We all know the statistics: 2.6 billion people around the world are without access to a basic toilet. Diarrhoea – the vast majority of it due to poor sanitation and hygiene – is the second biggest killer of children worldwide.
Between us, we also have many of the answers. We have experiences of low-cost technologies that are acceptable and affordable for poor communities in rural areas. We have been involved in designing communications programmes that have contributed to sustained behaviour change.
We have seen governments and civil society working together to set up policies and programmes that ensure access to better sanitation in challenging settings, such as crowded informal settlements in fast-growing megacities. We have also seen businesses grow up around sanitation and hygiene, allowing individuals to make a dignified living and clients to buy the sorts of products and services they want and need.
What we haven’t seen, however, is the rate of progress that is needed to achieve the Millennium Development target to halve, by 2015, the number of people living without access to basic sanitation. Nor have we seen the sort of progress that narrows the gap between rich and poor.
What is needed, today, is serious engagement around the sorts of programmes and policies that are going to help us reach beyond 2015 – to a world where all people have access to decent sanitation and hygiene. As a global community we need to agree what is needed, how to get there, and what skills we need to achieve results.
The WSSCC Global Forum on Hygiene and Sanitation will be the place for these discussions and decisions. It is for practitioners. WSSCC members and partners will wrestle with the challenges facing our sector today. They will gain inspiration from each other, and from people from other walks of life, who have made important, large-scale change happen.
India Water Portal and Arghyam are the social media partners for this 5-day conference. Watch this space for live updates and lively discussions on sanitation and hygiene.
Inspire to Act
Day 1 lived up to its name and provided a great amount of inspiration to the audience present at the WSSCC’s global forum on sanitation and hygiene.
The session began with Mr. J.S. Mathur, from the Ministry of Drinking Water Supply and Sanitation talking about how the government had set itself an agenda of ensuring sanitation and how it kept up with it.
“Keep your eyes on the people you want to reach”, said Rohini Nilekani, Chair and Founder, Arghyam
, India. Urging practitioners to be optimistic she suggested that we must learn from other sectors like education. Sourcing the diverse players –markets, philanthropy, the state and resource persons effectively would help us achieve the sanitation goal effectively, she said.
David Kuria from Ecotact, Kenya
opened his talk on "Global challenges, local innovations" pointing out that history began every morning. He outlined the need for social entrepreneurship and spoke about Ecotact’s role in the space. He ended calling everyone to action which is radical, real, immediate and dramatic, in the words of Jean Monnet.
Osama Manzar was unambiguous about his method to lift people out of poverty – “provide them with access to information”, he says. He spoke about the Digital Empowerment Foundation
’s efforts to make grassroots organisations, their work and local information available to a wider audience.
Nomathemba Neseni’s talk clearly brought out the message that sanitation is a passion and not a job. She spoke about the role of the state and civil society and said that civil society must continue to function as a facilitator, advocate and harnesser of resources for working on sanitation. Neseni is Commissioner, Human Rights Commission, Zimbabwe.
Breaking the Mould
The second session focused on “breaking the mould” in achieving sustainable sanitation.
Malini Shankar, Principal Secretary, Water Supply and Sanitation Department, Government of Maharashtra, India drew from various personal experiences to highlight how action at a smaller level by higher authorities will make systems in the government more efficient at providing sanitation facilities. She emphasised the need to change the 2 popular approaches to sanitation: the engineering and supply driven approach and said that great results were obtained when governments moved to an incentive and competition driven mode instead.
Karin Hulshof, Country Representative, UNICEF, India called upon the practitioners to rationalise what they thought was appropriate practice vis a vis the communities experiences/views. She said that pointing out the contradiction between their aspirations and current practices could be an effective method in effecting behaviour change. The other main message in her presentation was the need to link the dots between health and sanitation.
Ebele Okeke, Former Head of Nigerian Civil Service and WASH Ambassador, Nigeria pointed out that in WatSan projects, while water supply increases in importance, sanitation services remain either stagnant or even decrease in some cases. She suggested that practitioners must use the opportunity they get to influence decision making on sanitation.
This was followed by a presentation on the Sulabh
model by Bindeshwar Pathak. He also spoke about the need to decentralise human waste management.
“When you are up to your ears in alligators, it is difficult to remember that your objective was to drain the swamp,” said Louis Boorstin from Bill & Melinda Gates Foundation, USA, quoting from a poster he used to have on his dorm wall. He likened sanitation to draining the swamp. He said that the BMGF was focused on scale and innovation to solve the problem of poor sanitation access and use. He urged practitioners to measure their work objectively and to collaborate with all other players in the sector.
Amudha Periasamy spoke enthusiastically on the Menstrual Health and Hygiene programme of the Government of Tamil Nadu. She stressed on the importance of political will to ensure that sanitation is put on the top of the priority list. She also spoke about the various methods of ensuring behaviour change and highlighted the need to make an emotional connection to sanitation.
What drives behaviour change in sanitation and hygiene?
Some interesting questions came out of this topic, which was tackled from various angles through the first day of the conference. What can be done about the fact that rural populations already know most of the facts about sanitation that we’re still talking about as major issues, in spite of which they have not changed their behaviour, i.e. they still defecate in the open. Is the underlying sentiment along the lines of “why should I listen to an NGO or the government when they visit me only once in a way; they come, give their opinions and leave.”
