The Water and Sanitation Program - Environmental Health at USAID

The Water and Sanitation ProgramMedium-Term Strategic Framework on Sanitation

DRAFTTable of Contents1. INTRODUCTION..............................................................................................................................................12. SANITATION – TRENDS AND CHALLENGES ..........................................................................................12.1 GLOBAL SANITATION COVERAGE AND THE MDGS .................................................................................12.2 GLOBAL TRENDS AFFECTING THE FUTURE OF SANITATION SERVICES..................................................2• Rising Income Inequalities. ........................................................................................................................3• Urbanization...............................................................................................................................................3• Decentralization. ........................................................................................................................................4• Low Income Countries and Changing Aid Architecture.............................................................................42.3 SPECIFIC CHALLENGES OF THE SANITATION SECTOR.............................................................................5• Poor attention given to sanitation. .............................................................................................................5• The cost of inaction. ...................................................................................................................................5• Enormous financing needs..........................................................................................................................6• Need for more sustainable solutions...........................................................................................................63. EXPERIENCES OF WSP IN SANITATION..................................................................................................73.1 EVOLUTION OF AREAS OF FOCUS IN SANITATION....................................................................................73.2 RECENT SUCCESSFUL WSP EXPERIENCES...............................................................................................8• Total Sanitation Campaign (Bangladesh, Pakistan, India and Indonesia).................................................8• Sanitation as a Business (Peru)..................................................................................................................9• City Sanitation Strategy (Indonesia). .........................................................................................................9• Sanitation Financing for the Poor (Burkina Faso).....................................................................................9• Slum Sanitation Program (India). ............................................................................................................10• Development and Scale up of New Sanitation Technologies (Latin America). ........................................10• Sanitation MDG Roadmap (Ethiopia, Latin America, East Asia). ...........................................................10• Sanitation Partnerships and Advocacy (all regions). ...............................................................................104. WSP STRATEGIC RESPONSES TO THE SANITATION CHALLENGE ...................................................114.1 WSP AND SANITATION IN THE MEDIUM TERM ......................................................................................11• WSP as an Active Partner of the International Year of Sanitation and Beyond.......................................11• Implementation of Sanitation Roadmaps..................................................................................................14• Scaling up Change at Local Level. ...........................................................................................................154.2 KEY THEMATIC AREAS ...........................................................................................................................15• Behavior Change and Demand for Sanitation..........................................................................................15• Leveraging Financial Resources. .............................................................................................................16• Improved Service Levels...........................................................................................................................18• Improved Governance. .............................................................................................................................20• Programmatic Approaches in Sanitation. ................................................................................................22• Monitoring and Evaluation. .....................................................................................................................23• Cross-Sectoral Linkages...........................................................................................................................24Areas where WSP will be less active..................................................................................................................254.3 IMPLEMENTING THE SANITATION MEDIUM-TERM STRATEGIC FRAMEWORK.....................................25• Strengthen Sanitation Organizational Capacity.......................................................................................25• Contribute to Sanitation Outcome Indicators...........................................................................................26• Build New and Strengthen Existing Partnerships.....................................................................................27• Strengthen Communications and Knowledge Management. ....................................................................29

DRAFTEXECUTIVE SUMMARYThis document provides a medium-term strategy for WSP’s sanitation program. With the targetdate for achieving the Millennium Development Goals (MDG) fast approaching, severalmonitoring reports show that sanitation targets are at risk. The proposed strategy responds to thisurgent challenge, by:Identifying Trends and Challenges. In developing this strategy, one factor WSP examined wasglobal trends that affect the way sanitation services are planned and provided: Rising IncomeInequalities; Urbanization; Decentralization; Low Income Countries and Changing AidArchitecture.In addition to global trends, the sanitation sector has specific challenges, which must beconsidered, including: Poor attention given to sanitation; Cost of inaction; Enormous financingneeds; Need for more sustainable solutions.Providing WSP Strategic Responses to the Sanitation Challenge. Building on the experiencesgained, considering the trends and challenges, and in line with WSP’s Global Strategy FY2009-2018 Going to Scale, WSP’s strategy for sanitation will focus on advocacy efforts to draw thenecessary attention and action for sanitation; monitor progress; and increase understanding onhow to do it right. For the medium-term framework, this means particular emphasis on:WSP as an Active Partner of the UN International Year of Sanitation and Beyond -- The UNresolution has galvanized the international community to do more towards meeting the mainobjectives of the International Year of Sanitation, in accordance with the IYS Action Plan:• Increase awareness and commitment;• Mobilize alliances and secure real commitments;• Encourage demand-driven, sustainable solutions;• Secure increased financing;• Develop and promote policies and strategies;• Develop and strengthen institutional and human capacity;• Promote and capture learning.Supporting Implementation of Sanitation Roadmaps – It is expected that by 2012, an increasednumber of countries will be on track to achieve the sanitation MDG target by 2015, or if not ontrack, they will have national and local policies that will provide an implementation plan.Scaling up Change at Local Level – The Total Sanitation Campaign, the Public-Private HandWashing Initiative as well as the various sanitation marketing experiences in which WSP isinvolved have clearly shown the importance of the responsibility of households in bringing aboutchange in sanitation and hygiene practices.Implementing the Sanitation Medium-Term Strategic Framework. WSP plans to deliver itsstrategy using a combination of strong country and regional presence, with global expertise and a

DRAFTcomprehensive partnership strategy with other sector stakeholders. For the medium-termframework, this means particular emphasis on:• Strengthen Sanitation Organizational Capacity – Dedicated management attentionto sanitation; identification of sanitation focal points for each region; clear matrix ofresponsibilities for support to WSP country teams in their sanitation activities;continued support and strengthening of the Sanitation and Hygiene Global PracticeTeam (GPT).• Contribute to Sanitation Outcome Indicators – Support partner countries to achieveoutcomes and trends such as, MDG targets, total sanitation, financial rewards forperformance in the delivery of improved sanitation results, enhanced financialallocation systems and improved service levels.• Build New and Strengthen Existing Partnerships – Partnerships that are mutuallysupportive, measurable with clearly agreed-upon objectives, formalized in thesimplest possible way and a commitment to mutual understanding and continualadjustment to sustain partnerships.• Strengthen Communications and Knowledge Management -- Better understand theinformation needs and preferences of WSP’s target audience for sanitation;institutionalize quality for improved communication and KM sanitation outputs;Improve information sharing among WSP staff and key stakeholders in the area ofsanitation. For government officials and sectoral decision makers, WSP’s field-basedcommunication activities will work to: complement and support WSP technicalefforts in the area of sanitation; provide opportunities for effective dialogue andexchange of information and best practices; and position WSP as sector advisor andknowledge center in the area of sanitation.ii

DRAFT1. IntroductionThis document provides a medium-term strategy for WSP’s sanitation program, under the overalloperational framework and directions of the Global Strategy which will be presented to the WSPCouncil in June, 2008. It is the first in a series of documents to be prepared on sub-sectors ofcritical importance for WSP and its partners. Documents to follow are expected to includeMonitoring and Evaluation (including sector information systems and related activities at thecountry level), the role of the domestic private sector in the provision of water and sanitationservices, hygiene, and support to harmonization in the water and sanitation sector.The area of focus of this document is sanitation, but it is understood that there are strong linkagesto other medium-term sub-sectoral frameworks, especially hygiene. However, we consider thatthe issue of hygiene practices requires a separate document to ensure it receives adequateanalysis and evaluation and it is not subsumed into sanitation where it generally looses visibilityand attention. It is recognized that hygiene programs are an integral part of sanitationinterventions.2. Sanitation – Trends and Challenges2.1 Global Sanitation Coverage and the MDGsAccording to the Join Monitoring Program (JMP), an estimated 2.5 billion people worldwide stillremain without proper access to basic sanitation and thereby lack protection against preventablediseases, which claim thousands of lives every day, primarily of children under the age of five.Of these 2.5 billion, 2 billion live in rural areas. Seventy percent of those unserved live in Eastand Southern Asia, 20% in Africa, and 10% in Latin America. Figure 2.1 shows the countrieswith the largest unserved populations with improved sanitation.

