Presentation on factors that promote or inhibit the sustainability of improved sanitation in rural Bangladesh, based on research conducted in 50 local governments by the Water and Sanitation Program (WSP)
So let me start off three points on why did this study and why it should be of interest to you.The First point we did this study was to help the government of Bangladesh reflect on the significant progress they made in scaling up rural sanitation, and this study offered the opportunity to gain insights in how to improve programming moving forward. However the government is still working towards their of goal 100% sanitation coverage, The Second point we did this study is that the Water and Sanitation Program is actively working to help government counterparts find solutions to scale up sustainable rural sanitation programs. Currently there no better place than Bangladesh to find insights on 1.) how they have scaled up rural sanitation with a focus on collective outcomes, 2.) how sustainable have these outcomes been, and 3.) most importantly understanding why these outcomes have been sustained or not. And third – there reason why this study should be of interest to you there is paucity of data on understanding sustainability household latrine use and cessation of open defecation from using community led total sanitation approaches. If we are making investments in sanitation then we should also be trying to understand how sustainable those investments are.
A quick overview of what will be covered during this session
So the core issue being addressed with this study was to understand the factors that support or worked against sustaining the achievements made five years ago by local governments in attaining 100% sanitation coverage and stopping of open defecation. To investigate these factors we had four specific study objectives that I will focus on today:First – wanted to understand the current status of household sanitation behaviors and durability of facilities in these local governments areas Second – to understand why households have or have not sustained behaviors and their facilities since being declared open defecation freeThird – Has sanitation programming been sustained and has it helped sustain household behaviors and facilities?And Fourth – we wanted to know whether the growth or attrition of private sector sanitation providers affected the sustainability of household behaviors and facilities?
With respect to the background, let me give you a current snapshot of progress reported by the government in rural sanitation coverage since 2003 - the green line represents access to a hygienic latrine, and the redline line indicates trends in open defecation. These government statistics along the green line are generally supported the WHO/Unicef Joint Monitoring Program statistics that puts access to improved sanitation including sharing an improved type of latrine at around 76%.This progress coincides with the government’s national total sanitation campaign, which was at its peak between 2003 and 2006. And there are three points that I want to highlight about the campaign that I will also come back later.The first point is that the roots of this national total sanitation campaign are linked to the Community Led Total Sanitation approach that I am sure all of you heard of and that was pioneered in Bangladesh back in 2001 by a local NGO. While the government did not adopt all of the elements of the approach such as the philosophy of not using subsidies, the governments campaign did retain certain elements such as the focus on collective outcomes, behavior change and stopping open defecation, and using community mobilization approaches to stimulate demand for latrines. The second point is this rural sanitation program did not develop in a vaccum, but it is grounded in a strong policy and strategy with clear guidelines on how to program local government development funds, and it has a clear institutional home under the line ministry of local government, and it was guided by the national government and implemented by local governments across the country.The third point is that the study documented four nuanced approaches that helped local goverments scale up sanitation programming, and I am not going discuss those approaches today, but I just wanted to say that the reason that we did that was not to determine whether one approach was better than another, but to paint a broader picture of sanitation activities in Bangladesh and have a common understanding of the outcomes in these different local governments.
By 2005 - 480 local governments nationwide that were declared ODF and were rewarded for their achievements from the national government fro attaining 100% sanitation coverage and stopping open defecation. The local governments that were selected for this study represent the 4 nuanced approaches used during the campaign that I previously mentioned.CLICKWe took a random sample of 50 local governments out of the 480, which is about 10% of the total pool of local governments that were ODF in 2005. The consultants used quantitative and qualitative methods including a random sample of 3,000 householdsIn addition , 18 of these local governments were selected for more in-depth study using focus groups, key informant interviews, and transect walks. The yellow areas on this map indicate the districts from where we sampled the local governments, and as you can see the sample covers a wide geographic range of the country.
So let us turn to answering study objective 1, which was understanding the current status of sanitation behaviors and durability of latrinesAnd we will look at this through collective outcomes and by wealth quintile to see how the poor have faired.
