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Strategies to Connect Low-Income Communities with the Proposed Sewerage

Network of the Dhaka Sanitation Improvement Project, Bangladesh: A
Qualitative Assessment of the Perspective...

Article  in  International Journal of Environmental Research and Public Health · October 2020

DOI: 10.3390/ijerph17197201

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 International Journal of
Environmental Research
and Public Health

Article
Strategies to Connect Low-Income Communities
with the Proposed Sewerage Network of the Dhaka
Sanitation Improvement Project, Bangladesh:
A Qualitative Assessment of the Perspectives
of Stakeholders
Mahbub-Ul Alam 1, * , Fazle Sharior 1,† , Sharika Ferdous 1 , Atik Ahsan 1 , Tanvir Ahmed 2 ,
Ayesha Afrin 1 , Supta Sarker 1 , Farhana Akand 1 , Rownak Jahan Archie 3 , Kamrul Hasan 4 ,
Rosie Renouf 5 , Sam Drabble 5 , Guy Norman 5 , Mahbubur Rahman 1 and James B. Tidwell 6,7
1 Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka 1212, Bangladesh;
[email protected] (F.S.); [email protected] (S.F.); [email protected] (A.A.);
[email protected] (A.A.); [email protected] (S.S.); [email protected] (F.A.);
[email protected] (M.R.)
2 Department of Civil Engineering, Bangladesh University of Engineering and Technology,
Dhaka 1000, Bangladesh; [email protected]
3 Institute of Statistical Research and Training, University of Dhaka, Dhaka 1000, Bangladesh;
[email protected]
4 Dhaka Water Supply and Sewerage Authority (DWASA), Dhaka 1215, Bangladesh; [email protected]
5 Water & Sanitation for the Urban Poor (WSUP), London ECV4 6AL, UK; [email protected] (R.R.);
[email protected] (S.D.); [email protected] (G.N.)
6 Harvard Kennedy School of Government, Cambridge, MA 02138, USA; [email protected]
7 World Vision Inc., Washington, DC 20002, USA
* Correspondence: [email protected]
† Contributed equally to the first author.




Received: 31 August 2020; Accepted: 28 September 2020; Published: 1 October 2020


Abstract: In Bangladesh, approximately 31% of urban residents are living without safely managed
sanitation, the majority of whom are slum residents. To improve the situation, Dhaka Water Supply
and Sewerage Authority (DWASA) is implementing the Dhaka Sanitation Improvement Project (DSIP),
mostly funded by the World Bank. This study assessed the challenges and opportunities of bringing
low-income communities (LICs) under a sewerage connection within the proposed sewerage network
plan by 2025. We conducted nine key-informant interviews from DWASA and City Corporation,
and 23 focus-group discussions with landlords, tenants, and Community Based Organisations (CBOs)
from 16 LICs near the proposed catchment area. To achieve connections, LICs would require improved
toilet infrastructures and have to be connected to main roads. Construction of large communal septic
tanks is also required where individual toilet connections are difficult. To encourage connection in LICs,
income-based or area-based subsidies were recommended. For financing maintenance, respondents
suggested monthly fee collection for management of the infrastructure by dividing bills equally
among sharing households, or by users per household. Participants also suggested the government’s
cooperation with development-partners/NGOs to ensure sewerage connection construction, operation,
and maintenance and prerequisite policy changes such as assuring land tenure.

Keywords: urban sanitation; sewerage network; sewerage connection; low-income community; slum;
DSIP; affordability; Dhaka; Bangladesh

Int. J. Environ. Res. Public Health 2020, 17, 7201; doi:10.3390/ijerph17197201 www.mdpi.com/journal/ijerph
Int. J. Environ. Res. Public Health 2020, 17, 7201 2 of 18

1. Introduction

1.1. Urban Sanitation and Consequences

Worldwide, 2 billion people still lack a basic sanitation service, a burden disproportionately borne
by the world’s poor [1]. In urban areas globally, 47% of the population use safely managed sanitation
services, 38% use basic services, and 9% use limited services [1]. According to the WHO-UNICEF
Joint Monitoring Program (JMP) [2], improved sanitation facilities are those designed to hygienically
separate excreta from human contact; improved sanitation facilities which are not shared with other
households and the excreta produced are treated properly are considered safely managed sanitation
services. If the excreta from improved sanitation facilities are not safely managed, then those facilities
are classified as basic sanitation services; improved facilities, which are shared with other households,
are classified as limited services. In low-income communities in Dhaka, only 2% of the population
have access to safely managed sanitation [3], and no faecal material is considered safely managed
outside of a small fraction going into the sewer network [4]. The Bangladeshi low- and middle-income
communities usually earn between $2 to $20 per capita per day [5]. In low-income urban areas with
poorly developed infrastructure, high population growth coupled with low socio-economic status
leaves shared sanitation facilities often as the only viable sanitation option [6]. A common practice in
low- and middle-income countries like Bangladesh is to connect flush/pour-flush toilets directly to
drains, without any form of on-site containment [7]. Inadequate sanitation leads to environmental
pollution and has significant adverse health [3,8,9] and non-health consequences [10]. The Sustainable
Development Goals (SDG) 6 aims at ensuring the availability and sustainable management of water
and sanitation for all. It is estimated that just the capital expenditures needed to extend water
and sanitation services globally to meet the SDGs are $1.7 trillion up until 2030. Urban sanitation
makes up 44% of these costs [11]. Generally, these costs are funded both from the government, along
with other international agencies such as different development banks. Hereby, development banks’
investments in sanitation are usually not pro-poor and are failing to promote the transformational
change that is needed to overcome the urban sanitation crisis [12].

