Lessons from implementing water supply, sanitation and hygiene promotion activities in the coastal belt of Bangladesh

A new document [1] describes the key lessons learned from the large Coastal Belt Project, which was supported by Danida and the Government of Bangladesh during 1997-2009. The document highlights the processes, achievements and challenges of providing more than 12 years of extensive assistance to rural and small towns water supply, sanitation and hygiene promotion in the coastal regions of Bangladesh. During the years the project gradually changed its implementation modalities towards a high degree of alignment with national institutions and systems, including use of national planning and budgeting processes and public procurement rules.

The Project was largely successful in achieving its physical targets of more than 30,000 arsenic-free deep hand tube wells (DHTWs) and promoting construction of over 300,000 household latrines, construction of piped water supply in core areas of nine pourashavas, albeit with delays and additional costs.

The Project was implemented as a bilaterally-executed project. This gives rise to inherent differences resulting from parallel management structures, multiple sets of roles and rules and differing personal and institutional loyalties.

Following the devastating cyclone Sidr (“The Eye”) in November 2007, the Project constructed 1,050 additional tube wells, 1,000 household latrines and other infrastructure in storm-ravaged areas.

Photo from the Danida report

The sustainability of DHTWs and household latrines in rural areas is seen as high. Additional management and technical support is required to ensure the long-term sustainability of piped water supplies in pourashavas and mini-piped systems in rural areas, as well as public toilets and school latrines.

The Project’s efforts to assist pourashavas to improve solid waste management and drainage was less than successful. The situation in pourashavas in these areas remains unsatisfactory. There are serious difficulties locating sanitary dumping sites, which pose a potentially serious environmental hazard.

Following the Paris Declaration on Aid Effectiveness in 2005, the Project’s planning process and management has been more closely aligned with GOB and DPHE’s systems and procedures.

During its long life, the Project produced a wealth of documentation; manuals, guidelines, training and IEC/BCC materials. This material constitutes an important part of the Project’s contribution to the sector. Some of the most important and useful of these materials are listed in the publication.

In spite of its long life, the Project leaves behind unmet demand and a number of unresolved issues which will to a large extent determine the long-term impact of the Project’s many achievements.

A number of factors are seen as contributing to the Project’s successful achievements.

1. Conducive policies, strategies, regulations, rules and procedures adopted and practiced in implementing organizations
2. Experienced and dedicated professional/technical staff
3. Responsibility, commitment and accountability for results at all levels
4. Firm commitment to guidelines and procedures for poverty targeting, social mobilization and siting of facilities
5. Rate and quality of DHTW construction
6. Social mobilization/customer briefings supported by high quality IEC materials
7. Adequate cost-sharing to promote ownership
8. Cooperation from DPHE and local government (pourashava mayors and UP chairmen)
9. Appropriate and adaptable technologies to suit various hydrogeological conditions
10. Thorough documentation, accurate reporting, MIS and database updated and used
11. Baseline data, effect monitoring and impact assessments
12. Post-construction technical and managerial support for urban and school WSS facilities

The Project has helped to produce a number of competent sector professionals who continue to make important contributions to the sector. Outside the coastal belt, this may prove to be one of the Project’s most important and lasting legacies.

[1] Pendley, C.J. and Minhaj Uddin Ahmad, A.J. (2009). Learning from experience : lessons from implementing water supply, sanitation and hygiene promotion activities in the coastal belt of Bangladesh. Dhaka, Bangladesh, Royal Danish Embassy. 27 p.
Download full document [PDF file]

Web sites:

• Danish Embassy Bangladesh – Water & Sanitation
• Bangladesh – Department of Public Health Engineering
• GoB-Danida WSS Policy Support Unit

Contact persons:

• Dr. Guna N. Paudyal, Danida Senior Adviser, Bangladesh. (e-mail: guna [at] hysawa.org)
• Dr. Niaz Chowdhury, Programme Officer, Embassy of Denmark (e-mail: niacho [at] um.dk)
• Mr. Jan Møller Hansen, Deputy Head of Mission, Embassy of Denmark, Dhaka. (e-mail: janmha [at] um.dk)

