As authors of the WASH chapter of DCP-3, we wanted to share some of our key takeaways below:
sanitation and hygiene
When Prime Minister Narendra Modi launched the Swachh Bharat Mission in 2014, it marked the beginning of the world’s largest ever sanitation drive. Now, a 2017 survey by the Quality Council of India finds that access to toilets by rural households has increased to 62.45 per cent, and that 91 per cent of those who have a toilet, use it. Given India’s size and diversity, it is no surprise that implementation varies widely across states. Even so, the fact that almost every Indian now has sanitation on the mind is a victory by itself.
Achieving a task of this magnitude will not be easy. Bangladesh took 15 years to become open defecation free (ODF), while Thailand took 40 years to do so. Meeting sanitation targets is not a one-off event. Changing centuries-old habits of open defecation is a complex and long-term undertaking.
Women and girls are particularly affected by the lack of safe and accessible water, sanitation and hygiene (WASH). They suffer during menstruation and childbirth, and also carry the burden of hours spent collecting water when is it not easily accessible, causing them to miss school and risk rape and harassment. To address this, women and girls are emphasized in Sustainable Development Goal (SDG) #6: “By 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations.”
While anecdotal evidence is important — and well known — it is critical to also collect data and indicators to quantify the problems, to sensitize and inform stakeholders, and ultimately, to find solutions. However, we are struggling with a global lack of monitoring to collect such data.
Amena Begum resides in a village in the Habiganj district in Bangladesh and is a mother to three young children. Last year Amena spent US$100 to construct a toilet to ensure her three children were hygienically protected from feces.
Even though her family members have adapted to using the toilet, exposure to fecal contamination can occur anywhere. For example, while playing outside, a child may accidentally ingest soil with animal feces, or the child could be exposed when he or she eats food off of dishes washed with pond water.
It is also not uncommon for families without toilets to throw feces into a nearby bush, which remains exposed in their living area. These actions can lead to the contraction of hazardous, lethal diseases and create a traumatizing effect on the lives of many children, not to mention the unfavorable impact on the environment.
A new study on early childhood diarrhea in rural Bangladesh found that despite high on-site latrine access, frequent fecal contamination was present along all environmental pathways investigated. Human fecal markers on children’s hands and in soil, and rotavirus in stored water, soil and on hands had been detected. Animal (particularly ruminant) fecal markers were highly prevalent in water, soil and on hands.
The Independent Commission for Aid Impact (ICAI), UK’s aid watch dog, today, released its review of DFID’s programming and results in water sanitation and hygiene (WASH). In this impact review, they take a close look at the results DFID reported in its 2015 Annual Report; results that cost £ 713 million between 2010 – 2014.
Do read the full report here.
Some thoughts on the areas of concern in the report:
- The focus on ‘leaving no one behind’ is spot on. It is easy to stack up impressive WASH numbers if one ignores the poorest and the most vulnerable in communities. Safe sanitation and hygiene need to be universal for health benefits to accrue to communities. Within WASH, sanitation is specifically complex, sometimes also called a ‘wicked problem’ – a challenge foremost, of inducing lasting behaviour change. The very nature of careful social engineering required to bring about this behaviour change seems to run contrary to some of the factors that make an intervention scalable – an ability to standardise inputs and break programme components down to easily replicable bits.
- Within the broad basket of ‘service delivery’ interventions, WASH is one of the trickier sectors when it comes to measuring sustained impact, especially at scale. Naturally then, ICAI find that while DFID’s claims of having reached 62.9 million people are broadly correct, it is very hard to establish if the benefits are sustained. Therefore, the results reported remain at the ‘output’ level and that is what ICAI ends up assessing, even though what they set out to do is an ‘impact’ review. While the report speculates on sustaining benefits beyond the 2011-15 period, I wonder whether those that accessed the programme in 2011-12 continued to experience any benefits in 2015.
- The link with government systems, in terms of implementation, monitoring and sustenance remains unclear: another typical WASH issue. Barring say, India, (and this is true especially in sub-Saharan countries, government WASH budgets are highly inadequate. A lot of the work that happens is funded by donors and this implies that monitoring and maintenance happens outside the official system. Achieving local ownership in such a context is a challenge.
- ICAI finds it difficult to assess value for money (VfM) in DFID’s WASH programmes. On one hand, it finds that there isn’t enough competitive procurement, but also there is a lack of established metrics and benchmarks to analyse VfM. Following DFID’s own 3Es framework, an Economy and Efficiency analysis should be possile across the portfolio, and as far as I can tell, is rapidly being developed in the sector, and within DFID. However, partly as a consequence of the lack of ‘outcome/impact’ data, cost-effectiveness studies are likely to remain a challenge. This work by an OPM-led consortium should be particularly relevant in improving VfM analysis across the sector.
The World Bank at World Water Week 2015
As the global focus shifts to the Sustainable Development Goals (SDGs), and achieving universal access to water and sanitation, there will clearly be a need to mobilize private capital to help finance the necessary infrastructure. The Global Water Practice at the World Bank has been working with key public and private sector partners in over ten countries to mobilize domestic credit and address operating inefficiencies which negatively impact on the delivery of water and sanitation. To scale up (“billions to trillions”) it will be necessary to consider the incentives needed to attract and sustain such capital flows.