1.2. Sewerage Facilities in Dhaka: Current State

In urban Dhaka, the existing sewerage network serves only 20% of the total urban population,
mostly concentrated in wealthier areas. A 2005 census identified 4966 slums in Dhaka city and found
that almost all were without any sewerage network coverage. Dhaka’s current population density is
the 6th highest in the world—29,069 people per km2 (2020) [13]. Over 35% of the city’s population
(18 million) lives in Dhaka’s low-income settlements. Improved sanitation facilities are mostly found
among middle and higher-income households [14]. A rapid increase in urbanisation with insufficient
Faecal Sludge Management (FSM) services and inadequate investment in the sector are major barriers to
pro-poor urban sanitation [7]. Additionally, low-income households usually refrain from investments
in sanitation due to tenure insecurity [15]. Many residents in low-income settlements use simple
pit latrines with/without water seals, septic tanks, cluster latrines, communal latrines, or hanging
sanitation suspended over water bodies [14]. Faecal matter from pits and septic tanks spills over into
open areas, and stormwater in over-flowing open drains becomes contaminated with untreated sewage.
This poses significant health risks to the poor, who often live in low lying or unplanned settlements [16].
The Bangladesh Bureau of Statistics (BBS) identifies urban LICs to predominantly be characterised by
poor housing, poor quality or no sewerage and drainage, inadequate drinking water supply, and few
or no paved streets or paths [17,18]. Many LICs are also located near polluted water bodies, swamps,
or putrid drainage canals [19]. The urban poor population in this country is being neglected in many
ways in terms of social, economic, and infrastructural improvement [20–23]. Limited access to water
and sanitation services in slums could contribute to the poor health of slum residents [24].
Int. J. Environ. Res. Public Health 2020, 17, 7201 3 of 18

1.3. DSIP and LICs: Unaddressed Issues

Dhaka Water Supply and Sewerage Authority (DWASA) is a Bangladesh government agency
under the Ministry of Local Government, Rural Development and Co-operatives responsible for water
and sewage in Dhaka. DWASA has planned to implement the Sewerage Master Plan under the Dhaka
Sanitation Improvement Project (DSIP) with a loan of an estimated US$900 million from the World
Bank [25]. As part of the master plan, by 2035, all households and public/private facilities are planned
to have either access to the public sewerage system or improved on-site (or hybrid) facilities. The core
objective of the Master Plan is wastewater management and improving sanitation systems in Dhaka
City. However, this master plan does not clarify how connections to the sewerage network will be
made for illegal settlements. A clearer illustration of financial support for those not being able to afford
toilet renovation was also absent in the plan. Due to the per capita costs and estimated revenue that can
be collected, households in the urban centres are proposed to be given the highest priority for sewerage
access, whilst those in the transitional area will be served in stages. The remaining households situated
in the on-site treatment area will remain un-sewered until after the target year of the master plan.
Consequently, these households will be required to install individual on-site containment facilities or
to develop a cluster-wise community sewerage system for combined treatment of night soil/septic tank
sludge and sullage.
Phase 2 of the Master Plan, spanning 2015–2025, aims to achieve that wastewater be collected from
approximately 3.3 million people in the Pagla catchment and 1.4 million people in the Dasherkandi
catchment, assuming an estimated household connection rate of 65% [26]. However, the master
plan lacks clarification of an effective procedure to connect LICs in Dhaka city with the proposed
sewerage network. Moreover, in urban Bangladesh, faecal sludge management services are not
generally delivered through formal utilities but rather through well-functioning informal markets that
are operated by middlemen and local providers for emptying on-site septic tanks [19]. In order to
provide legal water connections to several areas in Dhaka, including LICs, regardless of tenure/holding
numbers, DWASA has previously altered and updated its citizen charter. For such cases, an LIC
department was also established, although informal markets continue to play a crucial role. Since
legal service connections have been extended towards LICs in the past with resident’s contributions
via incentives directed for cost-recovery and revenue collection for DWASA, such strategies could be
adopted in the case of providing legal sanitation services to the low-income residents as well [27–30].
Recent data suggest that 42% of urban residents rely on on-site sanitation facilities [31]. However,
Dhaka’s only treatment plant functions below capacity; due to several blockages and inefficiency
issues of the lifting pumps, the treatment plant is not getting enough faecal waste to treat according to
its full capacity. The existing network transports only 2% of the sewage produced, and only 0.3% is
effectively treated [31]. According to the plans stated in the DWASA Sewerage Master Plan of Dhaka
City for the period 2011–2035, sewer connections will be provided to all residents in Dhaka City as part
of the DSIP. However, there are many challenges to achieving this goal, including cost, engineering
design and construction, and modalities for financing and carrying out maintenance.

1.4. Study Objectives

This study aimed to assess the challenges and opportunities of connecting LICs to a sewerage
network in the Pagla catchment area under DSIP. Many studies have been conducted regarding water
supply and its pricing among slums in Dhaka [32–34] but less has been done for sanitation, especially
focused upon users’ priorities to connect to a sewerage network in urban Dhaka. Notably, we are not
aware of any research focusing on the priorities of toilet-users in low-income urban settlements to
understand their preferences or strategies to connect them with the sewerage network. This paper
presents the findings of the qualitative research regarding sewerage connections in low-income
communities under the Dhaka Sanitation Improvement Project.
Here, we (a) ascertained the perceived benefits of the proposed sewerage network, (b) assessed
the challenges and opportunities of connecting LICs to a sewerage network, and financing and maintaining
Int. J. Environ. Res. Public Health 2020, 17, 7201 4 of 18

those networks, (c) explored the perception of LIC residents about the affordability of connecting with
the proposed sewerage network, and (d) explored the perceived barriers to ensuring a well-functioning
sewerage system.

2. Methodology

2.1. Study Site

DWASA has planned a sewerage trunk main for the DSIP project to be implemented within
the sewerage master plan. DWASA split this into two distinct parts: The Western trunk main
and Eastern trunk main. To date, the project has mainly focused on the Eastern trunk main. Areas
planned to cover through the current phase are located in Dhaka South City Corporation (DSCC);
therefore, most of the study LICs were selected from DSCC. Additionally, we also chose two LICs from
Dhaka North City Corporation (DNCC) to illustrate a comparison with the LICs located in DSCC.
Hence, we selected study locations that were located within a distance of 2–3 km from the Eastern trunk
main. The study carefully considered the distance of the settlements from the proposed trunk main
since lack of detailed information regarding user perspectives and way-out to connect, nearby LICs
should not be skipped from having sewerage connection. The study was conducted from February
2019 to February 2020. LICs were selected purposively by considering the following:

1. Stratified by the size of the population: 11 LICs were selected where the number of households
was less than 500, and 5 other LICs were chosen with more than 1000 households;
2. Distance of the settlement from the proposed Eastern trunk main: 5 LICs within 500 m,
8 LICs > 500 m < 5 km, and 3 LICs > 5 km.

