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: Nigeria is one of the world’s five biggest contributors to the problem of open defecation, despite ongoing government efforts. In this post, Erin Flynn, Research Manager at WaterAid, looks at the country’s sanitation problem and whether the sanitation ladder will help Nigeria reach its ambitious targets. This post was originally featured on WaterAid's blog. You can find the original post here.
The bottom of the ladder
Felicity runs a successful dress-making business in Nigeria’s Enugu state. She first set foot on the sanitation ladder in 2012, when her village was ‘triggered’, or motivated, through Community-Led Total Sanitation (CLTS). The approach, which helps communities assess their sanitation situation, resulted in her husband building a basic pit latrine for their family home.
Although their building a latrine is considered a success in terms of CLTS, Felicity and her family are embarrassed by this basic structure, and inform visitors that the toilet is not finished, directing them instead to the bush. The water-based toilet the family dreams of would cost too much.
Felicity’s story is not uncommon. Since 2004, the Nigerian Government has used CLTS to move communities up the sanitation ladder, starting, if necessary, from the ‘cat’ method of dig and bury, or a basic pit latrine, moving up to a more expensive and sophisticated toilet. CLTS is a key component of the UK Department for International Development's sanitation, hygiene and water in Nigeria projects (SHAWN 1 & 2 ). Over the years WaterAid has played a significant role in the use and development of CLTS in Nigeria and beyond, including running a three country study in 2009.
Reaching the top
Surprisingly, despite the widespread use of CLTS, robust and reliable evidence in support of it in Nigeria and beyond is still relatively sparse.
WaterAid is continuing to build a body of evidence in Nigeria, through the Sustainable Total Sanitation (STS) project in Ekiti, Enugu and Jigawa states. The data and findings from formative research in 2014 gave valuable insight into common sanitation beliefs, practices and service availability. The findings exposed much about the sanitation aspirations of households in these states, like Felicity’s, who are upwardly mobile and exposed to urban life.
Importantly, the findings showed:
Open defecation is not safe or convenient and is difficult for sick and older people…
…but households aren’t ashamed to practice open defecation – it is better than starting at the bottom of the ladder, using a poor-quality toilet. A low-quality toilet is an embarrassment for the family.
Like Felicity and her husband, people have a strong desire for an ‘ideal’ water-based toilet – the last rung on the sanitation ladder. Such a toilet is easily cleaned, connected to modern urban life and aesthetically pleasing…
…but this is financially out of reach, costing between 44 and 77% of an average family’s annual income.
There is agreement that toilets result in happier and healthier households, thanks partly to approaches like CLTS…
…but these benefits are believed to decrease if the toilet is low quality.
Households have a fairly accurate understanding of the costs involved in constructing an ideal toilet (around £260)…
…but even when a household can afford a toilet, the process is long and involves several negotiations with different suppliers.
Giving households a step up
Nigeria is one of the world’s five biggest contributors to the problem of open defecation, with over 45 million Nigerians currently practising it. This situation is made worse by the country’s declining sanitation coverage – based on current trends, the new Global target of universal coverage will not be reached by 2030.
Successive Nigerian governments have made attempts to improve the country’s sanitation practices. In August this year, Ebonyi State Government made it illegal to defecate in the open (creation of such a law is also in progress in Yobe State) and Akwa Ibom State Government declared a “war against indiscriminate disposal of waste”. It is unclear what the implications of such laws will be in Nigeria; however, a recent study by WaterAid on the Asian Tigers highlighted the importance of political leadership, and changes in public health and hygiene policies, for resolving the issue.
Building on the insights we have gained about household aspirations and purchasing hurdles, the STS project is supporting local businesses to develop and sell high-quality, affordable and desirable toilets. Through the formative research and iterative testing of prototypes with businesses we have developed a new water-based toilet costing an estimated £85.
WaterAid have also supported the improvement of marketing and sales models to remove some of the purchasing burdens from households. Although not new to the sector, this market-based approach will be new to Nigeria. Delivered alongside CLTS and social marketing messages which reflect the pride and status associated with owning and using a good-quality toilet, we expect the approach to lead to increased toilet coverage and use.
