Global Waters In Focus

USAID Water Team
May 4, 2018 · 11 min read
Residents of a compound learn about how to maintain their new latrine and practice good sanitation and hygiene habits. Photo credit: PSI/USAID SSD Project


Locations: Benin, Côte d’Ivoire, and Ghana
Duration: 2014–2019
Implementing Partners: Population Services International (PSI), PATH, and Water and Sanitation for the Urban Poor (WSUP)


One of the greatest health threats facing West Africa is lack of sanitation. In Benin, Côte d’Ivoire, and Ghana, the rates are particularly low, with just 14.30, and 14 percent having access to basic sanitation, respectively. While urban areas have higher rates than rural areas overall, sanitation access among the urban poor is extremely low. The UNICEF/WHO Joint Monitoring Programme estimates that basic sanitation rates among the urban poor in all three countries are below 14 percent. Significant portions of the urban poor still resort to open defecation — in Benin, for example, 36 percent of the poor and 80 percent of the poorest in urban areas practice open defecation.

Efforts by national governments, development banks, and donors to improve urban sanitation have mostly focused on large infrastructure projects. However, many of these projects have yet to serve the poor and vulnerable. Moreover, the vast majority of the urban population with sanitation in these countries — especially the poor — use on-site sanitation, most of which is shared among multiple families. And fecal sludge collection services — a necessity for on-site sanitation — are often prohibitively expensive.

A vacuum truck illegally dumps fecal sludge into the environment in Ghana, a practice which leads to the contamination of food and water sources. SSD is working with vacuum truck operators to professionalize operations. Photo credit: PSI/USAID SSD Project

Many of the urban poor in these countries live in crowded, informal settlements where a family will reside in a single room in a compound house. These compounds usually lack sanitation services entirely. Sanitation facilities that do exist are shared among a number of families and irregularly maintained. Latrine pits and septic tanks languish unemptied, exposing the entire urban population to fecal matter. People living in these densely populated areas are especially vulnerable to disease. In recent years, all three countries have seen cholera outbreaks. These health crises cause avoidable deaths and inhibit growth and development.


The USAID West Africa Sanitation Service Delivery Project (SSD) is working to create a more effective, efficient, and inclusive sanitation market for the urban poor in Benin, Côte d’Ivoire, and Ghana by partnering with the private sector, governments and municipalities, and consumers. It aims for at least 25 percent of those gaining access to sanitation to be from the lowest poverty quartile.

Because SSD is covering new ground, it began by researching the opportunities, challenges, and obstacles to improving sanitation among the urban poor in each country. Consultations with a range of stakeholders was key to this process, including national-level water and sanitation offices and departments; local municipalities; vacuum truck operators (fecal sludge removers); toilet entrepreneurs including cement ring manufacturers, building contractors, plumbers, bricklayers, and hardware retailers; and end users such as landlords of compounds in which the urban poor reside, and the urban poor themselves.

The project employs a “lean start-up” approach, which means project staff: 1) identify and research opportunities; 2) present a rough prototype; 3) develop live prototypes; 4) pilot the prototypes; and 5) take it to scale. Based on the success of each step, the project team decides whether to modify the plan or whether to progress to the next step.

SSD is currently working with the private sector to implement business models that focus on on-site household sanitation and fecal sludge management (FSM). The household sanitation models build the capacity of the private sector to produce and market different technologies, such as double pit latrines with an innovative low-water plastic flush pan, soak-away pit latrines, and round concrete tanks ranging in price from $300 to $600.

A toilet artisan installs a new latrine. Photo credit: PSI/USAID SSD Project

The project works to provide the lowest cost options possible. In Benin, for example, SSD introduced latrines that cost 60 percent less than the average latrine on the market. In Ghana, to target the poorest households, SSD is also supporting a subscription service in which households pay a small weekly fee (amounting to $100 per year for a family of five and includes collection service) for use of a portable container-based toilet system. Families can pay for this service with mobile money. SSD has found that the poor are more easily able to pay small amounts over time rather than a high one-time cost to construct a latrine.

SSD’s FSM–focused efforts are working with vacuum truck operators to expand and improve the quality of service and accessibility of fecal sludge removal in each country.

Building the capacity of the private sector is an important first step to improving the quality of service. SSD is supporting target enterprises via a four-step capacity building process. First, project staff reaches out to federations of toilet entrepreneurs and vacuum truck operators to establish trust and learn more about each industry in each country. SSD then offers training to help these entrepreneurs improve their craft, professionalize operations, increase the transparency of pricing, and reduce operational costs. Once the entrepreneurs complete their training, the project gives them key equipment such as starter kits and SSD certification. Lists of “certified” entrepreneurs are provided to municipalities and end users to promote their services. The project plans to launch a government-sponsored certification program for vacuum truck operators this year.

