Scaling Up Rural Sanitation: Publications and Tools

Publication Type: Academic Publications

Sanitation Marketing in Cambodia (Rosenboom, Jacks, Kov, Robert, Baker; 2011)
A pilot sanitation marketing program was launched in Cambodia to make affordable, desirable latrines available through market channels. Option design, contractor training, awareness raising, and marketing resulted in a branded, low-cost pour-flush latrine. Trained suppliers have sold more than 7,400 units 22 months after project inception. Planned next steps include expanding technology choices (still lower costs, and/or suitable for challenging physical circumstances), developing stronger linkages with micro-credit schemes and developing approaches for scaling up the approach. Published in Waterlines, Volume 30, Number 1.

 Academic Publication |  Video

Sustainability of Rural Sanitation Marketing in Vietnam: Findings from a new case study (Devine, Sijbesma; 2011)
A research study conducted by WSP found that coverage had continued to grow in pilot communes two years after the end of a rural sanitation marketing pilot project. Promoters had continued their activities, albeit at a lesser intensity level, and many suppliers had expanded their product range and customer base and reported increased revenues. Lack of tailored information on more affordable toilet construction and financing were the main barriers for those who had not yet built a sanitary toilet, despite having been reached by the pilot project. Published in Waterlines, Volume 30, Number 1.

 Academic Publication

Sanitation Marketing as an Emergent Application of Social Marketing: Experiences from East Java (Devine; 2010)

Describes how WSP has introduced innovative formative research, social franchising, product branding, and integrated communications using mass media to overcome sanitation challenges in East Java. Published in Cases in Public Health Communication and Marketing, Volume 4.

 Academic Publication

Understanding Sanitation Options in Challenging Environments (WSP: Djonoputro, Blackett, Rosenboom, Weitz; 2010)
Across Southeast Asia many of the poorest communities live on marginal land or over water. Owing to adverse geographic and climatic conditions in these areas, neither conventional nor most well known ‘alternative’ sanitation options are feasible at affordable prices for poor communities or poor governments. A recent study in the region has started to develop a typology of challenging environments for sanitation as a means to: assess the scale of the challenges; understand the specific issues involved in improving sanitation; identify, develop or improve sanitation technologies to cope with different environments; and to disseminate the results in the study countries, regionally and beyond. Published in Waterlines, Volume 29, Number 3.

Academic Publication

What Does it Take to Scale up and Sustain Rural Sanitation Beyond Projects? (Mukherjee, Kumar, Cardosi, Singh, 2009)
New learning is currently demonstrating that projects need to identify and nurture key components of an enabling policy, institutional, and financial environment, for rural sanitation interventions to yield sustainable results at scale. Published in Waterlines, Volume 28, Number 4.

 Academic Publication

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Publication Type: Technical Reports & Papers

Promoting handwashing and sanitation : evidence from a large-scale randomized trial in rural Tanzania (WSP: Briceno, Coville, Martinez)

The association between hygiene, sanitation, and health is well documented, yet thousands of children die each year from exposure to contaminated fecal matter. At the same time, evidence on the effectiveness of at-scale behavior change interventions to improve sanitation and hygiene practices is limited. This paper presents the results of two large-scale, government-led handwashing and sanitation promotion campaigns in rural Tanzania. 

Working Paper

 

What Influences Open Defecation and Latrine Ownership in Rural Households? Findings from a 

Global Review (WSP: O’Connell; 2014)

As part of its Scaling Up Rural Sanitation and Domestic Private Sector Participation programs, WSP has been commissioning formative research studies among households. Three specific sanitation behaviors are covered in the review: open defecation, acquisition of toilets, and improvement of latrines. This review collects the results from formative quantitative and qualitative research reports and presentations from eight countries: Cambodia, India (Rajasthan, Meghalaya, and Bihar), Indonesia (East Java), Kenya, Malawi, Peru, Tanzania, and Uganda. The most salient factors influencing rural sanitation behaviors that emerged from the review include access to and availability of functioning latrines, sanitation products, and services; latrine product attributes (for example, perceptions of cleanliness and durability); social norms around open defecation; perceptions of latrine affordability; self-efficacy to build latrines; and competing priorities for other household items. The review also identified a number of emotional, social, and physical drivers. These include shame and embarrassment associated with open defecation, as well as perceptions of improved social status, privacy, and convenience associated with latrine ownership and use.

 

Working Paper

 

Pathways to Success: Compendium of Best Practices in Rural Sanitation in India (WSP, Government of India; 2014)

This report addresses the need to broaden communication on rural sanitation. The 16 success stories documented in the Compendium can be lessons of great inspiration and serve as models for various Gram Panchayats, Districts, and States across India in overcoming hurdles and obstacles in various fields as diverse as community participation, sustainability, resource mobilization, solid and liquid waste management, program implementation, IEC practices, and institutional reforms.

 

Report

 

Sanitation and Externalities: Evidence from Early Childhood Health in Rural India (WSP: Andres, Briceno, Chase, Echenique; 2014)

This paper estimates two sources of benefits related to sanitation infrastructure access on early childhood health: a direct benefit a household receives when moving from open to fixed-point defecation or from unimproved sanitation to improved sanitation, and an external benefit (externality) produced by the neighborhood’s access to sanitation infrastructure. The paper uses a sample of children under 48 months in rural areas of India from the Third Round of District Level Household Survey 2007–08 and finds evidence of positive and significant direct benefits and concave positive external effects for both improved sanitation and fixed-point defecation.

