The Millennium Development Goals and Sustainable, Effective Sanitation in Africa. Eddy Perez WSP January 2009

The Millennium Development Goals

and

Sustainable, Effective Sanitation

in Africa.

Eddy PerezWSP

January 2009

2

Which is more dangerous?

3

Source: UN Millennium Project Task Force on Water and Sanitation, Final Report. Health, Dignity, and Development: What Will It Take?, 2005,

The challenge of meeting the sanitation Goals

4

5

Population without access, rural and urban

0.6 billion

2.0 billion

6

Th

e I

nte

rnati

on

al

Year

of

San

itati

on

Th

e I

nte

rnati

on

al

Year

of

San

itati

on

www.wsp.org

8

Diarrhea disease burden by age

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0-4 5-14 15-29 30-44 45-59 60-69 70-79 80+

Years

% o

f G

lob

al B

urd

en o

f D

isea

se

Source: DCPP2

9

Excreta related desease claims the lives of over 5,000 children a day – nearly 1.5 million a year.

www.wsp.org

Th

e I

nte

rnati

on

al

Year

of

San

itati

on

10

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.

www.wsp.org

Th

e I

nte

rnati

on

al

Year

of

San

itati

on

11

Fecal contamination is the main source of diarrhea infections ….

Feces Future Victim

Fluids

Fingers

Flies

Fields/Floors

Sanitation

Food

Hygiene

Water supply

12

Sanitation MDG Goal: Halving the Proportion of peope without sustainable access to Basic Sanitation by 2015

13

14

Additional Child Deaths from Diarrhea

Source: Dying for the Toilet, WaterAid, 2006

15

Water and SanitationTwin Sectors?

Water Sanitation

16

Current World Bank WSS Portfolio

Total current World Bank WSS investments

US$ 14.4 billion

Total World Bank investments in Basic Sanitation only:

US$ 2.5 billion

Percentage of World Bank investment in Sanitation

17%

17

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

18

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

19

Open Defecation Fixed place Defecation

Cost

Simple Pit

Improved Pit

Pour Flush

Not Acceptable

Sanitation Ladder

JMP

20

Digging Deeper into Africa Sanitation MDGs

21

Sanitation Ladder Progress in 18 SSA Countries the last 10 years

Sample of 18 countries: Benin, Burkina Faso, Cameroon, Chad, Ethiopia, Ghana, Guinea, Kenya, Lesotho, Madagascar, Malawi, Mali, Mozambique, Nigeria, Rwanda, Senegal, Tanzania, ZambiaAverages calculated for each country based on different number of years in the period from 1995 to 2005Source: AICD DHS/MICS Survey Database, 2007

-0.4%

-0.2%

0.0%

0.2%

0.4%

0.6%

0.8%

1.0%

1.2%

1.4%

1.6%

Flush Toilet VIP/Chemical/SanPlat

Traditional Latrine Open Defecation

Pe

rce

nta

ge

of

co

un

try

sa

mp

le p

op

ula

tio

n

22

Gains in access across 18 SSA Countries by income group

Population weighted averagesSource: AICD DHS/MICS Survey Database, 2007

Q1 Q2 Q3 Q4 Q5

0%

50%

Open Defecation

1996-2000 2001-2005

Q1 Q2 Q3 Q4 Q5

0%

5%

10%

15%

20%

25%

Improved Latrines

1996-2000 2001-2005

Q1 Q2 Q3 Q4 Q5

0%

20%

40%

60%

80%

Traditional Latrine

1996-2000 2001-2005

Q1 Q2 Q3 Q4 Q5

0%

20%

40%

Flush Toilet

1996-2000 2001-2005

23

Current access patterns across SSA across income quintiles

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Q1 Q2 Q3 Q4 Q5

Flush toilet VIP/Chemical/ SANPLAT Traditional latrine Open Defecation


24

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

25

VIP toilet coverage by country

Population weighted averages, latest available yearSource: AICD DHS/MICS Survey Database, 2007

29%27%

25%23%22%

21%21%

18%

15%14%13%13%

12%11%10%

8%

4% 4% 3% 3% 3% 2% 2% 2% 2% 1% 1% 0% 0%0%

5%

10%

15%

20%

25%

30%

35%

Rw

and

aC

am

eroo

nZ

imb

abw

eG

han

aG

abo

nL

eso

tho

Co

mo

ros

Bu

rkin

a F

aso

Co

ng

o (

Bra

zza)