We selected a total of 16 LICs following these criteria from the slum list of Bangladesh Census of
Slum Areas and Floating Population 2014 (Figure 1). The names of the selected areas were: Agargaon,
Bhashantek, Dholpur, Duaripara, IG Gate Bank Colony, Kamlapur Railway, Kamrangirchar, Khilgaon
Bagicha, Lalchan Mukim Lane, Maniknagar Adorsho Staff Quarter, Mogbazar Railway, Mohajer Colony,
Nobinbag, Pagla, Shyampur, and Tekpara. Among these 16 LICs, 7 were situated on government
owned land, 8 were on private land or on land that was leased by a businessman or political person,
and the rest was residing on disputed land. Not all of the 7 LICs on government owned land had
legal permission to extend their settlements. “IG Gate Bank Colony” and “Maniknagar Adorsho Staff
quarter” areas had partial recognition to a certain level.
Int. J. Environ. Res. Public Health 2020, 17, x 5 of 18

Figure 1. Study location of the low-income communities (LICs) with proposed trunk main.
Figure 1. Study location of the low-income communities (LICs) with proposed trunk main.
2.2. Study Design
We chose qualitative research approaches so that the study can capture the attitudes of the
respondents. One of the core aims of the research was to illustrate user preferences. In this context,
qualitative research techniques seemed best suited, as they are not bound by the methodological
limitations and explain something which numbers merely are unable to reveal. These approaches
allowed us to be far more speculative about what we have chosen to investigate. This qualitative
exploratory study used Key Informant Interviews (KII) and Focus Group Discussions (FGD) for data
Int. J. Environ. Res. Public Health 2020, 17, 7201 5 of 18

2.2. Study Design

We chose qualitative research approaches so that the study can capture the attitudes of
the respondents. One of the core aims of the research was to illustrate user preferences. In this context,
qualitative research techniques seemed best suited, as they are not bound by the methodological
limitations and explain something which numbers merely are unable to reveal. These approaches
allowed us to be far more speculative about what we have chosen to investigate. This qualitative
exploratory study used Key Informant Interviews (KII) and Focus Group Discussions (FGD) for data
collection. Collected data were analysed to identify the LICs respondents’ point of view about their
needs and perceived benefits in terms of sewerage facilities, which were broadly unaddressed in
previous studies. This study tried to represent the perspectives of LIC residents and a pathway for
change to improve their lives.

2.3. Study Population

The study included two groups: authorities responsible for service delivery and residents in the LICs.
We performed key informant interviews (KIIs) with authorities and focus group discussions (FGDs) with
the three types of groups from LICs consisting of landlords, tenants, and Community Based Organization
(CBO) leaders. FGD participants resided either on governmental land as an unregistered settlement or on
land that is leased from the government by a third party. In the study, the group “landlord” means he/she
owned the house only, or they were allocated to use the land for a certain time, or who bought the land,
built houses, and receives rent from the tenants. For some cases, the landlord/homeowner did not live
with the tenants. Whether the respondent was a homeowner or tenant, we chose inland residents only.

2.4. Sampling
For the KIIs, we collected data on (i) the current sanitation status in LICs, (ii) implementation
strategies under DSIP or otherwise, (iii) recommendations for strategies to connect LICs to sewerage,
and (iv) future plans for implementation of DSIP. Key persons were selected for conducting key
informant interviews from Dhaka Water Supply and Sanitation Authority (DWASA), the Pagla
Sewerage Treatment Plant, and Dhaka City Corporation. Following an open-ended questionnaire, we
conducted KIIs with the officials who were directly involved with DSIP and were actively engaged
with the existing and proposed sewerage treatment plant. We also interviewed representatives from
a non-governmental organisation who were involved in urban sewerage service delivery. Key personnel
from an Engineering Research Institute, with experience implementing urban sewerage solutions,
and DWASA engineers from Maintenance, Operation, Distribution, and Service (MODS) zones involved
in strengthening the sanitation infrastructure, were also included. The interviewees were selected
based on their experience and knowledge regarding the Dhaka Sewerage Master Plan and those who
were closely involved with Dhaka Sanitation Improvement Project. The interviewed participants have
been listed in Table 1.

Table 1. Key informant interviews with the government and community stakeholders.

Designation Organisation/Department
Executive Engineer (C. C.) DWASA
Executive Engineer P&D (Sewer) Division of DWASA
Senior Community Officer DWASA
Executive Engineer Pagla Sewerage Treatment Plant (PSTP)
Ward Councilor and Board member of DWASA Councillor of 26 no. Ward Dhaka City Corporation and Board member of DWASA
Executive Engineer (2) MODS Zone (Jatarbari service area), DWASA
Research Officer ITN-BUET
Deputy Director Dushtha Shasthya Kendra (DSK)

For FGDs, we selected residents of LICs who were either tenants or house owners. We also selected
CBO/community leaders who were responsible for monitoring/decision making for LICs utilities or who
participated in various implementing activities previously. A rapid visit was carried out to select and finalise
Int. J. Environ. Res. Public Health 2020, 17, 7201 6 of 18

the field sites for conducting FGDs for this study. Additionally, information on the number of households,
population, toilet type/connection status, and distance from the trunk main was also collected during that
visit. Sixteen areas were selected and visited separately from the different low-income communities across
Dhaka city. FGDs were conducted with landlords/homeowners, tenants, and community leaders in their
own communities to get a communal response and to avoid excluding important perspectives of those
who would find travel difficult.
Twenty-three FGDs were conducted in total. Each discussion was conducted with 6–10 participants.
These included mixed groups consisting of (i) house owners/landlords and tenants together, (ii) groups
of only house owners/landlords, (iii) groups of tenants with current faecal sludge arrangement to storm
drainage, (iv) groups of tenants and house owners without sewerage connection, and (v) a group of
community leaders (Table 2). We tried to consider gender, age, and occupation while choosing our
FGD participant groups. However, except for tenant groups, in most cases, participants were males.
These FGDs assessed the satisfaction of the users regarding sewerage facilities in terms of their financial
status in different LICs, the demand for sewerage systems, barriers for implementation, challenges,
and opportunities of connecting LICs to a sewerage network, and affordability of proposed policies
and strategies.

Table 2. Number of focus group discussions (FGDs) with slum residents.

