SECTION THREE: CREATING THE ENABLING … · 32 Sanitation and Hygiene Promotion – Programming Guidance Very few countries currently have explicit stand-alone “sanitation and hygiene

30

SECTION THREE:CREATING THE ENABLING ENVIRONMENT

Changing the enabling environment so that investments in sanitation and hygiene promotion are consis-tently more effective, is a challenging task. In many countries or regions, the sort of high-level changeswhich are required (in policies, financial instruments, organizational arrangements and so on) may requirechanges to legal and regulatory instruments. Even if this is not required, for such changes to be translatedinto reality they have to be widely owned and accepted. For this reason such systematic changes may haveto develop slowly. Programmers may have to find pragmatic ways of making progress on the ground in themeantime.

This section discusses the sorts of changes which might be needed in the long run to secure consistent andeffective sanitation and hygiene promotion programmes. Chapter 3 talks about changes in policies whichmay be needed to facilitate a new role for government and the inclusion of new actors in sanitation in hy-giene promotion. Chapter 4 discusses how to make decisions about allocating resources between re-gions and between activities. Chapter 5 discusses what is known, and what you need to know, to designand roll out new financial instruments which can promote effective sanitation and hygiene promotion.Chapter 6 talks about appropriate arrangements for delivering services in terms of roles and responsi-bilities for different types of activity. Chapter 7 discusses the requirements for monitoring and evaluat-ing sanitation and hygiene promotion at the programmatic level.

This section should be read selectively by people who are involved in making long-term changes to the waysanitation and hygiene promotion are carried out. Many readers will of course be considering the subjectwithin the context of wider poverty alleviation strategies, so the ideas and recommendations included hereshould be read in the context of other changes you may be making to the delivery of social services.

Policies are defined as the set of procedures, rules, andallocation mechanisms that provide the basis for pro-grammes and services. They set priorities and provide theframework within which resources are allocated for theirimplementation. Policies are implemented through fourtypes of instruments:● laws that provide the overall framework; ● regulations in such areas as design standards, tariffs,

discharge standards, practices of service providers,building codes, planning regulations and contracts;

● economic incentives such as subsidies and finesfor poor practices; and

● assignment of rights and responsibilities for in-stitutions to develop and implement programs.

More details on the development of economic incentivesand assignment of rights and responsibilities can be foundin CChhaapptteerrss 55,, 66 aanndd 77..

In order to work out whether changes are needed to thepolicy framework, programmers need to provide an-swers to the following core questions:● Are existing policies adequate?● Will they result in the implementation of the vision for

sanitation and hygiene promotion?● How are these policies translated into programmes?● How effective are these programmes in improving

services?

3.1 The Policy Context

Chapter 3 Sanitation and Hygiene Policies

Sanitation and Hygiene Promotion – Programming Guidance

31

SECTION THREE: CREATING THE ENABLING ENVIRONMENT

Chapter 3: Sanitation and Hygiene Promotion Policies

The policy framework provides the instruments (guid-ance, positive incentives and penalties) which turn pub-lic priorities into reality. Policy may deal with:

● Targeting of Resources (see CChhaapptteerrss 66 aanndd 99):Policies can be used to signal where resources are tobe spent (which aspects of sanitation and hygiene pro-motion are to be funded, to what levels) and whichcommunities should be targeted.

● Equity: Policy statements, laws and budgetary alloca-tions can be used to steer resources to specific socialgroups or geographic areas. They can also support anequitable programming process by enabling the partic-ipation of marginalized groups or organisations (it couldfor example, require that public consultations on hy-giene issues are always attended by an umbrella bodywhich represents the interests of indigenous people).

● Levels of service (see CChhaapptteerr 1100)): Appropriate in-terventions may range from hygiene promotion alone,through the provision of simple sanitation systems, toimproved levels of service including indoor flush toi-lets. School sanitation and hygiene promotion will bea key element in most programmes. Policy can signal(a) what levels of service are acceptable (ie are thereminimum health, safety and environmental standardswhich need to be maintained?); and (b) what activi-ties will be promoted (through the provision of sub-sidy perhaps, or support to specific providers). Levelsof service decisions are usually reflected in technicalnorms and standards used by engineers, in buildingcodes, planning regulations and in allocations of fund-ing (see above). Historically, technical standards havetended to prohibit anything but the “highest” levels ofservice which stifles innovation and prices mosthouseholds out. This may need urgent review.Adopting standards which focus on outcomes ratherthan those that specify inputs (ie defining safe separa-tion of faeces from human contact, rather than dis-cussing bricks and mortar) may help to promote in-novation and enable flexibility if the situation changes(due to emergencies, influx of refugees, change inschool populations etc) See Section 4.7 for examplesof where this has happened in practice.

● Health considerations: The policy frameworkneeds to provide for the full range of interventions(access to technology, promotion of hygienic behav-

3.2 Signaling Public Policy Objectives

iours and the enabling environment) which will enablehouseholds to improve their health status. Policystatements and even laws may be particularly usefulin providing incentives for hygiene promotion to takea more prominent role over “traditional” latrine con-struction or ahead of curative health care.

● Environmental considerations: Sanitation is in-creasingly seen as a key issue in environmental pro-tection. Improper disposal of human wastes can pol-lute water bodies, groundwater, and land surfaces andaffect the quality of life for those living in the area. Inaddition, the economic impact of environmentaldegradation on tourism, fisheries, and other industriessensitive to pollution is a growing problem. Policiesmay be needed to address environmental protection,but these should be placed in the context of priori-ties (care is needed to ensure that environmental reg-ulations do not inadvertently preclude incrementalprogress in household sanitation for example).

● Financial considerations (see CChhaapptteerr 66): Policiesmay be needed to provide guidance on who will payfor what. This is particularly important where there isa shift away from a traditional ‘subsidised latrine’ ap-proach – but will also be necessary where a particularrevenue stream is to be allocated to financing aspectsof the programme. Whether or not such allocationsneed to be enshrined in law depends on the context.

● Institutional roles and responsibilities (seeCChhaapptteerr 77): Policies, or at the least, a high level poli-cy discussion may be needed to ensure that roles andresponsibilities are clearly defined (a) between publicagencies; and (b) between public and private/civil so-ciety agencies. A policy forum may also be able toprovide effective interagency coordination. Impor-tantly policy change may be needed to enable smallscale independent providers, non-governmental or-ganisations and other civil society groups to effective-ly play a role in promoting and implementing house-hold level and community sanitation and hygienepromotion activities. Some of these organisationsmay need legal recognition in policy. The develop-ment of institutional policy must also consider how or-ganisations charged with given responsibilities will im-plement them, and how their capacity may need tobe strengthened. Again, explicit attention must bepaid to how organisations are to be funded.


Sanitation and Hygiene Promotion – Programming Guidance32

Very few countries currently have explicit stand-alone“sanitation and hygiene promotion policies”. Recent re-search by USAID and EHP found only three examples(Nepal, Republic of South Africa and Uganda) wheresuch a policy could be said to exist. Such a unified poli-cy may not be required in every case. Well known ex-amples of successful programmes often pull in expertisefrom the health, education, water supply and sanitation,and social development fields, and make use of staff froma range of organisations. Policy dialogue could thus takeplace in a number of ways through:● the development of a single unifying policy framework

around which all organisations can develop their ap-propriate approaches and inputs (as for example inSouth Africa);

● the inclusion of sanitation within a wider poverty-re-duction and economic development framework (asfor example in Uganda, and at the local level in the cityof Johannesburg); or

● through inclusion of aspects of sanitation and hygienepromotion in policy relating to all relevant sectors (in-cluding health, education, housing, urban and rural de-velopment etc).

While it is not possible to define for every situation howpolicy should be framed, a useful principle might be tominimize policy at every level, to ensure that, whereverpossible, responsibility is delegated downwards (to localgovernments, communities and ultimately households).In some cases, however, the existence of policy at a“higher” level may be a useful incentive to improve per-formance (examples might include national regulation forprotection of the environment, and regulatory oversightof private sector providers provided at a level higher thanwhere the day-to-day contractual relationship with thepublic sector is managed).

3.3 Locating Policy

3.4 Building on what exists The legality of the policy framework is a key determinantof its legitimacy. Policies must therefore be rooted in theconventions of local laws, legislative acts, decrees, regu-lations, and official guidelines. For this reason informationabout existing legal conventions is essential to the devel-opment of effective policies (see RReeffeerreennccee BBooxx 88). Policy development also needs to be based on a goodunderstanding of: the basic situation (population, cover-age, investments; health status); institutional contexts (in-cluding the performance of service providers); how peo-ple are currently accessing services; what works (even onthe small scale locally); and what has potential to bescaled up.Importantly, there is no point in developing policies thatare beyond the capacity of the current institutional setup. This returns us to the theme of a cyclical process –

Policy development as a process can provide opportuni-ties to analyse and debate what works at the implemen-tation level. When approaches are recognised as part ofthe long-run solution to the sanitation and hygiene pro-

For: approaches to assessing current policySee: Elledge, Myles F., Fred Rosensweig and Den-nis B. Warner with John Austin and Eduardo A.Perez (2002) Guidelines for the Assessment of Na-tional Sanitation Policies Environmental Health Pro-ject Contract HRN-1-00-99-0011-00, WashingtonD.C.Get this reference from: EnvironmentalHealth Project at www.ehp.org

Reference Box 8: Sanitation policies

3.5 Applying the Principlesmotion challenge they can be converted into policy.Those leading the policy development process can en-sure that the principles of good programming are appliedboth in the process and in the outcome (see TTaabbllee 44)

policy is needed to improve current performance in theshort run, and to create incentives to strengthen the over-all institutional context in the longer run.

Table 4: Applying the Principles to Policy Development

Maximising publicand private benefits

Use policy to signal

● Targeting ofresources·

● Levels of service·● Health aspects·● Environmental

priorities·● Financial

approaches● Institutional roles

and responsibilities

Achieving Equity

Use policy instru-ments to steer re-sources to areaswhich have been neglected

Provide protectionfor marginalizedgroups of individualswithin organisationsor for marginalizedorganisations

Building on whatexists and is in demand

Root policy on goodunderstanding of theexisting legal frame-work, institutionalcontext and existingpractices

Align policy with ap-propriate financial andinstitutional instru-ments

Making use of prac-tical partnerships

Make efforts to linkpolicy upwards (togain political support)and downwards (togain acceptance andimplement on theground)

Building capacityas part of theprocess

Consider policieswhich will build ca-pacity, and use policydevelopment as partof the capacity build-ing effort

33


Chapter 3: Sanitation and Hygiene Promotion Policies

Policy reform takes time. Strong political support willaccelerate the timeframe, but policy change is a long-run objective of programming. Where possible, pro-grammers should maintain support for efforts to makepractical progress on the ground in parallel with thepolicy development process. This can be achievedthrough:

3.6 Programming Instruments

● creating space and ‘waivers’ of existing regulations toenable localized innovation and testing of new ideas;

● policy-related evaluations of pilots and investmentprojects;

● establishing technical working groups to review tech-nical norms and standards, building codes, profession-al training etc; and

● capacity building for regulators.

