
effective sanitation.  Chemical methods are of limited effectiveness
with these pests, so the easiest way to control them is to
limit their access to food and water.   That, in turn means
keeping food off the ground and the streets, and keeping trash
containers sealed.
 
To transport the waste from the collection bins to the disposal
site, some kind of vehicle should be used.   Whether powered by
man, animal, or engine, the transport device should have solid
sides, bottom and top to contain the trash.
 
The disposal site should be at least one kilometer from the
living areas, and should also be in the downwind direction.  The
site should not be waterlogged, marshy, or near the edge of a
waterway.  The site must be kept covered by soil, both to prevent
trash from blowing away and to keep pests from using the site as
a breeding ground.  Sufficient soil must be available to cover
the site on a daily basis, so that flies, rodents, and other
pests, will not be able to breed.
 
Surface water must be diverted away so that chemicals will not be
drained from the site or leach through it.   Seepage water from
these dump sites will also be highly polluted; steps must be
taken to prevent this water from reaching water courses used as
water supplies or for water contact such as bathing and laundry.
 
Because unemployment is often a problem in the same areas affected
by poor sanitation conditions, a large labor force may be
available to aid in the collection of wastes.   Indeed, in some
urban areas, a significant portion of the force is employed in
the collection and reprocessing of waste.
 
A key issue here is that many resources can be recycled, and some
resources--such as paper, aluminum. rags, glass, ferrous materials,
etc.--can be recycled with relatively low levels of technology.
Recycling of wastes should be considered as an important
option, because it offers at least three advantages:   It reduces
the amount of dry waste that must be dumped and covered; it
offers a cheap source of raw materials (wood pulp, metal, plastics,
etc.) that would otherwise be expensive; and it offers
gainful employment to members of the community.   Consideration
must be given, however, to the potential for personal injury and
for the spread of disease.
 
Collection for recycling should be subject to the same concern
for sanitation as collection for disposal; similar conditions
for the spread of disease and pests exist in both operations.
The people doing the collection/recycling should be educated
about the hazards of their job and the role they themselves can
pLay in the spread of disease.
 
FOOD SUPPLY
 
At the community level, good sanitation procedures for food deal
mainly with the routes by which the food reaches the consumer.
This means that the primary focus of sanitation efforts is in
conditions at the markets; at the working locations of the street
food vendors; and in the storage, preparation, and serving facilities
of permanent food establishments.   While control is difficult,
certain objectives have a very high priority.
 
First, safe and sanitary water supplies must be made available.
This is especially important in the marketplaces where vendors
congregate.  In these same markets, it is important that facilities
be provided for the sanitary disposal of liquid wastes.
Flies and other vermin must be controlled, mainly by eliminating
the sites where they breed such as garbage dumps or food dumped
in the street.  All food, and the utensils used to handle it,
should be kept as clean as possible.   All efforts to improve the
personal hygiene of those who handle the food will contribute to
the overall health of the community.
 
Depending on the resources available, several possible approaches
may be used to implement these objectives.   Ideally, new markets
should be constructed that would be carefully designed to control
the disposal of wastes and supply adequate quantitites of clean
water to the vendors.  A major source of contamination, particularly
for green vegetables, is the practice of washing these
vegetables with polluted water.   One possible solution is to
provide safe water supplies along the vendor travel routes, as
well as at the markets.
 
Some of the greatest sanitation problems occur at fairs, festivals,
and religious events.  The sudden increase of population in
small areas must be handled by provision of additional facilities
for waste disposal and provision of clean water, as well as clean
food.  Special measures during such events should include the
monitoring of the sale of cut fruits and uncooked vegetables, and
the insistence that all food be covered or otherwise protected
against flies.  The quality of the water and ice (if available)
used to prepare food and drinks should be carefully monitored.
Provisions should also be made for the cleaning and disinfection
of cooking utensils.  A further step is to promote single use
containers, such as those made from leaves and burnt clay.
 
INSECTICIDES
 
The use of insecticides to control insect pests is one of the
most powerful techniques for maintaining good community sanitation.
At the same time, it involves serious risks.   If people
are exposed improperly or excessively to these substances, they
can be seriously harmed.  If insecticide use is considered, costs,
benefits, and alternatives should be carefully evaluated.
 
There are a few basic considerations involved in the safe and
proper use of these pest control substances.   Great care must be
taken that these poisons do not enter water supplies.   Similarly,
these substances must not be sprayed at or near uncovered foods.
 
Insecticides should always be used according to directions; excess
will not prove any more effective than the amount specified.
Persons using insecticides must be properly trained, and must be
provided with protective clothing and masks.   These chemicals
must be stored in well marked containers away from food, feed,
and water, and secured in a safe place.   Common sense plays an
important role here, such as avoiding spraying into the wind or
using one's hands to mix solutions.
 
III.  IMPLEMENTATION OF SANITATION MEASURES
 
As a prelude to designing and implementing a community level
sanitation system, it is important to assess the existing environment
and life conditions in the community.
 
Sanitation is meaningless if survival is at stake.   Before people
can begin to think in terms of their health and cleanliness, they
must already have the basics of food, water, and shelter available.
If these basic needs have not been met, then it makes
sense first to devote community resources to fulfilling them.
However, sanitation must be considered simultaneously to make
food, water, and shelter safe enough for human survival, to avoid
a crisis such as an epidemic.   Once a serious sanitation problem
has developed, it may be too late to resolve it satisfactorily.
 
PLAN OF ACTION
 
To implement a sanitation system, it is necessary to conceive a
plan of action.  This plan is a series of specific steps that
will put each piece of the sanitation system in place.
 
