It’s easy for most of us to take the simplest things–like flushing a toilet–for granted. Yet almost 2.4 billion people lack access to modern sanitation, and nearly 1 billion practice open defecation, according to the World Health Organization. The problem is worst in rural areas of sub-Saharan Africa and south Asia, particularly India.
What’s to be done?
That’s hard to know, says Seeking Sanitation Success, an excellent report commissioned by Catholic Relief Services:
Very little information on sustained solutions is available, making funders and practitioners in the sector vulnerable to repeating mistakes or investing in unproven approaches.
The report also found:
There has been no NGO-led sanitation approach that leads to success at scale (depending on the definition).
The report was written by Susan Davis, who is the founder of Improve International, a small NGO aimed at improving the quality and sustainability of water and sanitation projects in poor countries. By phone, she explains that most progress in delivering modern sanitation has been led by governments, and not NGOs.
That doesn’t mean that NGOs can’t play a constructive role, she says. They can advocate for government action, they can help spur behavior change around sanitation (which is harder to do than you might think) and, importantly, they can help figure out which of the many approaches to sanitation work best.
This is an all-too-familiar story in global development. We don’t know enough about what works. Programs are under-studied. Results are under-reported, if they are reported at all. Successes are trumpeted. Failures, not so much. Followup is rare.
“People aren’t really paying attention to what happened 10 years ago,” Davis says. “We’re more excited by innovation.”
A nonprofit focused on evidence
Helping governments, foundations and nonprofits use evidence to improve their impact is the purpose of IDinsight, a nonprofit that I profiled in the July issue of The Chronicle of Philanthropy. My story, Data at the Speed of Life [subscription req’d], explains how IDinsight does high-quality, affordable research to enables nonprofits to learn quickly, adjust their programs and make more of a difference.
IDinsight’s work is valuable because too many leaders in global development “lack the evidence they need to make well-informed decisions,” says Neil Buddy Shah, IDinsight’s CEO and founding partner. This isn’t something you’ll read about on the websites of charities that help the global poor, but it’s true.
While reporting on IDinsight, I came across one of its clients, a Colorado-based nonprofit called iDE (it stands for International Development Enterprises) that stands out because it is committed to learning, to measuring its impact, to transparency and to developing market-driven solutions to global poverty. (All my biases!)
Which brings us back to toilets.
Traditional approaches to sanitation have provided free community latrines or toilets to all, driven by the belief that if-you-build it-they-will-come. But absent strong reasons to change behavior, these projects have disappointed. Put bluntly, people continue to crap outside, the way their parents and grandparents did. Numerous other strategies* have been deployed to end open defecation which, in case you didn’t know, can spread disease, pollute waterways and contaminate fruits and vegetables growing nearby.
iDE favors an approach known as sanitation marketing, which sets itself apart by treating households as consumers, not as beneficiaries. The NGO has been working in Cambodia since 2009, with the support of US AID, The World Bank, The Bill and Melinda Gates Foundation (which paid for the research with IDinsight), the Stone Family Foundation and the government of Australia.
It is getting results. iDE’s work in Cambodia has grown into “the largest-scaled improved rural sanitation project” led by an NGO anywhere in the world, according to Yi Wei, who directs iDE’s global WASH (Water, Sanitation and Hygiene) initiative.
The right product at the right price
Sanitation marketing aims to (1) increase the demand for toilets and (2) to strengthen the private sector’s capacity to supply them. This is Econ 101.”Everything we do is market-based,” says Chris Nicoletti, the global IQ director at iDE, who oversees its work on measurement. “It’s very much our ethos.” To succeed, iDE and its local partners need to design and make the right product and sell it at the right price.
Their product, known as the Easy Latrine, was developed in the late 2000s with the help of Jeff Chapin, a designer on leave from the renowned design firm IDEO. It’s been modified since then but remains a simple, low-tech, low-cost concrete latrine that came about using the principles of human-centered design, which is a fancy way of saying that Chapin and iDE listened to their customers at every step of the process. It’s made by local manufacturers and costs roughly $36, before delivery and installation, which brings the price up to about $50. A growing number of customers add what’s called an Easy Shelter, a cement structure that provides privacy to latrine users and costs another $200 or so. (That’s price-competitive, more than shelters made of sheet metal and less than those made of bricks, I’m told.)