The government of Bangladesh has long been commit-ted to improving the sanitation situation in the country.However recent research by WaterAID, showed thatwhile subsidies (the core plank of government sanitationpolicy) gave people the “opportunity” to construct la-trines they did nothing to generate the “capacity” to doso. In contrast the Bangladeshi NGO Village Educationand Resource Centre (VERC) has shown that commu-nities acting together can take steps to significantly im-prove their sanitation situation i . Villages where VERC hasworked have developed a whole range of new ap-proaches to solving sanitation problems, including thedevelopment of more than 20 new models for low-costlatrines. These achievements took place with almost nopolicy direction at all, almost as if the absence of any pol-icy constraint, coupled with the commitment of VERC tofind solutions to the problem, unlocked communities’

3.7 Practical Examples from the Field:What policy changes should we make?

ability to solve a problem for themselves. Analysis of thisstory might lead one to think that no policy is sometimesbetter than some policy. Another interpretation is thatthe most useful policy changes would relate to a redi-rection of some public funds from subsidies, to supportto participatory planning, and an evaluation of whethertechnical norms and standards could be reorganized togenerate incentives for technicians to add their expert-ise to local efforts to develop new latrine models.

The critical nature of technical norms and standards indetermining sanitation outcomes is very clear. In India thewidespread adoption of the Twin-Pit Pour Flush Latrine(with its associated high cost and high level of subsidy)may have been the single biggest constraint on scaling upaccess to rural sanitation in the past 15 years. By contrast,in La Paz-El Alto, Bolivia, the efforts of the private oper-



ator of the water and sanitation network, with supportfrom the Swedish International Development Coopera-tion Agency (SIDA) and the Water and Sanitation Pro-gram (WSP) resulted in the development of the condo-minial approach to sewered sanitation in the poorestneighbourhoods of the city (The approach was pio-neered in Brazil, and this project was an important stepin its replication as it was expanded into Bolivia for thefirst time). This experience enabled sanitation to be pro-vided to indigenous groups who had hitherto been ex-cluded from service provision, and resulted in adoptionof the low-cost technology as a standard for the utilityfor all income groups. The specific provision of fundsfrom SIDA to support WSP in technical training and ad-vocacy of the approach, resulted in a change in the na-tional norms and standards, which have enabled condo-minial sanitation to be rolled out in other municipalities.

Outside technical norms and standards, housing andplanning policy probably ranks highly in terms of influ-

encing sanitation outcomes. Where access to sanita-tion is bound up with land title (or lack of it) somepoor populations are consistently excluded. On theother hand where land title is positively linked tohousehold investment incentives to improve sanitationmay result. In Burkina Faso, eligible communities cangain land title if they construct latrines inside theirhouses while in Montego Bay, Jamaica, USAID had con-siderable success in generating demand for householdsanitation in poor neighbourhoods by providing the in-centive of land title.

At the highest level though, a thorough review and over-haul of sanitation and hygiene promotion policy has beenrare. Interestingly, in a review of 22 African countries,WSP found that only two (South Africa and Democrat-ic Republic of Congo) included hygienic practices in theirdefinition of access to “improved sanitation”, an indica-tor in its own right that policies are not yet dealing withhygiene improvement as a whole in many cases.

Notes for Chapter 3:

i One of the core tools of the approach is the use of participatory exerciseswhich explicitly look at how and where people defecate. A public transectwalk which sees the whole community walking through the village identify-ing where each household defecates, the so-called “walk of shame”, has be-come the “most important motivating tool, and in almost every case resultsin the setting up of the first community meeting to discuss solutions”.

Case Study Box 2: What Policy Changes should we make?

The analysis of the impacts of India’s use of the TPPF latrine is based on Kolsky, P., E Bauman, R Bhatia,J. Chilton, C. van Wijk (2000) Learning from Experience: Evaluation of UNICEF”s Water and Environmental San-itation Programme in India 1966-1998 Swedish International Development Cooperation Agency, StockholmSouth Africa’s systematic reforms are described in Muller, M. (2002) The National Water and Sanitation Pro-gramme in South Africa: Turning the ‘Right to Water’ into Reality Field Note 7 in the Blue-Gold Series, Waterand Sanitation Program – Africa Region, Nairobi and Elledge, M.F., Rosensweig, F. and Warner, D.B. with J.Austin and E.A. Perez (2002) Guidelines for the Assessment of National Sanitation Policies Environmental Health Project,Arlington VA p.4Information on Uganda’s Reform Programme can be found in Robinson, A. (2002) Water and Sanitation Sec-tor Reform in Uganda: Government Led Transformation Field Note 3 in the Blue-Gold Series, Water and SanitationProgram – Africa Region, Nairobi and Elledge, M.F., Rosensweig, F. and Warner, D.B. with J. Austin and E.A.Perez (2002) Guidelines for the Assessment of National Sanitation Policies Environmental Health Project, Ar-lington VA p.5The El Alto experience is described in Foster, V. (n.d.) Condominial Water and Sewerage Systems – Costs of Im-plementation of the Model Water and Sanitation Program, Vice Ministry of Basic Services (Government of Bo-livia), Swedish International Development Cooperation AgencyThe review of definitions of access can be found in Water and Sanitation Program – Africa (2003) Water Sup-ply and Sanitation in Africa: How to Measure Progress toward the Millennium Development Goals? Paper present-ed to SADC Meeting on Water Supply, Sanitation and Hygiene, Gaborone, Botswana August 4-7 2003

35


Chapter 4: Allocating Resources Strategically


Introduction In a world of limited resources it is necessary to developan approach to sanitation and hygiene promotion whichyields the maximum possible health benefit. The visionand objectives of the programme need to be matchedwith financial and human resources. This invariably meanssetting boundaries and steering resources to specificareas or activities. The following decisions need to betaken:

1. What resources will be made available forsanitation and hygiene promotion?

Allocations of funds and people to sanitation and hygienepromotion are usually made within a wider process ofbudgeting (for social programmes in general, or from awater supply and sanitation sector budget for example).To secure the needed resources for sanitation and hy-giene promotion you will need to:

● work out roughly how much money and how manypeople are needed to meet the objectives of the pro-gramme; and

● be prepared to make, and repeatedly prove, the casefor sanitation and hygiene promotion as a significantcontribution to the achievement of overall poverty re-duction goals.

To strengthen your case it may be useful to be able toexplain how resources will be spent when allocated, andalso to show what sort of coverage you could achievewith different levels of budgetary allocation.

2. What is the balance of activities to befunded?

Where funds are used to leverage household in-vestment (ie where public funds are to support house-hold investments rather than substitute for them) ratesof coverage may increase significantly. A smaller propor-tion of public resources will now be spent on construc-tion of hardware and subsidies for household latrines. In-stead public funds may increasingly be used to marketsanitation, promote hygienic behaviours and supportsmall-scale independent providers. The disadvantage ofthis approach, from a political perspective is that the di-rect link between funds and coverage will become lessclear. To ensure that politicians (who control funding de-

cisions) remain comfortable with the approach, house-hold investments in sanitation must be closely monitored,and selected investments in trunk infrastructure and fa-cilities in schools and public places should continue to bemade. This will enable politicians to demonstrate thattheir funding decisions are yielding tangible results.

Resource allocations should also keep pace with institu-tional capacity. Getting more sanitation facilities inschools is critical for example, but in some cases policiesand experience in the Department of Education mayconstrain progress and mean that investments madetoday may be wasted as facilities fall into disrepair. Insuch a case some resources must be allocated to thelong-term goal of changing the Department’s approachto school sanitation while resource allocations for con-struction of facilities are progressively increased overtime. Similarly, if funds are to be diverted towards hy-giene promotion, and if the best vehicle for this is the De-partment of Health, allocations should only be made inline with the human resources available in the depart-ment to go out and deliver hygiene promotion activities.A step-by-step approach may be needed so that in-creased financial resources can be matched with grow-ing human capacity.

3. Will the program target specific regionsand if so which?

Where resources are stretched, it may be appropriate towork, at least in the short term, in selected regions or lo-cations. Greater health benefits may accrue from a moregeographically focused programme.

Piloting: Focused programmes may be justified if newapproaches need to be tested and demonstrated aheadof wholesale institutional change. This “pilot” approachmay help to “shift gears” and increase the speed ofprogress in the sector but may well conflict with equityconcerns in the short term. Identifying areas where thechances of success are high is hard. Allowing the infor-mal sector and civil society to lead the process may workin some contexts along with the use of formal indicatorssuch as:

● existence of community organisations/ past experi-ence of collective interventions etc;

4.1 Focusing on objectives

Chapter 4 Allocating Resources Strategically


● presence of well-trained outreach workers who canextend their interventions effectively to include hy-giene promotion and sanitation marketing;

● pre-existence of sanitation practices and technologieswhich can be effectively scaled up;

● existence of small scale independent providers; and● potential for simple small-scale interventions to

achieve benefits (such as selecting areas where on-plot latrines are a potential solution rather than ad-dressing areas which require networked solutions).

Equity and Targeting: It is already known that de-mand for sanitation hardware is low – that is one reasonwhy coverage is so poor. But it is also clear that wheredemand exists provision may follow rapidly through theefforts of households themselves and the small scale pri-vate sector.

For these reasons, while available public subsidy for san-itation could probably be steered towards those areas ofhighest demand, a much more pressing issue in mostcountries is probably to work towards stimulation of de-mand in areas of greatest need. This means that both hy-giene promotion, sanitation marketing and support forthe enabling environment, should be targeted towardsthose areas.

The real problem then comes in assessing which areas fallinto this category. A number of approaches can be usedincluding targeting communities/ households with:

● poorest health status as indicated by incidence of epi-demic disease such as cholera;

● poorest overall health status as indicated by formal as-sessments using internationally agreed indicators;

● lowest access as assessed through formal empiricalresearch into numbers and use of latrines, incidenceof hygienic behaviours etc;

● highest incidence of poverty (as defined by agreed na-tional norms and assessed nationally or regionally); or

● highest incidence of other proxy indicators of pover-ty and/or poor access, such as low ownership of cap-ital assets, poor school attendance, or incidence ofwomen- and children-headed households.

Equity may also demand that support is specifically tar-geted towards those households/communities more af-fected by a specific health/poverty related situation –such as Acquired Immune Deficiency Syndrome (AIDS).More ideas about assessing needs and demands can befound in Reference Box 9.

4. Will the program target specific types ofcommunities and if so which? Depending on the institutional and demographic shapeof the country, it may sometimes be appropriate to pro-gramme specifically for rural, small town or urban situa-tions. Better programming may result from different ap-proaches being used for each type of community. On theother hand, it may be that better coverage could beachieved at lower costs if elements at least of the pro-gram (some aspects of hygiene promotion and sanitationmarketing for example) were developed for use nation-ally or across an entire region.

Targeting can also be used to reach communities whoare persistently excluded. Good information about cov-erage in rural, small town and urban areas may indicatea need to focus on one of these for example.

5. Will the program target specific segmentsof society and if so which? Some countries and regions may take a specific policy de-cision that public funds should be steered exclusively, orsubstantially, towards a specific segment of society. It isnot uncommon for countries to have a policy of target-ing the poorest, indigenous groups or specifically of thosewithout access to a minimum level of service. It is some-times difficult and costly to identify target communities,in which case proxy indicators (such as targeting sub re-gions where the incidence of poverty is high) may haveto be used. Sometimes the rich and powerful are ableto subvert such targeting, so if this approach is to betaken, explicit notice must be taken of how targeting isto be monitored and what incentives might be neededto secure funds for the stated objectives.

