Editor's Note: In this post Susan Davis, Founder and Executive Director of Improve International, discusses all of the possible definitions of sanitation success. This post originally appeared on Improve International's website, to view the original post click here.
During a recent desk review, we found there is no one widely accepted definition of sanitation success, even for broadly used approaches like community-led total sanitation.
Some consider long-term success to be the movement of households up the “sanitation ladder,” the idea of incremental progression between service levels of different quality. Success for sanitation marketing efforts can include an increase in local businesses who are investing in sanitation to expand their business, sales to target households, and number of households who are investing their own money into a toilet sold by these partner businesses. We realize we haven’t captured all possible definitions of sanitation success, but wanted to share what we found.
3iE: Sustained use is defined as the continued practice of a WASH behavior and/or continued use of a WASH technology at least six months after the period during which there was external support to community groups, leaders and volunteers in the form of training, supervision and feedback, distribution of technology, or provision of communication materials.
Global Sanitation Fund (GSF): The GSF works towards attainment of universal access to improved sanitation, which they measure using these indicators: number of people with access to improved sanitation, number of people living in open-defecation free environments, and the existence, and evidence of use, of a dedicated place for handwashing and availability of soap or ash (as a proxy for people washing their hands at critical times). The GSF includes in its description access to improved sanitation by all members of a community and proper handling, storage and treatment of human waste, but these are not included in their results.
Government of India: ODF is the termination of fecal-oral transmission, defined by a) no visible faces found in the environment/village; and b) every household as well as public/community institutions using a safe technology option for disposal of faces. A safe technology option means no contamination of surface soil, ground water or surface water; excreta inaccessible to flies or animals; no handling of fresh excreta; and freedom from odor and unsightly condition.
IRC Water and Sanitation Centre: The sanitation service level framework evaluates the services provided by the delivery of safe latrines using four indicators:type and accessibility of latrines to households (in line with national norms); use of sanitation facilities by members of the household;cleanliness, maintenance and pit emptying of the facilities; and environmental safety of fecal waste.
Joint Monitoring Programme (JMP): A sanitation facility is considered improved if it hygienically separates human excreta from human contact, but this indicator does not address the subsequent management of fecal waste. Safe management comprises several stages along the “fecal waste management chain,” from containment through emptying, transport, treatment, and reuse or disposal.
Netherlands Water Partnership: Sanitation facilities are only sustainable when people make their own choices and own contribution towards obtaining and maintaining them. People have to experience the toilet as an improvement in their daily life. Sanitation systems have to be embedded in the local institutional, financial-economic, social-cultural, legal-political, and environmental context.
Sustainable Sanitation Alliance (SuSanA): The main objective of a sanitation system is to protect and promote human health by providing a clean environment and breaking the cycle of disease. In order to be sustainable a sanitation system has to (1) promote health and hygiene effectively, (2) be financially and economically viable, (3) socially acceptable and institutionally appropriate, (4) technically appropriate including operation and maintenance (O&M), and (5) protect the environment and natural resources.
UN Sustainable Development Goal 6: Ensure availability and sustainable management of water and sanitation for all. Targets include:
6.1 By 2030, achieve universal and equitable access to safe and affordable drinking water for all
6.2 By 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations
6.3 By 2030, improve water quality by reducing pollution, eliminating dumping and minimizing release of hazardous chemicals and materials, halving the proportion of untreated wastewater and substantially increasing recycling and safe reuse globally
6.4 By 2030, substantially increase water-use efficiency across all sectors and ensure sustainable withdrawals and supply of freshwater to address water scarcity and substantially reduce the number of people suffering from water scarcity
6.5 By 2030, implement integrated water resources management at all levels, including through transboundary cooperation as appropriate
6.6 By 2020, protect and restore water-related ecosystems, including mountains, forests, wetlands, rivers, aquifers and lakes
6.a By 2030, expand international cooperation and capacity-building support to developing countries in water- and sanitation-related activities and programmes, including water harvesting, desalination, water efficiency, wastewater treatment, recycling and reuse technologies
6.b Support and strengthen the participation of local communities in improving water and sanitation management
WaterAid: Sustainability is about whether or not WASH services and good hygiene practices continue to work and deliver benefits over time. No time limit is set on those continued services, behavior changes and outcomes. In other words, sustainability is about lasting benefits achieved through the continued enjoyment of water supply and sanitation services and hygiene practices.
Water For People: Water For People envisions sanitation success in steps, summarized as follows:
- Family forever. “a loved latrine is a used latrine and household defecation behavior will be changed Forever.”
- Sanitation Business Forever. This moves the focus to sustainable service delivery.
- Forever sanitation services at scale. Any person with a pit latrine in any part of a city or district should be able to easily access the sanitation service they require, not just the ones in the relatively limited geographical area covered by the entrepreneurs supported as part of step 2. (Sugden, 2013).
WSP: The World Bank Water and Sanitation Program used the following performance indicators to rate relative success of sanitation case studies:
- Prevalence of open defecation
- Hygiene behavior
- Access to sanitation by the poor
- Environmental sanitation improvements
- Extent of self-financing
- Program cost per household
- Range of toilet components and designs utilized
- Local availability of sanitation wares and services
- Regular support and monitoring
- Implementation at scale
What’s your organization’s definition of sanitation success? Let us know in the comments section below or contact us.