Be

nin

Co

te d

'Ivo

ire

CA

RN

iger

Mal

iD

RC

Ke

nya

Mau

rita

nia

Tan

zan

iaN

iger

iaN

am

ibia

Ch

ad

Ug

an

daG

uin

eaM

oza

mb

iqu

eZ

amb

iaM

alaw

iE

thio

pia

So

uth

Afr

ica

Su

dan

26

Traditional latrine coverage by country


81%80%79%76%75%

70%67%66%64%62%59%59%58%

53%51%48%

44%41%39%

35%34%33%31%

24%

15%15%10% 8% 7%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

27

Open defecation by country


79%

72%70%68%62%

57%

49%47%45%43%

35%

28%28%27%25%25%

22%21%18%

15%14%14%13%12%10%7%

3% 2% 0%0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

28

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

29

Prevalence of open defecation

Benin Burkina Faso Chad Ethiopia Niger

Flush ToiletVIP/San

Plat/Chemical Traditionallatrine No facility

0%

20%

40%

60%

80%

100%


Key policy challenge is large scale behavior change at first rung of the ladder

30

Prevalence of traditional latrines

CAR Cote d’Ivoire Congo (Brazza) DRC Guinea Kenya Malawi Mali

Flush ToiletVIP/San


0%

20%

40%

60%

80%

100%


Mauritania Mozambique Namibia Nigeria Sudan Tanzania Uganda Zambia

Key policy challenge is how to finance upgrading of traditional latrines

31

Rising improved latrines

Cameroon Comoros Gabon Ghana Lesotho Rwanda

Flush ToiletVIP/San


0%

20%

40%

60%


Countries with lessons to share on how to expand access to improved latrines

32

Flush toilet and Traditional Latrine but missing Improved Latrine

Senegal South Africa Zimbabwe

Flush ToiletVIP/San


0%

50%

100%


Key issue is to expand the middle ground and bridge the gap between disparate groups

33

Moving from Open Defecation to the bottom rung of the Sanitation Ladder during the last 10 years


Mozambique

-3%

-2%

-2%

-1%

-1%

0%

1%

1%

2%

2%

3%

Flush toilet Vip/SanPlat/Chemical

Traditionallatrine

Opendefecation

Ethiopia

-5%

-4%

-3%

-2%

-1%

0%

1%

2%

3%

4%


Traditionallatrine

Opendefecation

An

nu

alized

ch

an

ge in

co

vera

ge

fro

m 1

995 t

o 2

005

34Population weighted averagesSource: AICD DHS/MICS Survey Database, 2007

Moving Up the Sanitation Ladder to the second rung in the last 10 years

Burkina Faso

-4%

-3%

-2%

-1%

0%

1%

2%

3%

4%

5%


Traditionallatrine

Opendefecation

An

nu

alized

ch

an

ge in

co

vera

ge

fro

m 1

995 t

o 2

005

Rwanda

-6%

-4%

-2%

0%

2%

4%

6%


Traditionallatrine

Opendefecation

An

nu

alized

ch

an

ge in

co

vera

ge

fro

m 1

995 t

o 2

005

35

Moving up to the third rung of the latter over the last 10 years

Senegal

-2%

-1%

0%

1%

2%

3%

4%


Traditionallatrine

Opendefecation

An

nu

alized

ch

an

ge in

co

vera

ge

fro

m 1

995 t

o 2

005


36

37

Sanitation promotion

Sanitation marketing

Hygiene promotion

Community organization

Monitoring & Evaluation

Infrastructure

Political leadership

National Sanitation policies

Sector reform (roles and responsibilities)

Institutional strengthening

Human resource capacity building

Financing sources and strategies

Software

Enabling Environments for Scaling Up

SanitationSustainable, Effective and Large Scale

Latrines

Pour flush toilets

On-site septic systems

Simplified sewer collection

Conventional sewers

38

Enabling environment•Policy

•Regulations •Institutions – roles & resps.•co-ordination mechanisms

•finance •strategies and guidelines

Increase Demand•advocacy

•sanitation awareness raising•hygiene promotion

•sanitation marketing

Improve supply•local advocacy

•local capacity building•funding mechanisms

•local strategies, action plans & budgets

• private sector & NGOs

Components of a Sanitation program

Fundamental Components for large Scale Sustainable Sanitation Programs

39

Promsing Approaches in Rural Sanitation

Community-led Total Sanitation (CLTS) showing

never-before-seen rate of access gains

in >30 countries

Sanitation Marketing drawing

in private sector enterprise and large-

scale household investment levels

Potentially, these approaches could answer the challenge of the Sanitation MDGs?

40

Open Defecation Fixed place Defecation

Cost

Simple Pit

Improved Pit

Pour Flush

Not Acceptable

Sanitation Ladder

JMP

41

MONITORING & EVALUATION

COST-EFFECTIVE

IMPLEMENTATION

FINANCING

AVAILABILITY OF PRODUCTS

AND TOOLS

IMPLEMENTATION CAPACITY

PROGRAM METHODOLOGY

INSTITUTIONAL ARRANGEMENTS

POLICY, STRATEGY & DIRECTION

ProgramaticENABLING

ENVIRONMENT

Policy, institutional and financial environment that enable PROGRAMS to create mutually self-sustaining growth of

DEMAND for, and SUPPLY of improved sanitation

42

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 sanitation

program.

Action Plan for Strengthening Enabling Environment in Tanzania

43

Measuring EE improvements planned for 2008-10 in Tanzania

Enabling Environment Assessment TSSM

0

1

2

3

4

5

6

Policy, Strategy and Direction

Institutional Arrangements

Program Methodology

Implementation Capacity

Availability of Products and Tools

Financing

Cost-effective Implementation

Monitoring and Evaluation

2010 2009 2008 2007

44

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

45

The “TWIN” WSS Sectors?

Which One is Sanitation?

46

Thank You

For more information:

www.wsp.org

Eddy Perez

Documents

The Millennium Development Goals and Sustainable, Effective Sanitation in Africa. Eddy Perez WSP January 2009