Under the STS, sanitation marketing and CLTS will be rigorously evaluated to help us understand how effective each approach is, both independently and combined. Although the study’s final results are not expected until 2016, it’s already clear that, in order to reverse the current trend and accelerate progress towards 2030 targets, Nigeria will need to rapidly introduce complimentary sanitation approaches that respond to the large-scale problem at hand.
The new approaches must respond to the aspirations of households, significantly reduce the cost and complexity of purchasing a hygienic (and desirable!) toilet and ensure financial mechanisms are available for the poorest. With these approaches in place, maybe Nigeria won’t need a ladder to reach it's ambitious sanitation targets after all.
The grant will support the organization's efforts to provide clean water, education, health care, and microfinance opportunities in a rural Ethiopian community of seventy thousand people. The initiative is expected to play a significant role, particularly for women and children, in advancing poverty-reduction efforts in the East African country.
"We are very impressed by the integrated community development model that Glimmer has developed over the past fifteen years," said IKEA Foundation CEO Per Heggenes. "Through our partnership, we expect great impact and better opportunities for thousands of children, while helping communities become stronger and better able to overcome the harsh conditions of rural life."
Source: "IKEA Foundation Awards $7 Million to a Glimmer of Hope." A Glimmer of Hope Press Release 10/21/2015.
Last month marked the released of the UN-Water GLAAS Special report for Africa, an initiative led by WHO in collaboration with the African Ministers’ Council on Water and the African Development Bank. The report, which draws on data gathered from 39 African countries, takes stock on progress made under the Millennium Development Goals and sets the scene for development around WASH under the post-2015 Sustainable Development Goals.
Key findings from the report include:
- Almost 75% of African countries surveyed have recognized the human right to water in their constitutions or legislations and nearly two thirds have recognized the right to sanitation.
- Internal monitoring results are frequently neither reported nor acted upon, especially in sanitation.
- Reported government-coordinated expenditure on sanitation and drinking-water ranged from 0.13% to 1.78% of GDP.
For more from our curated collection of WASH-related reports, visit the Recommended Reading section of WASHfunders.org.
Editor’s Note: This guest blog was authored by Muna Wehbe, CEO of the UK-based Stars Foundation. In the piece, Muna describes the foundation’s Impact Awards, a cornerstone of its programming, and explains why the award categories were expanded this year to recognize local organizations that have made an impact on the lives of children through interventions in WASH.
At the Stars Foundation, we have spent the last 12 years identifying and investing in exceptional organizations working to improve the lives of disadvantaged children. Since 2007, we have focused our energy on the annual Impact Awards – a program that recognizes and rewards outstanding local organizations operating in the countries with the highest rates of under-five mortality.
Initially, we only accepted applications from local charities in Africa, but gradually expanded to the Middle East and Asia-Pacific by 2010. Winners were awarded for both their effective management and impact on the lives of children in one of three categories: Health, Education or Protection.
Using this model, we have established relationships with some of the best local organizations in the developing world; organizations that are embedded in their communities, responding to local needs with innovative and effective development programs that, admittedly, are always more integrated than the reductive category headlines above would have you believe.
This was certainly true for Restless Development Nepal and Action for Integrated Sustainable Development Association (AISDA) in Ethiopia. While they were ostensibly awarded for their impacts in education and health respectively, a large proportion of their development interventions involved water — improving access to it, and raising awareness of the hygiene and sanitation issues that surround it.
This is symptomatic of many of our local partners.
The connections between health, education and water are undeniable. And after a comprehensive strategic review last year, in which we interrogated our proxy measure for need — UNICEF’s under-five mortality index (PDF) — it was clear how crucial improving water, sanitation and hygiene is to child survival, and to effecting lasting impact at scale. Unsafe or inaccessible water and poor sanitation and hygiene contribute significantly to the number of preventable child deaths each year.
But our Awards program did not reflect that.
So, in recognition of its enormous impact on child survival, Stars will be awarding its first two Impact Awards in the WASH category this year, no longer conflating it with health or education.
Marketing to, assessing and awarding in a new category has not been without its challenges.
In every category of the Impact Awards, we remain fairly agnostic about the specific interventions themselves, and instead focus on the overall impact the organization is having on the lives of children, as well as evaluate its management and governance practices.