Editor's Note: In this post, Millie Adam of the Centre for Affordable Water and Sanitation Technology (CAWST) discusses the benefits of providing capacity building support when investing in WASH initiatives. This post originally appeared on CAWST's website, to view the original post please click here.
A growing list of reports argue for increased emphasis and investment in capacity building for international development. That’s a good thing. Why then has that increased attention largely failed to catalyze funders and implementers to make greater investments in capacity building?
Capacity building is too often treated like a minor add-on to an infrastructure project, thought of as an added cost, or not budgeted or planned for until partway through a project when the gap in capacity becomes glaringly apparent.
Changing this mindset requires a paradigm-shift. Capacity building is a fundamental part of development that doesn’t simply take funds away from “real”/tangible results, but rather helps achieve targets and maintain outcomes.
To deliver sustained water, sanitation and hygiene (WASH) services to all by 2030, significant and meaningful investments in capacity building are needed from funders and implementers, in parallel with hardware investments.
The need for capacity building is clear and well-documented. Less so a clear case that lays out the benefits of investing in capacity building. There are five key benefits to investing in capacity building that should motivate donors and investors to ensure capacity building is a significant part of any initiative they are supporting.
1. Universal WASH coverage by 2030 is not achievable with current human resources.
The scale of the need alone makes the case for capacity building. As outlined by the IWA’s report An Avoidable Crisis: WASH Human Resource Capacity Gaps in 15 Developing Economies, “There are not enough appropriately skilled water professionals to support the attainment of universal access to safe water and sanitation”. Furthermore, the current formal systems for training will not produce enough people by 2030, so the human capacity gap threatens the success of the Sustainable Development Goals (SDGs).
As the UN-Water Means of Implementation states, “Investment in capacity-building has been a major challenge facing many countries and has to be addressed if the Goals are to be met.”
The UN-Water GLAAS 2012 report (chapter four) reported that less than 20 per cent of respondent countries consider the supply of skilled labour and technicians adequately developed to meet the needs in rural sanitation.
2. Capacity building increases the quality of implementation.
WASH practitioners often run into problems they are unable to solve on their own, thus hindering or halting a program; or they unknowingly implement incorrectly. Building the capacity of field workers increases their ability to:
- Evaluate options and select appropriate technologies
- Properly construct and install technologies
- Work with the community to create demand and change behaviour
- Be active, informed participants in the WASH sector who strengthen and scale-up programs or approaches.
If field workers are doing the above things well, then people will have access to high quality, locally appropriate WASH technologies that they want and use. Further, decision-making around WASH becomes a discussion with local stakeholders as opposed to a decision handed down from above, ensuring that WASH programs continue to serve the needs of end users.
A 2010 Water and Sanitation Program (WSP) technical paper, “Case Study on Sustainability of Rural Sanitation Marketing in Vietnam”, points to the importance of capacity building of practitioners. The case study looked at rural sanitation marketing in Vietnam and found that initial success of trained promoters and providers led others to build toilets for sale; the quality of construction and user satisfaction both declined.
3. Capacity building makes interventions more sustainable.
Programs need to be driven at the outset by local organizations on the ground: those who have the mandate to provide WASH services to their communities, who understand the local context and challenges, who take ownership of the services and who will still be there long after the rest of us have moved on. In many cases, those with the mandate don’t have the skills and knowledge they need to do the best job that they can and want to do. Building the capacity of those organizations translates to:
- Better decisions
- Higher adoption and sustained use
- Ability to overcome challenges and adapt to changing circumstances
- Ongoing delivery and maintenance of services for the long term
- Disaster resilience
- A slow but pragmatic exit strategy for those of us who aren’t local organizations.
The WSP technical paper on rural sanitation marketing referred to above concluded that the approach may not be sustained and expanded in the long term without institutionalized capacity building for promoters and providers (among other things).
Similarly, building capacity at the community level increases correct, consistent and continued use of WASH technologies. A key conclusion from the recent Cochrane review on water quality interventions was that interventions that achieved a higher compliance led to greater health impacts. In contrast, some technologies that performed well in controlled test settings achieved lower health impacts. From this, we can infer the importance of not only choosing appropriate technologies, but also building the capacity of local actors to effectively operate and maintain these technologies over time.
4. Capacity building can reach the hardest to reach.
The SDGs compel us to reach the poorest and those in vulnerable situations, which the MDGs did not reach in equal numbers. There is growing evidence supporting a renewed focus on those who are hardest to reach, such as UN-Water arguing that targeting the poorest 40 per cent of the population yields the biggest gains.
The 2014 GLAAS report argued that current funding isn’t going to those most in need. “If plans exist for reducing inequalities in access by targeting disadvantaged groups, the outcomes are commonly left unmonitored,” the report says. “Less than half of countries track progress in extending sanitation and drinking-water services to the poor.” The report went on to add that “the vast majority of those without improved sanitation are poorer people living in rural areas. Progress on rural sanitation — where it has occurred — has primarily benefitted the non-poor, resulting in inequalities.”
