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University of Toronto: Emory Global Health Case Competition


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University of Toronto: Emory Global Health Case Competition

  1. 1. C.L.E.A.N.The Key to Sustainable Total Sanitation Team 19 Kristy Hackett Samantha Kearney Theresa Lee Nicole Lipana Julia Roy Anjum Sultana S
  2. 2. Can Global Sanitation 2020 Contribute to China’s Prosperity? ?
  3. 3. Catalyst for economic prosperity Improve health Human Environment capital Sanitation Opportunity Education cost Labor Productivity
  4. 4. Where to invest? ?
  5. 5. Where to invest?
  6. 6. Why South East Asia?S Economic Gains S Soft Power S Growing population S International reputation S Increasing purchasing power S Political interest S Geographical proximity S Economic interdependence S Regional Stability S Access to natural resources S Need for sanitation S Established infrastructure improvement S Similar rural urban divide to China S Relative cultural similarity
  7. 7. Cambodia, Indonesia, Timor LesteS Rural/Urban Divide S Disproportionate access to improved sanitation S Cambodia – 20% vs. 73% S Indonesia – 39% vs. 73% S Timor Leste – 37% vs. 73%S 93 Million people in rural areas
  8. 8. Economic Cost :: Sanitation Cambodia, Indonesia China Timor Leste S US $6.2 Billion loss due to lack of sanitation [1] S China’s bilateral trade with these countries will increase by S Health US $240 million per year if universal sanitation coverage is S Productivity (Labor, education) attained S Environment (water, land) S Tourism[1] Water and Sanitation Program (2008)
  9. 9. What and how to invest?SWhat? SHow?
  10. 10. FeasibilityEconomic TechnicalCultural Scientific
  11. 11. Step 1: Community Engagement (Create Demand) S Community-Led Total Sanitation (CLTS) S Originated in Rajshahi, Bangladesh by Kamal Karr S Benefits: S Community Ownership S Behavioral Change S Community Empowerment S Evidence-Based S Decrease rates of open defecation: S CLTS: 92% S Non-CLTS: 28% [2][2] Rashid et al (2009)
  12. 12. Process of CLTS Pre Triggering Triggering Post Triggering• Selection • Participatory • Action Sanitation Planning• Building Profile Rapport Analysis • Follow Up • Ignition Moment
  13. 13. Demand Supply
  14. 14. Step 2: Ecological Sanitation (Provide Supply) EcoSan ApproachConventional Approach
  15. 15. EcoSan OptionsUrine diversion Composting dehydration toilets(UDD) toilets Semi-Vacuum sewers centralised biogas plants
  16. 16. CLTS C.L.E.A.N. EcoSan(Demand) (Supply)
  17. 17. C.L.E.A.N. Pre-triggering Engage community Building rapport Identify sanitation problems TriggeringParticipatory Sanitation Profile Analysis Ignition Moment Introduction of EcoSan and Solution building Develop plan Funding request Project Rollout Fund Build Adopt Report Evaluation Lessons Learned
  18. 18. C.L.E.A.N. :: Monitoring & Evaluation Template Acceptability Cost • Community-led Effectiveness • Participatory • DALYs avoided/ • Feedback loops 1$ spent • Equity-focused Health Impacts Environmental • Change in % Impacts ODF • Local water • Diarrheal disease quality • <5 mortality
  19. 19. Recommended Evaluation Design  Randomized Controlled Trial (Gold Standard) Region  Carried out by University partnersCLTS C.L.E.A.N. EcoSan
  20. 20. C.L.E.A.N. :: A Multi-faceted Approach Stakeholder Integration  Policy: Governments & Institutions  Implementation: Civil Society & NGOs  Research: Universities Benefits  Knowledge transfer  Evidence building in the scientific community  Capacity building of community  Soft power gains for China
  21. 21. Project Budget  US $5 Billion per East Timor; 3% year for 3 years of full-scale Cambodia; 27% implementationIndonesia; 70%
  22. 22. Additional Recommendation :: China in parallel Vast inequities between rural and urban populations within China Curb criticisms of not dealing with sanitation problems at home Lessons learned in neighboring countries are transferrable Strengthen research partnerships Become a world leader in environmentally sustainable sanitation initiatives
  23. 23. Key Messages1. C.L.E.A.N ignites the demand for and provides the supply of improved sanitation2. Benefits of C.L.E.A.N. go beyond sanitation, addressing issues of equity and global responsibility3. Improved sanitation in South East Asia leads to returns on investment and improves international relations and furthers economic gain
  24. 24. Thank You. Questions? 
  25. 25. References References Avvannavar, S. M., & Mani, M. (2008). A conceptual model of people’s approach to sanitation. Science of the Total Environment, 390, 1-12. Cheng, J. Y. S. (2013). China-ASEAN Economic Co-operation and the Role of Provinces. Journal of Contemporary Asia, 1–24. doi:10.1080/00472336.2012.757430 Ferguson, R. J. (2012). China’s Long-Term Relations With Southeast Asia: Beyond The Pivot. Culture Mandala: The Bulletin of the Centre for East-West Cultural and Economic Studies, 10(1), 3–20. Florini, A., Nachiappan, K., Pang, T., & Pilcavage, C. (2012). Global Health Governance: Analysing China, India and Japan as Global Health Aid Donors. Global Policy, 3(3), 336–347. doi:10.1111/j.1758-5899.2012.00173.x Hubbard, B., Sarisky. J., Gelting, R., Baffigo, V., Seminario, R. & Centurion, C. (2011). A community demand-driven approach toward sustainable water and sanitation infrastructure development. International Journal of Hygience and Environmental Health, 214, 326-334.