Hygiene promotion: lessons from Save the Children’s programme in Malawi

When Save the Children launched its School Health and Nutrition (SHN) program in Mangochi, Malawi in 1998, only 42 percent of schools had access to clean water and none had hand-washing facilities. [...] Only 54 percent of schools had separate facilities for girls. In 2003, when Save the Children expanded its SHN program in Malawi to Balaka district, the situation was a marginally better than it had been in Mangochi five years before [and] as in Mangochi, no schools in Balaka had hand-washing facilities.

Qualitative surveys conducted in both districts also showed that before Save the Children’s SHN program:

• Students traveled long distances to fetch water, which often made them late [to class or] miss class altogether;
• Girls who traveled to collect water faced harassment from boys and men;
• Girls missed school when they were menstruating due to the lack of privacy in school latrines;
• Students drank from unprotected shallow wells and rivers;
• Students did not wash their hands after using the toilet because there were no hand-washing facilities; and
• Despite the availability of facilities, many children did not use them because they were locked or unhygienic

To increase access to and use of safe water and sanitation facilities, Save the Children worked with communities, schools, and water and sanitation experts to construct and rehabilitate boreholes, latrines, and hand-washing facilities and to train teachers and communities on hygiene.

Separate, ventilated latrines with doors and handwashing facilities nearby not only promote good hygiene but also enable girls to consistently attend school. Photo. Save the Children

[...] Quantitative and qualitative end line surveys conducted in Balaka and Mangochi district in 2006 and 2007 respectively showed that the presence of adequate water and sanitation facilities have had a tremendous impact on children’s lives and communities.

Despite these important achievements, the project encountered a number of challenges:

• Only 33 percent of the handwashing facilities in schools were functional and none had soap or ash. [...] When communities provide soap, it usually gets stolen. Just 41 percent of children report hand-washing after visiting the toilet and only 28 percent of children said that they used soap and water the last time they washed their hands.
• Community resource efforts were not consistent. In less active communities that did not provide sand, bricks and labor, latrines and hand-washing facilities were not constructed. However, among most communities that did provide resources, community participation helped create a sense of ownership and ensured the facilities were well-maintained.
• Community members sometimes vandalized handwashing facilities [and] school committees could not always afford to [...] fix facilities quickly. To minimize these incidents, Save the Children directed communities to report all instances of vandalism to the police.
• Rural shop owners did not regularly keep borehole parts in stock, so community members had to travel long distances to buy them.
• Water monitoring assistants conducted frequent supervision of the water point committees to ensure the committees and the boreholes functioned properly.
• Monitoring of hygiene education in schools was infrequent, as primary education advisors rarely monitored the teaching of hygiene. [...] Some teachers said they were not comfortable with the topic due to its sensitive nature and the use of words such as “defecation.”

While Save the Children’s SHN program saw tremendous progress in improving access to safe water and adequate latrines, hand-washing remained a low priority for schools and communities. Hand-washing facilities are not maintained and children rarely wash their hands with soap or ash. A targeted campaign around the importance of hand-washing is needed. Save the Children’s experience in Mangochi and Balaka districts illustrate the importance of community participation and ownership along with regular supervision.

[...] After approximately 20 years of programming and ten years supporting School Health and Nutrition in the district, Save the Children is phasing its programs out of Mangochi. Malawi’s Ministry of Education adopted most of Save the Children’s School Health and Nutrition activities when it began a nation SHN program in 2007. Unfortunately, the provision of water and sanitation facilities is expensive and the government will probably not be able to bare the full cost to equip all schools with adequate facilities.

