A Review of User Vulnerabilities Associated with Shared Sanitation Practices in Sub-Saharan Africa

Aims: Shared sanitation was excluded from the basic service level due to perceived limitations of their hygiene, accessibility and safety. But how does the current body of scientific knowledge influence the narrative? This paper is aimed at reviewing data on the current status and vulnerability issues reported to be associated with shared sanitation in Sub-Saharan Africa (SSA). Methodology: Literature was searched using key search terms from nine databases. Peerreviewed articles and various reports of individual country studies published in English from January 2000 to April 2022 were selected. Results: As at 2020, the proportion of the population sharing sanitation facilities in SSA was estimated as 19% compared to 7% globally. The review revealed a mixed opinion about issues and vulnerabilities associated with shared sanitation which may have arisen from inconsistencies in the typologies and levels of sharing of facilities among the reviewed studies. Using shared sanitation was found to be associated with an increased risk of diarrheal diseases (OR=1.06; 95%CI: 1.03- 1.08) and non-partner violence against women (OR=1.52; 95%CI: 1.22-1.82). However, there is also evidence that many shared facilities, particularly those shared by a few (2-3) households, are clean, meet the needs of the users and afford them similar health outcomes as non-shared facilities. Conclusion: The findings of the review suggest that the outright exclusion of all forms of shared sanitation from basic sanitation potentially underestimates the global efforts and progress toward access to sanitation. There is a need to segregate communal and public toilets from privately shared facilities in future research as well as the progress reporting by the Joint Monitoring Programme (JMP). It is also recommended that steps are taken by the JMP to develop indicators for identifying and incorporating quality shared sanitation facilities into the basic sanitation service level in order to give a more realistic account of the global effort towards sanitation access.