Sanitation
While local support can go hand in hand with
attaining scale (as it does in Bangladesh, where
BRAC supports rural WASH), the observation
that “in five of the seven case studies,
local government capacity was found to be
insufficient to lead CLTS activities” does not
inspire confidence for the era of the SDGs.
Issues across demand, supply and the enabling
environment stand in the way of scale and
sustained progress.
So what does this mean?
Observation 2: One size does not fit all
There is not one approach that works best in all situations.
The reasons why people behave a certain way vary, and the
approaches used to change behavior should be based on
an understanding of those reasons. The results mentioned
above demonstrate this to some degree, and the Learning
Series report supports this also: “CLTS was widely
perceived as being universally applicable … even though
outcomes varied depending on community characteristics.
Rather than viewing it as a comprehensive solution …
CLTS should be considered as one component of a
sanitation strategy.”
While few people will argue with the fact that one size
does not fit all, too often governments or implementers
act as if one approach actually should fit all situations,
sometimes going so far as prescribing its use through
national policy.
Research from other countries and other organizations
shows similar variations based on context, ranging from
UNICEF in Mali reporting very positive CLTS outcomes
(in terms of access, use and even stunting of children), to
IPA in Bangladesh reporting mediocre results from CLTS
(or sanitation marketing) alone, but much better results
from CLTS combined with a subsidy. Recent research in
India shows enduring issues with the use of sanitation
facilities, and mixed results in terms of an increase in
coverage.
Observation 3: Many countries are unprepared for
scale
The CLTS Learning Series includes a comparative analysis
of CLTS implementation in seven countries in Africa
and Asia. Results support my opening observation: very
few (if any) projects are planned with scale in mind, and
many rely on an international organization to develop local
capacity, support implementation, monitor results, etc.
First, a project that aims to change behavior
should be designed on the basis of knowledge about
those drivers in the local context. Government offices or
organizations supporting sanitation activities at the local
level are likely to be important sources of information in
the project design phase.
Also, comparing trends in sanitation access and use
prior to and after an intervention can provide important
information about the additive effect of the intervention,
making it easier to judge the value for money provided by
the selected approach.
Finally, flexible, guiding sanitation policies are likely to
be more appropriate than fixed prescriptive policies. A
national sanitation policy requiring that programs identify
and address constraints on the demand and supply side
would leave more room for effective program design than
a national policy requiring the use of CLTS, for example,
or a national policy prescribing the use of subsidies for
toilet construction. Government investment in effective
knowledge exchange and outcome monitoring are likely
to be more useful in supporting the design of effective
programs than prescriptions about specific approaches
used throughout the country.
I would argue that no WASH practitioner reading this
should be surprised by my observations. Acting on them is
conceptually simple, even if it may be harder in practice.
About the author
Jan Willem Rosenboom is a senior program officer in the Water, Sanitation
and Hygiene Strategy for the Bill & Melinda Gates Foundation, based
in Seattle. He is a public health engineer who has been fascinated by water
and sanitation for many (many) years. At the foundation, he manages a
substantial grant portfolio including investments in market research and
market making, policy development, business model development, scaled
sanitation service delivery and low-cost sanitation product development.
Africa Water, Sanitation & Hygiene • May - June 2016
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