And while we’re thrilled with the results of the 2013 Awards, we recognize additional adjustments to the process may be needed as the level of technical expertise associated with assessing interventions in the WASH sector seem to be even more pronounced than in other categories.
We cannot reveal the names of the inaugural Stars Impact Award winners in WASH just yet (they will be announced at a ceremony in mid-December and we’ll post the winners here as well). But we can disclose that, unsurprisingly, local organizations working to improve the lives of children do not ever focus on just one development issue in isolation. Rather, they employ a range of projects and interventions to improve the health and wellbeing of their communities’ most vulnerable members.
That is the strength of local organizations. And we’re delighted that adapting our award strategy accordingly with the addition of the WASH category means we can now support even more of them.
The Conrad N. Hilton Foundation has announced a search for a senior program officer for its International Program/Safe Water Initiative. The person selected for this position will provide leadership in international grantmaking activities and projects and will have primary responsibility for the Foundation’s Safe Water initiative. This person is a key member of the international program team and reports to the director, International Programs.
The Conrad N. Hilton Foundation works to improve the well-being of the ultra poor in targeted developing countries by supporting sustainable access to safe water. The Foundation focuses its grantmaking on the rural poor in regions of Africa, Mexico, and India with low water access and high incidence of water-related diseases. Over the past two decades the Foundation has delivered more than $90 million in grant funds to provide more than 2 million people with WASH services in Burkina Faso, Ethiopia, Ghana, Mali, Niger, and water-stressed regions of India and Mexico.
Candidate requirements include:
- graduate degree in public health, public policy, social welfare, or a related field;
- demonstrated expertise and work experience in international water-related issues at program, research, and public policy levels;
- familiarity with water, sanitation, and hygiene policy at global, federal, state, and local levels;
- experience in strategic planning and implementation, and in coordinating public/private efforts for long-term, systemic social impact; and
- a minimum of 10 years of relevant experience in grantmaking and/or program development/management.
A passion for, and a commitment to, the Foundation's mission and international program priority areas are essential. Candidates must be legally authorized to work in the United States.
Editor’s Note: This guest blog was authored by Fatima Asmal-Motala for the Inter Press Service (IPS) news agency. Fatima interviews Jack Sim, the founder of the World Toilet Organization (WTO), about the state of sanitation in Africa and the strategies needed to improve upon it. A version of this post originally appeared here.
When the founder of the World Toilet Organization, Jack Sim, turned 40, he literally began counting how many more days he had to live and felt a sense of urgency to do meaningful things with the remainder of his life.
“Can you imagine a person coming into this world and spending his life only helping himself? When this person dies, his life has had no meaning, so why did he bother coming here?” he asks.
A successful businessman, Sim turned his attention to an area which he felt was severely neglected.
“The toilet was completely neglected in Singapore (his home country). I realised it was the same all over the world. People felt very embarrassed. Now I’ve broken the taboo and legitimised the subject through 12 years of effective advocacy. I am proud to say I have broken the taboo surrounding the subject of sanitation.”
Excerpts of the interview follow:
Why is good sanitation so important?
To grow a country, you need healthy people. You’d rather prevent people from being sick than cure them once they’re sick. Toilets are the cheapest preventative medicine in the world.
Proper sanitation, together with hand washing with soap, will reduce illness by 50 to 80 percent. A lot of illness — diarrhoea, worms and other diseases — are basically due to the spread of pathogens from the feces, transmission paths through the fingers, the feet, the flies and the fluid. If you can break this, people can be healthy.
We need covered toilets which flies cannot reach, people cannot step on, and rain cannot wash away and spread, as well as a place to wash the hands. To achieve this we need education — why is a toilet good for you — to make it a trend rather than a prescription. If it’s fashion, people will follow.
Toilets also need owners. Without an owner it will become dysfunctional very quickly. If someone buys a toilet, he feels he owns it. If he doesn’t own it, a sense of ownership has to be cultivated. People have to be trained as cleaners and as security personnel.
If you have no toilets, you get unhappy, unhealthy people — as a result of which you have low productivity, and low income. You then have to incur expenditure due to illnesses and this can break subsistence survival, creating a poverty cycle, which becomes a political problem. Good sanitation can prevent all these time bombs.
What progress has been made on the African continent in terms of sanitation?