Another interesting point brought up by Robert Aungur from the London School of Hygiene and Tropical Medicine
was the idea that most public health problems are linked to objects or products. For example, safe sex = condoms, deaths in car accidents can be prevented by wearing seat belts. But what is the tangible object associated with sanitation? A toilet is the first answer that springs to mind, but is it as direct as that?
Behaviour is something that is situated. In order for someone to change their habits, i.e. their behaviour, they need to have the right motive. People usually change their behaviour when there’s no other choice, so when talking about communication for behaviour change, it’s important to make it compelling according to Siddharta Swarup from the BBC World Service Trust
.Dr. Everold Hosein
, a senior WHO consultant and founder of COMBI – Communications for Behavioural Impact – made an energetic speech on the importance of making the solution something desirable, something people want, need or desire. He made a valid point that it is not the toilet that should be sold, just like Coca Cola does not sell the drink. Rather, it is selling an experience. So in talking to an end user about using a toilet and stopping the practice of open defecation, a good angle is the way in which a toilet can raise the status or standard of living for that family; how it can improve the quality of life for the women in that household by providing privacy.
Another example of an effective behaviour change campaign in India was the Balbir Pasha campaign conducted by Population Survey of India (PSI)
, that strove to get more men to use condoms and practice safe sex. The campaign was targeted specifically at the clientele of commercial sex workers, and saw a 300% increase in calls to their hotline number as well as a rise in sales in the red light area.
Exploring private sector partnerships
What drives behaviour change in sanitation and hygiene? A session that explored the potential of private sector partnerships in driving large-scale behaviour change examined the strengths and qualities of the private sector and business mindset, and how potential pitfalls of private sector involvement can be avoided.
Anila Gopalakrishnan from Lifebuoy, Unilever India
represented the point of view of the private sector investing in social development. Lifebuoy is Unilever’s cheapest product; it is not a luxury brand, and it aims to change hand washing behaviour. In order to do so it invests in learning as much as possible about the BOP (Bottom of the Pyramid) consumer. The various motivations to wash hands are germs/bacteria, being a good parent by setting the example for your children and also being a role model to your peers. Anila pointed out that there are some deterrents – people are lazy, they can’t afford soap, etc. It is also effective to have one clear message, because neither multi-pronged messaging nor double meanings works for such audiences. There needs to be awareness, commitment, engagement and reinforcement. Lifebuoy is an example of how brands can be a positive force, and Anila represents the private sector point of view that public-private partnerships are a natural evolution of philanthropy. The social and health impacts of such pioneering partnerships can be immense. A crucial lesson from Lifebuoy’s experience is that public-private partnerships can be a challenge, and that there needs to be a bridge to align objectives.
The other point of view represented on this panel was that of BRAC
, an organization in Bangladesh that sells sanitary towels to BOP consumers. BRAC’s strategy followed the direct marketing approach, using health volunteers to sell the product. These volunteers earn a commission for every sale. Babar Kabir, Director of BRAC voiced the social sector point of view that MNCs work on profit margins, so PPPs should work towards lowering costs in the interests of social good. Corporate social responsibility and NGOs have very different motivations in marketing and selling products to BOP consumers. Also, it is important to assess a clear social impact before any integrated campaign so that there is something to evaluate after.
The third and final perspective on the panel was that of Water for People
, represented by David Sparkman who talked about making sanitation “cool”. WFP tried using the message “buy the bathroom, get the toilet free” in Bolivia, in response to market research that showed that people here wanted the bathroom more than the toilet for the simple reason of privacy. WFP’s learning from this was that targetted messages based on market research don’t always work in sanitation. They have also tried market-based approaches by supporting sanitation start ups through Business Distribution Service providers - essentially locals who know their markets. The danger of this approach is whether the service actually reaches the poorest of the poor.
A concluding question out of this session was what exactly the private sector needs as a proven ROI in order to invest in sanitation, since the reason they don’t bother with it now is primarily because it isn’t profitable. Sanitation is a very low margin business which the private sector would only be interested in if it was on a massive scale. So what can NGOs do to make it an attractive investment?
Tipping Points: Getting from Small to Big
Fascinating examples from inside and outside the WASH sector will showcase how a small innovative idea can become big and is able to reach many millions. What does it take and what are the challenges which tip the balance and lead to large scale success?
Not just a piece of cloth. Anshu Gupta, Executive Director, Goonj
Some horrifying stories from Anshu on the shocking incidence of deaths among women because of poor sanitary care, i.e. they can't afford to buy pads. Circumstances forced them to re-use clothes, leading to disastrous consequences - one women died of tetanus because she re-used an old sari blouse that had a hook on it during her period. The sad thing is it is entirely preventable if pads were affordable to the poor.
The importance of communications and media in the success of development programmes is by now widely acknowledged. However, today’s media landscape is a fast changing one, and specific skills and techniques are needed in order to use media and communications effectively to have real and long-lasting impact in terms of social change. This session will take an in-depth look at the role of communications and media in affecting large-scale change and social transformation. The emphasis will be on understanding the mechanisms and the impact media and communications can have on social change processes and how to harness this strength for the sanitation and hygiene cause. Particular attention will be given to the modern media landscape, where communities themselves are increasingly producing their own stories and having a voice at a larger scale.