DRAFTFigure 2.1: Countries with the largest unserved population with improved sanitationIndiaChinaIndonesiaNigeriaBangladeshPakistanEthiopiaVietnamBrazilCongo DRMexicoSudanPhillipinesAfghanistanRussiaNepalMozambiqueYemenMyanmarTurkeyMoroccoCambodiaMadagascarBurkina FasoRomaniaIranPeruNigerCote D'IvoireVenezuela75756965474436232221211918141413121212111111111010108104735725- 100 200 300 400 500 600 700 800This year marks the halfway point in the effort to achieve the Millennium Development Goals(MDGs) by 2015. The World Bank’s Global Monitoring Report’s assessment of the MDGs atmidpoint presents a mixed picture. Although the poverty goal is likely to be met at the globallevel, thanks to a remarkable surge in global economic growth over the past decade, there areserious shortfalls in fighting critical MDGs in the areas of hunger and malnutrition. Lack ofadequate sanitation and its direct implications on children diarrhea has a major implication onmalnutrition. Reducing malnutrition is essential to success on a number of other MDGs whichare unlikely to be met, including maternal health, infant mortality and education.The JMP reports that access to sanitation has improved from 49% to 59% between 1990 and2004, but absolute numbers of unserved population have not changed much due to populationgrowth. To meet the MDG sanitation target by 2015, over 1 billion more people need to gainaccess. However, at the current rate of progress, MDG Target 10 on sanitation will not bereached before 2026. Many countries are making good progress, with half of the most populousdeveloping countries on track to reach the MDG sanitation target. Regions like Sub-SaharanAfrica are lagging behind, though some countries are making substantial progress. With currenttrends, in 2015 Sub-Saharan Africa will have 91 million more unserved than in 2004.2.2 Global Trends Affecting the Future of Sanitation ServicesIn addition to the above sanitation coverage figures, there are global trends that affect the waysanitation services are planned and provided:2

DRAFT• Rising Income Inequalities. The World Bank’s 2008 Global Monitoring Report alsohighlights that although high growth rates have helped reduce global poverty, they have beenaccompanied by rising income inequality in many developing countries. A recent study byInternational Monetary Fund (IMF) staff shows that since the beginning of the 1980s, percapita incomes rose in most countries, making most people in developing countries better off.However, income inequality within countries also increased in most cases, and this isparticularly important for sanitation, where the disparity in service levels between the highestand lowest quintile of the population is 1 to 4, as shown in the figure below.Figure 2.2Sanitation and income80706050% 4030201007549322617Poorest 2nd 3rd 4th Richest• Urbanization. Urbanization is accelerating in the developing world. Rapidly urbanizingeconomies in the developing world (Africa’s urban population quadrupled between 1971 and2001, and Asia’s is expected to double by 2030) has fueled growth, but has also beenaccompanied by increasing spatial disparities and changes in the location and nature of thedemand for infrastructure services. More than half the world's population now lives in cities,and this trend will intensify. The urban population is projected to grow to 4.9 billion by 2030,and the rural population to decline by some 30 million. Most of this urban growth will takeplace in developing countries. For example, urban populations of Africa and Asia areexpected to double by 2030, while in the developing world as a whole a very substantialincrease of 25% is projected over the same period. The speed and magnitude of thisdemographic transition is unprecedented. As indicated by the JMP, the projected increase inpopulation, under a business as usual scenario will increase the urban coverage rates from80% in 2004 to only 82% in 2015. This increase translates into 81 million more people inurban areas in 2015 to be added to the 611 million without access in 2014.An area of particular concern for sanitation is the explosive growth of small towns. It isexpected that about 75% of the population growth over the next 15 years will be in cities ofless than 5 million inhabitants, with over 50% in cities under 1 million. This trend willincrease the demand for sanitation infrastructure services in many places where such servicesare already in short supply and of poor quality, and where the institutional and financialcapacity to provide them is weak.3

DRAFTFigure 2.380 Slum Dwellers as % Urban Population707260505840%30203633 3228 28241006 6A second area of special concern is the rapid growth of slums, as illustrated in Figure 2.3from UN-Habitat showing the proportion of urban population that will live in slums by 2020.Although the sample size of the JMP data does not allow for a robust estimate of thesanitation coverage levels in slums, it is clearly much lower than for the rest of the urbanpopulation. High density and inadequate urban planning makes the provision of sanitationservices in slums a particularly difficult challenge that is growing in importance.• Decentralization. With increasing urbanization, the economic and political clout of citiesand other sub-national tiers of governments has increased and decentralization of serviceprovision and policy making is following suit, shifting to cities many responsibilitiespreviously the purview of central government. A major common problem is that manylocalities lack the financial, managerial and administrative capacity to provide the servicesand amenities demanded by households and enterprises. Urban poverty is a pressing concernand is often coinciding with greater decentralization, placing increasing responsibilities onlocal government for infrastructure and other basic services. This puts a premium onimproved management of municipal infrastructure.• Low Income Countries and Changing Aid Architecture. Since the late 1990s, there hasbeen a shift of official development assistance (ODA) out of infrastructure, due in part by theexpectation that private investment in infrastructure in developing countries would increasesignificantly. In recent years, low income countries have received less ODA for coredevelopment programs than they did on average during the early 1990s; as a result thecombined share of infrastructure and production dropped from 59% to 38% between 2001and 2004 1 . There appears to be a small change in trend in the last few years but it is too earlyto indicate a return to pre-1990 levels.1 IDA 15, Aid Architecture: An Overview of the Main Trends in Official Development Assistance Flows, February2007.4

DRAFTIn addition to the decline in ODA for infrastructure (including sanitation), two otherproblems affect low-income countries: large number of donors and lack of harmonizedapproaches. The number of bilateral and multilateral agencies which interact with recipientcountries has grown enormously. For instance, the average number of donors per countryrose from about 12 in the 1960s to about 33 in the 2001-2005 period. Furthermore, there arecurrently over 230 international organizations, funds, and programs. This is accompanied bysignificant earmarking of aid resources for specific uses or for special-purpose organizations,including global programs or “vertical” funds. Earmarking of ODA is still common in manybilateral assistance programs.At the same time, a new trend that has emerged is the assistance of Middle Income Countriesto poorer countries, although their focus has been mostly in energy, telecoms, and transport. 2China’s financing for African infrastructure is estimated to have exceeded $4 billion in 2006,a level comparable in scale to that of all OECD-DAC members. The Arab developmentfunds have been contributing around $500 million per year to African infrastructuredevelopment, particularly in the road sector. These new donors offer an opportunity to bringadditional resources to the sanitation sector, but harmonized approaches will be required tomaximize the long-term development impact of aid.2.3 Specific Challenges of the Sanitation SectorIn addition to the challenges described in the sections above, the sanitation sector has specificfeatures that make it most challenging among other infrastructure sectors. Some of these specificchallenges include:• Poor attention given to sanitation. Demand from users for better sanitation services is muchless than for other infrastructure services such as water supply, energy and roads. As aconsequence, the level of political attention to sanitation is much lower, with few exceptionsthat require further analysis of its political economy dimension. Sanitation, as opposed toother infrastructure sector, suffers from fragmented administrative responsibilities amongministries and government agencies (ministries and agencies of water supply, environment,public health, and local government are, to some degree, responsible for sanitation, as well asmunicipalities and other sub-national governments). In addition, sanitation is viewed bygovernment as a private household issue, as opposed to most other infrastructure services.Sanitation arouses deep feelings and attitudes of disgust and is not a topic that is discussedopenly in public in many cultures.• The cost of inaction. The lack of sanitation causes profound economic, health and socialimpacts, as illustrated in numerous studies that will not be repeated in detail in this strategicdocument. Diarrheal diseases have the largest contribution to the environmental burden ofdisease for children ages 0-14. Globally, about 3,900 children die everyday from diseasesassociated with lack of access to basic sanitation and unsafe water supply. However, theeffective use of oral rehydration therapy (ORT) has meant that deaths from diarrhea havegone done substantially but not the morbidity associated with it and the malnutrition effects.2 Schur, M., von Klaudy, S., Dellacha, G., 2006, The Role of Developing Country Firms in Infrastructure: A NewClass of Investors Emerges, In: PPIAF Publication, No. 3, April 2006.5