37


Chapter 4: Allocating Resources Strategically

4.2 The need for transparent rules

One of the most important mechanisms for establishingand maintaining trust between partners is to ensure that,where money is being allocated, there is a clear andtransparent process and a set of known rules. Whatev-er programming decisions are taken all partners shouldbe confident that (a) decisions about the rules for re-source allocation had a sound basis (even if the individ-uals disagree with the final decision); (b) resources arebeing allocated on the basis of these rules; and (c) boththe initial decision and the ongoing allocation of re-sources are carried out within an institutional arrange-

ment which precludes collusion and encourages the op-timum use of resources in the public interest. In many cases political reality may dictate the allocationof resources. This may mean that resources have to beshared equally between competing regions, or that moreresources must be steered towards areas of greaterpoverty. In such cases, where the case for resources al-location is not specifically technical, it is important to beas up-front as possible; most organisations and individu-als will accept that political processes are an importantpart of the institutional landscape.


For a discussion of demand in the context of water supply and sanitation projectsSee: Katz, T. and Sara, J. (1997) Making Rural Water Supply Sustainable: recommendations from a Global StudyUNDP-World Bank Water and Sanitation ProgramGet this reference at: [email protected]

For a discussion of the challenges of assessing and responding to needs and demands See: Cairncross, S. and Kinnear, J. (1992) Elasticity of Demand for Water in Khartoum, Sudan, Social Science andMedicine, 34 (2): pp183-189Dayal, R., C. van Wijk and N. Mukherjee (2000) Methodology for Participatory Assessments: Linking Sustainability withDemand, Gender and Poverty WSP on the web at www.wsp.org Coates, S., Sansom, K.R., Kayaga, S., Chary, S., Narendaer, A., and Njiru, C. (2003) Serving all Urban Consumers –a Marketing Approach to Water Services in Low and Middle-income countries. Volume 3 PREPP, WEDC, Loughbor-ough University, UK. on the web at www.lboro.ac.uk\wedcWhittington, D. (1998) Administering Contingent Valuation Surveys in Developing Countries World Development26(1): pp21-30Whittington, D. (2002) Improving the Performance of Contoingent Valuation Studies in Ddeveloping Countries Envi-ronmental and Resource Economics 22 (1-2): pp323-367Willing to Pay but Unwilling to Charge: Do Willingness to Pay Studies Make a Difference? WSP Water and SanitationProgram – South Asia Field Note (1999) on the web at www.wsp.orgWedgewood, A. and K. Samson (2003) Willingness-to-pay Surveys – A Streamlined Approach: Guidance notes forsmall town water services WEDC, Loughborough, UK. on the web at www.lboro.ac.uk\wedc

Reference Box 9: Needs and demands


4.3 Applying the Principles


TTaabbllee 55 sums up the principles as they apply to resource allocation.

Table 5: Applying the Principles to Resource Allocation


Use public funds toleverage, rather thansubstitute householdinvestment

Leverage expendi-tures across a rangeof social sectors

Achieving Equity

Consider targeting re-sources towards ex-cluded populationsand specific activitiesthat support the ex-cluded within commu-nities


Invest in informationgathering

Test ideas first wheninformation base isweak

Steer resources toareas where there isinstitutional capacityto spend


Ensure clear andtransparent processesfor allocation of fundsEstablish water-tightprocesses for trackingexpenditures

Communicate financ-ing decisions unam-biguously


Use resource alloca-tion to signal new ap-proaches and buildconfidence in them

Once decisions are made on what balance of resourceswill be steered towards activities, regions, communitiesand segments of society, what sort of instruments can theprogramme use to ensure that the programme aims areachieved? Clearly, this depends to some extent on theway in which programmes are to be financed and howorganisations are to be structured but some possible in-struments would include:

● Setting up targeted regional programmes or projects– setting aside funds specifically to be spent by localjurisdictions or by national agencies for designated re-gions;

● setting rules for externally funded interventions whichencourage funding to specific regions or in support ofagreed programming priorities;

● establishing demand-responsive funds which regions/urban centres or agencies could apply to use, wherethe rules of the fund reflect specifically the program-ming allocation priorities;

● creating (financial) incentives for staff of agencies towork in specific regions or communities; and

● setting aside funds to provide financial or other sup-port to non-governmental organisations and the smallscale private sector where these organisations seek tobuild their capacity in agreed programming priorityareas

39


Chapter 5: Financing

5.2 Where will the funds come from?

Sanitation and hygiene promotion come with a range ofcosts which can be covered from various sources. Theprogramme has to identify sources of funding for:

● Enabling Environment including the costs of pro-gramming, monitoring and evaluation, regulation,technical oversight, organizational change, training, co-ordination with other sectors, and public advocacy(to generate understanding of and support for thesector).

● Promoting Hygiene Behaviours based on asolid understanding of what current conditions are,and how they need to change to bring in the antici-pated health benefits. Thus financing is required for

assessing the current situation, development of mate-rials, training programmes, staff costs, transport andoffice overheads along with the ongoing costs of op-erating in communities and supporting a dynamicchange process at local level.

● Improving Access to Hardware including sani-tation marketing (costs include staff, transport, of-fice overheads, preparation of materials, cost of mediaplacement, training, construction of demonstration fa-cilities and other pilot interventions), capital costs(of household and shared facilities including materialsand labour) i, and operation and maintenancecosts (which will vary widely depending on the tech-nology chosen) ii.

The financing arrangements for the programme need to:

● be self sustaining (ie have internal integrity so thatfunds are always available for the key elements of theprogramme, and funding matches the responsibilitiesand capacities of different institutional partners);

● provide funds for all the agreed elements of the pro-gramme; and

● be consistent with the agreed principles.

In fact, the financing structure needs to be more than con-sistent with the agreed principles – the financing arrange-ments are likely to be one of the most powerful pro-gramming instruments for driving the application of those

principles which is why getting financing arrangementsright is such an important step in programming.

Costs may be covered from a range of sources including:

● central government;● regional / local / urban government; ● large scale private sector;● shared community resources; ● small scale private sector; and ● the household.

Note however, that any private sector investment will ul-timately be repaid from one of the other sources (gov-ernment, community or household).


5.1 What needs to be financed

Chapter 5 Financing

Sanitation and hygiene promotion have public and pri-vate costs and benefits. As a useful principle, public funds(government funds, external donor funds and so on)should generally be used to maximise public benefits; pri-vate funds should be used for essentially private elementsof the system (soap, individual latrines etc).

While the focus of financial planners may fall on financ-ing household investments in hardware, it is vitally im-

portant that adequate funding is available for all the otherelements of the programme and that household invest-ment is not out of scale with other supporting activities.For example, if investments are urgently needed in sani-tation for schools, public latrines in market places, and hy-giene promotion programmes, these are areas which, al-most by definition, need financial support from publicsources or explicit policy support to generate privatefunding (for privately- constructed and managed public

5.3 Assigning Programme Costs


TTaabbllee 66 illustrates four financing models, not to suggest that these are the only approaches but rather to show how arange of solutions may be employed in different cases.

Table 6: Illustrative Financing Models

Role

Enabling Environment

Hygiene Promotion

Sanitation Marketing

Capital costs

Operation andmaintenance

Urban, higher levels of subsidy to utility andhousehold

National government

Urban government

Urban government

Utility, repaid byurban government

Utility with grants fortrunk services,Household for house-hold services

Urban, no house-hold subsidy

Urban government

Urban government

Utility, repaid byhousehold

Utility, repaid byhousehold

Utility with grant forwaste water treat-ment, Household forall other

Rural, householdsubsidy

National government

Local / regional gov-ernment


Household and localgovernment

Household

Rural, no house-hold subsidy

National government



Household

Household

It is important to note here, that even the “no subsidy”model comes with significant public costs in the shape ofadministration, regulation, monitoring and evaluation andso on. The public benefits of sanitation and hygiene

promotion (and the corresponding public cost if no ac-tion is taken) mean that, whatever financial regime isadopted, government retains significant responsibilitiesand attendant costs.

latrines for example). Only once the financial structureof the whole programme has been established, will it bepossible to judge whether financial support to householdinvestments are appropriate or can be provided fromavailable sources.

In particular it is worth considering how grant and con-cessionary funding (available domestically or through ex-ternal support mechanisms) can be most effectively har-nessed to support the programme within the context ofwider poverty-reduction goals. The ultimate scale andnature of the programme should be decided on this basisand not in isolation.

Broadly costs might be allocated as follows:

● Enabling EnvironmentThese costs would normally be covered from nationalgovernment budgets, except in cases where federatedstates or autonomous urban areas take full responsibili-ty for programmes and have the financial means (throughlocal taxation) to support these costs.

● Promoting Hygiene BehavioursBecause hygiene promotion has a strong “public good”element, it would normally be part of the supporting roleof the programme and be covered from governmentsources at the appropriate level. This is a good area fortargeting soft or grant-funding from external sourcessince these costs are unlikely to be recovered from users.

● Improving Access to Hardware● Sanitation marketing costs may be covered from

government sources or from the private sector iii. ● The financing of capital costs of sanitation hard-

ware has traditionally been the significant elementin many sanitation programmes. What is arguedhere is that this is counterproductive and in mostcases sanitation hardware should be the responsi-bility of households. However this places a re-sponsibility on programmers to support and pro-mote goods and services which are appropriate.A further discussion of subsidies is included inSection 6.5 iv.

● In most cases households would be expected tocover operation and maintenance costsv.

41



5.4 Household self-financing – sanitation

5.5 Subsidies for sanitation

Where demand is sufficiently high, households may bewilling to meet the full capital and operational costs ofsanitation. Formal willingness-to-pay surveys can provideinformation about this, but they are expensive and diffi-cult to administer. As a first step, informal discussion, andparticipatory evaluations can be used to confirm whetherself-financing is viable. Some proxy-indicators of appro-priate levels of willingness-to-pay include:

● ownership of consumer durables of equivalent value;● high percentage of private house ownership;● extremely poor sanitary conditions, linked to high lev-

els of dissatisfaction; and

Relying on household investments for hardware inter-ventions can be problematic where:

● demand is low (due to conflicting demands on house-hold resources, high levels of poverty or low levels ofawareness);

● household action will have limited effect due to con-gested conditions (often in urban areas this problemis exacerbated because the only viable technical op-tion is piped sewerage of some sort); or

● there is a high percentage of rented accommodation– householders may be unwilling to invest in a housewhich is not their own, owners may be unwilling toinvest where tenants are readily available to rent poorquality housing.

In such cases subsidies may be advocated to jump-startlatent demand or in the interests of equity – to encour-age increased access for targeted segments of society.Many “sanitation” programmes have provided capitalcost subsidies which were either available universally (thisis always the case for piped sewerage for example), avail-able through means- testing which linked subsidies to“poverty”, or linked to specific levels of service. Theseprogrammes have consistently exhibited a set of prob-lems including:

● lack of financial sustainability; a policy which states thatcertain, usually poor, people are entitled to free or re-duced cost services, is meaningless if there are inade-quate public funds to support it;

● general awareness of health problems and the linkswith poor sanitation.

Where households are expected to finance sanitationthe message must be clearly articulated and unambigu-ously applied. Many households may be reluctant tomake the needed investments if they believe that (a) for-mer subsidy programmes are still operating; (b) subsidiesare likely to be reinstated; (c) alternative agencies mayprovide subsidies; or (d) subsidies can be made availableif pressure is brought to bear through local politicians.

● the relationship between poverty and access is morecomplex than programmers imagine - there may bemany reasons why people do not access services -cost may not be the most important. In this situationsubsidies may not increase access;

● subsidised facilities built during a pilot phase may ac-tually suppress demand as other households wait andsee if a subsidy will also come their way;

● subsidies often create expectations that cannot befulfilled in surrounding areas and among other incomegroups;

● the use of subsidies for construction of “standard” fa-cilities distorts the market and suppresses innovationsthat might bring down costs;

● substandard construction of “subsidized” latrines maysuppress demand;

● subsidies aimed at helping the poorest sometimes as-sociate a certain technology with poverty and theneed for assistance further distorting demand;

● means-testing for subsidies is expensive and ex-tremely difficult; and

● requesting a down payment or contribution to assessdemand before a subsidy is released may exclude thepoorest households.

