The objective of this paper is to review the global trends in urbanization with respect to availability of adequate sanitation and water supply services. Urbanization is unrelenting and rapid increase in the urban population in the less developed countries is of major global concern regarding this topic of sustainable sanitation and water. Most global urban growth is in the smaller cities and in the developing world. Half the urban developing world lacks adequate water and sanitation. Global urban access to waterborne sanitation is not affordable and thus is not a realistic option so alternative approaches are necessary. The treatment of drinking water cannot be a substitute for sanitation. In order to achieve sustainable sanitation, a change in attitude about human excreta and use of water is required. Essential features of a sustainable sanitation system are: containment, sanitisation and recycling. To improve water supply, we need to improve management practices, use full-cost pricing, introduce watershed approaches to protection and provide improved sanitation. Small urban initiatives need to go beyond the traditional sectors and new initiatives are required like on-site urban ecostations, source-separation of urine and faeces, decentralised greywater treatment and integration of sanitation into the cost of housing.

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