Bill & Melinda Gates Foundation

Tackling the Rural Sanitation Challenge

September 15, 2011

What will it take for all people in rural areas to have affordable access to safe, dignified sanitation that they really want to use? 

The challenge is so vast – more than 1.8 billion people living in rural areas either defecate in the open or use latrines so rudimentary that they’re not safe – that sometimes it’s hard to imagine making a dent in it.

But we believe that progress is possible. And I’m glad to report that, in parallel with the foundation’s efforts to find better ways to capture human waste through the Reinvent the Toilet Challenge, we’re also supporting innovative, large-scale efforts to help communities end the practice of open defecation and adopt safe sanitation practices.

Let’s start with the good news.  

Over the past five years, we’ve realized that community engagement is essential to ensure sustainable access to improved sanitation methods. Traditionally, governments and NGOs have built latrines without input from their intended users, only to be left wondering why many people don’t use or maintain these facilities. 

The more effective approach – generally known as community led total sanitation, or CLTS – starts by motivating a community to want to stop the practice of open defecation and to install, and actually use, household latrines. Not surprisingly, this inclusive approach generates more lasting results.  (For an explanation of how community engagement works in practice, please see a recent posting by Rose George.)

In 2007, the Water and Sanitation Program (WSP) of the World Bank launched a project with the audacious goal of achieving 100% “open-defecation-free status” for 4.5 million people in communities distributed across three countries (India, Indonesia and Tanzania).  This effort, supported by a grant from the foundation, combined the CLTS approach with two other components: 

  • Training local entrepreneurs to offer an affordable range sanitation products and services (increasing supply to meet increased demand) and
  • Engaging local governments to improve their sanitation policies and train local officials in implementing them (necessary to scale up work and sustain the adoption of safer sanitation over time). 

As of December 2010, with one year left to go, three million people were verified as living in open-defecation-free communities, and five million more were claimed but not yet verified.  (An article in Fast Company has highlighted this project.)

Another sign of progress comes from a recent study that focuses on Bangladesh, where the CLTS approach originated a decade ago. Researchers visited communities that had been declared open defecation free prior to June 2005, and they found that about nine out of 10 households owned or shared a latrine nearly five years later. So we have evidence that it’s possible to sustain gains from improved sanitation.

Despite these promising signs, we have much more to learn. 

Sometimes several villages successfully adopt CLTS … but the approach can’t be scaled up due to the absence of active government support or the high cost per household of achieving that outcome. 

In other cases, thousands of households have been convinced to install latrines … but the quality is so poor that the latrines fail within a year.  And sometimes only half or three-quarters of the community is motivated to install latrines, meaning there is still substantial open defecation and the attendant health risks.

So the core challenge for the next generation of rural sanitation programs is this:

How can we help rural communities around the world achieve safe sanitation at real scale (reaching millions with safe sanitation) while also supporting solutions that are effective (communities consistently achieving 100% open-defecation-free status), sustainable (communities staying open defecation free over time) and affordable (to households, governments and donors)?

That’s a tall order, as described in several recent studies by the Arghyam Foundation and WSP (PDF), but it’s a challenge that our grantees are eagerly tackling.  We’ll continue to share our progress, and pitfalls, as we help to improve models for wide-scale delivery of rural sanitation services going forward.

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