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The majority of the sanitation programs/projects have been mainly supply driven, often with full direct household subsidy, and with little or no community participation. Toilet technologies were predetermined with little understanding of user preferences. This has led to millions of dollars of investments in sanitation not yielding the desired results, as many of the facilities provided were unused or used for other activities. Evidence has shown that demand generation approaches that are user-led, integrate user preferences, and build on user’s motivations have been more successful in ending open defecation and increasing uptake of sanitation. Total Sanitation and Sanitation Marketing (TSSM) approaches have the potential to increase access at scale.
To respond to this challenge, the United States Agency for International Development (USAID) requested a review of the experience with Total Sanitation and Sanitation Marketing (TSSM) approaches and their application to the USAID context. USAID sees the potential in using these approaches to achieve coverage at scale. This document describes the above approaches, assesses their application to rural and urban areas, provides guidance on what it takes to make them successful, and offers recommendations to USAID.