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.
As efforts shift from rescue to relief in the aftermath of the recent earthquake in Nepal, pledges of aid from individuals, foundations, and others are growing steadily while logistical challenges threaten to delay the response.
An immediate priority for the WASH sector is to provide access to water, while longer term recovery will involve building infrastructure for safe water and sanitation. For those interested in supporting WASH-related relief and recovery efforts, we’ve pulled together some resources:
- The Global Public-Private Partnership for Handwashing has compiled a list of documents for WASH practitioners in Nepal responding to the earthquake, such as the World Health Organization’s Rapid Needs Assessment tool.
- The United Nations Office for the Coordination of Humanitarian Affairs (UN OCHA) is producing regular situation reports that provide an update on the humanitarian response in Nepal. According to UN OCHA, the earthquake has left 4.2 million people in need of WASH services.
- WASHfunders’ funding map pulls together foundation grants data, reporting on bilateral and multilateral funding, as well as social and economic indicators. A quick look at grants data in Nepal shows that a number of WASH organizations are already working on the ground in the country, including WaterAid, Splash, ANSAB, and the Environment & Public Health Organization, among others.
And if you’re interested in learning more about foundation engagement in disasters more generally, read the 2014 report produced by Foundation Center and the Center for Disaster Philanthropy, Measuring the State of Disaster Philanthropy.
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 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.
With the excitement and buzz of World Water Day behind us I’m left both inspired and concerned. I’m inspired because there is a growing understanding by WASH professionals that it will take market development and systemic change to truly solve the problem. These methods look overall at what is working and not working in terms of WASH services for populations at risk across value chains and within the market system, and then, based on that analysis, develop targeted interventions with pro-poor innovations to make markets work. What is also exciting is the impact that adopting and implementing these approaches might have on the development sector in general.
What is concerning is that I still only see a handful of WASH projects and organizations fully focused on market development and systemic change. In other words there is a lot of talk but no action. Why?
I think there are a few reasons that I hope will change quickly for the sake of WASH and for development overall.
1) WASH players are still learning how to do market development
While there have been some great thought pieces written recently about why market development approaches to WASH are critical to success, very few projects are modeling and testing these approaches. We need more players involved with market development approaches. We need more UN agencies, donors, foundations and governments asking for and demanding market development approaches to WASH programs. NGOs and other players should do market development systematically, learn from implementation (through state-of-the-art monitoring and evaluation), and share their findings with the WASH sector, as well as the wider community of practice. These findings should include real examples of what works and what doesn’t.
Fortunately for the WASH sector this energy for exploring market development comes at a time when the wider market development community (traditionally in the agriculture sector) is actively compiling and publishing practitioner resources. The market development community is also trying to get wider adoption from the health sector, in particular WASH.
2) Funders are still learning how to fund market development
Funders need evidence to drive their funding decisions (rightfully so), and market development work in WASH is in its early days. But we also know that traditional programming focused only on the number of boreholes installed or toilets constructed does not yield transformative change and is often unsustainable. And market development is also a field with some serious discipline and evidence-based thinking behind it (driven by DCED, BEAM Exchange and others). Donors looking to increase their impact should seriously consider funding new market development approaches, so long as those approaches have a rigorous evaluation process tied to them.
3) Market Development ≠ Marketing
Make no mistake; marketing is an important part of market development. Market development, though, is much wider and looks at understanding the total market as it is now and its potential for sustainable growth. It includes but goes beyond enterprise level support, as market failures will be at other levels too, especially in sanitation.
As for action, I’ve just joined PSI as Senior Technical Advisor for its WASH program and a primary driver for my move here was my new employers’ commitment to market development approaches in health. Recently, PSI has been adopting market development work into WASH, and sanitation particularly, and plans to continue to expand this work globally.
One of the programs I’m most excited about is a market development program we’ve just launched with USAID funding in West Africa (Benin, Côte d'Ivoire, and Ghana) to improve sanitation and fecal sludge management services for a projected one million people. The program, called Sanitation Service Delivery, involves partners PATH and WSUP, and will support interventions based on a market landscape and analysis in product and service design, business model development, government partnerships, and demand- and supply-side financing. There is also a strong component focused on shared learning that starts with this blog and that will continue in a variety of channels.
So learn with us and follow our progress as we build the evidence that market-based solutions in WASH work. In doing so, we hope to prompt those who are still skeptical to action as well.
