Can WASH deliver more than just sanitation?

This column first appeared on the Guardian’s WSSCC partner zone

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The abysmal state of access to safe water and sanitation facilities in the developing world is currently a major cause for alarm; 580,000 children die every year from preventable diarrheal diseases. This is due largely to the 2.5 billion people around the globe who do not have access to safe sanitation. Not only can an effective WASH intervention save lives, it can also engineer changes in the social fabric of communities that adopt these behavioural changes. This points to a key attribute of a successful WASH intervention – that through these programmes, communities not only access a new service that improves their quality of life, but they also learn from being part of a concrete intervention that emphasises equity and inclusion.

Let me explain how. Safe sanitation is essentially ‘total’. In a community, even one family practising open defecation puts the health of other families at risk. Also, unsafe sanitation practices pollute local potable and drinking water sources in the habitations. Together, this can undo any gains from partial coverage of WASH interventions. This much is now widely accepted by sanitation practitioners around the world. However, there remains a serious challenge when it comes to the implementation of this concept.

When a community is introduced to a WASH-focused behaviour change campaign, there are often variations in the levels of take-up in different families. This could be because of several barriers – financial ability, cultural beliefs, education levels, etc. In response, external agencies have many options. They can focus more on families in their behaviour change campaigns, offer them material and financial support or incentives, or exert peer pressure (which may in some cases become coercive, etc).

However, the best approach – whether facilitated by an external agent or not – is for a community to devise a collective response. The issue should be framed as a collective action problem that requires solving for the creation of a public good. In many instances, communities have come together to support the poorest families – social engineering at its finest. At its best, recognising the needs of every member of a community will lead to a recognition of the challenges that the typically marginalised groups face. It is this recognition that could prompt a rethink of social norms and relationships.

On the other hand, the power of peer pressure can be effective. Where families that are able, but unwilling, to construct a toilet and switch behaviour, the initial take-up from other families has a strong demonstration potential. In societies with caste and class differences, this can be deployed effectively to highlight choices that threaten the public good.

Encouraging the development of shared norms and collective action is also a key aspect of determining the role of subsidies in WASH programmes. As research evidence from Bangladesh shows, subsidies could be effective when targeted at communities, instead of at individuals. Where it is possible to measure progress at the community-level, subsidies can be designed and delivered accordingly. This will encourage communities to take up WASH as they would approach say, the building of a road or a school.

This is no longer just a theory. Increasingly now, various organisations have documented such successes. For example, in multiple NGO-led programmes in eastern India and Bangladesh, local community-based organisations formed initially to tackle sanitation went on to engage in collective livelihoods activities. However, as with any other, this theory too should be put to test – evaluated at different sites and for different approaches. Currently, we are not sufficiently focused on the positive social externalities a WASH intervention could generate, and as a result, are running the risk of restricting ourselves to narrow technocratic approaches. This needs to change.

This brings me to a key message I have for WASH interventions: do not hurry into scaling up. Given the urgency of the problem – about 2.5 billion people do not practice safe sanitation – this might seem completely counter-intuitive. However, there is the real risk that aiming for scale will lead to the perpetration of target-driven hardware interventions which will neither change behaviour, not create social cohesion. It is not unusual for organisations that rush to scale end up compromising on exactly those key design elements that made their pilots a success.

In conclusion, it is important to acknowledge that WASH interventions have the potential to go far beyond basic service delivery. In order to realise these gains, one must follow a very careful sequence of steps designed to promote community ownership and systematically change behaviour. The goal should be to nudge communities towards a public spirit and collective problem solving, so that WASH works as an entry point into communities, creating fertile ground for future interventions.

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