The Evolution of Sanitation throughout International Development
There is no accepted formula for development; only through trial-and-error do development programmers and implementers see what works. Assessments are further complicated because of differences between field sites. However, when international development began to take off in the 1960s, this was unknown to development practitioners of the World Bank, United Nations, and nonprofit organizations. For program effectiveness, accounting for many variables including—but not limited to—religion, gender, economics, customs, social status, geography, education, is necessary. Also, the community must buy-in to a program. However, many Western development theorists and practitioners initially thought if developing countries were provided Western technologies and policies they could develop the same way that their countries did. The first development decade proved otherwise when many implemented programs were upon evaluation were found to be largely unsuccessful. Since then, development approaches have evolved, especially throughout the International Drinking Water Supply and Sanitation Decade. This evolution in development approaches has had an impact on strategies to achieve total sanitation throughout developing countries.
The Beginnings (1960-1980)
After many countries in Africa and Asia became independent throughout the 1940s, 50s and 60s, international agencies—then dominated by developed countries—stepped in to offer counsel to the former colonies. The approach for international development during this time was very top-down and technical. International agencies like the United Nations, World Bank, and other NGOs told the governments how to develop and began assisting them with technical support that in theory would help the communities. For the most part, developing governments did what they were told in order to receive funds and assistance. One strategy for development was making improvements to the water and sanitation sector where countries were in dire need of assistance. UNICEF took special interest in this sector during this time because of the realization that “child health was dependent on safe water supply and sanitation” (Beyer, 1987:9) Their efforts in collaboration with WHO began in 1946 and were scattered throughout rural areas in a few countries. In an assessment of their work from 1946-1967, UNICEF admitted that these first efforts were more for “gaining technical experience for the UNICEF field offices than to providing a lead in the development of national policies and programs for water supply and sanitation” (Beyer, 1987:9).
Technological innovations, especially in borehole well drilling to access water supply, made it possible for many urban and rural communities to have clean, safe drinking water. Throughout the 1960s and 70s, international organizations and governments installed thousands of boreholes and hand pumps. Unfortunately, without community buy-in and technology transfer on how to maintain and fix these new wells and hand pumps these governmental gifts fell into disrepair. For example, in 1965, UNICEF assisted West Pakistan with the provision of water to a thousand rural communities; but, this led to the overextension of the public health engineering department’s resources and the equipment UNICEF donated was left unused (Beyer, 1987: 9). Development agencies would also learn the same lesson with sanitation. Initially, it was the case that sanitation programs were less emphasized and implemented separately from water supply, but implementers quickly learned that attempts to bring water supply without addressing sanitation were futile, though funding streams for the latter did not always reflect this.
Consistent access to water supplies also allowed nomadic communities to settle. But with settlement came unforeseen consequences, including land degradation but most importantly, waste management issues. The practice of open defecation that was once common to nomadic lifestyles was transferred to settlements without the understanding of what this could mean for health. Development agencies then responded by advocating for latrine building, thus equating sanitation with installation of latrines. This approach appeared logical, because bacterial contamination of water supply and foods would decrease, and so would the incidence of related diseases. However, total sanitation coverage proved much more complex. Focusing on introducing ‘hardware’ did not take into account the human or social aspect (Beyer, 1987: 4). As with the case of the hand pumps, latrines too fell into disrepair, failing to reduce open defecation and increase latrine usage. Communities often rejected this new technology for social (both cultural and religious) reasons, economic reasons, and for lack of interest in sanitation because they were neither consulted about their preferences and motivations regarding sanitation nor transferred knowledge about repairing broken latrines and accessing materials. In some cases, latrines became storage or the materials were used for other purposes while people continued to practice open defecation. These unanticipated uses led practitioners to make resolving latrine neglect priority.
The Transition: International Drinking Water Supply and Sanitation Decade (1981-1990)
In an effort to ramp up water supply and sanitation programming in developing countries, the United Nations issued the Mar de L’Plata Declaration of 1977, which declared 1981 to 1990 the International Drinking Water Supply and Sanitation Decade (IDWSSD). By the end of the 70s, development agencies and governments realized their technical approach to water and sanitation was not effective. Beyer, who authored UNICEF’s history in water and sanitation from 1946-86 notes,
The old “top-down” type of programming and project implementation left in its wake thousands of unusable costly installations in the form of derelict water treatment plants and broken hand pumps, leaving the communities in the same or worse health conditions as before. The same pertained to the scant efforts to promote environmental sanitation, a subject even less enticing to the communities. A full realization of the need for community participation, combined with the appropriate motivation and education, came about generally, only during the 1970s. This concerns any type of activity, but is particularly relevant to the very basic services of water supply and sanitation, which require concerted agreement and action on the part of the people who stand to benefit. (Beyer, 1987: 53).
The failure of the top-down approach hindered the water and sanitation sector. Sanitation coverage gains in both rural and urban areas increased marginally, but rural areas by 1980 only had 13 percent coverage whereas urban areas had 50 percent (Cairncross, 1992: 7). This large disparity was also reflected in water supply for the two areas.
