Securing Sanitation: The Compelling Case to Address the Crisis

This report, the synthesis of two previously released papers, discusses the situation and consequences of poor sanitation globally. It focuses on the economic case for investing in sanitation and explores ways and means to accelerate progress. The report was commissioned by the Government of Norway and prepared by the Stockholm International Water Institute (SIWI) in collaboration with the World Health Organization and the Norwegian Agency for Development Cooperation.

According to the report, there is a lack of public awareness and support for sanitation as a core development concern. Sanitation and the means to practice hygienic behaviours yield direct benefits in terms of health, education and economic productivity. To make the needed shift in progress, many countries need:

• institutional transformation;
• increased focus on household behaviours and
  community action;
• increased attention to raising demand;
• increased range of technologies and approaches;
• improved effectiveness of public expenditure on
  sanitation and hygiene promotion; and
• more money spent more effectively.

One of the most frequently cited reasons for the failure of sanitation programmes is the low level of expressed demand. A number of factors may influence demand for sanitation. Awareness of the availability and benefits of good sanitation is a factor. For example, knowing that latrines exist and can be used to store excreta and knowing that a latrine can improve the health of children and have a positive impact on household income. This information may also influence the priority attributed to investing in sanitation. Priority may vary between members of the households, and the report points out that it is important to design demand creation and assessment activities appropriately (for example building a latrine requires a decision by the member of the household responsible for major capital investments in the home and that person should be a key audience of a latrine marketing campaign).

The report proposes that traditionally many subsidy programmes have focused solely on latrine construction, but there is growing evidence that this may not be the most effective vehicle to increase access to sanitation. Subsidy programmes which focus solely on construction of latrines may fail because they are not self-sustaining, they fail to raise demand, and they fail to reach the economically poorest people because the household contribution is too expensive. Subsidies need to be designed to achieve whatever public policy objective has been agreed upon, and a more integrated approach to increasing access and demand may be more successful. A clear understanding of the current situation - what people want and are willing to pay for, and the reasons why households are failing to adopt hygienic practices or construct latrines - can provide insights into the most effective ways of supporting increased access.

In general governments may decide to:

• commission and pay for formative research to identify what motivates behaviour change;
• pay for national programme of hygiene promotion;
• pay for a elements of a national programme designed to stimulate demand for sanitation through mass media, social marketing etc.;
• support the development of a supply-side market of small scale independent service providers;
• promote and finance technical innovation;
• finance school sanitation and sanitation in health and community centres; and
• pay construction costs only for elements of the system whose public benefit is greater than
  the private benefit (trunk infrastructure, shared facilities, household facilities for the minority
  of households whose demand would otherwise not be high enough to construct hygienic
  means of excreta disposal, environmental infrastructure, etc.)

The report outlines how more could be done to strengthen the collection and use of data
at the local and national level and in sharpening the information available globally. For example, it would be useful to know how much money is currently being spent, where it is being spent and by whom. Information about the effectiveness of subsidies, public expenditure, hygiene promotion, and sanitation marketing would help to guide decisions about how to address the issue. According to the report, such decisions can best be made in the context of open and fair discussions with all sector actors, based on a good understanding of what is currently happening, and by involving households and communities in an evaluation of their own needs.