Includes Appendix and Reference

In low- and middle-income countries such as Kenya, access to safe sanitation is a significant challenge contributing to public health issues and economic burdens. Various sanitation interventions have been implemented to address these challenges. However, the effectiveness of these interventions in managing human excreta along the sanitation service chain remains unclear. Therefore, the primary objective of the research was to evaluate human excreta management and sanitation services in Iten Municipality, using the Shit Flow Diagram (SFD), to identify existing gaps and challenges. The study's specific objectives included determining the main onsite sanitation technologies used, evaluating their performance, generating SFD, and identifying potential health risks associated with the current sanitation service chain. A mixed-methods approach was employed, involving quantitative and qualitative data collection. A sample size of 388 household heads was determined using the Yamane formula and selected through a cluster random proportionate sampling technique. Qualitative data were obtained via purposely selected key informants and observations, using a checklist and a transect walk guide. Quantitative data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 26 for descriptive statistics and chi-square tests of association. Findings were presented in tables and charts. Qualitative data were transcribed and manually analyzed into themes, and the results were presented in a narrative format. Results indicated that major onsite sanitation technologies include pit latrines (69.1%), septic tanks (22.9%), and Anaerobic digesters(2.9%). The study also established that 69% of the waste was adequately managed, while31% was not safely managed, and 3% still practice open defecation. Pests (42%), odour(41.8%), malfunctions, and blockages (64.6%) were common issues with these on-site technologies. The results revealed that 28% of the population had experienced sanitation-related health issues in the past year, with 12.9% reporting diseases such as amoebiasis, dysentery, and diarrhoea. Additionally, 19.1% of respondents acknowledge local water source contamination, exacerbating health risks, as indicated by laboratory findings of high levels of E. coli and Total coliforms in various water sources. These findings underscore the need for enhanced sanitation infrastructure, standardized maintenance protocols, and community education to improve waste management and public health outcomes in Iten Municipality.