Source: Save the Children (2008). Improving water, sanitation, and hygiene behaviors in schools : successes and lessons learned from Mangochi District, Malawi. 4 p. Download here

Sanitation promotion: experiences from government-led initiative in southern Ethiopia

In Ethiopia’s Southern Nations Nationalities and People’s Region (SNNPR) an innovative programme has promoted latrine construction and use, hand washing and safe water storage and handling. The intervention is an example of how visionary government leadership can create the political momentum for low-cost sanitation and hygiene (S&H) and reach out to rural communities.

Papers from the Overseas Development Institute, in the UK, and the IRC International Water and Sanitation Centre, in the Netherlands investigate the SNNPR approach. The research was undertaken by Ethiopian researchers on behalf of the Research-inspired Policy and Practice Learning in Ethiopia and the Nile Region (RiPPLE) project.

[...] In 2003 the SNNPR Bureau of Health (BoH) began a new community health strategy, including S&H [which aimed] to reach households through paid health extension workers (HEWs) and volunteer community health promoters (CHWs) [and which] promoted latrine construction without any form of subsidy.

A combination of political promotion and institutional mobilisation was successful in launching and expanding the regional government’s strategy as a ‘movement’. [...] The key elements of the S&H strategy were designed to be politically attractive and administratively feasible, and were written in non-technical language.

The researchers found after the project:

• The proportion of households having latrines increased by a factor of eight.
• There was less acceptance of open defecation.
• Questionnaire results indicated better knowledge on hand washing, although actual practice remained poor.
• There were hand washing facilities in 82 percent of households, but only 6 percent were near the household latrine and few people used soap or detergents.
• Water storage and handling practices also remained poor.
• Men mostly decided latrine design, siting and construction, although women were involved in providing materials and plastering.

Despite these positive developments, doubts remain about sustainability and some latrines have collapsed [and] many are infested with flies. As CHWs are unpaid and receive little follow-up support or training, many have lost motivation. Higher levels of government have not provided enough technical support or monitored changes in household S&H behaviour.

[...] Aspects of the SNNPR experience which might help improve [sanitation elsewhere] include:

• promoting local, rather than donor-driven, S&H programmes and technology designs
• using community promotional change agents coordinated by local authorities in command and facilitation roles
• reviewing local S&H progress within wider health sector review processes
• ensuring that strategising, political positioning and communication are based on solid evidence
• realising that sanitation workers cannot make their case to high-level politicians without understanding the political dynamics around S&H.

Source: id21, 01 Apr 2009

Urban sanitation: Changing the Sanitation Landscape in Bangalore, India

The residents of Sudhamnagar, a slum community in Bangalore, made the big leap from defecating in the open until 2007 to having household latrines in 2009, proving that once people understand what they’re missing, they will find ways to get it.

The community’s efforts easily demystify many myths about sanitation: that sanitation requires expensive and high-tech solutions, that the poor have more important needs than sanitation, or that governments and utilities do not have access to financing for sanitation.

Sudhamnagar comprises 300 households of mostly daily wage earners. For a long time residents had no access to safe water supply, no basic sanitation facility in their homes, limited educational opportunity for children, and very little hope for a better quality of life.

“Everything changed when AVAS [Association for Volunteer Action and Services] stepped in and helped us by constructing a community toilet,” says Josephine, a local resident and member of the WATSAN committee.

In a dialogue faciltated by AVAS, residents identified basic facilities like housing, water, sanitation, and electricity as their most urgent needs. The dialogue later branched out to wider grounds-from education to health to land tenure to livelihood.

After ensuring that the community had stable land rights, AVAS and the WATSAN Committee negotiated with the local government and the Bangalore Water Supply and Sewerage Board (BWSSB) for the installation of water connections and construction of public toilets.

The public toilets were so popular that frequent use led to maintenance and cleanliness problems. As a result residents began constructing household latrines with technical guidance from AVAS, a little financial assistance, and the support of the WATSAN Committees.

“The poor are willing to pay if they have access to the service,” says Anita Reddy, AVAS’ Managing Trustee. “Accessibility, affordability, and participation in decision making are the critical ingredients that helped the residents change their lifelong habits,” she added.