In many cases, unserved people are dispersed, living in challenging conditions or have no legal tenure. In these situations, large scale infrastructure solutions either aren’t appropriate or aren’t affordable. To reach these people with WASH services, we need a variety of technologies and approaches and we need to work with different types of organizations; both require increased capacity across a range of players.
- Capacity building enables many small projects using a variety of technologies and approaches that can be adapted to those challenging situations
- Capacity building enables the organizations with the best likelihood of success to participate in WASH services (including small, local organizations, and those who might not focus on WASH, but who have strong relationships with vulnerable groups and who best understand their complex context)
- Capacity building enables the vulnerable or disadvantaged to actively participate in WASH programs and services
5. Capacity building addresses the gender gap.
One of the guiding principles of the Dublin Statement on Water and Sustainable Development is that “Women play a central part in the provision, management and safeguarding of water” and that to implement this principle, we must “equip and empower women to participate at all levels”. A reality check from the GLAAS 2012 report: “Half of the GLAAS respondent countries reported that women make up less than 10% of the professional/managerial staff”.
We all know the critical role of women in water. Building their capacity to fully participate not only works toward closing gender gaps, but also leads to better results for WASH programs.
According to an ADB gender equality results case study, significant participation of women (>40%) in preconstruction and postconstruction training on how “to plan, construct, manage, operate, and maintain water supply schemes and sanitation facilities […] equipped women with necessary skills and knowledge. This enabled them to engage more effectively in committees taking decisions related to the operation and management of water supply systems, undertaking maintenance with support from trained VMWs, and raising monthly tariffs.”
The 2012 GLAAS report profiles Ethiopia’s health extension programme. It was launched in 2003 in response to a lack of trained health workers; by 2009, there were 30 000 health workers. Women who have more than 10 years of formal education and who want to work in their communities are trained on family health, hygiene and environmental sanitation, and health education. “The success of this programme is a result of investment in training by donors, widespread acceptance within communities and investment in information systems on family health, demographic data and use of services.”
In short, capacity building is a good investment.
Failure is costly, and without capacity building projects are more likely to fail. The Rural Water Supply Network (RWSN) found in 2007 that an average of 36 per cent of hand-pumps across 21 countries in Africa were non-functioning. That represents a total investment of between $US1.2 and $US1.5 billion over 20 years. The topic is covered in this Triple-S Briefing.
Capacity building lays the groundwork for well-implemented WASH services which should increase adoption, extend the life of interventions and improve quality of implementation resulting in larger health impacts.
We all seem to recognize that capacity building needs to happen, and yet we consistently fail to put enough resources toward it. Our hope is that laying out the case for capacity building will help those who know it needs to happen argue for its inclusion and resourcing, but also that it will refine the way we do capacity building to ensure that we are in fact realizing the above benefits.
In CAWST’s experience of supporting 970 implementing organizations in 78 countries, the benefits don’t end there; we have seen how capacity building catalyzes action and then empowers people to take further actions, as well as how it provides opportunities for those with new skills, knowledge and confidence.
Editor's Note: In this post, Okey Umelo, Media and Communications Officer, and Patrick England, GSF Portfolio Support Analyst, at Water Supply and Sanitation Collaborative Council (WSSCC) discuss a new field guide for practitioners of Community-Led Total Sanitation (CLTS) – an empowering approach for improving sanitation and hygiene through collective behaviour change. This post originally appeared on the WSSCC site, to view the original post please click here.
This week, the Global Sanitation Fund (GSF) and the GSF-funded ‘Fonds d’Appui pour l’Assainissement’ (FAA) in Madagascar launched a new handbook on accelerating and sustaining the end of open defecation.
The handbook was launched during the GSF Learning Event in Antananarivo, Madagascar, inaugurated by Madagascar’s Minister of Water Sanitation and Hygiene, Roland Ravatomanga.
The ‘Follow-up MANDONA’ (FUM) handbook is a field guide for practitioners of Community-Led Total Sanitation (CLTS) – an empowering approach for improving sanitation and hygiene through collective behaviour change, rather than external subsidies or prescription. FUM aims to systematically engage communities after they have been initially ‘triggered’ and committed to ending open defecation.
‘Mandona’ is a Malagasy word which means ‘to push’. FUM brings the entire community together for a self-analysis of their sanitation situation, which then helps them immediately create models that prevent the ingestion of faeces. The approach harnesses the power of Natural Leaders to replicate these models across the community, which includes helping those that are least able, in order to advance to ODF status. By focusing on sustainable behaviour change, FUM is also a useful tool for addressing issues surrounding ‘slippage’, which relates to returning to previous unhygienic behaviours.
FUM was developed and refined by MIARINTSOA NGO, a sub-grantee of the FAA programme. Given the success of FUM in Madagascar and elsewhere, the GSF and FAA created the FUM handbook to provide a practical guide for how CLTS practitioners can implement the approach in their own contexts.
The weeklong global event where the handbook was launched brings together implementing partners, WASH experts, and high-level government representatives from GSF-supported programmes. These actors are exchanging ideas and sharing best practices for achieving improved sanitation and hygiene behaviour at scale.
During the launch, WSSCC Executive Director Chris Williams highlighted how FUM is engraining the sustainability of sanitation and hygiene behaviour change in Madagascar and beyond. “Once a village, or an entire commune, has reached ODF status, the story isn’t over. In fact, the work continues. This important publication documents the innovations that Madagascar has put together to systematically follow-up with villages.