If subsidies are to be used, programmers need to thinkcarefully and select a subsidy mechanism which is likelyto (a) achieve the intended policy outcome; (b) reach theintended target group; (c) be financially sustainable; and(d) be implemented in a clear and transparent manner.



The following general principles should always be ap-plied:

● in the public interest use subsidies to maximise healthbenefits and increase access specifically to groups whoare persistently excluded;

● subsidise the lowest possible level of service to max-imise spread and avoid distortions to the market.Leave room for households to make incremental im-provements over time;

● base subsidies on solid and rigorous informationabout what types of service people want and are will-ing-to-pay for, what is the affordability for the targetgroup, and what can be scaled up in the long term.

The range of sanitation subsidy instruments are summa-rized in TTaabbllee 77 and discussed further in the notes sec-tion6.

Table 7: Subsidy Mechanisms

Mechanism

Subsidies for latrine construction

Social subsidies

Consumption subsidies throughthe tariff (Urban networks)

Access subsidies through the tariff(urban networks)

Strengths

Direct link between input and output-Targets those households without ac-cess

Lower per-latrine costs. May supportlatent local suppliers

Uses existing tariff collection and pay-ment system

Addresses access problem directly andmay be better targeted

Weaknesses

Expensive and complex Overdesign and high costsInadequate funds to complete latrinesStifles innovation and the local marketProne to corruptionLimited reach

Targeting may be poorRequires national social policy frame-work

Poor targeting (does not reach the un-connected)May not overcome access barriersDoes not support in-house costs

Usually links water and sanitation - maynot reach some households who re-quire sanitation alone.

5.6 Supporting self-financing through micro-financeThe alternative to subsidies is the provision of appropri-ate financing services – commonly credit, but also ex-tending to savings, insurance and so on. Many micro-fi-nance programmes have failed in the past. This is oftenbecause financial services were provided by organisationswhich lacked the appropriate financial skills and failed tooffer an appropriate mix of services, or failed to establishtheir own financial integrity. In addition, provision of fi-nancial services can be very difficult in situations where:

● inflation has been or still is very high;● interest rates are high;● it is uncommon to borrow money for capital goods;● legal/ regulatory controls limit the activities of small

scale specialist credit agencies or prohibit lending for“non-productive assets”; or

● many ad hoc financial obligations make plannedhousehold expenditures very difficult for low-incomehouseholds.

If micro-finance is likely to be an important element ofthe programme then it is important to consider the fol-lowing possible programming interventions:

● policy / legal / regulatory changes to encourage smallscale financial service providers;

● capacity building for financial service providers to as-sist with a move into infrastructure service provision

43



5.7 Generating revenue for sanitation and hygiene promotion

5.8 Financial instruments to promote reform

● capacity building for non-governmental organisationsworking in infrastructure to assist with a move intomicro-finance;

● provision of seed funds, partial or full guarantees orother financial instruments to encourage on-lendingto small scale borrowers;

Moving away from the household as the focus of financ-ing, it may still be possible to use cross-subsidy or othermechanisms to generate some revenue which can beused to support hygiene promotion and sanitation in-vestments. Examples of possible tools include:

● levying a surcharge on water bills to finance new con-nections to sanitation networks, or hygiene promo-tion activities;

Financial instruments can also be used to promote re-forms which are needed to improve the enabling envi-ronment. This can be done, for example, by making fundsavailable in a way that creates incentives for local juris-dictions to change policies and innovate. Examples ofthese types of instruments include:● conditional grants (either tied to specific sectors and

activities, or granted on a discretionary basis) fromhigher to lower-tiers of government or departments;

● conditional grants linked to demonstrated improve-ments in performance;

● social investment funds/ special projects, independ-ently managed and able to provide grants to commu-nities in response to demand;

● community development funds, focused on creatingsocial capital in the poorest communities with opera-tional costs covered through fund income;

● institutional-reform-linked challenge fundsvii, to meetthe transactions costs of institutional reform;

● sector-wide frameworks within which poverty reduc-tion is linked to overall sector finance strategies – in-cluding: the sector-wide approach (SWAp) and Medi-um Term Expenditure Framework (MTEF) which arelinked to debt relief; investment lending (from devel-opment Banks) for sector investment and maintenance(SIM) and adaptable program lending (APL); and ad-justment lending through sector adjustment loans(SECAL) or poverty-reduction support credit (PRSC).

● cross subsidizing from richer households paying forsewered connections, to provide funds for on-site andlower costs public services; and

● building costs of extension of sanitation and hygienepromotion services into general utility tariff structures.

● pro-active use of concessionary development fundsfrom External Support Agencies to finance or guar-antee micro-finance services.


For more details on some of the availablefinancial instruments

See: Mehta, M., (2003) Meeting the FinancingChallenge for Water Supply and Sanitation: Incen-tives to Promote Reforms, Leveraging Resourcesand Improve Targeting World Bank, WSP Waterand Sanitation ProgramNew Designs for Water and Sanitation Transac-tions: Making Private Sector Participation work forthe Poor WSP Water and Sanitation Program,PPIAF (2002)Varley, R.C.G. (1995) Financial Services and En-vironmental Health: Household Credit for Waterand Sanitation EHP Applied Study No.2, Arling-ton VA.Credit Connections: Meeting the InfrastructureNeeds of the Informal Sector through microfinancein urban India. Issues Paper and Field Notes,WSP Water and Sanitation Program South Asia

Get these references on the web from:www.wsp.org or www.whelpdesk.org

Reference Box 10: Financial instruments




5.11 Practical Examples from the Field:How will we pay for the programme?

Table 8 shows how the principles can be applied when designing financial instruments.

Whatever financing mechanisms are chosen, they willneed to be established through the programmingprocess. This might require a number of interventionsincluding:● the development of specific policies backed up with

regulations and possibly a regulatory structure formonitoring (this might be the case for subsidies forexample);

In Lesotho a quiet revolution has been underway for thepast twenty years. In that time, the government has suc-cessfully increased national sanitation coverage from 20%to approximately 53%. The goal of reducing morbidityand mortality attributable to diseases associated withpoor sanitation through health and hygiene promotionand the promotion of VIP latrines appears to be beingachieved. During this time the policies of the governmentof Lesotho have specifically shifted away from subsidiz-ing latrines; much more money is now channeled to-wards promotion and training.

Table 8: Applying the Principles to Financing


Use public funds tomaximise public bene-fits; private (house-hold) finance shouldgenerally be reservedfor private elementsof the system (soap,latrines)

Achieving Equity

Ensure the financialregime is stable andsustainable

Use subsidies onlywhere they increaseaccess for the exclud-ed

Distribute adequatefunds to ensure soft-ware support reachesremote and poor re-gions


Understand whatpeople want and arewilling to pay for andpromote appropriategoods and services


Involve potentialfunding partners inprogramming deci-sions


Use specialized finan-cial skills in pro-gramme design

Allocate specific re-sources to capacitybuilding

● the establishment of a specific fund mechanism forhandling either programmatic or household financ-ing;

● the strengthening of an existing subsidy or fundmechanism (for example social funds) to enablethem to handle the new arrangements for financingof sanitation and hygiene promotion; and

● capacity building.

Key financial aspects of this story include; consistent sig-nificant allocation of the regular government budget tosanitation; and earmarking of these funds for promotion,training local artisans, and monitoring. In rural areas, gov-ernment funds are also used “to supply basic latrine com-ponents ‘at cost’ to households” to keep prices as low aspossible. The government also provides a subsidythrough its operation of the “loss-making pit-emptyingservice”. No direct subsidies are provided to house-holds. The main challenge of the arrangement appears to

45




be that the sanitation budget is mainstreamed at districtlevel in the health budget – which means sanitation com-petes with curative care for allocation of funds and manydecision makers view the latter as a priority. The sanita-tion budget has therefore experienced a decline over re-cent years. In addition the government separately pro-vides a 50% subsidy to the school sanitation programme.The total investments made by households is estimatedto be in the range of 3 to 6 times the government con-tribution.

In Mozambique the success of the National SanitationProgramme has been attributable in part to the abilityand willingness of external support agencies to providefunds for the subsidized provision of the domed latrineslab. A 1999 review of the program estimated that donorfunds accounted for a little over 50% of the costs of theprogramme with users contributing a little less than 40%and the government less than 10%. Nonetheless, theability of the programme to deliver the direct subsidy ina transparent manner and without massive overheadcosts, appear to have resulted in a fairly cost-effectivetransfer of resources to households. Furthermore, thesubsidies appear to have been effective because theywere specifically linked to the delivery of the componentof hygiene improvement whose cost was the major bar-rier to many households accessing latrines at all. This un-derstanding, developed through thorough research atthe outset of the programme resulted in a well-designedand targeted subsidy, and consequently an effective pro-gramme delivered at scale.

By contrast, the high cost of twin-pit pour flush latrines,adopted as a standard technology in India, resulted in theneed for a massive subsidy programme. This resulted in“fundamental difficulties of sustainability, bureaucracy andsuppression of any real demand for sanitation”.

Micro finance (both credit, savings and insurance) canplay a part in supporting household investment in sanita-tion where there is demand. Micro finance providers inIndia have conventionally been excluded from providingcredit for infrastructure which is not deemed to be a pro-ductive asset. Recent efforts by micro finance providersand the government with support from the World Bankhave resulted in a realignment of policies and incentivesso that provision of services can become more effective.In the isolated cases where investments in householdsanitation have been documented, the productive valueof the increased safety and convenience afforded by a

household latrine are reported to be significant, particu-larly for those employed in the informal economy.

In South Africa the long-term reform process has beensupported by a consistent allocation of governmentfunds for capital works (mostly, it must be said, expend-ed on water supply). This ability of the government tosupport investments in parallel with a programmingprocess has had a significant positive effect on the levelof support for reform. Investment funds can be used tosupport reform in other ways too; in India the govern-ment is establishing a city challenge fund which will beavailable to support the activities of cities undertaking dif-ficult local reforms and reorganizing service deliveryarrangements. Where public funds are scarce, internalcross subsidies are sometimes used to support sanitation;Burkina Faso applies an internal cross subsidy in the formof a sanitation surcharge on the water bill of all connect-ed water consumers, the resultant resources are ear-marked to provide sanitation to excluded populations.


Case Study Box 3: How will we pay for the programme?

