Scalable approaches to universal sanitation services

By: Erik Harvey, Head of Programme Support Unit.

WASH Matters

Over the past few years, WaterAid, like many other organisations active in the water, sanitation and hygiene (WASH) development sector, has been evolving. We have been developing our approaches to promote and support access to improved sanitation services and, inextricably, promoting improved and sustained hygiene behaviours.

To do this, we have shifted from focusing on supporting partners to deliver toilets and hygiene packages. Our current approach attempts to:

  • Achieve scalability by supporting government-run mass total sanitation initiatives.
  • Encourage sustainable behaviour changes through hygiene promotion initiatives in schools or community-wide approaches.
  • Ensure a complete service managing the waste chain from collection to reuse or disposal, rather than just access to a toilet.
  • Achieve equitable and inclusive access to services for all, irrespective of gender, culture, religion, physical ability or illness.

Here I will explore some of the challenges and learning around the first two points in a rural sanitation context.

With WaterAid’s work covering 26 developing country contexts, we have a unique ability to test, develop and modify approaches for different local contexts. The key is finding scalable approaches that support the strengthening of the local WASH sector as led or facilitated by government.

We have worked to scale and adapt approaches like Community Led Total Sanitation (CLTS) and Sanitation Marketing (SanMark) that particularly shift the emphasis away from subsidies for building toilets, towards personal and communal responsibility for improved hygiene behaviours and an improved sanitation. With 2.5 billion people without access to sanitation worldwide, the scale of the issue is huge and it solution lies as much in behaviour change as it does in any technical or service challenges.

For WaterAid, achieving access is only one part of the challenge – sustaining access is even more important. We have invested heavily in programme reviews and evaluations with the aim of understanding, learning about and adapting our approaches to achieve sustainable outcomes.

Currently, this is taking the form of our annual post implementation survey process and, an in depth three-year piece of research in Nigeria. At the same time, none of this happens in a vacuum. Other organisations, such as the Water and Sanitation Programme (WSP) of the World Bank, Plan International, UNICEF and others, are also implementing, testing, and researching in this area.

Over the past year or so, I have had the opportunity to learn from these organisations about the challenges and issues surrounding sustainable, scalable rural sanitation services. There is certainly a growing understanding amongst sector professionals that there are a number of fundamentals that seem to get lost when scaling some of these approaches up and this immediately impacts the chances of achieving sustainable access to the improved services.

The challenges facing an approach like CLTS include effective facilitation of the triggering exercise, and ensuring that facilitation methods and behaviour change ‘triggers’ are tailored for the local context. The low quality of the latrines built purely through community and individual innovation also creates a huge challenge for households to maintain their changed behaviours.

These are complex challenges that require skilled community facilitators, time, effort and investment to get right. When faced with the size of the sanitation crisis programmes aiming for scale end up taking shortcuts, spending less time on in-depth formative research and on finding and training natural facilitators.

Sanitation marketing is affected by similar issues. A successful programme requires the right mix of business, marketing and product development skills, which are not easily found in traditional non-governmental organisations or government departments. But without these skills, sanitation marketing can create dependencies within the market rather than attracting investment by the private sector, or end up attempting to sell non-aspirational products.

Sanitation marketing faces the challenge of balancing people’s aspirations against what they are able to afford in the short term. On its own, it’s unable to achieve universal access.

These issues are typical of singular approaches. Without investment in thorough contextual analysis, or time to develop the right capacities, appropriate financing mechanisms and other key environmental factors, progress towards sustainable and universal access to services will remain painfully slow.

Even more worrying, is the tendency to violently switch approaches and methods when poor effectiveness becomes evident. The WASH sector often searches for a ‘silver bullet’, but the following analogy seems to describe the situation much better for me:

I am a skilled carpenter and I have recently invested in a tool box containing all the right tools to produce high quality bespoke pieces of furniture. Word spreads quickly that my products are brilliant and orders start streaming in. In order to meet the demand I hire more staff, simplify my product range and give my staff hammers and nails only. Demand suddenly diminishes and my business suffers. In an effort to resolve the situation I now buy another set of tools, with different hammers and modify my product range, but the same happens again.

There is no ‘silver bullet’ solution and switching hammers does not work. We need the entire set of tools in our tool box and we need to spend time understanding our clients’ needs to make a suitable product range. We need the right skills to produce a diverse range of quality products.

It should no longer be a question of whether or not we should be mixing CLTS, SanMark, social marketing and on-going hygiene promotional efforts, we should be doing this as standard. The challenge lies in our ability to direct the necessary effort and resources to designing the right mix for each environment and accepting that each context will be different.

Approaches might be different across a country of even a province but the need to tailor approaches doesn’t mean that methods cannot be scaled up. It just means that our investment into preparation needs to be higher, to improve the impact.