DRAFTThe economic cost of inaction on sanitation services goes beyond health and includesimpacts on water resources, land use, lost time, and tourism. A recent study by WSP hasestimated in four East Asian countries that the economic costs associated with inadequatesanitation range from 1.3% to as high as 7.2% of these countries’ respective GDPs, with percapita losses as shown in Figure 2.4.Figure 2.4: Economic losses due to poor sanitation35Economic losses (US$ per capita)302520151050TourismOther welfareEnvironmentWaterHealthCambodia Indonesia Philippines Vietnam• Enormous financing needs. A recent World Bank paper (Yepes et al., 2008) presentinginvestment needs for the water supply, sanitation and wastewater sector worldwide in ruraland urban areas indicates that the global need between 2008 and 2015 would be about $109billion over the period. Of this total, the lower income countries account for $53 billion, thelow-middle income countries $50 billion, and the upper middle countries only $7 billion. Thestudy shows that investments needed vary widely across regions. Sub-Saharan Africa andSouth Asia require the largest investments as a share of GDP (2.0 % and 1.7 % of thecontinents’ respective GDPs). For urban sanitation, investment needs amount to a combinedtotal of $29 billion. In rural water and sanitation, Sub-Saharan Africa and South Asia haveconsiderably higher needs than other regions ($10.4 billion and $5.6 billion, or 0.59 % and0.57 % of their respective GDPs).There is a clear need to step up investment programs. However, additional funds forsanitation are not enough. The quality and equity of spending are equally important. Thanksto recent reforms in the sanitation sector, a number of developing countries are in a positionto use and leverage additional funds effectively. The changing aid architecture, includingnew donors, as well as new modalities of aid (such as output-based aid), can lead to moreresources and effective innovation, but also puts forward new challenges to achieveeffectiveness and coherence.• Need for more sustainable solutions. A large proportion of investments in the sector gotowards ineffective uses, including:o Highly subsidized latrines that are used for other services6

DRAFTo Ineffective solutions purchased by households who do not have access to a broadrange of optionso Extension of sewerage networks without the commensurate rates of connectionsfrom householdso Wastewater treatment plants that are not operated, or even when operated, do noteffectively benefit the environment due to the existence of other pollution sourcesof greater importance.Rapidly changing new technologies bring new opportunities to change the developmentparadigm and to provide new responses to development challenges. The sanitation sectorhas unfortunately not seen the same impressive technological development of othersectors (such as the expansion of mobile phone technology and internet access).However, it will be critical to bring in new membrane technologies, innovative paradigmsfor non-water based sanitation systems, decentralized treatment (particularly for therapidly expanding peri-urban areas of large cities), new bio-treatment for small towns,and radically different approaches to reduce sludge generation from basic solutions,among many others.3. Experiences of WSP in Sanitation3.1 Evolution of Areas of Focus in SanitationSince its establishment 30 years ago, WSP has gone through three phases of support of thesanitation sector. The 1980s were characterized by an emphasis on engineering technologies,with specific focus on low-cost technologies, including the Ventilated Improved Pit (VIP),SanPlat (plastic latrine slabs), and pour flush latrines, among others. The hypothesis at the timewas that upgrades in technological innovation and their dissemination in developing countries —through a top-down and heavily subsidized infrastructure approach — was the key trigger torapidly expand access to sanitation.In the 1990s, WSP changed its focus to more strategic approaches and greater involvement in thefocus to bottom-up and community-driven options. Some of the tools used during that decadeincluded Strategic Sanitation Planning, a strong emphasis on condominium systems, and thedevelopment, testing and replication of the Participatory Hygiene and Sanitation Transformation(PHAST). This decade also saw a clear emphasis on integrated solutions that included watersupply and sanitation, rather than the traditional focus on water supply first (assuming sanitationwould follow later on which rarely happened). During that decade, about five technologiescontinued to be considered acceptable and there was an inherent, if not explicit, requirement ofminimum technical standards for sanitation. The state was seen as the main provider of sanitationinfrastructure and subsidies, with NGOs being promoters of sanitation and hygiene, generally atthe household level and through labor-intensive PHAST approaches. At that time, sanitation wasnot in the original list of MDG targets.Over the last five years, the importance given to sanitation development in WSP’s projects hasbeen steadily increasing, reaching 46% of its annual budget in 2008 (Figure 3.1). For the firsttime, the proportion of the WSP’s budget dedicated to sanitation is larger than the one dedicatedto water supply (33%).7

DRAFTFigure 3.1: Fiscal Year 2008 Budget Allocation WSPFigure 3.2 below shows recent WSP thematic activities in sanitation and hygiene. It emphasizesthe importance of institutional reform and capacity building which is identified as a keyweakness of the sector. It is hence responding to the call of the Hashimoto Action Plan wherebynational governments have to assume leadership in dealing with the sanitation crisis, whilekeeping in mind that sanitation is a local issue where people have the final decisive word,although it cannot be negated that sanitation is a public good and requires institutional attention.A great deal of WSP’s capacity building activities are linked with supporting key innovativeexperiences that lead to behavior change as well as improvements in strategizing, planning forsanitation development and finance, appropriate technology choice, monitoring and scaling up ina sustainable manner.Figure 3.2WSP Sanitation & Hygiene Portfolio by themesPublic Expenditure,Finances and M&EIncreasing access for thepoorScaling-Up Pilot ProjectsSmall and MediumEnterprise SupportRegulation and Policy2%8%9%7%6%MDG Action PlansInstitutional Reform andCapacity BuildingAdvocacy and StrategicCommunications15%44%8%0% 10% 20% 30% 40% 50%3.2 Recent Successful WSP ExperiencesThis section summarizes a sample of successful experiences supported by WSP in differentcountries and regions over the last few years. These experiences serve as the basis for thestrategic directions set out in this medium-term strategic document for WSP’s involvement insanitation, and also illustrate the change in directions that the Program has taken in this historicalreview of its involvement in the sanitation sector.• Total Sanitation Campaign (Bangladesh, Pakistan, India and Indonesia). Looking at thestrength of a small scale pilot demonstrated by an NGO in Bangladesh with technical supportfrom WaterAID Bangladesh and financial support from DFID, WSP advocated the Total8

DRAFTSanitation approach which includes behavior change, demand creation, community action. Italso incorporated two critical elements to address scale and sustainability, which are i)making local governments’ responsive with specific roles for facilitation, and ii) provisionof incentives to the collectives on achieving outcomes as opposed to upfront householdhardware subsidy.Since 2003 the sanitation coverage in Bangladesh increased at an unprecedented yearly rateof 15.3% making the total rural coverage touching the 80% mark, while in India, thecoverage increased from less than 20 % in 2000 to close to 46% in 2007. The TotalSanitation Campaign approach is also being scaled up in Indonesia, where the Government isfinalizing a new national sanitation and hygiene strategy which combines three critical andinterrelated areas of intervention: total sanitation, handwashing with soap, and householdwater treatment.• Sanitation Marketing (Senegal, Vietnam). In Dakar, where 60% of the population wasliving in unplanned areas without adequate sanitation, WSP provided technical support forthe implementation and supervision of the peri-urban sanitation project financed by theWorld Bank. In 3 years the pilot program provided access to basic sanitation to 450,000people representing 20% of the total population of Dakar. A similar approach has been usedin Vietnam where the construction of latrines by local entrepreneurs has more than tripled inthe project area.• Sanitation as a Business (Peru). WSP in Peru, together with the Ministry of Constructionand Sanitation, SDC, USAID, FONDAM and Foundation Ensemble, promoted a new pilotproject to sanitation promotion in poor areas of five localities of Peru. This project integrateslessons from the Total Sanitation Campaign experience of South Asia, and the SanitationMarketing experience of Africa. An estimated 225,000 people are living in the pilotintervention areas, which include rural, peri-urban and small town locations. Results andlessons learnt from the pilot project, which lasts until 2009, will be used for scaling-up theinitiative into a national sanitation program.• City Sanitation Strategy (Indonesia). This project supports multi-departmental workinggroups in six diverse cities to identify priorities, actions plans and budgets towardsdeveloping a City Sanitation Strategy (CSS). The CSS informs pro-poor pilots, and theselection and design of future investments from foreign and domestic sources. The sixmayors recently met and signed a sanitation declaration, and the central Government hasbeen requested to provide similar support to many more cities.• Sanitation Financing for the Poor (Burkina Faso). In Ouagadougou (population 1 million,sanitation coverage 30%, with two thirds traditional latrines), the utility decided that in orderto improve sanitation, a levy or surtax on the water bill included. Managed through a specialaccount, and the resources generated focus more on sanitation promotion than on sanitationprovision. Over US$1 million is generated every year through this surtax, with a recoveryrate of 87%. More than 50% of the surcharge is used to promote on-site sanitation.9

