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)

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

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).

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.
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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.

Sanitation: Encourage families in Ghana to install home latrines

In Ghana, three-quarters of the population lack decent sanitation. Poor sanitation is the cause of many life-threatening diseases, including diarrhoea, and the lives of many children could be saved if latrines were installed in their homes. What factors affect whether families in Ghana have installed their own toilet?

A study [1] by the University of California Davis and the London School of Hygiene and Tropical Medicine considered why most families in Ghana do not have toilets. A behavioral model of the decision to install a home toilet was developed and interviews were conducted with a nationally representative sample of 536 mothers of young children living in rural or semi-urban areas.

[1] Jenkins, M.W and Scott, B. (2007). Behavioral indicators of household decision-making and demand for sanitation and potential gains from social marketing in Ghana. Social science and medicine ; yol. 64, no. 12 ; p. 2427-2442. doi:10.1016/j.socscimed.2007.03.010

Read more: id21, 10 May 2008