Demand-led approaches to Sanitation

1. Demand-led approachesto Sanitation

2. “What is the greatest medical milestone of the last 150 years?” Sanitation Poll carried out for the British Medical Journal, 2007 “That’s 2076 where I live!” MDG 7, Target 10: To halve, by 2015, the proportion of people without access to safe drinking water and sanitation

3. The Awful Truth… 88% of global diarrhoeal disease is attributed to safe water supply, inadequate sanitation, and hygiene 2.6 Billion people (almost 40% of global population) lack access to basic sanitation That's just the health outcome... 5,000 children under 5 die each day due to diarrhoeal diseases routed in inadequate water & sanitation – deaths which are preventable… 3

4. Objective of IY of S is to put the global community on track to achieve the sanitation MDG

5. 5 key messages of the I Y of S are: • Sanitation is vital for health – we’ve seen the statistics • Sanitation is a good economic investment • Sanitation contributes to social development • Less illness; improved nutrition among children; increased learning and retention among pupils; higher work productivity among adults; more dignity and privacy for all • Good sanitation practice protects the environment • Improved sanitation is achievable • $9.5 billion annual cost to reach the MDG 443 million school days lost each year due to diarrhoea: 4 in 10 children will not reach their full educational potential 5

6. How would you approach the following need? • Poor beneficiary community c.700 homes (4,200 pop.) • High incidence of diarrhoea, especially in under 5s, and worms amongst school-age children • Very low proportion of latrine ownership, with prevailing evidence of poor use and maintenance • Open defecation is prolific 6

7. The problem with supply-driven approaches Coverage may increase but take-up of proper latrine use is low, and mis-use is common Inappropriate technology (standardised approaches) often used No focus on cultural and social considerations Sanitation remains the poor relative in “WASH” or “Watsan” 7

8. Demand-led (Demand-responsive) approaches Although improved sanitation leads to improved health, people associate toilets with other benefits: Easy to use and maintain Privacy Less embarrassment for visitors Dignity! Status Asset Safety (especially for women) Comfort & convenience Less flies around compound

9. Rationale to a marketing approach: • Many people, including the poor, are willing to pay for good sanitation that will satisfy their requirements if the technology is packaged and marketed appropriately, and the supply mechanism is easily accessible Apply a marketing approach to sanitation

10. Social (or Sanitation-) Marketing Social marketing offers a more promising approach to promoting positive hygiene behaviours compared to traditional, health education-based approaches Definition of Social Marketing 'The use of commercial marketing techniques to promote the adoption of behaviour that will improve the health or well-being of the target audience or of society as a whole' (Weinreich, 1999) 10

11. Demand & Supply: Applying a marketing approach to sanitation is not just about advertising; it is also about ensuring that appropriate sanitation options are made available and that suppliers have the necessary capacityto provide the desiredservices. Sanitation marketing is about ensuring a balance between demand (user) and supply (products, provider) 11

12. How do you market sanitation?

13. Who’s involved in sanitation marketing? • SM creates opportunity for users, public sector, private sector, and NGOs all to get involved / to work together; • A partnership for sanitation marketing could be made up of the following groups: - Households - Informal toilet builders - Pit emptying truck operators - Market research agencies - Communication/advertising agencies - NGOs - Government agencies - Financial institutions

14. Sanitation marketing does NOT mean neglecting hygiene education: Meeting social aspirations does not make a toilet a sanitary facility. That can only happen when the sanitation system is combined with hygienic behaviour based on an understanding of the effect on health of good hygiene practice and safe excreta disposal. Personal and public hygiene and care for even the simplest sanitary facility are at the core of good sanitation! 14

15. Case StudiesDar es Salaam, TanzaniaWest Bengal, IndiaSulabh, Bihar State, India

16. Advocacy in promoting demand-led approach • Hygiene education often left to NGOs, with government coming in on structural phase > Limited buy-in by govts. • “Hook sanitation on health, and promote politically through citizen’s rights approach” (ODI) • > Sanitation as a public right, not just a private good: governments to take more responsibility • Acknowledge sanitation in the wider development agenda * • Use notion that sanitation is a good investment • Discrete budgets for sanitation are needed • Government incentives to stimulate private sector development • Long-term commitments: government planning processes must allow for this 16

17. Community Led Total Sanitation(CLTS) Focuses on igniting a change in sanitation behaviour rather than constructing toilets. Achieved through a social awakening, stimulated by facilitators. 17

18. Community Led Total Sanitation CLTS does not identify standards or designs for latrines, but encourages local creativeness. This leads to greater ownership, affordability and therefore sustainability. 18

19. Key components and methodology: Begins with a community-based appraisal of current sanitation practices, including open defecation. Methodology includes: • Mapping defecation areas, • Transect walks • Calculations of faecal load • Action planning 19

20. Difference between traditional approach and CLTS 20

21. Film clip Community-Led Total Sanitation, by Kamal Kar Produced by Plan International with the Institute of Development Studies Friday 19 Sept., 9.30 am, Room A

22. Impact on our sanitation programming? • Adopt demand-led approach wherever possible, and consider sanitation in respect of development outcomes generally, not just as a “WASH component” • Avoid straight subsidies on sanitation hardware Let every latrine be a wanted latrine (and therefore used) * • Re. advocacy, linkage of sanitation with water is often unhelpful – sanitation usually loses out to water (policy, strategy, budgets). • Consider approaches such as CLTS, but support with long-term hygiene education programmes (e.g. PHAST), and ensure hard sanitation outputs (latrines, disposal sites) are included in sanitary surveys. 22

23. Impact on our sanitation programming? continued • Public sector still has important role: - creating the right policy environment: incl. regulation (for price, quality, environmental impact, protection of water resources, etc.) - incorporating subsidies for hygiene promotion, sanitation marketing, supporting small-scale-providers, school sanitation, institutional sanitation, etc. • Consider urban & peri-urban (e.g. squatter, slum) projects: 60% urbanisation by next generation, of which 60% will be unofficial settlement! • Consider schools and churches as demonstration / entry points (Resources...)

24. Global Sanitation Fund (Launched March 2008) Run by the Water Supply and Sanitation Collaborative Council (WSSCC) of the UN Financing mechanism established to boost expenditure on sanitation and hygiene: Goal is to help large numbers of poor people attain safe and sustainable sanitation services and adopt good hygiene practices GSF supports other organisations’ (NGOs, CBOs, Local Govt.) implementation work by giving grants from a pooled global fund to selected organisations in eligible countries Must be linked to national sanitation policies/strategies Demand-led approaches, NOT supply- or subsidy-driven First round countries: India, Pakistan, Nepal, Senegal, Burkina Faso, Uganda, Madagascar. Second round of countries to be announced in 2009