DRAFT• Slum Sanitation Program (India). The Slum Sanitation Program was conceived to respondto the highest priority social-environmental-health needs in the country. It was implementedthrough partnerships led by the Municipal Corporation and inviting private organizations forconstruction and maintenance of the facilities. CBOs were formed and empowered to operateand manage toilet blocks, maintain membership registers, and books of accounts. Using thesuccessful experience of slum and community sanitation across the country and the successof the rural sanitation program, the Ministry of Urban Development of the Government ofIndia drafted a national urban sanitation policy that focuses on meeting outcomes in a timebound manner with appropriate performance-based incentives to make a difference in theurban sanitation situation in the country.• Development and Scale up of New Sanitation Technologies (Latin America). WSP hasbeen instrumental in supporting the design, development, as well as documentation andevaluation of new technologies. For example, condominial systems — small diameterssewers that are combined in such a way that they form only one network of collectors andtubes, with neighborhoods deciding together on the location of the network, its design and itsoperation and maintenance — originating in Brazil are now being implemented in other LatinAmerican countries, and interest outside the region is growing. Likewise, for ecologicalsanitation, WSP has followed and documented a project of the NGO CENCA thatimplemented ecological sanitation toilets in two peri-urban zones of Lima, Nievera andHuascar. The experience has shown that it is possible to develop ecological sanitation indense areas, as well as draw lessons learnt on technical, social, financial and institutionalaspects. WSP is also working with governments on both technical improvements andadvocacy and recognition for the approach• Sanitation MDG Roadmap (Ethiopia, Latin America, East Asia). Sanitation MDG roadmaps are country-owned action plans for the hygiene and sanitation sector, designed to assistgovernments to define and implement a common strategy to reach their sanitation targets.In Ethiopia, WSP provided technical support for the development of a national sanitationstrategy, MDG roadmap, strategy, and investment program. The sub-sector reform led to thedevelopment of a decentralized, multi-stakeholder, demand-focused approach. In LatinAmerica, initiatives have already advanced in Central America (Nicaragua, Honduras and ElSalvador), drawing on national and regional sanitation networks. Sanitation assessmentstudies were carried out for many Latin American countries in preparation of LATINOSANin November 2007, as a first step towards MDG sanitation roadmaps. A similar situationalanalysis for sanitation has been supported by WSP and other partners for all participatingcountries in the regional sanitation conference for East Asia – EASAN.• Sanitation Partnerships and Advocacy (all regions). WSP in partnership with UN agencies,Regional Development Banks, multilateral and bilateral Donors and NGOs, has organized aseries of Regional Sanitation Conferences to raise the profile of sanitation in the politicalagenda of National Governments. Five regional sanitation conferences have been supportedin 2007/2008 by WSP – LATINOSAN in Latin America (Cali, Colombia, November 2007),EASAN in East Asia (Beppu City, Japan, December 2007), AFRICASAN +5 in Africa9Durban, South Africa, February 2008), CARIBSAN in the Caribbeans (Jamaica, April2008), and SACOSAN 3 in South Asia (New Delhi, India, October 2008). The objectives of10

DRAFTthese Conferences were to share experiences and lessons learnt on policies, strategies,approaches to improve access to hygienic sanitation, and to explore ways to meet the MDGSanitation target. The recommendations of the AFRICASAN Conference held in 2002 inSouth Africa contributed to the adoption of a specific sanitation MDG target at the WorldSummit on Sustainable Development. In South Asia, the ministerial declaration of the firstSACOSAN held in Bangladesh launched the Community-Led Total Sanitation movementwhich is providing access to sanitation to millions of persons in Pakistan, India, andBangladesh.4. WSP Strategic Responses to the Sanitation Challenge4.1 WSP and Sanitation in the Medium TermBuilding on the experiences gained, and in line with WSP’s Global Strategy FY2009-2018Going to Scale, WSP‘s strategy for sanitation will continue to focus on advocacy efforts to drawthe necessary attention and action for sanitation; monitor progress; and increase understandingon how to do it right. For the medium-term framework, this means particular emphasis on:• WSP as an Active Partner of the International Year of Sanitation and Beyond. InDecember 2006, the General Assembly of the United Nations declared 2008 as theInternational Year of Sanitation (IYS). The resolution expressed concern on the slow andinsufficient progress made in achieving the global sanitation target, and recognized thatprogress can be made through active commitment and action by all players, including at thenational and local levels, as well as United Nations agencies, regional and internationalorganizations, civil society organizations and other relevant stakeholders. This has provided aplatform for WSP to make significant contributions towards meeting the main objectives ofthe International Year of Sanitation, in accordance with the IYS Action Plan:o Increase awareness and commitment: The objective of the regional sanitationconferences which WSP co-organized was not only to increase high-level awareness butto also create commitment from each country to reach the sanitation MDGs. Theseconferences have led to national follow up events in 2008, and more importantly, majornational policy reforms and sanitation scale-up programs in these regions, which WSPwill continue to support.o Mobilize alliances and secure real commitments: During the preparatory activities forthe regional conferences and the IYS, as well as through its regular work on sanitationand hygiene, WSP will work with governments and other key stakeholders to mobilizeand take concrete and effective action by a variety of country and local level supportactivities. Two areas of work will be the focus of WSP to support IYS Objective 2. First,WSP will support the preparation of sanitation status overviews that assess not onlycurrent sanitation access levels but also the factors that need to be addressed. Second,WSP will support the review and development of appropriate national sanitation policies;institutional organization and capacity strengthening plans; adequate sanitation financingplans; and effective and sustainable sanitation technology options, products and services.11

DRAFTThe country overviews will serve as a baseline to track progress against sanitation MDGtargets – not only in terms of tracking coverage but also in terms of tracking theimprovement and strengthening of the political and institutional environment that willenable the sanitation programs to scale up and be sustainable. Key examples of thisinclude the preparation of country status overviews for sanitation for about 30 countriesin Africa, about 14 of the poorest (and lowest sanitation coverage) countries in LatinAmerica and the Caribbean. WSP sill support regional processes in the Mekong basin tohelp countries compare lessons learned and support each other for action and tobenchmark progress. Similar analyses to support local stakeholders to mobilize for actionin sanitation and hygiene will be supported at the municipal level in Indonesia and thePhilippines. In South Asia, WSP will continue to provide policy advisory support togovernments on formulating sanitation outcome-focused policies and strategies to gainpolitical and institutional priority.o Encourage demand-driven, sustainable solutions: WSP will provide direct technicalguidance and in some cases channel financial support to governments that areimplementing sanitation programs that use demand-based approaches such as totalsanitation and sanitation marketing to reach rural and urban poor populations with accessto improved sanitation. Key examples include the Scaling Up Total Sanitation/SanitationMarketing project in Tanzania, India and Indonesia; Sanitation marketing programs inBenin, Kenya, Cambodia, Peru; and Total Sanitation programs in Bangladesh andPakistan.o Secure increased financing: By virtue of its special relationship with the World Bankand WSP Council members who are donors in the sector, as well as solid workingrelationships with regional development banks such as the African Development Bank(where WSP now has an office) and the Asian Development Bank, WSP will play animportant advocacy and facilitator role in assisting government to get access to increasedfinancing for increasing sanitation access for the rural and urban poor. In addition, WSPwill be part of project preparation teams with the World Bank, the Africa DevelopmentBank and other donor partners to provide sanitation specific expertise to assist in thedesign and preparation of projects to insure that they are designed in such a way as toaddress sanitation and effectively reach the rural and urban poor. An important objectiveof WSP in these interventions will be to promote a balance between the focus on waterand sanitation to ensure that sanitation and hygiene are not left behind. WSP will supportthe design and implementation of the sanitation components in water and sanitationprojects in Bangladesh, India, Pakistan, Niger, Benin, Indonesia, Malawi, Zambia andTanzania, among others. WSP will also be providing technical expertise to AfricaDevelopment Bank task team leaders in preparing sanitation projects that will result inincreasing sanitation access for rural populations and will likely be part of future projectpreparation teamso Develop and promote policies and strategies: The focus of WSP activities in thesanitation and hygiene sector is on change of outcomes rather than on provision ofinfrastructure. The focus of the Total Sanitation programs is on achieving opendefecation free status by villages. The core of Sanitation Marketing is to support the12

