Scaling Up Rural Sanitation A Case Study from the World Bank’s Science of Delivery Team Sarah Glavey & Oliver Haas DSAI Conference November 2015

Why do development projects succeed and fail? Case study about how the Indonesian government successfully scaled up rural sanitation services to address the needs of 25 million people between Our goal in writing the case study was to understand the how? and why? Context: building state capacity for implementation of development projects, programmes, interventions

Impact National Level: Rural people without access to improved sanitation down from 64% to 54% (2002 – 2012) Rural residents engaging in open defecation down 49% to 31% ( ) Diarrheal and parasitic diseases Provincial Level (East Java) A RCT of TSSM programme in East Java in 2013 showed 30 percent decrease in childhood diarrhea Funds used earlier for providing hardware subsidies fell to zero National Level: 25 million additional people gained access to sanitation in rural areas ( ) ++ health outcomes, ++ quality of life Provincial Level (East Java) From January 2007 to December 2010, TSSM project invested $3 million $1.7 million in local government investment $7.8 million household investments. Average annual district investment in TSSM was $8.53 per beneficiary. Sanitation entrepreneurs: 15,000 latrines, $1.3 million earnings Improved sanitation coverage in East Java X 10 national average

Science of Delivery How? & Why?

Problem Driven Iterative Adaptation XReproduce external solutions considered ‘best practice’ in dominant agendas Xpre-determined linear processes Xtight monitoring of inputs and compliance to ‘the plan’ Xtop down, assuming that implementation largely happens by edict Andrews, M., Pritchett, L., & Woolcock, M. (2013) Solve particular problems in local contexts create an ‘authorizing environment’ for decision making that allows ‘positive deviation’ and experimentation active, ongoing, experiential learning and iterative feedback of lessons into new solutions engage broad sets of agents to ensure reforms politically supportable and practically implementable

The Case Study Literature review: project docs, formal evaluations, internal notes Key informant interviews Identification of how and why gaps Research questions and interview questions 30 interviews carried out in Indonesia 2014 (national, provincial, local gov, NGOs, WB) Key concepts: Pain point, feedback loop, inflection point, adaptation, organisational change, behaviour change Causal mapping Additional interviews and write up

Case Study Process Overview

The Challenge The Development Challenge 2 of 4 leading causes of under-5 mortality: diarrhea and typhoid 11% of children in Indonesia suffer from fecal-borne diseases in any two week period. More than 33,000 children die each year from diarrhea, and another 11,000 die from typhoid 54 million people practice open defecation (WHO/UNICEF 2012). In rural areas just 46% of people have access to improved sanitation 31% still regularly engage in open defecation (WHO Global Health Observatory 2012). Indonesia lost $6.3 billion in 2006—equivalent to 2.3% GDP (World Bank 2008). Education and Gender equality outcomes MDGS: Worldwide 2.1 billion people have gained access to improved sanitation. Despite progress, 2.4 billion are still using unimproved sanitation facilities, including 946 million people practicing open defecation. SDGS: 6.2 Access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations 6.a Expand international cooperation and capacity-building support to developing countries in water- and sanitation-related activities and programmes 6.b Support and strengthen participation of local communities in improving water and sanitation management Indonesia’s Delivery Challenge More than 100 million of Indonesia’s 250 million people still lack access to improved sanitation (World Bank 2012) The scale of the need dwarfed Indonesia’s ability to deal with it. Population growth and lack of effective large-scale rural sanitation programs led to a decline in rural access to sanitation, from 43 percent in 1985 to 37 percent in Investment in infrastructure and subsidies, had failed to achieve results. An estimated $600 million in annual investment during 2005–15 was needed to achieve MDG targets Just $27 million a year invested by government in the sector over the previous 30 years, mostly urban. The government needed to increase private investment and find new mechanisms for delivering services at scale, particularly poor people living in a range of dispersed geographical locations across the country’s 17,000 islands.

Mapping Key Moments ConceptExampleWhat Happened Next? Pain pointFailure of subsidies Demand without supply Search for new ideas- CLTS Develop TSSM Feedback loopSuccess of CLTS in East JavaScale Up to 5 provinces Inflection pointDistrict heads to opt in to TSSMDistrict investment and commitment Adaptation/refi nement Development of TSSM to tackle supply Mason training to entrepreneur training Sanitation entrepreneurship APPSANI Organisational change Coordinating group WASPOLA WSP and gov social marketing capacity STBM national policy 2011 Gov capacity increased National scale up underway Behaviour change CLTS Key community groups ODF status Champions at all levels

Insights into How and Why SoD ConceptsInsights/Examples Adaptive Implementation CLTS was adapted TSSM developed and adapted Ongoing adaptation Focus on citizen outcome 25 million people gained access to rural sanitation services Buy in at all levels to ODF vision Multidimensional response Coordinating group – WASPOLA Bupatis wives, local religious leaders Evidence for results Started with field trial but planned for scale – pilots through existing programmes Use of data to gain champions at all stages ‘seeing Is believing’ Leadership for Change Policy and engagement at national, district, local levels Buy-in to workshops at local level Behaviour ChangeParadigm shift investment in subsidies to investment in behaviour change/health worker training Negative reinforcement, positive reinforcement

Why do development projects succeed and fail in achieving impact? ‘People do not just receive policies and implement them directly, but rather they go through a process of trial, learning, iteration and adaptation in their incremental attempts to improve development outcomes… Active learning through real-world experimentation allows us (all of us working in development) to learn from the ‘small-step’ interventions we pursue to address problems (or causes of problems). This experimentation does not involve (always) performing a scientific experiment where the context is suspended and the intervention is not allowed to change or vary over the life of the experiment. Rather, it is about trying a real intervention in a real context, allowing on the-ground realities to shape content in the process. This requires seeing lessons learned as a key emerging result. The necessary experimentation processes require mechanisms that capture lessons and ensure these are used to inform future activities’ Andrews, M., Pritchett, L., & Woolcock, M. (2013)

Thank You Acknowledgements: Oliver Haas, WSP, all who were interviewed The Global Delivery Initiative links development practitioners who are interested in sharing development experiences and lessons that focus on implementation and results. Case Study Library: