What Does It Take to Scale Up Rural Sanitation?

Today, 2.5 billion people live without access to improved sanitation.  The resulting human and economic toll is staggering:  millions of deaths and hundreds of billions of dollars in economic costs every year.  Of those without access to sanitation, 75 percent live in rural areas.  

Related Resources:

Full Report: What Does It Take to Scale Up Rural Sanitation?
The Water Blog

Scaling Up Sanitation
Policy and Sector Reform to Accelerate Access to Improved Rural Sanitation

Over the last 30 years, most rural sanitation interventions have had pockets of success, but were small in scale.  Learning how to expand on the successes of these small-scale projects to increase access at large scale has been an enduring challenge.  Project outcomes often fail the sustainability test once external funding ceases, and the benefits, even if sustained, remain limited to project areas.

Despite growing political will to do more about rural sanitation, the lack of evidence and examples of effective and sustainable large-scale rural sanitation programs has constrained governments and development partners.

A new WSP working paper, What Does It Take to Scale Up Rural Sanitation? aims to fill that evidence gap.  Starting in 2007, WSP provided technical assistance to help governments design, plan, implement, and monitor national rural sanitation programs that start at scale and are sustainable. This initiative was carried out in three countries, India, Indonesia, and Tanzania.  In each country, at scale service delivery was led by governments, communities, and the local private sector.  

The paper shares lessons and best practices learned from this work, specifically in:

  • generating demand for sanitation at the household and community levels;
  • increasing the supply of affordable, aspirational sanitation products and services; and
  • strengthening local and national governments to lead large-scale sanitation programs.

"For the past four years, WSP has been carrying out an evidence-based learning initiative, identifying best practices and policies for governments to scale up rural sanitation,” said coauthor and WSP Senior Water and Sanitation Specialist Eddy Perez.  “Although state-of-the-art knowledge on how to scale up rural sanitation is still a work in progress, together with our government and development partners, we have learned quite a bit.  This new product seeks to pull together our collective lessons to date.  Given the findings in the recent UN/WHO Joint Monitoring Program report that 2.5 billion people still do not have access to improved sanitation and that the global sector is far from reaching the MDG targets, we hope that this document will help inform policymakers and practitioners to develop sustainable large-scale rural sanitation programs that will significantly accelerate the rate of increase in access to improved sanitation. "

Key components are introduced and illustrated with examples from the field, including an overview to programmatic approaches that have been combined and tested to create demand, change behaviors, and improve supply chains:  

  • Community-Led Total Sanitation
  • Behavior Change Communication
  • Sanitation Marketing

The Working Paper also introduces various financing strategies that were used to accelerate access to improved sanitation—from offering incentives to communities to achieve open defecation free (ODF) status, to helping local masons access molds and raw materials, to developing or strengthening business networks to link masons with local hardware stores.  

Implementing a programmatic approach at scale requires an effective and sustainable service delivery model in which all stakeholders—national, state, and local governments, communities, the local private sector, and development partners—play a role. For example, national and state governments can support systematic policy and sector reforms and thus provide a strong supportive enabling environment, while local governments can lead promotion activities and provide ongoing monitoring and evaluation, and the local private sector can produce reliable and affordable materials at a pace that meets demand.

Lessons and insights from the program reinforced the assumption that local governments must play a central role in the implementation . Although they may lack capacity in some areas, local governments are the only structure in the country with the legal mandate, staff, and physical infrastructure to implement large-scale rural sanitation programs.