See also: Water rights: access to water means access to education in the slums of Bangalore, India, Source South Asia, 19 Nov 2007

Contact: Association for Voluntary Action and Service (AVAS), No. 9, 5th Cross, Puttaiah Compound, Ashwath Nagar, Bangalore 560094, India, Ph: +91-80-23516227, Email: avas [at] vsnl.com

Source: Ma. Christina Dueñas, ADB, Feb 2009

Corruption prevention: lessons from a community management sanitation programme in Kerala, India

An estimated 20-30% of funds and materials are diverted from sanitation programmes in South India due to corruption, experts have estimated. The Socio-Economic Unit Foundation (SEUF) has successfully employed a number of anti-corruption strategies in a participatory and community-based household sanitation programme, serving more than 200.000 families in 200 Panchayats (communities). It has become a model for many other regions in India.

Learning from experience, using different strategies, including all stakeholders, using preventative measures, reserving enough time and resources for participation and capacity building and focusing on quality assurance rather than anti-corruption are among the lessons SEUF has learned from the programme.

Read more in the Water Integrity Network (WIN) best practice information sheet on the project written by Kochurani Mathew.

See also the project case study and corresponding list of tools used in the project here.

The policy implications of accountability in municipal service delivery in Sudan

Musch, A. (2008). The policy implications of accountability in municipal service delivery in Sudan. The Hague, The Netherlands, Ministry of Foreign Affairs. 11 p. Download here.

This paper highlights the importance of issues of local government accountability to citizens, analyses how changes in accountability mechanisms have been accomplished in a specific case, and examines the policy implications. The analysis is based on the case of the city of Gedaref, in Sudan. Over a period of about eight years, many channels were created in the city through which citizens could express their concerns and demands. This compelled the local government to improve the quality of its services (drinking water, waste, health and education), issue rules that were seen to be fair, and allow the leaders of a great many citizens’ associations and participatory platforms access to decision-making procedures. Key elements in the process were increased public awareness of rights and standards, changed civic attitudes, the involvement of a critical mass of citizens, and recognition by the city authorities that they are dependent on these associations and platforms. Outside help was provided by Eindhoven, a twin city in the Netherlands through hands-on municipal service projects. Much of the funding came from VNG International’s LOGO South programme. This paper looks at how results were achieved in Gedaref and where the external actors had the greatest influence in bringing about change. It concludes with lessons and advice for donors who may wish to facilitate similar processes.

The paper recommends that donor officials:

• accept that effecting changes in accountability takes between five and ten years;
• spend less time on designing the best aid distribution channels and more time on finding trusted implementers;
• reward approaches that create choice for citizens and reach a critical mass of participation, and discourage approaches based on ‘the best accountability mechanism under the circumstances’, which are only open to a small group;
• accept approaches based on general principles that involve many civic organisations and multiple ways to reorient accountability downwards, but insist on details when it comes to the incentives.

Community-managed toilets: Tiruchirappalli, India, shows the way

The city of Tiruchirappalli in Tamil Nadu, India shows a way out of the sanitation crisis. The Tiruchirappalli model of community-managed toilets with bathing and washing facilities is an example of a partnership between sensitive city authorities, communities and NGOs, working together to address these problems. The work undertaken by these partners over the last six years has demonstrated how this can be taken to scale at the city-level. Within the next two years, it is expected that all slum communities in the city will be covered by community-managed toilets (CMTs).

Making Innovations Stick

When things are going smoothly, why would someone bother to innovate? Where do ideas for innovations come from? How come some succeed but many do not leave the drawing board or the pilot stage?

[...] Innovation in the water sector mostly comes through technical or technological breakthroughs [in] membranes and nanotechnology in water and wastewater treatment, water reuse and disinfection, the use of helium for tracing nonrevenue water, and [...] for instance the use of rubber, plastic or polyethylene sheets instead of a concrete structure for water storage.