Editor’s Note: This post is authored by Cor Dietvorst, Programme Officer at IRC. In his piece, Cor discusses the monitoring requirements surrounding India’s Swachh Bharat program, which Prime Minister Narendra Modi launched in October 2014 with the aim of ending open defecation in the country by 2019. He compares India’s sanitation monitoring initiative with other large-scale monitoring efforts with which IRC has been involved in Bangladesh and Indonesia. This post originally appeared here on the IRC blog.
According to some media the Indian government has unleashed “toilet police” or “toilet gestapo” into the country.1 In fact, the central government has instructed local officials to take photographs of new toilets to prove that they have not only been constructed but are also being used. If states don’t upload photos by February 2015, the water and sanitation ministry has threatened to withhold funding from a new national sanitation programme.2
Open defecation free by 2019
Prime Minister Narendra Modi launched the Swachh Bharat (Clean India) Mission on 2 October 2014. His aim is to attain a 100 percent open defecation free India by 2019. Since the launch, over half a million household toilets have been constructed.3
By implementing “real time monitoring” the government hopes it can correct past mistakes caused by ineffective monitoring and wasted investment in sanitation. The 2011 census revealed that 43% of government funded toilets were either “missing” or non-functional.4 Now the government wants to show that its investments in sanitation are delivering lasting results.
The Ministry of Drinking Water and Sanitation is appointing around two dozen additional staff including two joint secretaries and four directors to strengthen the implementation and monitoring of the Swachh Bharat Mission. An Expert Committee for innovative sanitation technologies and a national telephone helpline for rural water supply and sanitation are other new initiatives that will support the Mission.5
Local officials charged with monitoring toilet construction and use need to download an app on a mobile device. The app allows them to upload photos as well as the personal data and geo-coordinates of the beneficiaries to a public website. Progress is slow though: as of 14 January 2015, data of less than half a percent (2,383) of the newly constructed toilets has been recorded. Data collected before 2015 does not include toilet use.
How do other countries carry out large-scale monitoring?
Compared to examples of large-scale sanitation monitoring in Bangladesh and Indonesia, the toilet use indicators collected in India -- is the toilet in use, is it clean and is water available -- are rather limited.
The BRAC WASH programme in Bangladesh uses benchmark indicators developed by IRC for questions like: do all household members use toilets, do they use them at all times, and are there provisions for handwashing and pit emptying.6
In Indonesia IRC has helped design a monitoring system for the SHAW (Sanitation, Hygiene and Water) programme, where every three months 20,000 community volunteers visit more than 300,000 households. For SHAW monitoring is not merely an accountability tool as it is in India, but a way to motivate and encourage people to improve their sanitation facilities and hygiene behaviour.7
India's decision to track toilet use as part of its new monitoring initiative is a major step forward. From its neighbours, India can draw valuable lessons on how to monitor sanitation as a sustainable service that benefits all.
2 Letter to Principal Secretary/Secretaries in charge of Rural Sanitation all States and UTs. Ministry of Drinking Water & Sanitation, 05 Dec 2014
3 Unused rural toilets to face public scrutiny, The Hindu, 01 Jan 2015
4 Tiwari, R. The case of the missing toilets. India Today, 02 Oct 2014. See also: Hueso, A. & Bell, B., 2013. An untold story of policy failure : the Total Sanitation Campaign in India. Water policy ; 15 (6), pp.1001–1017. DOI: 10.2166/wp.2013.032. and Hueso, A., 2014. The untold story of India's sanitation failure, Addendum. Community-Led Total Sanitation.org, 11 Mar 2014
5 Nationwide monitoring of use of toilets will be launched from January, 2015, PIB, 31 Dec 2014
6 IRC - Monitoring at scale in BRAC WASH
7 Baetings, E., 2014. How are you and how is your loo?
Launched as part of last month’s celebrations for World Toilet Day, the Toilet Board Coalition is a business-led initiative that aims to develop commercially scalable solutions in response to the global sanitation crisis.
Initiated by Unilever in 2012, the Toilet Board Coalition brings together a number of businesses, government agencies, and other WASH organizations. In addition to Unilever, Coalition members from the business sector include Kimberly Clark, LIXIL, and Firmenich, as well as other funders and NGOs such as Stone Family Foundation, WaterAid, Water and Sanitation for the Urban Poor (WSUP), and the World Bank’s Water and Sanitation Programme.
The Toilet Board Coalition brings together the technologies, expertise, and resources of its diverse membership to identify, develop, and scale market-based solutions in sanitation.
One pilot business model already supported by the Coalition is the Clean Team project, based in Ghana. The project, which is run by WSUP and uses toilets designed by Unilever, offers fee-based waste removal services that provide households with a cheap and clean alternative to public toilets while supporting the supply-side structure through the employment of sales and maintenance staff.