To begin with, a determination must be made of the problems or
needs of the community, and priorities must be assigned to these
needs.  For example, perhaps liquid wastes are finding their
way into the water supply.  Then there is a need for some way to
dispose of the liquid wastes without affecting the water.  It may
be decided that a new source of water is needed, and that wells
must be built.  Another example:  perhaps garbage is piling up in
the streets, creating a breeding ground for flies, cockroaches,
and rats.  Then a system must be developed to collect the waste
from the streets and dispose of it in a safe place.
 
Once the community's sanitary problems and needs have been assessed,
priorities must be assigned among these needs.   For example,
it may be decided that the need for a safe water supply is even
more important than the need to remove the garbage.   So the water
supply problem would be dealt with first, and the garbage problem
later if only one can be resolved at a time.
 
A list of the problems and sanitary needs of the community forms
the building blocks of a plan of action.   Once these needs have
been determined, several further factors must be assessed:
 
     1.   What are the resources available to meet each of the
         needs?
 
     2.   What are the anticipated problems and solutions in
         implementing the goals of the plan?
 
     3.   What are the specific sites for latrine construction,
         for example, or the pickup and delivery points for
         garbage?
 
     4.   Who will monitor and supervise the operation and maintenance
         of the sanitation system(s)?
 
EDUCATION
 
Apart from all the designing, planning, and construction, perhaps
the most difficult aspect of implementing a sanitary system is
the task of educating the people.   Education is difficult even in
the best of circumstances, and much more so in overcrowded slum
conditions and poverty-stricken communities.   Interest and motivation
are difficult factors to arouse in people, particularly if
hunger and disease persist strongly in the population.
 
Yet, education is essential because the implementation of a sanitary
system may require the people to change long-established
habits.  For example, the people may be called upon to draw their
drinking water from a different source than they are accustomed
to, to use different toilet facilities, or to handle their foods
differently in the marketplace.   There may be strong resistance
among the people to changing old habits.   Consideration should be
given to minimizing changes, if this can be done without reducing
the effectiveness of the sanitation efforts.
 
Another kind of education is also essential:   Sanitation workers
must receive special training to make sure that their activites
do not make them into sanitary risks in their own right.  For
example, collecting wastes from homes and public places may be
one important step.  However, the people doing the collecting may,
if they are not careful, acquire diseases that they will pass
along to the rest of the community.   The same is true for those
people handling community water supplies and food.
 
For all such individuals involved in the running of sanitation
systems, it is imperative that they be fully educated about the
sanitation/health hazards in their jobs, and on the best ways to
achieve personal hygiene.  This kind of detailed education should
generally be provided by trained health care workers, who can
explain the interactipn between personal hygiene and community
hygiene, and the role that all people play in the common objective
of ensuring public health.
 
Health care workers also play a significant role in the education
of the general community.  But the most important figures in
community education are the political and religious leaders, or
the community elders--whichever leaders can hold the attention of
the people.  These leaders should set out to make people aware of
the problems, and the advantages to solving them, and help determine
the best approaches to take.
 
Ultimately, to be effective, a sanitation system must reach the
whole community, both in its physical extent and in the tendency
of the people to take advantage of it.   The community can provide
the most modern water and waste disposal systems available; but
if large segments of the people are not served by these systems,
a major breakdown in the sanitation level is likely to occur,
with the accompanying potential for the spread of disease and
infection.
 
                            REFERENCES
 
Appropriate Technology for Water Supply and Sanitation.   (vols. 1-12).
     Washington, D.C.:  World Bank.
 
Baumann, Werner and Karpe, Hans Jurgen.   Wastewater Treatment and
     Excreta Disposal in Developing Countries.  West Germany:  German
     Appropriate Technology Report, 1980.
 
Bull, David.  A Growing Problem:  Pesticides and the Third World
     Poor.   Oxford:  OXFAM, 1982.
 
Canter, L. W. and Malina, J. F. Sewage Treatment in Developing
     Countries.   Norman, Oklahoma:   The University of Oklahoma
     (under contract to USAID), December 1976.
 
Cointreau, Sandra J. Environmental Management of Urban Solid
     Wastes in Developing Countries (A Project Guide).  Washington,
     D.C.:   World Bank, June 1982.
 
Feachem, Richard G., Bradley, David, Garelick, Hemda, and Mara,
     D. Duncan, "Health Aspects of Excreta and Sullage Management:
     A State-of-the-art Review." (Appropriate Technology
     for Water Supply and Sanitation, vol. 3).  Washington, D. C.:
     World Bank, 1980.
 
Feachem, Richard et al.  Water, Health and Development:  An Inter-disciplinary
     Evaluation. London:  Tri-Med Books, Ltd., 1977.
 
Feachem, Richard, McGarry, Michael, and Mara, D. Duncan (eds.).
     Water, Wastes and Health in Hot Climates.  New York:  John
     Wiley and Sons, 1980.
 
Goldstein, Steven N. and Moberg, Walter J., Jr. Wastewater
     Treatment Systems for Rural Communities.  Washington, D.C.:
     Commission on Rural Water, 1973.
 
Golueke, Clarence G. Biological Reclamation of Solid Wastes.
     Emmaus, Pennsylvania:  Rodale Press, 1977.
 
Grover, Brian.  Water Supply and Sanitation Project Preparation
     Handbook (vol. 1, Guidelines).  Washington, D.C.:   World Bank,
     1982.
 
Kalbermatten, John M. et al. "A Planner's Guide."  (Appropriate
     Technology for Water Supply and Sanitation, vol. 2).  Washington,
     D. C.:   World Bank. 1981.
 
Kalbermatten, John M., Julius, DeAnne S., and Gunnerson, Charles
     G. Appropriate Sanitation Alternatives:  A Technical and
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