The description of the financing arrangements in Lesotho comes from Pearson, I. (2002) The National Sanita-tion Programme in Lesotho: How Political Leadership Achieved Long-Term Results Field Note 5 in the Blue-Gold Se-ries, Water and Sanitation Program – Africa Region, NairobiThe National Sanitation Programme in Mozambique is described in: Colin, J. (2002) The National Sanitation Pro-gramme in Mozambique: Pioneering Peri-Urban Sanitation Field Note 9 in the Blue-Gold Series, Water and Sani-tation Program – Africa Region, Nairobi and in Saywell, D. (1999) Sanitation Programmes Revisited WELL StudyTask No: 161 WELL – Water and Environmental Sanitation – London and Loughborough, London.The analysis of the impacts of India’s use of the TPPF latrine is based on Kolsky, P., E Bauman, R Bhatia, J.Chilton, C. van Wijk (2000) Learning from Experience: Evalutaiton of UNICEF”s Water and Environmental Sanita-tion Programme in India 1966-1998 Swedish International Development Cooperation Agency, StockholmMore information on microfinance for infrastructure can be found in World Bank (forthcoming) SustainablePrivate Financing of Community Infrastructure in India Report to the Government of India, World Bank, DFID. Ex-amples from India are in WSP-South Asia (2000) Credit Connections: Meeting the Infrastructure Needs of the In-formal Sector through microfinance in urban India. Issues Paper and Field Notes, WSP Water and Sanitation Pro-gram South AsiaReference is made to the city challenge fund in Mehta, M., (2003) Meeting the Financing Challenge for Water Sup-ply and Sanitation: Incentives to Promote Reforms, Leveraging Resources and Improve Targeting World Bank, WSPWater and Sanitation ProgramFor more information on South Africa’s Reforms see Muller, M. (2002) The National Water and Sanitation Pro-gramme in South Africa: Turning the ‘Right to Water’ into Reality Field Note 7 in the Blue-Gold Series, Waterand Sanitation Program – Africa Region, Nairobi and Elledge, M.F., Rosensweig, F. and Warner, D.B. with J.Austin and E.A. Perez (2002) Guidelines for the Assessment of National Sanitation Policies Environmental HealthProject, Arlington VA p.4The sanitation surcharge in Burkina Faso is described in Ouedraougo, A.J., and Kolsky, P. (2002) Partnershipamd Innovation for on-site sanitation in Ouagadougou, Burkina Faso Waterlines, Vol21, No2, pp9-11, October2002

47



Notes on Chapter 5:

i Capital costs for construction may be limited in rural areas to house-hold level facilities (although some investment in shared facilities, andfor the treatment and disposal of wastewater may be required). Inurban areas, in addition to household investments there may be sub-stantial costs associated with connecting to a sewerage network or informal collection and management of pit and septic tank waste. Labourand materials may be more expensive and attract greater overheadsif contractors are involved in construction. Where waste water treat-ment and disposal is included costs will rise significantly.

ii For simple rural schemes operation and maintenance costs may berelatively low but they will rise in urban areas and where shared facil-ities are constructed. In extreme cases with pumped sewerage, costsare likely to be prohibitively high.

iii In urban areas where there is an autonomous utility the costs of mar-keting sanitation to all consumers are likely to be covered from theutility budget (public or private). In those rural areas where the po-tential for local small scale provision is high, these costs may also ulti-mately be covered by small scales businesses which stand to recoupthem through the sale of sanitary goods. In the short term some sup-porting funding or credit may be needed from government to help pri-vate sector providers launch sanitation marketing efforts. Wherethere is no private sector with the requisite skills and where non-pri-vate sector solutions are to be used, then these costs will probably bepart of government support to the programme.

iv Note that in urban areas, there is almost always an element of sub-sidy, particularly where networked solutions are used. Even in West-ern Europe no cities fully recover the costs of wastewater treatmentfrom consumers.

v In rural areas or urban areas with on-site solutions this is easy to or-ganize through direct payment for pit emptying if it is required. In urbanareas the situation may become more complicated with some ele-ments of the costs being recovered directly (for example where house-holds pay a fee for emptying of septic tanks or pits), some through thetariff (where households have water connections as well as sanitaryservices they may pay a surcharge on the water bill for sanitation) andsome being subsidized (for example by grant payments from govern-ment to a utility which is operating a sewerage system.)

vi Types of Sanitation Subsidy

Subsidies for latrine construction

Direct Subsidies for latrine construction have been provided for manyyears in many countries. In this approach, public funds are usually madeavailable to households to cover all or part of the cost of constructionof a “standard” latrine. The funds may be delivered to the householdin advance, in installments during construction, or in arrears. Alter-natively, the household can apply for a latrine which is then built underthe direct supervision of government engineers with no money han-dled by the householder at all. These subsidy arrangements are char-acterized by a number of problems. They tend to be: expensive andcomplex to administer (usually a government engineer needs to certi-fy each latrine, often more than once);prone to cost related problems– standard designs may be over-designed and over-priced, or under-priced because standard rates used in the estimate may be outdated;and unresponsive to the bulk of demand, because costs are too high,or because there is insufficient capacity to respond.

Nonetheless they have proved popular because they deliver a quan-tifiable product and, particularly in rural areas, are one of the only waysin which many technical departments of government have been able torespond to the sanitation challenge.

Social subsidies

In a very few cases, social subsidies based on overall poverty indica-tors are available to the poorest households. These can then be spenton whatever services are most needed by the household. These sys-tems (of which Chile has the best known example) have lower per capi-ta costs than dedicated sanitation subsidy schemes and do not distortthe market for sanitation goods and services in the same way, as house-holds are free to purchase whatever they require on the open market.

However, such a system is only feasible if there is a national policyframework in place across all the social sectors.

Subsidised Consumption in Urban Areas

In areas with piped water and sewerage, government subsidies arecommonly delivered via the tariff. In these cases the subsidy on theuse of sanitation is usually achieved by proxy through subsidised con-sumption of water. The most common form of this is a cross-subsidylinked to overall water consumption (by means of an increasing blocktariff). This type of approach only benefits those people already con-nected to the network – which usually excludes the poor. It also con-tains a number of inherent biases against poor households who mayuse less water and thus benefit from a lower proportion of the sub-sidy, and against poor households who share connections and who maytherefore end up paying at the higher rate. It also does little or noth-ing to help households with the costs of in-house facilities (taps andtoilets) which are needed if private health benefits are to be realized.

Subsidised access to piped networks

More interesting approaches have been developed in some cases, tosupport new customers connecting to the water and sewerage net-work in urban areas. Historically, the real costs of connecting to urbanwater and sewerage networks were not borne by consumers. In con-trast much or all of the technical costs of connecting may now be trans-ferred to new consumers. This is unfair and contains a strong biasagainst the poor who are usually the ones who are not yet connectedto the network. In view of this, some utilities are attempting to struc-ture subsidies by increasing the general tariff and removing or reduc-ing the one-off connection fees associated with joining the network.This is an important step forward, recognizing as it does, that povertyand lack of access often go hand in hand.

vii A challenge fund, usually provided by central government, provides fi-nancial support to local administrations who show a willingness to re-form themselves in line with certain agreed general principles. Thefunds would usually be used to finance the actual process of institu-tional reform – including working out what needs to be done, and mak-ing the necessary policy, financial and organizational changes.



6.2 What will define successful organisations in your Programme?

With the right skills and well organized arrangements thevision of an effective sanitation and hygiene promotionprogramme can become a reality on the ground. Work-ing out which organisations should be involved, whatthey should do, and what support is needed to develophuman resources is a critical and exciting part of pro-gramming for change.

New organizational arrangements need to be:● consistent with your chosen vision and principles;● designed to make best use of government, NGOs, the

private sector, and grassroots organisations;● organised in a way which supports rather than sub-

verts community-level institutions and promoteshousehold decision making;

● staffed and funded adequately to deliver the agreedprogramme; and

● consistent with the political organisation of the coun-try, particularly the level of decentralization.

Building the right institutional arrangements is one of themost critical steps in programme development but it isusually the most difficult. Costly and difficult institutionalreorganizations should only be undertaken as a last re-sort. Much of what you need probably already exists.Programmers need to ask themselves:

● are there front-line units who can deliver elements ofthe programme?; and

● are there agencies/organisations who can supportthese units and provide the needed enabling environ-ment within which they can function?

The human resources you need may be found in a widevariety of places including:

● government agencies: including water and sanita-tion agencies, health departments, education depart-ments, environmental agencies, rural developmentteams, urban planning departments, local government.Human resources may be available at all levels of gov-ernment from the national down to the local level;

● civil society: households themselves, NGOs (work-ing in water supply , sanitation, social development,health, education etc), community based groups, self-help groups, local/community government, micro-fi-nance organisations etc; and

● private sector - small scale private providers, soapcompanies, building contractors, advertising agencies,media etc.

However, much of what exists may not be geared up toreflect the principles of good sanitation and hygiene pro-motion. Key aspects of many organisations may need tochange; the challenge is to find effective ways to makethis happen. Some of the characteristics of the newbreed of organisations include:

A focus on equity Organisations working locally, require specific skills andpersonnel to be able to focus on household needs andreach all segments of society (women and men, youth

and the elderly, different ethnic groups, those with accessto services and those without). One of the key and press-ing needs in many organisations is to realign responsibil-ities and build capacity so that the currently excluded seg-ments can become the focus of interventions. This lack of local level skill, is mirrored within organisa-tions, where ironically it is often staff with precisely theprofile to address these concerns, who are marginalizedbecause of their professional profile, or on the groundsof gender or age. It is crucial that the gendered natureof sanitation and hygiene promotion is acknowledged

6.1 Who is going to deliver your Programme?

Chapter 6 Roles and Responsibilities – Restructuring Organisations

49


Chapter 6: Roles and Responibilities – Restructuring Organisations

6.3 Allocation of Responsibilities

6.4 Capacity Building Approaches

and action is taken to change the orientation of tradition-al organisations, so that they can effectively work with thegroups who most need their support.

A focus on working in partnership It takes more than a single organisation to support sanita-tion and hygiene promotion. A huge number of peopleneed to start to act in a different way, which requires amassive realignment of the incentives which drive them.This discussion is about more than “inter agency coordi-nation”, it is about creating an interlinked web of people

all of whom are acting in response to the needs and de-mands of households.

Accountability and PerformanceFor this partnership to work the vision should be for in-stitutions which have:

● clear and distinct organizational responsibilities;● adequate accountability (checks and balances) to safe-

guard resources and ensure effectiveness; and● incentives to perform.

Examples of novel arrangements that emphasize a rolefor a range of partners do exist although few have ex-tended to national level. There is no “blue-print” solutionbut the following broad allocations of responsibility arecurrently a popular approach:

● National government: facilitation of programming,policy development, creation of facilitative laws andregulations, publication of verified national data oncoverage and progress, financing for technical assis-tance to small scale providers, community groups etc;

● Regional / local government: management ofhygiene promotion and community development ac-tivities (which may be carried out by in-house staff oroutsourced), monitoring of technical issues, licensingof small scale providers, certification of communitysupport organisations, coordination of local monitor-ing and collation of data for planning purposes, etc;

● Urban government: provision and managementof trunk services and facilities in some cases (either di-

rectly or through a utility), management of wastes, li-censing of small scale providers, oversight of creditproviders, technical assistance to communities etc

● NGOs: technical support to communities, delivery ofhygiene promotion and community development sup-port, provision of credit services, oversight of progressthrough participatory monitoring and evaluation etc;

● Small Scale Private Providers: sale and deliveryof sanitation goods and services, contribution to plan-ning and programming activities, may also providecredit directly or through dedicated credit providersetc;

● Communities; participatory planning, identificationof appropriate local institutions for management ofresources and facilities, assessment and negotiation oflocal demands, management of internal cross subsidiesif needed etc;

● Households; key investment decision making, fi-nancing and management of facilities, hygiene behav-iours and outcomes.

It has already been stated that capacity should be built inthe process of organisational change. While some ca-pacity building occurs because of structural changes toorganisations themselves, specific support can be pro-vided through two broad approaches. The first is train-ing to build individual skills, and the second could betermed organizational capacity building and would in-clude such interventions as strategic planning, manage-ment development, strengthening of systems and pro-

cedures (e.g. information and financial systems), devel-opment of technical approaches and methodologies, re-structuring, and staff developmenti.Capacity building can be particularly challenging when re-sponsibilities are decentralized. You may need to allo-cate a large percentage of resources and effort tostrengthen the performance of front-line teams if youwant the new vision of sanitation and hygiene promotionto become a reality.