 

Policy Research Working Paper

 

Analysis of Handwashing Behaviors Measured in Baseline Impact Evaluation Surveys: Findings from Peru, Senegal, and Vietnam (WSP: Ram, Briceño, and Chase; 2014)

Handwashing with soap has been shown to reduce diarrhea and respiratory disease, the two leading causes of childhood deaths in low- and middle-income settings. Global Scaling Up Handwashing was initiated in 2006 by WSP in Peru, Senegal, Tanzania, and Vietnam. The handwashing promotion interventions were developed using a framework known as Focus, Opportunity, Ability, and Motivation (FOAM). A handwashing promotion intervention can only result in improved health or other downstream benefits if it results in increased handwashing behavior. In the impact evaluation of Global Scaling Up Handwashing, handwashing is measured using self-reports, rapid observations, and structured observations, recognizing that each method provides useful insights into awareness about handwashing, the availability of materials necessary for handwashing, and the practice of washing hands at critical times. Specifically, with respect to the FOAM framework, this report addresses constructs within the focus, opportunity, and ability domains. The goal of this report is to describe handwashing behavior of households included in the project impact evaluation, as measured during the baseline surveys conducted in Peru, Senegal, and Vietnam. The baseline surveys of Global Scaling Up Handwashing indicate opportunities to improve handwashing behavior in all of the countries where interventions are being tested. In the future, correlations can be described between measures and relationship with disease risk and other hygiene behaviors in the home, including sanitation and household water treatment.

 

Technical Paper

 

Validity of Rapid Measures of Handwashing Behavior: An Analysis of Data from Multiple Impact Evaluations in the Global Scaling Up Handwashing Project (WSP: Ram, Sahli, Arnold, et al.; 2014)

There is increasing interest in improving handwashing in low- and middle-income countries. The validity of rapid handwashing measures was evaluated by comparing them to handwashing behavior measured during five-hour structured observations. Handwashing was measured in the impact evaluation of the Global Scaling Up Handwashing project, carried out by WSP in Peru, Senegal, and Vietnam. The project tested the effects of at-scale implementation of hand washing promotion on various outcomes, including behavior and health, in those four countries, using cluster-randomized controlled trial designs. Structured observations were carried out among a subset of households participating in end line surveys in each country. Regression was used to model the relationship between the rapid hand washing measure and the probability that hands were washed during the observed event, accounting for the repeated nature of structured observation data. This multi-country analysis of the validity of rapid handwashing measures confirms the utility of observing handwashing materials at the places where people wash hands, at the times most necessary for washing them (after fecal contact and before food preparation). The findings described reinforce the global imperative of improving handwashing behavior for prevention of the leading causes of death in young children.

Technical Paper

 

Impact Evaluation of a Large-Scale Rural Sanitation Project in Indonesia (WSP: Cameron, Shaw, Olivia; 2013)

This World Bank Policy Research Working Paper from WSP evaluates the impact of the Total Sanitation and Sanitation Marketing project in Indonesia, where about 11 percent of children have diarrhea in any two-week period and more than 33,000 children die each year from diarrhea. The evaluation utilizes a randomized controlled trial but is unusual in that the program was evaluated when implemented at scale across the province of rural East Java in a way that was designed to strengthen the enabling environment and so be sustainable. Among other findings, the authors found that diarrhea prevalence was 30 percent lower in treatment communities than in control communities at endline (3.3 versus 4.6 percent). The analysis cannot rule out that the differences in drinking water and handwashing behavior drove the decline in diarrhea. 

World Bank Policy Research | Working Paper | Research Brief | Field Note

Results, Impacts and Learning from Improving Sanitation at Scale in East Java, Indonesia (WSP: Pinto; 2013)

Indonesia has the second highest number of open defecators worldwide at 59 million, according to the 2013 update published by the WHO/UNICEF Joint Monitoring Program (JMP), and lags substantially behind its peers in the region in terms of access to sanitation. Efforts to expand sanitation coverage have barely affected the lives of poorest populations where rampant diarrheal disease continues to affect the health and well-being of the next generation of children. This field note presents the achievements, learning and reflections that resulted from implementing a large-scale sanitation program in East Java, Indonesia and provides recommendations for future initiatives aimed at increasing access to improved sanitation globally.

 Field Note

 Technical Paper

Policy Research Working Paper

Effects of Early-Life Exposure to Sanitation on Childhood Cognitive Skills: Evidence from India’s Total Sanitation Campaign (WSP: Spears, Lamba; 2013)

Early life health and net nutrition shape childhood and adult cognitive skills and human capital. In poor countries—and especially in South Asia—widespread open defecation without making use of a toilet or latrine is an important source of childhood disease. This paper studies the effects on childhood cognitive achievement of early life exposure to India’s Total Sanitation Campaign, a large government program that encouraged local governments to build and promote use of inexpensive pit latrines. 

 

Policy Research Working Paper

  

Village Sanitation and Children’s Human Capital: Evidence from a Randomized Experiment by the Maharashtra Government (WSP: Hummer, Spears; 2013)

Open defecation is exceptionally widespread in India, a county with puzzlingly high rates of child stunting. This paper reports a randomized controlled trial of a village-level sanitation program, implemented in one district by the government of Maharashtra.

 

Policy Research Working Paper

What Does It Take to Scale Up Rural Sanitation? (WSP; Perez, 2012)
This working paper shares lessons and best practices that were identified to generate demand for sanitation at the household and community level; increase the supply of affordable, aspirational sanitation products and services; and strengthen local and national governments to lead large-scale sanitation programs.  Key components are introduced and illustrated with examples from the field, including:  Community-Led Total Sanitation, Behavior Change Communication, and Sanitation Marketing.  The evidence presented in this Working Paper can help inform government and donor policies and practices, increase investment in sanitation, and ensure that these investments reach the poor.

Working Paper: English / French  

WEDC/WSP Online Learning Course: Rural Sanitation at Scale: English | French

Policy and Sector Reform to Accelerate Access to Improved Rural Sanitation (WSP: Rosensweig, Perez, and Robinson; 2012)
Increasing access to improved sanitation requires systemic sector and policy reform.   Baseline and endline assessments of the enabling environment for rural sanitation programs in India, Indonesia, and Tanzania in 2007 and 2010, respectively, sought to learn more about the effect of these elements on access to improved sanitation.   These assessments examined the programmatic and institutional conditions needed to scale up and sustain large-scale rural sanitation programs.

