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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: washfunders@foundationcenter.org.

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.
Photo Credit: CAWST

Photo Credit: CAWST

Challenge 1:  

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.

Challenge 2:

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.

Challenge 3:

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.

Challenge 4:

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.

Challenge 5:

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.

In Conclusion:

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.

References:

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.

Editor’s Note: This guest blog post was authored by John Sauer, Senior Technical Advisor for Water, Sanitation and Hygiene at Population Services International (PSI). In his piece, John outlines ways NGOs can work more effectively work to achieve the WASH benchmarks set by the Sustainable Development Goals. This post was originally featured on Impact, a hub for the latest news and analyses on global health and international development, which is supported by PRI. You can find the original post here.

First the good news: the number of deaths of children under 5 years of age was more than cut in half between 1990 and 2015.

As the global development community transitions from the Millennium Development Goals (MDGs) to the Sustainable Development Goals (SDGs), impressive stats like these help to buoy our spirits. Which we need, because we all know: there is much work still to be done.

For those of us working in the field of Water, Sanitation and Hygiene (WASH), the benchmarks for improving sanitation and fecal sludge management services for 2.4 billion (or possibly more) people, remain seriously off track. And with the expansion of the MDGs from eight goals to the 17 contained in the SDGs, many actors in differing sectors will have to think creatively about how to meet the need for resources, innovation and collaboration.

For the past 15 years, international NGOs have been at the forefront of ensuring progress on the MDGs, and we should celebrate this. But if we truly want to solve these problems in our lifetimes, we need to do even more. Below I outline three ways in which NGOs can work more effectively in the coming 15 years.

Children in Sindh, Pakistan, play at a water pump in a village near Dadu, in Sindh, Pakistan. Photo Credit: DFID/ Russell Watkins/ Department for International Development

Children in Sindh, Pakistan, play at a water pump in a village near Dadu, in Sindh, Pakistan. Photo Credit: DFID/ Russell Watkins/ Department for International Development

#1. Proactive vs. Reactive Planning to Strengthen Government’s Role

In most countries where NGOs work, governments have a mandate to achieve certain development objectives. This has never been more true since the adoption of the SDGs. These national, city, and district governments are looking for partners now that will stand by them for the long term and help them get there.

The challenge with some donor funding (and there are important exceptions) is that it is restricted to a specific time frame and doesn’t always enable the flexibility NGOs need to be a true long-term partner with governments. When the funding ends, so might that specific relationship with the government. This is not what governments need or want. We know from experience in the sanitation sector in Thailand, South Korea, Malaysia, and Singapore that when governments are dedicated consistently over time to hygiene, cleanliness and public health, achieving total sanitation and hygiene is attainable.

International NGOs need to find ways to be reliable partners to governments without depending on donor funding cycles. This would then empower NGO country offices to make long-term commitments to their local governments so that results are achieved on governments’ and local institutions’ timelines. Collaborating with governments and local institutions without being tied to a particular project, but rather to the long-term vision, could transform the way we work. Positioning ourselves in this way might also mean that local governments would see NGOs as a partner worth hiring themselves.

#2. Engaging the Private Sector

In the past several years we have seen a host of private sector companies (both local and multinational) begin to create specific business units targeted at exploring how to sell products and services to the so-called “base of the pyramid” (BoP) — the poorest socioeconomic class. The business community has at its disposal exponentially more resources compared to traditional development donors, along with the ability to make solutions sustainable by creating a market for their demand and supply.

But there is still a long way to go before these BOP units are mainstreamed in the business world. Donors, governments, and NGOs have an important role to play in influencing and supporting private sector players to shift towards serving these too-long-ignored customer segments.

According to The World Bank Water and Sanitation Program’s 2013 “Tapping the Market” study, national governments should do two things to incentivize the private sector to launch more business activity focused on improving sanitation: 1) invest in market intelligence; 2) invest money in private sector R&D to improve products and services. Unfortunately, evidence is slim that this advice is being followed.

Partnerships like the Shared Value Initiative provide a unique opportunity to be at the forefront of working with private sector companies – both multinational and local – in a new kind of partnership to bring the power of the private sector to bear on the health challenges that NGOs wants to solve. A key part of this work includes doing market development, which can help build the enabling environment for private sector success. Another piece is helping companies define, measure and implement what a “triple bottom line” means for different health areas.

Making shared value happen will—similar to working with local governments—require longer program cycles, as well as identifying and influencing donors to support this work. It is a welcoming sign that some donors are beginning to ask for this type of programming from development partners (particularly those in sanitation).