DRAFTdevelopment of a vibrant local market that provides sanitation solutions that are desiredand maintained by households. Many of these programs are rapidly evolving to includehandwashing and hygiene to ensure even greater gains on health and socio-economicoutcomes. Key examples include the implementation with partners of the Scaling UpHandwashing with soap project in Vietnam, Tanzania, Senegal and Peru; the East AfricaHandwashing Initiative in Kenya, Tanzania and Uganda; and coordination of thesecretariat of the global Public-Private-Partnership for Handwashing ( PPPHW)o Develop and strengthen institutional and human capacity: Capacity building is one ofWSP’s core mandates and this is reflected in the WSP IYS Action plan. Capacitybuilding by WSP will address a wide range of audiences and skill areas. Audiences willinclude national and local government policy and decision makers, public sectorinstitutional employees, utility staff, NGO staff and CBO members, technical specialistsand, journalists. WSP support to capacity building is focused on areas that go beyondclassroom training, and focus on:o Prioritizing and working in a way that ensures ownership by Government(especially at the local level where implementation takes place).o Providing facilitation and support to Government (local and central) to takeaction, rather than 'doing it all' through consultants employed to undertake thework.o Strengthening the use of practical 'on-the-job' approaches and active fieldexchange approaches that not only build capacity, but also ownership, politicalcommitment, and interdepartmental relationships.o Building the capacity of providers of sanitation infrastructure, goods, andservices to respond to increased demand is critical, and part of the sanitationmarketing approach.o Influencing the curricula of training courses by institutes and universities tobring state-of-the-art lessons to sector professionals.o Supporting networks of professionals and water utility/operators partnershipsto disseminate lessons learned through capacity building programs.o Using global connectivity to bring capacity building programs that promoteSouth-South cooperation and learning;Key examples include capacity building and training to be provided in Community LedTotal Sanitation approaches for state and district officials and implementing agencies inSouth Asia and South-East Asia; training programs for health and marketing specialistsfrom around the world in the “University of Handwashing” to learn how to set up largescale Handwashing programs; organizing and implementing “road shows” for nationaland state policy makers and city managers in India and; national and regional capacitybuilding on hygiene and sanitation in India. In East Asia through the Sanitation andWater Partnership for the Mekong Region (SAWAP), WSP is facilitating capacitybuilding through a range of government led initiatives and intra-regional learning. In thePhilippines, WSP will support the establishment of Centers of Excellence for sustainablesanitation to strengthen and develop the capacity of workers and professionals onsanitation. In Peru, WSP is involved in a capacity-building working group with theGovernment of Peru, helping to assess training capacity that exist in the country and the13

DRAFTbest way they could respond to the demand; and developing specific training curriculumwith local Universities on WSS in rural areas.o Promote and capture learning: WSP has a long and well received history of producinghigh quality advocacy documents and field notes describing interesting projects, andmore recently is focusing on bringing the best global knowledge on impact evaluationand evidence-based analysis to strengthen our advocacy and technical guidance efforts insanitation and hygiene. Key examples of global work that WSP will undertake for theIYS include a global study on sanitation financing practices at the project and programlevel that will look at experiences with sanitation subsidies, financial incentives forcommunity based sanitation results, etc. A second global study will be looking at thepolitical economy of sanitation that seeks to better understand vested interest that eitherconstrain or promote appropriate investments in sanitation to reach the rural and urbanpoor. A third study will be an East Asia multi-country regional study on the economicimpact of not having adequate sanitation and the economic benefits of sanitationimprovement (Economics of Sanitation Initiative).WSP will also be publishing and disseminating a wide variety of sanitation relateddocuments including technical guides, videos, advocacy documents, case studies, fieldnotes, etc. Examples of specific publications and other media planned for next yearinclude, among many others: a South Asia regional guidebook on community led totalsanitation for policymakers and practitioners; a Handwashing Program Operations Guide;a technical and advocacy document on condominial sewerage systems withdocumentation of experiences from Brazil and the Andean region; a guide on constructedwetlands for wastewater treatment; an “Accessing Sanitation” Video Game with theSerious Games Initiative; a compilation film of all previously produced WSP films onsanitation; and training modules of the Philippines Sanitation Sourcebook.• Implementation of Sanitation Roadmaps. It is expected that by the 2012, an increasednumber of countries will be on track to achieve the sanitation MDG target by 2015, or if noton track, that they will have clearly spelt out national and local policies that will provide anorientation and implementation plan. WSP will have at that time supported all focuscountries of intervention in establishing and implementing MDG Roadmaps for sanitation. Itis also expected that this technical assistance will be shared with new countries such asFragile States.These roadmaps will make an emphasis on scaling up strategies, using existing successfulexperiences, as the ones enumerated in the previous section, and providing assistance on thedesign of sector financing strategies together with World Bank Operations Departments, orother donors following the principles of harmonization of the Paris Declaration. In addition,these roadmaps are not only planning instruments to be developed at national level; WSP willalso be able to provide technical assistance at local level, facilitating the process ofintegrating sanitation development for the urban poor in urban planning. Financing strategieswill also deal with the development of sanitation markets where the private sector, includingfinancial institutions could be involved in both direct contributions and micro-creditfinancing, using the experience of pilot experiences currently being documented.14

DRAFT• Scaling up Change at Local Level. The Total Sanitation Campaign, the Public-Private HandWashing Initiative as well the various sanitation marketing experiences in which WSP isinvolved have clearly shown the importance of the responsibility of households in bringingabout change in sanitation and hygiene practices. The Total Sanitation Campaign is rapidlyspreading in several states of India and Bangladesh and has proven that its process can bescaled-up, with the interventions of political leadership at all levels. The HandwashingInitiative is based on the building of alliances between the public and private sectors topromote proper hygiene practices as well as the involvement of schools. The development ofsanitation markets is based on the promotion of both demand and supply for sanitationproducts and the inclusion of a micro-credit facility that can easily be replicated within acountry. These scaling – up mechanisms will continue to be promoted by WSP in three yearstime in close relationship with the development of the Sanitation Roadmaps, and new scalingup mechanisms will also be studied.4.2 Key Thematic AreasThe strategic responses of WSP to the sanitation challenge emerge from the overall responses putforward in WSP’s Global Strategy FY2009-2018. WSP will work along seven key themes:• Behavior Change and Demand for Sanitation. A key constraint in the scaling up of theprovision of sanitation services is the lack of demand by households and communities.WSP will continue to replicate and bring South-South learning and exchange ofexperiences in rural sanitation in the area of Community-led Total Sanitation (CLTS).The total sanitation approach focuses on stopping open defecation at the village level byhighlighting the problems caused to all residents by open defecation within and aroundthe community and by ensuring that every household builds, uses, and maintains its ownlow-cost toilet, or has access to and uses a shared toilet. The approach creates demand forsanitation by building upon a combination of peer pressure at the community level andcollective action to help destitute members of the community and public facilities(schools and hospitals) have sanitation solutions. The generation of demand for sanitationservices moves from the individual to the community level. The total sanitation approachpromotes and works towards the outcome of open defecation–free communities,regardless of the individual solutions chosen by households (which may vary—simplepit, improved pit, pour-flush toilet, VIP latrine, etc.—depending on income level) whilemaintaining protection of water sources such as wells.The success of total sanitation rests on the following core principles:o Total sanitation is about igniting behavior change and eliminating opendefecation, not (just) about building toilets. Hence, it focuses on outcomes andnot on hardware inputs.o Total sanitation is about collective action; hence, it mobilizes the communityrather than establishes household contacts. Sanitation is a private practice that haspublic consequences, but targeting the collective can eradicate externalitieso It is about local choice; accommodates a variety of technological options and getspeople on to the sanitation ladder.15

DRAFTo Incentives make a difference because they reinforce collective action. Thisprinciple involves directing incentives to the collectives and rewarding outcomesrather than subsidizing household toilets.A second approach to generate demand will be through sanitation marketing approaches.Based on a thorough and systematic analysis of the potential for a sanitation market, amarketing strategy is developed to promote demand for sanitation services. Themarketing strategy uses a variety of messages targeted to different audiences, as well asdifferent media—commercial advertising techniques (through a combination ofappropriate media such as print, radio, and TV), promotion through NGOs, Departmentof Health outreach teams, and others—within a consistent framework of well-designedmessages to generate demand and change behavior. This approach has been effectivelyused in Senegal and Vietnam, and is now being tested at scale with the support of WSP inother countries.In slum areas, there are no models that have demonstrated replicability for scaling-upservices. There are several models that focus on new ways to generate demand forservices through behaviour change of households and communities. For example, theMumbai, India, slum sanitation program implemented by the Municipal Corporation ofBrihan (Greater) Mumbai with support from the World Bank, supported about 330community toilet blocks (CTBs) with more than 5,100 toilet seats. This program isestimated to have benefited about 400,000 people in the slums of Mumbai. This programwas unique in (i) fostering a participatory and demand-led approach in a complexmetropolitan socio-cultural environment; (ii) supporting partnerships between themunicipality, NGOs, private construction agencies, and slum community groups; and (iii)initiating innovations and incentives. New approaches to change behavior and generatedemand for sanitation services will need to be developed and WSP will focus in this areaduring the period of implementation of this strategic framework.• Leveraging Financial Resources. The results of sustainability and performance ofsanitation programs in South Asia, as reported in a WSP study, clearly demonstrate thatprograms with higher levels of hardware subsidy are less sustainable (Figure 4.1).16

