Sanitation: Programming for scale – an online discussion hosted by WSSCC and SuSanA

WSSCC and the SuSanA forum have initiated an online discussion, live for the next five days. Here is a post by Tracey Keatman introducing the discussion: https://www.linkedin.com/grp/post/1238187-6051773852801908738?trk=groups-post-b-title

I have posted an introduction to the first sub-theme, Programming for scale, on the WSSCC Linkedin CoP; and on the SuSanA forum. The post is also reproduced below. I look forward to a lively discussion – see you there!

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Fortunately, there is no argument any longer about how critical ‘scaling up’ is when it comes to sanitation. However, unlike many other public health interventions, the sanitation challenge is complex, sometimes also called a ‘wicked problem’ – a challenge foremost, of inducing lasting behaviour change. The very nature of careful social engineering required to bring about this behaviour change seems to run contrary to some of the factors that make an intervention scalable – an ability to standardise inputs and break programme components down to easily replicable bits.

In the rush for scale, there is the real risk of 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. For instance, government-led sanitation programmes in India have continued to fail over two decades precisely because of a narrow focus on construction. Construction is important, but even there, there is a lot one needs to get right: usable and lasting designs, and implemented in a way that promotes, rather than detracts from local ownership.

The other issue is that of total inclusion. As is now widely understood and accepted, without the inclusion of all households in a community, gains from improved sanitation cannot be realised. Unless all families adopt hygienic sanitation practices, we will not make a dent on the incidence of disease prevalence. In sanitation, (say) 70% of those currently practising ODF switching to safe disposal of faeces would not be a success if the remaining 30% are uniformly distributed across the communities that have made the switch. So models that scale on the basis of willing consumers/ participants, rather than a focus on each person adopting it (such as micro-credit or cola or condoms) may not be easily transferable to sanitation. Therefore, comparisons with the number of mobile phone users aren’t really valid at a fundamental level. But we might have a lot to learn from effective marketing (social or otherwise), as demonstrated by say, the success of the polio vaccine campaigns around the world.

In sum, we have learnt that conventional approaches are not working: those that set up a false dichotomy between hardware construction and behaviour change; those that are content with pit latrines as opposed to functional toilets; those that use reductionist conceptions such as communities being open defecation free rather than focusing on personal and environmental sanitation and hygiene as a whole; and those that settle for incremental coverage instead of full coverage from the start.

All of this raises important questions for ‘going to scale’. Through this thread, it will be great to see a free-ranging discussion on the key operational challenges. To initiate the conversation, I will set out a few leads:

1. What are some successful examples of successful scale-up? How did these models address the issues of inclusion and equity? In terms of implementation, how have these models been able to create an iterative model that avoids blueprints?
2. In the cases of successful scale-up, were programmes initiated and sustained by governmental or non-governmental actors? What are the key elements of a successful partnership? How can we strengthen national ownership?
3. What is the role of the private sector – for example, in financing, communications, sanitation marts – in implementing sanitation at scale?

Looking forward to an exciting and enlightening conversation!