Implementation research: Water, Santiation, Health and Hygiene

1. Implementation research:Water, Santiation, Health and Hygiene David Hemson Centre for Service Delivery (CSD), HSRC

2. Introduction • The HSRC’s Centre arises out of a commitment to: • contribute scientific research towards not only understanding and explaining the requirements and dominant trends in service in service provision for human development, • but also to analyse and generate practical solutions to problems of planning and implementation. • The Centre will formulate a set of strategies to • help mitigate the service delivery problems in South Africa by • implementing multi-layered, action research projects • which aim to produce evidence-based knowledge and • demonstrations leading to local interventions that will have • a significant impact on the service delivery problematic in the country and else where in Africa.

3. The CSD is working actively to: • Develop strategies to accelerate service delivery to achieve universal access, • Monitor and measure the impact of policies and programmes such as Batho Pele, etc, • Undertake implementation research to diagnose bottlenecks and understand the dynamics in planning and budgeting.

4. KPA and CSD engagementKPA from Strategic Framework for Water Services and DWAF KPI

5. Addressing government objectives • The CSD is engaged with country partners in Southern Africa in a major project, Measuring Service Delivery. • This research focuses on the study of socio-political dynamics, good practice interventions, the development of implementation models, inter-departmental coordination in monitoring and evaluation, and cooperative engagement between technological and social initiatives. • Assessment of expanded works (EPWP) and futures research is also being undertaken. The CSD is focusing on impact evaluation to be able to provide concrete evidence on the effects of different policies and technologies.

6. Key objectives • Government Programme of Action 2007, Social Cluster • 4.3 Complete concrete plans on implementation of the final stages of programmes to meet the targets for universal access to water in 2008, sanitation in 2010 and electricity in 2012 • 7.2.3 All schools to have access to clean water and sanitation • Government Programme of Action 2007, Governance & Administration Cluster • 1.3 Batho Pele • 1.3.1 Implementation of Batho Pele programmes

7. Universal access • Although there has been general progress, the target of universal access to piped water for all by 2008 will not be reached and that for sanitation by 2010 is in doubt. • There is also a challenge to meet the objective of safe water and improved sanitation in all schools. The most accessible areas are largely served, but there are difficulties in reaching the more remote. • Taking three “rural” provinces (Eastern Cape, Mpumalanga, and Limpopo), for instance, the backlog declined from 34.6% to 28.4% but the numbers in the backlog increased over the period 1995-2005.

8. Safe Drinking Water • The linkages between water, hygiene and health improvement are critical given high HIV and TB prevalence, for instance, pathogens incriminated in diarrhoeal cases among HIV-positive individuals are also found in the household drinking water.

9. Lag in Sanitation • Sanitation also poses a peculiar challenge and lags behind water delivery; while 89% of the population accesses piped water, only 64% has improved sanitation i.e. 25% of the population accessing piped water does not have improved sanitation in 2007 (Community Survey). The bucket toilet eradication campaign has succeeded in formal urban areas, while the backlog in rural areas and informal settlements still remains.

10. Accelerated delivery • Despite pro-poor financing mechanisms (as contained in the Equitable Share formula), there is evidence that improved access to piped water and improved sanitation is slow in those municipalities which have the greatest backlogs. In municipalities such as Mbizana LM and Sisonke DM, for instance, there has even been a decline in access to piped water between the years 2001-2007. Research is on-going in this respect.

11. Perceptions matter • Perceptions of delivery matter as confirmed by service delivery protests and xenophobic outbursts. The preliminary results of an assessment of Batho Pele (from the SA Social Attitude Survey, 2007) indicate that progress is acknowledged although there is substantial dissatisfaction about consultation and responsiveness. • For instance, while 45,8% feel that government is providing basic services of good quality (“Service Standards”, Batho Pele 2); 66,5% felt that municipalities do not consult communities on basic services (“Consultation”, Batho Pele 1).