Organisational change can be costly, time consuming and,if handled badly, deeply dispiriting for staff and the gen-eral public alike. While managers in the private sectorcan take unilateral decisions and act rapidly, this is rarelypossible in the public sector. Change may have to occurwithin the context of complex public- service rules andregulations. Organisational changes may only be possi-ble once wider policy/ legal changes have been made. Most commentators agree that the best approach to or-ganizational change involves eight broad steps: establish-ing a sense of urgency, forming a guiding coalition, creat-ing a vision, empowering others to act on the vision,planning and creating short-term successes, consolidatingimprovements; and institutionalizing new approaches.This list echoes the programming process discussed in

Section Two and suggests that reshaping organisationsshould be seen as an integral part of the new sanitationand hygiene promotion programme.

Different countries and contexts will demand differentapproaches, but you may consider some of the follow-ing tools:

● formal working groups at the highest level which main-tain transparency, ensure people feel represented andto lend legitimacy to the process;

● specialized sub-committees to represent specific in-terest groups (organized around services or interestgroups); and

● wide consultation.

6.5 Managing the Change Process

The principles of good programming can be used ot guide both the process and the outcome of organizational re-structuring as shown in Table 9.



Table 9: Applying the Principles to Organisational Restructuring


Reflect the central im-portance of house-hold decision making

Invest in capacitybuilding at local levels.

Build capacity of regu-lators and others set-ting public policy

Achieving Equity

Build capacity withinorganisations to en-gage with all segmentsof society

Change the orienta-tion of traditional or-ganisations to reflectthe gendered natureof sanitation and hy-giene promotion


Understand the exist-ing institutional land-scape

Look at non-tradition-al actors (small scaleindependent pro-viders, voluntary or-ganisations etc) whileanalyzing organisa-tions


Establish organisationswhich have: clear re-sponsibilities; ade-quate accountability;and incentives to per-form.


Invest in capacitybuilding and managingthe change process.

Allocate resourcesfor this up front

Organisational restructuring will rarely take place for san-itation and hygiene promotion alone. Ideally it shouldoccur within a wider review of how social sector supportin general is delivered. It may be appropriate to wait fora wider social development catalyst (such as the prepara-tion of a Poverty Reduction Strategy Paper for example).Once it is clear that organizational restructuring is re-

quired a number of long term programming instrumentscould be brought to bear including:

● Restructuring of organizational profiles of public agen-cies, through proactive hiring and redundancies, togradually shift the balance of skills;

● Realignment of resources and priorities in training or-

51



ganisations (schools and higher education) to changethe balance of skills entering the workforce;

● Provision of incentives (usually financial) to encouragestaff of public agencies to move into specific regions,or into the private sector, in response to program-matic priorities;

● Provision of incentives to encourage innovation andlocal level coordination between agencies;

● Hiring of specific management skills to support a shiftin the approach to service provision;

● Financial and other technical support to build the ca-pacity of potential programme partners (public sector,small scale private sector, NGOs etc);

● Explicit provision of funds (usually from central gov-ernment) to support the above restructuring inter-ventions;

● Capacity building of existing organisations specificallyto increase their effectiveness in sanitation and hy-giene promotion (for example, training water supplyregulators to work more effectively in sanitation, twin-ning utilities in different regions of the country so thatlessons learned in one region can be effectively passedon); and

● Linking as many staff as possible to participatory pro-gramming activities so that capacity can be built in ashared environment of learning and change.

For ideas on a range of approaches to organizing the sector and managing organizational change

See: Blokland M., Lilian Saade and Meine Pieter van Dijk (2003) InstitutionalArrangements for Municipal Wastewater and Sanitation - case studies from Argentina,India, Mexico, Philippines, South Africa, Switzerland and Zambia, Institutional andManagement Options Working Group, Water Supply and Sanitation CollaborativeCouncilBrocklehurst, C. (Ed) New Designs for Water and Sanitation Transactions: Making the Pri-vate Sector Work for the Poor, WSP Water and Sanitation Program, PPIAF (2002)Clayton, A., (1999) Contracts or Partnerships: Working Through Local NGOs in Ghana andNepal ,WaterAID, LondonCullivan, D.E. et al (1988) Guidelines for Institutional Assessment for Water and WastewaterInstitutions, WASH Technical Report No. 37, USAID, Washington.Edwards D.B. (1988) Managing Institutional Development Projects: Water and Sanitation Sec-tor, WASH Technical Report 49, USAID, Washington.Macdonald, M., Sprenger, E., Dubel, I. (1997) Gender and organizational change: bridging thegap between policy and practice. Royal Tropical Institute, The NetherlandsSaadé, C., Massee Bateman, Diane B. Bendahmane (2001) The Story of a Successful Public-Private Partnership in Central America: Handwashing for Diarrheal Disease Prevention USAID,BASICS II, EHP, UNICEF, The World Bank Group Sansom, K.R., Franceys, R., Njiru, C., Kayaga S., Coates S. and Chary S., J. (2003 - forth-coming), Serving all urban consumers – a marketing approach to water services in low and mid-dle income countries. Volume 1 - guidance notes for government’s enabling role, WEDC,Loughborough University, UK.Sansom, K.R., Franceys, R., Njiru, C., Kayaga S., Coates S. and Chary S., J. (2003 - forth-coming), Serving all urban consumers – a marketing approach to water services in low and mid-dle income countries. Volume 2 - guidance notes for managers, WEDC, LoughboroughUniversity, UK.

Subramanian, A., Jagannathan, N.V.& Meinzen-Dick, R. (eds) (1997) User organizationsfor sustainable water services (World Bank Technical Paper 354). World Bank,Washington, DC.

Reference Box 11: Organizational roles and responsibilities


>


WELL (1998) DFID Guidance Manual on Water and sanitation Programmes, WEDC,Loughborough University, UK.Yacoob M. and Rosensweig F., (1992) Institutionalising Community Management: Processesfor Scaling Up, WASH Technical Report No. 76, USAID, Washington.

Get these references on the web from: www.wsp.org or www.whelpdesk.org and good technical libraries

For more details on how to manage organizational change effectivelySee: Cockman P., Evans B. and Reynolds P. (1999), Consulting for real people – a client-centred approach for change agents and leaders, McGraw Hill, UK

DFID (2003) Promoting institutional and organisational development, Department for In-ternational Development, London, UK

Edwards D.B. (1988) Managing Institutional Development Projects: Water and SanitationSector, WASH Technical Report 49, USAID, Washington.

Edward D.B., Rosensweig F., and Salt E. (1993) Designing and implementing decentralisa-tion programs in the water and sanitation sector, WASH Technical Report 49, USAID,Washington.

Ideas for a Change (1997) Part 1: Strategic processes – how are you managing organisation-al change? Part 2: Organisational diagnosis – how well do you read your organisation? OlivePublications, Durban, South Africa

Russell-Jones, N. (1995) The managing change pocketbook. Management PocketbooksLtd, Alresford, Hants

Senior B. (2002) Organisational Change, second edition, Pearson Education Limited (), UK

Get these references from: good technical libraries and on the web at www.lboro.ac.uk and www.dfid.gov.uk

Examples of root-and-branch restructuring are rare,largely because such changes are politically difficult, tech-nically challenging and can also be expensive in the shortterm. Many governments would hesitate before insti-tuting a complete overhaul of service delivery arrange-ments. However, such reforms can yield impressive re-sults, and there have been successful examples. In Chilefor example, the government carried out a completeoverhaul of water supply and sanitation service delivery

arrangements for urban areas which paved the way forprivatization which occurred about ten years after the re-structuring. In Nicaragua, reforms have also been madein the way both water supply and sanitation are over-seen. There is a concensus that while Nicaragua did avery good job of addressing planning and regulatory func-tions, service delivery remains a problem.

6.8 Practical Examples from the Field:Who’s going to deliver our programme?

>

53



For many countries, such complete reforms may seemtoo daunting. In many cases it seems unlikely that realprogress can be made without some sort of reorganiza-tion, but some countries have managed to develop in-novative organizational arrangements within the frame-work of existing formal structures.

In 1995 and 1996 USAID carried out an evaluation of anorganisation which it had been supporting in Cambodia.The Program officer for USAID in Cambodia concludedthat the organisation, whose name is “Partners for De-velopment” “take their name…very seriously in work-ing with villagers, NGOs and the government of Cam-bodia”. The review noted that PFD had been instru-mental in “revitalizing and stablising some of the mostremote and under-served areas of Cambodia….using ademand responsive approach to rural community devel-opment.” The role of PFD has been to introduce andpromote technologies appropriate to the village com-munities. But PFD has gone beyond this, constantlyworking to improve the technologies and approachesand evolving their approach to fit with communitiesneeds. Here it is possible to see that a flexible but high-ly professional non-governmental organisation has beenable to influence the approach to rural community de-velopment within a government programme.

In the Swajal Project in Uttar Pradesh in India, the gov-ernment of Uttar Pradesh developed a highly formalisedapproach to selecting, training and contracting with sup-port organisations who then worked with communitiesto build their capacity to plan and implement rural watersupply and sanitation projects. The approach developedin Swajal is now widely applied across India – almost anyorganisation is eligible to apply to become a support or-ganisation – in Swajal the majority were NGOs but pri-vate sector and governmental organisations also partici-pated. The arrangement was challenging; many NGOswere uncomfortable with the contractual relationship,while government was often uneasy with the outspokenviews of the support organisations. Inherent in this ex-perience is the challenge of finding ways to work to-gether which safeguard public funds and agreed policies,while enabling the creativity and flexibility of non-gov-ernmental partners full play to influence the approach.

In Kerala, where the Dutch government supported theestablishment of decentralized support organisations,known as Socio Economic Units as part of a long-termproject, the SEUs were able to evolve into a permanent

and effective support organisation for rural developmentin the State. Here the SEUs themselves were instru-mental in devising approaches which then became partof a state wide programme.

Non-governmental organisations may also seek engageformal or government agencies in programmes they havedeveloped but here too the experience is mixed. Per-haps the best known urban sanitation programme, theOrangi Pilot Project in Pakistan, has persistently struggledto get the utility in Karachi to recognize the investmentsalready made by households in the Orangi neighbour-hood in sanitation, and this experience has been repli-cated in many places across the country.

On the other hand, in West Bengal the experience of theRama Krishna Mission, with support from UNICEF, hashad a fundamental influence on State and ultimately na-tional policy. The original project, which was launched inthe early 1990s and continues to this day, shifted insti-tutional responsibilities to the local level—successfullyforging an action coalition between local NGOs, com-munity-based organisations, and Panchayats (the lowestform of local government, usually covering three villages).Existing local youth groups and their cluster organisa-tions, working together with local panchayats, were gal-vanized by an effective intermediary NGO, the Ramakr-ishna Mission Lokashiksha Parishad (RMLP). The youthclubs conducted much of the implementation in coordi-nation with the panchayat, and a subcommittee calledthe “WATSAN committee” was responsible for com-munity-level implementation. Cluster organisations of theyouth clubs, at block level, backstopped with logistics andcoordinated hardware inputs. They were, in turn, sup-ported by RMLP. The role of the central and state gov-ernments and district officials was to provide financialand technical support and to help adjust appropriate sup-portive policies. UNICEF provided technical and financialassistance for the overall effort.