The  assessments found that the most significant progress was made in four of the eight enabling environment component areas studied: program methodology, implementation capacity, availability of sanitation products and services, and monitoring and evaluation. The countries with the strongest enabling environment, such as Himachal Pradesh, India, which has achieved almost universal access, made the most progress in scaling up rural sanitation. The learning experience also indicated that not all components of the enabling environment are equally amenable to external intervention. External agencies have less influence, for example, in strengthening political will than in strengthening implementation capacity.  

Working Paper

Identifying the Potential for Results-Based Financing for Sanitation (WSP and SHARE: Trémolet; 2011)
Results-Based Financing (RBF) offers an alternative to traditional sanitation financing by allocating public funds based on the achievement of specified results. This working paper offers practical ideas for advancing the use of results- and performance-based financing mechanisms in the delivery of sustainable sanitation services. The proposed “Grow Up with a Toilet” RBF program in Cambodia, for example, targets sanitation finance to improving sanitation among young children and promoting ongoing sanitation development. RBF incentives can also encourage service providers to provide services to the poor, such as in Morocco, where three providers of piped water and sewerage services received subsidies based on both their completion of the project and its ongoing support. Learn More

Working Paper

Long Term Sustainability of Improved Sanitation in Rural Bangladesh (WSP: Hanchett, Krieger, Kahn, Kullmann, Ahmed; 2011)
A WSP study of 53 Union Parishads, declared 100% sanitized/open defecation free almost five years ago showed that 90% of households had sustained use of a latrine that adequately confines feces. Factors associated with this outcome include a shift in social norms away from open defecation to using a latrine; on-going sanitation programming that reinforces latrine use; and easy access to private sector sanitation providers. In addition, a comparative analysis of four programmatic approaches used revealed little variation in sustained outcomes.
 Technical Report  | Webinar

Partnering on the Road Towards Achieving Total Sanitation in East Africa (WSP: Coombes; 2011)
In East Africa, access to basic sanitation remains low, and intensive work is needed across the region to achieve sustained scaling up of sanitation. Determining how governments and non-governmental agencies can work together more effectively to achieve this goal is essential. This Learning Note highlights a learning exchange held for representatives from the Government of Tanzania and six non-governmental organizations. An initial outcome included consensus on a set learning questions to expand the knowledge base in areas such as equity and inclusion, sanitation marketing, and monitoring and evaluation.
 Learning Note

Gender in Water and Sanitation (WSP: Rop; 2010)
As the Water and Sanitation Program and its partners continue to explore and document emerging practice from the field, this working paper highlights, in brief form, approaches to redressing gender inequality in the water and sanitation sector. The review is intended for easy reference by sector ministries, donors, citizens, development banks, non-governmental organizations and water and sanitation service providers committed to mainstreaming gender in the sector. Two central features in the review are the illustration of good practices—which provide a quick pointer for replication, and are intended to guide tailoring the practice to local context—and end-of-chapter checklists, which provide practitioners with gender issues and responses to consider at various stages of decision making in the water and sanitation sector.

 Working Paper: English / French

Output-Based Aid for Sustainable Sanitation (WSP and GPOBA: Trémolet , Evans, Schaub-Jones; 2010)
Reviews experience to date with Output-Based Aid (OBA)  for sanitation and examined its potential to improve both  the delivery of public  financing to the sanitation sector and access to sustainable sanitation services. Key questions included: What explains such limited use of OBA-financing approaches for sanitation? How can OBA subsidies be delivered to providers of sanitation services? What other components (e.g., support services to small-scale independent providers, micro-finance, etc.) may be required to improve chances of success of OBA schemes for sanitation?
 Working Paper

Financing On-Site Sanitation (WSP: Kolsky, Tremolet, Perez; 2010)
Public investments of varying forms enable an absolute increase in the number of poor people gaining access to sanitation, varying from 20 percent to 70 percent, according to a WSP study of six cases in Bangladesh, Ecuador, India, Mozambique, Sénégal, and Vietnam. This report identifies the best-performing approaches, relevant factors, and issues to consider when designing a sanitation financing strategy. An overview report and country case studies are available.  Learn More
Technical Report (See country studies, below) | Technical Report (Spanish)
 Country Studies: Bangladesh / Ecuador / India / Mozambique / Sénégal / Vietnam

Findings from Impact Evaluation Baseline Surveys (WSP; 2010, 2011)
Baseline data collected from nearly 2,100 households in East Java, Indonesia, reveals high rates of diarrhea and associated disorders such as childhood anemia. These health outcome measures will continue to be tracked during the project to assess the causal impacts of the project interventions. Learn More
 Technical Report: East Java

Managing the Flow of Monitoring Information to Improve Rural Sanitation in East Java (WSP: Mukherjee; 2011)
WSP’s Scaling Up Rural Sanitation has linked community-based sanitation access monitoring  in real time with district and province level databases. A key innovation has been the development of a monitoring system that uses cell phones, SMS-text messaging, and a central database to transmit and store information reported from the field. Learn More
Working Paper 

Monitoring Systems for Incentive Programs: Learning from Large-scale Rural Sanitation Initiatives in India (WSP: Kumar, Singh, Prakash; 2010)
In India, national and state level incentive programs are being used to reward rural communities verified open defecation free. Effective monitoring of these programs is essential - without it, accurate verification is not possible. WSP assessed two monitoring systems, one on the national level and the other at the state level, analyzing the process to identify best practices for scaling up and replication.  These systems, together with the participation of local governments, have promoted a significant increase in rural sanitation coverage. Learn More
 Guidance Note

Case Study on Sustainability of Rural Sanitation Marketing in Vietnam (WSP: Sijbesma, Truong, Devine; 2010)
To investigate the sustainability of sanitation marketing as an approach to creating and meeting rural sanitation demands in Vietnam, WSP collaborated with IRC International Water and Sanitation Centre and ADCOM to follow-up on a pilot project conducted by IDE from 2003 to 2006. Knowledge products available include: the case study, a summary report, and a presentation from one of the authors. Learn More
 Technical Report: High Res /  Low Res | Research Brief

