Paradigm Shifts Total Sanitation in South Asia Soma Ghosh Moulik Water and Sanitation Program-South Asia Water Week 2007 : Session 9 Washington DC, February 28, 2007
This presentation highlights : Paradigm shifts in rural sanitation Mechanisms for scaling up 2
Why is Rural Sanitation a Concern in South Asia? Practice of open-defecation is one of the most serious concerns More than 600 million rural people in South Asia are defecating in the open everyday! High incidence of diseases continue Children and women are the worst sufferers Women and adolescent girls face severe problems of safety and privacy The economic and health cost of poor sanitation are phenomenal 3
Addressing the problem Traditional answers to solve the rural sanitation problem : Focus on household toilet construction to improve sanitation access Provide high subsidy to build toilet Assumptions : income is an issue construction of toilets is the solution Huge investments made till 2000 Substantial progress in construction and visibility Govt of India (till 2000) alone spent $ 62 million and constructed 3.2 million toilets 4
Results? Overall impact : POOR Programs focused on targeting few households through construction subsidies No ownership by users ( less than 50% used) Toilets soon converted to alternate uses Why did the subsidy continue? Politically correct to provide upfront subsidies for toilet construction Patronage of schemes and power structures Donors are also at fault - those financing want to see physical infrastructure on the ground 5
Alternative Paradigm Tackle the root cause of poor sanitation performance fix open defecation in rural areas Paradigm shifts : Behavior change NOT toilet construction Address the collective NOT individuals Ignition for community action NOT hardware subsidy Communities are made to realize their closeness to the sanitation problem in a participatory way Instill a sense of disgust and shame at collective level This approach was first piloted in Bangladesh and is known as Total Sanitation 6
Results! 7
Significant drop in open defecation Communities chart their own future Increased community action and collective decision for improved sanitation behavior 8
Local Resource Mobilization Communities use own resources, innovate and have open and indigenous technology choice (safe confinement of feaces) Cost Pour Flush Not Acceptable Simple Pit Improved Pit Open Defecation Fixed place Defecation 9
Vibrant Private Market Market forces responding to demand Private sector provides a variety of options 10
Continuous Monitoring Communities form local committees to monitor their own progress and achievements 11
Peer Pressure Mobilizing the hard nuts to change behavior Community sets up own rules! Penalty and rewards The village signboard announces No one defecates in the open in our community. 12
Social Change We do not marry our girls to villages that practice open defecation 13
Elements Traditional And Total Sanitation Approach : A Comparison Standard Approach New Approach: TS Approach Starts with latrines Starts with people Message Technology Motivation Time frame Monitoring Outcome Latrine construction by Households Fixed model & few options Individual subsidy Unknown No. of toilets constructed Some latrines built Change of collective behavior by the entire community Flexible design innovated by community & Menu of options Self-respect is the main motivation Short 6-9 months No. of ODF and sanitized communities No more open defecation and collective behavior change 14
Performance vs Hardware Subsidy Performance (scored: 0-20) 0 2 4 6 8 10 12 Plan Bangladesh West Bengal TSC Ahmednagar TSC Gramalaya TSC NGO Forum Rajarhat LPP Performance Subsidy Andhra Pradesh 0 10 20 30 40 50 60 70 Hardware subsidy (US$ per household) 15
Scaling Up Role of institutions Involving Local Governments : to tackle externalities Engaging Political Leadership: forging consensus and eliciting support across political spectrum Role of information Synthesizing information and ensuring dissemination in real time help in catalyzing policy reform - regional policy exchanges Cross learnings - taking indigenous innovations to scale and adapting to local conditions Role of incentives Fiscal incentives and rewards to local governments to confer recognition on evidence of collective behaviour change 16
Emerging Miracle Significant increase in sanitation coverage in 3 years! Out of 4500 local governments in rural Bangladesh, 1041 have declared 17 ODF in 2006
Local Government Incentives in India 9825 10000 9000 8000 7000 6000 5000 4000 3000 2000 1000 41 781 0 2005 2006 2007 NGP Local Governments Sub-Districts Districts Pop criteria > 1000 1000-1999 2000 to 4999 5000 to 9999 10000 + Upto 50000 Abov e 50000 Upto 1million 1 million and above $ 1100 2200 4400 8800 11,000 22000 44000 66000 110,000 18
Where has this approach spread? Pakistan Nepal Peru Bolivia AFR Ethiopia Haryana India Himachal Pradesh SAR Madhya Pradesh Maharashtra EAP BangladeshCambodia LAC Tanzania Indonesia 19
Do we know that this approach works? 20
We know that. Aiming behavior change gives better results Upfront subsidies for toilet construction dampen mobilization Channeling collective rewards after collective behavior change is achieved, is an effective incentive for change Working with local governments and incentives to local governments are effective vehicles for scaling up Possible to reach universal coverage within a short period of time 21
What we do not know is. Long term sustainability - of changed behaviors, of impact on health and well being -it is too early to state To address this issue, scientific and rigorous impact evaluation and monitoring systems are being attempted and designed However, Total Sanitation approach is promising and showing results Achieving ODF status is not a one-off event Need to keep the sanitation issue alive! 22
Thank you 23
Evidence shows that.. Decrease in Diarrhea due to ODF % of toilet use 120 100 80 60 40 20 0 29 38 95 26 100 7 40 35 30 25 20 15 10 5 0 % of households with diarrhea recall Open Defecation Villages Almost ODF ODF 24 Source: Knowledge Links, Formative Research for sanitation IEC manual, (2005)