Latrines sold slowly at first. A World Bank Field Note from 2012 found that households bought 10,621 latrines from local private enterprises in the first two years, results it called “promising.” WHO’s most recent estimate, also from 2012, is that 8.6 million Cambodians practice open defecation. How could iDE speed adoption? Being a learning organization–seeing what works and what doesn’t–was key.
To improve the sales process, iDE worked with Whitten & Roy Partnership, or WRP, a global consulting firm, to train the Cambodian rural sales agents who go door to door selling toilets. “They get very high-quality training on how to sell,” Nicoletti says. “They are mentored, managed and trained by WRP.” WRP found, among other things, that sales commissions at first weren’t high enough to motivate the agents, so the commissions were increased. Instead of wielding Powerpoint presentations, Cambodian salespeople go door-to-door with flip charts to guide them through their spiel.
IDinsight was brought in to see if offering financing would help, as I wrote in the Chronicle of Philanthropy:
To test the market, IDinsight ran a set of randomized, controlled trials. Nearly 90 percent of Cambodian consumers, they found, were unwilling to pay the market price for a latrine, which ranged from $35 to $55. But when they were offered a 12-month loan, half of these same consumers agreed to pay $50.
Meantime, iDE worked to simplify and consolidate the supply chain and help local government officials promote improved sanitation. “The iterative approach is part of our DNA,” Yi Wei says. “There’s always room for improvement, and the market is always evolving.”
All the tweaks made a difference. Latrine coverage in Cambodia had grown by about 1.5 percent a year from 1992 through 2012. Since then, coverage has increased by 6.4 percent a year in the seven provinces where iDE works. Cumulatively, iDE has sold 238,406 latrines through its network of about 100 latrine producers and 300 sales agents. Program costs per unit have dropped, as volumes grew. Here’s an iDE website with more information.
What happens next?
That’s the good news, but issues remain. For now, there’s no single strategy for disposing of the waste after the latrines fill up, which takes months or years.
Susan Davis of Improve International says that, without a plan to recycle or dispose of sludge, the program can’t be called a success, yet. “We as a sector have focused on getting people to stop going outside and start using a toilet,” she noted. “What happens next?”
iDE is seeking “a commercially viable fecal sludge management solution,” perhaps by creating businesses to collect the waste and turn it into fertilizer, Nicoletti says. The Stone Family Foundation and the government of Australia continue to support iDE in Cambodia but the Gates Foundation no longer supports the work, unfortunately; it’s been pushing a a buzz-generating challenge to reinvent the toilet.
A couple of closing thoughts: First, solving hard problems like sanitation takes time. To tackle them, grantmakers need to commit for the long term, particularly as nonprofits like iDE demonstrate progress and a willingness to learn. It’s tempting to turn to the next new thing, before we even know whether the last old thing has worked.
Second, iDE’s commitment to research does not appear to be rewarded in the nonprofit “marketplace,” such as it is. Without shared metrics around success and with little transparency in the sector — as I blogged about last year in Water Taps and Information Gaps — the work of one NGO can’t be compared with another. Flashy websites and marketing claims (“every dollar goes directly to clean water projects”) carry the day.
Yi Wei asks: “How are we ever going to use resources more efficiently if we are not going to be more transparentand accountable?”
Fortunately, people at IDinsight tell me there’s more demand for their work than they can handle. That’s a sign that more foundations and charities, like iDE, want to learn how to do what they do better.
*Other strategies include Community Led Total Sanitation (CLTS), Ecosan (toilets that deal with the treatment and reuse of feces), Community Approaches to Sanitation (CATS), School-Led Total Sanitation (SLTS), Public Pay Toilets, etcetera, etcetera.
Originally published at nonprofitchronicles.com on July 28, 2016.