Group of Participants Number of FGDs

Landlords 9
Tenants with sewer connection to
4
the storm drainage
Tenants without a sewer
6
connection
Landlord-tenant (mixed) 2
CBO leaders 2

2.5. Data Analysis

Audio recordings of the KIIs and FGDs were transcribed, translated, and the following themes
and codes were finally summarised (Supplementary Table S1). Conceptually similar data were
grouped into sub-categories and subtopics/themes. Summarised data were coded primarily following
the inductive reasoning approach, where all collected information was considered. While coding, firstly,
open coding was done where concepts were labelled and defined, and categories were developed
based on the dimensions of the information. Afterwards, data was related together through axial
coding in order to reveal codes and to identify relationships among the open coded data. Finally, core
categories/themes were identified through selective coding, which included all the data, and thereby
primary findings were illustrated thoroughly based on the major thematic areas. Thus a combined
code list was prepared for analysis, and data were then analysed using thematic analysis method [35].
We also cross-checked our data during fieldwork to ensure its validity while talking to different
respondents in different areas. During organising, coding, interpretation, and in all stages of data
analysis, we did not intend to misinterpret any data by prioritising our viewpoints (Figure 2).
In this study, thematic analysis was chosen not to merely count phrases or words in a text but
to explore explicit and implicit meanings within the primary data. In brief, thematic analysis was
performed through the process of coding in six phases to create meaningful patterns. These phases
were: familiarisation with data, generating initial codes, searching for themes among codes, reviewing
themes, defining themes, and preparing the final report [36]. We included codes in the analysis if they
met all of the following evaluation criteria:
grouped into sub-categories and subtopics/themes. Summarised data were coded primarily
following the inductive reasoning approach, where all collected information was considered. While
coding, firstly, open coding was done where concepts were labelled and defined, and categories were
developed based on the dimensions of the information. Afterwards, data was related together
through
Int. axial
J. Environ. Res.coding in order
Public Health to7201
2020, 17, reveal codes and to identify relationships among the open coded 7 of 18
data. Finally, core categories/themes were identified through selective coding, which included all the
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should build a sewerage network” and “government should take the responsibility to monitor it.”

3.1. Perceptions of Current Faecal Sludge Management Situations

Only one group out of 16 study areas had private household toilets, while 13 FGDs mentioned
“shared toilet” as their only toilet facilities. These respondents typically shared their toilets with 5–30
other households. Toilets were almost always provided by “different NGOs” (15 FGDs). Only 3 areas
had septic tanks connected to their toilets, but they were not connected to the main sewerage line.
“Narrow lanes” were one of the most commonly reported problems with the current sewerage system
Int. J. Environ. Res. Public Health 2020, 17, 7201 8 of 18

in 18 out of 23 FGDs. Collection and management of faecal sludge were mentioned as difficult to carry
out either manually or via vacutag in those areas because of these narrow lanes. Exit pipes of toilets
were usually “connected to storm drainage.” Among 16 LICs, we found storm drains completely open
in 3 LICs, yet several toilet exit pipes were connected with those drains. In 11 LICs, storm drains were
mostly covered but still had minor uncovered sections. We did not find any storm drainage in the rest of
the LICs. These types of connections eventually allow faecal matter to be disposed into an open water
body near to the study areas such as a canal or a lake. Moreover, three different additional “technical
issues” were identified. These were “pipe blockage,” “pipe leakage,” and “narrow connecting pipes”
(Supplementary Table S1). “Pipe blockage” was mentioned 51 times, “pipe leakage” was mentioned
36 times, and “narrow connecting pipes” was mentioned 17 times with “problems of the current
sewerage system.” Nine tenant FGDs had mentioned that during the rainy season, there was frequent
overflow inside their household area from the drains and canals where faecal matters finally exit.
They perceived that it occurred due to insufficient drainage facilities for disposal of faecal material
and other wastes during heavy rainfall. Both tenant and homeowner groups in 2 FGDs mentioned that
their houses were situated at a lower elevation than the nearby sewer pipes, which resulted in frequent
overflow of wastes after heavy rainfall during the monsoon season.

“In the rainy season, our excreta travel back due to an overflow in the drains; it is common that dirty
water with faecal matter enters even into our living room.”
—FGD, Female tenant, IG Gate Bank Colony

Furthermore, “no water supply facility inside the toilet” was mentioned by the participants 62
times with “problems of the current sewerage system.” Hereby, respondents addressed that there
was no water supply line inside the toilet and as such whenever they used the toilet, they needed to
take water from external water sources (such as nearby tube-wells) for flushing and washing. They
mentioned it as a severe problem as it is difficult to take sufficient water along with them when they
use the toilet. Therefore, they cannot properly practice sanitation-related personal hygiene practices or
clean the toilet. Landlord/homeowner groups from the four study locations out of sixteen mentioned
that the land on which they were residing was owned by the government, and it was repeated in
3 FGDs that they did not have legal registration from the government. Therefore, they remained
uncertain about the government granting permission to them to live there, and hence were not taking
any initiatives to improve their toilets. In these three study areas, it was visible that faecal matter
and household wastewater were openly mixed with a nearby water body.

“Most of the toilets in our slum are hanging toilets, and slabs are set upon the bamboo-made floor,
and faeces finally go to the open water body, even our houses stand upon the water body.”
—FGD, Male tenant, Mogbazar slum

Four different “health hazards” commonly met the evaluation criteria. They were “bad odour,”
“cholera,” “diarrhoea,” and “skin diseases” (Supplementary Table S1). “Bad odour” was mentioned
113 times, “diarrhoea” was mentioned 72 times, “cholera” was mentioned 43 times and, “skin disease”
coincided 39 times with common “health hazards” because of the situation of the current sewerage
system. Tenant groups in 2 FGDs had experienced faecal odour in their supply water.