#3. Bringing It All Together: Collective Impact

Collective impact is deliberate and disciplined framework to bring government, private sector and civil society together to foster social change.  The conditions of successful collective impact are simple enough, but often not all are present and aligned in traditional partnership efforts. These five conditions, as listed on the Collective Impact Forum, are:

  • Common agenda: coming together to collectively define the problem and create a shared vision to solve it;
  • Shared measurement: agreeing to track progress in the same way, which allows for continuous improvement;
  • Mutually reinforcing activities: coordinating collective efforts to maximize the end result;
  • Continuous communications: building trust and relationships among all participants;
  • Strong Backbone: having a team dedicated to orchestrating the work of the group.

Collaboration for impact is considered one of the preconditions for making faster and better progress in development, but no approach has been mainstreamed yet. In the coming years, NGOs should champion and push for collective impact in their work globally. This will not be easy and will require writing collective impact work into proposals as well as identifying new sources of flexible funding whose stewards understand the leverage such work brings.

The development sector is at a crossroads as it figures out how to work differently to realize the SDGs. How will it have to adapt and evolve its practices (if not turn them entirely on their head) to succeed at ending poverty in our life times? It’s clear that many of the pieces of the puzzle (strengthening governments, market development, shared value, collective impact) are on the table already. To create even more transformation in the international development space in the next several years we must learn how to fit them together. 

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.

Left: Felicity’s latrine. Right: an example of a modern, aesthetically pleasing toilet to which Felicity and others in Nigeria aspire. Photo Credit: WaterAid/Jeff Chapin

Left: Felicity’s latrine. Right: an example of a modern, aesthetically pleasing toilet to which Felicity and others in Nigeria aspire. Photo Credit: WaterAid/Jeff Chapin

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.
Local business owner, Emeka, with a prototype of the new toilet. Enugu, Nigeria. Photo Credit: WaterAid/Nneka Akwunwa

Local business owner, Emeka, with a prototype of the new toilet. Enugu, Nigeria. Photo Credit: WaterAid/Nneka Akwunwa

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.

Sanitation marketing

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.

Editor's Note: Innovation is often heralded as a major route to solving the global water and sanitation crisis. But is it the key, and should innovation be all about miracle inventions? In this post, Rémi Kaupp, Urban Sanitation Specialist at WaterAid UK, discusses whether and where it might be useful. This post was originally featured on WaterAid's blog. You can find the original post here.

Do we need more innovation? It is one of the values in our new strategy, and the fact that so many people still don’t have decent water and sanitation in the 21st century should call for massive and rapid innovation…shouldn’t it? Well, I have three problems with it.

First, there isn’t much that needs improvement about having a tap connected to mains water and using a toilet that flushes into a sewer. These are services that most people around the world aspire to, and they fulfil people’s right to water and sanitation. Sure, they could be improved – we should use less water, we need to recover nutrients instead of losing them, etc; these ideas are already the focus of many engineers in richer countries.

Julius Chisengo and Cleophas Shinga empty the contents of a pit latrine using a Gulper pit-emptying pump, Dar es Salaam City, Tanzania. Credit: WaterAid / Eliza Deacon

Julius Chisengo and Cleophas Shinga empty the contents of a pit latrine using a Gulper pit-emptying pump, Dar es Salaam City, Tanzania. Credit: WaterAid / Eliza Deacon

Second, the main ingredients needed to achieve universal water and sanitation coverage are well known, and, as is common in international development, they are not glamourous: large investments of public money, stronger institutions, better coordination between actors, targeting the most marginalised – i.e. the bread and butter of WaterAid’s advocacy.

Third, and most irritatingly, when we say “innovation”, we often hear “invention”. Barely a week goes by without our technical advisers receiving news of yet another miracle invention that will surely save the problem worldwide. So what is wrong with these?

Typically:

  • They are often point-of-use treatment systems, i.e. water filters, which can be useful in certain conditions (in emergencies, where people really have no choice but to gather water from a river or unsafe well), but often address a small part of the problem. Perfect water quality isn’t as problematic as the distance to the source in rural areas, and its price in cities, and therefore the quantity that people can use for hygiene and sanitation. 
  • Many inventions are developed by Northern inventors with few ties to local communities or consideration of local markets, and assumptions are made about what people actually want or need. The market studies we conduct always give surprising insights into people’s aspirations and hurdles. 
  • Many inventions use materials and techniques that are not available in the targeted countries, creating unsustainable supply chains. It is hard enough to have supply chains for sanitary pads and pump parts, let alone water filters or other more complex technology!
Looking beyond product development

I could go on, but enough ranting. We are nowhere near the target of everyone having safe water and sanitation, so we need to do better – and yes, we need innovation. We have to remember that there are many types of innovation beyond just the development of a new product. The SMS service used in Dakar for sludge collection tankers is an exciting example – the technical aspects are interesting, but, for me, the most interesting features are the strong leadership of the sanitation agency ONAS, the market studies that were used to design this new service, and the willingness to work between authorities and private operators. This sort of collaboration is a key innovative behaviour we need to see increasingly.

