Report summary

Sanitation and the poor

Authors: Rebecca Scott, Andrew Cotton and Beenakumari Govindan, July 2003

Task management: Rebecca Scott and Andrew Cotton

Quality assurance: Prof. Sandy Cairncross

Executive Summary

There are currently 2.4 billion people worldwide without access to improved sanitation. Inadequate sanitation is a key link in the cycle of disease and poverty that affects the world’s poorest people, who would otherwise contribute more to overall economic and social development. Of the global burden of disease, nearly a quarter (23%) is a result of poor environmental health, of which 28% is attributable to diarrhoea – itself primarily a consequence of poor sanitation.

In this document we adopt the definition of sanitation used in the UNICEF Sanitation Programming handbook, namely a process whereby people (men, women and children) demand, effect and sustain a hygienic and healthy environment for themselves. This is achieved through a combination of hardware (latrines), hygiene promotion and other supporting software activities and the development of an enabling environment to ensure that hardware and software can be delivered.

The World Summit on Sustainable Development (WSSD) in Johannesburg in 2002 adopted an international sanitation target – to halve the number of people without access to basic sanitation by 2015. This target now sits alongside the target for water supply in support of the Millennium Development Goal (MDG) of ensuring environmental sustainability. Improved sanitation directly impacts on other MDGs:

achieving universal education and promoting gender equality;
reducing child mortality; and
improving maternal health.

One of the reasons so many people do not have sanitation is that the demand often does not exist, or is constrained through – for example – ignorance, mis-information, past bad experience, unnecessary bureaucracy or regulation; this contrasts with other services such as water and power. Sanitation programmes have traditionally been supply driven, lacking any significant consultation with users on what their requirements are. One way to promote sanitation is through the application of social marketing techniques. Social marketing of sanitation aims to both create and satisfy a demand, through the provision of adequate services alongside the adoption of appropriate hygiene practices, for the correct use and sustainability of the facility.

The challenge of providing access to sustainable sanitation services at the scale required is huge, more so because there are relatively few examples worldwide of successful large scale sanitation programmes. Requirements include the following.

An overarching vision and political will at the highest level to take on the national challenge and to articulate the broad objectives – for example around the likely role of government, civil society and the private sector in service delivery.
Development of national policy which interprets the vision and reflects a broad consensus of key stakeholders. The policy needs to indicate appropriate regulatory and institutional frameworks; very few countries have a national sanitation policy.
Strategies to translate policy into programmes; for example, there might be different strategies for: rural communities and the urban poor; school sanitation; emergency situations; and longer term needs.
Development of programmes which enable improvements to sanitation to be ‘rolled-out’ at the scale required. The programme will typically set out overall objectives and a consistent set of rules (e.g. on finance or human resources) which are applied at the level of individual projects. Whilst a range of approaches to sanitation provision have been developed, tried, tested and modified on a small scale over the years, the basic problem remains – achieving any sense of scale in sanitation programmes.
Implementation of programmes through smaller projects or schemes which may involve different stakeholders, e.g. government, private sector, NGOs, - all of whom operate within the framework of the programme.
Monitoring of activities and subsequent evaluation of impacts, that enables the learning of lessons to inform and support further policy development.

The role of government is changing from that of service provider to that of ‘enabler’ – supporting local government and local management of sanitation services – through, for example, moves to greater decentralisation. The relationship between government, service providers and beneficiaries (poor households) therefore becomes more complex, requiring careful planning, management and development of clear roles and responsibilities.

Capacity development – getting people with the right skills in the right place today and tomorrow – is a major constraint to reaching the MDG target. Skills such as social marketing, promotion and facilitating access to finance for the poor may need to become generic at local government level if service delivery is to be scaled up.

Key issues in relation to policy, strategic planning, programme development, implementation and monitoring include inter alia :

better co-ordination between different sectors which have responsibility for sanitation (e.g. health, education, water);
institutional arrangements which define clear roles and responsibilities: local government is likely to have an increasingly important role;
programmes which focus on demand generation, which are themselves demand responsive;
ensuring that vulnerable and marginalized groups are included;
creating better access to finance for poor households; and
capacity development around key skills, to deliver demand based approaches.

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