In addition to its training and certification program, SSD partners with the private sector to make sanitation more accessible. The project links sanitation entrepreneurs with each other, so customers who want to build a latrine do not have to separately seek out a latrine artisan, a latrine installer, a plumber, and a fecal sludge removal service. The project also partners with microfinance institutions (MFIs) to offer loans to poor customers who could not otherwise afford a latrine, including those in the bottom 40 percent of wealth distribution in each country. In addition, SSD is working with FSM businesses to start call centers, which enable customers to dial one number to receive fecal sludge removal services on demand, with transparent pricing, and benefit from follow-up and quality control services.

SSD partners with governments to facilitate an improved enabling environment for sanitation, with a focus on building their capacity to institute and enforce sanitation laws that address sanitation challenges in each country. The project further builds government capacity by sponsoring study tours for officials to each of the three countries, so they can observe best practices and exchange learning.

In Abidjan, Cote d’Ivoire, a landlord received the key to a new nine-block latrine for his compound. Photo credit: PSI/USAID SSD Project

Educating consumers, including landlords, tenants, and households, about the benefits of the various sanitation products is critical to generating demand for sanitation products among the poor. SSD partners with municipalities to identify potential landlords and households that could benefit from a new or improved latrine. Landlords are a key audience, since a large proportion of the urban poor live in landlord-owned compounds. Sales agents affiliated with the project meet with landlords to demonstrate how a new or improved latrine could make their property cleaner and safer, while enabling them to retain good tenants and raise rents when appropriate.

SSD collaborates with both the private sector and government to conduct sanitation marketing initiatives using a variety of approaches — flyers, brochures, radio spots, cultural shows, community demonstrations, and private home visits. Special attention is given to ensure marketing approaches are culturally appropriate and reach the poor — in Benin, for example, community leaders play traditional gongs in neighborhoods to capture the attention of community members, and relay messages about sanitation.

Throughout implementation, SSD is engaging in constant monitoring, modifying its engagement with stakeholders as necessary, and compiling lessons learned. The hope is that these lessons learned can be applied by sanitation stakeholders throughout the three countries after the project’s completion.


Getting SSD activities fully off the ground took about two years due to its ambitious scope and large number of stakeholders. Now in its fourth year of implementation, SSD has begun to successfully identify and address factors inhibiting the growth of urban sanitation markets in the region. As of the end of FY2017, the project had helped more than 1,000 people gain access to basic sanitation; more than 900 to gain access to limited sanitation; more than 2,000 to gain access to sanitation shared by fewer people; and more than 400 people to gain access to safe FSM services. These numbers will most likely increase significantly as the full impacts of SSD’s work to improve the enabling environment for sanitation and bolster the market for sanitation are realized.

Sales agents affiliated with SSD teach a local resident about low-cost sanitation options. Photo credit: USAID

Government officials in all three countries have found study tours and other capacity-building exercises helpful, and are beginning to take a larger role in implementing and enforcing sanitation laws. For example, in Kumasi, Ghana, the municipality has started enforcing a law mandating all landlords provide at least one toilet for tenants using a three-strike system. They levy a small fine for the first offense, a larger fine for the second offense, and an even larger fine that, taken with the other two fines, equals the price of a toilet, for the third offense. While it is still early, this promises to increase enforcement.

SSD has also engaged key enterprises to build their capacity and increase their professionalism, enabling them to expand their businesses. To date, the project has trained, and continues to support, more than 200 latrine builders.

The project has had particular success with FSM entrepreneurs. SSD facilitated a process that enabled members of federations of vacuum truck operators to examine their desludging tariffs together and reach consensus on changes that would increase demand for their services. As a result, the federation decided to reduce their tariffs and create a more transparent pricing platform. In Côte d’Ivoire, where the operators typically had an acrimonious relationship with the government, SSD facilitated meetings between the government and vacuum truck operators, which helped them build trust with each other. In addition, the FSM call centers, which are still fledgling, have received positive responses from fecal sludge entrepreneurs and customers alike.

However, willingness to pay for sanitation products and services in all three countries is still low, despite lower prices, improved products and services, increased transparency, and credit options. While a latent demand exists for sanitation products and services, many of the urban poor have multiple competing priorities that inhibit them from investing in sanitation.