An illustration of this ineffective approach often comes from India. Latrinization, or the installation of latrines, resulted in failure for India from the 1980s to even now. In 1985 the Indian government launched the Centrally Sponsored Rural Sanitation Program (CSRSP) where they allocated funds to increase the building of Twin-pit pour flush (TPPF) latrines recommended by the World Bank’s TAG (Technical Advisory Group). For residents, however, costs were too high and there was little motivation to build. (UNICEF, 2002: 8-9). Findings from the Government of Andhra Pradesh, which allocated considerable funds to a statewide sanitation program post-2001, show that of the 2.95 million household latrines constructed, 50 percent of the subsidized toilets went unutilized or used for non-sanitation purposes (Moulk and Sanan, 2007: 3). In other Indian states such as Himachal Pradesh and Maharashtra, the latrine usage was 30 percent and 47 percent respectively. Though improved sanitation doubled from 1990 to 2006, India ranks among the countries with the lowest improved sanitation, with coverage at 28 percent (WHO/UNICEF, 2008: 13). Once again, the ‘hardware’-oriented approach failed.
Through evaluations, development agencies began to tease out what did and did not work for water supply and sanitation development. Consensus grew around a more community participation approach to development and health education. In 1979 a female health worker in Pakistan successfully started integrating health education (with special emphasis on child survival) into water and sanitation, and began training teams of men and women called sanitation teams (Beyer, 1987: 5). These programs focused on female involvement especially because women are responsible for water supply and they have the most to gain from adequate sanitation—namely hygiene and privacy. Health education then became mandatory in all programming (Beyer, 1987: 34).
Meeting the goals of the decade would, as UNICEF indicated, require,
the skills and motivation of millions of people—engineers, administrators, public health specialists, hand pump caretakers, teachers, mothers and children. Not only does this carry with it a tremendous need for training. It implies the need for many professionals to adapt their skills and attitudes to local requirements. Some of the more “high-fallutin” engineers, sociologists and others may have to modify their concepts of technology and people considerably (Beyer, 1987: 34).
UNICEF recognized—as others did in water and sanitation development—not only would training for community involvement be required, but also that development planners would need to undergo a paradigm shift for development programs to work. In Zimbabwe, the paradigm shift on sanitation technologies had already begun when the Blair Research Institute developed the VIP (ventilated improved pit) latrine, “an example of a low-cost, ‘appropriate’ technical development” that UNICEF used “on an increasing scale” throughout the decade (Beyer, 1987: 35). By the end of IDWSSD, development agencies increasingly adopted the social mobilization approach to development despite the “tremendous investment in ‘human resources development’ [that] would be required” (Beyer, 1987: 34). No longer would communities be left in the dark about development projects going on in their backyard; they would now get to help plan and implement those projects. From the 1960s through the International Drinking Water Supply and Sanitation Decade, development underwent a transformation from a top-down approach to a bottom-up approach, or sustainable development.
The Sustainable Development Agenda and Sanitation (1990 – Present)
Experiences from the past development decades armed 90s development practitioners with valuable information. Some of the questions and challenges that still needed to be addressed in the shift from “hardware” (technical) to “software” (human resources) included “How are water and sanitation programs to be organized and financed? How can people be trained, organized, and motivated to install, use and maintain the facilities? and How can institutions develop the sector further and make improvements more sustainable?” (Cairncross, 1992:1) By 2000, many of these questions were at least addressed or answered. “Software” development, increasingly incorporated in many program, became the foundation for the Participatory Hygiene and Sanitation Transformation (PHAST) initiative of the World Health Organization (WHO) and joint United Nations Development Program (UNDP) and World Bank program. The major push for financing would come from the initiation of the Millennium Development Goals in 2000, a collaborative effort of governments, multinational organizations, private sector, and nongovernmental organizations (NGOs). However, despite the triumph over old challenges and increased knowledge, there are still many roadblocks and challenges to address.
The PHAST approach of the 1990s.
Hygiene Education and community participation were emphasized, if not fully integrated, throughout water and sanitation programs by the 1990s. In 1993, WHO and the World Bank-UNDP Joint Monitoring Program took these effective approaches to sanitation and created the PHAST Initiative (Participatory Hygiene and Sanitation Transformation). This program was “designed to promote hygiene behaviors, sanitation improvements and community management of water and sanitation facilities using specifically developed participatory techniques” (WHO/World Bank-UNDP, 1997; v).[1] Sanitation had been hard to promote because people could not see or understand the health benefits of it. The underlying principle governing the PHAST Initiative was that “no lasting change in people’s behavior will occur without health awareness and understanding”; better hygiene and sanitation will only be adopted if people believe it “will lead to better health and better living” (WHO/World Bank-UNDP, 1997; 2). For an effective PHAST, the program needed to involve all members of society (children, adults, men, women, different classes/social status, extension workers). The participatory process had to allow people to: “assess their own knowledge base; investigate their own environmental situation; visualize a future scenario; analyze constraints to change; plan for change; and finally implement change” (WHO/World-Bank-UNDP, 1997; 2). Kenya, Uganda, Botswana and Zimbabwe were the first countries to carry out the 18-month pilot program. The pilot phase yielded positive results: communities actively participated, the participatory method sparked latrine building and hygiene practices, extension workers became better equipped to work with communities, among other positive outcomes. Despite the success of the PHAST pilot program, the three-partner organizations left the initiative behind by the end of the 1990s. However, by the end of the 90s a similar approach to participation would emerge and sustain itself into the next millennium. This approach was called Community-Led Total Sanitation.
