Significant progress is needed, in both large cities and small towns, to meet the ambitious targets set at international and national levels relating to universal access to safely managed sanitation. There has been increased recognition in the urban sanitation sector that in rapidly growing cities, there is unlikely to be a single centralized sanitation solution which can effectively deliver services to all demographics, and that heterogeneous approaches to urban sanitation are required. At the same time, due to competing investment priorities, there is a greater focus on the need for sanitation investments to address multiple objectives. However, calls for more informed sanitation planning and a more dynamic and disaggregated approach to the delivery and management of sanitation services have had limited impacts. This is in part due to the complexity of the drivers for sanitation investment, and the difficulties involved in identifying and addressing these multiple, often conflicting, goals. This paper examines three potential drivers of citywide sanitation decision-making – public health, sustainability and economic performance – via the three proxies of contamination, climate change and costs. It examines the importance of each driver and proxies, how they are considered in investment decisions, the current state of knowledge about them, and priority aspects to be included in decisions. At present, while public health is a common driver for improving sanitation, there are significant gaps in our understanding of fecal contamination spread and exposure, and how to select sanitation solutions which can best address them. Climate change is sometimes seen as a low priority for the sanitation sector given the immediacy and scale of existing challenges and the uncertainty of future climate predictions. However, potential risks are significant, and uninformed decisions may result in greater costs and increased inequalities. Cost data are sparse and unreliable, and it is challenging to build robust cost-effectiveness analyses. Yet these are needed to compare citywide options based on least-cost over their full life cycle. This paper provides insights into how existing evidence on contamination, climate change and costs can inform decisions on sanitation investments and help chart a sustainable way forward for achieving citywide services.

中文翻译：

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成本、气候和污染：全市卫生投资决策的三个驱动因素

大城市和小城镇都需要取得重大进展，以实现在国际和国家层面设定的与普遍获得安全管理的卫生设施有关的宏伟目标。城市卫生部门越来越认识到，在快速发展的城市中，不太可能有一个单一的集中式卫生解决方案可以有效地为所有人口提供服务，并且需要采用不同的城市卫生方法。与此同时，由于相互竞争的投资优先事项，人们更加关注卫生投资的需求，以实现多个目标。然而，呼吁制定更明智的卫生规划以及对卫生服务的提供和管理采取更具活力和分类的方法，但效果有限。这部分是由于卫生投资驱动因素的复杂性，以及识别和解决这些多重、往往相互冲突的目标所涉及的困难。本文通过污染、气候变化和成本这三个指标，研究了全市卫生决策的三个潜在驱动因素——公共卫生、可持续性和经济绩效。它检查每个驱动因素和代理的重要性、在投资决策中如何考虑它们、对它们的当前知识状态以及决策中要包括的优先方面。目前，虽然公共卫生是改善卫生条件的共同驱动因素，但我们对粪便污染的传播和暴露以及如何选择最能解决这些问题的卫生解决方案的理解存在重大差距。鉴于现有挑战的紧迫性和规模以及未来气候预测的不确定性，气候变化有时被视为卫生部门的低优先级。然而，潜在风险很大，不知情的决定可能会导致更大的成本和更多的不平等。成本数据稀少且不可靠，构建稳健的成本效益分析具有挑战性。然而，需要根据整个生命周期中的最低成本来比较全市范围的选择。本文提供了有关污染、气候变化和成本的现有证据如何为卫生投资决策提供信息的见解，并有助于制定实现全市服务的可持续发展方式。