Building the Capacity of Local Government to Scale Up Community-Led Total Sanitation and Sanitation Marketing in Rural Areas (WSP: Rosensweig; 2010)
One of the central premises of the Global Scaling Up Rural Sanitation project is that local governments can provide the vehicle to scale up rural sanitation. In all three project countries—India, Indonesia, and Tanzania—local governments are at the center of the implementation arrangements. This report looks at the experience to date in three project locations in developing the capacity of local government to carry out its role in rural sanitation. Learn More
 Working Paper

Introducing SaniFOAM: A Framework to Analyze Sanitation Behaviors to Design Effective Sanitation Programs (WSP: Devine; 2009)
Why do individuals with latrines continue to defecate in the open? What factors enable individuals or households to move up the sanitation ladder? Before sanitation behaviors can be changed, they must first be understood. The SaniFOAM framework, developed to help answer some of these questions, categorizes sanitation behavioral determinants under Opportunity, Ability, and Motivation. With the letter F for Focus, these categories spell out F-O-A-M.  Learn More
 Working Paper: English / French

Learning at Scale in Indonesia (WSP: Mukherjee; 2009)
Home to 20 percent of Indonesia’s poor, only 55 percent of the rural population in East Java has access to any kind of sanitation. In this challenging context, WSP is working with national and local government to generate sanitation demand and improve market supplies of sanitation products and services at scale.
 Field Note

Enabling Environment Assessments for Scaling Up Sanitation Programs (WSP; 2008)
Baseline enabling environment assessments were conducted to assess the programmatic and institutional conditions needed to scale up, sustain, and replicate WSP’s approach to scaling up rural sanitation in India, Indonesia, and Tanzania. The reports discuss knowledge gaps and priority areas for learning and recommend interventions and practices that can be used to strengthen the enabling environment. 
 Synthesis Report

 Country Studies: Himachal Pradesh / Madhya Pradesh / Indonesia / Tanzania

Global Learning Strategy (WSP: Frischmuth; 2008)
The learning strategy develops a structured process of generating, sharing, capturing, and disseminating knowledge about what works in scaling up and sustaining sanitation programs. This learning process will help enable evidence-based decisions by policy-makers and implementation of large-scale programs.
 Working Paper

Economic Impacts of Sanitation (WSP; 2007)
A 2007 study by  WSP found that the economic costs of poor sanitation and hygiene totaled over US$9.2 billion a year (2005 prices) in Cambodia, Indonesia, Lao PDF, the Philippines, and Vietnam. A second phase analyzed  the cost-benefit of alternative sanitation interventions. WSP has now carried out an ESI study in India, with others in process or planned for Bangladesh, Pakistan, and countries in Africa, Latin America, and the Caribbean. Learn More
 Country Studies:  Cambodia / Indonesia / Lao PDR / Philippines / Vietnam

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Publication Type: Research Briefs
 

Promoting Handwashing and Sanitation: An Impact Evaluation of Two Large-Scale Campaigns in Rural Tanzania

This research brief provides background on the problems of poor sanitation and hygiene in rural Tanzania, an overview of two large-scale campaigns that sought to address these problems, and the key results of a recent evaluation of the impact of these efforts.

Research Brief | Policy Research Working Paper

 

 

Improved Sanitation Can Make Children Taller and Smarter in Rural Tanzania (WSP: Quattri, Rand; 2014)

In Tanzania, 87.8% of households do not have access to improved sanitation, such as a latrine or a toilet that separates human feces from human contact. The situation is worse in rural areas, where 92.5% of households do not have improved sanitation. Among those without sanitation, 5.6 million individuals defecate in the open. Unfortunately, the situation is getting worse, not better. In 2012, more people in rural Tanzania were defecating in the open than in 2000. In those same areas, 45% of children under five were found to be stunted in 2010. Nutrition interventions alone can only reduce stunting by 36% and mortality by 25%. Other interventions are needed to make up the rest of the height difference. Recent research has shown that differences in open defecation can explain up to 54% of the variation in average child height in some developing countries and more than 60% if density of open defecation is considered. This analysis was conducted to determine if a lack of improved sanitation can similarly explain the large amount of stunting in Tanzania. This brief discusses an analysis conducted by WSP to examine the link between sanitation and stunting in Tanzania.

 

Research Brief

 

Investing in the Next Generation: Children Grow Taller, and Smarter, in Rural Villages of Lao PDR Where All Community Members Use Improved Sanitation (WSP: Quattri, Smets, Inthavong; 2014)

One of the underlying causes of child malnutrition—in addition to the mother’s and child’s dietary diversity and health care situation—is unsafe water, inadequate sanitation and poor hygiene practices that lead to increased exposure to human feces. While urban sanitation access in Lao PDR is 90%, 50% of rural households are still practicing open defecation and/or using unimproved sanitation as of 2012. Remote and poor rural areas are even worse off and only 13% of the poorest households are using improved sanitation. Inequalities along ethnic groups are persistent, with 74% of Lao-Tai families using improved sanitation and only 30% of Mon Khmer, 46% of Hmong-Mien and 30% of Chinese-Tibetan. During the last decade child malnutrition has improved very marginally and almost 49% of rural children were stunted in 2011 [27% of urban children]. Stunting has a permanent impact on the life of a child. It does not only affect the child’s height, but also her/his cognitive abilities. Stunted children are likely to become less productive adults, and be less able to contribute to their country’s growth and prosperity.

Research Brief

 

Investing in the Next Generation: Children Grow Taller, and Smarter, in Rural, Mountainous Villages of Vietnam Where Community Members Use Improved Sanitation (WSP: Quattri, Smets, Nguyen; 2014)

Widespread lack of improved sanitation in rural areas of Vietnam leads to stunting, i.e. children being too short for their age. It is not the water that makes children sick and malnourished, it is the feces: sanitation is the primary barrier to stop the ingestion of human feces. The use of unimproved latrines in rural villages in mountainous regions of Vietnam leads to five-year-old children being 3.7 cm shorter than healthy children living in villages where everybody practices improved sanitation. This difference in height is irreversible and matters a great deal for a child’s cognitive development and future productive potential. A child remains at risk of stunting if community members use unimproved sanitation facilities, even when the child’s family uses improved latrines themselves. Universal usage of improved sanitation is needed to adequately address stunting.