After almost 5 years had past, we found 68% of the local governments had high access and use based on the household survey sample. Meaning 90-100 % of the HH surveyed either owned or shared an improved type of latrine.28% of the local governments had moderately high access meaning that 70-89% of the households owned or shared an improved type of latrine.And only 4% of local governments had household access less than 50%.MAIN POINT - While there was some slippage five years later from the ideal state of 100% households having access to and using an improved latrine, and there is clearly room for improvement particularly in these sections, I would consider that this picture is relatively positive with respect to sustained access.
MAIN POINT - While there was some slippage five years later on average across these local governments 89% of households own or share an improved type of latrine with only 11 using an unimproved latrine or defecating in the open. With respect to sustainability this is a pretty positive picture.
When we look at sanitation wealth quintiles, the statistical analyses indicates that the odds of rich households owning or sharing an improved latrine are 2.72 times greater than the odds households in the poorest wealth quintile to own or share an improved latrine.However, while we know that richer households will always fare better than the poor, the more interesting point here is that over 80% of households in the poorest wealth quintile were using an improved type of latrine demonstrating that the achievements in reducing open defecation were successful across wealth quintiles.CLICKMAIN POINT – While we know that the poor will always be at a disadvantage of gaining access this suggests that a focus on collective outcomes may be a factor in helping ensure equity across wealth quintiles..
Shifting from sanitation coverage and use let us now try to understand durability of the improved types of latrines that households are using. We wanted to look at the durability of latrines because our was hypothesis that if households are continuously having to rebuild or repair their latrine then they may be more likely to abandon latrine use and defecate in the in open.
We use duration of ownership of the household’s current latrine as one proxy measure for durability. From this graph we see that 69% of households have owned their current latrine for more than 3 years indicating that they built their current latrine during the campaign or shortly after. And little over a ¼ of HH have built a new latrine in the last 3 years. MAIN POINT – using duration of ownership as a proxy for durability it seems that good portion of the latrines that are currently in use have been service for a while, which is a positive finding.
If we see that concrete, wood, or an earthen slab as another proxy measure for durabilityWe see that the majority of these HH in these local governments installed durable type of slab such as concreteThe small percentage of earthen slabs that we found were largely in local government areas supported by NGO using CLTS, which is consistent with the philosophy of the approach to promote low cost local materials. MAIN PIONT – Is that most households that own or share an improved type of latrine installed a more durable type of slab such as concrete, which is a positive sign with respect to durability. One caveat is that the qualitative research did highlight that construction standards are not uniform and quality of concrete parts is an issue in some places.
With that summary in mind let us look at study objectives 2, 3, 4 to understand three factors that may contribute to these positive outcomes we found from study objective 1
So in understanding why households have sustained latrine one positive factor is Social Norms. And social norms are essentially informal rules in a society that sanction or disapprove of a particular behavior.We captured this factor through the qualitative research, which clearly showed that social norms around open defecation have changed. Repeatedly through focus group discussions or key informant interviews we heard a similar theme that open defecation is not an acceptable practice, and those who continue to practice open defecation are socially criticized. CLICK FOR FIRST QUOTEIn addition, we found that marriage arrangements and religious events are widely assumed to require use of “hygienic” latrines further demonstrating that open defecation is not a respectable or socially sanctioned practice.Some of the insights that gathered about why social norms shifted are embodied in this second quote. CLICK to read second quoteWe found this theme across all areas, which indicates that sanitation campaign was very influential. The confluence of national government leaders, local government authorities, community leaders, mass media (includingradio and television), NGO workers all promoting that households need to use a latrine and stop open defecation was engrained in most rural Bangladeshi households. MAIN POINT - Repetitionof messages through various channels likely helped shift the social norm of defecating in the open as an acceptable practice to one that is now rejected by most households.
A second important factor that we found appears to be ongoing sanitation activities. This study found that two-thirds of local government chairmen still promote sanitationCLICK for AnimationThis indicated that sanitation programming has been sustained at some level by local governments.Quantitative analysis also showed that households who reported being visited by anyone talking about latrine use were 1.48 times more likely than households not being visited to own or share an improved latrine.Additionally we found that for households exposed to some form of NGO sanitationfollow-up program were 1.8 times more likely own or share an improved latrine compared to households not reporting having an NGO follow up program.MAIN POINT – So while clearly our study design cannot link causality between ongoing sanitation activities to owning or sharing an improved latrine, our statistical analysis indicates that this is one possible predicator of that may have a positive effect on sustaining latrine use.
