What Does it Take to Achieve Universal Water Security and Sanitation?  Putting Poor People at the Center

By Nicole Hod Stroh

 “The single biggest failure of leadership is to treat adaptive challenges like technical problems”- Ronald A. Heifetz

Safe drinking-water, sanitation and hygiene (WASH) is a prerequisite for sustainable development on many dimensions including public health, food security, women’s empowerment, and poverty reduction. Despite the relentless efforts by states and the international community over the past few decades, the lack of WASH is still one of the major contributors to global mortality. It is time to rethink the way the international community manages WASH services, by leveraging the wealth that exists in the local communities, accelerating innovation, promoting greater collaboration, and brining a new mindset of humility and adaptive leadership to ensure sustainability and scale in both service delivery and the promotion of healthy habits.

In 2017, almost 2.1 billion people (29 per cent of the world’s population) did not have access to basic levels of water and sanitation services and 892 million people continued to practice open defecation. Children are specifically affected. Over 1,200 children under 5 die every day as a result of poor sanitation. This is more than AIDS, measles and tuberculosis combined. The lack of WASH facilities can prevent students from attending school (particularily girls), reduce work productivity and impose a higher burden on women, as they must spend most of their day fetching water, leaving them less time to engage in other activities such as studying, working or attending their children. In conflict areas, women are placed at great risk of rape and violence, as they have to walk long distances to gather water.

It has become clear to the international community that at this pace, the world will not reach this SDG by 2030.

Creating water and sanitation infrastructure while encouraging healthy hygiene habits is not a one-size-fits-all solution. Systemic problems require systemic solutions that span policy, technology, capacity building, and behavioral change. Lessons from past interventions point to the need to think and work differently to achieve these goals by putting poor people at the center of service provision.

Here are 5 interdependent strategies to accelerate WASH services for the millions of people that so desperately need it: 

1. Accelerate and Scale Transformative Technologies

Traditional toilets and wastewater infrastructures are difficult to introduce as new solutions in developing countries, especially in highly dense urban slums. They are very expensive to build and to maintain and require tremendous amounts of land and energy. This calls for the introduction of new technological innovations. 

It is crucial to accelerate the development of off-grid (that does not require sewers or electricity to operate), low-cost, commercially viable toilets and safe drinking water technologies. According to the Gates Foundation, the market for sanitation products is estimated to become a $6 billion global annual revenue opportunity by 2030. Private-public investments can help create a thriving WASH service ecosystem in developing countries with new products, jobs and services. Governments and the investment community must champion these efforts. 

But technology alone cannot fix the problem. We must focus on connecting these innovations with the local community, particularly women, to ensure that they are properly adopted and scaled. 

2. Placing the Customer at the Center

Research shows that there are critical gaps between policy and implementation, leading to poor service delivery. Even the most perfectly designed solutions often face major setbacks on the ground: lack of community buy- in (resulting in vandalism or neglect), technical and logistic problems, and patchy and inefficient service delivery. The emerging WASH-tech companies described above are likely to make the same mistake. Why? Solutions are often conceived and designed in the boardrooms of Development Organization, Multilateral Banks, national governments or R&D Labs. The poor, the ultimate user of these services, are rarely consulted. There is a huge disconnect between the solutions that are offered and the problems and needs on the ground. 

A customer-centric model gravitates around what the customer wants and needs. Products are co-created and delivered with the community. Instead of focusing on solutions, this model uses a demand-driven approach at every stage of the process—from product conception to the final service delivery—leading to increased accountability to the beneficiaries. Through this model, direct customer interaction and the satisfaction of the community becomes paramount.

Introducing customer-centric models in the provision of WASH services can be done by hiring people that demonstrate empathy and vocation for customer orientation, by consulting and co-creating with the community at every step of the process and by systematically collecting data on customers experience and measuring impact.  

3. Creating Grassroots Power and Accountability

Decades of ineffective water and sanitation services by local governments have stimulated the blooming of dynamic grassroots enterprises, who have been active in informal productive processes and service delivery; mobilizing, organizing, and engaging with the community and the local government. Although these grassroots enterprises are often unable to scale due to their lack of capacity and financial arm, they have acquired the highest level of expertise regarding what works and what doesn’t, what are the right solutions for their community’s problems, and who are the key stakeholders to get to buy-in. Private technologies and service providers can work together with grassroots entrepreneurial initiatives to co-design the right distribution channels, payment mechanisms, logistics and maintenance models to ensure the appropriate assimilation of the service over the long term.

4. Behavioral Change and Adaptive Leadership 

Improved access does not guarantee more usage. Consider for example the case of India, where the World Bank links one in ten deaths to poor sanitation. For decades, the Indian government has been subsidizing toilets in remote villages. Yet, as The Economist puts it, “Simply punching holes in the ground at breakneck speed will not solve the problem”. Many toilet subsidy recipients used the funds for other purposes, and in 40% of households with a working toilet, at least one family member still preferred to defecate outside. Often, bathrooms are the only concrete structure in the house, so families use them as storage for food, chickens and even temples.

The private sector can use its commercial marketing expertise to build integrated marketing communication for behavioral impact, position hygiene and toilet use as a preferred method at a massive scale. But top-bottom approaches, technical solutions and fancy advertising is not enough to reach the last mile. The adaptive leadership theory explains that it is crucial to distinguish technical challenges from adaptive ones. A solution usually already exists for technical problems. It is a matter of identifying the necessary resources and expertise and connecting them with the problem. In the case of adaptive challenges, however, the solution is latent. There are multiple perspectives that offer multiple solutions. There are major tradeoffs, compromises and losses. 

The answers are not clear in anyone’s eyes and might require a long process of adaptive work, which must be given back to the community itself. Solving the problem on behalf of the community is often not sustainable.  As a result, working closely with the community leadership and the local women is critical to understand the needs and motivations and co-create programs that encourage norm creation and dissemination of behavioral change through health and hygiene education, dignity and respect. In Bangladesh, for example, a sanitation program proved to be highly impactful when women were placed in charge of choosing the location and type of toilets for their homes. Conversely, in India, people that defecate outside have been beaten, punished and shamed. 

5. Monitoring and Accountability

Rigorous and integrated data and monitoring mechanisms are crucial to track progress across populations and geographic locations, to inform policies and improve services.This information should be made available to the public to ensure transparency and accountability.

Increasing accountability to those impacted by those services—the poor—can strengthen the legitimacy of international development agencies and ultimately reach better development results. To do this effectively the local communities must be involved at every step of the way. As they become aware of their rights, they can hold their local governments and service providers accountable for WASH services. Policies and procedures for participation by local communities in the management of water and sanitation can ensure that they remain informed, consulted and represented in the delivery of these vital services. Specifically, the role of women’s participation is increasingly important as a measure of equity.

With these 5-pronged strategy we can accelerate the provision of WASH services around the world, by combining both technical and adaptive solutions and placing poor people at the center of the work. 

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