Photo Essay: These Countries Are Making Sanitation Gains with USAID’s Help
As we celebrate World Toilet Day and the transformative health and economic impacts of access to improved sanitation this November 19, USAID takes you from Ethiopia to Indonesia in this photo essay to showcase how innovative thinking, government action, and private sector participation are collectively improving sanitation around the world. Learn how USAID is helping contribute to our partner countries’ progress toward safe sanitation for all.
INDIA
“Sanitation is more important than political independence,” Mahatma Gandhi once remarked, revealing the former Indian leader’s keen awareness of sanitation’s crucial role in uplifting communities. But more than 70 years later, India — today home to more than 1.3 billion people — still struggles with considerable sanitation challenges.
In recent years, a new generation of leaders has elevated the importance of improved sanitation at the local and national levels, stepping up efforts to eliminate open defecation and facilitate access to latrines and toilets in rural and urban areas alike. In 2014, the Government of India launched the multi-year Swachh Bharat (“Clean India”) campaign, which has received support from a diverse group of partners — ranging from USAID to India’s private sector. On October 2, 2019, India held nationwide celebrations with an announcement befitting Gandhi’s 150th birthday: The construction of some 110 million toilets nationwide to help lay the foundation for a cleaner and healthier future. Moving forward, the Swachh Bharat campaign will focus on sustaining India’s open defecation free status by maintaining toilets and improving the responsible treatment of sewage.
USAID’s support of India’s sanitation improvement efforts includes a partnership with the country’s Ministry of Housing and Urban Affairs and the Bill and Melinda Gates Foundation. To provide technical assistance to the Swachh Bharat campaign, USAID/India and the Gates Foundation support a project management unit within the ministry to provide online training for municipal officials, monitor the country’s sanitation progress, facilitate access to new funding sources, and make it easier to identify promising sanitation projects that could be rapidly developed and implemented at scale. Mirroring the Government of India’s robust efforts to foster greater private sector engagement to improve the country’s sanitation outlook, USAID also helped enlist Google to track usage rates of public sanitation infrastructure. According to the most recent data available, India’s progress is evident on a global scale: As of 2017, the country boasted the world’s fifth highest annual rate of change in basic sanitation access (2.54 percent), as well as the third largest decrease in open defecation rates (-2.76 percent).
ETHIOPIA
It is no secret that Africa’s second most-populous nation has long struggled with open defecation, a practice that heightens the transmission risk of waterborne illnesses and jeopardizes public health. But thanks to a sustained effort to curb open defecation as part of its One Water, Sanitation, and Hygiene (WASH) National Programme, Ethiopia has emerged as one of East Africa’s greatest sanitation success stories in recent years, earning the coveted title of world’s top performer in terms of annual rate of change in open defecation (-3.34 percent) in 2017.
What has driven such significant changes? A multi-faceted approach — including public education and behavior change campaigns — deserves much of the credit. USAID is supporting the Government of Ethiopia’s efforts in this regard through initiatives such as the USAID Transform WASH program (2017–21), which is developing and promoting market-based sanitation solutions to increase business interest in the sector and speed communities’ progress on the path to open-defecation-free status. Last year, for example, USAID/Ethiopia sponsored a WASH summit that brought together the Massachusetts Institute of Technology’s Design Lab and Ethiopian health workers, government officials, and interested community members. Together, they brainstormed and created sanitation and hygiene products geared toward the Ethiopian market to spark innovation in the sanitation sector, attract interest from Ethiopia’s private sector, and grow the market for affordable sanitation products and services to help build upon the country’s recent sanitation momentum.
By 2021, Transform WASH seeks to help more than 1 million Ethiopian households gain access to an improved toilet facility. Further fueling progress in the sanitation sector, the Government of Ethiopia is also preparing to launch a national campaign against open defecation to build on the country’s recent momentum in eliminating that practice.
NEPAL
Though relatively small in stature compared to its giant neighbors, Nepal has been making big strides in improving its sanitation outlook in recent decades. According to the latest data, the country ranks fourth in the world in terms of annual rate of change in open defecation (-2.67 percent) and third in the world in terms of annual rate of change in basic sanitation access (2.76 percent). These improvements have not only helped create healthier communities, they have also helped erode long-held stigmas surrounding menstrual health in rural Nepal.
USAID supports Nepal’s sanitation and hygiene improvements with initiatives like the Safe Practices on Water, Sanitation, and Hygiene (SAFE-WASH) II project. Since 2014, SAFE-WASH II has partnered with communities in rural western Nepal, where a lack of adequate water and sanitation services and facilities had long hampered economic development and even contributed to cholera outbreaks, such as a 2009 episode that claimed the lives of several hundred people. In support of the country’s ongoing efforts to eliminate open defecation, the project has aligned itself with the Government of Nepal’s 2011 National Sanitation and Hygiene Master Plan and has been working with WASH committees in rural villages to build latrines and improve water supply access. To further local accountability, each committee has been urged to create an action plan revolving around the slogan “Sanitation and hygiene for every person, every day.” By the time SAFE-WASH II concludes operations, USAID and local partners are aiming to help three districts in western Nepal achieve open defecation free status, and empower more than 80,000 households with access to improved sanitation.
