Sometimes, travel teaches us more about home than the place we visit. So during a recent visit to San Francisco, I reflected on some of the issues we face at home in Honolulu.

San Francisco and Honolulu face similar problems. Demand for housing has outpaced supply, driving up prices. Gentrification has refigured neighborhoods. And there is constant tension between longtime residents and recent arrivals.

In addition, San Francisco struggles with a sizable homeless population. Like our own homeless community, these people often lack basic necessities like toilets and showers. The lack of toilets leads to human waste being scattered throughout the city. And the lack of sanitary conditions often leads to illness.

Cory Lum/Civil Beat

Our state is on the verge of recession, and government finances are tight. The buzzword is “public-private partnership,” the collaboration of public and private sectors. As we embark on public-private partnerships to address hygiene concerns in Honolulu, we can learn from the experience of San Francisco.

Public-Private Restrooms

Finding a clean public restroom in San Francisco is tough, in part because of a bad contract the state entered into with outdoor advertising firm JCDecaux. That contract allowed JCDecaux free advertisement on San Francisco sidewalks in exchange for operating a few dozen “self-cleaning” toilets.

Unfortunately, the city did not properly negotiate the revenue sharing, so they’ve missed out on the massive profits that JCDecaux collected from selling ads.

In addition, the potties were not maintained well. I talked to some locals while visiting, and they reported that the green toilets were consistently filthy.

The lack of public toilets is partly to blame for the human waste that litters the city. The poop problem has gotten so bad that a local software engineer developed an app, SnapCrap, that allows users to take geotagged pictures of crap and send them directly to the city’s Public Works department.

San Francisco’s human waste problem has attracted high profile detractors. In the last year, President Trump has repeatedly criticized its dirty streets. San Francisco Mayor London Breed has committed to addressing the mess, though the work is slow.

The Pit Stop program provides a used-needle exchange in addition to public toilets, and the city hired attendants to help keep the public toilets clean. However, there are only two dozen locations to service a city of more than 800,000 (excluding visitors). Most of those locations close at night, but the city recently instituted 24/7 service in certain areas.

San Francisco is not alone in struggling with sanitation. Typhus and tuberculosis have reemerged among the homeless in Los Angeles. Hepatitis A outbreaks have occurred in San Diego. In downtown Honolulu, you can find feces underfoot during a walk through Chinatown or down Fort Street Mall.

As we seek to prevent health issues at home, we should be mindful of the mistakes that San Francisco made.

Hygiene at Home

In an era of limited government resources, it can be tempting to enter into public-private partnerships to solve social problems.

But, as San Francisco illustrates, those partnerships are not a panacea.

In Honolulu, city authorities are partnering with many nonprofits to address hygiene among the homeless. Through these partnerships, the city is working to establish hygiene centers, rest stops and joint outreach centers.

It’s been four years since the hygiene center at Pauahi Hale was opened. The idea behind Pauahi Hale is simple. In addition to providing housing for chronically homeless people, the facility has public bathrooms, so homeless people can stop by to shower, shave, and groom themselves.

Providing a place to take care of hygiene needs benefits the homeless population, but also helps the broader community. Homeless people are less likely to intrude on private businesses seeking to use their restrooms, and they’re less likely to relieve themselves in the bushes or on the sidewalk. This helps prevent the spread of disease.

But Pauahi Hale only serves the homeless population in Chinatown, while demand for services is distributed across the island.

One of the most innovative solutions is Project HieHie, a mobile shower service on Oahu. But fixed locations are helpful in communities with large homeless populations.

Thus, a few other permanent locations have been opened in the past year. Last year, a hygiene center opened in Iwilei. The Punawai Rest Stop has showers, restrooms and a laundry facility. In addition, it connects homeless people to other service providers.

The Punawai Rest Stop is a collaboration between Mental Health Kokua and the City and County of Honolulu. Unlike JCDecaux, Mental Health Kokua is a nonprofit with years of experience dealing with the homeless. In this case, it makes sense to enter into a public-private partnership because the private service provider has experience and good incentives.

The Chinatown Joint Outreach Center opened last June, and the Kaneohe Joint Outreach Center opened just a few months ago. These facilities go further than the rest stops, providing free health care services for the homeless. In addition, they link homeless people to other service providers.

Each Joint Outreach Center represents a partnership of government with private sector partners including the Hawaii Homeless Healthcare Hui, which was co-founded by Dr. Scott Miscovich and Dr. Josh Green before he was elected Lieutenant Governor.

The landscape of hygiene resources for the homeless includes restrooms, showers, laundry facilities, and medical care. But these resources can only mitigate the hygiene problems among the homeless. They won’t solve the unsanitary living conditions that those living on the streets must contend with.

Kahauiki Village is an example of a successful public-private partnership between the aio Foundation and state and county governments. Providing stable housing and bathroom facilities is the best way to deal with hygiene issues among the homeless. But the larger the scale of the public-private partnership, the more cautious we should be.

As our state teeters on the edge of recession, we will need to look beyond the walls of government for solutions to social problems. The question is not whether public-private partnerships will happen, but whether those public-private partnerships will be effective and efficient.

Experience is a hard teacher, so we should strive to avoid the mistakes made by other cities. Let’s choose partners carefully and do due diligence before we commit public resources to a public-private partnership.