“Toilet Board Coalition develops initiatives to fight the sanitation crisis.” Unilever Press Release 11/19/2014.
Tim Smedley. “World Toilet Day: business steps in to tackle open defecation with affordable toilets.” Guardian 11/19/2014.
Editor’s Note: This guest post was authored by Leith Greenslade, Vice-Chair at the MDG Health Alliance, a special initiative of the Office of the United Nations Special Envoy for Financing the Health Millennium Development Goals. To coincide with the Global Day of Action for Child Survival, Leith writes about the relationship between toilets and childhood stunting, describing the scope of the problem and discussing the potential for improved sanitation through public-private partnerships. The original version of this post appeared here.
October 16th is Global Day of Action for Child Survival and I’m thinking about my mother…
“Don’t ever, ever eat in the toilet!” When I grew up I imagined every mother in the world admonished her children with this warning. If you’ve grown up hearing this message, as so many children in middle and high income countries have, you simply cannot think of food and toilets in the same sentence without some discomfort. And yet it turns out the relationship between food and toilets is much more positive than our mothers ever led us to believe.
Quite simply, children who grow up in communities who use toilets are less likely to be malnourished and children who grow up in communities that defecate openly are much more likely to become what is called “stunted”, a horrible word that means much more than just being too short for your age and describes a condition that slows mental as well as physical development preventing children from reaching their full potentials.
How does the relationship between toilets and stunting work? The evidence is rolling in. Children who grow up surrounded by feces -- animal and human -- ingest it constantly which can trigger a disorder of the small intestine called “environmental enteropathy”. The intestinal walls of children who have this condition constantly "leak" bacteria into the blood stream causing chronic low-grade infections that consume vast amounts of energy to fight, leaving less nutrients available for growth.
Small problem?…Not exactly. An estimated 1 billion people practice open defecation globally and 165 million children are stunted, with the greatest concentrations of both in countries like India, Indonesia, Pakistan, Ethiopia, Nigeria, Sudan, Nepal, China, Niger, Burkina Faso, Mozambique and Cambodia. In these countries, open defecation and childhood stunting have enormous health and economic costs. Globally, they are major contributors to the 6.3 million child deaths that occur each year, most from infectious diseases such as pneumonia and diarrhea, cost hundreds of billions of dollars in medical treatment for those who get sick, and significantly depress economic growth and development.
India is the eye of the storm with the world’s highest concentrations of open defecation (600 million), stunted children (62 million) and child deaths (1.3 million). To accelerate investments in reducing open defecation and improving child nutrition in India, the United Nations Foundation, the MDG Health Alliance and WASH Advocates co-hosted a discussion in September with leading experts to explore how public-private partnerships could tackle the sanitation/nutrition challenge in a more integrated way.
Participants included the Public Health Foundation of India’s Ramanan Laxminarayan, UNICEF’s Sanjay Wijesekera, Jean Humphrey from Johns Hopkins School of Public Health, Analia Mendez of Unilever, Lucy Sullivan from the 1000 Days Initiative, and Gardiner Harris from the New York Times, whose scathing article on the lack of access to toilets in India inspired the conversation. The discussion was in support of the UN Secretary-General’s Every Woman Every Child movement.
The panel acknowledged that food interventions alone can close only about a third of the average growth deficit of Asian and African children and that the global development community has substantially underestimated the contribution of sanitation and hygiene to childhood growth. Although there was agreement that increasing access to locally designed, manufactured and marketed toilets in participation with the private sector is a critical part of the solution (with Jim McHale from American Standard sharing details of their success in Bangladesh with the SaTo toilet and Analia Mendez outlining Unilever’s new Uniloo project), the panel argued for a big push to increase demand for toilets.
Gardiner Harris cited the recent SQUAT survey that revealed a strong preference for open defecation among older males in India and the work of the Rice Institute’s Dean Spears which shows that Hindus are 40% more likely than Muslims to practice open defecation, a factor that accounts for the large (18%) child mortality gap between Hindus and Muslims. Experts agreed education efforts and incentives to encourage toilet use should target the sub-populations most resistant to change.