Research Brief

The Missing Link in Sanitation Service Delivery: A Review of Fecal Sludge Management in 12 Cities (WSP: Blackett, Hawkins, Heymans; 2014)

Globally, the great majority of urban dwellers, especially poor people, rely for their sanitation on non-sewered systems that generate a mix of solid and liquid wastes generally termed fecal sludge. In poor and rapidly expanding cities, fecal sludge management (FSM) represents a growing challenge, generating significant negative public health and environmental risks. Without proper management, fecal sludge is often allowed to accumulate in poorly designed pits, is discharged into storm drains and open water, or is dumped into waterways, wasteland, and unsanitary dumping sites. This study seeks to assess the extent of this issue, and the major constraints that need to be overcome to improve fecal sludge management.

 

Research Brief English/Spanish

 

Impact Evaluation of a Large-Scale Rural Sanitation Project in Indonesia (WSP: Cameron, Shaw, Olivia; 2013)

This World Bank Policy Research Working Paper from WSP evaluates the impact of the Total Sanitation and Sanitation Marketing project in Indonesia, where about 11 percent of children have diarrhea in any two-week period and more than 33,000 children die each year from diarrhea. The evaluation utilizes a randomized controlled trial but is unusual in that the program was evaluated when implemented at scale across the province of rural East Java in a way that was designed to strengthen the enabling environment and so be sustainable. Among other findings, the authors found that diarrhea prevalence was 30 percent lower in treatment communities than in control communities at endline (3.3 versus 4.6 percent). The analysis cannot rule out that the differences in drinking water and handwashing behavior drove the decline in diarrhea. 

World Bank Policy Research | Working Paper | Research Brief | Field Note

 

Poor-Inclusive Urban Sanitation: An Overview (WSP: Blackett, Hawkins, Heymans; 2013)

Delivering poor-inclusive urban sanitation requires improved service delivery, rather than a focus on infrastructure. This is the core finding of a global review by WSP on challenges, trends, and approaches at the global, national and city levels to achieve viable poor-inclusive urban sanitation at scale. This summary paper highlights key observations and lessons from the original study report: “Delivering Sanitation to the Urban Poor: A Scoping Study” (2012; unpublished).

 

Study

Research Brief

Research Brief

Findings from Hygiene and Sanitation Financing Study in Lao PDR (WSP: Colin; 2012)
In Laos, very little information is available on how much money is being spent on sanitation and hygiene, by which entities, for what purposes, or in what locations. There is also little information on who benefits from this expenditure. WSP conducted a study to provide an overview of the current status of sanitation and hygiene financing and to provide useful information and recommendations that can help strengthen planning and accelerate progress in sanitation and hygiene. This Research Brief summarizes the mains findings of that study in Lao PDR.

 Research Brief

Political Economy of Sanitation (WSP; 2011)
This technical paper presents the results of a Global Economic and Sector Work (ESW) study on the political economy of sanitation in Brazil, India, Indonesia, and Senegal that was conducted by the Water and Sanitation Program (WSP) and the World Bank. The purpose of the study is to help WSP and sanitation practitioners in understanding the political economy of sanitation and therefore to support partner countries better in the design, implementation, and effectiveness of operations that aim to provide pro-poor sanitation investments and services to improve health and hygiene outcomes. Learn More
 Technical Report  |  Research Brief

Case Study on Sustainability of Rural Sanitation Marketing in Vietnam (WSP: Sijbesma, Truong, Devine; 2010)
To investigate the sustainability of sanitation marketing as an approach to creating and meeting rural sanitation demands in Vietnam, WSP collaborated with IRC International Water and Sanitation Centre and ADCOM to follow-up on a pilot project conducted by IDE from 2003 to 2006. Three years after the conclusion of an IDE-led sanitation marketing pilot project, the number of sanitary product providers and the demand for sanitary toilets continued to develop but progress over a longer term may be less sustainable. Learn More
 Research Brief

Economics of Sanitation Initiative — Studying the Economic Impacts of Sanitation (WSP; ongoing)
A 2007 study by  WSP found that the economic costs of poor sanitation and hygiene amounted to over US$9.2 billion a year (2005 prices) in Cambodia, Indonesia, Lao PDR, the Philippines, and Vietnam. WSP has recently carried out an ESI study in India, with others in process or planned for Bangladesh, Pakistan, and countries in Africa, Latin America, and the Caribbean. Learn More

The second phase of ESI in Southeast Asia analyzes the cost-benefit of alternative sanitation interventions and will enable decisions on how to more efficiently spend funds allocated to sanitation. The study was conducted in Cambodia, Indonesia, Lao PDR,  the Philippines, Vietnam, and Yunnan Province in China.

