ABSTRACT
Much current discussion of sanitation marginalizes sewerage, usually on the basis that it is too expensive for most developing countries. Yet, sewerage systems have a massive impact upon public health, especially child health, and are a classic example of a public good. This chapter examines how these systems have developed in the North and how they are being developed in the South. The public sector, and public finance, is central to this development as it solves the problems of insufficient demand from even richer consumers, unaffordability to the poor, and the impossibility of making investment in universal systems profitable. The taxation capacity of the central and/or local state is thus more important for sewerage than pricing issues, and cannot be substituted by either private investment or by community organization, which lacks both the necessary tax base and the necessary spending power. Avoidance of tax finance requires retreating to sanitation without sewerage at the cost of much higher levels of infant mortality – especially in cities.