There are some great technical innovations in our sector, such as pre-paid water meterssimplified sewers, and the Gulper pit-emptying pump, and the lessons of their pilots are always very similar: they only work if they are developed in response to residents’ needs; they need to be led by the local water and sanitation agency or authority; and they are not usually standalone innovations but fit within broader actions towards improving water and sanitation.

Where is innovation needed?

So where do we need innovation? I have a few suggestions:

  • Pit emptying: Despite our attempts, we still haven’t found a safe and sustainable way to empty toilet pits and then to transport the sludge to a treatment station. The issue isn’t so much having a better pump or vehicle than finding how to run a sustainable business in that area, and what sorts of toilets would be both easier to empty and attractive to people.
  • Sanitation tariffs: Bills aren’t sexy, but they are the main resource utilities have to invest in more infrastructure. There are some ideas from around the world, but an issue is how to keep bills affordable for the poorest people while ensuring their right to good services is fulfilled. 
  • Monitoring water pumps: We know pumps break often and after just a few years, so can we track their failure and repair rate? Although again there are exciting technological innovations in this area, the real shift needs to be in how data are used by institutions and businesses to keep pumps functioning.
  • Making facilities accessible: It has been a long journey to have more accessible toilets in Europe, and there is still much to do. We know the technology needed, but how can we make sure accessible facilities are everywhere more quickly? How do we overcome the joint issues of technology, regulation and endemic inequality?

These are just my ideas – please do suggest other areas in the comments! For instance, perhaps you know of something exciting happening in humanitarian emergencies.

For me, the value of “innovation” isn’t in finding the solution to all water problems worldwide; it is more about persistence and openness, the willingness to try new approaches with an open mind, to sometimes fail and acknowledge it honestly, to learn and adapt and try again. This journey can be as exciting as the last ten years in toilet pit emptying!

Editor's Note: This post is authored by Jack Sim, founder of the World Toilet Organization (WTO) and BOP HUB, and a leading global advocate for sanitation. This post first appeared on the Huffington Post as part of its "What's Working: Sustainable Development Goals" series in conjunction with the United Nations' Sustainable Development Goals (SDGs). 

Toilets need to compete with mobile phones and televisions as desirable lifestyle products in order to achieve sanitation for all.

For one-third of the world's population, a clean, safe toilet -- something many of us take for granted -- remains out of reach. The Millennium Development Goal target of halving the proportion of people without sustainable access to basic sanitation wasn't even nearly reached. In fact, the target has been missed by almost 700 million people.

The proposed sustainable development goals (SDGs) include a standalone goal dedicated to water and sanitation -- Goal #6: "Ensure availability and sustainable management of water and sanitation for all," and targets to end open defecation and halve the proportion of untreated wastewater. So how do we ensure the success of this goal?

Usage is key

Firstly, it is crucial that we are clear that for this goal to succeed, we will need to see a clean, safe toilet and sanitation being USED by all by 2030.

As we work to improve access to sanitation across the globe, it is critical that we address sanitation behavior. It will not be enough to simply ensure access to sanitation -- people need to be using toilets in order to realize the health, dignity, economic, and gender benefits of achieving 100 percent sanitation coverage. Installing toilets in India, for instance, without addressing behavioral change, has resulted in thousands of free toilets becoming storage sheds or chicken coops, while the owners continue to defecate outside. A survey by RICE found that in India many still consider open defecation to be preferable and "part of a wholesome, healthy, virtuous life."

Driving behavioral change is key to ending open defecation. Rational messages used by educational campaigns in the past have not gotten through. Toilets need to compete for priority on an emotional level, rather than a rational level. We need to motivate people by appealing to their pride and dignity, and position toilet use as aspirational, associated with improved social status.

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79 percent of the population in Mozambique still lacks access to improved sanitation. Photo Credit: WorldToilet.org

Driving Demand

Generating desire for toilets among BoP ["bottom of pyramid," or world's largest but poorest socio-economic group] populations is crucial. The chief obstacle in promoting sanitation is not the ability of BoP populations to afford it, but that they do not prioritize sanitation over other investments, like cell phones and televisions. While only 40 percent of Indians have an improved sanitation facility, current statistics show that around 77 percent have a mobile-phone subscription.

Toilets need to be able to compete in terms of desirability with lifestyle items like a mobile phone for people to prioritize investing in improved sanitation.