The study found that sanitation interventions have very favorable socio-economic returns to households and society, contributing improved health, clean environment, dignity and quality of life, among many other benefits. In addition, while the study showed sanitation options that protect the environment are more costly to provide (and environmental benefits are difficult to quantify in economic terms), the benefits are highly valued by households, tourists and businesses. When environmental benefits to downstream populations of proper wastewater management are valued, it can considerably increase the economic returns.
 Research Briefs (ESI Phase II): Cambodia | Indonesia | Lao PDR | Philippines | Vietnam | Yunnan Province, China
 

Factors Associated with Achieving and Sustaining Open Defecation Free Communities: Learning from East Java (WSP: Mukherjee; 2011)
Research conducted in 2010 in East Java to identify factors associated with achieving and sustaining behavior change by communities to become ODF shows that communities achieving ODF status within two months of triggering achieved markedly higher access gains. In addition, evidence from environmental observation, latrine ownership records, reported usage, and observation of facility maintenance show that 95 percent of the QUICKLY ODF communities had sustained their behavior change 4 to 28 months after ODF declaration.  Factors associated with QUICKLY ODF communities include high social capital, high-quality CLTS triggering, access to latrine supplies, easy payment terms, absence of external subsidy packages to a few households out of all, and regular monitoring. These QUICKLY ODF communities represent the most efficient model for scaling up sustainably.
Research Brief | Report

Evaluating the Political Economy for Pro-Poor Sanitation Investments (WSP; 2011)
Summarizes the results of a Global Economic and Sector Work (ESW) study on the political economy of sanitation in Brazil, India, Indonesia, and Senegal conducted by the Water and Sanitation Program (WSP) and the World Bank. Among the key findings of the study: Sanitation practitioners must understand the political economy of sanitation and better support partner countries in the design, implementation, and effectiveness of operations that aim to provide pro-poor sanitation investments and services to improve health and hygiene outcomes. Learn More
  Research Brief

Long Term Sustainability of Improved Sanitation in Rural Bangladesh (WSP: Kullmann, Ahmed; 2011)
Analysis of 53 Union Parishads, that were declared 100% sanitized/Open Defecation Free almost five years ago, shows that 90% of households have sustained use of a latrine that adequately confines feces. Factors associated with this outcome  include a shift in social norms away from open defecation to using a latrine; on-going sanitation programming that reinforces latrine use;  and easy access to private sector sanitation providers. In addition, a comparative analysis of four programmatic approaches used to reach  100% sanitation coverage and cessation of open defecation revealed little variation in sustained outcomes in these 53 Union Parishads. 
 Research Brief

Financing Household On-Site Sanitation for the Poor (WSP: Kolsky, Tremolet, Perez; 2010)
Public investments of varying forms enable an absolute increase in the number of poor people gaining access to sanitation, varying from 20 percent to 70 percent, according to a WSP study of six cases in Bangladesh, Ecuador, India, Mozambique, Sénégal, and Vietnam. This Research Brief summarizes findings from a Technical Report. Learn More
 Research Brief

Findings from the Impact Evaluation Baseline Survey in Indonesia (WSP: Cameron, Shaw; 2010)
Baseline data was collected from nearly 2,100 households in the implementation area. Among other findings, the survey revealed high rates of diarrhea and associated disorders such as childhood anemia. Learn More
Research Brief

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Publication Type: Learning Notes

Learning Note

Sanitation Markets at the Bottom of the Pyramid: A Win-Win Scenario for Government, the Private Sector, and Communities (WSP: Baskovich; 2011)
Research conducted in 2010 in Peru to identify techniques for reaching the population at the bottom of the pyramid shows that linking public infrastructure investments in water and sanitation with strategies for ensuring access to affordable products and services, healthy behaviors, and adequate maintenance of new sanitary infrastructure can improve public policies for sanitation. Domestic private participation at the bottom of the pyramid is viable and can be achieved through efforts such as the Creating Sanitation Markets initiative, which promotes sanitation for the very poor, with a focus on the domestic private sector’s active involvement in sanitation supply, and public awareness of sanitation as a business opportunity.
Learning Note

Learning by Doing: Working at Scale in Ethiopia (Faris (WSP); Rosenbaum (FHI 360/WASHplus); 2011)
In 2006, WSP partnered with the Government of Ethiopia, the Amhara Regional Health Bureau, and USAID’s Hygiene Improvement Project (HIP) to launch the Learning by Doing Initiative in Amhara Regional State, focused on achieving total behavior change in sanitation and hygiene. The project started at scale, reaching an initial 93,000 households in four districts (estimated population of 418,000) and then expanded further to include an additional 90 districts. Overall, 5.8 million people were reached and 2.8 million more people stopped practicing open defecation and now use an open pit latrine. Key strategies discussed included building capacity at the community level and developing and testing tools and training manuals.
 Learning Note

Utilizing Community-Based Registers to Monitor Improved Access to Sanitation and Hygiene in Tanzania (WSP: Coombes; 2011)
Efforts to systematically collect data to monitor sanitation and hygiene conditions at the community-level face many challenges. To address some of these challenges in Tanzania, WSP collaborated with local governments and village-level CLTS committees to implement community-based and managed registers. This Learning Note reports on a validation exercise conducted through a random sampling of sub-villages and households to assess the use of the registers, including the accuracy and frequency of data collection.
 Learning Note

Emergent Learning About Learning (WSP: Frischmuth; 2011)
A challenge for projects implemented at scale and in multiple countries is to capture and disseminate learning in a way that is systematic, timely, and of benefit to country teams, clients, partners, and programmers. Another challenge is to continuously test key assumptions underlying the program design and activities. To mitigate these challenges, WSP developed a Team Charter, Learning Action Plans, and Learning Strategies to establish and support a culture of learning. Learning has also been integrated learning into the Results Framework.
 Learning Note

Building the Capacity of Local Government to Scale Up Community-Led Total Sanitation and Sanitation Marketing in Rural Areas (WSP: Rosensweig; 2010)
One of the central premises of the Global Scaling Up Rural Sanitation project is that local governments can provide the vehicle to scale up rural sanitation. In all three project countries—India, Indonesia, and Tanzania—local governments are at the center of the implementation arrangements. This report looks at the experience to date in three project locations in developing the capacity of local government to carry out its role in rural sanitation. Learn More
Working Paper :  English  / French |  Learning Note

Output-Based Aid for Sustainable Sanitation (WSP and GPOBA: Trémolet , Evans, Schaub-Jones; 2010)

This  study  reviewed experience to date with Output-Based Aid (OBA)  for sanitation and examined its potential to improve both  the delivery of public  financing to the sanitation sector and access to sustainable sanitation services. Key questions included: What explains such limited use of OBA-financing approaches for sanitation? How can OBA subsidies be delivered to providers of sanitation services? What other components (e.g., support services to small-scale independent providers, micro-finance, etc.) may be required to improve chances of success of OBA schemes for sanitation?
 Learning Note