“Ours is a hanging toilet. We don’t even have any drain here. So faecal matters stuffed beneath
the ground of the toilet and travel with the water we use in the toilet”.
—FGD, Male house owner, Tekpara

3.2. Perceived Benefits of Sewer Connection

Two broad themes met the evaluation criteria through which a range of benefits was identified
from all the FGDs. These were environmental benefits and health benefits. Based on all FGDs with
Int. J. Environ. Res. Public Health 2020, 17, 7201 9 of 18

landlords/homeowners, tenants, and community leaders, the most frequently mentioned environmental
benefits of having a sewerage connection were safe disposal, no bad odour, no clogged drain, no
overflow, safe drinking water, and no contact with wastewater. In 19 FGDs, participants perceived that
having a proper sewerage network would be the safest system, and the enclosed disposal of faeces
would prevent the openly passing raw excreta. Participants expected that if their existing toilets can be
connected with the proposed sewerage network of DWASA, it would be safer for them in terms of
their health and hygiene practices. Generally, in all study areas, all the tenants of each group expressed
a stronger desire to have a sewerage connection than landlords, mentioning that it would result in
a cleaner environment quality as well as prevent various diseases. Moreover, sewerage connections
were seen as a way to prevent bad odour, which was the most common complaint in 20 FGDs.
Furthermore, tenant groups in 3 FGDs claimed that cleaning the drain was expensive, and no
one wanted to take the responsibility of cleaning the clogged faeces in the blocked or leaking drains.
Residents wanted to avoid providing cleaning costs or taking responsibility upon themselves. This
sometimes resulted in quarrels between neighbours. These groups also hoped that having proper
sewerage connections would improve the social relationship among the neighbours.
Another major environmental benefit perceived by the tenants in 5 FGDs was that wastewater
would no longer overflow onto their surroundings, and their drinking water and food would not be
contaminated by it. They perceived that drinking water pipes would not mix with the drain water pipes,
if a proper sewerage connection can be installed. In 2 FGDs with tenant groups, it was also mentioned
that wastewater contact with their skin could be avoided, and Muslims would not have to worry about
becoming impure if the faecal matter did not travel back and overflow into their surroundings.

“We are living by the side of a canal. This canal is badly filled with huge wastes. All its need is 10
minutes of heavy rainfall to overflow of waste in our surroundings. We could have separate drains
to pass different wastes in a proper way. If the sewages don’t mix with other wastes and don’t go to
the canal, there is a less chance to see them back with the overflow”.
—FGD, Male tenant, Khilgaon Bagicha

Based on all FGDs with landlords/homeowners, tenants and, community leaders, the most
frequently mentioned health benefits of having a sewerage connection were no contact with pathogens,
no contamination, no mosquitoes and flies, no breathing problems, and no skin diseases. In 21 out of 23
FGDs, participants perceived that having a proper sewerage network would eventually lead to better
health of their children as well as the general public. Having a cleaner and safer disposal of faeces would
lead to the prevention of contact with disease-causing pathogens and lesser incidences of diarrhoea,
cholera, jaundice, etc. Moreover, if the excreta did not end up in water bodies, their drinking water
and food would not be contaminated, and they could avoid many waterborne diseases. Along with
these health consequences, respondents in 5 FGDs with tenants and 6 FGDs with landlord/homeowners
also hypothesised that this proposed sewerage network would also have a great positive impact on
the environment. They perceived that if the LICs would be connected with the proposed sewerage
network, both environmental hazards and poor health consequences will be lessened. In 8 FGDs,
both landlord/homeowners and tenant groups expressed that mosquitoes and flies would not have
emerged if the water bodies were clean, and thus dengue and chikungunya could also have been
avoided. Tenant groups expressed greater concern about possible health benefits. In 6 out of 10 FGDs
with the tenant groups, respondents hoped that they would not have to visit the hospital too frequently,
and health-related costs would be reduced. They asserted that this proposed sewerage connection
is important for them to mitigate the negative consequences of current faecal sludge arrangement to
storm drainage in terms of their health crisis. Due to their limited income and demographic situation,
such proposed services would be beneficial for them, which they could not afford by themselves.
Int. J. Environ. Res. Public Health 2020, 17, 7201 10 of 18

3.3. Willingness to Connect to a Sewerage Network

Three key personnel from DWASA, who are also actively engaged in DSIP, mentioned that
households within 100 feet of the proposed main sewerage line would be forced to connect with
that sewerage network after imposing regulations by concerned authority (i.e., City Corporation or
DWASA). They also added that residents of these areas might need to obey this regulation in order to
continue their residency. This plan was also evident in the Sewerage Master Plan documents. Four
different technical strategies met the evaluation criteria with “possible strategies” (Supplementary
Table S1). These were “building a sewerage network on government’s cost” (4 KIIs), “improve existing
toilets,” including hanging toilets (2 KIIs), “subsidised service charges” (2 KIIs), and “providing loans”
(2 KIIs). One KII mentioned “Providing loans” to the homeowner for improving their toilet to connect
with the sewerage network to increase sewerage connection rates.
Participants in almost all the FGDs were found to be willing to connect their toilets with
a sewerage network under some circumstances, with five key conditions mentioned—“no installation
cost“for sewerage connection, “household type/size based service charges,” “area-based subsidies,”
“income-based subsidies,” and “financial support for toilet improvement” (Supplementary Table S1).
“No installation cost” was mentioned 77 times. Landlords/homeowners had mentioned that
the government should bear the cost of building a sewerage network in 7 FGDs while offering
that they could contribute a tiny part for the connecting pipes to connect their toilets with the network.
“Household type/size based service charges” was mentioned 17 times in 2 FGDs with tenant groups.
These groups perceived that the monthly service charge should be fixed based on the toilet type
and the number of users. “Area-based subsidies” was mentioned 23 times, and “income-based
subsidies” was mentioned 31 times along with “willingness to pay.” These subsidy types were
mentioned in one FGD of community leaders and 4 FGDs with tenant. Landlord/homeowner groups
in 3 FGDs and tenants in 2 FGDs disagreed about the best modality, with some claiming that service
charges should be fixed in terms of toilet types and the number of users in a single-family because they
share their toilet with other families. Other respondents stated that as they live in a low-income area
(i.e., Mohajer colony) and they earn poor wages in comparison with the other areas of the city, subsidies
should be fixed considering the type of area. The latter group perceived that it would be better if they
had to pay subsidised service charges since they were from a low-income community and were living
in poor conditions. In 3 FGDs with landlord groups, “financial support for toilet improvement” was
mentioned 12 times. Financial support from the government or other non-government organisations
was considered necessary if the costs of renovating existing toilets to be able to connect to sewers
were too high. Homeowners living on government land wanted to ensure their investment would
not be lost due to displacement. They were not informed whether they would get permission from
the government to stay. These respondents commonly mentioned that, in the recent past, several
LICs who used to live in a government land got a legal notice to leave their residences. Therefore,
currently, they are also afraid of facing such cases. For this reason, they were not willing to invest
much in sanitation.