Formal partnerships for specific hygiene activities, whichinvolve both government, non-governmental and privatebodies, are gaining prominence. In Central America,USAID, UNICEF and the World Bank supported an in-novative partnership between private soap manufactur-ers and the public sector to promote handwashing withsoap. A 2001 evaluation of the partnership concludedthat the public and private benefits had been high com-pared with costs. The evaluation also listed the follow-ing critical factors in the success of the partnership; pres-



ence of an experienced and neutral catalyst; a goodcause; a clear road map; solid market research; publichealth backing; clear allocation of roles, responsibilitiesand expectations; joint decision making; sequencingwhich enabled timely progress to be made.

Working with private sector providers of goods and serv-ices is challenging however. The main problems seem torevolve around finding mechanisms to support privateproviders (for example, masons, pit emptying contrac-tors, vendors of soap and other hardware) which do notstifle the private sector market. A 2000 evaluation ofUNICEF’s water supply and sanitation programmes inIndia noted that support to the Rural Sanitary Marts (a“one-stop” retail outlet which sells sanitation constructionmaterials and hygiene products) was “an intuitively at-tractive idea” as it linked service provision to a revenuestream and would seem to reduce the need for publicsubsidy. However, progress in setting up RSMs was slow(between 1994 and 1999 UNICEF established only 558RSMs in various states). Many of these subsequently wentout of business or barely managed to break–even. Theproblem seems to have been that early successes with theapproach were not analysed in sufficient detail to deter-mine the critical features of success. UNICEF’s experi-ence with RSMs globally is extremely important for coun-

tries seeking ways to work with and support small scaleentrepreneurs in the hygiene improvement business.

In Honduras the government decided to reorganize thepublic utility to develop a flexible and responsive ap-proach to supporting rural water supply and sanitation atcommunity level. The “TOM” program established mo-bile “Technician in Operation and Maintenance” posi-tions, based in regional offices of the national utility.These regional offices have substantial authority to makedecisions. Based on the “circuit rider” model of the USA,the mobile technicians have been able to provide con-sistent support to communities seeking to manage theirown systems and the arrangement has been operatingsuccessfully since 1995. The arrangement was first pi-loted for two years in one department, and this is a use-ful lesson in how to test and then roll out innovative or-ganizational arrangements.

Most of these experiences show us that in any pro-gramme which relies on multiple organisations to deliv-er a coordinated array of goods and services, the qualityof the partnerships between them may be at least as im-portant as their individual performance in determiningthe outcome.

55



Case Study Box 4: Who’s Going to Deliver our Program?

The reforms in Chile are described in detail in Bitrán, G.A. and Valenzuela E.P. (2003) Water Services in Chile:Comparing Public and Private Performance World Bank Private Sector and Infrastructure Network, Public Poli-cy for the Private Sector Note No. 255The reforms in Nicaragua are described in Walker, I. and Velásquez, M. (1999) Regional Analysis of Decentrali-sation of Water Supply and Sanitation Services in Central America and the Dominican Republic Environmental HealthProject Activity Report No. 65, Washington D.C.More information on Partners for Development can be found in Environmental Health Project (2002) North-east Cambodia Community Water and Health Educational Program, USAID Grant No. 442-G-97-00008-0, Final Eval-uation.The Swajal Pilot Project is described in various publications. A useful starting point is WSP-SA (2001) Com-munity Contracting in Rural Water Supply and Sanitation: The Swajal Project, India Water and Sanitation Program.Further information on the government of India’s rural water supply and sanitation programme is availablewith the Rajiv Gandhi National Drinking Water Mission on the web at www.rural.nic.in/rgndw.htm . TheSEUs in Kerala are described in Van Wijk-Sijbesma, C. (2003) Scaling Up Community-managed water supplyand sanitation projects in India presentation to the IDPAD Water Seminar, IHE, Delft, The Netherlands, May12-13, 2003The Midnapore experience has been written up in many places, but an interesting perspective from the mid1990s can be found in UNICEF (1994) Sanitation, the Medinipur Story, Intensive Sanitation Project, UNICEF-Calcutta, India, and Ramasubban, K.S., and B.B. Samanta (1994) Integrated Sanitation Project, Medinipur, UNICEF,India.The handwashing partnership in Central America is described in detail in Saadé, C., Massee Bateman, DianeB. Bendahmane (2001) The Story of a Successful Public-Private Partnership in Central America: Handwashing for Di-arrheal Disease Prevention USAID, BASICS II, EHP, UNICEF, The World Bank Group The experience of RSMs in India is described in Kolsky, P., E Bauman, R Bhatia, J. Chilton, C. van Wijk (2000)Learning from Experience: Evalutaiton of UNICEF”s Water and Environmental Sanitation Programme in India 1966-1998 Swedish International Development Cooperation Agency, StockholmThe institutional arrangements in Honduras are described in Fragano, F.,C. Linares, H. Lockwood, D. Rivera,A. Trevett, G. Yepes (2001)Case Studies on Decentralisation of Water Supply and Sanitation Services in Latin Amer-ica Environmental Health Project Strategic Paper No. 1, Washington D.C.

Notes for Chapter 6

i Training approaches might include:

● Formation and strengthening of training networks – these mightinvolve numerous disciplines and attract participation from pub-lic, private and civil society organisations, or alternatively theymay be more focused, providing a “safe space” for colleagues towork together to build internal capacity;

● Twinning and/or secondment of staff – to facilitate practical shar-ing of experience and build up mutual understanding of how dif-ferent partners work; and

● Formal in-service and continuing education – one of the real con-straints in many public sector agencies and in NGOs is that staffare so focused on working at field level that they are not able tokeep up with new ideas and find time to think about how theymight undertake their jobs more effectively. Creating a cultureof inquiry is challenging, particularly where organisations have atradition of top-down command and control, but the capacity toquestion how things are done can be built. It may be best tolaunch efforts at a formal level – responding to the prevailing cul-ture of the organisation, if successful, the process can move onto become more acquisitive over time.



7.2 What is Monitoring and Evaluation?

Monitoring and evaluation enable programmers to seewhether things are happening on the ground as plannedand whether activities are resulting in the expected out-comes. Results from both monitoring and evaluation areneeded as inputs to the ongoing programming process.

While evaluations can be handled on a periodic basis,monitoring systems are needed to generate regular reli-able datasets which can provide a picture of what is hap-pening in real time and over time. As a general rule themonitoring system should be:

● simple – providing just enough information for deci-sions to be taken;

Monitoring systems provide a rapid and continuousassessment of what is happening. Monitoring is primarilyneeded at the implementation (project) level to showwhether:

● inputs (investments, activities, decisions) are beingmade as planned;

● inputs are leading to expected outputs (latrines built,behaviours changed); and

● inputs are being made within the agreed vision andrules.

Evaluation provides a more systematic assessment ofwhether visions and objectives are being achieved in thelong run in the most effective manner possible. “Forma-tive” evaluation aims to diagnose problems, and is bestdone internally for maximum learning and capacity build-ing. “Summative” evaluation is aimed at deciding whichoutcomes have been achieved (it measures, for example,

whether resources have been spent as intended) and isan important tool in generating confidence in the pro-gramme. It is usually best done externally, to increasecredibility.

Neither monitoring nor evaluation are designed to es-tablish causal links between interventions and outcomes(proving for example a link between handwashing andreduced incidence of diarrhoea). This type of causal con-nection is the subject of research which should be usedas the basis for programme design. Where there aregaps in the empirical evidence base for sanitation and hy-giene promotion, specific research may have to be com-missioned to prove such relationships.

Table 10 sums up the main uses of monitoring and eval-uation within both programmes and at the project (im-plementation) level.

● decentralised - operating at the lowest appropriatelevel and providing information where it is needed tomake necessary decisions;

● responsive – providing information where it is need-ed in real time;

● transparent – providing access to information bothupwards and downwards; and

● relevant – based on the vision and objectives of theprogramme.

There is some truth in the saying that “what gets moni-tored, gets done” – the design of the monitoring systemcould have a profound effect on how well the pro-gramme is actually implemented. For this reason key out-comes and activities must be monitored.

7.1 Thinking about Monitoring and Evaluation

Chapter 7 Monitoring and Evaluation

57


Chapter 7: Monitoring and Evaluation

7.3 What to Monitor and Evaluate?

At the programmatic level it is essential to monitor keyresults (ideally improved health) to ensure that public in-vestments are resulting in public benefits. However,monitoring long term health trends is difficult and can

probably only be the subject of periodic evaluation. In-stead, it is often more practical to measure service cov-erage, use of facilities and hygiene behaviors.

Table 10: Uses of Monitoring and Evaluation

Programme planning, development and design

Project level implementation

Monitoring

Measure crude inputs and outputs (usea progamme performance monitoringplan with agreed indicators) Track processes and instruments (usethe monitoring system, and informationmanagement systems with periodic re-porting)

Assess whether programme is ontrack, delivering services, conformingto standards and targeting the rightpeople (establish a routine monitoringsystem) Motivate communities to solve prob-lems (use participatory communitymonitoring) Quality assurance (through supervi-sion)

Evaluation

Asssess needs, problems and assets(through situation analysis) Establish a baseline reference point(use baseline quantitative data collec-tion) Explore programming options andidentify solutions (carry out formative,qualitative studies)

Check whether implementation is re-sulting in the delivery of the programmevision and objectives (mid-term evalua-tions or periodic reviews can be usedto correct approaches) Assess whether projects resulted inthe desired impact and outcomes (finalevaluations, covering quantitative andqualitative assessments) Solve technicalor programmatic problems (throughoperations research).

Based on available research and experience, most sectorexperts agree that if certain key behaviours occur at thehousehold level then it is reasonable to assume thathealth benefits will follow. The Environmental HealthProject suggest that the following four essential house-hold practices are key to the reduction in diarrhoeal dis-ease:

1. wash hands properly with soap (or local alternative)at critical times (includes the availability of a place forhandwashing and soap);

2. dispose of all faeces safely – especially those of youngchildren who cannot easily use a toilet;

3. practice safe drinking water management in thehousehold (includes the use of an improved watersource, safe water storage, and possibly water treat-ment at the point-of-use; and

4. practice safe food management in the household.

A sanitation and hygiene promotion programme willclearly influence the first two of these behaviours, and, ifwell designed, should also impact on water and food hy-giene.Monitoring and evaluation can thus focus on these keybehaviours, and on a selection of easy-to-measure inputsto generate a picture of what is happening on the groundand what are the primary results. While the exact ap-proach may vary with your programme Table 11 sug-gests a generalized framework for monitoring whichwould provide simple and robust information at the pro-grammatic and at the implementation level. While mostof these indicators can be monitored using regular mon-itoring tools (see Table 12) those marked in bold mayrequire verification through periodic evaluations.Note that at the implementation level you may need moredetailed information about changed behaviours at thehousehold level. These should be the subject of detailedproject monitoring systems. For more information on thedesign and use of indicators see Reference Box 12.



