More key elements

Levels of service
Sanitation services can range from indoor flush toilets connected to sewers to simple pit latrines located some distance from the house. In most cases the level of service is determined by costs, the economic status of communities and households, and the willingness of users to pay for or otherwise contribute to the installation. The availability of water - as a transporting agent, a cleaning agent, or a personal hygiene agent - also affects the level of service provision, as do several other factors such as convenience, status (in terms of attractiveness and modernity) and perceptions of health impacts. To be sustainable, the minimum adequate levels of service for any given community are determined by all of the above factors. Considering that these will change with time, people should be given the opportunity to start with modest (but safe) facilities and improve as their financial capacity grows.
Health issues as key rationale
The health impacts of sanitation and the associated economic implications for national and household economies are a primary reason for developing sanitation policies. Adverse health impacts can result from unsanitary handling, disposal or reuse of human excreta and domestic wastewater. Although decisions may be made on the basis of service levels, convenience, costs or regulatory factors, the health consequences of sanitation provision should be the key rationale for formulation of policies. These policies should guide the subsequent implementation of sanitation programmes so as to encourage the desired health outcomes. To accomplish this the policies should address identified sanitation-related health concerns, such as diarrhoeal rates, infant mortality, helminth infections or cholera epidemics. It is essential that the general public is made aware of the problems that arise from poor sanitation and understands the role that proper sanitation services can play in addressing these problems. (For more information on hygiene promotion, see the TOP on hygiene promotion).
Environmental considerations
Increasingly sanitation is being seen as a major issue in environmental protection. Improper disposal of human wastes can pollute surface and groundwater bodies and the land surface, causing great risks to health and impacting the local economy; and such practices can adversely affect general aesthetics and the overall quality of life for those living in the vicinity. A growing problem in many countries is the economic impact of environmental degradation on tourism, fisheries and other industries sensitive to pollution. The most serious problems occur when large quantities of human excreta are concentrated in limited areas, such as at sewer outfalls, sludge beds or septic tank disposal sites.
Financial issues
The costs associated with implementing national sanitation policies include: (a) the capital costs required for sanitation infrastructure and facilities; (b) the recurrent costs required to operate and maintain the facilities and; (c) the programme costs for such aspects as training, institutional development, community organisation and hygiene improvement. Capital costs are those of the initial investment, provided either in the form of a loan or grant, and are much higher in the beginning than over time. Recurrent costs are those needed for ongoing management of the facilities and are paid by individual households through user fees. In addition to operation and maintenance, recurrent costs for sewered systems should include depreciation, debt service, and expansion of facilities. Programme costs include such activities as training, promotion and technical assistance. These costs are generally ongoing, but are higher in the early stages of a project when the facilities are constructed. These three categories of costs can be allocated to various parties or stakeholders. Sources of funds typically include national governments, local governments, external donors and users. The national budget process is an important factor in determining how these costs are allocated.
Institutional dimensions
To be effective, sanitation policies and associated programme development and implementation must be the responsibility of one or more institutions. In most countries responsibility for sanitation is divided among a number of ministries, based on their involvement in urban affairs, housing and public services, rural development, environmental protection and local government administration. This can lead to a confusing mix of institutional activities, sometimes resulting in overlapping authorities or in a situation where no organisation seems to have clearly defined responsibilities, thereby resulting in gaps in sanitation coverage, or even conflicting directives. To avoid such problems the sanitation needs of all population target groups should be the clear responsibility of specified institutions.