“In the case of water lines, the number of plots in each street was counted, and an underground
connection was created with each plot so that no matter what, households would be able to connect
and future expansion would be possible with the pre-developed system. A similar strategy will be
followed for the sewerage line so that the network is present for users to connect. And also, the LICs in
the city which meet these criteria will be able to connect. Proper community mobilisation is required
for increasing sewerage connection number among these LICs.”
—KII, Key personnel, DWASA

The DWASA Sewerage Master Plan of Dhaka City is designed to ensure that sewerage facilities are
accessible to the whole city. Only a few technical strategies met the evaluation criteria with “possible
strategies,” such as a “communal tank,” which was mentioned in 4 KIIs. Relevant DWASA authorities
Int. J. Environ. Res. Public Health 2020, 17, 7201 11 of 18

have an initial plan to build communal septic tanks (underground) in some areas where placing
connecting pipes is almost impossible due to narrow lanes within a community. Stacked wastes would
be transferred and disposed into the Pagla Sewerage Treatment Plant (PSTP) station via the main trunk
line. However, the lack of sufficient space to set up such communal septic tanks was mentioned in 2
FGDs with landlord groups. A few additional technical strategies were suggested in the 4 KIIs with
DWASA officials. Frequently suggested strategies included:

1. Imposing residency regulations upon community members to get connected with

the sewerage network;
2. Rebuilding the hanging toilets in LICs by DWASA authority;
3. Allowing communal toilets for LICs to be built under DSIP;
4. Dhaka City Corporation should widen the roads and operate on-site sanitation in
difficult-to-connect areas.

3.4. Affordability of Having Sewerage Connection

We explored to what extent users are willing to pay for sewerage network connections
and maintenance during the focus group discussions. Preferences regarding payment methods
and affordability varied primarily based on their financial situation and occupancy status as a landlord,
house owner, or tenant. In most cases, the participants were willing to pay for their sewerage
connections as they believed that it would benefit them. Four different preferences met the evaluation
criteria with a possible payment method. These were monthly bills, one-time payment, equated
monthly instalments (EMI), and cash vouchers. Monthly bills were mentioned 68 times with possible
payment methods for sewerage service charges. Tenant groups in 8 FGDs mentioned that similar to
other utility bills, and they could pay a monthly service charge.
It has been mentioned in the sewerage master plan that sewerage service fees may be charged up
to 2% of the total monthly income of the users based on the services received. Based on all the FGDs,
the amount ranges from 50–500 taka monthly. Among 8 LICs, tenants from Kamalapur Railway
Colony, Kamrangirchar, and Duaripara wanted to pay within the range of 50–100 BDT, while tenants
from Tekpara and Dholpur mentioned a range of 200–400 BDT, and the tenants from Lalchanmukim
Lane, Maniknagar, and Nobinbag could afford 300–500 BDT as sewerage service fees. This amount
would be paid by dividing the charge among the user households. This range was regarded as
“affordable” based on all FGDs with tenant groups. Nevertheless, these 8 tenant groups were not at
all willing to pay for sewerage connection installation or toilet improvement costs. Moreover, they
perceived that it was the responsibility of the landlords to manage sewerage facilities to make the lives
of their tenants easier. In their existing situation, the tenant groups were bearing the cost for minor
repairs and regular maintenance; the amount ranges from 50–500 taka per household depending on
the toilet condition. In 2 FGDs, tenants reported that they were tackling minor repairs communally,
but the landlords/homeowners should provide adequate toilet facilities.
We found tenant groups paid a certain water bill (200–300 BDT) monthly to the water suppliers,
such as the water pump owner, from whom they collected their drinking water. Two tenant’s groups
in Lalchanmukim Lane and Shyampur were found buying water from mosques by paying a fee per
litre. Tenants in only one study area used a water supply provided by an NGO for which they had
to pay 800 BDT (9.4 USD) per month on average. One-time payment was mentioned 13 times with
possible payment methods for sewerage connection installation in 4 FGDs with the landlord groups.
In most cases, they preferred their “affordable” range, which is from 10–20% of the total cost needed to
have sewerage connections in their toilets. This percentage is perceived by them as affordable based
on their income and previous experiences like sharing costs among themselves while setting up a toilet
by different NGOs, considering the context of IG Gate Bank Colony and Maniknagar slum where few
toilets were built by different NGOs and homeowners of these areas bore the total cost through EMI as
well as sharing costs among themselves. As such, in this study, they perceived the 10-20% range of
Int. J. Environ. Res. Public Health 2020, 17, 7201 12 of 18

the total cost as affordable for them. Nevertheless, they demanded financial help from the government
to manage the rest of the amount.
Equal monthly instalments (EMI) was mentioned by the participant 7 times, and cash vouchers
was mentioned 4 times with possible payment methods for sewerage connection installation and toilet
renovation cost by the landlord/homeowner and community leader groups. In 3 FGDs, landlord/homeowner
groups suggested that they could afford EMIs for a certain period if the government or NGOs initially
rebuilt their toilets with a proper sewerage connection. Community leaders in 2 FGDs also suggested
that being a low-income community, respective homeowners would be able to afford the least amount.
The government could provide financial support like cash vouchers, discounts, and easy loans to renovate
their toilets. Apart from this issue, landlords/house owners in at least 4 FGDs repeated that some of them
might not be able to afford the required amount for both sewerage connection and toilet renovations or
setting up new toilets. Those whose households were far away from the proposed main sewerage line may
require longer connecting pipes as well as more money to get connected to sewer networks than others.

“We are poor in terms of our income, and it becomes difficult for us to afford all of our basic needs. We
cannot afford a high amount of money regarding toilets. If the government pays 34 of the total cost,
then we will pay the rest 41 for toilet improvement.”
—FGD, Male CBO leader, Dhalpur

In 2 KIIs, participants hoped DWASA would execute a plan to install sewerage connections free
of cost at the LICs. At present, tariffs are equal for all types of DWASA consumers. In 3 KIIs, it was
assumed that if the government permits, tariffs could be reduced for LIC residents. DWASA may also
introduce a certain level of cross-subsidies for sewerage bills, although such options have not yet been
explored in detail.