Table 11: Indicative Programme Performance Monitoring Plan for Sanitation and Hygiene Promotion

Improved Health

Essential Household Practice

Programming and Policy

Financial Instruments

Organisational Restructuring

Access to Sanitation technology

Hygiene Promotion

Objective

i) Reduced incidence or preva-lence of diarrhoeal diseaseii) Reduced incidence or preva-lence of other key disease groups

i) Incidence of handwashingii) Proper disposal of adult faecesiii) Proper disposal of children'sfaeces

i) Development of real partner-ships for optimum policy develop-mentii) improved equity of access

i) Improved efficiency ii) Financial sustainability (100% ofoperation costs for providing im-proved sanitation and hygienepromotion funded on a continu-ous basis)

i) Alignment of organisations tosupport household decision mak-ing

i) Access to improved sanitationfacilitiesi) Acces to improved sanitation facilities

i) All households show a substan-tial improvement in essentialhousehold practicesii) All primary schools complywith basic water supply, sanitationand hygiene standards

Suggested indicator(inputs)

i) total public investment instrengthening regulatory/oversightroleii) New policies dealing explicitlywith securing access for poor andvulnerable households

i) - total cost of programme-funding provided by source(government, private, house-hold)- number of agencies involved

i) front-line staff with skills towork effectively with householdsand communities in all necessaryorganisations.

i) - total household and public ex-penditure on sanitation facilities - communities covered by sanita-tion marketing

i) total public expenditure on hy-giene promotionii) communities with active hy-giene promotion through commu-nity-based promotors

Suggested indicator (outputs)

i) % of children under 36months with diarrhoea in thelast 2 weeksii) Incidence (number of newcases) of trachoma, guineaworm, etc.

i) % householders washinghands at appropriate timesii) % of adults whose feacesare disposed of safelyiii) % of children under 36months whose feaces are dis-posed of safely

i) number of positive changesmade in policy, legal and regulato-ry instrumentsii) distribution (on geograph-ic, social, gender and commu-nal grounds) of - improved sanitation cover-age - range of technologies avail-able and affordable by poorhouseholds - primary schools with safewater and improved sanita-tion

i) sanitation coverage - poorhouseholdsii) percent of operating costs re-covered from users/households

i) % of household heads know-ing: - who to contact to accesssanitation goods and service- who to contact if sanitationfacility breaks down

i) % of households with access toan improved sanitation facility

i) % of adults in householdswho know critical times forhandwashingii) % of households who useimproved sanitation facilitiesiii) % of schools with - sanitation facilities - separate sanitation facilities

for boys and girls - handwashing facility - sanitation and hygiene

teaching

Implementation Outcomes

Programme Results

Creation of Enabling Environment

59



7.4 How to do the Monitoring and Evaluation?

There are a wide range of tools available which can beused to generate information for monitoring and evalu-ation purposes. It is important to locate the responsibil-ity for these tasks in an appropriate institutional home.Where possible monitoring should be carried out byagencies who can make immediate use of the informa-tion. As mentioned above, some evaluation is best car-

ried out externally. Furthermore it is important to havein place a process for disseminating the results of moni-toring and evaluation exercises, to increase accountabil-ity and to ensure that data is used as widely and effec-tively as possible. Table 12 provides examples of thebroad range of tools available. Reference Box 12 pointsto sources of more information on this important topic.

Table 12: Some Tools for Monitoring and Evaluation

Tools

Responsibility

Dissemination of results

Monitoring

● Sanitation surveillance question-naires

● Network/ system operation andmaintenance checklists

● Supervision checklists● Financial summary/ audits● Participatory monitoring tools

● Ministry of health/ water and sanita-tion/ rural development/ urban de-velopment etc

● Utility● Local government· Communities

·● Public score cards and report cards● Publish in newspapers/ radio/ TV

spots● Provide fliers or other information

in community locations in rural andurban communities

·● Annual/ regular institutional report-ing

● Internet

Evaluation

● Situation analyses, technical, socialand institutional reviews● Participatory impact assessments/Participatory rapid appraisals● Sanitation and hygiene model ques-tionnaires● Qualitative studies, mid-term andfinal evaluations

● As for monitoring but use should bemade of independent public or privatesector organisations with skills in evalu-ation techniques● Non-governmental organisations·Umbrella/ apex professional bodies● Universities● National statistics or census bureaus

● As for monitoring plus● Journal articles/ conference papersetc● TV/ Radio profiles


For information on the global monitoring systemSee: Joint Monitoring Program of UNICEF and WHO and the Global Assessment (2000) ReportGet this reference on the web at: www.wssinfo.org

For ideas on setting up monitoring and evaluation systems including the selection and design ofindicatorsSee: Kleinau, E., D.Pyle, L. Nichols, F. Rosensweig, L. Cogswell and A Tomasek (2003) Guidelines for AssessingHygiene Improvement At Household and Community Level Environmental Health Project Startegic Report No. 8 on the web at: www.ehp.org

Reference Box 12: Monitoring and evaluation

>



Principles of good programming can equally be appliedto the monitoring and evaluation systems, both in the de-sign of the approach and in the aspects of the pro-

gramme which are the focus of monitoring and evalua-tion efforts (see Table 13).

Table 13: Applying the Principles to Monitoring and Evaluation


Design a systemwhich is

● Simple● Decentralised● Responsive● Transparent● Consistent with

the programme vi-sion and objectives

Measure public andprivate benefits

Achieving Equity

Ensure information isavailable upwards anddownwards to em-power participants asmuch as possible

Ensure coverage datatake into account dis-tribution of access be-tween differentgroups


Use existing monitor-ing and evaluationmechanisms andprocesses. Base onexisting evidence ofcausal relationships

Link upwards to in-ternational monitor-ing systems (ie JMP)


Make use of all avail-able institutional ca-pacity for monitoringand evaluation


Link monitoring infor-mation to capacitybuilding; make infor-mation available anduse it to analyse per-formance

WELL (1998) DFID Guidance Manual on Water Supply and Sanitation Programmes WEDC Loughborough Univer-sity, UK on the web at: www.lboro.ac.uk\wedc Kathleen Shordt (2000) Monitoring for Action IRC, Delft, Netherlands

For other ideas about monitoring and evaluation tools See: Naryan, D. n.d. Participatory Evaluation: Tools for Managing Change in Water Technical Paper No. 207, WorldBankRoark, P. (1990) Evaluation Guidelines for Community-Based Water ad Sanitation Projects WASH Technical ReportNo. 64, Arlington VA.Hutton, Guy (undated, c.2002) Considerations in evaluating the cost effectiveness of environmental health interventionscited in Appleton, Brian and Dr Christine van Wijk (2003) Hygiene Promotion: Thematic Overview Paper IRC In-ternational Water and Sanitation CentreGet this reference on the web at: www.irc.nl Dayal, R., C. van Wijk and N. Mukherjee (2000) Methodology for Participatory Assessments: Linking Sustainability withDemand, Gender and Poverty WSPGet this reference on the web at: www.wsp.org/english/activities/pla.html

Reference Box 12: Monitoring and evaluation>

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The most important programming decisions relating tomonitoring and evaluation are probably allocating ade-quate resources, elevating status to an M&E system, andcredible technical competencies. Programmers need todecide early on in the programming process:

● Who will be responsible for M&E;● What will be monitored and at what scale;● How will M&E be funded; and

● How and when will the information be used in theprogramming process.

Key to the success of monitoring and evaluation are sys-tematic planning and implementation. This means thatthese activities such the development of a performancemonitoring plan, a baseline and impact data collection,and the development of a monitoring system are includ-ed in the program strategy and work plans including thenecessary human and financial resources.

7.7 Practical Examples from the Field: How will we knowwhether our programme is working?Monitoring systems are only as good as the informationthey contain. Because of this, simple and relevant indi-cators must be identified and adapted for each situation,drawing as much as possible on existing indicators. Thisincreases the ability to compare findings within a coun-try and over time. A recent evaluation of definitions of“access” to “improved sanitation” in sub-saharan Africafound that there was little consistency between defini-tions used in different countries or with the definitionscontained in the Joint Monitoring Program (JMP). On re-flection this is not surprising, as national definitions will fallin line with national approaches to investment and withlocal cultural and social norms. So for example, while theJMP does not include “traditional latrines” in its definitionof improved sanitation, some African countries feel thatthis is a good first step on the sanitation ladder, and counthouseholds with access to a traditional latrine as covered.

Data collected can be used in many ways for making pro-gram decisions. Two environmental health assessmentsconducted by Save the Children and EHP in 2001 and2002 in the West Bank of Palestine found serious con-tamination of drinking water with thermotolerant fecalcoliform bacteria. The quality was much worse for waterdelivered by tanker than for other sources. These find-ings led to program interventions that focus on thechemical treatment of tanker water and cisterns used byhouseholds to store water.

Formative research and household surveys in the DRCongo suggested that soap was widely available tohouseholds in rural and urban areas, but that handwash-

ing behaviors were largely inadequate. Sanitation facili-ties were present, but mostly unusable. The SANRUprogram decided to start hygiene promotion by inte-grating behavior change for handwashing into an existingPrimary Health Care program and to address sanitationat a later point until the resources to improve sanitationfacilities were available.

While definitions of access and coverage must beworked out in each case, these must be translated intosimple formats to enable information to be collectedconsistently and reliably. In Honduras for example, theM&E system for water supply defines four categories ofsystem:

A – in full working orderB – possibly not working but actions of the Mobile Main-

tenance Technician could easily bring it up to “A”C – possibly not working and requires investments which

are within the economic capacity of the communityD – not working-substantial investment required prob-

ably beyond the economic capacity of the commu-nity.

This simple typology enables the mobile technicians whovisit them periodically to easily keep account of the sta-tus of all the systems under their remit thus rapidly build-ing up a national picture of who is covered with functionalsystems. The beauty of this approach is that it is simple;allows for continuous real-time monitoring, takes into ac-count the condition of the system, not just whether it wasoriginally constructed; and makes use of the existing op-



eration and maintenance arrangement to collect datarather than setting up a separate M&E function. Getting hold of information on sanitation coverage andhygienic practices is likely to be much more challengingthan getting information on water supply. A study inthree countries in East Asia used participatory techniques

to uncover a range of inherent biases hidden beneathgeneralized coverage statistics. Nonetheless, with care-ful design, a few key indicators can almost certainly be de-vised in most cases to generate manageable informationfor monitoring programmatic outcomes.

Case Study Box 5: How will we know whether our programme is working?

The Joint Monitoring Programme of UNICEF and WHO provides some guidance on what is to be monitored,and also gives access to global information on progress towards the Millennium Development Goals. It canbe found on the web at www.wssinfor.org.Definitions of Access are discussed in Evans, B. and J. Davis (2003) Water Supply and Sanitation in Africa: Defin-ing Access Paper presented at the SADC conference, Reaching the Millennium Development GoalsExperiences from the West Bank and DR Congo are summarised in the following two documents which alsoprovide links to other resources: Camp Dresser McKee (2003) West Bank Village Water and Sanitation Pro-gram: Findings from Environmental Health Assessments Environmental Health Project Brief No. 17, July 2003and Camp Dresser McKee (2003) Improving Urban Environmental Health in Democratic Republic of Congo Envi-ronmental Health Project Brief No. 16, June 2003.The institutional arrangements in Honduras are described in Fragano, F.,C. Linares, H. Lockwood, D. Rivera,A. Trevett, G. Yepes (2001) Case Studies on Decentralisation of Water Supply and Sanitation Services in Latin Amer-ica Environmental Health Project Strategic Paper No. 1, Washington D.C.Sanitation experiences in East Asia are described in Mukherjee, N. (2001) Achieving Sustained Sanitation for thePoor: Policy and Strategy Lessons from Participatory Assessments in Cambodia, Indonesia and Vietnam Water andSanitation Program for East Asia and the Pacific

Notes for Chapter 7:

i Additional monitoring indicators dealing with access to water and othersanitary facilities can be added, to provide a more comprehensive pic-ture of progress towards wider hygiene improvement goals (see Klein-au et.al. (2003) for detailed ideas on how to establish a full scale mon-itoring system at both project and programme level).

Documents

SECTION THREE: CREATING THE ENABLING … · 32 Sanitation and Hygiene Promotion – Programming Guidance Very few countries currently have explicit stand-alone “sanitation and hygiene