FUM has become one of FAA’s most important tools for empowering over 1.6 million people to live in open defecation free environments on their own terms. Due to its success in Madagascar, FUM has recently become a core strategy for national sanitation and hygiene programmes in Uganda, Nigeria, Benin, and Togo.
Kamal Kar, the Chairman of the CLTS Foundation, which has extensively supported the FAA programme to develop their CLTS approach, emphasized the importance of the handbook in sharing proven approaches to practitioners around the world: “I am glad that the Malagasy NGO, MIARINTSOA, with the help of the FAA programme, WSSCC and the GSF, has systematically documented their experience of post-triggering follow-up from their implementation of CLTS over the last 4-5 years. Publication of this Follow-up MANDONA handbook is indeed a step forward towards country-wide scaling up of good practice of CLTS in Madagascar and beyond.”
“I must say that the emergence of thousands of ODF villages in Madagascar, starting with my multiple support visits to the country since 2010 to strengthen the approach, is a brilliant example of quality CLTS implementation with its central philosophy of local empowerment. I believe that this handbook will be useful in understanding and ensuring post-triggering follow-up in CLTS for sustained behaviour change.”
Editor's Note: In this post, Andy Narracott, Deputy Director for Global Water at Evidence Action discusses how we can scale up cost-effective water access, sanitation, and hygiene programs.
Recently Jan Willem Rosenboom, a WASH senior program officer at the Bill & Melinda Gates Foundation, wrote a candid post on just how hard it is to reach scale for water and sanitation projects.
We agree. We are a long way off from “universal and equitable access to safe and affordable drinking water for all,” especially in rural areas. To meet the Sustainable Development Goals (SDGs), water access, sanitation, and hygiene (WASH) programs need to plan for scale from the start and have a clearer focus on "what works." Likewise, donors need to invest in scalable projects and let go of those that never will, as sexy as they might look.
We at Evidence Action have a unique mission to scale up cost effective global development interventions that have been proven to work through rigorous evaluation. I lead our Dispensers for Safe Water program that serves 4.5 million rural people with chlorine essential for safe drinking water. Dispensers for Safe Water was also a beneficiary of an early multi-year grant from the Bill and Melinda Gates Foundation in 2010.
We are now operating in three countries and are achieving sustained usage of ~60%. We are the largest safe water player in these three countries by a wide margin. We are also recovering 100% of our field costs from carbon credits rather than resorting to user fees that would screen out a huge cohort of people who are very rural and very poor.
We have learned a bit about how to successfully transition from a randomized controlled trial to operating at scale over the years, and I’d like to share some key lessons:
1. Standardizing operations is essential. We've standardized operations focused on expansion into a simple five-step process. These five steps describe the way we move into a new area, from a first engagement with government officials, right through to ongoing chlorine delivery. Over time, the five steps transformed our pilot into a replicable model ready to roll out in new geographic areas - and one that is highly scalable. We know what resources are required for each step - both human and financial resources. And we have introduced the kaizen of our work: to continually look back and see what we can do better next time.
2. Relentless focus on controlling costs. Think scrooge hunched over a table under candlelight counting coins. But joking aside, when it only costs $1.40 a person/year for a continuous supply of chlorine that kills 99.9% of harmful pathogens in water, we're talking reduction in disability-adjusted life years (DALYs) and diarrhea averted. Every operational improvement and every innovative idea is tested against the basic equation of whether we can increase our user adoption while staying extremely cost effective—providing value for every penny spent.
We have been able to reduce the cost per person of chlorine dispensers, which continually decreases as we scale and reach more people. For example, we will purchase 1.5 million liters of liquid chlorine this year from local suppliers in East Africa. This allows us to negotiate even harder for lower prices.
We have tested whether it’s more cost effective to deploy a larger number of motorbikes for the chlorine supply chain that reach remote areas easier but can carry less chlorine, or a fewer number of cars that can carry more chlorine but have a harder time reaching remote areas. We have calculated what the dispensers density point is by which motorbikes become more cost effective, and we can plan and manage our supply chain accordingly.
This focus on continuous measurement and improvement - the kaizen of our work - forces us to continually find more efficient ways to achieve each of the five steps at a lower cost.
3. Investment in scaling is essential. Obviously, this is not a golden nugget of wisdom but the simple truth. Just as it takes time to reach a breakeven point in a business, it takes time for a development intervention to be sustainable. We have made the hard decision to pause our rapid growth to explore new lines of revenue as one of our revenue areas, carbon credits, has declined as carbon markets have fallen. Proven development interventions need financial backing to get them through the valley of death, even more so than the tech startups of San Francisco. Concomitantly, if donors are serious about reaching scale they need to pull the plug on those projects that will never scale cost effectively, no matter how sexy some pilots seem.
With a clear mission focused explicitly on scale, with standardising operations, and a relentless focus on cost reductions and economies of scale, we think scale in WASH is not only possible, it is essential.
