Delivering life-saving toilets at scale in Africa's cities

Lita Nyenga, a widow living with her daughter in Malawi’s capital, Lilongwe, longed for an improved toilet, but could not afford to build one. Although her burnt brick toilet has degraded to unsafe levels, Lita, her daughter, and their tenant household of three continued relying on it as they had no other option. Today, Lita sees hope when she wakes up to witness her toilet almost completed. She was among the first 1,700 households to sign up for the available 1,000 toilets for the first phase of the World Bank-funded Lilongwe Water and Sanitation Project (LWSP) in Malawi.

This toilet construction program targets 8,000 vulnerable households residing in the peri-urban areas of Lilongwe. Improved sanitation solutions in the city will reduce fecal contamination and prevent enteric infections, especially among children. A similar program is under implementation in neighboring Zambia as part of the Lusaka Sanitation Program, and will soon start in the cities of Tete and Quelimane in Mozambique under the Mozambique Urban Sanitation Project. But the experience shows that providing non-networked sanitation to millions of unserved city households is a significant service delivery challenge that most utilities or municipal sanitation departments are ill-equipped to handle.

The toilet construction programs are part of a broader World Bank engagement through the Citywide Inclusive Sanitation approach aimed at improving access to safely managed sanitation through the provision of emptiable household toilets. While the technology is relatively simple, the delivery mechanism is far from straightforward. Many utilities struggle to implement and sustain toilet construction projects as part of their service offering after the source of financing and the involvement of external partners has ended. Emerging experience points to three critical ingredients for a successful toilet construction program. The first is demand creation. An improved and emptiable toilet is generally more expensive than a self-constructed traditional unimproved toilet; thus, households on constrained budgets will not rush to get one.

The conventional prescription for the demand problem is behavioral change communication (BCC). However, while BCC is important, it is not enough to generate demand. Utilities and municipal authorities must devise other ways to nudge households to sign up for an improved toilet using insights from behavioral science. For example, in Lusaka, the utility provided up to an 85 percent time-limited discount on improved toilets, equivalent to the cost of the toilet's substructure. In addition, the utility partnered with the city council to develop and enforce new sanitation bylaws and standards. Behavior studies showed that even a mere threat of enforcement resulted in 91 percent more uptake than other types of messaging.

After generating the demand, the next question is how to meet that demand. In all the programs referred to, utilities and municipal departments have partnered with the private sector to deliver services through output-based and performance-based service contracts for toilets and fecal sludge management (FSM) services. The output-based agreements are structured to share the demand risk between the utility or municipal authority and the contractor. Thus, besides sanitation marketing by the utility, the contractors are incentivized to promote toilets and encourage households to sign-up. For instance, in Lilongwe and Lusaka, the contractor receives 30 percent of the unit bid price of each toilet unit upon “signing up” customers as indicated by verified customer contribution. The utility pays the remainder (70 percent) upon verified completion of construction according to pre-specified quality standards. On the other hand, the FSM contracts incentivize the expansion of FSM services to unserved areas according to prescribed service performance criteria.

Although all three programs are still under implementation, early results indicate that simple behavior nudges to stimulate demand and well-structured partnerships with the private sector can deliver toilets at scale. The Lusaka program, for example, provided 3,500 toilets, serving 63,000 people within the first three years of implementation. In Lilongwe, the program is picking up pace, with 167 of the planned 1,000 toilets of phase 1 currently under construction. Excitement is already building in Quelimane and Tete, although the toilets are still at the design stage. Households consulted during the engineering design expressed willingness to sign up for the program, and the domestic private sector is eager to join this new approach to service delivery. Together, the three programs will benefit 35,000 households (close to 200,000 people) in the targeted cities.

The third aspect concerns mainstreaming the toilet program as part of the city sanitation service package. In Lusaka, the utility has received approval from the regulator, National Water and Sanitation Council (NWASCO), to utilize the sanitation surcharge to continue the household toilet construction program. Existing unimproved toilets are viewed as a public health hazard for all the city residents, thus justifying public financing mechanisms (such as a sanitation surcharge) to fund improvements for the low-income residents. In Mozambique, the toilet construction program fits into a broader set of reforms aimed at improving access to sanitation services for all. So far, six cities have established the sanitation regulatory framework and introduced sanitation tariffs, which among other sanitation services, will support toilet construction programs to enable access for the poor and vulnerable residents and minimize public health risks.

These experiences give us reason to believe that African cities can overcome the urban sanitation challenge in the next decade with the right set of demand and supply-side interventions and a progressive framework for public financing that recognizes the lack of access to emptiable toilets as a public health hazard.