The good news is that Africa is currently experiencing one of its most peaceful periods in recent history. Because of that, its economic growth is on average faster than even the Asian growth rate. When people have a little bit more money, they have higher expectations. So the demand for toilets is easier to create.
On the African continent there has been some progress in terms of the community-led total sanitation approach which triggers people to dig their own holes, thereby encouraging them to have their own rudimentary toilets.
Through this approach, people realise the need for a proper toilet quickly. They start by digging a hole and going to a fixed place to defecate. This is already a big change of behaviour — they suddenly feel disciplined; they feel the need to be private, to protect their neighbours.
So the first phase is just to go to a fixed place, and to cover the hole. It’s very rudimentary, but it’s better than being outside, where women can get molested.
In the second phase, people are encouraged to buy toilets, which cost between 50 to 100 dollars. Once they own them, jealousy and comparisons set in — and nobody likes to be looked down upon.
How high is that “demand” currently in Africa?
What we need to do is to move the toilet to a higher level on the list of personal priorities — as high as the cell phone. For most people on the continent, the priority has been a television set, then a cell phone, but not a toilet. What we need to do is to make it fashionable to own a toilet — to convey the message that if you don’t have a toilet, you’re living in an animal state. People don’t want to be classed as living in an animal state.
What about the supply side — how easy is it for an individual to access a toilet?
We have to make toilets available either by the government, or affordable for people to buy, with on-site treatment, safe sanitation, and maintenance cleaners who are also professionally trained as technicians. And we also have to provide education for the community to care for their toilets so they can continue to enjoy using them. In other words, on the supply side, the effort requires a combination of people, the government and the private sector.
What about South Africa? Has any progress been made here?
A little bit. But the growth of informal settlements is creating a lot of difficulties, not just in terms of provision of toilets, but also where to put them. You can’t put a permanent structure on illegal land. Yet people need toilets. There needs to be some legal policy reform that allows a permanent toilet.
Why should it be mobile? Sometimes a mobile toilet is too far away to comfortably access. Also people are practising open defecation — so there’s a habit change barrier. They may ask, why should they use toilets which are not well-maintained, which are dirty and smelly and full and which can’t even be used?
The government is also not fast enough in terms of provision, but I think they are interested in speeding up the programme because they know that you can’t have a nation of sick people.
How is the World Toilet Organization involved in improving sanitation in Africa?
We have partnered with Unilever to launch an academy. We are going to go to schools and encourage children to start using toilets earlier; when they use toilets at school, they’ll promote usage at home.
Supply of toilets on the African continent has not caught up with demand. This academy will train people to manufacture toilets in very small factories, thereby creating businessmen who are making affordable products at a profit, selling to their own communities.
What happens is that sanitation now goes beyond health and hygiene. When a woman has an income, she has more power at home; she can use her money wisely for the family; she has a bigger say when talking to her mother-in-law and husband.
So we’re creating gender equality and sustainability. We did very well in Cambodia. In three years 24,000 toilets were manufactured, generating 48,000 dollars for sales agents. We look forward to the day every person everywhere has access to a clean safe toilet at any time they need to go.
The African Ministers' Council on Water, an initiative of the African Union, has announced a three-year, $2 million grant from the Bill & Melinda Gates Foundation to build its capacity for sanitation policy development, monitoring and evaluation coverage, and WASH-related advocacy across the continent.
Awarded through the foundation's global development program, the grant will be used to provide training and technical assistance in four countries working to develop and adopt effective sanitation and hygiene policies and plans; organize the fourth AfricaSan conference as a mechanism for tracking progress, refining targets, and enabling peer support and advocacy for implementation of the 2008 eThekwini Declaration and AfricaSan Action Plan; and help countries fulfill their obligations to report to the AU.
"We face tremendous challenges of diminishing access to clean water and safe sanitation," said AMCOW executive secretary Bai Mass Taal. "AMCOW is committed to working with partners such as the Bill & Melinda Gates Foundation to reduce this scourge and improve access to safe sanitation, thereby achieving our overall goal of decreasing poverty and disease in the continent."
Source: “African Ministers' Council on Water (AMCOW) Gets US$2 Million Grant to Improve Sanitation Coverage in Africa.” African Ministers' Council on Water Press Release 12/18/12.