Water Currents: Sanitation Topics


Because sanitation uptake continues to lag behind drinking water in terms of access gains, development practitioners are taking a closer look at what has and hasn’t worked in the past, modifying approaches that delivered early wins but not sustainable gains in coverage, and making sanitation financing a priority.
USAID is doing its part to fill evidence gaps related to sanitation and behavior change and support the reduction of open defecation and movement of communities up the sanitation ladder by identifying, researching, and sharing best practices for the delivery of water, sanitation, and hygiene (WASH) services and sustained behavior change. The Agency has also made it a priority to close financing gaps to help countries achieve universal access to WASH services through sustainable and creditworthy business models, increased public funding, and expanded market finance for infrastructure investment.
This issue contains recent studies and resources on a variety of sanitation-related topics such as market-based sanitation, community-led total sanitation, fecal sludge management, sanitation financing, and others.

Market-Based Sanitation
Gaming for Profit: Using a Game to Learn about Market-Based SanitationUSAID, November 2019. USAID’s Market-Based Sanitation game teaches the fundamentals of a sanitation market system and how an enterprise’s choices affect their viability as a business. Links to the game materials are on the USAID WASHPaLS (Water, Sanitation, and Hygiene Partnerships and Learning for Sustainability) website.

Developing Consumer Markets within Rural WASH SystemsAll Systems Go! WASH Systems Symposium, March 2019. This paper takes a look at how consumer WASH markets are being developed and the role of different types of actors in the system.

Webinar: Designing Effective Sanitation EnterprisesUSAID WASHPaLS, September 2018. WASHPaLS presents a detailed discussion of the elements of a sanitation enterprise, including mechanisms and practices, design approaches, and key considerations based upon the findings of a WASHPaLS desk review.

Triggers for Growing a Sanitation Business Aimed at Low-Income Customers: Experience from Five CitiesWater and Sanitation for the Urban Poor (WSUP), May 2019. This Topic Brief presents WSUP’s experience supporting sanitation businesses oriented toward low-income customers in five cities. Each case study highlights changes to the business model or enabling environment with the potential to trigger business growth.

Ensuring the Quality of Sanitation Products During Project Scale-UpPSI, June 2019. The USAID–funded Sanitation Service Delivery Project uses a market-based approach to increase access to sanitation.This includes identifying and supporting private sector actors to produce prefabricated latrine materials and install household latrines.

Community-Led Total Sanitation
Policy Diffusion in the Rural Sanitation Sector: Lessons from Community-Led Total Sanitation (CLTS)World Development, December 2019. This paper analyzes the reasons that drove the wide diffusion of CLTS. The approach was perceived as a fast and effective solution to the problem of open defecation and spread under the leadership of influential donors, NGOs, persuasive practitioners, and academics.

A Market-Based, Pro-Poor Approach to Rural SanitationGlobal Communities, October 2019. This report discusses a major paradigm shift for CLTS approaches and related government programs and policies in Ghana.

How Does Community-Led Total Sanitation (CLTS) Promote Latrine Construction, and Can It Be Improved? A Cluster-Randomized Controlled Trial in GhanaSocial Science & Medicine, January 2020. This study examines what psychosocial determinants enhance the effectiveness of CLTS in increasing latrine coverage and whether CLTS would be improved with the addition of the risks, attitudes, norms, abilities, and self regulation approach, known as RANAS.

An Examination of CLTS's Contributions Toward Universal SanitationUSAID WASHPaLS, August 2018. The review offers a description of the CLTS intervention, tracing its evolution in theory and practice, and analyzes its strengths and weaknesses. Read the report or view the webinar that presents the findings.

Sustainable Total Sanitation in Nigeria: Final Research ReportInstitute for Fiscal Studies, 2019. This evaluation examines the large-scale rollout of two different WaterAid sanitation interventions in Nigeria, one taking a CLTS approach and the other focused on sanitation marketing, their impacts on toilet ownership, and the possible interactions between the two approaches.

Role of Implementation Factors for the Success of Community-Led Total Sanitation on Latrine Coverage. A Case Study from Rural Ghana. Environmental Science and Technology, April 2019. This study of 94 communities in rural Ghana determined that the success of CLTS interventions can be improved by investing in follow-up visits, the support of local leaders, and the careful application of incentives.

