Current state and trends of access to sanitation in Ethiopia and the need to revise indicators to monitor progress in the Post-2015 era.
BACKGROUND
Investigating the current level and trends of access and identifying the underlying challenges to sanitation system development will be useful in determining directions developing countries are heading as they plan to promote sustainable development goals (post 2015 agenda). This research investigates the status and trends of access to improved sanitation coverage (ISC) in relation to the MDG target in Ethiopia with the aim of identifying prevailing constraints and suggesting the way forward in the post-MDG era.


METHODS
We examined data from a nationwide inventory conducted in accordance with the sanitation ladder at the national level and from a household survey in randomly selected urban slums in Addis Ababa. The inventory data were analyzed and interpreted using the conceptual model of the sanitation ladder. We used administrative reports and survey results to plot the time trend of the ISC.


RESULTS
The data from the nationwide inventory of sanitation facilities, which are presented along the sanitation ladder reveal that more than half of the Ethiopian population (52.1%) still used unimproved sanitation facilities in 2014. The majority (35.6%) practiced open defecation, implying that the country is far from the MDG target for access to improved sanitation (56%). Most people in urban slums (88.6%) used unimproved sanitation facilities, indicating that the urban poor did not receive adequate sanitation services. Trend analysis shows that access to ISC has increased, but Central Statistical Authority (CSA) data reveal a decline. This discrepancy is due to differences in data collection methods and tools. Dry pit latrines are the most widely used toilet facilities in Ethiopia, accounting for about 97.5% of the ISC.


CONCLUSIONS
The sanitation coverage is far from the MDG target and the majority of the population, mainly the urban poor, are living in a polluted environment, exposed to water and sanitation-related diseases. The sanitation coverage estimates might be even lower if proper utilization, regular emptying, and fecal sludge management (FSM) of dry pit latrines were considered as indicators. In order to enhance sanitation services for all in the post-MDG era, urgent action is required that will establish proper monitoring and evaluation systems that can measure real access to ISC.
Department of Environmental Health Science and Technology, Jimma University, P. O. Box: 378, Jimma, Ethiopia. abebe.beyene@ju.edu.et.
Abebe
A
Beyene
Research and Development Directorate, Ministry of Water, Irrigation & Energy (MoWIE), P. O. Box: 5744, Addis Ababa, Ethiopia. tamenehd@yahoo.com.
Tamene
T
Hailu
Water & Sanitation Program (WSP), the World Bank, Ethiopia Country Office, P. O. Box: 5515, Addis Ababa, Ethiopia. kfaris@worldbank.org.
Kebede
K
Faris
Department of Epidemiology and Biostatistics, University of California, 185 Berry Street, Box 0560, San Francisco, CA, 94143 - 0560, USA. helmutk@comcast.net.
Helmut
H
Kloos
D005002:Ethiopia; D006801:Humans; D011204:Poverty Areas; D012499:Sanitation / Q000706:statistics & numerical data*; D012722:Sewage; D014038:Toilet Facilities / Q000706:statistics & numerical data
D012722:Sewage