A third important factor that we found was that 95% households who own or share an improved type of latrine self-reported having high access to latrine parts suppliers and masons. While the poor are more likely than the rich to self-repair or install a latrine, rich and poor households alike appear to have similar access to parts suppliers and masons, which is give households the opportunity to repair, upgrade, or install an new latrine.
We also found that 74% of households that own or share an improved latrine self-reported having access to pit empting services. The level of access reported by poor and rich households was similar. MAIN POINT - If a household’s latrine falls into disrepair, is damaged, or the household wants to increase their satisfaction of using the latrine by making improvements, having access to service providers is vital. This study found that a very high percentage of households reported an ability to access latrine materials, skilled labor, and pit emptying services from the local market, which we consider a positive factor in sustaining latrine use.
So those were some positive factors that we think help explain why sanitation behaviors and facilities have likely been sustained, but now lets explore some factors that work against households using an improved type of latrine, and remembering that this segment is only 11% of study population.
One reason why households have not sustained use of an improved type of latrine is due to natural disasters such as cyclones and floods that are common to Bangladesh. The qualitative analysis indicated that those who live in flood prone areas have a more difficult time continuously rebuilding their latrine when it is damaged. The quantitative findings show that coastal and flood prone areas have a higher percentage of households using unimproved facilities compared to other geographic areas. MAIN POINT - In areas that are disaster prone, local government leadership becomes even more essential to ensuring that sanitation is high priority in the wake of disasters.
A second factor which is essentially the opposite of what I mentioned before may be the lack of ongoing sanitation activities. In 8 of the 50 local governments in this study there was more than 20 percent of households using an unimproved latrine or defecating in the open. A common characteristic among these 8local governments is that none had a chairman actively working on sanitation at the time of the study. In addition, 5 of these local governments had no NGOsanitation follow-up program. MAIN POINT - While we are not able to attribute causality between lack of sanitation programming and households using unimproved latrines, a hypothesis emerging is that ongoing sanitation programming is a factor that affects the sustainability of behaviors.
The last factor that I will mention is the lack of access to cash/credit.Of those households that defecate in the open or use an unimproved latrine, 63% of them cited that lack of money was the reason for not building an improved latrine. Also we found of the households who do either own or share a latrine, that only 16% of them knew where to access a loan or financing to build a latrine. MAIN POINT - Low access to credit or financing for households with modest means may be a temporary constraint for those hoping to build a new latrine or repair an existing one, but lack of access to cash and financing is even more of an issue for those households in the two lowest wealth quintiles particularlyfor those who have no latrine and want to gain some basic access.
So in conclusion – our findings indicate sanitation behaviors and facilities have by and large been sustained recognizing that there is some degree of open defecation and use of unimproved latrines in almost all local governments. The key factors that we found to support sustained use of latrines include: a strong enabling environment. This study highlighted the linkages between Bangladesh’s vision, roadmap, political will, and focus on collective outcomes created an enabling environment that allowed for large scale implementation of rural sanitation promotion interventions. This concerted effort energized and mobilized local governments and communities nation wide regardless of programmatic nuances used for implementation.CLICK This mobilization likely help shift social norms around open defecation and increased demand for latrines, CLICKWhich likely prompted the private sector to respond to household needs. It is this active private that continues to provide latrine parts and services that enable most households to sustain latrine use. CLICKThese factors coupled with ongoing sanitation promotion that provide reinforcing messages and support to householdsCLICKall appear to help contribute to sustaining sanitation behaviors.
So when I began this presentation I gave you two reasons why we did this study and one reason why you should be interested. I would like to close on these three points.The first reason that I mentioned why we did this study was to provide insights to the Government of Bangladesh so that they can make informed decisions about their future programming to achieve 100% sanitation coverage.What we found was that the sanitation picture in these local government looks pretty good, but there were still a segment that is defecating in the open and using unimproved latrines, which are largely the poorer households. We know that community mobilization techniques and focus on collective outcomes helps create demand for sanitation; however, it does not appear to be sufficient to ensure that the poorest households sustain access to improved sanitation.So one solution to consider is the application of sanitation marketing which can be used to compliment community mobilization approaches.One component of sanitation marketing is to strengthen the private sector’s ability to offer a range of affordable products and services. A concrete example of this is linking micro-finance institutions to sanitation service providers so that providers can offer credit or payment plans to ease the burden on poor households allowing them acquire improved access to sanitation. And this particular approach has been successfully piloted by WSP in Bangladesh and is now being incorporated into the sanitation component of a planned rural water supply and sanitation loan from the World Bank to the government of the Bangladesh. So the application of sanitation marketing has a lot of potential in Bangladesh, and it will be exciting to watch how things roll out there.
