Impact Evaluation of a Large-Scale Rural Sanitation Project in Indonesia

Total Sanitation and Sanitation Marketing (TSSM) is the Indonesian component of World Bank Water and Sanitation Program's Scaling Up Rural Sanitation initiative. The approach consists of raising awareness of the problems of open defecation; marketing sanitation products; and supporting policies, financing, training, and regulations that are conducive to these efforts. Therefore, desired outcomes of the program include changes in perception of the consequences of poor sanitation, toilet construction and access to improved sanitation, reduction in open defecation, and child health outcomes. This impact evaluation assesses these results using a randomized controlled trial (RCT), and unlike many RCTs that are carried out on pilot programs, it looks at an intervention that has been implemented at scale and led by the government under real-world conditions, providing more reliable estimates. TSSM is associated with sanitation improvements overall, particularly among wealthier households that had no sanitation prior to the intervention

Building Towards a Future in Which Urban Sanitation Leaves No One Behind

Plans to improve access to sanitation in towns and cities of the global South are hampered by multiple challenges. One is a lack of reliable information. In particular, global and national-level data often diverge from data on particular settlements, collected by inhabitants of those settlements themselves. Local data highlight the inadequacy of living conditions -- and in so doing evidence the difficulties in securing improvements. Another challenge lies in the setting of standards around acceptable sanitation. At a global level, for instance, shared sanitation is not considered part of "improved" sanitation. Yet the reality for many low-income urban populations is that communal sanitation can be hygienic, cost-effective and locally acceptable.The difficulties in reaching a consensus around data and standards point to the importance of diverse approaches to increasing and improving sanitation, including considering both on-site and off-site solutions. They also highlight how crucial it is for the planning and implementation of all such solutions to be inclusive of those often missing from global debates, such as the low-income urban groups that cannot afford substantial sanitation spending. Financial and political commitments, drawing on the circumstances and approaches articulated by low-income groups themselves, will be key to securing a future in which everyone has access to the sanitation they need

Rethinking Sanitation: Lessons and Innovation for Sustainability and Success in the New Millennium

This report highlights some of the key lessons learned from the past about sustainable sanitation solutions, new thinking emerging from consolidated learning and innovative experimentation on-the-ground, and some of the conditions necessary for success if real improvements in sanitation are to be achieved and sustained in rural and urban areas. Special attention is placed on the shift from supply-led sanitation projects to demand-led and market-oriented projects. The report concludes that with much deeper attention and broadened interest in sanitation, a more realistic view of the complexity, time, resources and effort needed to meet the challenge of large-scale sustainable changes in sanitation at the household level

Rural Water Supply and Sanitation Challenges in Latin America for the Next Decade

A decade after a 1999 World Bank-sponsored meeting of Latin American water and sanitation experts, there has been progress in rural sanitation in that region. Nonetheless, the Millennium Development Goals for improved sanitation services may be out of reach. Looking toward the next ten years, important challenges for rural water and sanitation will include: ensuring long-term sustainability of sanitation services and monitoring systems, improving the contribution of municipal government, and establishing appropriate legal and financial policies

Sanitation as a Business: Unclogging the Blockages

The first Unclogging the Blockages conference took place in Kampala, Uganda in February 2014 with the aim of putting on the table some of the major challenges facing the scale up of sustainable sanitation as well as collaborating towards innovaive soluions. This report summarizes the discussions and takeaway messages from the conference, including concrete action plans developed around a number of thematic areas. [KEY FINDINGS]Market based approaches are key to addressing some of the main barriers for scaling sustainable sanitation solutions. Participants came away with a much richer understanding of the principles and key tenets of sanitation as a business. A push for greater integration in sanitation programming between the housing, energy, business, health, and education sectors will allow for sustainable city and district-wide sanitation services.Unlocking finance for businesses and households and embedding monitoring within all work is critical. One interesting outcome of the group work was a suggestion to form a Global Sanitation Financing Alliance.Supporting sanitation businesses to be successful in the realities of the market requires on-the-ground, real time, market-focused technology development and R&D. A variety of these technologies were on display at the meeting

What Influences Open Defecation and Latrine Ownership in Rural Households?: Findings from a Global Review

In this review, the Water and Sanitation Program of the World Bank identifies commonalities and differences across sanitation market research studies it has conducted in eight countries since 2006 to determine factors that affect sanitation behaviors. Three specific behaviors -- open defecation, acquisition of toilets, and improvement of latrines -- are covered

School Sanitation in Underserved Urban Areas in India

This paper discusses how GIZ is supporting the Ministry of Urban Development in improving the sanitation situation for the urban poor. It selected 47 schools in five Indian cities to significantly improve the sanitation conditions, aiming to build awareness and capacity. All schools showed measurable improvements on school sanitation at the end of the project

The True Cost of Poor Sanitation

New research in this report, building on pioneering work from the World Bank's Water and Sanitation Programme, underscores the hidden costs of poor sanitation. Death and disease are tearing families apart. Children drop out of school and fail to reach their potential, especially young girls. The research shows how poor sanitation has a substantial impact on the economy. Countries with poor access to sanitation are losing significant proportions of their GDP – in India, this figure is over 5%.With such significant social and economic costs associated with poor sanitation, the argument for addressing this challenge cannot be ignored. More investment is needed, not just in terms of capital investment, but also in terms of a broader dialogue and discussion among governments, international organizations and the private sector about the need to prioritize this urgent issue. The time for concerted, coordinated action is now

Evaluation of the Costs and Benefits of Water and Sanitation Improvements at the Global Level

This study estimated the economic costs and benefits of a range of selected interventions to improve water and sanitation services. The entire analysis is based on changes in water and sanitation service levels. For developing countries, the World Health Organization (WHO) favors intervention options that are low cost, that are feasible, and do not require heavy maintenance. The costs of the interventions include the full investment and annual running costs. The benefits of the interventions include time savings associated with better access to water and sanitation facilities, the gain in productive time due to less time spent ill, health sector and patients costs saved due to less treatment of diarrheal diseases, and the value of prevented deaths. The results show that all water and sanitation improvements were found to be cost-beneficial, and this applied to all world regions

Monitoring sanitation and hygiene in the 2030 agenda for sustainable development: A review through the lens of human rights

International monitoring of drinking water and sanitation has been jointly carried out by WHO and UNICEF through their Joint Monitoring Programme (JMP). With the end of the Millennium Development Goals (MDGs) era in 2015, the JMP has proposed a post-2015 framework for integrated monitoring of water and sanitation targets included in the Sustainable Development Goal no. 6. This article discusses how each element of the proposed sanitation target and corresponding indicators can be understood from a human rights perspective. Building on the MDGs, and although some of the weaknesses and gaps persist, the discussion suggests that the post-2015 proposal is a step forward towards a monitoring framework where human rights elements related to sanitation are effectively promoted. In addition, to support the interpretation and implementation of the normative content of human rights obligations related to sanitation, the study proposes a reduced set of easy-to-assess indicators to measure the normative criteria of this right, which are then grouped in a multidimensional framework to describe increasing levels of sanitation service. To do this, the study combines literature review and specific local experience from three case studies. It is shown that the proposed monitoring tools, namely the indicators and the multidimensional indicator framework, provide guidance on monitoring the human right to sanitation. In doing so, they might ultimately help sector stakeholders in the realization of this right.Peer ReviewedPostprint (published version