Life on the beach – the stunning location of the AfricaSan 4 Dakar conference, in a grand hotel perched on the Senegalese coast, was not enough to distract the participants of the IDS CLTS sharing and learning workshop from their task. As usual, the workshop was held the day before the main AfricaSan conference to profit from the gathering together of so many experienced WASH professionals. The event proved almost too popular – something like 90 participants turned up – making it quite challenging and time-consuming to capture and discuss the diverse views of the large group. One of the ice-breaking activities, in which participants had to position themselves in a global map in relation to Senegal, showed that the WASH practitioners and experts present had travelled from the USA, from Europe and from all over Africa, from South and South-East Asia, and even one person from Australia!

Sustainability was high on the agenda of most participants. Social, technical and institutional sustainability were discussed in detail, with Kamal Kar arguing strongly that institutional sustainability – ensuring that governments have policies, strategies, capacity and budgets that support CLTS and enable long-term sanitation improvement – was more critical than the other areas. In his words, without the government budget and support, the technical and social approaches will never be scaled up or sustained.

Many of the discussions at the sharing and learning event were on familiar issues, but a few issues stood out.

Is sanitation marketing effective in reaching the poor?
Despite recognition that sanitation marketing is a growing and important component of sanitation improvement, several participants asked whether sanitation marketing is effective in reaching the poor, and whether microfinance is relevant in poor African countries where even productive loans are difficult to sell. It was suggested that the products promoted by sanitation marketing remain unaffordable for many, and that genuinely poor households often struggle to take out toilet loans. One participant from Cambodia, the home of two of the most successful sanitation marketing projects in the world, went as far as to suggest that sanitation marketing producers “profit from the poor” by promoting expensive facilities, and convincing poor households to sacrifice other spending priorities in favour of toilet purchases.

There wasn’t enough time to discuss these issues in detail during the session, but I question whether these poor households are forced to purchase the toilets, however powerful and effective the demand creation activities. And I would hope that the toilets installed bring many benefits to the user household. Nonetheless, the point is pertinent – too many sanitation marketing interventions end up promoting products that are expensive for poor households – our target group, as this group usually includes those with the highest disease burden. Formative research and human centred design processes seem to lead to the production and promotion of aspirational products, often influenced by expectations raised by subsidized facilities provided by previous projects.

As far as I know, few genuinely affordable products have emerged from sanitation marketing efforts – products that cost less than USD 10, which poor African and Asian households might consider purchasing to upgrade or improve their simple toilets. This may explain why few sanitation marketing programs have gone to scale – I know of several well-designed programs that have sold fewer than 100-200 sanitation products after 3-4 years of expensive research and development.

The SaTo flapper pan developed by American Standard costs only USD 1.50 to manufacture (with local manufacture now being developed in Uganda and Nigeria), and offers the first glimpse of an affordable and desirable sanitation product, which might be attractive to national wholesalers and local suppliers. Until we see more of this sort of truly low-cost and innovative product, I question whether sanitation marketing will have the impact that we all hope to see?

Why are ODF success rates so much higher in Africa than in Asia?
The participants were asked to share any information available on ODF success rates in their countries – the number of communities triggered, and the number currently verified to be ODF. Numbers were provided from seven different countries, although most were partial data collected by specific programs (including data from Global Sanitation Fund programs in four countries).

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The first striking feature of the data presented was the scale and reported success rate of the GSF Madagascar program: more than 12,600 communities triggered, and an 87% ODF success rate, resulting in nearly 11,000 ODF communities. While an impressive achievement, and reinforced by a strong and positive presence by the Government of Madagascar at the AfricaSan conference, these data inevitably raise questions over the speed and efficacy of the achievement; the quality of the verification processes; and the risk of sustainability problems in this huge, new ODF population. As Robert Chambers noted, the lesson from India, where premature claims of large-scale success (since disproved by the 2011 Census data) have significantly undermined sanitation efforts, should remind us that reliable verification processes, and regular checks on the quality and effectiveness of these processes, are critical in building confidence in ODF outcomes. Furthermore, while some studies have suggested that rapidly achieved ODF outcomes tend to reflect genuine and sustainable processes, the sheer scale of some of these achievements will present significant challenges to monitoring and support systems in these countries.

The second interesting feature was the much lower ODF success rate reported in Cambodia. The five African countries reported ODF success rates ranging from 46% to 96%, with even the lowest African country (Nigeria) reporting almost double the 25% success rate found in the GSF Cambodia program. These data seem to confirm that ODF success rates are much higher in Africa than in Asia – a 2012 regional CLTS study in the East Asia and Pacific region found that ODF success rates ranged from 4% to 36% (with Cambodia reporting the highest rates in the region).

When CLTS was first spreading in South Asia, in the early to mid-2000s, many African sanitation stakeholders refused to believe that CLTS was suitable for Africa – it was suggested that CLTS only worked in Asia because of the higher population densities, and that triggering effects were particular to the social and cultural contexts found in Asia. Today, we are starting to see the opposite – that CLTS may be more successful in Africa, perhaps because simple pit latrines tend to be more acceptable and appropriate in poor African communities than in Asian communities (where pour-flush toilets and washing after defecation are often preferred). More work is required to be sure that the impressive ODF gains made in Africa can be sustained, as several countries already report high levels of reversion to open defecation. Which brings us back to the sustainability discussion!