DRAFTFigure 4.1: Performance of Sanitation Program with Varying Levels of Hardware SubsidyEmerging lessons and practice in the sanitation sector suggests that a radical shift isrequired from financing “subsidies and grants for sanitation facilities” to financingstrategies designed to facilitate “sanitation promotion and leveraging resources”, asillustrated in Figure 4.2. This shift focuses on four main principles:o Change subsidy schemes to become financial rewards systems for performance inthe delivery of improved sanitation results (rather than construction of latrines) atthe community level (instead of the individual households), using measures suchas the achievement of 100% open defecation free (ODF) status.o Use financing resources to support the promotion of sanitation to create demandand improve hygienic behaviors.o Provide financial incentives for local entrepreneurs to enter the sanitation market(access to credit, training programs to enhance their technical and businesscapacities, etc.)o Allocate limited public resources strategically to maximize both public andprivate benefits (for example software, hardware for destitute members ofcommunity or where public benefits are required, waste final disposal and reuse,research, development and diffusion of new technologies, marketing of sanitation,capacity building and training)17

DRAFTFigure 4.2WSP will focus its emphasis to influence three main areas of financing, in priority order :(i) public government funding in a way that leverages other sources of funding and isbased on the principles described above; (ii) household and domestic private sector whichare critical pillars of financing for the overall sanitation sector; and (iii) financing fromthe IFIs (including the World Bank, AfDB, and bilateral donors) to bring into theirfunding lessons of experience of effective large-scale sanitation programs.WSP is currently undertaking a global study of good lessons of sanitation financing thatwill serve as a key global guidance document for this key theme.• Improved Service Levels. Under this theme, WSP will continue to explore theintroduction of innovative and environmentally friendly technology; and new approachesto enhanced pro-poor services, including through the involvement of domestic privatesector providers. In the area of innovative and environmentally friendly technology,WSP will continue the long-standing work in areas such as condominial system (Figure4.3) that have been shown to reduce construction costs by as much as 25% for thesewerage, and as much as 40% with enhanced participation of the community inconstruction and operation. WSP is bringing these lessons to other regions.Figure 4.3: Traditional and Condominial Sewerage Designs18

DRAFTA second area of work for WSP will be on innovative small-scale decentralizedwastewater treatment technologies, which are critical for the sustainable management ofsanitation systems in small towns and peri-urban areas. The experience with biofilters inCentral America, and decentralized systems in East Asia are some of the examples thatwill serve as basis to work further in this area.Finally, in terms of Ecological Sanitation (EcoSan), WSP will continue supporting thereplication of successful lessons emerging from its review work in Africa, and the initialexperiences in Bolivia. Some of the emerging lessons include: (i) different cultural,geographic and demographic situations produce different reactions to EcoSantechnologies and therefore adaptation is critical; (ii) sanitation programs need expertise inmarket research and the design of social marketing, so that EcoSan is promoted as oneamong a range of technological solutions that enhance the range of options available tohouseholds; (iii) EcoSan marketing needs to effectively target households with higherenvironmental awareness willing to invest the time and resources for enhancedmanagement of their waste; (iv) the financing strategies for EcoSan should not distort themarket for other products but rather focus subsidies in areas where the public benefits aredemonstrated and can be valued.In the area of innovative sanitation technology, WSP will incorporate the lessons learnedfrom its work in the 1980s and avoid the belief that technology alone can solve thesanitation challenge. While innovations in technology are indispensable to achieve thesanitation MDG and beyond, without parallel reforms in finance, governance, behaviorchange, and programmatic approaches, it will not be possible to scale-up assistanceeffectively and sustainably in this area.The role of the domestic private sector has been fundamental in the provision ofhousehold sanitation solutions. Small-scale providers include those involved in pitemptying and disposal services (suction truck operators or manual latrine cleaners) andeven treatment facilities, to those owning and managing communal toilet facilities tothose providing technical services for the construction of on-site solutions. In addition tothe provision of individual sanitation solutions in rural areas, small-scale providers play acritical role given their ability to provide sanitation services in illegal and ad hocsettlements, to provide lower levels of more affordable services, to provide flexibility interms of payments. Many of these benefits accrue to the poorest and more vulnerablehouseholds with complex needs and capacities.The potential of the domestic private sector in service delivery in low-income countries isoften constrained by the bottlenecks it faces in relation to finance, technical andcommercial capacity, specifically in:o a lack of capacity in the supply-side of the market;o policy, institutional and financial constraints to supply-side markets;o a lack of incentive for government to facilitate an enabling environment for thedomestic private sector;o immature and unreliable demand-side forces; and19

DRAFTo a lack of capacity for users to hold providers and government accountable.WSP has been working in a global initiative to understand better new ways to support theprivate sector in the delivery of the water and sanitation services. With over 25 projects in16 countries, the global and local activities are fairly advanced and the lessons of practicewill be analyzed in a workshop to be held in June 2008. The scaling-up and replication ofthese lessons to other countries and regions will be the basis for the implementation ofthis key theme under the sanitation strategy.• Improved Governance. Under this fourth key theme of the sanitation mid-termframework, WSP will focus on the areas of decentralization, institutional capacitybuilding,regulation, civil society participation, accountability, and anti-corruptionprograms. In this important theme, WSP will use the lessons that emerged from itsEthiopia program where a key portion of the upstream support focused on: (i) raising thepolitical profile of sanitation through AfricaSan conferences and ministerialcommitments; (ii) facilitate a consensus around a national sanitation strategy; (iii)clarification of institutional mandates for sanitation; (iv) detailed implementationframework (the National Hygiene and Onsite sanitation protocol); and (v) federal andregional strategic plans for sanitation to pave the road for a national sanitation programwhich can receive harmonized support from donors. In practical ways, the WSP programover a period of almost a decade tackled a variety of governance issues in sanitation thatare now leading to large scaled-up program with noticeable change on the ground.WSP reviewed at the 2007 Council its global lessons on governance and capacitybuilding needs of the sanitation sector. Some of the lessons that have emerged from itswork, and that will be used in the implementation of the key theme of sanitationgovernance, include:o Design and implement effective advocacy process to find champions forsanitation. The champions need to be both at the highest levels (such as theMinister of Rural Development of India and Minister of Local Government ofBangladesh as key figures in total sanitation campaigns) and at the local level (forexample local champions in the Basia Region of Uganda have ld from 45% to75% coverage in one year, with same resources and mobilization of population;and in the Southern Region of Ethiopia: from 20% to 75% in 2 years)o Improve the enabling environment (financial resources allocation, policies,institutional arrangements, M&E, regulation)o Prioritize sanitation and hygiene in PRSPs and other financial instruments toscale-up programs and interventionso View decentralization as an opportunity as it can be a potentially powerful tool toscale-up and break sectoral barriers. At the national level, difficult barriers acrosslarge ministries can make it difficult to move forward the sanitation agenda. Atthe local level, with smaller agencies and champions at the sub-national leveladministration, progress can be more easily achieved.o Explore, when possible, comprehensive governance reviews that encompass fromthe national to the local level. Figure 4.4 illustrates how the Indonesia Sanitation20

DRAFTSector Development Program (ISSDP) aims to establish a sustainable frameworkfor pro-poor sanitation services through the development of effective andcoordinated policy-making, institutional reform, strategic planning and awarenessbuilding.Figure 4.4: Institutional and Governance Levels of ISSDPIn terms of regulation reform, as part of the key theme of governance in the sanitationsector, WSP’s lessons of experience show that the focus of the regulatory frameworkshould be in ensuring sustainability of the sector, namely:o Market alone will not take care of externalities: waste transportation and finaldisposal for all types of technical solutionso Restrictions on inadequate technical solutions for specific environmentalconditions (and/or subsidies to discourage use of sub-optimal solutions butwithout distorting too much the market)o Land tenure, especially in densely populated slums that unblocks provision ofsanitation serviceso Rational and enforceable treatment and disposal standardsFinally, in the area of civil society participation and accountability, recently, WSPcompleted a review of 10 models of pioneering Indian “voice” and “client power”initiatives, devised by consumer and civil society groups, local governments, publicservice providers, and state or central government agencies. These models provide a veryinteresting menu of options and models by which to design citizen involvement throughimproved access to information in the WSS sector. These models include:o Participatory budgeting in Kerala where local neighborhood groups and WardCommittees contribute project ideas for their city, negotiate with counterparts,and reach an agreement with the local municipal council on specific projects forthe year;o Consumer courts and consumer grievance redressal forms, based on theConsumer Protection Act;21