A chief obstacle is financial, with many of the urban poor reporting that the cost of purchasing and maintaining a toilet is too high. Landlords say that a number of their tenants default on rent, which makes paying for sanitation — especially regular FSM payments — prohibitive.

An instructor teaches toilet artisans how to perfect their craft. Photo credit: PSI/USAID SSD Project

MFIs have been able to play a role in alleviating these concerns. Helping consumers finance sanitation, whether through loans or through mobile installment payment plans, has been a major factor in convincing them to invest in sanitation. MFIs have made sanitation options that would otherwise be out of reach to consumers accessible. Mobile money has been particularly effective at helping poorer customers afford sanitation; 82 percent of subscribers to the mobile container toilet in Ghana now pay automatically with mobile money. Mobile money not only makes payment easier for consumers, but it also reduces operational overhead for financial institutions and service providers.

But financial issues are not the only impediment to the urban poor obtaining sanitation. SSD found that land issues also play a major role. Because land is scarce, especially in slum areas, there is often not enough room for a latrine. Furthermore, land rights in these areas are often insecure, which can mean that landlords are reluctant to invest in a toilet for their compound. SSD is now experimenting with shared latrines and portable latrines to overcome these obstacles.

SSD found that while its sanitation marketing measures have resonated with consumers, social and behavior change communication (SBCC) is needed, including a focus on the importance of sanitation and its link to common health issues such as cholera and diarrhea. The project is now working on integrating SBCC across all activity implementation, and will measure the impact of communication on product sales and demand for service delivery.

The project’s monitoring has been a key factor to addressing obstacles in a timely manner. The monitoring system is based on the concept of adaptive management, where monitoring information is regularly and rapidly used in decision-making. SSD has also aligned its monitoring system with the UNICEF/WHO Joint Monitoring Programme sanitation ladder used to monitor progress against the Sustainable Development Goal target for sanitation. However, SSD has expanded on this system with a more nuanced and inclusive framework for solutions accessible to the urban poor including shared latrines. The project found that while the ultimate goal should be a private household latrine, providing access to latrines shared by fewer people is also an important step forward.

While it is still too early to gauge the full impact of the project’s numerous activities, its success at finding solutions to some of the largest obstacles inhibiting the widespread adoption of sanitation could potentially facilitate improved sanitation among the urban poor for the long term.

Lessons Learned

  • Getting the input of the poor is critical to ensuring sanitation options introduced are attainable for them and meet their needs.
  • While the “lean start-up approach” is an effective way to learn about the challenges facing various stakeholders, it is very time-consuming. It is important to plan sufficient time for research when piloting a new approach.
  • Because the poor have limited funds and multiple competing priorities, SBCC that educates them on the links between sanitation and health is necessary to increase demand for sanitation. SBCC campaigns should employ communication media the poor have access to, such as radio and in-person demonstrations.
  • Land tenure issues often impede the urban poor, especially those in slums, from investing in sanitation. Shared and subscription latrines are viable alternatives for areas with insecure land rights.
  • Prohibitive prices for FSM services stop many landlords and poor households from investing in sanitation. To build a market for toilets, it is important to ensure that FSM services are affordable, professional, and accessible. Mobile container toilets in which subscription prices include FSM services are another way to accommodate the urban poor.
  • Costs for most toilets are still prohibitive for the urban poor. Microfinance and mobile money are effective ways to enable these populations to afford a toilet.
  • Targets for urban sanitation projects need to be realistic, given the financial and land constraints facing the urban poor. For these populations, private improved household sanitation can be out of reach. A pro-poor urban sanitation plan should also integrate solutions such as composting toilets and shared latrines.

By Celia Zeilberger

To learn more about SSD, visit:

This Global Waters In Focus case study appears in Global Waters, Vol. 9, Issue 3; for past issues of the magazine, visit Global Waters’ homepage on

Global Waters

Global Waters tells the story of USAID's water-related efforts around the globe, featuring in-depth articles exploring solutions to local as well as global water challenges, opinion pieces by development professionals, and first-hand accounts from stakeholders and beneficiaries.

USAID Water Team

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USAID and its partners improve access to clean water and safe sanitation to create a healthier and more #WaterSecureWorld. For more, visit

Global Waters

Global Waters tells the story of USAID's water-related efforts around the globe, featuring in-depth articles exploring solutions to local as well as global water challenges, opinion pieces by development professionals, and first-hand accounts from stakeholders and beneficiaries.

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