NB Health Care
It’s Time to WASH Up: Three lessons for developing effective water, sanitation and hygiene interventions
Access to sanitation is recognized as a fundamental human right, but the global community is still far from meeting its 2015 Millennium Development Goal target to halve the proportion of the population without sustainable access to safe drinking water and basic sanitation.
On March 22, we reflected on World Water Day with reminders of grim statistics. Diarrheal disease is the second biggest killer of children under 5 years old globally, and every day approximately 2,000 mothers lose a child to the disease, which is primarily caused by a lack of access to safe toilets and clean water.
Given the extreme need for improved WASH (Water, Sanitation & Hygiene) products and services in low- and middle-income countries, the R4D Market Dynamics team spent the past six months exploring potential opportunities to broaden access to improved WASH interventions in urban India. The team leveraged deep experience in the global health and nutrition sectors along with expertise applying market-shaping approaches to provide insight into assessing market needs and opportunities.
This was R4D’s first engagement in the WASH sector and there isn’t a more appropriate time to highlight some the organization’s preliminary findings and takeaways from its market dynamics work.
First, WASH solutions should ideally be locally tailored to meet the needs of the end user:
To develop, deliver and scale up a new solution in any geography, particularly large markets like India, where each state can feel like its own country, it is critical to first assess the needs and capabilities of the targeted community. This is especially true in the WASH sector, where the ways people go to the bathroom, wash their hands and procure water are deeply embedded in cultural norms and lifestyles, making a one-size-fits-all solution unlikely to be effective on a large scale. Building a successful WASH intervention requires first asking key questions about consumer needs, identifying gaps in the landscape and evaluating consumer behavior and willingness to try new practices.
For example, PATH, a global nonprofit that develops lifesaving health technologies, has an array of household products in its WASH portfolio, including water filters, latrines, clean cook stoves, solar lanterns and hand-washing stations. For each of these interventions, PATH takes stock of the products and practices already in the market to identify needs, gaps and challenges that currently exist. What do current practices look like? Which products are available? How much do they cost? Who is using them and how are they working?
(An urban water spout in India, left. Photo by Ben Brown)
By asking these key questions and taking an inclusive market approach that brings together local experts in manufacturing, marketing, financing, nonprofits and government, PATH has designed improved low-cost water filters for low- and middle-income consumers in multiple countries. Most notably, PATH notes its improved ceramic water pot filters realized highly positive results after an 11-month field trial in Cambodia:
• Outsold the earlier designs 17 to 1 when offered with microfinance loans;
• Use had increased to 43 percent among microfinance members;
• Approximately 90 percent of the original users were still using their ceramic water pot filters;
• Commercial partners recovered all of their costs, allowing them to expand the model without more donor support.
Second, strong service delivery, beyond a technically-sound product or technology, is a key component to success:
It is commonly thought that once everyone has a toilet and a water filter, the water and sanitation problems of a community are solved. However, what happens if a toilet has a leak? What does a household do with all the waste that is collected in its septic tank? How can a person fix or replace a broken water filter? A single product or intervention cannot address all of these challenges at once.
Proper infrastructure along the value chain, ranging from complex underground pipe systems to the simplest of water containers, is required to effectively deliver WASH interventions and ensure sustainable impact. In order to determine where inefficiencies within the existing infrastructure occur, local manufacturing and sourcing capabilities, monitoring and evaluation competencies, and human capital capacity of a targeted community must all be evaluated and built into the design and introduction of any new innovation. In short, not only should engineers develop WASH products hand-in-hand with the users, but they should also collaborate with market-shapers for a holistic approach to delivering sustained impact. In doing so, more innovative service delivery models can be identified and effectively targeted to fill in those critical distribution gaps.
Sanergy is a notable WASH group that incorporates strong service delivery and user-centered design throughout its value chain. Sanergy has built a network of more than 170 high-quality “Fresh Life” branded toilets in the slums of Nairobi by franchising them to local micro-entrepreneurs. Employees collect waste from the toilets daily and deliver it to a central processing facility where the waste is converted into organic fertilizer for farmers. The model ensures marginalized communities have increased access to affordable, improved sanitation facilities while also providing a safe way to treat human waste and capitalize on its reuse value. The company now has more than 8,000 users daily and plans to scale to thousands of toilets serving more than 50,000 low-income customers every day.
Finally, WASH is inextricably linked to other development challenges:
The lack of access to safe sanitation and clean water holds back social and economic development through negative impacts on health, education and livelihoods. Most affected are women and girls, whose physical, economic and social growth are disproportionately hampered by walking long distances to carry heavy buckets of water, and missing school due to bathrooms that are often not gender-segregated. In addition, diarrhea and poor WASH services contributes significantly to malnutrition, stunting and the overall global burden of disease.
Access to WASH improves maternal, newborn and child health in a multitude of ways and has effects that can last for generations. The most effective WASH interventions must take this into account in design and implementation processes in order to serve the most vulnerable populations and address their critical needs and challenges.
World Water Day is a time for the global community to recognize the severe effects poor sanitation and unsafe water have on a large portion of the world’s population (more than 40 percent of the world lacks access to adequate sanitation!) and the extent to which these challenges impact the lives of women and children. Yet these challenges are preventable and treatable – nearly nine out of 10 cases of diarrhea can be prevented, with sufficient WASH interventions.
Through interventions that place an emphasis on the end beneficiary and leverage local private-public expertise in design and delivery, there is potential to dramatically improve not only WASH outcomes, but to also impact the health and economic opportunity outcomes that are so closely linked to this critical sector. In doing so, we can use our resources effectively to tackle this crisis together and create lasting impact for those who need it most.
Ben Brown is a senior program associate at the Results for Development Institute.