DRAFTo Mobilization of rural electricity consumers by the Consumer Unity and TrustSociety to get them involved in the power reform process in the state ofRajasthan;o The online complaint monitoring system of the Brihan-Mumbai MunicipalCorporation;o Public Interest Litigation, which permits litigants to file cases on issues that affectthe public at large; the most famous example being the Delhi Vehicular PollutionCase;o Citizen Report Cards, which was started in Bangalore and has been nowreplicated in numerous countries, including the most recent WSP experience inKenya.WSP is currently undertaking a global review of experience on the political economy ofsanitation, as part of this key theme of sanitation governance. Political economy in thisstudy is understood as referring to interdisciplinary studies that draw upon social andpolitical theory in addition to economic principles in order to understand how politicalactors, institutions and economic processes influence each other. The political economyof sanitation therefore refers to the political and economic processes and players whichdetermine the extent and nature of investment in sanitation. This systematic assessmentwill identify and evaluate the political constraints to improved sanitation for the poor;specifically, it is critical to identify which stakeholders support or oppose sanitationinvestments, why they take this stance, and how best to address this process. The role thatsocial and cultural aspects play in regard to sanitation will also be assessed. The workwill collect primary and secondary data to analyze stakeholder interests, incentives,influences, institutions, impacts, and risks in selected case studies to draw commonlessons. The work will support evidence-based decisions in sanitation investment whichhave a stronger pro-poor focus and thus will improve health and hygiene outcomes on theground.• Programmatic Approaches in Sanitation. Under this key area of work, WSP willsupport in its focus countries the development of sanitation MDG roadmaps, sectordevelopment plans, and scaling-up programs including SWAPs. Two important areas offocus will be the incorporation of sanitation in PRSPs and the harmonization of sanitationpolicies and initiatives among donor and technical agencies in line with the principles ofthe Paris Declaration.WSP has supported a variety of MDG roadmaps (combined water and sanitation, as wellas sanitation only). The sanitation MDG roadmaps have three basic objectives: (i) todevelop a participatory and consensual national planning framework to achieve thesanitation MDG; (ii) to compile and analyze existing data (at the national and subnationallevel, disaggregated spatially and by income levels) to better define the actionsneeded and to monitor progress in the path of the MDG roadmap; and (iii) to develop along-term plan, with short- and medium-term specific targets along the way.22

DRAFTThe main steps in these roadmaps have been:Main StepsMain Outputs1 WSS/MDG Review Country WSS/MDG Study2 National Consultation National Workshop Reports3 Agree Plan, Target and Action Internally-Owned WSS/MDG Plan4 Implementation Investment Programs5 Monitoring Scorecard progress reports every 2 yrs/countrySome of the success factors in the preparation and launching of the sanitation MDGroadmaps include:o The preparation of the sanitation MDG roadmap needs to be owned by theagencies responsible for the sector and endorsed at the highest political level toensure the achievement of commitments based on a broad consultation.o The sanitation MDG roadmap should include lessons from sub-sectoral programs(in urban, peri-urban and rural settings) but bringing best-practice lessons ofexperience from countries with similar contexts.o The sanitation MDG roadmap should be designed based on the currentinstitutional capacities of the sector.o The effectiveness of sustainable large-scale programs and the harmonizedinvestment support from donor agencies is predicated on the existence andeffective operation of M&E systems for the sanitation sector (which is the fifthkey theme of this sanitation medium-term framework).WSP is currently collecting lessons from experience in the preparation and launch ofsanitation and WSS roadmaps in its four regions. These lessons will serve as the basis forreplication and improvement of these processes in other countries, and for the expectedrefinements of the roadmaps at the sub-national level.WSP is also preparing a series of case studies on harmonization experiences in the watersupply and sanitation sector for the 2008 Accra conference that will review progresstowards implementation of the Paris Declaration. The lessons emerging from these caseswill be critical in the WSP work to support harmonized approaches to support scaled-upprograms in sanitation.• Monitoring and Evaluation. In this area, the Joint Monitoring Program has afundamental role in the collection and analysis of demand-side data collected bystatistical agencies and household surveys around the globe in a systematic and consistentfashion. This data is indispensable for national and global monitoring of progress towardsachieving the sanitation MDG. WSP will focus in a complementary area of M&E,specifically in the assistance to national and sub-national agencies in the development,maintenance and improvement of their information and monitoring systems, to be usedfor management, planning, oversight and institutional relations. For example, WSP willsupport:23

DRAFTo At the utility level, sanitation services management information systems in theareas of operation, commercial/customers (billing and collection), andinvestment/construction/ procurement;o Benchmarking efforts across utilities, that can be used by utilities to compare theirperformance in sewerage systems, by regulators to follow progress onperformance and compliance; and by community groups to have data that canhelp in client voice and power processes;o Sector information systems that compile data from various utilities and agencies,as well as household solutions to provide an integrated view of the status of thesanitation sector, its gaps and results;o Outcome-based systems that will measure not only the number of sanitationsolutions, but also their use and effectiveness (particularly in processes thatsupport total sanitation campaigns and related outcome-based rewards programs);o Impact-based systems that will monitor the improvements in health, social andeconomic indicators associated with changes in sanitation conditions;In all the above systems, WSP will work with counterpart countries to ensure that M&Eis not done as an objective in itself, but rather:o Supports budget decision making, planning and policy making;o Helps agencies manage activities at the sector, program and project level; ando Enhances transparency and support accountability relationshipsThree important dimensions of successful M&E systems are: (i) the utilization of theM&E information; (ii) the good quality of the data as well as analyses based on that data;and (iii) the sustainability and evolution of the M&E system. These factors are linked torelations among stakeholders and incentives to provide, check, utilize and improve thedata• Cross-Sectoral Linkages. Sanitation has fundamental connections with other sectors thatwill be explored and supported by WSP as part of its seventh key area in the strategicmedium-term framework. The most important ones are:o Gender dimensions of sanitation, along two lines: (i) critical impacts as opendefecation forces women to compromise their modesty and face danger of rape oranimal attack as most women will only relieve themselves after dark; and girlswill miss school or eventually stop attending when they start menstruating whenseparate and adequate sanitation facilities are not available in schools; and (ii) thevoice of women in the design and implementation of sanitation programs iscritical for their effectiveness.o Environment and water resources management are two critical dimensions of theimpacts of inadequate sanitation, though in many cases the investments inwastewater treatment are ineffective as the plants are not operational or if theyare, the design standards are excessive or not effective given the existence ofnumerous polluting sources of greater importance in the river basins.o Urban planning is fundamental for the cost-effective design and implementationof sewerage and sanitation investment programs in rapidly growing cities. Land24

DRAFTuse is closely related and a difficult policy issue for many cities in developingcountries.o Rural development can be enhanced with effective sanitation solutions that lead toimproved health and productivity and can be inputs into the agricultural systems,especially at the subsistence level if the fertilizer value of waste can be leveraged.In these areas, WSP will partner with other agencies to ensure that the best expertise isbrought to partner countries in cross-sectoral issues where the Program does not have thein-house expertise.Areas where WSP will be less active. A critical aspect of a sanitation document is to identify areas wherethe Program will not be as active or will have no role given its comparative advantage. These areasinclude:• Large-scale engineering and master planning of sewerage systems, except in the interface andservice provision to the poor;• Large-scale environmental impacts of inadequate wastewater treatment at the basin level, wherethere are other partners in the sector with better skills and experience• Transaction design, financing and private sector schemes for BOT and related arrangements forwastewater treatment plants• Advanced technologies for treatment of wastewater at large scale, particularly of centralizedsystems• General advocacy for the sector, as there are other organizations (such as the WSSCC) that arebetter placed to do it. WSP will contribute to these advocacy efforts providing the technicalexpertise and lessons of experience that can be used by other partners in their advocacy efforts.WSP will continue to undertake specific advocacy efforts with sector specialists and policymakers at the national level to support reforms process of the sector.• Large-scale training in sanitation issues, as there are other organizations (such as IRC, WEDC,etc.) that are better placed to do so. WSP will provide information and materials for use by thesepartners, and will try to influence the curricula of training agencies in developing countries tomainstream these lessons in the training of specialists, particularly sanitary engineers.4.3 Implementing the Sanitation Medium-Term Strategic FrameworkAs outlined in the Global Strategy, WSP plans to deliver its strategy using a combination of itsstrong country and regional presence with global expertise, with a comprehensive partnershipstrategy with other stakeholders in the sector and the countries in which we operate. For themedium-term strategic framework for sanitation, this means in particular:• Strengthen Sanitation Organizational Capacity. In order to achieve the objectives setout in this medium-term strategic framework, WSP will continue to strengthen itsoperational capacity and organizational structure along seven lines:o Dedicated management attention to the issue of sanitation;o Assignment of the responsibility for setting up and overseeing the monitoringsystem for the sanitation strategy to the Sr. Strategy and Operations Officer;o Continued implementation of global sanitation program with the support ofdonors under the overall technical guidance of a Sr. Sanitation Specialist in WSP-HQ;o Identification of sanitation focal points in each of the WSP regions;25

