The Millennium Development Goals
and
Sustainable, Effective Sanitation
in Africa.
Eddy Perez
WSP
January 2009
Which is more dangerous?
2
The challenge of meeting
the sanitation Goals
3
4
Population without access, rural and urban
Urban 0.6 billion
24%
2.0 billion Rural
76%
5
6
International Year of Sanitation
TheThe International Year of Sanitation
www.wsp.org
Diarrhea disease burden by age
100%
90%
% of Global Burden of Disease
80%
70%
60%
50%
40%
30%
20%
10%
0%
0-4 5-14 15-29 30-44 45-59 60-69 70-79 80+
Years
Source: DCPP2 8
The International Year of Sanitation
Excreta related
desease claims the
lives of over 5,000
children a day –
nearly 1.5 million a
year.
9
www.wsp.org
The International Year of Sanitation
In sub-Saharan Africa,
a baby’s chance of
dying from diarrhea is
more than 500 times
that of a child in the
developed world.
10
www.wsp.org
Fecal contamination is the main source of
diarrhea infections ….
Water supply
Sanitation Fluids Hygiene
Fingers
Feces Food Future
Victim
Flies
Fields/
Floors 11
Sanitation MDG Goal: Halving the Proportion of peope
without sustainable access to Basic Sanitation by 2015
12
13
Additional Child Deaths
from Diarrhea
Source: Dying for the Toilet, WaterAid, 2006 14
Water and Sanitation
Twin Sectors?
Water Sanitation 15
Current World Bank WSS Portfolio
Total current World Bank WSS US$ 14.4 billion
investments
Total World Bank investments US$ 2.5 billion
in Basic Sanitation only:
Percentage of World Bank 17%
investment in Sanitation
16
Underlying Factors of the Sanitation Challenge
Little demand at the household and community level for
improved sanitation
Limited supply of sanitation-related products and services from
both the private and public sectors
Lack of clarity regarding roles and responsibilities within
government, and among the public and private sector,
households, and communities
Nonexistent, unclear, or even counterproductive public policies
that create real constraints to scaling up promising approaches
Lack of credible and useful data regarding costs and lessons
learned from projects and approaches that are reported to be
successful and effective
Inability to scale up the small scale “islands of success.” mostly
implemented by NGOs
Lack of political interest and will
17
What About Sanitation?
“To the people of poor nations, we
pledge to work alongside you to make
your farms flourish and let clean
waters flow; to nourish starved bodies
and feed hungry minds”.
Presidential Inaugural Address
Barack Hussein Obama
18
Sanitation Ladder
Cost
JMP
Pour
Flush
Improved
Not Acceptable Pit
Simple
Pit
Open Defecation Fixed place Defecation
19
Digging Deeper into Africa
Sanitation MDGs
20
Sanitation Ladder Progress in 18 SSA
Countries the last 10 years
1.6%
1.4%
Percentage of country sample population
1.2%
1.0%
0.8%
0.6%
0.4%
0.2%
0.0%
Flush Toilet VIP/Chemical/San Traditional Latrine Open Defecation
-0.2%
Plat
-0.4%
Sample of 18 countries: Benin, Burkina Faso, Cameroon, Chad, Ethiopia, Ghana, Guinea, Kenya, Lesotho, Madagascar, Malawi, Mali, Mozambique, Nigeria,
Rwanda, Senegal, Tanzania, Zambia 21
Averages calculated for each country based on different number of years in the period from 1995 to 2005
Source: AICD DHS/MICS Survey Database, 2007
Gains in access across 18 SSA
Countries by income group
Flush Toilet Im proved Latrines
25%
40% 20%
15%
20% 10%
5%
0%
0%
Q1 Q2 Q3 Q4 Q1
Q5 Q2 Q3 Q4 Q5
1996-2000 2001-2005
1996-2000 2001-2005
Traditional Latrine Open Defecation
80%
60% 50%
40%
20%
0% 0%
Q1 Q2 Q1 Q2
Q3 Q4 Q3
Q5 Q4 Q5
1996-2000 2001-2005 1996-2000 2001-2005
Population weighted averages 22
Source: AICD DHS/MICS Survey Database, 2007
Current access patterns across SSA
across income quintiles
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Q1 Q2 Q3 Q4 Q5
Flush toilet VIP/Chemical/ SANPLAT Traditional latrine Open Defecation
Population weighted averages 23
Source: AICD DHS/MICS Survey Database, 2007
Digging Deeper into Africa
Sanitation MDGs
How does the sanitation challenge
differ across countries in Africa?