3.5. Barriers of Being Connected with the Sewerage Network

The core limitation of the existing sewerage network of Dhaka city is that it only covers 20% of
the total area. The Sewerage Master Plan aims to connect the whole city under a single sewerage
network, which is to be completed by the year 2035. However, there are several barriers which may
prevent this.
Based on 9 KIIs, the most frequently mentioned barriers under major risks and challenges were
ever-growing populations, high-rise buildings, narrow roads, overlapping of various utility connections
under the same road, and an old sewerage network (Supplementary Table S1). Densely populated
areas in slum settlements are likely to be one of the major barriers to the implementation of the DWASA
strategy. Along with this population density issue, one KII indicated that previously it was possible to
install a sewerage pipe below 150 centimetres in diameter. However, the growing numbers of high-rise
buildings and population density require it to be a minimum diameter of 200 centimetres, which is
challenging for the implementing authority. Overlapping of various utility distribution lines such as
gas, water, or other utility lines passing through the manholes were also found as major obstacles for
annual mass cleaning.

“Changing and replacing pipelines at a time running under the city is not possible since the entire
city would face heavy traffic. Because all pipelines are installed underground of the road, and if these
lines need to be repaired or replaced, roads will be blocked.”
—KII, Executive Engineer, Sewer Division, DWASA

Moreover, the existing sewerage network is too old to function. Leakages and waste overflow
were frequently reported complaints. Narrow connecting roads in some areas like the old Dhaka
region make cleaning activities very difficult even with a vacuum truck.
Int. J. Environ. Res. Public Health 2020, 17, 7201 13 of 18

“Many roads and lanes in Old Dhaka areas are extremely narrow, and setting up a new sewerage line
will be a tough task and almost impossible there.”
—KII, Key informant, DWASA

At present, the only sewerage treatment plant at Pagla (PSTP) has a capacity to treat 120 mL/d
per day, whereas only 50–70 mL/d is being brought into the plant. This happens because secondary
and tertiary lines have blockages in different locations since the network was built in 1977.

“The pipe of the new trunk main will be more than 5 feet in diameters. However, in some areas,
the secondary and tertiary pipe’s diameter is about 2 or 3 feet, which is narrower than the requirement
of that area. This narrow sewerage pipes often get clogged with other waste that enters during various
construction works.”
—KII, Key informant, DWASA

4. Discussion
Ensuring sewerage coverage for all residents in Dhaka city will be challenging for the Dhaka
Sanitation Improvement Project (DSIP) due to the many engineering and management barriers.
This study explored the challenges and opportunities of connecting LICs to a sewerage network
and the affordability of connecting those LICs to a proposed sewerage system from a financial
and infrastructural perspective. In general, the study confirms previous findings on the challenges
facing governments and utilities to provide adequate faecal sludge management in slum settings.
Furthermore, it provides more detailed information on the perceived barrier and facilitators providing
sewers in LIC settings to inform strategies to achieve sewer connections for residents of dense
low-income urban settlements.
Solid waste is a critical issue in slums, especially the more congested ones [37]. In this study,
drain pathways and water bodies were also invariably reported to be filled with faecal sludge. It was
evident from the observation that there is a lack of sanitation infrastructure in every visited LIC,
and most of the population had pour-flush sanitation systems and do not utilise septic tanks. Hence,
untreated faecal wastes are openly disposed of in canals leading to the risk of groundwater infiltration,
with potentially severe consequences on human health and physical environment [38]. Collection
and management of faecal sludge were difficult to carry out because of the narrow lanes within LICs.
Currently, residents of the LICs share the cost of emptying the tanks. Respondents preferred sewerage
connections rather than having a septic tank as septic tanks were perceived to cost more than sewerage
connections initially. Moreover, infrastructural limitations like the absence of water supply, drainpipe
blockage, and leakage, and narrow connecting drainpipes met the evaluation criteria for issues with
the current faecal sludge arrangement to storm drainage. Bad odour, cholera, diarrhoea, and skin
diseases were also identified as the most negative effects of current poor sewerage facilities. LIC
residents argued that they would prefer to connect their toilets with the proposed sewerage network to
lessen their existing physical and environmental hazards.
For improving the current situation of sewerage facilities, DWASA has planned to fund and build
a sewerage network; improve existing toilets including hanging toilets; subsidise service charges for
the poor; provide loans for toilet renovation or for building new toilets, and for installing sewerage
connection pipes; and build communal septic tanks for areas mentioned in the Sewerage Master
Plan [26]. Four suggestions were recommended by the landlords/homeowners and tenants, including
fully subsidising the installation cost for sewerage connections, collecting service charges based on
household type/size, providing area-based subsidies and income-based subsidies, and providing
financial support for toilet improvement. A similar model exists in another country- a simplified
sewerage model was deployed in the Orangi Pilot Project (OPP) in Pakistan, with financing mechanisms
divided between the residents and the government. In such case, the residents would finance the smaller
scale internal components such as household sanitary latrines and underground sewers, whereas
Int. J. Environ. Res. Public Health 2020, 17, 7201 14 of 18