The second reason why carried out this study is that WSP is helping government counterparts scale up rural sanitation programs in various countries, and we wanted to gain insights from Bangladesh on how sustainable have their achievements been and more importantly why so that we could use those insight in our technical assistance to other countries. While this purpose of this study was to identify factors that help sustain sanitation behaviors one of the things I took away and appreciate from this study is that it also documented to some extent the development of the national campaign. For me this was really interesting, because WSP’s theory change to help governments scale up sustainable rural sanitation programming essentially focuses on strengthening the enabling environment which includes: 1) developing sound policy and strategy, 2.) identifying an institutional home for sanitation, 3.) allocating budget for sanitation promotion, 4.) having a programmatic approach, and 5.) doing capacity building. One might say that these things are obviously needed, and my response would be then why do we still have 2.6 billion people without access to improved sanitation.In retrospect, when I look at Bangladesh and see what they put in place to scale up sanitation it is exactly these enabling environment factors. So what I would conjecture is that we wouldn’t even be here talking about social norms, continued programming, and an active private sector if Bangladesh would not have strengthened its enabling environment back around 2003. So my main point is that Bangladesh paints a really nice picture of how these enabling environment factors needed to be addressed up front before scaling up sanitation programming. And once they were in place, Bangladesh also shows you what is possible. So for sanitation practictioners the take away message is to engage your government counterparts and focus on the enabling environment.
And my third and last point is that hopefully this presentation gave you glimpse of why latrine use has been sustain in the majority of households in these local governments; but obviously this presentation was really just a high level overview of the study so I encourage you to download and read the full technical report, which offers many more insights on things such asSharingCleanliness of latrinesSatisfaction levelsPerceived Benefits and many more things as wells.For those of you linked through the webinar hopefully you can download the report from this hyperlink and if not you can go to the WSP website. Also if you want to really understand the development of CLTS and the national campaign in Bangladesh I encourage you to read the chroniciles of CLTS in Bangladesh……
Just to close – this study would not have been possible without the commitment and quality of a great team of consultants and the support from the Government of Bangladesh, its development partners, and my WSP and World Bank colleagues in Bangladesh and here in Washington DC.I would also like that extend my appreciation to those who helped pull together this webinar and session.Thank you.
WSP Long-term Sustainability of Sanitation in Rural Bangladesh study bbb july 21 2010
Long-term Sustainability of Rural Sanitation<br />Findings from a Study in Bangladesh<br />Craig Kullmann<br />1<br />
Overview of Session<br /><ul><li>Study Objectives
Study Objectives<br />3<br />Understand current status of sanitation behaviors and durability of latrines<br />Why households have or have not sustained behaviors and their latrines.<br />Has sanitation programming been sustained and has it helped sustain behaviors and latrines?<br />Have private sector sanitation providers helped sustain behaviors and latrines?<br />
18 Local Gov’t with in-depth Qualitative </li></li></ul><li>6<br />Study Objective 1a: What is the Current Status of Sanitation Behaviors?<br /><ul><li>By Collective Outcomes
By Wealth Quintiles</li></li></ul><li>7<br />Study Objective 1a –What is the Current Status of Sanitation Behaviors?<br />
8<br />Study Objective 1a –What is the Current Status of Sanitation Behaviors?<br />OD<br />Confining Feces<br />
9<br />Study Objective 1a –What is the Current Status of Sanitation Behaviors?<br />Over 80% of the poorest households own or share an improved latrine (n=3,000)<br />
10<br />Study Objective 1b: What is the Durability of Latrines?<br />