The Role of Social Identification for Achieving an Open-Defecation Free Environment: A Cluster-Randomized, Controlled Trial of Community-Led Total Sanitation in GhanaJournal of Environmental Psychology, December 2019. Researchers studied the effectiveness of CLTS in more than 100 communities in Ghana to determine whether social identification affected open defecation rates. The results highlight the need to consider the social context when planning and implementing sanitation campaigns.

CLTS Knowledge Hub – Community-Led Total Sanitation. The CLTS website aims to be a global hub for CLTS, connecting the network of practitioners, communities, NGOs, agencies, researchers, governments, donors, and others involved or interested in CLTS. The knowledge hub publishes Frontiers of CLTS: Innovations and Insights and each issue focuses on a specific CLTS topic.

Fecal Sludge Management (FSM)
Faecal Sludge Management Landscape in South Asia: Synthesis of a Multi-Country StudyWaterAid, September 2019. The objective of this study is to understand the key elements of the macro-level enabling framework for FSM and on-the-ground interventions in Bangladesh, India, Nepal, and Pakistan.

Safely Managed Sanitation in High-Density Rural Areas: Turning Fecal Sludge into a Resource through Innovative Waste ManagementWorld Bank, September 2019. This report explores the challenges of fecal sludge management in densely populated rural areas and it presents some typical current practices, examples of financially sustainable FSM services, and global innovations in waste management with potential replicability for FSM.

Sanitation Financing and Cost-Benefit Analyses
Facilitating Relationships Between Private Sanitation Service Providers and Commercial Banks in SenegalUSAID WASH-FIN, April 2019. USAID WASH-FIN (Finance) technical support is helping foster links between private sanitation service providers and commercial banks in Senegal as well as encouraging these banks to explore additional opportunities in markets previously unknown to them. Additional financing studies and resources are available on the WASH-FIN website.

India: Can Microloans Increase Toilet Ownership and Use? World Bank, August 2019. This evaluation found that sanitation loans increased toilet ownership and reduced open defecation.

Doing More with Less: Smarter Subsidies for Water Supply and SanitationWorld Bank, August 2019. This report explores how public resources can be used most effectively to achieve universal delivery of water supply and sanitation services and guide policymakers on improving subsidy design and implementation.

Who Gives a Sludge about Toilets? Building Markets for Safe and Sustainable SanitationSocial Finance, November 2019. Social Finance partnered with USAID, the Stone Family Foundation, and iDE to design the world’s first development impact bond for sanitation. This $10 million bond is a groundbreaking initiative that brings safe sanitation to some of the poorest and most vulnerable households in Cambodia.

Benefit‐Cost Analysis of Community‐Led Total Sanitation: Incorporating Results from Recent EvaluationsBill and Melinda Gates Foundation, January 2019. The authors state that CLTS interventions would pass a benefit-cost test in many situations, but that benefit-cost metrics are not as favorable as many previous studies suggest.

Health Costs and Benefits from a Pilot Rural Sanitation Intervention in IndiaJournal of Water, Sanitation and Hygiene for Development, September 2019. This study examined the costs and health benefits of sanitation interventions undertaken over a three-year period by the National Rural Drinking Water Security Pilot Project in India. Researchers quantified the health-related net benefits and the software and infrastructure costs associated with latrine construction and found positive economic returns.

Evidence-Based Policy Analysis? The Strange Case of the Randomized Controlled Trials of Community-Led Total SanitationOxford Review of Economic Policy, Spring 2020. Researchers state that cost–benefit analysis could still “save” CLTS because small treatment effects may still yield net positive economic benefits if the costs of implementing CLTS programs are modest.

Other Sanitation Studies and Resources
Systems Reboot: Sanitation Sector Change in Maputo and LusakaWSUP, November 2019. This Discussion Paper provides examples of how a systems approach can be applied at a city level by looking at two cities—Lusaka, Zambia, and Maputo, Mozambique—that have experienced positive change in their onsite sanitation sector over the last decade.

UNC Water Institute—Testing CLTS Approaches for Scalability. This website contains reports and resources from Plan International’s Testing CLTS Approaches for Scalability project, which aimed to advance rural sanitation efforts in Kenya, Ethiopia, and Ghana by improving the cost-effectiveness and scalability of CLTS.


Water Currents
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USAID Water Team