Despite barriers on both the demand and supply sides, panelists acknowledged that political commitment for ending open defecation has never been stronger. At the global level the United Nations Deputy Secretary-General, Jan Eliasson, is leading the End Open Defecation campaign and the Indian Prime Minister, Narendra Modi, announced the Swachh Bharat Mission with the goal of ending open defecation in India by 2019, to coincide with Mahatma Gandhi’s 150th birthday. There is now an opportunity for other stakeholders, especially the private sector, to fully engage with these public partners to drive down open defecation rates and simultaneously invest in child nutrition interventions. By delivering sanitation and nutrition investments together to the largest populations of children living in the open defecation communities, the deaths of many more children could be prevented and the lifelong impacts of stunting dramatically reduced.
Almost fifteen years ago the Millennium Development Goals (MDGs) set out to halve child hunger, reduce child deaths by two thirds and double access to toilets. With just 450 days left until the MDG deadline, the world has managed to reduce childhood stunting by 35%, child mortality by 50%, and those without basic sanitation by 30% -- impressive, but not enough to achieve the targets. In the time remaining, we need to pull out all stops to build new public-private partnerships to invest aggressively in integrated sanitation and nutrition solutions prioritizing the largest populations of children who grow up constantly exposed to feces.
If you have ideas for a new sanitation/nutrition public-private partnership in any of the countries listed above please contact me at email@example.com or send an email to firstname.lastname@example.org.
Editor’s Note: This post is authored by Sanjay Banka, Director at Banka BioLoo, an Indian company that manufactures and promotes biodigester toilets for use in parts of the country where the lack of infrastructure prevents the use of more conventional sanitation facilities. In the piece, Sanjay discusses the development of the biotechnology used in the toilets and describes the successes and challenges that the company has experienced while working to improve sanitation in India.
Sanitation facilities in India are alarmingly poor with over 600 million people (half of India's population) having no access to toilets. This lack of access, coupled with other inadequacies in waste disposal, such as the Indian Railways’s open-chute toilet system wherein human waste drops on the rail tracks, poses health hazards, raises environmental concerns, and leads to water contamination.
To address India’s sanitation problems, the government, NGOs, non-profit organizations, donor agencies, development bodies, and the private sector have been working in their own way, often with very little concerted effort. The partnership between India’s Defence Research and Development Organization (DRDO) and Banka BioLoo, however, provides one example of how cross-sector collaboration can work to provide sanitation solutions. Using technology developed and licensed by the DRDO, the R&D arm of the Indian Ministry of Defence, Banka BioLoo is working to meet the need for basic, easy-to-install and hygienic human waste disposal mechanisms in areas without sewerage and other sanitation infrastructure.
The DRDO had been grappling with the challenge of managing and treating the fecal matter of its defence personnel. After several years of research, the Organization developed a set of bacteria that “eat away” at human waste. Having successfully used these bacteria to treat the night soil of soldiers guarding the Indian borders, in 2010, the DRDO decided to extend the benefits of the technology to the civilian population by licensing the bio-technology to commercial firms. A host of businesses, including Banka BioLoo, signed the transfer of technology. Since then, Banka BioLoo has developed the necessary infrastructure to inoculate the bacteria and has built a business model that positions bio-toilets as a cost-effective and environmentally-friendly sanitation solution.
Bio-digester technology treats human waste at the source. A collection of anaerobic bacteria that has been adapted to work at temperatures as low as -5°C and as high as 50°C act as inocula (seed material) to the bio-digesters and convert the organic human waste into water, methane, and carbon-dioxide. The anaerobic process inactivates the pathogens responsible for water-borne diseases and treats the fecal matter without the use of an external energy source.
The only by-products of the waste treatment process are pathogen-free water, which is good for gardening, and biogas, which can be used for cooking. Bio-toilets do not require sewage connectivity and because the process is self-contained, bio-toilets are also maintenance-free. While we explain the functioning of the system to users, no specific training is required.
Banka BioLoo employs a for-profit model in distributing its bio-toilets. This approach is consistent with the thinking that came up in discussion recently at the 2014 WASH Sustainability Forum in Amsterdam, where it was recognized that many households are able and willing to pay for good quality sanitation services. Unfortunately, many are being offered cheap and possibly sub-standard systems. As solution providers, we need to be wary of poor quality “solutions” and instead appeal to the aesthetic and aspirational needs of society. While affordability is certainly an issue, it should not come at the cost of developing a sub-par product.
While we strongly believe in the for-profit model to help ensure sustainability, we are also looking for alternate financing options for households that are unable to pay for the toilet outright. We are in discussion with government agencies and microfinance institutions to develop programs that would provide subsidies or microloans to consumers.
