Today I continued to follow the conversation about new directions in the over-all system of international WASH development. There is a lot of talk about changing the way aid business is conducted. But it’s hard to say how all this lofty talk will translate into actually useful change. I sensed some frustration on the part of developing country governmental reps and residents. No one’s talking about power dynamics. I also listened to some interesting sanitation reports.

Session on ‘Beyond “Business as Usual”: Changing Behaviors to Build Sector Systems That Last’. Dominick de Waal (WSP) talked about the many aspects of the Joint Sector Review process, trying to pull together various kinds of information, especially on various types of costs. There is not enough information available on what households actually spend on water. ‘We are trying to persuade governments that poor people actually spend a lot of money on water’.

Some 8 or 9 break-out groups talked about issues with SWA and donor-NGO-government relationships in general. I listened in on a discussion among participants who were mostly from Africa. Some were arguing that donors require accounts from governments who have been signing on to ‘aid effectiveness agreements’ for a long time, but ‘We’re still incurring high transaction costs on small projects’, said Vida Duti, of IRC Ghana. The question came up about SWA, whether it wasn’t just duplicating things already going on. There are too many systems at play, two agreed, with the U.N., NGOs, donors, and so on.

Other groups reported back on their deliberations. These were some comments: NGOs are in competition to appear to be causing big changes (the ‘attribution’ issue). Their funding depends on it.  ‘We need a JSR for donors and NGOs that will change our institutions’. One suggested that NGOs may block the focus on improving governments. USAID was said to be the main perpetrator ‘projectising everything’.  ‘Donors need to have faith in governments’. (This issue of mutual trust/mistrust has come up before at some plenaries.) ‘Strengthening government systems is difficult’. There is a big gap between the actual services being provided by local governments and the information collected at the national level. Better data are needed on what’s happening on the ground. (The monitoring issue, again and again.)

Plenary: Louis Boorstin (Osprey Foundation), A Long Enough Lever: Drivers for change in the WASH System. He started the talk with the quote from Einstein that insanity is doing the same thing over and over and expecting a different result. If we are to achieve sustainable and affordable services, we may need to think about ‘systems’. Our system includes Users, Product and Service Providers, Regulators and Policy Makers, and Funders and influencers

Highlights from the talk – ‘There isn’t enough attention paid to learning’. ‘We need a theory of change’ that includes an understanding of how it all works: Connections among the players, ...The current donor emphasis [on specific results] among funders isn’t compatible with the complex whole-sector approach. ‘Results’ and ‘value for money’ doesn’t measure systems, how to make them work better. ‘Certainty paradigms’ are problematic: It’s assumed that proposers know solutions, and that implementation will work. But ‘sustainable, good quality sanitation services at scale in rural areas’ – no one really knows how to do this. Hygiene is even harder. We don’t know enough about behavior change, and hygiene is all about that. We should recognise that and operate in a way that respects that. ‘If we are to build power into the SDGs, we should spend the first seven years figuring out how to do things better’.
‘If you don’t know how your support is benefitting the ‘system’, you’re not doing your job’. We all need to pitch in. At the top of the system is “governance.”  All players should help this work.

Sanitation sessions, James Fuller (U. Of Michigan) - ‘longitudinal’ study in northern Ecuador, to test effects of sanitation as ‘herd protection’ on child height-for-age z scores. Calculated proportion of houses with improved sanitation within 500 m. radius. Those living in places with many latrines came out better than others, even if their own households didn’t have latrines. New message: sanitation of whole communities, or majority, innoculates residents against problems in much the same way that vaccinated populations protect even those who are not vaccinated.

Geophagy, Environmental Enteropathy, and Stunting in Children in Rural Bangladesh, Jamie Perin & Christine Marie George. Undernutrition is estimated to be a major contributor to over half of young children’s deaths globally. Children are most susceptible to growth faltering during the first two years of life. A contributor is chronic inflammation, caused by environmental enteropathy. Intestinal villi are blunted. Inflammation occurs. Nutrient absorption is reduced. This likely to be the mechanism by which sanitation causes stunting.

Clarissa Brocklehurst Scaling up Rural Sanitation in India: Positive Determinants of Success in Eight Indian States.
Looked at 14 years (2001-2013) of activity by WSP to introduce demand-led sanitation, CLTS and its daughters. WSP also did advocacy with decision makers: support to the enabling environment. This was a desk-based study mainly. Concerned with eight states. The key WSP interventions were these:

• Creating ‘champions’: Highly resource-intensive (study visits etc.); had unpredictable results.
• Increasing awareness among decision-makers: had less influence in the states with low progress across the board (girls ed etc.)
• WSP itself did hands-on training at state and district levels. Often successful but not within WSP’s mandate. This confused people about WSP’s role. People started to perceive them as a training org.

We tried to figure out why it worked (uptake was better) in some places:

1. Local awareness of poor progress resulted in decision makers willing to take action.
2. Opportunities to work in areas that were not the poorest. (We’re learning that CLTS doesn’t work everywhere.)
3. Presence of “local champions”
4. Absence of other development actors helped to reduce confusion, increase focus.
5. Enabling cultural factors: CLTS worked better in tribal communities than in places where there was a lot of caste influence. (I confirmed with her later on. She did say this.)

The 8 states were Meghalaya, Rajasthan, Himachal Pradesh, Maharashtra, Haryana, Jharkhand, MP, Bihar. In the first four, all the above factors were in place. Haryana had a big caste factor, so it wasn’t as good as the first three. Jharkhand and the other last three had almost none of the above.

Conclusions: Indian training institutions have to pick up responsibility for training. Development partners have to work together, coordinate, do what they do best. Everybody doesn’t have to do everything.

Q&A
Jan Willem Rosenboom (Gates Foundation): There’s a lot of non-demand-driven san programming in India now led by the gvt. Have you come away knowing now what to do in places like Bihar?

Clarissa: Our impression was that WSP had tried to introduce bottom-up approaches, and there was some frustration with the government’s top-down, one-size fits all approach. A big loan is sought. It’s likely that the gvt will go with the tried-and-found-to-fail approaches, to get fast coverage results. Changing the subsidy culture isn’t really possible. It’s not just san. WSP is trying to be pragmatic. Looking for some kind of ‘hybrid approach’.

Kamal Kar (CLTS Foundation): Telling them that subsidy can be combined with other approaches won’t work. It has to be either a gold pot or a stone pot. Compromise of local empowerment: WSP shouldn’t move away from that.

Clarissa: We were trying to figure out why it worked in Himachal Pradesh but not elsewhere.

Eddy Perez (formerly with WSP): ‘Technical assistance’ is the WSP’s ‘business model’. Trying to promote iterative learning. Did it work? Clarissa: When they sought new implementation models and tools, it was a factor. Helped gvts figure out how to monitor: identify a gap and find a solution for it. When WSP started to look too much like an implementation agency, supporting triggering, this confused local governments. They complained later that WSP hadn’t come back and finished the job. They didn’t understand the WSP role.

Scaling up Indonesia’s Rural Sanitation Mobile Monitoring System nationally, presented by Deviariandy Setiawan (World Bank).
A government-led and government-funded program of having health workers send back data on local sanitation is providing good monitoring data.
The discussion asked about the quality of the data, considering that India’s programme looked good on paper, but facts were ‘cooked’, not real. The presenter says the facts are checked (but I didn’t catch just how).

Suzanne Hanchett works as a consultant and is a partner in Planning Alternatives for Change