the larger trunk main external sewerage installation finances were borne by the local government.
Residents of a particular lane were considered a single organisational unit allowing internal funding to
be cohesive among households [39].
Notably, financial support from the government for building sewerage connections and subsidised
sewerage service charge was the most prioritised strategies suggested by the participants. These two
were closely related to the level of affordability of the LIC users. A community’s average cost of water
and wastewater services within a municipality’s district is measured as a percentage of the median
household income within the city limits. If this value is greater than 4.0% or 4.5% for both water
and wastewater services, the system is considered to be of high cost and not affordable for families [40].
Consistent with these affordability parameters, our study findings confirm four different preferences,
which were commonly identified as a possible payment method. These were monthly bills, one-time
payment, equated monthly instalments (EMI), and cash vouchers. The tenants stated that landlords
should bear the installation and maintenance cost of the sewerage network, although they were willing
to pay a share of the total costs via the monthly bill. Landlords agreed to pay a maximum of 20%
of the total installation cost of sewerage connection from trunk main to the LIC toilets. For setting
up the septic tank and installing connecting pipes from the proposed trunk main, providing loans
to landlords was suggested by a few key personnel of DWASA and landlord groups of the study.
Though NGOs tried to meet people’s sanitation needs in different ways [41], past studies found that
LICs often are excluded from sanitation programs implemented by both the government and NGOs
as well [42,43]. Moreover, it was largely neglected by WASH NGOs that land tenure/insecurity may
potentially impact on the successful implementation of a sanitation project [44]. The present study
noted that among 16 LICs, a significant portion of the participants who are living in a government land
without legal permission expressed concern that their permanent residency must first be ensured before
they would consider sharing in the resources needed to be connected to the sewerage network. This
was consistent with the results from another study for slum upgrading in Bangladesh [16]. Furthermore,
a study in low-income urban areas in Senegal also found that tenants were more willing to pay for
operational costs rather than capital costs of sanitation due to having limited security for tenure [15],
thus exemplifying the fact the permanent residency status affects the decision to invest in household
sanitation. Although DWASA Sewerage Master Plan is designed to ensure sewerage facilities for
the whole city, there is no clear decision about legalising illegal residences. Residents of LICs noted
that the ever-present danger of eviction is particularly threatening for those illegally occupying public
lands. Other slum dwellers who were renting space were also more or less vulnerable regarding
eviction, consistent with previous studies [45].
While introducing the proposed sewerage network in our study LICs, the issue of the illegal
settlement was also addressed as one of the major problems behind the current state of sanitation.
Participants from 8 LICs asserted that as they were not permanently settled, they were not willing
to renovate the existing toilet facilities or even interested to bear any cost of installing the sewerage
connection. Therefore, this study tried to identify their interest to pay for being connected to
the proposed sewerage network within their affordability range, which has remained unaddressed in
previous studies on this issue [46].
Present findings noted that by overcoming the stated barriers, most of the proposed policies to
connect LICs with the sewer network are feasible given strong demand from residents themselves.
As seen by the OPP’s approach to sanitation, most of Orangi’s informal households and settlements
in Karachi had adopted the simplified model of the sewer program overcoming collective action,
co-production, affordability, and technical challenges [47]. Growing populations, high-rise buildings,
densely populated areas in Dhaka’s slum settlements, narrow lanes, overlapping of various utility
connections under the same road, and an old sewerage network were the prime barriers. Despite
existing demand for improved sanitation, there remains limited scope for these slum dwellers to
improve their sanitation conditions. To achieve the ultimate outcome of the DSIP and to ensure proper
connections, community mobilisation efforts must be initiated by DWASA and include capabilities
Int. J. Environ. Res. Public Health 2020, 17, 7201 15 of 18

beyond their existing ones, perhaps enlisting the aid of NGOs or other organisations or creating distinct
business units within the utility [48].

5. Limitations
Our study was limited to LICs near the proposed Eastern Trunk main, and thus may not be
representative of all of Dhaka or generalisable to other settings. However, the current study covers
most potential LICs relevant to the present phase of DSIP and forms the basis of further assessments
and evaluations, which may provide more generalisable learning. Secondly, a number of priorities
were reported by the FGD participants, but this study did not consider the associated costs of each
priority. As policymakers need to understand these trade-offs before making large scale decisions,
these findings should be used to inform large-scale quantitative surveys, as were conducted subsequent
to this qualitative phase.

6. Conclusion and Recommendations

Our study sought to represent the voice of LIC residents on the issue of faecal sludge management
regarding both preferred services and their view of the consequences of an improper sewerage system.
This study captured a range of situations across 16 low-income communities, with an emphasis on
understanding the socio-cultural context. Through customised and context-oriented plans, there is
reason to expect that LICs can be connected with the main sewerage network. Residents of the LICs
currently lack high-quality sanitation facilities and as such, they expressed their need to have sewerage
connections for ensuring better living conditions. Key recommendations for policymakers generated
from the findings of the study were as follows:

1. The perceived necessity of providing a cost-free installation of sewerage connection;

2. A need to review the legal framework for residency/land tenure for the unregistered LICs;
3. Ensuring that the utility/service providers adequately conduct community mobilisation;
4. Ensuring financial support both from governmental and non-governmental organisations;
5. Setting affordable service fees for the users;
6. Introducing appropriate subsidy structures, including income- and area-based subsidies, for tariffs;
7. Deploying alternative sewerage treatment procedures, where necessary;
8. Imposing strict laws to reduce faecal waste disposal to open water bodies.

For estimating cost and user willingness-to-pay for different sewerage arrangements, a quantitative
study is needed. In addition, the potential role of a designated community member for the maintenance
of sewerage facilities at the community level should also be investigated. It may be feasible for DWASA
to potentially introduce a single model (utility tariff collection process similar to electricity bill) to
manage a sustainable sewerage service for all.

Supplementary Materials: The following are available online at http://www.mdpi.com/1660-4601/17/19/7201/s1,

Supplementary Table S1: Thematic distribution of codes and selection.
Author Contributions: M.-U.A., A.H., A.A. (Ayesha Afrin), and F.S. supervised the data collection, analysed
and summarised the data, and developed the data collection instruments. M.-U.A. and F.S. drafted the original
manuscript together with S.F., F.A., S.S., M.R., and J.B.T., and participated sufficiently in the work of analysis for
appropriate portions of the content. T.A., R.J.A., R.R., S.D., G.N., M.R., and J.B.T. revised the manuscript critically
for important intellectual content. M.-U.A., K.H., J.B.T., G.N., R.R., S.D., and M.R. had substantial intellectual
contributions to conception and design for this study. F.S., S.F., S.S., A.H., A.A. (Ayesha Afrin), F.A., and M.-U.A.
were involved in data collection and made contributions in the acquisition of data, and they also were involved in
analysis and interpretation. All authors have read and agreed to the published version of the manuscript.
Funding: This research was funded by Water & Sanitation for the Urban Poor (WSUP).
Acknowledgments: icddr,b is grateful to the Governments of Bangladesh, Canada, Sweden, and the UK for
providing core/unrestricted support. We are grateful to Water, Sanitation for the Urban Poor (WSUP) for funding
this project. We thank all data collectors who collected and processed data. Finally, we would like to thank
the residents of the community who provided their valuable time.
Int. J. Environ. Res. Public Health 2020, 17, 7201 16 of 18

Conflicts of Interest: The authors declare no conflict of interest.

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