Sixty percent of people in South Asia lack access to adequate sanitation. Achieving the seventh Millennium Development Goal to halve the population without access to sanitation by 2015 will therefore require a massive effort. Access needs to increase quickly and widely but programmes must also be sustainable.

The Water and Sanitation Programme – South Asia looked at experience in Bangladesh, India and Pakistan to find lessons on how to achieve large-scale sustainable sanitation programmes.

Historically, such programmes have focussed on supplying infrastructure, judging success by the number of toilets installed. Experience shows, however, that without activities in communities to explain and promote sanitation and hygiene, as well as maintenance support, many toilets quickly fall into disrepair and disuse.

The Total Sanitation Approach focuses on outcomes rather than inputs. It aims to eliminate defecation in open areas through a variety of community-wide approaches. Some programmes are run by the local government, some by non-governmental organisations (NGOs) and a small number involve a partnership between the two.

NGO programmes tend to be small-scale and use their community development experience to focus on smaller levels of operation. For example, NGOs promote household level sanitation and hygiene and low cost hardware, such as toilets and washing cubicles. Government more commonly uses mass media awareness campaigns, subsidised hardware and incentives or sanctions (such as fines for open defecation) to promote hygiene.

Success stories combine NGO participatory approaches with government’s power to create incentives for behaviour change. To build on these successes requires several strategies:

• focus on a campaign mode of delivery with capacity development of all stakeholders for behaviour change
• local governments should be at the centre of programme implementation to meet public health objectives and ensure the programme’s sustainability
• focus on cost-effectiveness, which means providing a variety of choices, including low cost hardware as well as sanitation and hygiene promotion to ensure equity
• involve poor people through collective-decision making
• form local community-level organisations, such as self-help groups, that can take on hygiene promotion and monitor behaviour change
• develop strong monitoring systems to measure outcomes and progress for all villages in a programme

The Total Sanitation Approach is an improvement on old style programmes, but it requires careful planning to be successful at field level, with proper understanding of community responses to marketing, hygiene promotion and financing.

Key lessons for policymakers looking to use the experience of small-scale projects more widely and meet the seventh Millennium Development Goal:

• For long-term sustainability, policymakers should encourage the private sector to respond to market forces and supply hardware. Producers should be helped and encouraged to produce suitable low cost hardware.
• High subsidies for expensive equipment mean less money to spend on community level activities. Low or no subsidies for very low cost technology is more effective over the long term and can cover a larger geographical area.
• Accountability of implementing organisations needs improving to ensure that poor households are able to exercise choice and can be helped to construct their own toilets. Improved installation and maintenance is also necessary and local people should manage this.
• Sustainable programmes require donor support and co-ordination for large scale projects and in the long-term

Source(s):
‘Lessons Learned from Bangladesh, India, and Pakistan. Scaling-Up Rural Sanitation in South Asia’ WSP Report, by Andrew James Robinson, May 2005 (PDF) Full document.

Funded by: UK Department for International Development, AusAID

id21 Research Highlight: 19/09/2006

Further Information:
Andrew James Robinson and Soma Ghosh Moulik
Water and Sanitation Programme-South Asia
The World Bank
55 Lodi Estate
New Delhi 110 003
India

Tel: + 91 (0)11 24690488
Fax: + 91 (0)11 24628250
Contact the contributor: wspsa@worldbank.org

The World Bank

Other related links:
"Addressing shanty-town blues: guidelines for effective and sustainable sanitation"

"Managing water and sanitation: keeping it clean and simple"

"Water, Engineering and Development Centre (WEDC), University of Loughborough, UK"

"More from the Water Supply and Sanitation Collaborative Council"

"See also the International Water and Sanitation Centre"

"WHO reports on Water and Sanitation"

"WSP helps the poor gain sustained access to improved water supply and sanitation services"