Total Sanitation and Sanitation Marketing (TSSM) Project – A WSS & H learning Initiative

1. Lessons from a Global Initiative to Understand Large-Scale Sanitation and Hygiene ImprovementsNilanjana MukherjeeWith inputs from Ajith Kumar, Nat Paynter, Ousseynou Diop, Ratna I. JosodipoeroFebruary 2008

2. Total Sanitation and Sanitation Marketing (TSSM) Project – A WSS & H learning Initiative TSSM is a partnership between WSP, The Bill and Melinda Gates Foundation, and Country Governments in India, Indonesia, Tanzania Its Goal To identify interventions with the potential to be: • Effectivein addressing the health, economic and social inequities of those with inadequate WS&S&H; • Sustainablein terms of long-term operations and financing; and • Scalableto reach hundreds of millions of people in the developing world

3. Tackling Sanitation at Scale

4. To find answers to : Learning Objectives of TSSM • What works programmatically at scale, why and how well? • What are the health, social, and economic impacts of community-led total sanitation and sanitation marketing? • What is the cost-effectiveness of these interventions? • What policies enable effective scaling up? • What financial mechanisms are needed? Using learning from impact evaluation, results-based monitoring system, and action learning

5. Sanitation Marketing Community-Led Total Sanitation Integrating the Total Sanitation and Sanitation Marketing Approaches Enabling Environment For Scaling Up

6. Examples of Lessons to Date from the Countries India Tanzania Indonesia

7. Enabling policy environment that shifts focus from household construction and use, to collective behavior change – creating Open-Defecation Free (ODF) environments, Lessons from India: Elements of High Performance -1 • Facilitated participatory community-driven ignition approaches trigger demand. • Demand created has to be supplemented by affordable options of supply of products and services.

8. Fiscal incentives & recognition to local governments as well as communities upon evidence of collective behaviour change ensures scale up. • Institutional structures with emphasis on local govts. ensures sustainable change at community levels Lessons from India: Elements of High Performance -2 • A rigorous multi-stage peer monitoring system ensures sustainability of outcomes. • Cross learning through taking indigenous innovations to scale and adapting them to local conditions ensures spread across regions.

9. Lessons from India: Scale up of ODF Communities

10. Lessons from Indonesia:Demand and Supply • Unleashing demand before the market is ready to supply pushes prices up and arrests further growth of demand. • The poor are willing to invest in sanitation. But demand is depressed in rural markets because sellers are offering little choice to the poor !Producers and vendors lack interest and resources for diversifying sanitation supplies and developing a range of affordable options for poor consumers. • Local Governments need to Identify and address specific drivers and inhibitors of local demand, to scale up effectively. They vary widely across countries, regions, cultures, gender, etc • MDG challenge = influencing poor consumers’ choice in favor of improved sanitation.

11. Lessons from Indonesia: Enabling Environment Building Policy-level consensus reached : Govt. and donor investments will NOT achieve sanitation MDGs in Indonesia, because: During 2005-15, country needs $600 million/yr to achieve MDG targets, whereas Average investment for last 30 yrs only $27 million/yr !. THEREFORE : • New approaches needed to leverage large investments from private sector and millions of households. • The small Govt. +donor funds must NOT be wasted on constructing latrines for a few hundred/thousand households. • Govt +donor funds to be used for raising demand for, and improving market supply of , “improved sanitation”. From Govt. of Indonesia’s Community-Based Sanitation Strategy, final draft awaiting Ministerial decree in March 08.

12. Lessons from Indonesia:Sustainability and Impact • “ODF only the starting point for collective behavior change. • To sustain change achieved needs a “beyond ODF strategy” e.g. • Ongoing community monitoring • Peer/third-party evaluations • Rewards/incentives for continued progress upwards on the Sanitation & Hygiene Ladders . • Ongoing promotion of “improved sanitation” by producers and sellers of services/facilities.

13. Lessons from Tanzania: Early thinking on TSSM • Limited supply of trained masons hinders stimulating demand • Don’t know how to construct slabs • Don’t know how to market skills • Have not studied household as consumer • Little demand from households discourages suppliers • History of subsidy • History of interventions telling people what they want – remarkable failure rate • High basic latrine coverage, but high diarrheal incidence • Little OD, need to focus on improving latrines, reaching whole communities Typical rural latrine • Difficult enabling environment hampers movement in sector • No policy, unharmonized strategies • Poor sector coordination • Difficult environment for small businesses (e.g., fluttering currencies, rapidly rising petrol/cement prices, heavy registration bureaucracy)

14. Lessons from Tanzania: Early thinking on TSSM, continued • Before stimulating Demand, important to have robust Supply • Otherwise run risk of demand-resistant communities • Need to understand limitations and opportunities of small businesses • Help masons in understanding consumer; access financing • Demand needs to be motivated at a community-wide level • Building on shame-peer pressure-reward combination of CLTS • HH need guidance and access to funding • Incremental steps up sanitation ladder • Enabling environment • Integration into GoT workplans • Development of National Sanitation and Hygiene Policy has begun • Develop business environment sympathetic to small businesses SanPlats constructed during mason training

15. To Sum up : Scaling up with sustainability and cost-effectiveness • Requires catalyzing both demandandsupply of improved sanitation services. • Demand and supply forces need to grow, mutually sustain, and reinforce each other. • This does not happen automatically in the market. • Enabling environment necessary to facilitate balanced growth of demand and supply. • Critical to engage and work on all three fronts

16. Thank You Household industry sparked by CLTS-generated demand in East Java Purchasing SanPlat - Tanzania