Large variation across African
countries in their current patterns
of access to sanitation
24
VIP toilet coverage
35% by country
29%
30% 27%
25%
25% 23%22%
21%21%
20% 18%
15%
14%13%13%
15% 12%
11%
10%
10% 8%
4% 4%
5% 3% 3% 3% 2% 2%
2% 2% 1% 1%
0% 0%
0%
Co k ina F s
R
C
o
ad
nya
ia
(Br s o
dan
ica
Les n
er
a
t e d nin
ana
li
a
a
Ma a
ire
n
a
a)
ia
we
Tan nia
Zam e
Eth wi
ia
ro
ot h
a nd
bi
and
bo
Mo Guine
CA
DR
Ma
eri
r oo
u
iop
mib
Nig
azz
z an
Ch
a
la
' Ivo
biq
A fr
mo
bab
Be
ta
Ke
Su
Gh
Ga
Nig
me
Ug
Rw
uri
Na
za m
Co
uth
Zim
Ca
Ma
ngo
So
r
Co
Bu
Population weighted averages, latest available year 25
Source: AICD DHS/MICS Survey Database, 2007
Traditional latrine coverage
by country
90%
81% 80% 79%
80% 76% 75%
70% 67%
70% 66%64%
62%
59% 59% 58%
60% 53% 51%
48%
50% 44%
41% 39%
40% 35% 34% 33%
31%
30% 24%
20% 15% 15%
10%
8% 7%
10%
0%
Br os
Co R C
Nig R
t ho
Na s o
ad
a
uth opia
er
mb n
ica
ia
Zim e nin
nz a
li
d' Iv a
n
da
a
me ia
a)
Eth re
e
rk i bwe
ia
bia
l
ia
i
ga
law
ny
d
CA
Ma
an
o
ine
iqu
r oo
mb
Nig
er
r
an
azz
tan
oi
Fa
an
Ch
Mo Gab
an
D
mo
A fr
so
mi
ne
Ke
Gh
i
ba
B
Ma
Gu
Za
Ug
Rw
uri
na
Le
Se
Ta
o(
za
Ca
Ma
te
So
Co
ng
Bu
Co
Population weighted averages, latest available year 26
Source: AICD DHS/MICS Survey Database, 2007
Open defecation
90%
80%
79% by country
72%70%
68%
70%
62%
60% 57%
49%
50% 47%45%
43%
40% 35%
28%28%27%
30% 25%25%
22%21%
18%
20% 15%14%14%13%12%
10%
10% 7%
3% 2%
0%
0%
C
ya
na
d
in
an
nda
on
er
ia
Mau bia
ia
nea
eria
i
a
l
aso
a
a wi
bia
nia
Cam z a)
o
on
s
Mal
ire
we
ega
ue
DR
Ch a
and
fric
iop
oth
Ben
zan
oro
Nig
Ken
G ha
Sud
G ab
i
'Ivo
Zam
biq
az
ero
rita
Ug a
Nam
bab
Mal
G ui
Nig
aF
Sen
th A
Eth
Les
Rw
Co m
Tan
(Br
za m
ed
kin
Zim
Sou
go
Co t
Bu r
Mo
Co n
Population weighted averages, latest available year 27
Source: AICD DHS/MICS Survey Database, 2007
How does the sanitation challenge
differ across countries?
Four country groups emerge
- Countries dominated by open defecation
- Countries dominated by traditional latrines
- Countries where improved latrines are on the
rise
- Countries where both flush and traditional
latrines are increasing
Policy implications differ substantially
28
Prevalence of open defecation
Benin 10 0 %
Burkina Faso 80%
Chad 60%
Ethiopia 40%
Niger 20%
0%
F lush T o ilet
V IP/ San
Plat / C hemical T r ad it io nal
lat r ine N o f acilit y
Key policy challenge is large scale behavior change at first rung of the
ladder
Population weighted averages, latest available year 29
Source: AICD DHS/MICS Survey Database, 2007
Prevalence of traditional latrines
CAR Mauritania
Cote d’Ivoire Mozambique
Congo (Brazza) Namibia
10 0 %
DRC Nigeria
80%
Guinea Sudan
60%
Kenya Tanzania
40%
Malawi Uganda
20%
Mali Zambia
0%
F lush T o ilet
V IP/ San
Plat / C hemical T r ad it io nal
lat r ine N o f acilit y
Key policy challenge is how to finance upgrading of traditional
latrines
Population weighted averages, latest available year 30
Source: AICD DHS/MICS Survey Database, 2007
Rising improved latrines
Cameroon
Comoros
60%
Gabon
Ghana 40%
Lesotho 20%
Rwanda 0%
Flush Toilet
VIP/San
Plat/Chem ical Traditional
latrine No facility
Countries with lessons to share on how to expand access to improved
latrines
Population weighted averages, latest available year 31
Source: AICD DHS/MICS Survey Database, 2007
Flush toilet and Traditional Latrine
but missing Improved Latrine
100%
Senegal
South Africa 50%
Zimbabwe
0%
Flush Toilet
VIP/San
Traditional
Plat/Chemical No facility
latrine
Key issue is to expand the middle ground and bridge the gap between
disparate groups
Population weighted averages, latest available year 32
Source: AICD DHS/MICS Survey Database, 2007
Moving from Open Defecation to the bottom rung of
the Sanitation Ladder during the last 10 years
Ethiopia
4%
Annualized change in coverage
3%
2%
from 1995 to 2005
1%
0%
F l ush t o i l et V i p / S an T r ad i t i o nal O p en
-1% P l at / C hemi cal l at r i ne d ef ecat i o n
-2%
-3%
-4%
-5%
Population weighted averages
33
Source: AICD DHS/MICS Survey Database, 2007
Moving Up the Sanitation Ladder to the second
rung in the last 10 years
Burkina Faso
5%