Editor's Note: In this post, Heloise Greeff, Doctoral Researcher, Water Programme, at the Computational Health Informatics Lab and Smith School of Enterprise and the Environment at the University of Oxford, discusses how we can pro-actively monitor the condition of handpumps and ensure that millions of people can access a reliable water source. This post originally appeared on the REACH program's site, the orginal article can be accessed here.
Predictive health monitoring is widely used in engineering applications to detect damage to infrastructure as early as possible. Forecasting failure rather than merely detecting failure once it occurs helps to reduce the downtime of systems. Ideally, predictive maintenance can be used to avoid downtime completely. With this approach already widely used in many fields from commercial and military jet engines to patient monitoring in health systems, it is now being extended to monitoring the condition of handpumps in rural villages.
The handpump remains a reliable and low-cost method to access groundwater, making it a critical component of rural water supply for around 200 million people in Sub-Saharan Africa. Community handpump models, such as the Afridev and India MK II, are designed to lift water from deeper sources than traditional rope and bucket systems which can only be used in shallow wells. However, high water demands result in continuous usage and frequent breakdowns. Unfortunately, practical challenges in the supply of spare parts combined with a lack of local skills and resources result in an estimated 30% of handpumps in Africa not working at any given time.
The use of predictive maintenance in handpumps has the potential to limit interruptions of weeks or more which are common across rural Africa. A broken handpump in a remote village can force women or girls to walk up to 20 kilometres to find alternative sources which may be contaminated or expensive. Reliability and sustainability of water supplies are important to ensure healthy communities, societies, and economies in all regions of the world.
The Oxford University ‘Smart Handpump’ was successfully introduced in 2012. Proof-of-concept for the remote monitoring of handpumps used a simple microprocessor, accelerometer and global system for mobile communications (GSM) components. The Smart Handpumps provide hourly data on usage.
In 2014 a preliminary analysis used high frequency accelerometer data to show that these patterns contain useful information. High-rate waveforms from the accelerometry data can be processed using robust machine learning methods that are sensitive not only to the dynamics of the whole system but also the subtle interaction between the user and the pump. The small changes in pump dynamics and the subtle reactions of the user become a prominent signal in determining the deterioration of pump mechanics and imminent failure. This same signal can also be used for monitoring the level of the shallow aquifer at the pump location.
By retrofitting a simple and inexpensive device to a standard pump handle, the Smart Handpumps are able to pro-actively monitor the condition of handpumps and ensure that millions of people can access a reliable water source.
In February 2016 we visited 33 different handpumps across the Kwale County in southeast Kenya. We recorded 103 different users extracting approximately 5,059 litres of groundwater using the handpumps. These data will be used to produce a low-cost predictive maintenance system that is scalable across large rural regions. The development of a prototype hardware system is being supported by UNICEF, funded through a competitive tender process, as part of their Product Innovation portfolio. Field testing will be conducted in partnership with UNICEF country programmes in Eastern and Southern Africa.
By monitoring the heartbeat of thousands of handpumps across Sub-Saharan Africa and South Asia, it is possible to give millions of people access to a reliable and secure water network. The handpump network has existed for many years and despite being neglected remains the most reliable method to access groundwater in remote locations as the world advances to achieving universal drinking water security.
Take a look at the video to see our work in Kwale County in Kenya in action:
Editor's Note: In this post Andy Narracott, Deputy Director of Global Safe Water, discusses how we can ensure equitable and sustained access to safe water.
There has been huge progress made in improving access to safe water. This year, the number of people without access to an improved drinking water source fell below 700 million for the first time in history. This means that more than 6.6 billion people, or 91% of the global population, has an improved drinking water source, up from 76% in 1990. In sub-Saharan Africa alone, 427 million people gained access to an improved drinking water source, an average of 47,000 people per day, every day, for the last 25 years.
‘Access to an improved water source’ refers to a water source—such as a well or spring—that, by nature of its construction and when properly used, adequately protects that source from outside contamination, particularly fecal matter.
This might seem like great news, and in many ways it is. But measuring whether people have access to water alone is not enough; it is a static measure that only gives a very high-level indication of progress towards one dimension of what it means for people to have safe water in the home.
This measure does not take into account how sustained this access to safe water is over time. What happens when the hand pump breaks or the new well runs dry? Measuring a snapshot in time does not account for whether there is access to safe water in the future.
It also does not account for the actual use of safe water systems. Uptake by users of safe water products is notoriously low when it is reported at all. It is also often only measured by unreliable recount. And lastly, measuring access does not say anything about the quality of the water that is actually consumed by users in the home. In fact, there has been no explicit requirement that the water should be drinkable at the point of use.
Imagine a rural and largely poor community in Malawi. Individuals there have to fetch water at water points that can be miles away. This is back-breaking work when you consider that a full ‘jerrican’ weighs the same as the maximum baggage allowance on most airlines. By the time the water is brought home and stored for later use, all it takes is a dirty cup or child's hand to make the water unsafe to drink. Yet the Millennium Development Goals (MDGs) count this as a success so long as there is a well or other protected source within a certain distance.
Infrastructure, such as a well or a pipe, is not sufficient to ensure sustained access over time, good quality water, and consistent use by the most marginalized communities. Research has shown that increased access alone makes no impact on diarrhea rates, which is the second biggest killer of children under 5.