Community-led, demand driven: The new millennium.
Community-Led Total Sanitation (CLTS), a current development approach used in sanitation, takes into account both consumer demand and community involvement. The overall premise is self-help. Kamal Kar, who worked as an evaluator for Water Aid, developed CLTS after working in Bangladesh on an evaluation of Water Aid’s project with Village Education Resource Centre (VERC) from 1999 to 2000. In an interview with author of The Big Necessity, Rose George, Kar said he was called on to evaluate this project because WaterAid “couldn’t understand why its Bangladeshi branch had been building latrines for years, but 40 percent of the country’s illnesses were still the excrement-related kind” (Kar quoted in George, 2008: 187). Kar believed that the question to resolve was not a matter of why the hardware subsidies were not working, but instead why open defecation was still occurring (Kar quoted in George, 2008: 187). Similar to the PHAST approach, CLTS places power in the hands of the community through a process called “participatory rural appraisal,” where villagers develop a map of their area during a walkthrough and on that map they mark where open defecation has occurred while adding to a running calculation of how much excrement their community is producing without disposing of it properly (George, 2008: 189; Kar and Chambers, 2008: 27). The objective of CLTS is to become ODF, or open defecation free, by triggering a feeling of disgust amongst the community about their unsanitary surroundings (Kar and Chambers, 2008: 7).
In short, the focus of CLTS is to change sanitation behavior instead of constructing toilets or using hardware subsidies (Kar and Chambers, 2008: 7). According to Kar “CLTS is driven by sense of collective achievement and motivations that are internal to communities, not by external subsidies or pressures” (Kar 2008: 9). , Kar and others point out where CLTS is implemented, communities can undergo a number of different social changes, including increases in women’s rights, increased school attendance particularly among girls, increased interest in food securities, and other social goods. Kar notes that general sanitation campaigns can also be effective; however, they must emphasize ‘community empowerment’ over ‘target achievement’ (Kar and Chambers, 2008: 11). Kar argues that history of hardware subsidies in an area can be a barrier to CLTS triggering, because if a government subsidy program exists or had, a subsidy becomes the expectation. (Kar 2008: 15-16). Plan International, where Kar works, has observed such difficult triggering processes in their CLTS pilot villages in Bangladesh, Nepal, Tanzania, Ethiopia and Bolivia where the traditional hardware subsidy approach had been used. Nevertheless, many CLTS programs—not just PLAN’s—have seen successful results.
A program similar to the CLTS program in Bangladesh to arise out of India before CLTS made its move to India was the Gram Vikas model created by Joe Madiath who won the 2006 Kyoto World Water Grand Prize, a major award in water and sanitation development. Madiath, also interviewed by George, wanted to focus on sanitation at the community level as opposed to solely the household level because, “it only takes one family without a latrine to pollute all common areas and drinking water” and therefore, defecation though “it is a solitary business…its repercussions are plural and public” (Madiath quoted in George, 2008: 179). Furthermore, he cited increasing water supply access as integral to this process because essentially “there was no point supplying latrines unless he also provided water to cleanse with” (Madiath quoted in George, 2008: 180). Not doing this was a mistake he claimed the government made. Madiath decided that in order to increase latrine usage and access, he “would have [all families in villages] agree to build a toilet and bathroom, and they would all have to agree to pay for it” by contribut[ing] 1,000 rupees ($25) to a common fund” so that there would be “one hundred percent sanitation” (George, 2008: 179-180). Those who continue practicing open defecation are fined 51 rupees, with the report of the transgression receiving half, while the other half is deposited in the village fund (George, 2008: 184).
The Gram Vikas model wanted to fight back against the long held assumption that the poor can’t pay without subsidies but at the same time providing hardware subsidy services. Instead he described the poor’s funding choices as a matter of priorities that he hoped to change. He said, “a toilet is rarely considered urgent when there is food to buy and school fees to pay, even when the lack of a latrine contaminates the food and makes the children too ill to go to school” (George, 2008: 180). Though progress has been somewhat slow—361 out of 50,000 villages in the Orissa project area have 100 percent sanitation (George, 2008: 184). The Gram Vikas project has undergone some “sanitation contagion”, which means “the more villages that join, the easier it gets” because news of the benefits spread (George, 2008: 183).
It has taken over five decades to reach the point where addressing sanitation begins with community effort and is driven by demand. In part 2 of my thesis, I discuss how the laws of supply and demand figure into increasing the widespread adoption and availability of latrines.
For more facts about sanitation, visit this World Health Organization slideshow