In order to drive demand, the image of a toilet will need to be transitioned from dark, dirty, smelly to bright, clean and happy. And we need the reality to match this image. We need to design the toilet to be a wonderful place to visit, and provide populations with a product that is well-designed, well lit and ventilated, and easy to clean -- a much more comfortable, convenient and enjoyable option than open defecation. And simultaneously, we have to ensure the supply of good quality and affordable toilets.

The product needs to be so desirable that people will want to own and use a toilet. And we can appeal to people's sense of pride, and their competitive nature, encouraging them to decorate their toilets, painting them with bright colors, using stencil designs on the outside walls to show off to their neighbors. Owning and using a toilet needs to become a trend, and eventually the norm.

Tackling the sanitation taboo

As we work to see sanitation prioritized by the end-users, we also need to continue working to ensure that sanitation is a top priority for global leaders. Sanitation and water being included as a standalone goal signals that the issue is starting to become more of a global priority. Sanitation has slowly become more of a priority for world leaders in the 14 years since World Toilet Organization was founded on the 19th November 2001 (now celebrated annually as UN World Toilet Day). However, the current level of prioritization is still far from what is needed, especially given the scale and impact of the sanitation crisis. It's time for toilets to be treated as an urgent global priority.

We need to continue to address the taboo nature of sanitation, by calling a toilet a toilet and not being afraid to talk about shit. As former Secretary General of the United Nations Kofi Annan said, "No other issue suffers such disparity between its human importance and its political priority."

I have a vision of a world with clean, beautiful, safe and "happy" toilets being used by all. By addressing behavioral change, driving demand for improved sanitation and continuing to advocate for sanitation to be prioritized at the highest levels, I'm confident we can achieve this vision and reach one-third of the world with improved sanitation, positively impacting the lives of some 2.4 billion people.

To find out what you can do, visit here and here.

Follow Jack Sim on Twitter: www.twitter.com/JackWTO

Pit Emptying and Marketplace Development: A Mucky Business from Water For People on Vimeo.

Market development in sanitation is, both literally and figuratively, a mucky business. A recent video from Water For People thoughtfully illustrates the different approaches and limitations the organization has experienced in its attempts to establish a city-wide market for pit emptying services in Kampala, Uganda.

After identifying transportation costs as a main constraint to the scaling of the city’s pit emptying sector, Water For People helped to establish Sanitation Solutions Group with the aim of growing the market for this service. The Group leases vehicles and equipment to the best performing businesses already existing in the informal sector and supports pit emptiers in becoming franchisees, helping to professionalize an industry to which few aspire.

Watch the video and share your own insights and lessons learned for market-based solutions in the WASH sector in the comments!

WHO, UNICEF Warn of Lack of Progress on Improving Sanitation

The lack of progress on sanitation threatens to undermine the child health benefits from gains in providing access to safe drinking water, a report from UNICEF and the World Health Organization warns.

The report, Progress on Sanitation and Drinking Water: 2015 Update and MDG Assessment (90 pages, PDF), found that 2.4 billion people, or one in three on the planet, still lack access to sanitation facilities. At the same time, the gains in access to safe drinking water are substantial, with some 2.6 billion people having gained access since 1990, including 427 million people in sub-Saharan Africa. The report also found that the number of children under the age of 5 who die each day from diarrhea caused by inadequate drinking water, sanitation, and hygiene has been halved over the last fifteen years. Progress on sanitation, however, has been hampered by inadequate investments in behavior-change campaigns, lack of affordable products for the poor, and social norms. While some 2.1 billion people have gained access to improved sanitation since 1990, and 68 percent of the world's population use an improved sanitation facility today, those numbers fall short of Millennium Development Goal targets by nearly 700 million people and 9 percentage points.

"What the data really show is the need to focus on inequalities as the only way to achieve sustainable progress," said Sanjay Wijesekera, head of UNICEF's Water, Sanitation and Hygiene programs.

According to the report, access to adequate water, sanitation, and hygiene is critical in the prevention and treatment of nearly all neglected tropical diseases, which affect more than 1.5 billion people worldwide, causing blindness, disfigurement, permanent disability, and death. The practice of open defecation also is linked to a higher risk of stunting, which affects 161 million children globally. To address the situation, the report calls for disaggregating data so as to better identify target populations; focusing efforts on the hardest to reach, particularly the poor in rural areas; developing technologies and approaches aimed at bringing sustainable sanitation solutions to poor communities at affordable prices; and improving hygiene in homes, schools, and healthcare facilities.

"Until everyone has access to adequate sanitation facilities," said Maria Neira, director of WHO's Department of Public Health, Environmental and Social Determinants of Health, "the quality of water supplies will be undermined and too many people will continue to die from waterborne and water-related diseases."

 "UNICEF, WHO: Lack of Sanitation for 2.4 Billion People Undermining Health Improvements." UNICEF and World Health Organization Press Release 06/30/2015.

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.

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