We think that the new WASH Sustainable Development Goals (SDGs) are more useful. They place an equal focus on a continuous supply of water, of good quality, at an adequate price. Where urban water networks exist, this is an achievable set of goals. But in rural areas, in the home when water sources numbers in the thousands and are widely dispersed?
With technology like Dispensers for Safe Water, this is possible.
Evidence Action has a network of 27,000 chlorine dispensers across 5,500 square miles, in three countries currently serving 4.5 million people. The dispensers were rigorously tested in randomized controlled trials and are served by a robust chlorine distribution and maintenance supply chain that ensures 98% uptime across three countries in even the most rural areas.
Dispensers are salient to users because they are installed directly at the water source. Evidence Action is focused on achieving high levels of usage by making water chlorination the norm through local community promoters. Dispensers are also highly cost-effective compared to other interventions, and they are equitable, targeting communities with the least access to consistently safe water.
Water is central to equitable development, and we welcome this renewed global focus on ‘safe water as a service’ that takes into consideration a sustained supply of water, of good quality, at an adequate price.
Editor's Note: A new report from the World Bank's Water and Sanitation Program finds that meeting global WASH goals will require not only additional public funding, but also improved resource allocation and service efficiency. In this post, Guy Hutton shares key findings from the report along with some next steps. You can find the original post here.
When the Millennium Development Goals (MDGs) were signed, a commitment was made to deliver improved water and sanitation to half the unserved population. This ambitious target was met for water but not for sanitation, with 2.4 billion people still lacking improved sanitation in 2015. The first part of our new study, The Costs of Meeting the 2030 Sustainable Development Goal Targets on Drinking Water, Sanitation, and Hygiene, estimates the cost of finishing what was started as part of the MDG target.
The study found that globally current levels of financing are likely to cover the capital costs of achieving universal basic WASH by 2030. The global capital costs amount to $28.4 billion per year (range: $13.8 to $46.7 billion). However, despite this good news, the current allocations need to be redirected and there will need to be significantly greater spending on sanitation (accounting for 69% of the cost of basic universal WASH) and operations and maintenance, as well as in the most off-track countries which are mainly in sub-Saharan Africa and South Asia.
But this isn’t the full story.
Even while the MDG sanitation target was not met a new global target was set, as part of the Sustainable Development Goals (SDGs). The targets and proposed indicators within the water goal (6.1 and 6.2) talk about ‘safely managed’ services, which includes continuously-available, on-plot water supply and an improved service chain to ensure safely managed fecal waste. When these additional services are costed, they amount to approximately $87 billion per year (range: $61 to $123 billion). Then, we needed to add the basic sanitation and hygiene cost, as well as part of the basic water cost (as many households will not go direct to safely managed water). This takes the cost of achieving targets 6.1 and 6.2 to about $114 billion per year (range: $74 to $116 billion). At 0.39% of the sum of gross domestic product (GDP) of the 140 included countries (range: 0.26 to 0.55%), $114 billion per year requires an additional 0.27% of global GDP spent on WASH, hence requiring massive additional in-flows of financing to the sector.
As these funds are unlikely to be met in any major way from traditional bi- or multilateral aid, it is likely that the investments need to be met from the growing tax revenues of developing country governments and from the private sector recognizing the business potential in the long-term provision of WASH services.
And perhaps, this is the most important part of the story.
Sustained universal coverage requires more than capital inflows: financial and institutional strengthening will be needed to ensure that capital investments translate into effective service delivery.
Tariff policies will need to be strengthened but affordability will remain a critical issue, especially in low-income countries and communities where even the operational costs of basic WASH can add up to more than 5% of the poverty income levels.
Understanding costs is an important part of planning and implementing services to reach universal coverage, but financing should be viewed as part of a broader strengthening of the services system that includes development of technology, private suppliers and providers, policy reform, institutional strengthening, regulation and improved monitoring and evaluation. Financing needs to be planned for operational costs, as well as the capital cost numbers presented above.
Of course, some of the estimates presented here are at best back-of-the-envelope calculations, as there are so many unknowns such as current service levels and underlying cost data are at times weak. However, the results of this study provide some hard-to-ignore findings such as where the majority of costs (and challenges) are likely to occur, and they provide a basis for discussing global, regional and national priorities. The study provides an approximate global number on the costs of meeting two of the 169 targets, which should be compared with the costs and financing for achieving the other SDG targets, thus enabling an overall prioritization of the development agenda, such as has already been started by theCopenhagen Consensus Center, an exercise which was also conducted for water and sanitation.
In order to encourage deeper analysis, the underlying worksheets are available online for countries to rework the calculations made in this study based on different input data. However, these superficial assessments should not replace the implementation of detailed investment plans and financing strategies within each country as well as at sub-national level.
This study is a collaborative effort by the World Bank, the United Nations Children’s Fund (UNICEF), the World Health Organization (WHO), and a range of sector partners engaged in the post-2015 process revolving around the new Sustainable Development Goal framework. The task team leader is Guy Hutton, senior economist at the Water and Sanitation Program (WSP) at the World Bank, supported by Mili Varughese, WSP operations analyst. In addition, the team consists of Eddy Perez, Jema Sy, Luis Andres, and Chris Walsh. Rifat Hossain (WHO) from the WHO/ UNICEF Joint Monitoring Programme for Water Supply and Sanitation conducted the coverage forecasts in 2015 for the baseline. Full acknowledgements are provided in the report.
