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

2 Which is more dangerous?

3 The challenge of meeting the sanitation Goals

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5 Population without access, rural and urban 0.6 billion 2.0 billion

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The International Year of Sanitation

8 Diarrhea disease burden by age Source: DCPP2

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

10 In sub-Saharan Africa, a baby’s chance of dying from diarrhea is more than 500 times that of a child in the developed world. The International Year of Sanitation

11 Fecal contamination is the main source of diarrhea infections …. Feces Future Victim Fluids Fingers Flies Fields/ Floors Sanitation Food HygieneWater supply

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

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14 Additional Child Deaths from Diarrhea Source: Dying for the Toilet, WaterAid, 2006

15 Water and Sanitation Twin Sectors? WaterSanitation

16 Current World Bank WSS Portfolio Total current World Bank WSS investments US$ 14.4 billion Total World Bank investments in Basic Sanitation only: US$ 2.5 billion Percentage of World Bank investment in Sanitation 17%

17 Underlying Factors of the Sanitation Challenge n Little demand at the household and community level for improved sanitation n Limited supply of sanitation-related products and services from both the private and public sectors n Lack of clarity regarding roles and responsibilities within government, and among the public and private sector, households, and communities n Nonexistent, unclear, or even counterproductive public policies that create real constraints to scaling up promising approaches n Lack of credible and useful data regarding costs and lessons learned from projects and approaches that are reported to be successful and effective n Inability to scale up the small scale “islands of success.” mostly implemented by NGOs n Lack of political interest and will

18 What About Sanitation? n “To the people of poor nations, we pledge to work alongside you to make your farms flourish and let clean waters flow; to nourish starved bodies and feed hungry minds”. Presidential Inaugural Address Barack Hussein Obama

19 Open DefecationFixed place Defecation Cost Simple Pit Improved Pit Pour Flush Not Acceptable Sanitation Ladder JMP

20 Digging Deeper into Africa Sanitation MDGs

21 Sanitation Ladder Progress in 18 SSA Countries the last 10 years Sample of 18 countries: Benin, Burkina Faso, Cameroon, Chad, Ethiopia, Ghana, Guinea, Kenya, Lesotho, Madagascar, Malawi, Mali, Mozambique, Nigeria, Rwanda, Senegal, Tanzania, Zambia Averages calculated for each country based on different number of years in the period from 1995 to 2005 Source: AICD DHS/MICS Survey Database, 2007

22 Gains in access across 18 SSA Countries by income group Population weighted averages Source: AICD DHS/MICS Survey Database, 2007

23 Current access patterns across SSA across income quintiles Population weighted averages Source: AICD DHS/MICS Survey Database, 2007

24 Digging Deeper into Africa Sanitation MDGs n How does the sanitation challenge differ across countries in Africa? n Large variation across African countries in their current patterns of access to sanitation

25 VIP toilet coverage by country Population weighted averages, latest available year Source: AICD DHS/MICS Survey Database, 2007

26 Traditional latrine coverage by country Population weighted averages, latest available year Source: AICD DHS/MICS Survey Database, 2007

27 Open defecation by country Population weighted averages, latest available year Source: AICD DHS/MICS Survey Database, 2007

28 How does the sanitation challenge differ across countries? Four country groups emerge - Countries dominated by open defecation - Countries dominated by traditional latrines - Countries where improved latrines are on the rise - Countries where both flush and traditional latrines are increasing n Policy implications differ substantially

29 Prevalence of open defecation n Benin n Burkina Faso n Chad n Ethiopia n Niger Population weighted averages, latest available year Source: AICD DHS/MICS Survey Database, 2007 Key policy challenge is large scale behavior change at first rung of the ladder

30 Prevalence of traditional latrines n CAR n Cote d’Ivoire n Congo (Brazza) n DRC n Guinea n Kenya n Malawi n Mali Population weighted averages, latest available year Source: AICD DHS/MICS Survey Database, 2007 n Mauritania n Mozambique n Namibia n Nigeria n Sudan n Tanzania n Uganda n Zambia Key policy challenge is how to finance upgrading of traditional latrines

31 Rising improved latrines n Cameroon n Comoros n Gabon n Ghana n Lesotho n Rwanda Population weighted averages, latest available year Source: AICD DHS/MICS Survey Database, 2007 Countries with lessons to share on how to expand access to improved latrines

32 Flush toilet and Traditional Latrine but missing Improved Latrine n Senegal n South Africa n Zimbabwe Population weighted averages, latest available year Source: AICD DHS/MICS Survey Database, 2007 Key issue is to expand the middle ground and bridge the gap between disparate groups

33 Moving from Open Defecation to the bottom rung of the Sanitation Ladder during the last 10 years Population weighted averages Source: AICD DHS/MICS Survey Database, 2007

34 Population weighted averages Source: AICD DHS/MICS Survey Database, 2007 Moving Up the Sanitation Ladder to the second rung in the last 10 years

35 Moving up to the third rung of the latter over the last 10 years Population weighted averages Source: AICD DHS/MICS Survey Database, 2007

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37 Sanitation promotion Sanitation marketing Hygiene promotion Community organization Monitoring & Evaluation Infrastructure Political leadership National Sanitation policies Sector reform (roles and responsibilities) Institutional strengthening Human resource capacity building Financing sources and strategies Software Enabling Environments for Scaling Up Sanitation Sustainable, Effective and Large Scale Latrines Pour flush toilets On-site septic systems Simplified sewer collection Conventional sewers

38 Fundamental Components for large Scale Sustainable Sanitation Programs

39 Promsing Approaches in Rural Sanitation Community-led Total Sanitation (CLTS) showing never-before- seen rate of access gains in >30 countries Sanitation Marketing drawing in private sector enterprise and large- scale household investment levels Potentially, these approaches could answer the challenge of the Sanitation MDGs?

40 Open DefecationFixed place Defecation Cost Simple Pit Improved Pit Pour Flush Not Acceptable Sanitation Ladder JMP

41 Programatic ENABLING ENVIRONMENT POLICY, STRATEGY & DIRECTION INSTITUTIONAL ARRANGEMENTS PROGRAM METHODOLOGY IMPLEMENTATION CAPACITY AVAILABILITY OF PRODUCTS AND TOOLS FINANCING COST-EFFECTIVE IMPLEMENTATION MONITORING & EVALUATION Policy, institutional and financial environment that enable PROGRAMS to create mutually self-sustaining growth of DEMAND for, and SUPPLY of improved sanitation

42 Short-term (1-6 months) n Develop cost-effective implementation program n Build availability of products and tools n Launch policy development process Medium-Term (7-12 months) n Strengthen institutional arrangements a LGA level (stronger implementation team) n Develop National Rural Sanitation Plan Long-term (13-36 months) n Develop robust national M+E system, stronger data collection n Develop national guidelines for implementing rural sanitation program. Action Plan for Strengthening Enabling Environment in Tanzania

43 Measuring EE improvements planned for in Tanzania

44 Summary: Key Elements of Effective Approaches to Addressing Sanitation n Create real demand for improved sanitation n Improve the availability of supply for sanitation options that respond to the demand n Create effective financing mechanisms including subsidies for the poor n Implement effective hygiene behavior change interventions n Develop large scale national/regional programmatic approaches n Help to create an enabling environment for sustainability at national and local government levels n Develop effective M&E systems

45 The “TWIN” WSS Sectors? Which One is Sanitation?

46 Thank You For more information: Eddy Perez