Annualized change in coverage
4%
3%
from 1995 to 2005
2%
1%
0%
F l ush t o i l et V i p / San T r ad i t i o nal O p en
-1% Pl at / C hemi cal l at r i ne d ef ecat i o n
-2%
-3%
-4%
Rwanda
Annualized change in coverage
6%
4%
from 1995 to 2005
2%
0%
F l ush t o i l et V i p / San T r ad i t i o nal O p en
Pl at / C hemi cal l at r i ne d ef ecat i o n
-2%
-4%
34
Population weighted averages -6%
Source: AICD DHS/MICS Survey Database, 2007
Moving up to the third rung of the latter over the
last 10 years
Senegal
4%
Annualized change in coverage
3%
from 1995 to 2005
2%
1%
0%
Flush toilet Vip/San Traditional Open
-1% Plat/Chem ical latrine defecation
-2%
Population weighted averages
35
Source: AICD DHS/MICS Survey Database, 2007
36
Latrines
Infrastructure Pour flush toilets Software Sanitation promotion
On-site septic systems Sanitation marketing
Simplified sewer collection Hygiene promotion
Conventional sewers
Community organization
Monitoring & Evaluation
Sanitation
Sustainable, Effective and Large Scale
Political leadership
Enabling National Sanitation policies
Environments
for Scaling Up Sector reform (roles and responsibilities)
Institutional strengthening
Human resource capacity building
Financing sources and strategies 37
Fundamental Components for large Scale
Sustainable Sanitation Programs
Components of
a Sanitation
program E n ab ling en viro n m ent
• P olic y
• R eg ulations
•Ins titutions – r oles & r es ps .
• c o-or dination m ec hanis m s
• financ e
•s t r ategies and guidelines
Im p ro ve s up p ly
Inc re as e D e m and • loc al advoc ac y
• advoc ac y
•loc al c apac it y building
• s anit ation awarenes s rais ing
• funding m ec hanis m s
• hygiene pr om otion
• loc al s tr ategies , ac t ion plans
• s anit ation m arketing
& budget s
• pr ivat e s ec t or & NGOs
38
Promsing Approaches in
Rural Sanitation
Community-led Total Sanitation Marketing
Sanitation (CLTS) drawing in private sector
showing never-before- enterprise and large-
seen rate of access scale household
gains in >30 countries investment levels
Potentially, these approaches could answer the
challenge of the Sanitation MDGs?
39
Sanitation Ladder
Cost
JMP
Pour
Flush
Improved
Not Acceptable Pit
Simple
Pit
Open Defecation Fixed place Defecation
40
Policy, institutional and financial environment that enable
PROGRAMS to create mutually self-sustaining growth of
DEMAND for, and SUPPLY of improved sanitation
POLICY,
STRATEGY &
DIRECTION
MONITORING & INSTITUTIONAL
EVALUATION ARRANGEMENTS
COST- Programatic
PROGRAM
EFFECTIVE ENABLING
METHODOLOGY
IMPLEMENTATION ENVIRONMENT
IMPLEMENTATIO
FINANCING
N CAPACITY
AVAILABILITY
OF PRODUCTS
AND TOOLS
41
Action Plan for Strengthening
Enabling Environment in Tanzania
Short-term (1-6 months)
Develop cost-effective implementation program
Build availability of products and tools
Launch policy development process
Medium-Term (7-12 months)
Strengthen institutional arrangements a LGA level (stronger
implementation team)
Develop National Rural Sanitation Plan
Long-term (13-36 months)
Develop robust national M+E system, stronger data
collection
Develop national guidelines for implementing rural
42
sanitation program.
Measuring EE improvements
planned for 2008-10 in Tanzania
Enabling Environment Assessment TSSM
Policy, Strategy and Direction
6
5
Monitoring and Evaluation Institutional Arrangements
4
3
2
1
Cost-effective Implementation 0 Program Methodology
Financing Implementation Capacity
Availability of Products and Tools
2010 2009 2008 2007 43
Summary: Key Elements of Effective
Approaches to Addressing Sanitation
Create real demand for improved sanitation
Improve the availability of supply for sanitation options that
respond to the demand
Create effective financing mechanisms including subsidies
for the poor
Implement effective hygiene behavior change interventions
Develop large scale national/regional programmatic
approaches
Help to create an enabling environment for sustainability at
national and local government levels
Develop effective M&E systems
44
The “TWIN” WSS Sectors?
Which One is Sanitation?
45
Thank You
For more information:
www.wsp.org
Eddy Perez
46