Learning to Scale Up Rural Sanitation Programs

Water and Sanitation Program, World Bank

The Bill and Melinda Gates Foundation has contributed $17.4 million to support the Total Sanitation and Sanitation Marketing project (TSSM) in Tanzania, India and Indonesia. In Indonesia, the initiative is a collaboration between the Government of Indonesia, the World Bank’s Water and Sanitation Program, and the Bill and Melinda Gates Foundation.

Project objectives

  • Support hygienic sanitation and improved health for poor communities in rural villages
  • Generate sanitation demand at scale through Community-led Total Sanitation (CLTS) and Sanitation marketing approaches by local governments
  • Increase the supply of affordable sanitation products and services at scale by working with local small scale entrepreneurs through Community-led Total Sanitation (CLTS) and Sanitation marketing approaches


  • Between November 2007 and July 2011, over 1.1 million people gained access to improved sanitation facilities fully financed by households themselves
  • Community investments for sanitation improvements in TSSM project districts were 10-30 times larger than the cost of government interventions of other districts in Indonesia
  • TSSM approach resulted in 10-15 times the number of new household toilets, compared to subsidy-based approaches like “stimulant packages” or construction credit
  • Within 18 months of intervention, a 49% increase in access to improved sanitation (over baseline access) was observed


  • Securing sustainable institutional and political commitments at national and local government levels
  • Operationalizing a national rural sanitation program to act as a vehicle for scaling up in multiple provinces
  • Sustaining local government sanitation budgets after the program ends
  • Setting up a reliable country-wide performance benchmarking and monitoring system

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