DRAFTo Identification of global technical experts in areas of specific importance forsanitation (economics, finance, gender, etc.);o Clear matrix of responsibilities for support to WSP country teams in theirsanitation activities; ando Continued support and strengthening of the Sanitation and Hygiene GlobalPractice Team (GPT).The Sanitation and Hygiene GPT is a global virtual team of WSP practitioners workingon sanitation issues. The functions of the Sanitation and Hygiene GPT include:o Global knowledge generation, cross-regional fertilization, and active learning;o WSP positioning in sanitation;o Global flagship products (not only publications but also majorconferences/partnerships such as the regional sanitation conferences);o Lead participation in conferences/working groups – the GPT will be a keyexternal interlocutor of WSP in sanitation;o Safe space review/quality enhancement for all WSP products in sanitation (notonly GPT products);o Mentoring of junior staff in the GPT;o Active participation and leadership in World Bank thematic groups and otherWorld Bank activities with the objective of leveraging, learning, influencing andcoordinating on sanitation issues;o Knowledge gatherer of lessons learned and thinking in the subject by donors andother partners; ando Coordination and work with similar groups and practitioners in other IFIs andpartner donor agencies.A key principle in the selection of GPT products is its relevance to WSP counterpartcountries and agencies, and the innovative nature of issues analyzed at the frontier ofchallenges in the sanitation sector.• Contribute to Sanitation Outcome Indicators. In its work on the seven key themes of thesanitation medium-term framework, WSP seeks to contribute to supporting partnercountries achieve the following outcomes and trends (expressed as indicators):26

DRAFTThemesOutcomes and trendsGeneral outcomes and trends • Increased number of countries on track to achieve the sanitation MDG target by 2015• Increased number of countries accelerating their improved sanitation coverage to a ratebeyond the minimum requirements to achieve the sanitation MDG target with anultimate objective of full coverage• Increased number of countries with policies and programs supportive of sustainablesanitation solutions (technically, financially, and environmentally)Behavior changes and demand • Increased number of countries/ states/ regions using total sanitation as a pillar of theirsanitation programs• Increased number of countries using sanitation marketing concepts to increase demandfor sanitation and behavior change at the household and community levels• Increased number of donor and IFI programs that incorporate the concepts of totalsanitation and sanitation marketing in their designLeveraging financial resources • Improved subsidy schemes at the country/state level that use financial rewards systemsfor performance in the delivery of improved sanitation results• Enhanced financial allocation systems used by countries/ states shifting away fromblanket hardware subsidies to approaches that support the promotion of sanitation tocreate demand and improve hygiene behaviors• Increased number of countries that shift the designs of financial systems for programsor in policies to focus on maximum public and private benefitsImproved service levels • Increased number of projects, programs and countries/ states that adopt newtechnologies for improved service (e.g., condominial systems, sustainable sanitationtechnologies)• Increased number of countries/ states with enabling policies and programs thatincorporate non-state providers in the improved delivery of sanitation services andwith effective support programs for sanitation SMEsGovernance • Increased number of well-identified champions at central and local government levelfor sanitation• Increased proportion of PRSPs that prioritize sanitation in countries with low levels ofsanitation access• Effective decentralized programs that provide the platforms for sub-national agenciesand local governments to support sanitation• Improved regulatory systems that provide effective platforms to scale up sanitation• Increased number of countries/ states that design and implement “voice” and “clientpower” initiatives, that provide consumers and civil society groups a better mechanismfor accountabilityProgrammatic approaches • Increased number of countries/ states with sanitation MDG roadmaps (or water andsanitation MDG roadmaps with adequate attention to the sanitation sector) designedand under implementation• Increased number of harmonized sanitation investment programs with all key externalsupport agencies involvedMonitoring and Evaluation • Increased number of improved sanitation M&E systems designed and implemented atthe utility, regulatory agency, region or country levelCross-sectoral linkages • Increased proportion of sanitation programs with adequate gender mainstreaming• Build New and Strengthen Existing Partnerships. In line with the overall WSPpartnership strategy endorsed by the WSP Council in its session of 2005, WSP willstrengthen and consider the establishment of new partnerships with sector agencies andother stakeholders under the following principles:o Mutually supportive, measurable and clearly agreed-upon objectives are essentialto effective partnerships27

DRAFTo Partnerships should be formalized in the simplest possible way while maintainingaccountability and minimizing riskso Sustaining Partnership requires a commitment to mutual understanding andcontinual adjustmentThe WSP partnership strategy document also identified four types of partnerships forWSP: a) policy influencing partnerships; b) implementation/ investment partnerships; c)networking and capacity building partnerships; and d) learning partnerships.Policy influencing partnerships are those long-term partnerships established over a longtime with counterpart government agencies. These partnerships are characterized by theirlong-term nature, mutual understanding, trust, and patience. WSP plays a key role inthese partnerships by linking national level policy makers with international thinking andalso with potential funding partners. WSP will continue to enter into strategic policyinfluencing partnerships with counterpart agencies working on sanitation. Good examplesinclude the sanitation partnerships with the Government of Peru for the Sanitation as aBusiness Program, with the Government of Indonesia for the ISSDP program, with thegovernments of Pakistan and Bangladesh for their national total sanitation programs, andwith the Government of Ethiopia at the central and local level for their sanitationprogram.Implementation/ investment partnerships should not be confused with contracting WSPstaff to implement others’ programs. An effective implementation partnership is onewhere WSP can bring some of its specific skills to assist in increasing the effectiveness ofan investment program at the upstream analytical stage, the design stage, or themonitoring and evaluation stage. Often intimately bound up with a policy developmentprocess, this influence can be brought to bear on pilot projects or on investments at scale.Good examples of implementation/investment partnerships in the area of sanitationinclude the involvement of WSP in the design of sanitation programs funded by theWorld Bank in all four regions, the role of WSP in the investment programs of Pakistansub-national sanitation programs, the sanitation pilots in Indonesia, the sanitationinvestment programs by several donors in Ethiopia, and the global Scaling Up projectsupported by the Gates Foundation being implemented by four countries around theworld.Networking and capacity building partnerships have been a major focus for WSP for anumber of years (one of the early examples being the ITNs). In these types ofrelationships WSP usually brings specialized knowledge of the sanitation sector andexperience of how to organize capacity building processes to support a national orregional network, which has a particular sector focus. Often these types of partnershipsinvolve multiple partners. They may be quite informal in nature and rely on thewillingness of organizations to work together to promote a new idea or support a process.They tend to work well when the idea is well formulated, when there is a secure flow offunds for a definite time period, or where there is a strong local institution, which isanchoring the activity. Good examples in the area of sanitation include the WSP supportto the regional networks of sector professionals in Central America, the regional water28

DRAFTutility partnerships (especially in Africa and East Asia), and the partnership with theAfrican Development Bank (which is also expected to evolve into animplementation/investment partnership).In learning partnerships WSP works with a partner or partners to improve sectorknowledge and disseminate new ideas. These partnerships can be divided into thosewhich are led by WSP and those where WSP plays a supporting role. Crucially to besuccessful, these types of relationships seem to require leadership from one selectedplayer who is willing to take the lead in assuring the quality of the conceptualization ofthe learning and can steer the implementation of needed research. Good examples in thearea of sanitation include the strong collaboration with the Water Supply and SanitationCollaborative Council (WSSCC) and UNICEF (at the corporate, regional and countrylevels). Other learning partnerships include those established for specific projects withWEDC, LSHTM and PPIAF.• Strengthen Communications and Knowledge Management. Knowledge managementand communication play a pivotal role in the Water and Sanitation Program (WSP).Throughout its 25-year history, the Water and Sanitation Program has createdinformation that orients sector professionals to new and more effective ways of providingaccess to safe water and sanitation services. Committed and proactive engagement withgovernment clients at the local level, and knowledge management (KM), advocacy, andpromotion of new thinking globally position WSP as a key player in the water sector.As part of its global communications and knowledge management strategy endorsed bythe WSP Council in 2006, WSP will, in the context of the sanitation medium-termstrategic framework: a) better understand the information needs and preferences ofWSP’s target audiences in the area of sanitation; b) Institutionalize quality for improvedcommunication and KM sanitation outputs; c) Improve information sharing among WSPstaff and key stakeholders in the area of sanitation. For WSP’s primary counterparts—government officials and sectoral decision-makers—WSP’s field-based communicationactivities will work to: a) complement and support WSP technical efforts in the area ofsanitation to influence sector policy and promote inter-institutional alliances to achievecommon objectives; b) provide opportunities for effective dialogue and exchange ofinformation and best practices on sanitation issues; c) position WSP as sector advisor andknowledge center in the area of sanitation.29