Training and Capacity Building to Scale Up Sanitation (WSP: Moise; 2010)
As part of the Water and Sanitation Program’s Global Scaling Up Rural Sanitation Project, a cascading training model has played an essential role in building the capacity of local governments to scale up rural sanitation in India, Indonesia, and Tanzania. This Learning Note reviews training and capacity-building activities and recommends four areas for further improvement.
 Learning Note

Benchmarking Local Government Performance on Rural Sanitation (WSP: Kumar, Singh; 2010)
To strengthen outcome-focused management of the rural sanitation sector in India, the Water and Sanitation Program, in partnership  with the Government of Himachal Pradesh, developed a five-step process to monitor and benchmark performance on a monthly basis across all twelve districts in the state.
Learning Note:  English / French

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Publication Type: Presentations

Webinar: Investigating Long-term Sustainability of Rural Sanitation in Bangladesh (World Bank and WSP; July 2011)
This webinar (recorded live in Washington, D.C., July 21, 2011) is based on a 2010 WSP study in rural Bangladesh to gain insights into whether sanitation (i.e., latrine use) outcomes from Community-led Total Sanitation approaches are sustainable over the long-term. Researchers found that almost 90 percent of households in the areas studied have sustained use of a latrine that adequately confines feces, but that hygienic maintenance is relatively poor. Presenters discuss data from 50 local governments declared 100% sanitized/open defecation free almost five years ago. More information, including a link to watch the webinar, is available on the Bangladesh Webinar Event Page.
Webinar

AfricaSan 3, Kigali, Rwanda (July 2011)
What will it take to get Africa on track to meet the MDG for sanitation by 2015? To discuss and present viable solutions to this question, WSP joined government officials, sanitation practitioners, and civil society organizations at the Third African Conference on Sanitation and Hygiene (AfricaSan 3), hosted by the Government of Rwanda and the  African Minister’s Council on Water (AMCOW). More than 800 participants attended the conference, representing over 50 African countries in addition to global regions. More information, including PDFs of WSP presentations, is available via WSP's AfricaSan 3 Event Page.
WSP's AfricaSan 3 Event Page

International WEDC Conference,  Loughborough University,  UK (July 2011)
The 35th WEDC International WEDC Conference held in July 2011 at Loughborough University convened over 200 delegates. Papers related to WSP research included Suzanne Hanchett, et al, Sustainability of Sanitation in Rural Bangladesh; Orlando Hernandez, et al, Combining Sanitation and Hand Washing Promotion: An Example from Amhara, Ethiopia; and Eddy Perez,  Sustainable Rural Sanitation at Scale: Results and Lessons from India, Indonesia, and Tanzania.
 Conference Paper (Hanchett; Bangladesh) | Conference Paper (Hernandez; Ethiopia) |Presentation (Perez; Sustainable Rural Sanitation at Scale)

Case Study on Sustainability of Rural Sanitation Marketing in Vietnam (WSP: Sijbesma, Truong, Devine; 2010)
To investigate the sustainability of sanitation marketing as an approach to creating and meeting rural sanitation demands in Vietnam, WSP collaborated with IRC International Water and Sanitation Centre and ADCOM to follow-up on a pilot project conducted by IDE from 2003 to 2006. This presentation introduces the research methodology and key findings.
 Video Presentation 

WSP Approaches to Scaling Up Rural Sanitation in Ethiopia and Tanzania (WSP: Muluneh; 2010)
Presentation on WSP's work with local and national governments and the local private sector to end open defecation and scale up rural sanitation in Ethiopia and Tanzania. Presented at World Water Week, June 2010. 
 Presentation Slides

WSP Approaches to Scaling Up Rural Sanitation (WSP: Perez; 2010)
An overview and video summarizing WSP's work with local and national governments and the local private sector to end open defecation and scale up rural sanitation in Indonesia, India, and Tanzania. Presented at World Water Week, June 2010. 
 Presentation Slides

Scaling Up Rural Sanitation in India (WSP: Kumar; 2010)
This presentation offers a summary of WSP's work with local and national governments and the local private sector to end open defecation and scale up rural sanitation in the states of Himachal Pradesh and Madhya Pradesh, India. Presented at World Water Week, June 2010.
 Presentation Slides

Sanitation Marketing in Tanzania and Indonesia (WSP: Paynter, Devine; 2010)
Starting in 2006, WSP has supported implementation sanitation marketing initiatives in India, Indonesia, and Tanzania. This presentation shares approaches, results, and lessons learned around the sanitation marketing component and how behavior change approaches have guided the design of the intervention in Tanzania and Indonesia. Presented at the World Bank, October 2010.
 Presentation Video

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Publication Type: Toolkits and Multimedia

And the Winner is....Community-led Total Sanitation in Himachal Pradesh

The Indian state of Himachal Pradesh has made good progress in achieving rural sanitation outcomes and is well recognized as a high performer at an all-India level. This film showcases the state-level strategy which resulted in successful outcomes. 

 

Video

 

 

No Toilet no Bride: Total Sanitation in Haryana

The Indian state of Haryana has made rapid strides in achieving rural sanitation outcomes within a short span of time. This video shows the community driven behavior change approach which helped the state achieve sanitation coverage of 56 percent in 2011 from 29 percent in 2001.

 

Video

 

 

Success with Sanitation Business in Indonesia (Bahasa)

A video overview of the sanitation business model in Indonesia illustrates a one-stop shop sanitation business model targeted at entrepreneurs and other stakeholders.

 

Video

 

 

Pacitan, Indonesia - Open Defecation Free (Bahasa)

Pacitan is the first district in Indonesia to successfully achieve Open Defecation Free (ODF) status through the Total Sanitation and Sanitation Marketing (STMB) program. This video illustrates STBM implementation that emphasized empowerment, participation, and community behavior change process.

