It’s my 5th WEDC conference! This year the conference is in Hanoi, Vietnam co-hosted with the National University of Civil Engineering. WEDC Conference is a key international meeting attended by WASH policy and programme staff, academics, activists and experts. The papers will be available on-line shortly (www.wedc-knowledge.lboro.ac.uk) but in anticipation, here are some thoughts from the conference about the research and practice presented.

 In her key note presentation, Isabel Blackett focused on the urban sanitation agenda. Practitioners are working in a very different landscape now from the one operating at the time when sanitation was included as a target under MDG 7 at the World Summit on Sustainable Development in Johannesburg. Even as 2.5 billion lack improved sanitation, technologies no longer takes centre stage as the leading challenge. New approaches have been developed and tried and tested at scale – CLTS and sanitation marketing and variants - have become important as they hold the potential to be delivered at scale. Isabel remarked how, in the last decade or so, we have seen a global sanitation movement, advocacy and dialogue as well as reliable data and monitoring systems have been game-changing for the sector. This recent progress stands in stark contrast to repeated failure to achieve global improvements in access since 1990. Despite the ‘uphill battle’, advocates remained undaunted. We heard how the proposed SDGs hold the potential for historic progress on universal access, with unprecedented statements on the importance of eliminating open defecation as well as increasing access in schools and health facilities. Meeting these targets will require more attention to difficult environments (i.e. high and low density settlements, floating people, inundated areas, people living over water and so forth); inequalities in access (MHM, violence, sanitation for all at scale) and sustaining sanitation services (including faecal sludge management). In many ways the challenge now is how to build on the foundation of what has gone before. And toilets aren’t going to be enough to solve these challenges.

Menstrual hygiene management

Access to sufficient water and sanitation to enable women and girls to manage menstruation in the home, work place, schools, public spaces is central to the dignity, health and well-being of women and girls. We heard how WSSCC has taken a 3-pronged approach to supporting MHM: breaking the silence on a stigmatised and taboo issue; incorporating MHM into the rural national sanitation programme Nirmal Bharat Abhiyan; safe disposal materials. Researchers are expanding the topic further: with aging population, the implications of peri-menopause for WASH needs in low income countries deserves further attention. MHM is one of the areas where WASH practitioners are working with multiple stakeholders and partners outside the sector, for instance sexual and reproductive health experts as well as education actors. 

Sanitation approaches

The sector has seen a shift in focus from technologies to service delivery to enabling active processes, to questions about who has access and how effective and sustainable programmes can be delivered at scale in practice. GOAL’s CLTS project (2008) in Sierra Leone was initially successful but found ODF slippage rate close to 30%, over 4 years. Slippage was a result of dissatisfaction with the quality of latrines and lack of access to markets for improved sanitation hardware. It was reported that slippage appears to be increasing over time but the extent of slippage is unclear. In response GOAL initiated a sanitation marketing project in 2013 that aimed to improve access to the market; products were developed and branded with high sales in the first 3 months but affordability and remoteness remained issues. On a similar theme, some of the successes and challenges for rural sanitation in Vietnam were also highlighted in this session. A study of sanitation supply chain in north-west Vietnam revealed that in low density rural setting with high rates of poverty, toilet coverage is lower. These areas also experience the highest costs of sanitation products due to impact of distance and transport costs. More attention is required to ensure equitable outcomes in remote rural (remote, low density, ethnic minorities) contexts. The examples highlight the potential of cottage industry with affordable products that would help mitigate transportation woes, particularly in low-density rural areas, where simple things like bringing products to market are a challenge.

Side Event: How can CLTS be improved? Scaling up, cost-effectiveness and sustainability

The side event generated a discussion on the findings from the ODF sustainability study undertaken by Plan International in Africa as well as the ongoing research such as the Testing CLTS Approaches for Scalability in Ethiopia, Ghana, and Kenya. Isabel Blackett’s key note reminded us of the neglected status of sanitation; one of the ways to turn around the marginalized status is to demonstrate the positive impacts. One of the many interesting points made in Jonny Crocker’s presentation on project partnership between Plan International and the Water Institution at the University of North Carolina on ‘Testing Community-led Approaches for Scalability’ was to highlight cases found in the grey literature on CLTS where the literature reaches conclusions that cannot be justified by the methods – especially on the health benefits.  Positive thinking, inflated claims and overly simplified narratives, are not a sound basis for programming or policy making. Perverse incentives can lead implementing agencies and those who should know better to produce celebratory discourse, perhaps the result of the pressure to over-claim results and impacts or else through inadequate reporting/verification systems. At worst, such claims undermine the interests of the very people intended to benefit from an expansion in the use of sanitation and raises further questions about the effectiveness of such approaches. It is right then to expert challenge and critique and be open and honest about when things go wrong, fix and learn from them. By re-focusing on core values and core capacity, we can continue to improve the way we work and the impact we have. For academics, the obvious response is to continue to improve the quality and the relevance of the data in order to eliminate bias and conflicts of interest and further our understanding of the precise causal role/impact that sanitation can have. This project is intended to collect, critically evaluation and disseminate practice lessons about implementing CLTS at scale. But we still have a lot to learn about the best way for research to have impact on programming and policy and mobilise action.

Sue Cavill is an independent WASH consultant.