WASHfunders’ Recommended Reading section has expanded with the recent addition of some new publications. Resources added in the past several months include:
Leave No One Behind: Voices of Women, Adolescent Girls, Elderly, Persons with Disabilities and Sanitation Workforce summarizes the sanitation and hygiene hopes and aspirations of thousands of women and men of different ages and physical ability, across rural and urban areas in eight South Asian countries.
Water, Sanitation, Hygiene, and Nutrition in Bangladesh: Can Building Toilets Affect Children's Growth? provides a systematic review of the evidence to date, both published and grey literature, on the relationship between water and sanitation and nutrition.
Building Towards a Future in Which Urban Sanitation Leaves No One Behind analyzes the challenges to improving access to sanitation in towns and cities of the global South.
Sanitation and Child Health in India examines the effects of sanitation coverage and usage on child height for age in a semi-urban setting in Northern India.
New publications are added to WASHfunders’ Knowledge Center on a rolling basis, via IssueLab, a service of Foundation Center. And we accept suggestions! If you’d like us to add a case study, evaluation, white paper, or issue brief that is of interest to those in the social sector working in WASH, please contact us: email@example.com.
Editor's Note: In this post, Shauna Curry, CEO of the Centre for Affordable Water and Sanitation Technology (CAWST), presents five main challenges to achieving global access to safe water and sanitation. This post originally appeared on CAWST's blog. You can find the original post here.
The poor bear the brunt of the burden of inadequate water, sanitation and hygiene (WASH) and the link between WASH and health is undeniable. An estimated 842,000 people die each year due to diarrheal disease that could have been prevented by WASH interventions; 361,000 are children under the age of five years old. Health impacts go beyond diarrheal disease: half of global malnutrition and one quarter of stunting in children are due to waterborne diseases like chronic diarrhea and intestinal worms, and diarrhea is responsible for 17% of global disability (PMNCH, 2014).
The Sustainable Development Goals (SDGs), recently adopted by the United Nations, have sparked a renewed focus on what strategies will be necessary to achieve universal access to safe water and basic sanitation by 2030. This won’t be an easy goal to reach – how we define the challenges will influence our direction and prospects for success.
CAWST sees five main challenges to achieving sustained, universal access to safe water and sanitation:
- The scale of the need for safe water, sanitation and hygiene.
- The variability of water and sanitation problems and consequently the variability of solutions from place to place and from time to time.
- How to best sustain essential WASH services over the long-term.
- How to reach people most in need.
- The integration of water, sanitation and hygiene for health.
The Scale of the Need – Water, Sanitation and Hygiene to Half the World’s Population
The sheer scale of the issue is a challenge in itself. It will be no small feat for half the world’s population to gain sustained access to safe water, basic sanitation and good hygiene practices (and to do so in 15 years).
Even critical institutions like health care facilities and schools lack water and sanitation. A study in 54 low- and middle-income countries found that 38% of health care facilities lack access to an improved water source, 19% lack sanitation and 35% do not have water and soap for handwashing (World Health Organization & United Nations’ Children’s Fund, 2015).
The scale of the need will increase, particularly as populations grow, available freshwater is used and contaminated at increasing rates, and the climate changes.
To date, solutions have tended toward infrastructure, implemented by a few organizations. This approach alone has not been successful in reaching everyone, and there aren’t enough local people with the required knowledge and skills to deliver universal, safely-managed WASH by 2030. The current formal systems for training, such as university and vocational programs, are important but will not produce enough WASH practitioners to meet the demand by 2030.
No single solution will result in universal access by 2030. A range of adaptable and scalable solutions are needed to overcome geography, gender and socioeconomic barriers.
Solutions will require many organizations working cohesively to provide smaller-scale, decentralized WASH services, especially at the household level. Those many organizations need support and increased capacity in order to reach unserved populations with sustained WASH services.
The Variability of the Problem and Therefore the Solutions
Water and sanitation issues are highly variable from location to location, from season to season and community to community; and people who lack WASH are often living in the most challenging geography and climate.
One-size-fits-all solutions have not worked and cannot be the strategy to scale-up reach. For example, water quality, rainfall and hydrology are site-specific and have important implications on technology selection and siting. Incorrect choices can exacerbate an already poor condition (e.g. digging a simple pit latrine that further contaminates groundwater).
Customized water and sanitation services are needed that capitalize on existing local knowledge of conditions; and local people need to have the capability to make informed choices and be able to respond effectively to changing conditions.
Sustaining Water, Sanitation and Hygiene Services for the Long-Term
Focus over the past decades has been on water and sanitation infrastructure. This approach is costly in up-front capital, operations and ongoing maintenance. It requires a highly educated, skilled workforce and often doesn’t reach the most marginalized communities, nor address specific contextual challenges.
Sustained operation and maintenance of this infrastructure has been challenging. For example, 30% of water hand-pumps in Africa are not working (RWSN, 2009). The failure of community water and sanitation systems is often a failure of operation and maintenance, rather than a failure of the basic technology.
