Ex-Post Evaluation: Madagascar RANO-HP

RANO-HP Kids washing hands

The Madagascar Rural Access to New Opportunities for Health and Prosperity (RANO-HP), implemented from 2009 to 2013, aimed to increase sustainable access to safe water supply, improve sanitation coverage, and expand hygiene practices for communities in Madagascar.

What We Did

Through household survey and interviews with beneficiaries, the evaluation team explored barriers and facilitators of sustainability, focusing on the activity’s sanitation and hygiene components. These included:

  • community-led total sanitation (CLTS)
  • behavior change messaging
  • public WASH “monoblocks” (combined public water point, latrine, shower and laundry station) managed via a variety of different mechanisms

Villanova University recently completed a similar evaluation of RANO-HP and its sister activity RANON’ala, conducted during the same time period as this evaluation. It focuses on the sustainability of both activities’ water supply interventions.

How We Did It

Data collection occurred in September and October 2016. This evaluation explored the following broad questions:

  1. To what extent are the levels of sanitation facility functionality and hygiene usage/behaviors that were measured at the close of the RANO-HP activity still observed three years later?

The evaluation team addressed Question 1 through a replication of the RANO-HP endline quantitative household survey and sampling methodology in all 26 communes and re-verification of 69 villages previously declared to be open defecation free (ODF) using endline methodology.

  1. Which factors influenced the ability to sustain sanitation and hygiene facilities and behaviors? Why?

The team analyzed 53 qualitative interviews with a variety of stakeholders in six communes to further explain quantitative results for Question 1, and to serve as the primary data source for addressing Question 2.

What We Learned

On the positive side, CLTS interventions helped produce large gains in sanitation coverage achieved. However, many of RANO-HP’s results were not sustained three years after the activity closed.

  • Latrine use showed significant slippage in four of the activity’s five targeted regions.
  • Most communities that were declared to be ODF at the end of RANO-HP were practicing open defecation again.

Barriers to success included:

  • Literacy: Households with a non-literate respondent were less able to sustain WASH outcomes.
  • Financial constraints: These were the main barrier to maintenance of improved sanitation, even for simple technologies such as pit latrines and tippy taps. RANO-HP had established village savings and loan associations (VSLAs) and a microfinance loan product, but only one remains in use, in an urban area.

It’s worth noting that female-headed households were slightly more likely to use a latrine compared to male-headed households. They also opted for higher quality latrines over time by a small margin.

Next Steps

These findings led to several recommendations for future USAID programs, including:

  • CLTS can lead to rapid adoption of sanitation, but maintaining these gains is a challenge and may require interventions beyond CLTS, ideally implemented by local governments.
  • Future programs should continue to address the challenge of financing for sanitation. (Click to read an issue of USAID’s Water Currents newsletter focused on this topic.)
  • The decision-making differences observed between female and male headed households should be considered when designing future strategies to facilitate sustained WASH behavior.

About The Ex-Post Evaluation Series

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The USAID Water Office is conducting a series of independent ex-post evaluations of the Agency’s water, sanitation, and hygiene (WASH) activities to inform future USAID investments in the sector and to better understand the long-term impact and sustainability of its interventions several years after projects close.

This evaluation series will help USAID understand whether and how its activity results have been sustained. All activities included in the series must have been closed for a minimum of three years and could not be recipients of Office of U.S. Foreign Disaster Assistance or Food for Peace funding. Preference is given to USAID missions that are at a point in their design cycle to incorporate learnings into upcoming WASH programs.

This evaluation series builds upon USAID and Rotary International’s WASH Sustainability Index Tool, a framework to assess a WASH activity’s likelihood to be sustainable according to the following factors: availability of finance for sanitation; local capacity for construction and maintenance of latrines; the influence of social norms; and governance.