But recent years have also seen legal and institutional as well as financial changes. In 2005, the Asian Development Bank (ADB) introduced innovative financial products [including the] multitranche financing facility, sub-sovereign and non-sovereign public sector financing facility, local currency lending for the public sector, and refinancing modality. In 2007, Viet Nam passed [...] legislations [that] transformed water from a social good to a business commodity and opened up the entire sector to change.

[It took] Singapore’s Public Utilities Board (PUB) [...] 30 years of research and experimentation before they perfected the multiple barrier process that [transformed] recycled wastewater [into] a source of safe drinking water. And even when the reclaimed water has passed world standards on safety, PUB continued to test the product in increments.

[...] In a nutshell, an environment conducive to innovation in the water and sanitation sector is possible but only with a real partnership among research, industries, operators and clients, where risk would be properly identified, shared and managed among all parties.

Source: Hubert Jenny and Alexis Ngo,  ADB, Dec 2008

Willingness to pay for sanitation in the BRAC’s Water, Sanitation and Hygiene Programme, Bangladesh

Bin Seraj, K.F. (2008). Willingness to pay for improved sanitation services and its implication on demand responsive approach of BRAC Water, Sanitation and Hygiene Programme. (RED working paper ; no. 1).  Dhaka, Bangladesh, BRAC Research and Evaluation Division (RED). 16 p.
Download here

This study aimed to provide some insights into sanitation-related strategies taken by the BRAC Water, Sanitation and Hygiene (WASH) Programme from an economic point of view. The aim of this report included measuring and identifying the factors that influence willingness to pay for improved sanitation services for the households without any latrine facilities in rural Bangladesh. A contingent valuation survey was carried out in four upazilas under BRAC WASH programme to determine household willingness to pay and affordability to pay for basic sanitary latrine options. The results indicate that about 80% of the households were willing to pay for improved sanitation services. Of the total households who were interested in paying for sanitary latrine about 92% preferred payment in monthly installments. The mean willingness to pay was found to be Tk. 69 if paid monthly installments and Tk. 825 if paid in single payment. The mean willingness to pay for the overall sample size was found to be within the range of 1-2% of the disposable income of the households. Economic hardship was found to be the major reason for not installing sanitary latrine. Health, cleanliness and prestige were found to be three major motivating factors for installing sanitary latrine. Regression analysis using ordered logit model showed that odds for spending money for improved sanitation services were higher for households with better income, households who believed that unsafe sanitation lead to diseases and households belonging to already intervened programme areas. As programmatic implications, this study suggests that credit facilities along with convenient location of the village sanitation centers are necessary to fulfill sanitation-related targets set by the programme. This study has also established a causal relationship between health awareness and willingness to pay for improved sanitation services. However, it was found that even if all the stated conditions are met, there will be some households who would not be able to pay for their latrines and will need some sort of cash incentive or subsidy.

Privatization Revisited: Lessons from Private Sector Participation in Water Supply and Sanitation in Developing Countries

A study [1] by the Asian Development Bank (ADB) shows that private sector participation (PSP), has not shown encouraging results in the water supply and sanitation (WSS) sector. In particular, private resources have not been adequately mobilized to solve WSS sector problems as anticipated by the proponents of PSPs. PSPs in the WSS sector managed to succeed in environments where effective regulation, good governance, and contract enforcement were prevalent. Effective demand for improved WSS services and innovative approaches for competition also paid an important role. Experience also showed that public water utilities can work well when anchored on reforms with ingrained internal and external accountability, customer orientation, and autonomy. While ownership itself hardly influences the efficient provision of WSS services, the interdependence of the public and private players should not be overlooked; a reasonably well-functioning public sector is a precondition for the success of private provision of WSS.

[1]  Gunatilake, H. and Carangal-San Jose, M.J.F. (2008). Privatization revisited : lessons from private sector participation in water supply and sanitation in developing countries. (ERD working paper ;  no. 115). Manila, Philippines, Asian Development Bank. 49 p. Download here [PDF file, 2 MB]