Addressing this failure requires learning from the successes of those infrastructure that have been used and maintained for many years. At its core, we need to (i) increase skills and knowledge of people to use and maintain the technology and/or service and (ii) select water and sanitation products and services – including household-level solutions – which are affordable to implement, operate and maintain and appropriate to the context.
Reaching People Most in Need
Overwhelmingly, it is the poorest who lack better water and sanitation. Virtually the entire poorest 25% of the world’s population does not have piped water and the inequality in coverage between rich and poor is even greater for sanitation than for water (JMP, 2014).
Addressing this challenge requires both supporting those who serve the people most in need and providing water and sanitation solutions that marginalized households can afford over the long-term.
Integrating Water, Sanitation and Hygiene (WASH) for Health
Many of the water and sanitation approaches employed to date in international development focus on providing either improved water or improved sanitation or improved hygiene. Global monitoring programs, such as the Joint Monitoring Program of UNICEF and the WHO count access to each of the three separately. Alternatively, organizations have the vision to implement all three and struggle to do so when faced with the realities on the ground.
All three – water, sanitation and hygiene – are intertwined and all three are needed for sustained impact. Water, sanitation and hygiene are fundamental for healthy homes and broader systemic change.
The question is then how to implement so people have water and sanitation and hygiene for generations? Start with interventions that will be (i) the easiest for households to adopt immediately and for the long-term, and (ii) provide an entry-point for motivating action on other WASH components. Furthermore, longer term commitments are needed that work towards households having all three components: water, sanitation and hygiene.
Overcoming Challenges to Reach Everyone by 2030
Addressing these five challenges will go a long way towards achieving universal access to safe water and sanitation by 2030. We will reach that goal through many organizations implementing many projects of varying scale, technology and approach.
There are thousands of existing local organizations and government agencies that are best-suited to reach their own populations with safe water and basic sanitation. In the weeks, months and years ahead, alongside these organizations, we need to build capacity, create and sustain demand, provide products and services, monitor for improvement and provide appropriate financing.
In this way, we can collectively achieve sustained services for generations to come.
JMP [Joint Monitoring Programme] (2014). Progress on Drinking Water and Sanitation 2014 Update. WHO Press. Geneva.
PMNCH [The Partnership for Maternal, Newborn, & Child Health] (2014). PMNCH Knowledge Summary #30 Water, sanitation and hygiene – the impact on RMNCH. Available at:www.who.int/pmnch/knowledge/publications/summaries/ks30/en/
Prüss-Ustün, A., Bartram, J., Clasen, T., Colford, J. M., Cumming, O., Curtis, V., et al. (2014). Burden of disease from inadequate water, sanitation and hygiene in low- and middle-income settings: a retrospective analysis of data from 145 countries. Tropical Medicine & International Health, 19(8), 894–905. Available at: http://doi.org/10.1111/tmi.12329
RWSN [Rural Water Supply Network] (2009) Handpump Data 2009. Selected Countries in Sub-Saharan Africa, RWSN, St Gallen, Switzerland
WHO [World Health Organization] and UNICEF [United Nations Children’s Fund] (2015) Water, sanitation and hygiene in health care facilities: Status in low- and middle-income countries and way forward. WHO Press. Geneva.
As 2015 comes to a close, we’re looking back and taking stock of the variety of topics featured on the WASHfunders blog this year – from the importance of systems in creating social change to the impact of the Sustainable Development Goals and the COP21 negotiations on the WASH sector. Featured below are the top five most popular blog posts from 2015.
This post was authored by Danielle Keiser of WASH United, a Berlin-based organization that acts as the Secretariat for Menstrual Hygiene Day. In her post, Danielle provided a round-up of events being organized all over the world to draw attention to this critical development issue.
This post was authored by Sarah Dobsevage, Director of Strategic Partnerships at WaterAid America. In her post, Sarah, who heads up WaterAid’s partnerships with foundations and corporations in the US, describes her organization’s work with drought-prone communities in Burkina Faso, particularly around training local people to develop the skills needed to address WASH problems.
In her post, Shauna Curry, CEO of the Centre for Affordable Water and Sanitation Technology (CAWST), highlights the capacity gap that exists in the WASH sector due to a shortage in skills and the scarcity of local water and sanitation professionals. She describes the central focus that CAWST has placed on human resources and capacity building for WASH and suggests a number of ways in which funders in the sector can work to narrow this gap.
This post was authored by John Sauer, Senior Technical Advisor for Water, Sanitation and Hygiene at Population Services International (PSI). In his piece, John lauds the growing appreciation among WASH practitioners for market-based, holistic approaches to challenges in the sector, but also notes that this enthusiasm has been slow to translate into action. He lists several reasons for this sluggish adoption and describes what PSI is doing to apply the principles of market development to its projects on the ground.
Our most-read post was authored by Alix Lebec, Director of Strategic Alliances at Water.org. Alix writes about the potential for impact investing to help address the global water crisis, which currently attracts far less funding than the WHO estimates is needed. She describes how Water.org has adopted this approach to leverage philanthropic capital and scale up their WaterCredit model in India.
Leave a comment to let us know what WASH topics you would like to see covered in 2016. Interested in contributing a piece yourself? Contact us at firstname.lastname@example.org. Thanks for reading and Happy New Year!