Today was the start of a three day Regional Learning event in Thailand on scaling up sanitation and hygiene for East Asia and Pacific, jointly organised by WSP, UNICEF, Plan International and WaterAid. Attending are over 60 participants from 8 countries in the region (PNG, Timor Leste, Vietnam, Cambodia, Indonesia, Lao PDR, Myanmar, Philippines).

This meeting builds on the previous learning and sharing of experience at meetings including EaSan III (East Asia Conference on Sanitation and Hygiene, Bali 2012). I have the opportunity to participate on behalf of the CLTS Hub, and will share my reflections in a daily posts in the blog. In this one I reflect on the key theme of the day; operational implications for reaching the poor and vulnerable. 

These are exciting times for sanitation and hygiene in East Asia and the Pacific; on the whole the region has seen a steady decline in open defecation since 1990 and has made impressive gains in access to improved sanitation in both urban and rural areas. The region has also demonstrated many innovations in programming for some of the region’s most vulnerable people, which have been piloted at scale. The hope is that this momentum will translate into universal access. The danger is that currents rates of access fail to be sustained or that people that have stopped open defecation revert back or else fail to move up the sanitation ladder. The challenge is therefore to ensure that change is managed in such a way as to progressively reduce inequalities, improve levels of service, as well as making sure progress is picked up in national and global monitoring systems.

In the morning we learned about regional sanitation and hygiene experience; Cambodia, Lao PDR, Philippines, and Vietnam. In the afternoon this over view was complemented by specific topics: output-based payments to reach the poor, based on the experience of the East Meets West Foundation and practical lessons to address social inclusion and gender equity from SNV’s programmes in the region.

The day began with a security briefing, given the anti-government protests in Bangkok and many of the presentations returned to security in all its guises throughout the day (safety nets, security/collateral for loans, security blankets and comfort zones). The rest of the blog reflects on these themes.

Safety nets

With the World Bank intensifying support to the ‘bottom 40%’, the launch of UNICEF’s New Strategic Plan for WASH in 2014, and SDGs aiming for universal access to sanitation and hygiene, momentum is building to focus on the hardest to reach people at a faster rate.

A number of countries in the region are considering partnering with existing targeting systems (such as country poverty alleviation or social safety net programmes) in order to increase access to improved sanitation for the poorest. For instance in the Philippines, WSP and others are looking at the Conditional Cash Transfer Programmes (4Ps) programme as a potential pathway to scale sanitation and hygiene. The 4Ps was launched in 2008 targeting 3 million households. 4Ps households receive set of cash grants (maximum of $40/month) if they comply with certain health and education conditions. Sanitation and hygiene behaviours could then be added as a ‘soft condition’ to the CCT. Such integration seems like a step forward in terms of reduction and elimination of inequalities and in recognising the multiplicity and integrity of people’s lives and mix of priorities, strategies, influences and activities.

Financial security

We heard that Governments and agencies have been looking for ways to reduce the upfront investment required for sanitation. The region has a number of examples of how programmes and delivery mechanisms have been designed to target the poor through subsidy and incentives. For instance in Lao PDR, Plan International are using a smart subsidy (a targeted time limited voucher) to increase ODF coverage through lowering toilet costs to the most vulnerable households (as identified through government poverty data and community level processes). The subsidy is used within a Community-Led Total Sanitation Approach. In Vietnam, the Vietnam Women’s Union (VWU) operated a large-scale government revolving loan fund program to rural households to pay for latrines. The program was scaled up via the Vietnam Bank for Social Policy across much of Vietnam. In Cambodia, WSP are assessing the potential to introduce a sanitation loan to allow non-poor and poor households to spread payments over time to ease high upfront cash constraints.

The NGO East Meets West Foundation offers rebates of about US$20 to poor and vulnerable households who construct a household latrine that meets Vietnam government hygienic standards. The program uses community-based targeting methods to identify households that qualify for the rebate. The NGO visits every latrine to verify it is complete before the cash rebate is provided.

False sense of security

In general people like guarantees, contracts, assurances, pledges, insurances but we know that gains in sanitation and hygiene behaviour changes don’t come with a lifetime warranty. Gains in access can be sometimes quickly lost, and PNG is one example in the region where progress on improved sanitation is going backwards. Participants also reported that households are reverting after a community is declared ODF. A critical knowledge gap is how to permanently and successfully maintain use of improved sanitation and hygiene practices
 

Safety in numbers

It is already clear that achieving universal access to improved sanitation will depend on more than the accumulated ‘rational’ choices of individuals. Commentators and practitioners alike recognise that an individual’s decision about their sanitation and hygiene behaviour, personal preferences and the possibility of change greatly depend on wider societal norms and values. The session on gender and inclusion was helpful to ground the discussion based on SNVs experience. The region can boast many good examples where woman have leadership positions (indeed some of these leaders attended the event); women have also been recruited and trained as social mobilisers and masons/technicians. Whilst women may be visible at triggerings or in the community, it seems they disappear at the level of decision making on policy and programme or in supply chains (even though they may be ‘assistants’ in family businesses). SNV’s experience has been that men are generally less responsive to sanitation and hygiene promotion in communities and so home visits have been organised. 

A number of the countries represented acknowledged that the poorest people are living in rural areas, in mountainous regions, populated by people from many minority ethnic groups. In these contexts who does the triggering matters since when another ethnic groups triggers it can be perceived as an outside intervention and therefore be less successful.  It was also interesting to hear how it takes time to build field team’s confidence and capacity to ‘walk the talk’ on gender and inclusion issues

Personal security

Some participants raised concerns about the risks of violence associated with sanitation – including a distressing example of the gang rape of a woman in one community when she went out to defecate.  Participants highlighted the potential benefits of improved access but were unsure of practical steps that they could take to reduce vulnerabilities through policy, programming and monitoring indicators. This issue has particular resonance for me at the moment as I am working with Sarah House, Marni Sommer and Suzanne Ferron on a toolkit aimed to shine a light on this problem and encourage practitioners to build their capacity to make WASH safer and more effective.

Secure in the knowledge that …

These Learning Events are intended to accelerate progress in access by shortening the learning curve on what works and what doesn’t in the region. The real challenge - most difficult and most important in this era of evidence and rigour - is to confront what we think we know, learn from others and be willing to stand at the edge of what is familiar and comfortable.