Despite significant investments, rural sanitation coverage in South Asia is barely keeping pace with population growth and over 900 million people (66 percent of the total population) remain without access to adequate sanitation. How can current approaches to the development and provision of rural sanitation in the region be improved? Compiled by the Water and Sanitation Programme – South Asia, this paper presents a series of case studies, analyses success factors and outlines policy implications for scaling-up strategies.
Decision-makers are recognising the importance of adequate sanitation for public health and poverty alleviation. South Asia contains more people without sanitation than any other region on earth. The vast majority of this unserved population are poor and live in rural areas. In recognition of the magnitude and severity of this challenge, governments, donors and NGOs have made huge rural sanitation investments over the last few decades.
Conventional sanitation programmes tend to focus on the construction of sanitation facilities and are often deemed successful simply because they reach coverage targets. By contrast, the total sanitation approach is a community-wide initiative aimed at universal toilet use, which focuses on stopping open defecation and similarly highlighting the advantages of good hygiene practices.
- The total sanitation approach recognises that sanitation is both a public and private good and that individual hygiene behaviour can affect the whole community.
- Total sanitation refers to a community-wide ban on open defecation and requires that every household in the community either owns or has access to a sanitary toilet.
- Open defecation is an important measure of programme outcomes as it indicates the size of the population without access to a toilet and, where 100 percent toilet coverage is claimed, confirms whether those that have toilets are using them.
- Government programmes concentrate on financial incentives and sanctions, including hardware subsidies and fines for open defecation.
- Participatory processes used by NGOs have achieved reasonable successes in awareness-raising campaigns and by assisting in the rapid construction of low-cost toilets.
There is no standard solution for the large-scale provision of rural sanitation services. One of the key challenges facing the rural sanitation sector in South Asia is to develop large-scale national programmes that produce sustainable and affordable rural sanitation services. The case studies suggest a range of implications for scaling-up activities:
- It is apparent that the unsuccessful programmes are supply-driven, concentrating on building standard toilet designs or sewerage systems and paying scant attention to toilet usage.
- The successful programmes provided high access to sanitation and ensured high toilet usage through a combination of participatory processes, hygiene promotion and institutional incentives.
- High hardware subsidies do not necessarily translate into increased toilet usage as such programmes typically reach fewer people and households that build toilets often feel less ownership for their facilities and may be disinclined to make lasting behavioural changes.
- As households usually pay in advance for toilet materials and installation, responsibility for sanitation programmes should be devolved to the lowest level of local government to improve targeting and increase local accountability.
- More attention should be paid to evaluating the effectiveness of hygiene promotion activities and assessing their impact on long-term hygiene behaviour and public health.