11<br />Study Objective 1b– What is the Durability of Latrines?<br />
12<br />Study Objective 1b– What is the Durability of Latrines?<br />
13<br />Exploring Factors Supporting Sustained Outcomes<br />Study Objective 2: Why have households sustained behaviors and their latrines?<br />Study Objective 3: Has sanitation programming been sustained and has it helped sustain behaviors and facilities?<br />Study Objective 4: Have private sector sanitation providers helped sustain behaviors and latrines?<br />
14<br />Study Objectives 2: Why have households sustained behaviors and their latrines?<br />Social Norms Positively Reinforce Latrine Use<br />“The sanitation revolution and the 1971 independence revolution had the same character.” Local Gov’t Chairman<br />“All spots in the village are free of open defecation. Hanging latrines no longer pollute the waterways and people understand that open defecation is a type of social negligence.” Focus Group Discussant<br />
Study Objectives 3 -Has sanitation programming been sustained and has it helped sustain behaviors and facilities?<br />Sanitation Programming has been Sustained and Appears to Help Sustain Latrine Use (n=50)<br />Reminding constituents<br />1/3 Very Active LG<br />1/3 Moderately Active LG<br />1/3 Inactive LG<br />Use ADP funds for sanitation<br />Declaring rules against open defecation<br />Providing latrine parts to poor families<br />15<br />
16<br />Study Objectives 4- Have private sector sanitation providers helped sustain behaviors and latrines?<br />High Access to Parts Suppliers/Masons <br />Access<br />n=2,487<br />Access<br />Access figuresare self-reported based on household survey<br />
17<br />Study Objectives 4- Have private sector sanitation providers helped sustain behaviors and latrines?<br />High Access to Pit Emptying Services<br />No Access<br />Access<br />Access<br />n=2,686<br />Access<br />Access figuresare self-reported based on household survey<br />
18<br />Exploring Factors Working Against Sustained Outcomes<br />Study Objective 2: Why have households not sustained behaviors and their latrines?<br />Study Objective 3: Does lack of sanitation programming effect sustain behaviors and facilities?<br />Study Objective 4: Have private sector sanitation providers helped sustain behaviors and latrines?<br />
19<br />Study Objectives2 - Why have households not sustained behaviors and their latrines?<br />Natural Disasters<br />
20<br />Study Objectives3 - Does lack of sanitation programming effect sustain behaviors and facilities?<br />Lack of Sanitation Programming May Affect Sustained Latrine Use <br />Improved<br /><ul><li>8 out of 50 Local Governments had >20% of households with unimproved latrines/open defecation
5 of the 8 had no follow up sanitation program</li></ul>Un-improved<br />
21<br />Study Objectives 4- Have private sector sanitation providers helped sustain behaviors and latrines?<br />Lack of Access to Cash/Credit<br /><ul><li>63% of households indicated lack of money</li></li></ul><li>22<br />Conclusion About Sustaining Latrine Use<br />Enabling Environment<br />Social Norms<br />Active Private Sector<br />Sanitation Programming<br />Sustained Behaviors<br />
23<br />Program Considerations – Inside of Bangladesh<br />Application of Sanitation Marketing<br /><ul><li>Households that still don’t have basic access
Strengthen private sector to offer affordable range of products and services</li></li></ul><li>24<br />Program Considerations – Outside of Bangladesh<br />
For More Information on …<br />Sharing<br />Cleanliness<br />Satisfaction Levels<br />Perceived Benefits<br />Additional Analysis<br />www.wsp.org/scalingupsanitation<br />Chronicles of CLTS in Bangladesh view at www.bitly.com<br />
Study Team<br />Dr. Laurie Krieger – The Manoff Group (Project Director)<br />Dr. Suzanne Hanchett – Planning Alternatives for Change Consulting (Team Leader)<br />Mohid Khan – Pathway Consulting Services (Deputy Team Leader)<br />Craig Kullmann – Task Manager – WSP <br />Rokeya Ahmed – WSP-Bangladesh<br />Santanu Lahiri, Abdul Motaleb, Mark Ellery, Mansoor Kabeer - WSP Colleagues in Bangladesh<br />Eddy Perez, Jacqueline Devine, Nila Mukherjee, Soma Gosh, and Pete Kolsky, Amy Grossman- WSP and World Bank Colleagues in Washington DC<br />Government of Bangladesh<br />Development Partners in Bangladesh<br />