 

Video

 

 

Out in the Open - Lao PDR

The video features one of the "Open-Defecation Free" villages that have successfully moved away from a subsidy approach through a Community-Led Total Sanitation program and also shows Government stakeholders elaborating on challenges and opportunities in rural sanitation.

 

Video

 

 

Sanitation in Indonesia: Follow-Up is Essential in CLTS

This video shows that simply launching Community-Led Total Sanitation (CLTS) in villages without further monitoring will fail to change people's collective behavior.

Video

 

Brochure

The Trigger: A Film on Community-Led Total Sanitation—5 Day Workshop (WSP; India, 2012)
This video provides an overview of the WSP approach to CLTS training in a workshop setting that is inclusive and hands-on and also describes the steps involved in implementing the approach.

Video

Introductory Guide to Sanitation Marketing (WSP: Devine and Kullmann; 2011)
WSP’s approach to scaling up rural sanitation combines three components — Community-led Total Sanitation (CLTS), behavior change communication, and sanitation marketing — in addition to efforts to strengthen the enabling environment. Of these, sanitation marketing is a relatively new field and WSP has amassed significant insights and resources through action learning efforts in various countries. With a goal to create a practical resource for program managers and commercial and social marketing specialists, lessons and resources were harvested to develop a companion online toolkit that includes narrated overviews, videos, and downloadable documents including research reports, sample questionnaires, and more.
 Introductory Guide: English / French / Spanish  Online Toolkit

Scaling Up Rural Sanitation in Indonesia (WSP; 2010, 2011)
Scaling Up Rural Sanitation in Indonesia aims to strengthen public and private partnerships to improve supply chain of sanitation to the population without access. The videos below, filmed in Indonesia, illustrate key aspects of this objective:

Sanitation Marketing/CLTS Intervention in District Sequence summarizes the district technical assistance process, using Community-Led Total Sanitation (CLTS) strategies; Triggering: Only the First Step of CLTS shows that triggering CLTS in communities and then forgetting about them is a sure way to fail to bringing about collective behavior change; Unleashing Latent Demand for Sanitation features how Scaling Up Rural Sanitation began campaigns to raise consumer demand for sanitation amid competing priorities among community members; Marketing Sanitation in East Java features small-scale sanitation entrepreneurs serving households in Indonesia's East Java province, one of the most densely populated places on earth (38 million people).
 Video -- Sanitation Marketing/CLTS Intervention in District Sequence (2011)

 Video -- Triggering: Only the First Step of CLTS (2011)

 Video -- Unleashing Latent Demand for Sanitation (2011)

 Video -- Marketing Sanitation in East Java (2010)

Sanitation Marketing in Cambodia (WSP; 2010)
The Sanitation Marketing Project was launched in Cambodia in early October 2009, aiming to have over 10,000 toilets installed by households in rural villages over a period of 18 months through market force and demand creation activities. Unlike conventional approaches to sanitation improvement, which usually provide hardware subsidies to households and overlook the market as a driving force to sustainable sanitation, the current approach
 Video

Sanitation Marketing in Peru (WSP; 2010)
Creating Sanitation Markets Initiative in Peru aims to strengthen public and private partnerships to improve supply chain of sanitation to the population without access.

Let’s Change Their Future shares the findings of baseline research, told from a child’s point of view; Inaugurating a Dream shares the excitement of a poor family as they celebrate their new bathroom; Sanitation, A Great Dealshares business opportunities in sanitation; targets opportunities for small retailers, medium wholesalers, large-scale sanitation and construction suppliers, local providers of plumbing and masonry services, communal sales promoters, and micro finance institutions.
 Video- Let’s Change Their Future 

 Video- Inaugurating a Dream 

 Video- Sanitation, A Great Deal

Sanitation Marketing in Tanzania (WSP; 2010)
Communities in rural Tanzania are reducing the spread of disease and creating local sanitation markets. Local masons are trained to make slabs, or Sanplats, which are more hygienic. These are purchased for US$5 by households and added to existing pit latrines.
 Video

Improving Sanitation in Bangladesh (WSP; 2010)
A music video features a popular folk singer; messages focus on the adverse impacts of open defecation; the imperative of sanitary latrines for all; sanitary latrines need not be expensive; and sanitary latrines are necessary for health.
 Video

Overview: Approaches to Scale Up Rural Sanitation (WSP: Perez; 2010)
Short interview describes WSP's work with local and national governments and the local private sector to end open defecation and scale up rural sanitation in Indonesia, India, and Tanzania. From at World Water Week, 2010.
 Video

Communication Tools Menu (WSP; 2008)
Developed to support WSP’s work to improve rural sanitation  in Indonesia, this resource collects the strategies, materials, and campaign routes from the project’s work in East Java. Including radio spots, posters, and competitions, the broad menu of communication tools targets diverse audience groups.
 Communication Tools Menu

Information Catalog: Choices of Sanitation Facilities (WSP; 2008)
Analyzes the advantages and disadvantages of different sanitation facilities in rural environments, based on affordability, safety, privacy, maintenance, durability and other relevant criteria.
 Information Catalogue

Sanitation Board Game  (WSP; 2008)
Developed  to support WSP’s work to improve rural sanitation in India, this board game for children offers a playful, interactive way to teach safe sanitation.

 Children’s Board Game

Script for a School Play (WSP; 2008)
Developed to support WSP’s work to improve rural sanitation in Indonesia, this script can be used with children to produce a school play. The messages remind children that open defecation is a dangerous source of diseases, and a wrong, sickness-spreading practice.
 Children’s Script

Training of Trainers to Conduct Community-Driven Total Sanitation (WSP; 2007)
A field-tested tool for resource agencies engaged in training potential master trainers and scaling up community-driven total sanitation. Module 1 includes nine guidance notes on sanitation technologies, hygiene practices, mappings, and monitoring tools. Module 2 includes resources to facilitate a five-day training program on community-driven total sanitation.
 Module 1: Guidance Notes |   Module 2: Trainer’s Notes

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