IDS AfricaSan session on CLTS and sustainability
The IDS session on CLTS and sustainability attracted a large and attentive audience. Matt Bond (FH Designs) presented on the learning from disseminating the findings of a four-country study on ODF sustainability. Matt suggested three elements had been important to their knowledge management strategy:
• Crowding in
• Planning
• Collaboration

Crowding in concerns the involvement of key stakeholders, including the country project teams and communities, in the process. The aim is to avoid an extractive process, whereby outsiders come in and generate learning that is then shared with the donors and project managers, without much effort to share this learning with those who did the work, or were affected by it. Matt suggested that they deliberately involved a range of stakeholders in the design and implementation of the study, and built in feedback sessions with the country teams and other project stakeholders at the end of the process.

This approach requires explicit planning from the start. Recognition that these sharing and learning activities are important and often require budget, capacity and time, thus need to be designed and scheduled at an early stage of the work. All too often, the focus is on completing the evaluation, and only afterwards do thoughts turn to how best to disseminate the findings.

Matt’s final point was around collaboration. He noted that the ODF sustainability study recruited a panel of peer reviewers, who reviewed the design, implementation findings and analysis, and were involved throughout the process. This collaboration opened the study team to learning and information from a number of other similar studies, which informed and influenced the design and implementation; and also greatly increased awareness of the study, and expanded the networks for sharing and discussing the study findings.

Social norms for ODF sustainability
Mike Gnilo (UNICEF headquarters toilet team) shared an interesting presentation on how social norms relate to ODF sustainability. UNICEF has talked about social norms as an important aspect of CLTS programming for some time, but it has remained – for me, at least – a fairly abstract concept with little information on how it may benefit policy, programming or practice.

Mike elaborated the concept, explaining that where social norms have changed or strengthened the chances of sustained outcomes improve – people are more likely to cooperate to sort out problems, and tend to be more committed to sustaining the new practices or outcomes. A randomised control trial (RCT) on CLTS in Mali found significant benefits in improved sanitation and hygiene practices, and in health outcomes, but also found that people within the ODF communities were more likely to cooperate with each other.

The suggestion was that programming should encourage the formation and strengthening of social norms around improved sanitation and hygiene: creating aspirations for improved behaviours and outcomes; encouraging pledges, plans and other collective commitments; and recognising (for example, through verification) achievements to generate a sense of pride and efficacy in the new outcomes.

Mike explained how this thinking was incorporated into the implementation of a phased approach to sanitation development in the Philippines. Sanitation and hygiene goals were broken down into a series of more achievable steps to encourage the sense of efficacy; and verification of each step required the development of a plan and a pledge to reach the next step, thus reinforcing the sense of progress and aspiration towards the higher (and more valued) goals.

Sanitation finance for sustainability and equity
My presentation on sanitation finance for sustainability and equity, which also draws on experiences from the development and implementation of the phased approach to sanitation development in the Philippines (mentioned in Mike’s presentation on social norms) elicited some interesting questions from the audience.

Several participants asked whether the provision of post-ODF incentives, including financial incentives such as targeted subsidies and conditional grants, might encourage communities to short-circuit the ODF process in order to gain these incentives, with the risk that the outcomes are not sustainable.

Evidence of similar problems is widely available in India, where the Nirmal Gram Puraskar (a higher level award to Gram Panchayats that are verified to be meet a selection of sanitation and hygiene criteria, including ODF status, 100% improved sanitation in households and institutions, solid and liquid waste management, and handwashing with soap) was found to generate a large number of temporary gains (and sometimes fraudulent gains) because of the political and financial lure of the awards. However, the NGP is a different creature – it was a one-off award that required achievement of a large and difficult set of collective outcomes, with few mechanisms to encourage the sustainability of these outcomes after the event.

In contrast, the phased approach to sanitation development includes a series of simpler steps – three steps in the UNICEF Philippines program – that are designed to be easier to achieve, with verification of each step that includes re-verification of the previous step to check sustainability. The second step also includes verification of a community sustainability monitoring system, which must track toilet use as well as what happens to full pits and septic tanks.

As a result of this longer and phased process of monitoring and verification, there are checks that reveal what happens to the post-ODF incentives – whether they are converted into improved outcomes, or not – and whether previous outcomes have been sustained. The process is not just about grabbing the incentives and then stopping, as it encourages communities to work towards higher levels of sanitation and hygiene improvement through a continuous process of support and follow-up.

The phased approach provides a framework for sustained support and follow-up, something which is often lacking where a time-limited project drives the activities. The sanitation finance within the phased approach is then designed to provide incentives to progress beyond ODF, demonstrate to other communities that ODF achievement has other benefits (such as further support and assistance), accelerate progress towards the higher level objectives, and tackle the weaknesses of previous approaches in reaching the poorest and most disadvantaged households with sustainable sanitation and hygiene improvements.

Andy Robinson is an independent WASH consultant.