12. Meeting needs of poor Dissatisfaction with service delivery is greatest among the poorest such as those in rural areas whose voices may not be heard. For instance, among the lowest income group 45.4% were dissatisfied with water and sanitation services while among the highest income group only 5.3% were dissatisfied (SASAS 2005). Participation in public consultation is generally low, but the poor tend to make more use of existing structures (e.g. Ward Committees) for participation.

13. Recommendations 1. A review of planning and implementation is needed to gain knowledge as to why targets are not being met and to ensure that adequate resource flows lead to accelerated delivery. Although new deadlines are being set (for 2014), not all problems are resolved with more time being made available.

14. Recommendations 2. Institutional redesign is needed to ensure greater accountability within and between institutions and to the public. A number of departments (e.g. DWAF, DOH, DPLG, and DOE) and municipalities need to have their work aligned to achieve accelerated delivery and improved impact on health with clear responsibility assigned to agencies and staff positions. Apart from better delivery this will also strengthen the perception that Batho Pele principles are being acknowledged.

15. Recommendations 3. Greater support should be given to encouraging public participation among the poor through Ward Committees, community groups, social movements, and with civil society generally.

16. Recommendations 4. The African Conference on Sanitation and Hygiene 2008 highlighted the lag in improved sanitation delivery. As well as accelerated delivery, good practices and sustainability, decisive initiative is needed to place people at the centre of sanitation campaigns to embed hand-washing facilities and practices in schools and homes. Health and hygiene promotion can be eclipsed by the drive for delivery.

17. Recommendations 5. Attention needs to be focused by DPLG and DWAF on encouraging feedback and greater responsiveness in municipal service delivery. In relation to outbreaks of diarrhoea and other water service-related diseases, for instance, a protocol for open access to relevant information is needed to achieve a rapid response from municipalities and the people.

18. Recommendations 6. Increasing use should be made of tools such as the index of multiple deprivation at the provincial and municipal level to inform policy makers and to focus on clusters of deprivation.

19. Recommendations 7. Those municipalities which, despite a history of backlogs, are accelerating delivery should be studied to understand what practices they employ and these should be modelled and replicated more widely.

20. Children carrying water: TECL/ILO Cholera epidemic study WASH campaign research project Revised school curriculum; “Engaged” health promotion WRC Voice and sustainability project Accreditation + materials: Development Practice (Water Services), SAQA Learnership #23093 Developing HESET (Health, Environment, Social, Economic and Technical) toolkit to establish impact of water services, UJ Technology Transfer For Poverty Reduction (DST) Value for Money project PSC’s Evaluation of Government’s Poverty Reduction Program Expanded Public Works Program Methodology for assessment Service delivery, analysis of data project Review of State of Nation commitments Public participation in planning project Southern African Trust: Measuring Service Delivery, BMT Related projects and reports

21. Relevant publications • Poverty and Water - Explorations of the reciprocal relationship (eds), CROP International Studies in Poverty Research Zed Press. • Community development and engagement with local governance in South Africa. Community Development Journal. May 22, 2008. • Can participation make a difference? Prospects for people’s participation in planning. Critical dialogue. 3 (1): 9-15. 2007. • Last but not least? Free Basic Water and the poorest. Chapter for book on Free Basic Water. • Commitment to accountability. Water Sewage and Effluent, pp31,33. May 2007. • The burden of care: water, health and gender in the Dolphin Coast concession. Urban Forum 18(3): 211-225. October 2007. • ‘The toughest of chores’: Policy and practice in children collecting water in South Africa. Policy Futures in Education. Volume 5, Number 3, pp315-326, 2007. • The long walk: burden child water collection. SA Labour Bulletin, Volume 30, Number 4, pp26-28. October-November 2006. • KZN: Pipedream for the province’s poor? Mail and Guardian. 28 April 2006. • Learning to live with rats. Mail and Guardian. 28 April 2006. • The cholera aftermath. Mail and Guardian. 14 July 2006.