Banka BioLoo has also worked with charities and other development organizations to provide bio-toilets in underserved areas. In March 2013, some members of the student chapter of Engineers Without Borders (EWB), studying in Gitam University, decided to undertake a project to help provide sanitation facilities in Rudraram village, at the outskirts of Hyderabad in southern India. Using a combination of student efforts, input from family members, sponsored funds, and contributions from user families, Banka BioLoo, in partnership with EWB, installed five bio-toilets. In 2014, the project provided bio-toilets to 20 additional families. The student community is keen to develop a 10-kilometer radius around the university as an open defecation free area.
One remaining challenge in promoting the use of the toilets involves the perception among some Indians that sanitation is not worth paying for. Many are comfortable with defecating in the open. In promoting the bio-toilets, we explain the negative effects on the health and well-being of society -- particularly women and children -- that are associated with open defecation. As this understanding continues to develop in India, the demand for sanitation products, such as the bio-toilets, will grow. We are actively working in this direction, trying to provide economical and eco-friendly sanitation systems for all -- from the most marginalized populations to large institutions and corporations across various states in India -- while building up the good reputation of the latrine.
Earlier this month, the Sanitation and Water for All (SWA) High Level Meeting (HLM) was hosted by the World Bank in Washington, D.C. The partnership’s third convening -- watched closely by those involved in the WASH sector -- brought together ministers of finance, health, and WASH from developing countries, as well as donors and other development partners to discuss specific commitments to achieve universal access to clean water and adequate sanitation.
An important outcome of the HLM was the endorsement of 265 new commitments addressing a range of issues in WASH -- from increasing the availability and efficiency of financial resources, to improving access to services and strengthening the institutions responsible for the delivery of water and sanitation.
In a short video report posted to SWA’s website, Barbara Frost, Chief Executive of WaterAid, discusses her impressions of the meeting and lauds the group’s open dialogue about sector-wide challenges -- such as addressing donor fragmentation and balancing the involvement of the private sector with the human right to water.
A webcast from the 2014 meeting has also been made available on the World Bank’s website.
The Bill & Melinda Gates Foundation and India's Biotechnology Industry Research Assistance Council have announced the winners of the Reinvent the Toilet Challenge: India.
Six organizations were awarded grants totaling $2 million to develop innovative "next-generation toilets" that can deliver safe, affordable, and sustainable sanitation solutions in India. A collaboration between the Gates Foundation, BIRAC, and the Indian Ministry of Science and Technology, the competition is funded by investments of $1 million each from the Gates Foundation and the ministry's Department of Biotechnology.
Announced at the "Reinvent the Toilet Fair: India" in New Delhi, the grant recipients are Eram Scientific Solutions, which, in partnership with the University of South Florida, will field test a solar-powered modular electronic toilet that is integrated with a mixed-waste processing unit; the Amrita School of Biotechnology, which will test the use of viral agents to kill pathogens and odor-producing bacteria in fecal waste; Pradin Technologies, which will test the viability of using ultrasound to reduce water use in toilets; the Indian Institute of Technology Roorkee, which, in partnership with Fresh Rooms Life Sciences, will develop a single-household container that uses human feces to incubate black soldier fly larvae, which can be processed into marketable products; the Institute of Chemical Technology, which will evaluate the concept of using fine sand-like material and an air blower to create a water-free toilet interface free of odor and flies; and BITS Pilani K.K. Birla Goa Campus, which, in partnership with Ghent University and Sustainable Biosolutions, will design a septic tank that uses electrochemistry to reduce organic pollutants and improve the quality of discharged effluent.
"Effective and comprehensive sanitation seems an impossible dream for India," said BIRAC chair K. Vijay Raghavan. "Yet today we see a congruence of new and applicable science and technology, its affordability, and sustainable implementation. This congruence is a great opportunity, which we cannot afford to let slip. By implementing effective solutions in each kind of social context, big problems can be dealt with in small units and be catalysts for scaling up."
The Gates Foundation also announced a partnership with South Africa's Department of Science and Technology to field test technologies developed as part of the global Reinvent the Toilet Challenge. The foundation and DST will invest $1 million and approximately $2.76 million (30 million rand), respectively, in the effort.
"By applying creative thinking and new approaches to sanitation challenges, we can improve people's lives. And we have no doubt that these new partnerships with India and South Africa will help us achieve this," said Brian Arbogast, director of the Water, Sanitation & Hygiene team at the Gates Foundation. "We believe that with governmental leadership, new business models, and innovation, we can dramatically increase the progress made in tackling this global sanitation crisis."
"Indian Researchers Selected to Develop Next Generation Toilets." Bill & Melinda Gates Foundation Press Release 03/22/2014.