TANZANIA
Fewer than one in three of Tanzania’s nearly 60 million people have access to safely managed or basic sanitation services. With such a daunting level of unmet need for improved sanitation, it comes as little surprise that open defecation remains a major public health concern, drawing the attention of public and private sectors alike. Slowly but surely, however, Tanzania is beginning to turn the tide and take charge of its sanitation challenge: In 2017, the country emerged as one of Africa’s top performers in terms of annual rate of change in basic sanitation access (1.51 percent), outpacing Botswana and Mali and falling behind only to Lesotho, Cabo Verde, and Mauritania in the most recent global top 20 rankings.
Today, projects like the USAID-supported Water Resources Integration Development Initiative (WARIDI) are further driving progress in the country’s WASH sector, as USAID teams up with local partners in both the public and private sectors to help improve access to better sanitation facilities as well as safe water services. Launched in 2016, WARIDI aims to help 1 million Tanzanians gain access to basic sanitation facilities by 2021 in a bid to curb open defecation. To that end, WARIDI and its partners are facilitating collaboration between local government authorities and businesses to improve the effectiveness and sustainability of sanitation interventions, helping communities access business development services for the WASH sector, and strengthening the supply chain of sanitation-related products and services to better serve the growing Tanzanian market. One particularly promising technology is the “SATO pan,” an inexpensive low-flow toilet geared for use in pit latrines where even rudimentary sewer infrastructure might not be available. Developed by LIXIL with support from the Bill and Melinda Gates Foundation, SATO pans are easy to clean and maintain and can require just 200 milliliters to rinse. As part of a global campaign to deploy this affordable sanitation technology, SATO now has a manufacturing license for Tanzania with hopes to scale-up deployment of this promising sanitation solution in the coming years.
INDONESIA
Home to more than half of the country’s 260 million residents, Indonesia’s cities have grown in population by more than four percent annually — the fastest urban growth rate in Asia. By 2025, more than two out of every three Indonesians will live in an urban area, meaning that municipal authorities will have to think creatively about how to best deploy technology and financing to get sanitation services and infrastructure to the crowded urban areas that need it.
Thanks to the efforts of sanitation advocates at all levels of government and within local communities, Indonesia appears well-positioned to further build the capacity of its sanitation sector. According to the most recent available data, the country ranked eighth in the world in 2017 for annual rate of change in expanding access to basic sanitation (1.88 percent) while simultaneously reducing its annual rate of change for open defecation by 1.34 percent. Nevertheless, unregulated wastewater disposal and underfunded sanitation services are still prevalent in many cities, putting families and communities at constant risk of contracting waterborne diseases. These challenges also stand in the way of Indonesia realizing its vision for self-reliance in providing universal access to safe water and sanitation for its citizens.
To improve the country’s sanitation outlook, the USAID Indonesia Urban Water, Sanitation and Hygiene Penyehatan Lingkungan untuk Semua (IUWASH PLUS) project has expanded the reach of sanitation services, strengthened wastewater utilities’ financial footing, and implemented public awareness initiatives and behavior change campaigns by working with the private sector, donors, non-governmental organizations, utilities, and 35 local governments in eight provinces since 2016. Growing Indonesia’s urban sanitation market has been a primary focus of these efforts. To that end, IUWASH PLUS engages the private sector to facilitate microfinance loans, assists the government to target subsidies for the poor so that more families and neighborhoods can stay healthy, and promotes community savings arrangements so that interested residents can construct more toilets and septic tanks. Local private sector firms contribute corporate social responsibility funds so that sanitation improvements are even more affordable. This heightened private sector engagement enhances quality of life for urban neighborhoods by allowing families to spend savings on their childrens’ education and other essential needs, while improving the financial bottom line of firms and utilities in the sanitation sector.
Today, nearly three out of four Indonesians can access basic and safely managed sanitation services. Keeping its focus on meeting the needs of the country’s most vulnerable communities, IUWASH PLUS aims to increase access to safely managed sanitation to more than 500,000 Indonesians by 2021.
Follow @airsanitasi on Twitter, Facebook, and Instagram for the latest IUWASH PLUS updates.
Sanitation Definitions
Basic sanitation: An improved facility that is not shared with any other household. Improved sanitation facilities include flush toilets to sewer system or septic tank, pit latrines with slab, or composting toilets, which provide the largest health benefits by safely separating excreta from human contact.
Safely managed sanitation: The use of improved facilities that are not shared with other households and where excreta are safely disposed in situ or transported and treated off-site. Improved sanitation facilities are facilities that provide the largest health benefits by safely separating excreta from human contact. Such facilities can include flush toilets to sewer system or septic tank, pit latrines with slab, or composting toilets.
By Chris Holt and Russell Sticklor
Additional Resources:
This photo essay appears in Global Waters, Vol. 10, Issue 6; for past issues of the magazine, visit Global Waters’ homepage on Globalwaters.org.
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