  26. 26. References References Langergraber, G., & Muellegger, E. (2005). Ecological sanitation – a way to solve global sanitation problems? Environmental International, 31, 433- 444. Montgomery, M. A. A. (2007). Water and Sanitation in Developing Countries: Including Health in the Equation (pp. 16–24). Mosler, H-J. (2012). A systematic approach to behavior change interventions for the water and sanitation sector in developing countries: a conceptual model, a review, and a guideline. International Journal of Environmental Health Research, 22(5), 431-449. Murphy, H.M., McBean, E.A., & Farahbakhsh, K. (2009). Appropriate technology – a comprehensive approach for water and sanitation in the developing world. Technology in Society, 31, 158-167. Nelson, K. L., & Murray, A. (2008). Sanitation for unserved popualtions: Technologies, implementation challenges, and opportunities. Annual review of Environment and Resources, 33 199-151.
  27. 27. References References Rud, S. & Munch, E. V. (2008). Ecological sanitation: Selected example projects from Sub-Saharan Africa, Asia and Europe. International Conference: Pahtways towards Sustainable Sanitation in Africa. Ouagadougou, Burkina Faso. SOIL (February 2011). Introduction to EcoSan toilets. UNICEF, & World Health Organization. (2012). Progress on Drinking Water and Sanitation (pp. 1–66). Water and Sanitation Program. (2007). Economic Impacts of Sanitatn in Southeast Asia Summary (pp. 1–14). Water and Sanitation Program. (2012). Introductory Guide to Sanitation Marketing Implementation (pp. 1–14). Water & Sanitation Rotarian Action Group (2012). Guidelines for planning sustainable sanitation projects and selecting appropriate technologies. Wasrag Technology Series.
  28. 28. References 68). References WaterAid. (2011). Construction Of Ecological Sanitation Latrine (pp. 1– Werner, C., Panesar, A., Rud, S.B. & Olt, C.U. (2009). Ecological sanitation: Principles, technolgoies and project examples for sustainable wastewater and excreta management. Desalination, 248, 392-401. Whittington, D., Jeuland, M., Barker, K., & Yuen, Y. (2012). Setting Priorities , Targeting Subsidies Among Water , Sanitation , and Preventive Health Interventions in Developing Countries. World Development, 40(music), 1546–1568. World Health Organization. (2012). Global Costs And Benefits of Drinking-Water Supply And Sanitation Interventions To Reach The MDG Target And Universal Coverage (pp. 1–67).
  29. 29. Appendix AAdditional Recommendation :: China in parallel Yunnan province  Rural population: 31.375 million  46.3% in need of improved sanitation Total cost: US $745 million  Including cost of technology, facilitators, evaluation, and overhead cost
  30. 30. Appendix B: Cambodia,Indonesia, Timor Leste
  31. 31. Appendix C: Stakeholder Engagement Government – Ministry of Health, Water & Environment, Education (multi- sectional) NGOs Universities and Researchers Leading Sanitation Experts within Ministry Regional District - Health & Environment District Community/Village Level Elders, Leaders, Village Governing Council
  32. 32. Appendix D: Why Not Africa? Maintaining Current Investment Proportion Harder to Achieve Universal Sanitation Risky Investment No Established Infrastructure
  33. 33. Appendix E: SWOT Analysis for Investment in Africa Weakness Strength - Low level of infrastructure- Natural resources - Political uncertainty (Human- Large population (900M, to Rights and conflict)double) - Sanitation infrastructure can’t- Emerging market support population growth- Rising middle class - Low level of ODF in both urbanMany ODF initiatives and rural area - Distance from China is high, meaning increased cost - Most need Total Cost to achieve universal sanitation coverage SSA: US $52 Billion Threat SEA: US $10 Billion - Uncertainty about whether resources exist Opportunity - Urbanization Benefit:Cost Ratio- Generate trade and extraction - Environment SSA: 2.8- Increased purchasing power - Sanitation low in urban areas SEA: 5- Room to improve ODF% - Unfeasible sanitation target due to- Global stability and recognition many confounding issues- High reward - Increased cost due to distance - Soft power decreases - High risk
  34. 34. Appendix F: Biogas
  35. 35. Appendix G: Composting Toilets
  36. 36. Appendix H: Urine Diversion Dehydration
  37. 37. Appendix I: Evidence of CLTS Not Effective
  38. 38. Appendix J: Budget for China C.L.E.A.N. Program
  39. 39. Appendix K: Global Budget Calculations
  40. 40. Appendix L: Philanthropy Lots of money with comparatively little economic ROI Foreign aid can simply be aid and doesn’t have to come with strings attached This further improves international relations, friendliness and soft power
  41. 41. Appendix M: Evaluation Methodology Qualitative:  In-depth interviews with key stakeholders at community level (women, children, youth, facilitators, village government members)  Focus on equity of uptake/participation/decision making
  42. 42. Appendix N: Evaluation Methodology Quantitative:  Household Surveys (pre/post) in each village  Measures of water contamination  RCT: compare changes in indicators between arms  Surveys to capture:  Health indicators  Cost effectiveness data  HH hygiene/sanitation knowledge  Attitudes towards C.L.E.A.N. approach
  43. 43. Appendix O: Five Year Plan :: GANTT Chart
  44. 44. Appendix P: Evidence for CLTS
  45. 45. Appendix Q: EcoSan Selection(s)