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‘Last Mile’ groups are those who are not currently reached by sanitation and hygiene programmes (or not able to sustain improved sanitation and hygiene behaviours) due to challenging contexts they live in or because they are vulnerable in some way. In this workshop, participants identified the ‘Last Mile’ in East and Southern Africa as populations with:

  • Technical challenges (rocky and sandy soils, high groundwater, water scarcity, remote locations, lakeside/beach communities, disaster-prone);
  • Cultural challenges (beliefs/taboos/practices that prevent or limit latrine use/sharing);
  • Social challenges (exclusion/marginalisation, gender issues, disability and lack of labour, pastoralists, mental health issues)
  • Low social cohesion (seasonal fishing communities, peri-urban, small-scale miners)

Recommendations for reaching the ‘Last Mile’ include:

  • Improve efforts to identify the ‘Last Mile’ – this should include collecting information on disease burdens amongst these groups and associated costs of inaction to help advocacy efforts. 
  • Advocate for and develop more inclusive systems and processes, for example:

 - Recognise the ‘Last Mile’ in policies, guidelines and programme processes;
 - Allocate human resource capacity and budget to reaching the ‘Last Mile’;
 - Promote effective coordination between government and partners to ensure resources are spread across the country and certain regions to enhance coverage and reach;
 - Develop specific strategies for hard to reach groups (consider regional strategies where the issues are similar and local solutions are limited);
 - Work with specialist organisations that are already familiar with the relevant issues, and know how to communicate and work with vulnerable groups;
 - Monitor progress and outcomes in ‘Last Mile’ groups;
 - Ensure that ‘Last Mile’ groups are targeted in follow-up visits;
 - Share lessons, case studies and innovations.



There has been little movement up the sanitation ladder in the region, with some people stuck using unimproved and unhygienic toilets. Sanitation marketing has seen some pockets of success, but there are no clear examples from the region of successful or large-scale market-based sanitation initiatives. Sanitation marketing has received little government support, with few incentives for the private sector to accelerate the pace of change. Those reached are often not the poorest or most vulnerable. A step change is required in the region.

Recommendations for moving up the ladder include:

  • Sequence rural sanitation initiatives based on good analysis of community needs and demand. Affordable options must be available to capitalise on household demand, because it could be difficult to introduce improved toilet options later in the process.
  • Promote different options to move up the sanitation ladder, which are targeted to the various market segments.

 - Improvements can include incremental upgrades to existing, unimproved toilets using locally available solutions, and based on ability of households to pay.
 - Local solutions to make toilets accessible for people with disabilities or older people should also be promoted. 
 - Develop options for hygiene and services down the sanitation chain
 - Improve affordability, including effective finance solutions that reach many, and the least able.



Most governments in the region support a no-subsidy approach to CLTS, as evidenced by no-subsidy clauses in national policies and strategies. Challenges remain however that could delay the achievement of the SDGs. Most countries have limited budgets allocated for sanitation (and are over-reliant on donor funding), and there are not enough staff with the necessary capacity to ensure that all communities are reached, and that regular follow-ups and long-term support are provided. Although coordination mechanisms exist in many countries, the effectiveness of these mechanisms varies, with some functioning well at the national (policy and regulation) level and less well at the implementation (sub-national) level, and vice-versa. These challenges affect ongoing monitoring, and limit the reach of sanitation programs.

Recommendations to strengthen Government Systems include:

  • Support governments to create an enabling environment for businesses to accelerate the scale of sanitation marketing, and lower the cost of materials. Market-shaping activities that connect the private sector to demand could also be explored.
  • Use evidence like budget briefs or costed analyses for institutional triggering to advocate for increased sub-national and national government budget. Where funding is available at sub-national level, this can be leveraged for planning, human resources development, implementation and ongoing monitoring.



There are a number of monitoring and evaluation challenges identified in the region, for example, Government monitoring systems rarely collect information on gender, disability, poverty or other indicators related to ‘Last Mile’ groups. Also when it data is collected Government monitoring systems face challenges related to scale, finance and data quality, reliability and timeliness. Also project monitoring systems may incorporate more disaggregated indicators but are not always aligned well with government systems. A fundamental issue across the region is that the sector does not prioritise learning from past efforts.

Recommendations to improve monitoring, evaluation and learning include:

  • In the region, there is a need for an alignment of indicators (across government, development partner and international systems) to enable better use, aggregation and comparison of data, and to align with SDG indicators.
  • Strengthen the quality of monitoring systems to include equity, gender, moving up the ladder (results including failures and reach), and more systematic post-ODF sustainability monitoring. This will require both planning and budgeting.
  • Process monitoring (e.g. of capacity, resources, use of systems) is important for data reliability. Systematic spot checks on the accuracy of the data collected are recommended.

Download the workshop learning brief in English and French